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Subject: A Question about Obamacare rss

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Matt Thrower
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So, it's in the news this side of the pond again.

Debates about Obamacare pass me by for two reasons. Firstly because functional nationalised healthcare is a given in most of the rest of the western world, and the amount of fury expended by republicans fighting against what's considered a norm elsewhere amuses me. Second because, not being American, I've neglected to look at the law in any kind of detail.

But then I was struck by something. There was a gap in my understanding. What if a lot of the people railing against Obamacare were doing so not because they thought free basic healthcare wasn't a right, but because it was a bad way of delivering that healthcare? Or even, to be a little less charitable, because they felt that while free basic healthcare was a good idea, there was no cost-effective way to introduce it into a free market system that had lacked it for so long?

Because, let's face it, there aren't really any anti-Obamacare people standing up and saying that you can't have free healthcare because the poor are too worthless to deserve it, or that it might encourage hard-working people to work a bit less hard, or that it might cut into the multi-million dollar profits of big corporations. They might be thinking it, but they're not saying it.

So that's my question: is Obamacare bad because it fails to deliver what it's supposed to deliver, or at least fails to do so in a cost effective manner?

 
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Jon M
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Wow, that's a great way to get some reasonable responses - accuse the people who oppose Obamacare of being spiteful.
 
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Matt Thrower
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Jon_1066 wrote:
Wow, that's a great way to get some reasonable responses - accuse the people who oppose Obamacare of being spiteful.


OK, I removed it because I wanted to get some reasonable responses.

But if you read the question carefully, I was asking for some solid economic arguments against the law. If those arguments exist and hold water - which I presume they do - then that's fine. I'm not accusing anyone of anything.
 
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Boaty McBoatface
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The problem is that (given the provision is provided by private (for profit) companies) any economic impact may only be indirectly related to Obamacare. It may well be down to pure profiteering (in the short term at least).

It's a terrible system that (in some respects) contains the worst of both Private and state care. In 2012 the United States spend some 17.6 percent of its GDP on healthcare, the UK spends around 8 percent. While the U.S. has 2.4 practicing physicians per 1,000 people, the UK has 2.7. The USA is not getting value for money out of this huge outlay.
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Boaty McBoatface
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b a n j o wrote:
The irony of course, is that the GOP fought tooth and nail to have the single-payer provision removed from the original draft - only to now complain that the law is watered down, and thus ineffective.
Not really an irony, more cynicism.
 
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Jorge Montero
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The problem with Obamacare is that it really doesn't go against the real problems of American care.

Healthcare in the US is extremely expensive. It's not uncommon to see copays, with insurance, that are about the same as the full price of going to a private doctor in Europe. Medicines are expensive. Inpatient care? Silly expensive.

the ACA goes against a secondary problem: Insurance availability. Subsidizing insurance for some, and making it mandatory, should help some outcomes, but it's just treating the symptom and not the cause. Sure, many European countries have everyone insured automatically, but it works because it's single payer, which makes sure there is someone that is actually interested in lowering general costs, and that someone can change the law to make it so.

So the ACA attempts to make things look like they do in Europe, except it doesn't when doing so would lead to opposition from a major medical lobby. So nothing on providing more competition to doctors, or making sure hospitals provide sensible billing.

Now, I don't see how it's worse overall than the disaster we had before, but it looks like a very expensive bandaid.
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People oppose Obamacare because they are spiteful... No, really. most people I talk to in real life who make offhand comments about how Obamacare is going to topple our economy don't know ANY thing about it. So, either they are brain dead sheep who have been cowed by the spectre of socialism, or they are part of Boehner's crew of thugs who will "make Obama fail at any cost".

The people who legitimately know the weaknesses of the bill and want to fix them are far and few between.
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Ken
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MattDP wrote:
What if a lot of the people railing against Obamacare were doing so not because they thought free basic healthcare wasn't a right, but because it was a bad way of delivering that healthcare?


Well, it is a relatively bad way of delivering care. It doesn't reach everyone, it leverages a system where inefficiencies abound, it doesn't really address many of the issues that lead to rising costs, and it doesn't address fundamental questions about structure at all. It's a private/public structure for insurance and really nothing else, which leaves huge swaths of the medical industry relatively unchanged.

But that's to be expected - it's the first real law targeting the issue in decades. The NHS met with significant opposition when it was formally proposed and has required numerous changes over the years to both address delivery/quality issues and manage costs. One shouldn't expect perfection out of the gate, and many of those arguing against the ACA tie it to other issues that they find important.
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Daniel Edwards
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hibikir wrote:
The problem with Obamacare is that it really doesn't go against the real problems of American care.

Healthcare in the US is extremely expensive. It's not uncommon to see copays, with insurance, that are about the same as the full price of going to a private doctor in Europe. Medicines are expensive. Inpatient care? Silly expensive.

the ACA goes against a secondary problem: Insurance availability. Subsidizing insurance for some, and making it mandatory, should help some outcomes, but it's just treating the symptom and not the cause. Sure, many European countries have everyone insured automatically, but it works because it's single payer, which makes sure there is someone that is actually interested in lowering general costs, and that someone can change the law to make it so.

So the ACA attempts to make things look like they do in Europe, except it doesn't when doing so would lead to opposition from a major medical lobby. So nothing on providing more competition to doctors, or making sure hospitals provide sensible billing.

Now, I don't see how it's worse overall than the disaster we had before, but it looks like a very expensive bandaid.


Good post and this all makes sense to me except I'd say that coverage (or lack thereoff) seems very clearly to go to cost if indirectly.

Going to hospitals for something that could have been treated preventatively. Health related bankrupcies. Just generally having a sicker and therefore less productive workforce because Joe doesn't want to go to a doctor about that cough. These all impose major financial costs on everyone in the society and just how much they in turn inflate primary healthcare costs is pretty difficult to say.

But yeah it works the same way in reverse as well. Control primary costs and you make cover more affordable, and address coverage from the other end.

But of course just how do you go about attempting to keep costs down without government being a primary supplier? Its not something that gets addressed much but the dirty socialist secret is that countries like the UK manage costs at least in part by saying "You Mr GP you will be making £100,000 a year". With the fight over Obamacare on the verge of suspending government I don't see how that flies short some kind of collapse.
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Ken
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myopia wrote:
...but the dirty socialist secret is that countries like the UK manage costs at least in part by saying "You Mr GP you will be making £100,000 a year".


But the UK's isn't the only model about and many of the others don't set physician salaries explicitly. Those that use an insurance model often use reimbursement rates and covered procedures (very similar to Medicare here) as the method to control costs.

And many medical professionals in the US already encounter similar limits on income due to the negotiated rates for care that insurance companies establish. Doctors are not making the kind of money that they used to make relative to other professions.

Quote:
With the fight over Obamacare on the verge of suspending government I don't see how that flies short some kind of collapse.


That's because the ACA is only one of 20 or 30 issues that the people threatening a shutdown actually want to see changed. It's the high profile one that they're using on their battle standard, but it's only the tip of the iceberg. It's not even the largest fiscal priority that they have, in general.

Don't confuse the issue that they've selected as their "point man" with their actual agenda. This isn't about just the ACA.
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Daniel Edwards
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perfalbion wrote:
myopia wrote:
...but the dirty socialist secret is that countries like the UK manage costs at least in part by saying "You Mr GP you will be making £100,000 a year".


But the UK's isn't the only model about and many of the others don't set physician salaries explicitly. Those that use an insurance model often use reimbursement rates and covered procedures (very similar to Medicare here) as the method to control costs.

And many medical professionals in the US already encounter similar limits on income due to the negotiated rates for care that insurance companies establish. Doctors are not making the kind of money that they used to make relative to other professions.

Quote:
With the fight over Obamacare on the verge of suspending government I don't see how that flies short some kind of collapse.


That's because the ACA is only one of 20 or 30 issues that the people threatening a shutdown actually want to see changed. It's the high profile one that they're using on their battle standard, but it's only the tip of the iceberg. It's not even the largest fiscal priority that they have, in general.

Don't confuse the issue that they've selected as their "point man" with their actual agenda. This isn't about just the ACA.


Both fair points. And the first reveals a real shame I suppose. Theoretically at least you had the opportunity to look at every system in the world and pick the best bits. And look where you ended up But I guess its just phase 1 as you say.
 
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Boaty McBoatface
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bjlillo wrote:
The ACA isn't "free healthcare for all." It's a requirement for employers and individuals to purchase health insurance and a system of exchanges to allow approved insurers to sell approved plans to people. There are also subsidies for those whose income falls under a certain level and fines for those who don't purchase insurance. There are insurance pricing requirements (can't price based on pre-existing conditions, young people's insurance can't be less than 1/3 the cost of old people's insurance, people 26 and under can be on their parents' insurance plans, etc...)

The reasons people are railing against it is because it
1) is expensive with lots of tax increases
2) raised and is raising costs of insurance for the vast majority of people who already have health insurance
3) punishes young people disproportionally
4) doesn't address the real problem of the high cost of American care
5) violates the First Amendment
6) exempts Congress and their staffers from their own law
7) reduces individual and economic freedom

There's probably a few others I'm forgetting as well right now. It's amazing how many things are just plain screwed up in this bill.

It's not universal health care. It's a semi-universal insurance scheme supported by the health insurance industry.
How does it violate the first?
 
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Daniel Edwards
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slatersteven wrote:
bjlillo wrote:
The ACA isn't "free healthcare for all." It's a requirement for employers and individuals to purchase health insurance and a system of exchanges to allow approved insurers to sell approved plans to people. There are also subsidies for those whose income falls under a certain level and fines for those who don't purchase insurance. There are insurance pricing requirements (can't price based on pre-existing conditions, young people's insurance can't be less than 1/3 the cost of old people's insurance, people 26 and under can be on their parents' insurance plans, etc...)

The reasons people are railing against it is because it
1) is expensive with lots of tax increases
2) raised and is raising costs of insurance for the vast majority of people who already have health insurance
3) punishes young people disproportionally
4) doesn't address the real problem of the high cost of American care
5) violates the First Amendment
6) exempts Congress and their staffers from their own law
7) reduces individual and economic freedom

There's probably a few others I'm forgetting as well right now. It's amazing how many things are just plain screwed up in this bill.

It's not universal health care. It's a semi-universal insurance scheme supported by the health insurance industry.
How does it violate the first?


You cannot have missed the eleventy thousand threads on employers not having to provide cover for "womens issues" if it violates their religious beliefs.
 
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Paul DeStefano
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bjlillo wrote:
The reasons people are railing against it is because it
1) is expensive with lots of tax increases
2) raised and is raising costs of insurance for the vast majority of people who already have health insurance
3) punishes young people disproportionally
4) doesn't address the real problem of the high cost of American care
5) violates the First Amendment
6) exempts Congress and their staffers from their own law
7) reduces individual and economic freedom


You seem to think these are bad things...

1: Good. I think people need to pay more taxes. That is not a joke.
2: OK. Sometimes inflation jumps. This will regulate it.
3: Or it gives a benefit to older people.
4: Agreed. And isn't meant to. Yet. Baby steps.
5: No idea what this means.
6: Tons of people are unaffected. Not liking it for this is spiteful.
7: OK. I think people need more guidance on their economic 'freedom'.
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Paul DeStefano
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myopia wrote:
You cannot have missed the eleventy thousand threads on employers not having to provide cover for "womens issues" if it violates their religious beliefs.


Hogwash.

They put a new traffic light at the north end of my block over the summer.

I don't want it there.

Yet taxes which I pay installed it.

It took down a huge maple tree, which was then thrown through a wood chipper.

This violates my religious beliefs.

But, in keeping church (any church) and state apart, I understand that for the benefit of the town, it had to happen (there's a school on my block).

Things like this happen all the time. Your taxes pay for wars you don't want. To claim it violates first amendment is saying all taxes do. Now that is a more viable argument, and one worthy of another thread.

 
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Boaty McBoatface
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myopia wrote:
slatersteven wrote:
bjlillo wrote:
The ACA isn't "free healthcare for all." It's a requirement for employers and individuals to purchase health insurance and a system of exchanges to allow approved insurers to sell approved plans to people. There are also subsidies for those whose income falls under a certain level and fines for those who don't purchase insurance. There are insurance pricing requirements (can't price based on pre-existing conditions, young people's insurance can't be less than 1/3 the cost of old people's insurance, people 26 and under can be on their parents' insurance plans, etc...)

The reasons people are railing against it is because it
1) is expensive with lots of tax increases
2) raised and is raising costs of insurance for the vast majority of people who already have health insurance
3) punishes young people disproportionally
4) doesn't address the real problem of the high cost of American care
5) violates the First Amendment
6) exempts Congress and their staffers from their own law
7) reduces individual and economic freedom

There's probably a few others I'm forgetting as well right now. It's amazing how many things are just plain screwed up in this bill.

It's not universal health care. It's a semi-universal insurance scheme supported by the health insurance industry.
How does it violate the first?


You cannot have missed the eleventy thousand threads on employers not having to provide cover for "womens issues" if it violates their religious beliefs.
I have seen them, I have just not seen how not allowing religions special privileges under law is making an established (rather then the almost complete opposite, it's preventing laws based upon religious beliefs) religion. It also does not force anyone to do anything more then not be allowed to force their views on their workers. It forces no one to take contraception.

It also not wholly true, and is an example of the kind of compromise that the right says Obama does not make http://www.theguardian.com/world/2013/feb/01/obama-compromis....
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Paul DeStefano
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bjlillo wrote:
Employers with 50+ employees are required to purchase health insurance for their full time employees (defined as those who work 30+ hours per week.)


Finally.

Change hurts someone.

Always does.

But this change is clearly an improvement.

Here's a tip for those at the lower end of the skill scale:

Work better. Strive. Don't be complacent.
 
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bjlillo wrote:
We're not talking about taxes, dear. We're talking about employers and individuals being forced to purchase insurance


A government imposed fee is a government imposed fee.
 
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Paul DeStefano
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BJ, do you realize that many religions find telling someone they cannot have an abortion is against their belief?

It's against many basic tenets of allowing someone to control their body.
 
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Geosphere wrote:
myopia wrote:
You cannot have missed the eleventy thousand threads on employers not having to provide cover for "womens issues" if it violates their religious beliefs.


Hogwash.

They put a new traffic light at the north end of my block over the summer.

I don't want it there.

Yet taxes which I pay installed it.

It took down a huge maple tree, which was then thrown through a wood chipper.

This violates my religious beliefs.

But, in keeping church (any church) and state apart, I understand that for the benefit of the town, it had to happen (there's a school on my block).

Things like this happen all the time. Your taxes pay for wars you don't want. To claim it violates first amendment is saying all taxes do. Now that is a more viable argument, and one worthy of another thread.



I didn't say I agreed. I was merely acting as a guide to the many other eye bleeding threads on topic.
 
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Paul DeStefano
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myopia wrote:
Geosphere wrote:
myopia wrote:
You cannot have missed the eleventy thousand threads on employers not having to provide cover for "womens issues" if it violates their religious beliefs.


Hogwash.

They put a new traffic light at the north end of my block over the summer.

I don't want it there.

Yet taxes which I pay installed it.

It took down a huge maple tree, which was then thrown through a wood chipper.

This violates my religious beliefs.

But, in keeping church (any church) and state apart, I understand that for the benefit of the town, it had to happen (there's a school on my block).

Things like this happen all the time. Your taxes pay for wars you don't want. To claim it violates first amendment is saying all taxes do. Now that is a more viable argument, and one worthy of another thread.



I didn't say I agreed. I was merely acting as a guide to the many other eye bleeding threads on topic.


Oh, I'm disagreeing with the concept, not you. Sorry.
 
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Boaty McBoatface
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bjlillo wrote:
slatersteven wrote:
myopia wrote:
slatersteven wrote:
bjlillo wrote:
The ACA isn't "free healthcare for all." It's a requirement for employers and individuals to purchase health insurance and a system of exchanges to allow approved insurers to sell approved plans to people. There are also subsidies for those whose income falls under a certain level and fines for those who don't purchase insurance. There are insurance pricing requirements (can't price based on pre-existing conditions, young people's insurance can't be less than 1/3 the cost of old people's insurance, people 26 and under can be on their parents' insurance plans, etc...)

The reasons people are railing against it is because it
1) is expensive with lots of tax increases
2) raised and is raising costs of insurance for the vast majority of people who already have health insurance
3) punishes young people disproportionally
4) doesn't address the real problem of the high cost of American care
5) violates the First Amendment
6) exempts Congress and their staffers from their own law
7) reduces individual and economic freedom

There's probably a few others I'm forgetting as well right now. It's amazing how many things are just plain screwed up in this bill.

It's not universal health care. It's a semi-universal insurance scheme supported by the health insurance industry.
How does it violate the first?


You cannot have missed the eleventy thousand threads on employers not having to provide cover for "womens issues" if it violates their religious beliefs.
I have seen them, I have just not seen how not allowing religions special privileges under law is making an established (rather then the almost complete opposite, it's preventing laws based upon religious beliefs) religion. It also does not force anyone to do anything more then not be allowed to force their views on their workers. It forces no one to take contraception.

It also not wholly true, and is an example of the kind of compromise that the right says Obama does not make http://www.theguardian.com/world/2013/feb/01/obama-compromis....


The wrongtadictory is strong in you today. That's not a compromise. That's a lie told to people like you to make you more comfortable with oppressing religious people.
What do you mean it's a lie, has this exemption not been written into the act? As to oppressing religious people, I have no issue with stopping people forcing me to obey their religious beliefs. No one is forcing them to do anything that their faith tells them they cannot do. Also the freedom to believe is absolute, not the freedom to act.
 
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Paul DeStefano
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bjlillo wrote:
Geosphere wrote:
bjlillo wrote:
We're not talking about taxes, dear. We're talking about employers and individuals being forced to purchase insurance


A government imposed fee is a government imposed fee.


It's not a government imposed fee. It's purchasing a product from a private corporation.


Who is telling you to do that?
 
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bjlillo wrote:
Geosphere wrote:
bjlillo wrote:
Geosphere wrote:
bjlillo wrote:
We're not talking about taxes, dear. We're talking about employers and individuals being forced to purchase insurance


A government imposed fee is a government imposed fee.


It's not a government imposed fee. It's purchasing a product from a private corporation.


Who is telling you to do that?


OK, so you don't even understand the most basic concepts of Obamacare then. Why are you even participating in this discussion?


Because I don't care who pays to where.

I just want socialized medical care.
 
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bjlillo wrote:
Geosphere wrote:
bjlillo wrote:
Geosphere wrote:
bjlillo wrote:
We're not talking about taxes, dear. We're talking about employers and individuals being forced to purchase insurance


A government imposed fee is a government imposed fee.


It's not a government imposed fee. It's purchasing a product from a private corporation.


Who is telling you to do that?


OK, so you don't even understand the most basic concepts of Obamacare then. Why are you even participating in this discussion?


And its pretty funny that when forced to answer a question you don't want to, you don't answer at all and attack instead.
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