Obamacare is going to sting a lot

[renbutler]

It's better because it's private and not nationalized. It's a philosophical issue for me in that regard.

Your reasoning is just private is better than national? Because reasons?  Is this your viewpoint for just healthcare or does it expand to other nationalized services?

Because I have a Libertarian streak, I generally oppose government entitlements.

As I've mentioned, private insurance also has its own benefits that have already been addressed. Flaws too.

[renbutler]

That said, I fully support philanthropy from doctors, hospitals, corporations, and individual donors who will help pay for those who simply are unable to afford coverage for their illnesses.

If this magical universe existed I'd be alll for it.

Really? Are you seriously suggesting those things haven't happened? They are all well known and popular philanthropic concepts.

Now, if you wanted to suggest that it probably wasn't enough to help everybody who legitimately needed it, you'd be on to something.

[beltim]

Costs of plans would have to come way down for individuals to be able to afford them. For costs to come down, you need healthier people in the pool. So you need a mandate that everyone is in the system to handle risk. Otherwise healthy and young people won't buy insurance until they're actually sick or have families and want to protect their kids. If we go back and let the system exclude them, we'll have bunch of young healthy people who are going to be loaded up on debt when they find out they're actually not invincible. If we don't have a mandate and don't let sick people be excluded, the system will not be sustainable.

Getting more people enrolled in insurance won't make a huge difference to costs, though.  At least 84% of Americans currently have health insurance (http://www.census.gov/prod/2010pubs/p60-238.pdf).  Assuming all of the remaining 16% have no health care costs at all and pay the average premium, the MAXIMUM that this could lower everyone's insurance premiums is by 16%.  And, of course, the supposition that the people without health insurance do so because they're healthy and use no health care is crazy and obviously wrong.

[renbutler]

Thanks for spelling out your beliefs.  I understand where you are coming from, but I disagree on many levels.  Insurance companies/corporations have the ability and the desire to maximize profits, not come up with a fair solution to ensure that their employees are receiving adequate healthcare coverage.  People have been shown to make very poor decisions when it comes to longterm benefits or costs.

And I think it's essential that people face the consequences for their obviously poor decisions.

And before somebody gets really stupid about that, no, I don't think we should just let people die if they can't afford insurance.

Unless you recommend that hospitals check payment ability prior to lifesaving treatment we have universal coverage.

 

I've already made it clear that doctors should continue to treat those who absolutely cannot pay for care.

The issue with the way healthcare occured in the past was that those that did the correct thing by buying insurance were paying for those that chose not to buy insurance.  Obamacare is not allowing the slackers to choose no insurance and then stick it to society when they have a major issue that they can not pay for. You buy insurance or you pay a penalty.  It is set up to help the wage slaves who are making pennies, but everyone is required to be insured.

The problem is that, like you always have with government, you will STILL ultimately have the minority paying for the majority. That's not changing. The only difference will be the breadth of the redistribution, largely sticking the "rich" instead of "society."

No, I'm not asking people to pity the rich. (And, no, I'm not close to being rich myself.)

Saying we should go back to having individuals price out healthcare is a joke as they have no leverage, no knowledge on what a fair price is, and for the most part no longterm thinking to save for catastrophe type expenses.  When people fail to go to the dentist, doctor, and take their drugs then very expensive treatment is the result.  Looking to charity is a joke. 

I'm already on record supporting fairness and transparency in what doctors and hospitals charge for services.

Why not just create a system that provides this vs. forcing people to beg for charity? 

Beg for charity? Who said anything about begging?

Everyone needs healthcare.

Everybody needs food, water, clothing, and shelter. Gov't might as well pay for those too, right? Maybe the government can demand at least a little something in return, and everybody can become a government employee...

[MoneyCat]

We are also seeing massive boycotts of those companies for cutting hours and hiring only part-time as well.  The free market at its finest.

This is the first I've heard of this. Can you point us to some examples?

(Not doubting or challenging. Just asking.)

Here's one off the top of my head:
http://www.forbes.com/sites/rickungar/2012/12/04/papa-johns-applebees-and-others-pay-huge-price-for-anti-obamacare-politicking/

And another:
http://americablog.com/2012/12/obamacare-papa-johns-dennys-applebees.html

Meanwhile, sales at Costco have skyrocketed ever since it became known that they offer their employees full employment (40 hours+), $22/hr wages, and health coverage:
http://www.huffingtonpost.com/2013/06/06/richard-galanti-wages_n_3396101.html

Basically, Americans don't like to hear that big companies are screwing people and they vote with their wallets.  There are plenty of fish in the sea.

[renbutler]

Okay, well I love the notion of people taking it into their own hands instead of demanding that the government "do something."

At the same time, I completely understand why those companies feel like the government unfairly forced their hands.

[randymarsh]

Now, if you wanted to suggest that it probably wasn't enough to help everybody who legitimately needed it, you'd be on to something.

Yes that's what I was saying.

Regarding food and clothing...I mean those products are fundamentally different. They aren't purchased when someone's life is in danger. Prices can easily be compared and there's a wide range in prices. I can buy a $10 Walmart jacket or a $200 Northface one. You can't choose between a 5K chemo treatment or a 100K one. Both are incredibly predictable purchases. If I need a course of antibiotics, I can't really hold off for a month like I would if I ripped a pair of jeans.

[MoneyCat]

To me, all the complaining about "freeloaders" using Obamacare and everything is just silly.  The way it works currently is that no hospital can refuse treatment to somebody who can't pay for it.  So they give them treatment and the people don't pay them.  Usually, the poor people (who aren't poor enough for Medicaid) run up the hospital bills and then discharge them through bankruptcy.

Do the hospitals write it off as charity work?  Nope.  They pass the cost of all those uninsured people onto the hospital bills of people who DO have insurance.  Why do you think it costs $10 for a dose of Tylenol at the hospital?

So, basically, the question really is do you want to pay more for poor people to have healthcare (current system) do you want to pay less for it (Obamacare)?  Not paying for it is not an option.

[ny.er]

From the article Renbutler posted

While premiums may go up in other states, Obamacare advocates say people will receive more comprehensive coverage. Also, the law limits the amount people have to pay out-of-pocket for deductibles and co-pays to $6,350 in 2014.

This paragraph is why I don't understand so many people on this board are supporting Obamacare.  We frown upon comprehensive coverage for car, house, and life insurance.  But when it comes to health insurance, there's a tacit assumption that comprehensive is better.

The difference is that a house and car have a limit to their value, and these are things that are easy enough for a Mustachian to self insure. Even life insurance can eventually be dropped, if you know a certain level of income can be derived from passive investments. Health care isn't like this at all. Even if you keep yourself healthy, there are accidents and illnesses that can cost millions to cover.  This would wipe out most Mustachian's stash. It's too much of a wild card. I personally don't believe our national health plan needs to be "comprehensive" but I do believe everyone should be covered for a catastrophe, some immunizations (for the public good), and Obamacare brings us a little closer to that end.

[ace1224]

wow. i think affordable health insurance is a great idea.  currently i pay 80 a month through my employer for a BCBS HDHP.  the deductible is 2500 each and my company contributes 1000 a year, i currently contribute 50 a pay period.

my dad has to pay 1300 a month for just him as he is self insured.  craptastic

[Luck better Skill]

  I have seen two conflicting quotes in this thread.  One says 50% do not have health insurance, the other that 84% do have health insurance. 

  Affordable health insurance/care is a great slogan.  I hope over the next few years I am pleasantly surprised how well it works out as I currently have doubts.

[renbutler]

I believe the suggested answer was "philanthropy".

Just hang out by the highway overpass and ask passing motorists to pour a little Interferon into your begging cup.

That's not really close to what I was suggesting.

[renbutler]

umm yeah.  what if you're born with it and its not your fault?  what if its genetic?

You could always immediately place your child on your insurance at birth as continuing coverage. It's always been the smart thing to do, and problem solved.

[beltim]

  I have seen two conflicting quotes in this thread.  One says 50% do not have health insurance, the other that 84% do have health insurance. 

  Affordable health insurance/care is a great slogan.  I hope over the next few years I am pleasantly surprised how well it works out as I currently have doubts.

My source was from the Census, so I'm pretty confident it's right.  I've never heard anyone bandy about a 50% number.

[renbutler]

First, you said people with past health issues should pay higher rates.

Of course higher risk should mean higher rates. Just like every other kind of insurance.

If you have a problem with that, I'm sure you will support health COVERAGE instead of health insurance.

[infogoon]

Health insurance should be private and individual. And hospitals and doctors should continue to provide care to everybody regardless of their ability to pay, so nobody will be left out.

And I think it's essential that people face the consequences for their obviously poor decisions.

And before somebody gets really stupid about that, no, I don't think we should just let people die if they can't afford insurance.

I don't understand how you reconcile these things.

Everyone should have private health insurance, untethered to their employer, but everyone should get care regardless of their financial or insurance status, and nobody should be allowed to die although they should face consequences for their decisions. And the government shouldn't be involved at all.

[renbutler]

I don't understand how you reconcile these things.

Everyone should have private health insurance, untethered to their employer, but everyone should get care regardless of their financial or insurance status, and nobody should be allowed to die although they should face consequences for their decisions. And the government shouldn't be involved at all.

First, the government should play a role of protection against malicious doctors and insurers, and opening up the insurance across state lines. They should require that all doctor/hospital fees become completely transparent. (That's not all, but their role should remain limited.)

Second, the insurance will become affordable if people use it only for CATASTROPHIC, financially draining illnesses, instead of for checkups and buying aspirin. People can use the money they save by not paying ridiculous premiums for low deductibles. The consequences should be for people who can afford insurance but choose not to buy it until it's too late, and for people who choose a lifestyle that leads to certain lifestyle illnesses. No, the consequence should NOT be death, but rather a major financial hit. Once their money is gone, assistance should kick in. They should not expect to buy insurance after the illness or accident, no more than I should expect to buy car insurance after the accident.

Yes, everybody should continue to get care no matter how legitimately poor they are. If that means my hospital bill will be higher, so be it.

[rtrnow]

First, you said people with past health issues should pay higher rates. Maybe not the day the child was born but when then? Since I'm the one being boorish by calling out a statement you made which results in the below private message. Let's but what you wrote out there for everyone too. I am enjoying that you get so angry when about this.

Of course higher risk should mean higher rates. Just like every other kind of insurance.

If you have a problem with that, I'm sure you will support health COVERAGE instead of health insurance.

There's no reason to "call me out" on my comments, because I have no reason to be ashamed of those facts.

You're not boorish for disagreeing with me. You're boorish for misrepresenting my comments in an angry, insulting, boorish manner.

Now, please, let the people who want to talk respectfully about this serious topic have their thread back.

No more personal sidetracks. Agreed?

As stated by others, health insurance is NOT or should not be treated like other insurance. I won't rehash that. If you really wanted to have a conversation, there was no need to send me a private message and post the reply in an attempt to in your words "embarrass" me. I didn't take your statement out of context. I called it shitty and selfish and I think it was. If strong language get's you that upset, maybe you're on the wrong site.

[ender]

In my opinion, forcing everyone to get government mandated insurance isn't really insurance, it's a universal healthcare system.

The long term implications of this should be fairly obvious. Eventually, the Obamacare system will run into difficulties. Either insurance companies will have to raise policy premiums a significant amount, the government will have to significantly subsidize the cost, or the quality of care will decrease. This is nearly a mathematical certainty given the stipulations of Obamacare. I suspect some combination of all three.

At some point it also seems obvious there will become a second tier of private health-care, because people who can afford it will eventually want a higher quality of care, but perhaps this is a separate conversation.

But pretty much mathematically and by definition, if you are healthy and in a "low risk" demographic you are going to have higher insurance costs.

[infogoon]

First, the government should play a role of protection against malicious doctors and insurers, and opening up the insurance across state lines. They should require that all doctor/hospital fees become completely transparent. (That's not all, but their role should remain limited.)

Second, the insurance will become affordable if people use it only for CATASTROPHIC, financially draining illnesses, instead of for checkups and buying aspirin. People can use the money they save by not paying ridiculous premiums for low deductibles. The consequences should be for people who can afford insurance but choose not to buy it until it's too late, and for people who choose a lifestyle that leads to certain lifestyle illnesses. No, the consequence should NOT be death, but rather a major financial hit. Once their money is gone, assistance should kick in. They should not expect to buy insurance after the illness or accident, no more than I should expect to buy car insurance after the accident.

Yes, everybody should continue to get care no matter how legitimately poor they are. If that means my hospital bill will be higher, so be it.

So, if you're relatively wealthy, you can get insurance. If you're "legitimately poor", you can get free care. And if you're in the middle, you can be bankrupted by a trip to the hospital.

That's pretty much the system we have now, isn't it?

[renbutler]

So, if you're relatively wealthy, you can get insurance. If you're "legitimately poor", you can get free care. And if you're in the middle, you can be bankrupted by a trip to the hospital.

That's pretty much the system we have now, isn't it?

No, I'm middle class, and I have insurance. Our son's first few months would have bankrupted us, but we were covered.

Now, our insurance was through our employer. I would prefer that people be able to pool their risk with greater ease privately, so that we never feel stuck in a job just for the health benefits. I'd much rather have affordable private insurance, and there are ways to accomplish that without government subsidies.

Instead of subsidizing care, government should ensure that hospitals and doctors don't rip people off by charging arbitrary or obviously ridiculous rates and fees. They should allow insurers to pool risk across state lines. Individuals should have more power to negotiate lower out-of-pocket fees like the insurers can do (although some people can already get bills reduced just by explaining their financial situation). And malpractice litigation should be reformed so that malpractice insurance doesn't further jack up rates astronomically.

This is not a complete solution, and there are other things that can be done. But it's a start. Ultimately, though, I think that everybody has a right to health care, but not necessarily government-subsidized and -controlled health care.

[Huffy2k]

It never fails...  Any debate between left and right will always end with someone on the left dropping the "F" bomb and lobbing the personal insults.  Keep up the good work renbutler.  I was enjoying this debate until it got sidetracked a bit recently...

[infogoon]

Now, our insurance was through our employer. I would prefer that people be able to pool their risk with greater ease privately, so that we never feel stuck in a job just for the health benefits. I'd much rather have affordable private insurance, and there are ways to accomplish that without government subsidies.

I agree with you on that -- coupling employment and health insurance is a silly system that's rife with unintended consequences.

I think that the "exchanges", in combination with the individual mandate, are supposed to help resolve that. At least, that was the original intent when the Heritage Foundation came up with the idea, using the power of free market competition to drive down premiums by increasing the market participation of informed consumers. Soon we'll see how it works in the real world.

[Sparafusile]

Everybody is entitled to their opinion whether you believe the same thing or not. If you are getting your feathers rustled, I encourage you to read one of the many other wonderful threads on this site instead. Please keep it civil so this discussion can continue.

[renbutler]

Thanks! Great work as usual by the mods.

[TrulyStashin]

I do find it interesting how people are mad at the government but don't very upset that companies are doing anything they can to get out of covering employees. Most people don't have a problem blaming Obamacare instead of criticizing their employers.

IMO, employers should be out of the health insurance game completely.  I would much prefer single payer or a government insurance system. But we don't have that (except the VA, medicaid, Medicare, CHIP, etc.)

We've had this employer system for quite some time. If that's the route we're going to continue on, where we say as a country that our employers should have an interest and obligation to provide health insurance to their workers, then we should really be questioning and criticizing our employers for wanting to avoid responsibility and cut expenses at all costs. It's beyond clear that companies consider those in low skill low wage jobs (retail, fast food, servers, etc.) to be replaceable cogs in a machine. If you're sick it's not our problem, show up for your shift or your fired, appreciate your minimum wage paycheck and don't ask for benefits because you should feel lucky we've given you the opportunity to work at all.

+1 and to paraphrase MMM, "If your business model is built on refusing to provide employee health benefits, then your business model sucks."

[renbutler]

+1 and to paraphrase MMM, "If your business model is built on refusing to provide employee health benefits, then your business model sucks."

What business's model is built on refusing health care benefits?

Note that simply refusing those benefits isn't the same as building your business model around it.

[TrulyStashin]

  I have seen two conflicting quotes in this thread.  One says 50% do not have health insurance, the other that 84% do have health insurance. 

  Affordable health insurance/care is a great slogan.  I hope over the next few years I am pleasantly surprised how well it works out as I currently have doubts.

My source was from the Census, so I'm pretty confident it's right.  I've never heard anyone bandy about a 50% number.

Does that figure from Census include people on Medicaid, Medicare, VA, CHIP or other government health programs? 

I bet it does which is why it is so high.  For a long time now, the number of Americans without private insurance has hovered between 45 and 50%.  Prior to Obamacare, we saw a steady erosion of the percent of employers offering health insurance benefits.  It was widely documented but here's one link.   http://www.examiner.com/article/study-shows-millions-of-americans-are-without-adequate-health-insurance

[TrulyStashin]

+1 and to paraphrase MMM, "If your business model is built on refusing to provide employee health benefits, then your business model sucks."

What business's model is built on refusing health care benefits?

Note that simply refusing those benefits isn't the same as building your business model around it.

I made the point, early in this conversation, that coupling employment with health insurance is a bad system that impairs U.S. competitiveness.  I continue to believe it is an accurate point -- frankly, that whole business model sucks.  Employers should not be saddled with providing health insurance and Americans should be free to be employed, be self-employed, or retired without having it impact their health insurance. 

I was responding to the comments about businesses, such as Papa Johns, refusing to offer insurance to employees because it might reduce profits or increase the price of a pizza by a small amount.  THAT business model especially sucks when you consider that without employees, there would be no profits to begin with.  How companies treat their human capital should be part of how we evaluate them and value them in the free market.

[beltim]

  I have seen two conflicting quotes in this thread.  One says 50% do not have health insurance, the other that 84% do have health insurance. 

  Affordable health insurance/care is a great slogan.  I hope over the next few years I am pleasantly surprised how well it works out as I currently have doubts.

My source was from the Census, so I'm pretty confident it's right.  I've never heard anyone bandy about a 50% number.

Does that figure from Census include people on Medicaid, Medicare, VA, CHIP or other government health programs? 

I bet it does which is why it is so high.  For a long time now, the number of Americans without private insurance has hovered between 45 and 50%.  Prior to Obamacare, we saw a steady erosion of the percent of employers offering health insurance benefits.  It was widely documented but here's one link.   http://www.examiner.com/article/study-shows-millions-of-americans-are-without-adequate-health-insurance

Of course it does.  Those are insurance programs, right?  And one of the features of the Affordable Care Act is to expand Medicaid so that it covers more people.  That's one of the major ways to expand insurance coverage to cover another 10-12% of the population (http://www.cbo.gov/sites/default/files/cbofiles/attachments/43900_ACAInsuranceCoverageEffects.pdf)

[randymarsh]

But pretty much mathematically and by definition, if you are healthy and in a "low risk" demographic you are going to have higher insurance costs.

Prices will go up most likely for low risk groups, but in exchange, they know they'll still be able to get coverage when they're 50 and have a pre-existing condition. They also will have better access to preventative services now which should be beneficial from a health standpoint and lower costs over time as we catch things when they're cheaper to treat. It's a give and take.

[renbutler]

I made the point, early in this conversation, that coupling employment with health insurance is a bad system that impairs U.S. competitiveness.  I continue to believe it is an accurate point -- frankly, that whole business model sucks.  Employers should not be saddled with providing health insurance and Americans should be free to be employed, be self-employed, or retired without having it impact their health insurance. 

I was responding to the comments about businesses, such as Papa Johns, refusing to offer insurance to employees because it might reduce profits or increase the price of a pizza by a small amount.  THAT business model especially sucks when you consider that without employees, there would be no profits to begin with.  How companies treat their human capital should be part of how we evaluate them and value them in the free market.

Okay, well I agree with your last sentence. I just don't really see companies truly building the business around not providing health care benefits. Employee benefits are just one of many important things that goes into modeling a business.

[MoneyCat]

I made the point, early in this conversation, that coupling employment with health insurance is a bad system that impairs U.S. competitiveness.  I continue to believe it is an accurate point -- frankly, that whole business model sucks.  Employers should not be saddled with providing health insurance and Americans should be free to be employed, be self-employed, or retired without having it impact their health insurance. 

I was responding to the comments about businesses, such as Papa Johns, refusing to offer insurance to employees because it might reduce profits or increase the price of a pizza by a small amount.  THAT business model especially sucks when you consider that without employees, there would be no profits to begin with.  How companies treat their human capital should be part of how we evaluate them and value them in the free market.

Okay, well I agree with your last sentence. I just don't really see companies truly building the business around not providing health care benefits. Employee benefits are just one of many important things that goes into modeling a business.

You can't really depend on companies to be "kind" to their employees as part of a free market system because they are looking for short term profits to satisfy investors, even if it means screwing their business in the long term by damaging their human capital.  It's really the corporate business climate that's ruining things for everybody, because CEOs don't feel that they have the "luxury" to build their business properly anymore.  In an ideal world, Obamacare wouldn't be necessary, but unfortunately, we live in the corporate world where companies are screwing workers to save a nickel here and a dime there without regard for long-term prospects of such a strategy.

[renbutler]

Here's a really eye-opening article about Obamacare. It's written by a conservative, but he's just laying out the concerns about it that's he's heard from Obamacare supporters that he's encountered at a health symposium.

http://www.realclearpolitics.com/articles/2013/08/08/five_lessons_from_obamacare_supporters_119549.html

Here are the concerns from the left, summarized and mostly directly quoted from the piece:

1.) Health insurance exchanges are going to be problematic, and in some states, non-functional.

2.) Rate shock is tangible and real, and there is skepticism that young and healthy people will sign up.

3.) There is an abiding sense of frustration that the work of implementing has been difficult and is behind schedule, but the real problem is the public relations side – for which they blame the administration.

4.) There is a marked preference for talking about the Medicaid expansion issues over the exchanges.

5.) There is now more willingness than ever of the lefty health policy types to admit that Obamacare solves very little in terms of what it is aiming to achieve ... realizing that this law actually offers them very little in terms of a step toward their longterm goals… The conversations go like this: “It was the right thing to do… but it has a ton of problems… and we have to start thinking about what comes next.” It represents recognition on the left’s part that post-2016, this law is going to be reopened, reformed, and significantly altered at a minimum.

I know that complaints from the right might not concern many of you, but, again, note that these concerns are coming from the left.

[MoneyCat]

The left have never said that Obamacare is the greatest system in the world.  What we really wanted was a single-payer system that was an expansion of the healthcare provided for Congress.  However, all the conservatives starting crying about "socialized medicine", so we had to compromise and go with Romney's plan from Massachusetts where healthcare marketplaces were set up with private insurance.  Then, once the right realized that the left were going to use their plan, they started crying about that too.

Clearly, Obamacare is going to do what it's designed to do, since we've already had smaller-scale testing of the program in Massachusetts and Vermont.  The right just doesn't like to deal with reality.

[infogoon]

The left have never said that Obamacare is the greatest system in the world.  What we really wanted was a single-payer system that was an expansion of the healthcare provided for Congress.  However, all the conservatives starting crying about "socialized medicine", so we had to compromise and go with Romney's plan from Massachusetts where healthcare marketplaces were set up with private insurance.  Then, once the right realized that the left were going to use their plan, they started crying about that too.

That's an excellent synopsis. Unfortunately, we have a President who pre-emptively concedes and gives up ground in the interests of appearing "bipartisan", so a single-payer system or a public option were never even seriously considered. A shame. We can run a single-payer system for poor people, or for veterans, or for the elderly, but running it for anyone else would obviously be socialism and the end of the world.

[renbutler]

The left have never said that Obamacare is the greatest system in the world.  What we really wanted was a single-payer system that was an expansion of the healthcare provided for Congress.  However, all the conservatives starting crying about "socialized medicine", so we had to compromise and go with Romney's plan from Massachusetts where healthcare marketplaces were set up with private insurance.  Then, once the right realized that the left were going to use their plan, they started crying about that too.

Clearly, Obamacare is going to do what it's designed to do, since we've already had smaller-scale testing of the program in Massachusetts and Vermont.  The right just doesn't like to deal with reality.

Now that's quite a loaded response. And it's especially odd in light of the fact that it was a response to legitimate concerns on the left.

Do you have anything to say about their concerns, instead of essentially "crying" about how the right "cried?"

[renbutler]

That's an excellent synopsis. Unfortunately, we have a President who pre-emptively concedes and gives up ground in the interests of appearing "bipartisan", so a single-payer system or a public option were never even seriously considered. A shame. We can run a single-payer system for poor people, or for veterans, or for the elderly, but running it for anyone else would obviously be socialism and the end of the world.

Now you're just piggybacking on the complaining and looking backward instead of addressing all the legitimate present concerns.

[infogoon]

That's an excellent synopsis. Unfortunately, we have a President who pre-emptively concedes and gives up ground in the interests of appearing "bipartisan", so a single-payer system or a public option were never even seriously considered. A shame. We can run a single-payer system for poor people, or for veterans, or for the elderly, but running it for anyone else would obviously be socialism and the end of the world.

Now you're just piggybacking on the complaining and looking backward instead of addressing all the legitimate present concerns.

You're presenting "lefty" concerns about Obamacare's implementation as if it's a shocking development. It's not. Historically, "the left" has had problems with this law from the very beginning, because they wanted a proper nationalized health care system rather than a byzantine pile of subsidies to the for-profit insurance companies.

I'm not piggybacking on the complaining, I'm attempting to provide some historical context that you seem unaware of.

[renbutler]

You're presenting "lefty" concerns about Obamacare's implementation as if it's a shocking development. It's not. Historically, "the left" has had problems with this law from the very beginning, because they wanted a proper nationalized health care system rather than a byzantine pile of subsidies to the for-profit insurance companies.

I'm not piggybacking on the complaining, I'm attempting to provide some historical context that you seem unaware of.

Actually, I've seen quite a few people in this very thread talking about all the great things the act is going to accomplish, and they're defending it with little more than a passing acknowledgment that there are flaws (often addressed only as an attempt to place blame politically). Their predictions are quite an "eye-opening" contradiction to the concerns in the article.

I would simply like to hear their take on all the issues going forward, which are presented in the article. The key words being "going forward."

[Lans Holman]

I would simply like to hear their take on all the issues going forward, which are presented in the article. The key words being "going forward."

OK, here goes.
1) As far as the exchanges go, my sense is that the states that really want to make it work are going to make it work.  The ones who have decided for whatever reason to drag their heels are probably going to succeed in dragging their heels.  They've had lots of time to work on this. 
2) It's too early to say about rate shock but I think some states are looking at reductions.  As far as young, healthy people signing up, I don't think people will do it right away out of some kind of social obligation, but I do think it's likely that over time this will be established as a social norm and people who can afford insurance but choose not to carry it will start to be seen as freeloaders.  (Side note: aren't they, really?  I've always thought that if you framed this right more conservatives would appreciate that when someone shows up at the hospital for treatment without insurance or goes bankrupt because of medical bills, we are all paying for it, sooner or later)
3) The PR has been bad, no question.  What percentage of Americans still don't even realize this is happening?
Not sure about 4.
5) Certainly, a lot of people on "the left" are still disappointed about the faillings of this law.  A law with such diverse goals was bound to disappoint a lot of people.  I think if you were starting from scratch and trying to provide health services to as many people as possible it certainly wouldn't be what anyone would have come up with.  But when you start with a system where a lot of people are happy with their current coverage but a huge number of people lack coverage, and you want to expand coverage without adding to the deficit, this is what you end up with.  It would be nice to see some more ideas in it about long term cost controls but it seemed like when they started talking about that it got shouted down as "death panels".

[renbutler]

Thank you for the detailed answers. There's one specifically I'd like to address.

2) It's too early to say about rate shock but I think some states are looking at reductions.  As far as young, healthy people signing up, I don't think people will do it right away out of some kind of social obligation, but I do think it's likely that over time this will be established as a social norm and people who can afford insurance but choose not to carry it will start to be seen as freeloaders.  (Side note: aren't they, really?  I've always thought that if you framed this right more conservatives would appreciate that when someone shows up at the hospital for treatment without insurance or goes bankrupt because of medical bills, we are all paying for it, sooner or later)

I don't see the uninsured as freeloaders, even as somebody with a conservative nature. Health insurance should be a choice, not a mandate. And if they end up needing treatment, they suffer financially first (the ones who can afford insurance) before anybody picks up the rest of the tab.

What will really suck is for those healthy uninsured who would never really need any assistance during their time they are uninsured. They would be forced to buy a product they didn't want OR need. Hopefully they would be wise enough to eventually buy insurance as they age, before they need coverage, but that's a separate issue. If programs are so great, there shouldn't need to be a mandate to participate in them (and certainly we wouldn't need to grant over a thousand waivers, many of them to people who support the president and his bill).

Also, we will all still be "paying for it, sooner or later" under the new system. Those government subsidies come from our taxes, after all. The act called for 20 new taxes or tax hikes -- and not really focused on the rich as some people might want. And much of that money will be lost to new and existing levels of bureaucracy.

How is that any better, really?

[Lans Holman]

Thank you for the detailed answers. There's one specifically I'd like to address.

2) It's too early to say about rate shock but I think some states are looking at reductions.  As far as young, healthy people signing up, I don't think people will do it right away out of some kind of social obligation, but I do think it's likely that over time this will be established as a social norm and people who can afford insurance but choose not to carry it will start to be seen as freeloaders.  (Side note: aren't they, really?  I've always thought that if you framed this right more conservatives would appreciate that when someone shows up at the hospital for treatment without insurance or goes bankrupt because of medical bills, we are all paying for it, sooner or later)

I don't see the uninsured as freeloaders, even as somebody with a conservative nature. Health insurance should be a choice, not a mandate. And if they end up needing treatment, they suffer financially first (the ones who can afford insurance) before anybody picks up the rest of the tab.

What will really suck is for those healthy uninsured who would never really need any assistance during their time they are uninsured. They would be forced to buy a product they didn't want OR need.

But the whole point is that you never really know when you're going to need insurance.  I'll use myself as an example so it's clear I'm not knocking anyone else's choices.  I didn't have insurance for several years between graduating college and my first serious long term job.  I probably could have gotten the money together for some kind of catastrophic plan but I chose not to.  In the back of my mind, was that choice influenced by the idea that if I got really sick, somebody else would end up paying for it?  You bet.  It's not like I had any assets to worry about.  In retrospect, I definitely feel like I was a bit of a freeloader , although I got away with it.  In a system where we have committed to not turning anyone away from our hospitals, and one accident or illness can come out of nowhere to lead to millions of dollars in expenses, I don't think it's unreasonable to ask that everyone be paying in somehow.  I'm always surprised more conservatives don't see it that way. 

[mindaugas]

Also, regarding the notion "that's what it's there for"...

...IMO, health insurance should be for catastrophes that would financially destroy somebody -- you know, real insurance. I don't like how it is used for virtually every health-related expenditure.

+1. Yes, this right here. Health insurance is meant to cover your assets.

For a family of 3 I'm paying $300/mo with $10k deductible for BCBS. My wife is pregnant, this year is going to sting. Already has with an emergency visit :( I used to be able to afford my employer's health care but the plan skyrocketed to $790/mo and there is not high deductible option because the minimums have been lowered.

I feel like the health care reform was put in place to drive insurance companies out of business and pave the way for UHC.

[randymarsh]

1. This is a concern overall I agree, but I don't see this as problem with Obamacare. I see this as Republican governors/states being petty. Obamacare seems to be working in states where people want it to work. This is recurring theme I see with the right. They start with the premise that the government is bad and nothing done by the government works. Then the government implements a new program or whatever and the right prevents funding or finds loopholes etc. Then a bit later they point a finger and say "See we told you government doesn't work!" Good ideas don't work when you want them to fail from the start.

2. Agreed. If young and healthy people don't sign up however and the system can't cope with the expense of unhealthy people...then it may collapse and we could finally pass one of those "Medicare for all" bills that's floating around. A win for me, but I know you disagree.

3. Agreed. I think the government in general has a horrible PR problem. This is an area other countries don't have have to deal with as much because of our state vs. fed separation. The fed provides a lot of resources, but often times they're filtered through state and local agencies. People don't realize that much of the "Federal Income Tax" line on their paychecks goes back into programs in their states and cities in the form of grants and other funding and partnerships.

5. Agreed. I thought from the start it wasn't fully baked. Insurance companies basically wrote the damn thing. You had Pelosi saying we'll find out what's in it...once we pass it. Uh what? That's not how legislation should work. That said, I do think it's a small step forward and hopefully this will keep the movement towards a much better system in motion.

[oldtoyota]

I agree with Lans' points about the surprise of not seeing how everyone having insurance could be good for society and for business.

Because I need health insurance, it would have been hard to start a biz without insurance. I know others who have given up their business to take a job somewhere they could get health insurance. This means that they could not grow their business.

[renbutler]

... I don't think it's unreasonable to ask that everyone be paying in somehow.  I'm always surprised more conservatives don't see it that way.

Not to derail the thread, but conservatives see federal income taxes that way, and they get a lot of blowback for it from the other side. (Even a large part of payroll taxes can get refunded with the earned income tax credit -- but either way, not everybody is paying into the general fund.)

In regard to health insurance, honestly, not everybody will be paying in. Or, more accurately, the subsidies will give back much of what they pay in -- just like earned income tax credit does.

[renbutler]

Thanks for your reply too:

1. This is a concern overall I agree, but I don't see this as problem with Obamacare. I see this as Republican governors/states being petty.

Even if that were true, it should have been anticipated, and crafted differently to avoid having politics ruin the legislation after it's passed.

People don't realize that much of the "Federal Income Tax" line on their paychecks goes back into programs in their states and cities in the form of grants and other funding and partnerships.

I realize it, but I also realize that it sucks to have such a large chunk taken out as it passes through DC, when that money could have just stayed in the state to begin with.

Along the same lines, states should have just been allowed to implement the Mass. health insurance plan if they really wanted it. The feds didn't really need to force it on every state -- particularly ones with a less wealthy and healthy population that will face far more challenges.

[sol]

(Even a large part of payroll taxes can get refunded with the earned income tax credit -- but either way, not everybody is paying into the general fund.)

I'm sure you're aware that the EIC, like the individual mandate, was a conservative idea that liberals embraced and adopted, only to find conservatives suddenly opposing it.

First proposed by Barry Goldwater, enacted under Gerald Ford, and expanded by every Republican administration since.  Look it up. 

[rtrnow]

Also, regarding the notion "that's what it's there for"...

...IMO, health insurance should be for catastrophes that would financially destroy somebody -- you know, real insurance. I don't like how it is used for virtually every health-related expenditure.

+1. Yes, this right here. Health insurance is meant to cover your assets.

I tend to agree, but with the current lack of transparency in the pricing model this seems impossible. I have had a HDHP since it was first offered, but despite trying to price shop no one can really give you a straight price. Plus you lose the bargaining power of large plans. For example, a recent small procedure resulted in my doc being reimbursed $125. I called ahead and ask for the cash price bc I know I'm unlikely to reach my deductible and would just pay to save some money. My cash price $300+.

I feel like the health care reform was put in place to drive insurance companies out of business and pave the way for UHC.

Personally after years of fighting claims with these companies I would cheer if they went out of business. Whether run by the govt or privately, I don't like health as a for profit business. I'm generally in favor of a model that would hopefully result in a private industry heavily regulated by the govt.