Soon, it looks like we’ll be saying good-bye to Obamacare. Republicans are rejoicing. Democrats are despairing. The 20 million or so people who got heath care coverage because of the program are panicking.
Republicans like Paul Ryan call the program a disaster and claim it’s in a death spiral. They can’t site much evidence for their claim. In reality, they just don’t think the government should be in the business of helping people get health care. That’s why they’ve opposed Medicare and Medicaid for decades.
The Affordable Care Act came after years of skyrocketing premiums, increasing out-of-pocket costs, and a steadily rising number of uninsured Americans. For people like me with pre-existing conditions, insurance was unaffordable. For others, lifetime caps left them destitute after serious illnesses caused them to lose everything. Medical debt was a leading cause of bankruptcy in the United States.
Today, because of Obamacare, we don’t have pre-existing conditions. We don’t have lifetime caps on insurance. Adult children can stay on their parents’ insurance plans until they’re 26 years old. Premiums, which rose 31% during the five years prior to enactment of Obamacare, are 20% less than they were predicted to be in 2009, the year before the Affordable Care Act was passed. Twenty million people now have coverage who wouldn’t without Obamacare.
That’s the bar Republicans will need reach with their replacement plan. It’s pretty high. Donald Trump’s advisor Kellyanne Conway says that no one who has insurance now will lose it when Obamacare is repealed. That’s a tall order and sounds remarkably like the promise, “If you like your plan, you can keep it,” that hurt the Democrats.
Obamacare didn’t crash the economy or bankrupt the country like Republicans predicted. However, higher deductible plans have become more common, leading to higher out-of-pocket costs. Premiums are rising again, though not quite as fast as before Obamacare. The individual mandate remains highly unpopular and has not led to as many young people signing up as initially hoped.
If Republicans can put in place a plan that reduces premiums, lowers deductibles, ends the mandate, keeps the same number of people insured, and doesn’t bring back pre-existing conditions or lifetime caps, then I’m behind them all the way. I don’t believe they can do it, though. Instead, I’m betting they take insurance away from millions of people and return to caps, sending millions more into bankruptcy again.
Let’s be clear. Repealing Obamacare is not about helping people or making health care more affordable or accessible. It’s an ideological move to appeal to the Republican base. It’s a belief that government shouldn’t provide assistance to families and that health care should be treated like any other commodity. If you can afford it, you can have it. If you can’t, tough luck.
Thomas Mills is the founder and publisher of PoliticsNC.com. Before beginning PoliticsNC, Thomas spent twenty years as a political and public affairs consultant. Learn more >
Should citizens be provided police protection only if they (or their employer or neighborhood association) can hire a private security firm to provide it? Of course not and no one would suggest that…but that is how health insurance works in this country. Governments do provide services (roads, public education, environmental protection, national security, to name but a few) and those services are most necessary when there is no economic incentive in the marketplace…such as providing health insurance to someone who was unfortunate to have pulled the short straw of cancer, birth defect, accident, etc.
Insurance companies are financial institutions and are very capable at evaluating and limiting their financial risks. I don’t begrudge then their profits but when they are unable to offer health insurance at affordable rates to an individual who has been diagnosed with ALS, or who is 59 and works in a low-paying job without benefits, then I think we have a moral imperative to intervene and, yes, to subsidize.
Personally I think our economy would boom if we had universal health coverage. Most job growth occurs in small companies. Some of us are fortunate enough to love our jobs and our employers but many employees remain in dead-end or unsatisfying jobs because they can’t afford to leave the health insurance subsidy that most large companies provide.
Is that really a solution?. We’re already $20 trillion in debt and climbing. The mainstream taxpayer isn’t interested in being the single payer.
False argument. We are in debt because 54% of the federal budget is spent on an enormous federal Offensive war machine, a pervasive spying net on everything we do, a Homeland Security which puts too many fatted calves in chairs and not enough at ports and rail stations, and the debt service for past cost overruns. In any case, the cost we have NOW for medical is real but not set in stone – preventative care for exercise and ten years of insulin will cost a lot less than when we saw the foot off that poor bastard to the tune of 750,000.
WE CAN REDUCE the cost of healthcare,
and
WE ARE ALREADY PAYING – when the indigent go to the emergency room, and spend 10 – 30 times as much on a service, because they had no preventative care, then skip out on paying, you realize… you’re already paying, right??
To: Disgusted. Great explanation. Check out Germany and Switzerland for excellent health care under a national plan. Nor do France, Great Britain or Canada deserve the condemnation I have often seen in the press and/or commentary.
I think your analysis makes sense, but I fear too many people wish to avoid the reality of what it means to do without medical care because one has no health insurance. And make no mistake, people in that situation do not obtain adequate health care. I also have known people who would not, could not change jobs because of a pre-existing condition that would not be covered — or would not be covered for the first year or 90 days of new employment. Sadly, the ACA did not change that for individually purchased policies, only group employer purchased policies. Whether any insurance companies made voluntary changes in some states, I do not know. One could hope so, but I would not bet on it.
Elections have consequences and we lost plain and simple. When it come to health care there were two kind of Trump voters the first was people who have wanted Obamacare repealed the day it was enacted, the second group does not want Obamacare repealed but it is not a high priority to them if it is. Those people won and repeal and other things are going to happen as a result of it. The party needs to put forth a plan that the majority of voters not only like but that it is a high priority to them, other wise blogs like this are going to have these academic discussions that do not mean a whole lot to most voters.
“If Republicans can put in place a plan that reduces premiums, lowers deductibles, ends the mandate, keeps the same number of people insured, and doesn’t bring back pre-existing conditions or lifetime caps, then I’m behind them all the way.”
I’m with you on this Thomas. I want our fears about the repeal of ACA to be unfounded and alarmist. I want the Republicans to put a better plan in place that makes health care affordable for everyone. There may be some unforeseen solution to the problem of astronomical medical costs and large number of uninsured people that people on the left have missed, but I doubt it. If they can do it, I will applaud them, but it isn’t going to happen.
So far, Republicans have only come up with one answer: “Get sick and die on your own dime.”
The attempt to put Health Care on the national agenda was the undoing of Bill Clinton’s presidency. Republicans fought against providing coverage to poor and middle-income people by attacking the president’s character. They hated Hillary’s task force’s attempts to design and recommend health insurance. Former Sen. Alan Simpson spoke candidly after he retired and he said that Bill Clinton was certainly not guilty of most of the charges he and his GOP colleagues had leveled at him during his time in office. They knew it when they made the charges. Simpson told the interviewer that Republicans were trying anything to undermine his power and authority by spreading vicious gossip him: that he murdered Vince Foster, or had done something unethical at the Travel Office, or got involved in a bogus land deal in Arkansas. They knew the charges weren’t true. They really didn’t want to deal with health care. “Things just got a little out of hand,” he said, referring the impeachment. There was never any discussion by the Republicans to install a different kind of insurance for the uninsured. It was only about stopping the Democrats. So Republicans have had 25 years to offer an alternative. They don’t want an alternative.
Under the Obama Administration, Democrats attempted to deal the health care again, and it was met with the same fierce, dishonest, nasty opposition. These current Republicans are retro-Republicans of the Koch Brothers ilk. They want to remove all laws which provide any legal rights to the poor and the middle class. They want to get rid of Social Security, Medicare, Unemployment Insurance, and the ability to sue for discrimination. They would strip away all workers’ rights if they could get away with it. In Wisconsin, the GOP, using the ALEC model laws, beat down government unions. When the GOP speaks of removing regulations, they mean getting rid of laws protecting workers, overtime pay, pollution laws, and anti-discrimination rules. They are happy to regulate abortion, stop gay marriage, impose a Christian prayer on everyone, establish a government church, and control contraceptives.
The Republicans did everything they could to keep ACA from becoming law, and then attempted to repeal it, what, 63 times? I have lost count. It looks like they will succeed this time. Americans have died in states where the Medicaid expansion was rejected, and Americans will die when 30 million of them lose their health insurance.
The Republicans deal with the fact that their actions will cause Americans to die like so many psychopaths. They have no guilt, remorse, shame or sense of common decency about it. They issue death sentences to vulnerable Americans with a sense of glee and purpose.
Why are medical services so expensive that they are unaffordable by most individuals without a third party picking up the tab? Was this always the case?
Are you really going to ask that question when you already know the answer? The high cost of a medical degree, the years spent earning it, the restrictions on the number of candidates, guarantee that a shortage of physicians mean high salaries. But let’s not blame the doctors – removing the insurance companies from the equation BY ITSELF would reduce the cost to society by half. Unless you can get an insurance company to operate at 2% administrative overhead, like Medicare. Other HUGE costs are indigents or resistant payers, the general cost of running a germ free (as possible) facility, specialized food services, armies and waves of support personnel (P/A’s Nurses, Aides, Respiratory, Biomechanical, and other therapists, ultrasound, xray, and other imaging specialists, and an army of housekeeps) as well as one of my favorite peeves, extraordinarily expensive tests done on private machines which should be publicly owned in regional centers and utilized at capacity instead of being ATMS for specialist practices.
What’s different now from when people, by and large, didn’t need comprehensive health coverage in order to pay routine medical expenses? Did doctors not used to have to get medical degrees? Did they not used to use expensive medical equipment?
The rising cost of major medical insurance is absolutely a function of the rising cost of medical care – doctors, hospitals and prescription drugs. Insurance is a payment mechanism not an end product. Insurance companies collect premiums which are used to pay the costs of emergency rooms, chemotherapy, annual check-ups, surgery and medicine. You provide your insurance to the provider, and they usually bill the carrier. Any difference between the medical bill and the covered costs is paid by the patient. Insurance companies write checks and negotiate payments. Insurance stands between the patient and the care providers.
The idea that insurance could be less costly without dealing with the cost of the providers is nonsense. For insurance rates to decline, doctors, hospitals and drug companies must charge less than they currently bill the carriers.
A night in a hospital in North Carolina will be at least $1,500 for the bed. An MRI costs about $3,500. A CT Scan will run about $5,000.
A visit to the Emergency Room is around $3,000. A kidney stone without surgery will run around $10,000, with surgery, it will run about $35,000.
Prenatal care for a baby is about $2,000. A normal vaginal delivery is about $10,000, and a C-Section without complications is about $16,000.
Often testing for certain ailments require multiple visits and many tests. It is not unreasonable to expect 4 or 5 CT Scans or MRIs before certain problem can be diagnosed properly.
Medical costs have been rising astronomically over the years. Was this always the case? No.
Many years ago I worked tobacco in the summers, and I cut my wrist by accident. The cut was deep and required three stitches. The doctor did a crude but effective job. I still have the scar decades later. He charged $2.00 per stitch or a total of $6.00. He was a country doctor, the kind that don’t exist today. Today, that injury would easily have cost $2,000.
The structure of modern medicine has changed completely and it is much more elaborate, much more technologically sophisticated and, in reality, much better.
Certain cancers were a death sentence when I was a kid. Today, they are routinely cured. Great strides have been made in medicine, but those strides have a large price tag attached.
If improved technology is the driver of rising medical costs, then why do other high-technology industries generally see FALLING prices over time? Why are MRIs more expensive, while computers, flatscreen TVs, and smart phones LESS expensive than when they were first introduced?
Because MRI machines are FAR larger and more complex than run of the mill computers which are mass produced in large numbers. Also MRI machines are astronomically more expensive to buy, equip a room for and operate. There is no comparison. The down side – there is a cost for this advanced technology. We could go back to old x ray machines but there would be far more mistakes and missed diagnoses. If we want top of the line advanced health care – there is a heavy cost for it. The inefficiencies inherent in multiple payers contribute just as much to escalating health care costs as technology. Multiple payers mean EVERY HOSPITAL AND PHYSICIAN GROUP have to have their own administrative staff to handle insurance billing claims and payment. Also when you have a hospital stay you receive a separate bill from multiple providers – the hospital, the attending physician, the anesthesiologist, etc. meaning multiple overhead for all those providers. The best way to handle this is for the hospital to consolidate ALL costs into a single itemized bill, take care of insurance billing and in turn reimburse the various providers thus requiring only ONE layer of overhead – not 4 or 5. The system is full of bloat but no one is willing to deal with it as long as they are getting sufficient income. The PATIENT is the one who bears the burden of increasing prices, not providers! They are just fine with the status quo!
It’s much more storied than that Jay. It goes all the way back to Teddy R. and the Bull Moose party. That was a major premise Teddy had for the country; affordable health care and the Republicans just couldn’t stand for it. It split the party and vote and Woodrow Wilson won. So their history of resistance to this is 105 years old and counting.
This also plays into the scenarios of several other Republican theories of governance. Controlling the population. We all know that natural resources are finite. We know that the ability of the planet to sustain the increase in population is rapidly approaching a critical level. How better to control the population, the United States for right now and later the globe, than to control access to healthcare? How better to control the costs of people living longer than by controlling the duration of life? How better to close the prospective gaps in entitlements than to lessen the demand on them?
No, I’m not a conspiracy theorist. But when you analyze what is being done and contrast it with current Republican policy across a spectrum of social programs, what other conclusion can be derived? This isn’t a short-term perspective. This is looking across the next three decades and further.
The tragedy here is, the poor and the middle will suffer the most. They will endure this burden the most since they are the ones most dependent on health insurance. The wealthy won’t suffer; they have the means to sustain themselves and get healthcare. In a financial crisis, they have the means to perpetuate themselves. In any disaster or shortage, they will have the means to still procure resources.
I’m not trying to incite a class rebellion either. I’m simply pointing out that Republicans are fostering policy that is most beneficial to themselves and those of their social strata. Government by virtue of the people, must stop those things from happening.
Adam from his insular position behind the microphone seeks to stir debate with his questions. Specifically, he wants to know if healthcare is an inalienable right? I will answer with Lincoln. “…government of the people, by the people, and for the people….” Not government for some people, or a few people, or those with a large bank account, or fortunate enough to be born into a wealthy family. We live in the 21st century, not the 18th. We have the ability and the means to take care of our citizens to ensure that they may pursue life, liberty, and happiness with a high quality of health. Healthcare is becoming basic to our needs for a future.
Republicans can’t do it by themselves however; they don’t have the numbers. We have the means to stop what it is they’re doing. But we Democrats haven’t and have failed. Republican stories have two basic premises. Those tales which show their policies as the most opportune and those tales which show any policy contradictory to what they want as being the most acrimonious.
TY – repooplinut nonsense. The author is 100% correct – “If you can afford it, you can have it. If you can’t, tough luck.”
this encapsulates the repugnant position exactly. If you dont make enough cash or dont have a good job, oh well FU
joe
Do people have an inalienable right to be provided with medical services?
Do they have an inalienable right to public education? Apparently so – the government funds it and everybody under 18 is required by law to attend! How is health care any less important?
If everyone has an inalienable right to medical services, how can doctors and hospitals charge for providing them?
You’re right Adam. A single payer system like the rest of the civilized world has IS the way to go. Good suggestion. And I applaud you for having the courage to admit it.
So does that mean that doctors, nurses, and other medical service providers do not own their own labor? If not, what does that make them?
If you are performing labor in exchange for a salary, are you not selling your labor? Don’t you have to own something in order to sell it?
You keep asking about “inalienable rights” in an inappropriate way. An inalienable right is a more metaphysical concept than a legal construct. Jefferson’s use of inalienable rights in the Declaration of Independence was rhetorical. He was elevating human existence above commerce. He was saying that there are aspects of humanity which cannot be bought or sold. You cannot buy the mineral rights to a human being. You cannot buy or sell a human being’s soul.
When you ask about the sale of services of any kind, you are asking about something which is alienable. Important rights are alienable. You have alienable rights in contracts, real estate, stocks and bonds, goods and services.
It is a non-sequitur to ask how does one market something that cannot be sold. It is like asking whether a fish must obey traffic laws when riding a bicycle.
The sale of labor in the marketplace is governed a contractual matter.
Because doctors and hospitals continue to be the providers, Government is simply the payer!
You can’t be serious. The question is nonsense and a waste of our time.
You say it’s a question of ideology? Perhaps it is and certainly the enactment of Obamacare was also ideological. At the same time, Obamacare was never about healthcare either, so much as it was about federal government control. The entire sector of healthcare was traditionally the purview of the individual states in accordance with the Tenth amendment so perhaps it is entirely appropriate to regard Obamacare through an ideological lens. And as the Reps made repeal a campaign promise to repeal, just as the Dems have long made healthcare imposition a campaign promise, that makes a strong case that the entire issue is ideological. Back to the question of ideology, However, and arguing to the contrary viewpoint that it is not ideological, it’s worth remembering that Obamacare’s putative constitutionality was upheld by virtue of the fact that it is merely a “tax” which is within Congress’ constitutional authority to impose. So in this sense, this is nothing more than the repeal of a tax.
Of course the differences are ideological. The Republicans believe that access to affordable health care by low income persons (25 – 30% of the population) is something that should be worked out in the private marketplace. THE PRIVATE MARKETPLACE HAS SHOWN NO INCLINATION TO DO SO. Industry and Party inaction on the issue bespeaks their belief that there really is no problem at all or at least it is not a problem that the private sector can solve – yet the Federal government should stay out of it (kind of hypocritical don’t you think – I can’t solve the problem so you shouldn’t either) . This historical lack of acknowledgement that there is even a problem reveals the Party’s serious lack of moral grounding. I would argue that private sector and party inaction actually CAUSED the Affordable Care Act we have today. Here’s a dose of reality – most Democrats don’t care about government-run health care – they just want at least some BASIC level of affordable health care for low income uninsured persons, whether its publically of privately provided. The real issues are:
1. How do we cover preexisting and chronic health conditions, which can be expensive?
2. Do we need a lifetime cap (probably so)?
3. How much subsidy can we afford for those who can’t afford market rate?
4. How do we cover adult dependent children (21+) or do we?
5. Do we force everyone to buy full coverage insurance or do we allow people to choose their own level of private insurance coverage or opt out entirely? In that sense a simple universal health care tax on wages might be simpler and less expensive than the present system. I’m all for less expensive and choice.
6. How do we get a handle on health care costs which a major driver of the problem?
Instead of pulling the rug out from under 20 million people, I think a complete reassessment of ACA should done and changes made to meet reality. Blind retraction of the Act may have negative repercussions on the cost of health care for ALL of us – not just low income persons whom the Act was intended to assist! This needs to be thought out before Republicans pull the trigger!
I say BULLSHIT! to that nonsense about “Government control” The Affordable Care Act was the first crude step in realizing the linkage between living and living as healthy as possible, that having healthcare was not just some privilege for the exploiting Plutocrat class, that the government would live up to the LIFE, LIBERTY, AND PURSUIT OF HAPPINESS clause of THE DECLARATION, that the WELFARE of the citizens which was assigned as a responsibility to the government in THE CONSTITUTION was not just empty words. The fat sweaty bully in the room is the Insurance Cabal, stealing as much as 60% of the premium dollar, money that goes to support a useless industry in this case. The clerks and accountants we can absorb into other industries, the Fat Cat CEOs and other overpaid slime… well, they can get real jobs.
Across the Civilized World, the “DEVELOPED” nations, there is but one still mired in a nineteenth century Dickensian view of their citizens as fodder to be abused and left to die, and that is the US.