Repeal of the ACA: Confused!

That was probably me, Treco. I think I started to type in a quote, probably spelled it wrong, and then went back to cut and paste the rest. Maybe? Anyway, you can assume any grammatical issues are mine. I’m terrible about proofing things here, and I type on this forum like I’m talking. Lots of fragments. Starting sentences with “and.” A multitude of sins.

Actually I was thinking @anon50325502.
Don’t tell him though. It will be our secret.

I have a theory that I can’t validate, but here it goes.
Healthcare has become more unaffordable above your reasons - more expensive procedures and amount of expense in one’s final months. Actually, I thought the expense % was even higher.

My theory is that expense have gone up due to company-provided insurance, and government programs of Medicare and Medicaid. These subsidized programs enabled a large populaton to demand healthcare well beyond the range of what would have been supplied if all payers were solely responsible.
Not only more customer demand, but with many opportunities for the providers to bilk the system.

Anecdotally - Uncle Joe has a heart attack in 1900, either he recovers or he doesn’t. But no one was spending hundreds of thousands per incident. As stated, l can’t prove.

1 Like

I think subsidized health insurance is definitely a part of the issue. I don’t think it’s that simple, though. For example, life expectancy is about 1.5x higher now than it was in 1900.

In continuing the trend of things I can’t validate, most people don’t begin to suffer expensive medical issues until after their 50s. Things like Alzheimer’s weren’t really an issue because most people died before it could manifest:

As you know, polling numbers on the ACA are all over the map. For example, the numbers differ sharply depending upon whether people are asked about ‘Obamacare’ vs ‘the ACA.’

http://politicalticker.blogs.cnn.com/2013/09/27/poll-obamacare-vs-affordable-care-act/

Further, even people who ‘disapprove’ don’t necessarily want it repealed:

http://politicalticker.blogs.cnn.com/2014/03/31/five-things-polling-tells-us-about-obamacare/

Finally, among those who disapprove of the ACA, there remains strong support for significant components of the law:

https://www.bloomberg.com/news/articles/2014-03-12/americans-stick-with-obamacare-as-opposition-burns-bright

The point of all this being, polls that ask ACA: Approve or disapprove? are too simplistic to capture the public stance regarding the law.

One reason people in these places had difficulty is that their Republican governors opted out of the Medicaid expansion. These are precisely the people who would be hurt by that political decision.

Unfortunately, this was not a viable option, because the GOP absolutely refused to participate in crafting the law. (That was the strategy they decided upon on the night of Obama’s Inauguration, remember?)

Further, the GOP is now perfectly positioned to do precisely the same thing–pick their plan, and shove it down the Dems’ throats. So I say, have at it, and let the chips fall where they may. If indeed the GOP has a better way, they will lock up control of the govt for generations to come. If not…

This is the moral hazard argument, and it certainly applies to some aspects of consumer behavior. The problem with it is, people don’t seem particularly inclined to get unnecessary medical care just because they can. Nobody wants to get fillings put in their teeth if they don’t have cavities.

In my opinion, this is a greater moral hazard threat.

As an aside, depending upon how they’re calculated, such numbers can be very misleading, especially if they include infant and childhood mortality (which used to be vastly higher than they are now, and thus strongly skew average life expectancies downwards).

Indeed. This is part and parcel of my ‘victims of our own success’ argument.

If you want to talk about partisan obstructionism, you’d have to talk about Harry Reid, and tactics used by the Dems during that time. Part of the legacy that has created the current partisan divide. A lot of the current ill will goes back to Harry Reid, IMO. He ended up hurting some of his own party by stonewalling. I imagine these tactics seemed like “good political strategy” to Dems at the time. Anyway, here’s an op ed on the other side of the coin.

WSJ, Sayonara, Harry Reid, Oct 2016.
The retiring Democrat did lasting damage to the Senate by making it sharply partisan.

Harry Reid, who has led Senate Democrats since 2005, is shrewd, temperamental and highly partisan. But as the 76-year-old Nevadan nears his retirement after next month’s elections, he has grown sentimental. Mr. Reid wants to leave the Senate in Democratic hands. “To cap his career,” the Washington Post’s Ben Terris wrote in a September retrospective, “Reid wants to leave the Senate better than he found it.”

Democrats have at least an even chance of making Mr. Reid’s first wish come true. Republicans hold a 54-vote majority in the upper chamber, and on Nov. 8 they could lose as many as seven seats. But as for leaving the Senate better than Mr. Reid found it when he arrived in 1987? There’s little chance of that—and he has only himself to blame.

Mr. Reid’s leadership changed the Senate dramatically but often carelessly. The upper chamber had traditionally been collegial, high-minded, cautious. During Mr. Reid’s tenure as majority leader from 2007 to 2015, it became more like the House. There was less time for serious floor debates and amendments. Decorum suffered. So did bipartisanship.

The Nevadan’s contempt for his political foes didn’t help. Mr. Reid pursued personal vendettas from the Senate floor. He relentlessly attacked the conservative Koch brothers as if they were a threat to America’s survival. Though he was demoted to minority leader after Republicans took the Senate in 2015, Mr. Reid hasn’t given up these attacks. In September, he went after Joe Heck, the Nevada congressman running for the seat that Mr. Reid is vacating. The minority leader, speaking on the Senate floor, said that the Kochs had “anointed” Mr. Heck. “He is their puppet. He is their puppet. He is their puppet.”

His nastiest attack came in 2012, when he claimed—as usual from the Senate floor—that Mitt Romney hadn’t paid federal income taxes for a decade. No evidence was offered. When it turned out that Mr. Romney had paid income taxes, Mr. Reid refused to apologize. “It’s one of the best things I’ve ever done,” he told the Washington Post.

To get his way, Mr. Reid was willing to go to extremes. In 2013, wanting to stack the appeals court in Washington, D.C., he pushed through the “nuclear option.” Mr. Reid altered Senate rules to bar filibusters on most judicial nominations, allowing approval with only a simple majority. That change didn’t apply to Supreme Court nominees, but Mr. Reid says he has laid the groundwork to kill the 60-vote requirement for them, too. If Republicans “mess with the Supreme Court, it’ll be changed just like that,” he told Talking Points Memo last week.

Mr. Reid has urged Democrats to end the filibuster on legislation as well, which would significantly alter the way the Senate works. The current majority leader, Republican Mitch McConnell, defends the filibuster. Killing it, he said in a 2011 speech, would “undermine the Senate’s unique role as a moderating influence and put a permanent end to bipartisanship.”

Not that bipartisanship concerns Mr. Reid. To pass ObamaCare he brushed aside any thought of compromising with Republicans. When the bill was being drafted in committee, he and the White House feared it would not be liberal enough. So Mr. Reid yanked it from the committee and drafted it secretly in his own office. This shortsighted decision is a major reason the health-insurance program remains unpopular to this day. Zero Republicans voted for it.

With sweeping, nationwide legislation, the longstanding practice is to seek bipartisan backing. This was achieved with Social Security, Medicare, Medicaid, civil-rights legislation and the interstate highway act. Bipartisanship ensured lasting popularity. “One party can’t jam legislation down the other party’s throat,” Democratic Sen. Max Baucus told the New York Times in 2013. “It leaves a bitter taste.”

It can also lead to legal wrangling. In his haste to schedule the ObamaCare vote before Christmas, the law was slapped together, leaving glitches. Ambiguous language about insurance subsidies had to be resolved by the Supreme Court, another contribution to its unpopularity.

At times, the Senate under Mr. Reid appeared dysfunctional. But that was the way he wanted it. He specialized in denying senators the ability to offer amendments to pending bills. During Mr. Reid’s final year as majority leader, he permitted roll-call votes on only 15 amendments, 10 times fewer than usual.

Although this was aimed at Republicans, it also turned Democrats into ciphers. Alaska Sen. Mark Begich had no amendments voted on in his six-year term, an embarrassing fact that the GOP used to defeat him in 2014.

Mr. Reid prevented up-or-down votes on the Keystone XL pipeline and a repeal of ObamaCare’s medical-device tax. As minority leader he backed President Obama’s recess appointments when the Senate wasn’t in recess. The Supreme Court overturned that scheme.

Mr. McConnell has sought to revive the Senate’s traditional role. Committees are important again and the chamber isn’t governed by the whims of one man. But the filibuster for judicial nominees hasn’t come back, nor has the collegiality. So some of his damage may be lasting. Is Mr. Reid leaving the Senate better than he found it? No. But at least he’s leaving.

1 Like

to clarify
Are you agreeing there is a temptation to provide ‘too much’ care, along the accompanying costs?

I am agreeing that a defined-benefits system with a third-party payer is vulnerable to abuse in certain respects, yes.

For example, consider the direct-to-Medicare-recipient ads for various durable medical equipment (DME) items–knee braces, walkers, motorized wheelchairs, etc–that are all over TV. These ads encourage Medicare recipients to demand that their doctor authorize them to receive the DME “at little or no cost to you!” So, Mr. Medicare Pt goes to his doctor and demands the magic knee brace he saw advertised on TV. (Never mind that the etiology of the pt’s knee pain is not amenable to treatment via a brace.)

Now the doctor is in the awkward position of having to either 1) be the ‘bad guy’ by saying no, which will cause her to lose the goodwill of the pt (if not lose the pt entirely), or 2) save herself the headache of an extended argument by simply authorizing the DME. And the moral hazard inherent in the third-party-payer system makes it easier for her to go the second route.

(BTW, this is why healthcare-supply companies now seem to do as much direct-to-consumer marketing as they do direct-to-doctor. They have discovered that a properly ‘motivated’ pt is the best salesperson the company can have.)

Forgive me, PP, but saying ‘the reason the GOP was utterly intransigent for the entirety of the Obama Presidency is because Harry Reid’ is weak sauce indeed. There was no mention–none–of Reid when Republican leaders met during Obama’s inauguration. Their goal was to deny Obama any legislative victories, not to get revenge against Reid.

As an aside: For the WSJ to blame Reid for McConnell’s failure to bring back the filibuster for judicial nominees is as absurd as it is insulting (to McConnell). If, as the article states, McConnell wanted “to revive the Senate’s traditional role,” all he need do is, well, do it. To blame the ghost of Harry Reid for McConnell’s impending implacable partisanship is a case of what I will call ‘historical previsionism.’ (Copyright 2017 EyeDentist. All rights reserved.)

1 Like

Forgiven. I’ll agree with you that there has been ugly partisan politics on both sides. Harry Reid is certainly not everything, not by a long stretch. BUT… You knew it was coming.

IMO Reid’s inability/ complete unwillingness to work with anyone was a big liability. I don’t think the Dems saw it at the time, and I’m not sure they see it now.

NY Times finally reporting on it in 2014, using terms like “strong armed,” “brutish” to describe him. Moderates from his own party were beginning to just feel incredibly frustrated that they would have nothing to show in terms of meaningful legislation.

This one give the stats on the number of amendments Reid sat on, and the way he changed the senate. From the National Review article below.

“Allowing a “reasonable number of relevant amendments” from the minority party has not always been considered a concession in the Senate. It was once referred to as “regular order.” Despite Reid’s claims that he has been “very generous with amendments,” the number of amendment votes per year (not counting non-binding budget amendments, which by law cannot be limited) has declined from 218 in 2007, when Reid became majority leader, to 67 in 2013. Since July of last year, Republicans have been allowed a grand total of four amendments.”

http://www.nationalreview.com/article/368369/harry-reids-obstructionism-andrew-stiles

You can’t talk about intransigence without acknowledging Reid. Moderates from both parties were increasingly frustrated. He set the bar for his ability to NOT bring anything to a vote. We’ve never seen anything like it in our lifetimes. There was no substantial reform of many federal programs because as a majority leader, Reid successfully blocked them from coming to the floor. Period. At a rate nobody has ever done before.

Likewise, you can’t talk of intransigence without acknowledging Gingrich and Dole in the 90s:

https://www.bloomberg.com/view/articles/2016-06-22/what-republicans-obstruction-costs-them

Another perspective on Reid’s 'obstructionism:

Technically, we don’t need alternatives. The underlying system is still in place.
Still, the 30,000 ft view appears to be the creation of a more competitive market place. What that looks like remains to be seen. Hopefully, it includes price capping on life saving drugs and foreign drug competition. Drugs are the largest piece of the puzzle. If we can get drug prices under control then the rest of the healthcare market place should follow suit. Drug competition/ Insurance competition is the key piece to driving the price down. We need to get the supply side to flood the market, essentially. The way to do that is allow lots more drugs into the country and remove state boundaries from insurance plans. The two things the market place wants the least is what we need.
Coverage isn’t the problem. Having more people covered under crappy plans looks good to rich politicians as it gives the appearance of improvement, but coverage has never been the problem. The problem has always been cost. Remove the cost problems and the coverage problems are far less daunting.

1 Like

What? You don’t appreciate preaching tolerance through bullying?

1 Like

No wonder this is so confusing. 133 Million vs 500,000 people. Don’t you love politics?

_How Many ObamaCare Patients Have Pre-Existing Conditions?_Betsy McCaughey, WSJ
Jan. 18, 2017

The president claims 133 million, but it’s more like 500,000—and there are better ways to insure them.

Can Democrats scare Republicans into giving up their plans to repeal ObamaCare? They’re certainly trying: President Obama recently warned that if Congress junks the Affordable Care Act, “133 million Americans with pre-existing conditions” will be in jeopardy. That’s a phony figure, for several reasons. The actual number is roughly 500,000.

For starters, half of Americans get their insurance through an employer, according to the Kaiser Family Foundation. Another 34% are on Medicaid or Medicare. For all these people, pre-existing conditions are no barrier to coverage.

Pre-existing conditions mattered before ObamaCare only in the individual market, but even there few were affected. In 2010 Rep. Henry Waxman, then the Democratic chairman of the House Energy and Commerce Committee, issued a report on the individual market. It stated that the four largest insurers— Aetna, Humana, UnitedHealth and WellPoint—declined to issue policies to about 250,000 people a year because of their medical histories. A 2011 report from the Government Accountability Office found a similar number.

The Waxman memo also explains that insurers also sometimes issued policies with “riders” to exclude certain coverage. The four big insurers refused to pay about 70,000 claims a year because of pre-existing conditions.

Even so, many people with pre-existing conditions managed to get health coverage through the high-risk pools run by 35 states. Those pools covered about 225,000 people in 2011, according to the Kaiser Family Foundation.

But some states did not operate high-risk pools. Others, including California and Florida, had patients on waiting lists or capped enrollment. So in 2010 the Obama administration opened a temporary nationwide high-risk pool to serve that unmet need. Enrollment peaked at 115,000 in March 2013, Kaiser reported.

Adding together these figures indicates that around 500,000 people with pre-existing conditions would need protection once ObamaCare is repealed. That’s a minuscule fraction of Mr. Obama’s 133 million. The president’s number is from a misleading report produced by his own Department of Health and Human Services, which vastly exaggerates the health problems serious enough to result in a coverage denial. For example, the report counts 46 million people with high blood pressure. Even more deceptively, the report includes people covered by employer plans or Medicaid.

Not even ObamaCare architect Jonathan Gruber says that the ban on pre-existing conditions expanded the ranks of the insured. An October article for the New England Journal of Medicine, co-written by Mr. Gruber, attributes 63% of the gains in coverage under ObamaCare to the expansion of Medicaid and 37% to the subsidies for buyers with low incomes. The individual mandate, the paper states, had “no significant effect.” Pre-existing conditions aren’t even mentioned.

Republican plans to repeal and replace ObamaCare include re-establishing federally funded high-risk pools, with a guarantee of no waiting lists. That’s likely to cost $16 billion to $20 billion annually—or about $32,000 per person, which was the average patient cost in the federal high-risk pool in 2012. Sixteen billion dollars is far more than what Republicans are currently budgeting, but far less than the $56 billion that will be spent on ObamaCare subsidies this year, according to the Congressional Budget Office.

Patients with serious illnesses probably would be better off with coverage through high-risk pools than under the status quo. ObamaCare plans offer narrow networks that exclude many top-drawer hospitals and specialists like oncologists.

High-risk pools would also subdue premium increases for healthy buyers by removing the largest costs from the insurance pool. The sickest 5% of Americans account for 50% of health-care spending, according to Kaiser. The healthy can see that paying the same price for insurance as the sick is a bad deal. That’s why ObamaCare enrollment skewed older and sicker than expected, causing insurers to lose $2 billion a year. UnitedHealth, Aetna and others have fled the market or dramatically raised premiums. Funding high-risk pools for the sickest Americans—and doing it soon, as part of this month’s budget reconciliation—could avert a market collapse.

That’s what Alaska did last June. State officials acted on their own to stave off a 40% increase in ObamaCare premiums by paying for the sickest people with $55 million in taxpayer funds. It worked, keeping premium growth to single digits. Congress can do the same for the entire nation. It will mean improved coverage for people with serious illnesses and a fair deal for the healthy.

That beats scaring the nation with phony numbers and fake news about pre-existing conditions.

—Ms. McCaughey, a senior fellow at the London Center for Policy Research, served as lieutenant governor of New York (1995-98).

1 Like

Anyone watch Ted Cruz debate Bernie Sanders?

I didn’t think it was even close. Ted won. Bernie tried to debate emotion.

3 Likes

nope but will watch.

thanks

Cruz peeled him like a grape.

EDIT: At least Bernie had the honesty to admit he would like to bankrupt a small business owner if it meant that they were paying for their employees healthcare.

Let us say a prayer of thanks that we dodged a Bernie Sander’s economy.

4 Likes

This was stunning, but credit to him for being honest.

1 Like

http://hosted.ap.org/dynamic/stories/U/US_CONGRESS_HEALTH_OVERHAUL?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2017-02-20-03-16-20

Interesting points, things at least seem to be moving. The GOP appears to be attempting to replace portions and move forward with some semblance of a working plan.

1 Like