Senate votes to repeal ACA

[boyerbt]

All I can say is, its about time.....

I don't have a problem with everything in the law, but the big thing that totally irked me,

Lets not forget how this law originally passed, entirely on part line, without any republican involvement. It was done legally, but in such shady, rushed fashion. I'm sorry, but this is what happens when you exclude half the country in passing a bill that FORCES EVERY PERSON IN THIS COUNTRY TO DO SOMETHING, even if the they don't want to. You cant just ignore the other half of the country when you do something like this, no matter how bad you want it, or how good you think it will be for everyone. Why do you think their are such strong feelings against it?

Unlike republicans trying to repeal it or change tax laws? Over half of the votes went to Hillary so I doubt you can make the argument that the vast majority of Americans want what you are advocating. Saying that almost half the country doesn't want something and thus should not be forced to do it? Welcome to democracy.

I do not believe that the entire collection of each respective party agrees with their party in regards to the ACA. Just because a person votes for one political party does not mean that they align completely in every instance. I am sure that there are some Republicans who are upset with the ACA repeal and some Democrats who are happy with this.

[frugledoc]

The view of the US healthcare system from the UK is that it appears cruel and expensive. Cruel in that it often bankrupts patients or leaves them without life saving treatment.

Our NHS (which to be fair the current government is trying to destroy) costs half as much per person as the US system and it covers 100% of the population.

Wealthy folk can pay privately if they want to skip queues etc.

[Dollar Slice]

There have been a TON of medications jacked up like the epipen that haven't made the news. I have had asthma/allergy problems since childhood, and I've had five different medications soar in price (3 for asthma, 1 epipen, and 1 cream to treat dermatological reactions). All of them are extremely common medications and most of them have been around for many years. It's all profiteering because there are no regulations to prevent it.

Actually, that's not quite true.  These companies can get away with jacking up the prices because they have government enforced monopolies.  The pharma industry in the US is not an example of capitalism at work.  Without those long patent terms providing these companies with an enforceable monopoly, all pharma prices would trend towards their total production & distribution costs.  Not necessarily cheap, but cheaper than they are now.

Many of the medications being jacked up are actually generics. It's slow and difficult to get new generics approved (for good reason, in many cases) so if someone buys up all the companies producing them, or finds some loophole in the patenting, they are able to have a monopoly for some years until/unless some other company starts making it and gets it approved through the system. Albuterol got jacked up because they had to (for legal reasons) change the propellant in the inhaler; that allowed them to get a new patent for the whole inhaler, even though the actual medication has been generic for many years. Epi-pen is also a medication that is not protected by patent (but the delivery device is patented, like the albuterol inhaler). The skin cream I mentioned is a generic made by multiple manufacturers and they all mysteriously decided to jack the price by 1500% around the same time. The skin cream manufacturers are now being sued for illegal price fixing. This is happening all over the place to many common generic medications.

[NESailor]

You don't think there will be doctors catering to the self-paying high income crowd?  That's how it works in every other developed single payer country.  My home country (not the US) including.

I think there definitely would be.

Net result for high income people still includes paying more money for less care though. They just have the option of paying even more money to get the same level of care they were already getting.

I'm really not trying to knock single-payer and the optional additional coverage that is available in countries with single-payer. I'd be happy if something like that got implemented in the US.

Just saying that there are people who stand to lose in the move. For a large percentage of Americans, the healthcare system works out spectacularly.

That's absolutely true.  The problem we are talking about is the other large percentage of Americans for whom the system doesn't work spectacularly, though.  This percentage happens to be the highest in the developed world. 

I think it's safe to say that the wealthy (which includes pretty much everyone reading this...as well as the person typing this) will do just fine regardless.  This is not guaranteed for those who rely on government support.  Should they? That's a different question.

[Greenback Reproduction Specialist]

So you believe gov should tell people how to live and how much of their income they get to keep? Or how they get to spend it?

This is a fact of life in any country worth living in.

I don't think this is necessarily true. But the bigger and more important question is, are you ok with it? How does it make you feel to have to get permission to do things more and more in life?

[Quidnon?]

There have been a TON of medications jacked up like the epipen that haven't made the news. I have had asthma/allergy problems since childhood, and I've had five different medications soar in price (3 for asthma, 1 epipen, and 1 cream to treat dermatological reactions). All of them are extremely common medications and most of them have been around for many years. It's all profiteering because there are no regulations to prevent it.

Actually, that's not quite true.  These companies can get away with jacking up the prices because they have government enforced monopolies.  The pharma industry in the US is not an example of capitalism at work.  Without those long patent terms providing these companies with an enforceable monopoly, all pharma prices would trend towards their total production & distribution costs.  Not necessarily cheap, but cheaper than they are now.

Many of the medications being jacked up are actually generics. It's slow and difficult to get new generics approved (for good reason, in many cases) so if someone buys up all the companies producing them, or finds some loophole in the patenting, they are able to have a monopoly for some years until/unless some other company starts making it and gets it approved through the system.

And you just pointed out how, even after the patent expires, the pharma industry isn't a free market; you know that right?

 Albuterol got jacked up because they had to (for legal reasons) change the propellant in the inhaler; that allowed them to get a new patent for the whole inhaler, even though the actual medication has been generic for many years. Epi-pen is also a medication that is not protected by patent (but the delivery device is patented, like the albuterol inhaler).

Still proving my point, so I don't know what kind of counterpoint you were trying to make here.

The skin cream I mentioned is a generic made by multiple manufacturers and they all mysteriously decided to jack the price by 1500% around the same time. The skin cream manufacturers are now being sued for illegal price fixing. This is happening all over the place to many common generic medications.

A cabal isn't an example of a free market either.

[mathlete]

I don't think this is necessarily true. But the bigger and more important question is, are you ok with it? How does it make you feel to have to get permission to do things more and more in life?

Extremely generally speaking? It doesn't make me feel good.

In the narrow case of having to petition the government in order to do certain things, certain things being expressly forbidden by the government, and losing out on portions of my income for things I may not agree with though...

Compared with what I get in return, which is living a phenomenally privileged life in a first world country, I'm okay with it.

I completely understand why someone may feel differently of course, and I'm open to different ideas. I don't really see anyone else in the game doing it better than the United States or some other similar wealthy Western nation. 

[bacchi]

I completely understand why someone may feel differently of course, and I'm open to different ideas. I don't really see anyone else in the game doing it better than the United States or some other similar wealthy Western nation.

I hear Somalia has a great health care plan.

[lbmustache]

I still don't get how the ACA got everyone insurance.  My dad is 59 and kinda forced retired.  He brings $1400 a month from pension.  After any side work he may have, his income is maybe $24k per year.  Yet for him to get insurance thru Obamacare it was $60 per month with a $10,000 deductible or almost $400 a month with a couple hundred deductible.  Neither of which he can afford.  These were after the credits. 

My mom used to buy her own PPO from Blue Cross for around $350 a month.  After ACA, her plan was gone and the next plan available was over $1500 a month with a huge deductible.

So I just don't understand how this benefited people.

Well, as a counter:

My dad had cancer twice. Paid almost $1500 A MONTH to be insured, with a reasonable deductible, pre-ACA. Could only find one insurer  to cover him - Kaiser Permanente. After ACA, he paid $350/month with a $6k deductible.

[Greenback Reproduction Specialist]

Extremely generally speaking? It doesn't make me feel good.

In the narrow case of having to petition the government in order to do certain things, certain things being expressly forbidden by the government, and losing out on portions of my income for things I may not agree with though...

Compared with what I get in return, which is living a phenomenally privileged life in a first world country, I'm okay with it.

I completely understand why someone may feel differently of course, and I'm open to different ideas. I don't really see anyone else in the game doing it better than the United States or some other similar wealthy Western nation. 

I think we are on the same page at least in that regard. But the encroachment seems to be never ending, and I'm just tired of people thinking they know what is better for everyone else and passing laws the take away individual choice. We have enough laws and regulations already, we don't need to keep adding to the list of things we need permission to do, in my opinion we already went to far.

[mathlete]

Well, as a counter:

My dad had cancer twice. Paid almost $1500 A MONTH to be insured, with a reasonable deductible, pre-ACA. Could only find one insurer  to cover him - Kaiser Permanente. After ACA, he paid $350/month with a $6k deductible.

This. The winners in ACA were those who were previously uninsurable.

Options were abysmal for these folks before. If you weren't employed, on Medicare, or on Medicaid, you were either playing huge COBRA premiums or you were SOL.

ACA got expensive because they didn't push enough young, healthy people into the exchanges. Too many plans were grandfathered, and too many young people decided to pay the fee instead of getting on board.

[mathlete]

I think we are on the same page at least in that regard. But the encroachment seems to be never ending, and I'm just tired of people thinking they know what is better for everyone else and passing laws the take away individual choice. We have enough laws and regulations already, we don't need to keep adding to the list of things we need permission to do, in my opinion we already went to far.

Yeah. It mounts. And it can be frustrating. Especially if you try to lead a life that minimizes your impact on others and the environment like many on this board.

The thing with healthcare though, is that we've sort of already decided that we're not going to deny people life-saving care, and that medical debt is discharged in bankruptcy.

We have a major problem, whether we choose to address it or not. It can certainly be argued that the ACA wasn't the best way to address.

The only, non-encroaching solution I can think of is requiring people to pay for care up front. I don't think many would find that palatable though.

[Metric Mouse]

All I can say is, its about time.....

I don't have a problem with everything in the law, but the big thing that totally irked me,

Lets not forget how this law originally passed, entirely on part line, without any republican involvement. It was done legally, but in such shady, rushed fashion. I'm sorry, but this is what happens when you exclude half the country in passing a bill that FORCES EVERY PERSON IN THIS COUNTRY TO DO SOMETHING, even if the they don't want to. You cant just ignore the other half of the country when you do something like this, no matter how bad you want it, or how good you think it will be for everyone. Why do you think their are such strong feelings against it?

Isn't it being repealed along party lines? And in all likelihood isn't all of the government's agenda for at least 2 years gong to be along party lines with half the US being left out. Your statements seem very partisan or hypocritical.

Last year a repel bill passed both houses to wind up on Obama s desk. There were democrats who voted to repel it. So implementation was strictly along party lines, but repel is like to be bi partisan.

[NESailor]

Well, as a counter:

My dad had cancer twice. Paid almost $1500 A MONTH to be insured, with a reasonable deductible, pre-ACA. Could only find one insurer  to cover him - Kaiser Permanente. After ACA, he paid $350/month with a $6k deductible.

This. The winners in ACA were those who were previously uninsurable.

Options were abysmal for these folks before. If you weren't employed, on Medicare, or on Medicaid, you were either playing huge COBRA premiums or you were SOL.

ACA got expensive because they didn't push enough young, healthy people into the exchanges. Too many plans were grandfathered, and too many young people decided to pay the fee instead of getting on board.

Here's the big sticky ideological hangup.  Young healthy people may not need insurance or healthcare but the system needs them to be in the pools.  If the mandate goes away and we don't find a way to persuade young (conservatives) to join the party...those young conservatives may not have all those glorious choices when they're not young and healthy anymore.  Any system that simply relies on the insureds absorbing the costs for all the people who are not insured and can't pay for whatever reason is going to keep getting more and more expensive regardless of what we do with all the other bits.  A death spiral may have occured even without the ACA given enough time and enough people making the choice not to get insurance.

I can understand people with real physical and mental issues who can't afford insurance defaulting on crazy bills from the ER.  But I find it absolutely despicable when someone who COULD HAVE carried at least catastrophic insurance but chose not to ends up injured and the stiffs providers by not paying the ensuing bills.  Eff that person and their free choice then.

[FIRE Artist]

Damn right!  Its in everyone's best interests for women to be able to manage their birth rates.  But the pharma's charge what they can get away with because many women are willing to pay that much to manage their wombs.  I <3 capitalism, but this and epipens are medical needs that I believe suit the common good.  What I want to know is why do we as a society hand out SNAP benefits (feeding folks that can't quite feed themselves) and vilify (BC pill are murder!) those of us who work hard to make sure we aren't making more mouths to feed than we can realistically manage.

Couldn't disagree more. Fertility in the US has already fallen below replacement. The median age has increased from about 30 to about 38 since the 1980s.

We're already creating an old, sick, dependent population.

Older people consume a lot of public spending and rely on a younger and healthier population to support them.

So the answer to an aging population is unplanned/unwanted pregnancies by the poorest Americans who can't afford to pay out of pocket for the pill?  You must be kidding. 

Want to know how Canada is dealing with this problem?  Immigration.  There are enough people on this planet, just look outside your borders. 

[Quidnon?]

You don't think there will be doctors catering to the self-paying high income crowd?  That's how it works in every other developed single payer country.  My home country (not the US) including.

I think there definitely would be.

Net result for high income people still includes paying more money for less care though. They just have the option of paying even more money to get the same level of care they were already getting.

I'm really not trying to knock single-payer and the optional additional coverage that is available in countries with single-payer. I'd be happy if something like that got implemented in the US.

Just saying that there are people who stand to lose in the move. For a large percentage of Americans, the healthcare system works out spectacularly.

That's absolutely true.  The problem we are talking about is the other large percentage of Americans for whom the system doesn't work spectacularly, though.  This percentage happens to be the highest in the developed world. 

According to whom, and by what metric?  The fact that all Britons have basic coverage is a technicality, when there are confirmed cases of pensioners that have to drink the water from the potted plants in the hospital hallways.  Cuba officially guarantees basic medical care to all it's citizens as well, and does anyone here believe that is true in practice?  The Soviet Union actually declared it a right.  The economic reality is that health care is a service, a special case certainly, but still a service.  And much like any other service, the distribution of said services are never equal in practice.  Each single payer system rations care in different official (life cycle cost limits, approved procedures), and unofficial (extended wait times for expensive procedures, political privilege) ways; but they all ration.  The system in the US (mostly) rations care by the ability to pay the costs.  Obamacare didn't change that, but instead attempted to redistribute those costs from those who consume the services to others who don't (presently) need such services.  Generally speaking, it moves the burden of costs from the older and less able to afford the services that they require; to the younger and less likely to consume services in the near term.  The question, in my opinion, should not be "is it fair that I have to pay for my own heart transplant?" to "is it fair that I have to pay for your heart transplant?"

[lbmustache]

Well, as a counter:

My dad had cancer twice. Paid almost $1500 A MONTH to be insured, with a reasonable deductible, pre-ACA. Could only find one insurer  to cover him - Kaiser Permanente. After ACA, he paid $350/month with a $6k deductible.

This. The winners in ACA were those who were previously uninsurable.

Options were abysmal for these folks before. If you weren't employed, on Medicare, or on Medicaid, you were either playing huge COBRA premiums or you were SOL.

ACA got expensive because they didn't push enough young, healthy people into the exchanges. Too many plans were grandfathered, and too many young people decided to pay the fee instead of getting on board.

Yep, and that's WITH A MANDATE!

Not sure what Congress is proposing to replace ACA (what has been going on for the past 6 years???) but this is a good article about how Rhode Island tried something similar to what a replacement ACA plan would look like, and it didn't do so great. Basic gist: remove the mandate, and young people don't sign up at all, thus resulting in even higher costs for those with health problems or older individuals.

http://www.politico.com/agenda/story/2016/12/republican-health-reform-ideas-obamacare-unlikely-work-000252

My personal view is... ACA had it's fair share of issues, but it's either this or a single payer system (not sure if America is ready for that). Y'all thought ACA was bad, well it's about to get a whole lot worse.

[Quidnon?]

My personal view is... ACA had it's fair share of issues, but it's either this or a single payer system (not sure if America is ready for that). Y'all thought ACA was bad, well it's about to get a whole lot worse.

Maybe so, but sometimes things have to get worse before they can get better.

[scantee]

I don't think this is necessarily true. But the bigger and more important question is, are you ok with it? How does it make you feel to have to get permission to do things more and more in life?

What's your reference point here? In the not-so-distant past, women weren't allowed to have their own credit cards, people in mixed-race relationships weren't not allowed to get married. In many respects, our freedoms have seen amazing expansion in the last fifty years.

The fallacy you seem to be buying into is that return to the status quo (i.e., repeal of ACA and return of the traditional private market, in additional to employer-sponsored care) isn't a means of control or a limit on your freedom. But it absolutely is. Health insurers "control" you just as much as the federal government does: they tell which doctors to see, when you can see them, what they will pay for and what they won't. Now, you might be fine with this kind of control -- more likely, you don't recognize it as such because you're so inculcated to it -- but please do realize that it is just as much a limit on your "freedom" as you seem to think the ACA is. 

[Dollar Slice]

And you just pointed out how, even after the patent expires, the pharma industry isn't a free market; you know that right?

Still proving my point, so I don't know what kind of counterpoint you were trying to make here.

A cabal isn't an example of a free market either.

My apologies, I thought we were having a, intelligent and nuanced discussion about real-world issues with subtle shades of gray. I didn't realize we were supposed to be arguing or proving each other 100% wrong or 100% right.

I was partially agreeing with you and expanding on that issue (it's not just patents, but also...etc.), and also still insisting that these companies need to be regulated to prevent this sort of profiteering.

I will probably not be back to this thread since it is clearly heading towards a fight, so you don't have to waste your energy on a reply if you don't want to :-)

[mathlete]

Damn right!  Its in everyone's best interests for women to be able to manage their birth rates.  But the pharma's charge what they can get away with because many women are willing to pay that much to manage their wombs.  I <3 capitalism, but this and epipens are medical needs that I believe suit the common good.  What I want to know is why do we as a society hand out SNAP benefits (feeding folks that can't quite feed themselves) and vilify (BC pill are murder!) those of us who work hard to make sure we aren't making more mouths to feed than we can realistically manage.

Couldn't disagree more. Fertility in the US has already fallen below replacement. The median age has increased from about 30 to about 38 since the 1980s.

We're already creating an old, sick, dependent population.

Older people consume a lot of public spending and rely on a younger and healthier population to support them.

So the answer to an aging population is unplanned/unwanted pregnancies by the poorest Americans who can't afford to pay out of pocket for the pill?  You must be kidding. 

Hahah. Not exactly. Though I see why what I said was confusing. CheapskateWife said it was in everyone's best interest if women are able to manage their birth rates. My brain skipped over the "are able to" part. I agree, avoiding unplanned pregnancy is a good thing and all women should have that option.

It's kind of beside the point now that you've pointed out my error in understanding, but I believe that it would be better if it weren't so cost-prohibitive for people who want children to have children. With the rising cost of giving birth, c-sections, insurance, single-family homes, college, etc., lots of young people are choosing to delay/not have kids. I think that's unfortunate.

Want to know how Canada is dealing with this problem?  Immigration.  There are enough people on this planet, just look outside your borders.

America imports workers too ya know. We even have a sign on the front door advertising that. Though maybe not for long...

[mathlete]

Yep, and that's WITH A MANDATE!

Not sure what Congress is proposing to replace ACA (what has been going on for the past 6 years???) but this is a good article about how Rhode Island tried something similar to what a replacement ACA plan would look like, and it didn't do so great. Basic gist: remove the mandate, and young people don't sign up at all, thus resulting in even higher costs for those with health problems or older individuals.

http://www.politico.com/agenda/story/2016/12/republican-health-reform-ideas-obamacare-unlikely-work-000252

My personal view is... ACA had it's fair share of issues, but it's either this or a single payer system (not sure if America is ready for that). Y'all thought ACA was bad, well it's about to get a whole lot worse.

Agreed. Getting rid of the mandate, but keeping the pre-existing conditions thing in place would be an absolute disaster.

Of course they could always drop the mandate AND the coverage of pre-existing conditions and we'd be back at square one.

[Metric Mouse]

Maybe we should be asking "Should we be charging for heart transplants?"

[bacchi]

I don't think this is necessarily true. But the bigger and more important question is, are you ok with it? How does it make you feel to have to get permission to do things more and more in life?

What's your reference point here? In the not-so-distant past, women weren't allowed to have their own credit cards, people in mixed-race relationships weren't not allowed to get married. In many respects, our freedoms have seen amazing expansion in the last fifty years.

The fallacy you seem to be buying into is that return to the status quo (i.e., repeal of ACA and return of the traditional private market, in additional to employer-sponsored care) isn't a means of control or a limit on your freedom. But it absolutely is. Health insurers "control" you just as much as the federal government does: they tell which doctors to see, when you can see them, what they will pay for and what they won't. Now, you might be fine with this kind of control -- more likely, you don't recognize it as such because you're so inculcated to it -- but please do realize that it is just as much a limit on your "freedom" as you seem to think the ACA is.

And whether you get a plan or not (preexisting conditions denial) and whether to drop you or not when you get sick (rescission).

[NESailor]

You don't think there will be doctors catering to the self-paying high income crowd?  That's how it works in every other developed single payer country.  My home country (not the US) including.

I think there definitely would be.

Net result for high income people still includes paying more money for less care though. They just have the option of paying even more money to get the same level of care they were already getting.

I'm really not trying to knock single-payer and the optional additional coverage that is available in countries with single-payer. I'd be happy if something like that got implemented in the US.

Just saying that there are people who stand to lose in the move. For a large percentage of Americans, the healthcare system works out spectacularly.

That's absolutely true.  The problem we are talking about is the other large percentage of Americans for whom the system doesn't work spectacularly, though.  This percentage happens to be the highest in the developed world. 

According to whom, and by what metric?  The fact that all Britons have basic coverage is a technicality, when there are confirmed cases of pensioners that have to drink the water from the potted plants in the hospital hallways.  Cuba officially guarantees basic medical care to all it's citizens as well, and does anyone here believe that is true in practice?  The Soviet Union actually declared it a right.  The economic reality is that health care is a service, a special case certainly, but still a service.  And much like any other service, the distribution of said services are never equal in practice.  Each single payer system rations care in different official (life cycle cost limits, approved procedures), and unofficial (extended wait times for expensive procedures, political privilege) ways; but they all ration.  The system in the US (mostly) rations care by the ability to pay the costs.  Obamacare didn't change that, but instead attempted to redistribute those costs from those who consume the services to others who don't (presently) need such services.  Generally speaking, it moves the burden of costs from the older and less able to afford the services that they require; to the younger and less likely to consume services in the near term.  The question, in my opinion, should not be "is it fair that I have to pay for my own heart transplant?" to "is it fair that I have to pay for your heart transplant?"

But that's what insurance is -  a cost redistribution scheme.  It works best if there are lots of people who pay in and few people who draw.   Anything that doesn't aim to do exactly that is going to put upward pressure on premiums and we're exactly where we are today (or worse, where we were before).  Rationing is part of the answer as unpopular as it may seem.  It doesn't happen enough.  People still consume the care here...they just don't pay.  So the cost is entirely born by those who pay their premiums (and obfuscated by the crazy employer-based system) and taxpayers (and we know not everyone pays taxes). 

[StarBright]

I suspect there is a strong negative correlation coefficient between Variable A) the number of times a person actually dealt with a health insurance company prior to ACA, and Variable B) their enthusiasm to repeal Obamacare...

This ^ I've had a high deductible HSA through work for years because that is what was offered. I don't really like it, and I don't think it works particularly well, but I'm pleased to have insurance. The ACA didn't change a darn thing for us (except our pricing has stayed relatively flat for individuals since 2012).

But when I hear people complaining about "Obamacare" they often seem to be complaining about the back and forth that I've experienced with my HSA. The days of our parents' easy, awesome PPOs (I'm an older millenial) are long gone and they aren't coming back.

[MilesTeg]

All I can say is, its about time.....

I don't have a problem with everything in the law, but the big thing that totally irked me,

Lets not forget how this law originally passed, entirely on part line, without any republican involvement. It was done legally, but in such shady, rushed fashion. I'm sorry, but this is what happens when you exclude half the country in passing a bill that FORCES EVERY PERSON IN THIS COUNTRY TO DO SOMETHING, even if the they don't want to. You cant just ignore the other half of the country when you do something like this, no matter how bad you want it, or how good you think it will be for everyone. Why do you think their are such strong feelings against it?

You're ignoring the party politics when you claim it was done "shady and rushed". The ACA is the same plan proposed by conservative think tanks and implemented by republicans in MA (see: RomneyCare). The only reason it was a party line vote was because our politics are CRAZY and it's PARTY before COUNTRY. The strong feelings aren't about the law itself, the strong feelings are about 'team blue' vs 'team red'.

[Quidnon?]

I don't think this is necessarily true. But the bigger and more important question is, are you ok with it? How does it make you feel to have to get permission to do things more and more in life?

What's your reference point here? In the not-so-distant past, women weren't allowed to have their own credit cards, people in mixed-race relationships weren't not allowed to get married. In many respects, our freedoms have seen amazing expansion in the last fifty years.

This is very true with regard to social issues, quite the opposite with regard to many economic issues.

The fallacy you seem to be buying into is that return to the status quo (i.e., repeal of ACA and return of the traditional private market, in additional to employer-sponsored care) isn't a means of control or a limit on your freedom.

There hasn't been a true private market, or free market, in health care in the United States since before World War 2.  No one here, except maybe a historian, would even know what that would look like today.

But it absolutely is. Health insurers "control" you just as much as the federal government does: they tell which doctors to see, when you can see them, what they will pay for and what they won't.

Yet, before the ACA, I could tell them whether or not I was going to do business with them at all, or go find a different company or policy that fit my needs better.  Now I can't.  The ACA has harmed me in both measurable and immeasurable ways.  It made my previous catastrophic plan illegal.  My premiums tripled the first year that the ACA regulations went into effect.  The costs of my chronic medications rose immediately, even though they are all generics.  My private medical history was required to be entered into a database without my consent, that I know for a fact can be accessed by just about anyone with user access to that database in my city. (my consent is no longer required for any medical professional to see my medical history, even those that are not emergency room staff, or even doctors.  All that is needed is some of my personal data; name & birthdate being the simplest.  Which happens to be on my driver's license, so not even difficult data to get; and from there my SSN, veteran's status, current and former addresses, etc. are visible)

Now, you might be fine with this kind of control -- more likely, you don't recognize it as such because you're so inculcated to it -- but please do realize that it is just as much a limit on your "freedom" as you seem to think the ACA is.

Not so, because before the ACA, I had a choice to refuse that my medical history be electronic.  I had the choice to reduce my premiums in exchange for a higher deductible, catastrophic coverage, cancer optional coverage, or no coverage at all.  The power to chose, without interference in that choice, is freedom.  If I don't have the power to choose, even if that choice is wrong by any objective or subjective measure, without interference; then I am not free.

[Quidnon?]

Maybe we should be asking "Should we be charging for heart transplants?"

So a heart surgeon should work for free?  Do you know what it's called when a person must perform a service, without compensation, for another person?

[protostache]

My private medical history was required to be entered into a database without my consent, that I know for a fact can be accessed by just about anyone with user access to that database in my city. (my consent is no longer required for any medical professional to see my medical history, even those that are not emergency room staff, or even doctors.  All that is needed is some of my personal data; name & birthdate being the simplest.  Which happens to be on my driver's license, so not even difficult data to get; and from there my SSN, veteran's status, current and former addresses, etc. are visible)

I'm not sure what city you live in, but access without authorization and specific need is a textbook HIPPA violation and is a firing offense everywhere in the US. It doesn't happen, and if it does it's swiftly taken care of (a member of my family was fired and her medical license revoked for specifically this).

[GuitarStv]

Maybe we should be asking "Should we be charging for heart transplants?"

So a heart surgeon should work for free?  Do you know what it's called when a person must perform a service, without compensation, for another person?

No need for a straw man.  He didn't type 'Should surgeons be paid for work?'.

The 'we' referred to was a societal 'we'.  It's possible (and in most developed countries the norm) to pay for medical treatment from the public coffers, the same way that the police, firefighters, and large infrastructure projects are paid for.  Health of citizenry is a public good.

[rpr]

AFAIK, the US is the only country in the developed world whose residents worry about the affordability of health care to this extent.  That should give us something to think about.

[prognastat]

All I can say is, its about time.....

I don't have a problem with everything in the law, but the big thing that totally irked me,

Lets not forget how this law originally passed, entirely on part line, without any republican involvement. It was done legally, but in such shady, rushed fashion. I'm sorry, but this is what happens when you exclude half the country in passing a bill that FORCES EVERY PERSON IN THIS COUNTRY TO DO SOMETHING, even if the they don't want to. You cant just ignore the other half of the country when you do something like this, no matter how bad you want it, or how good you think it will be for everyone. Why do you think their are such strong feelings against it?

Unlike republicans trying to repeal it or change tax laws? Over half of the votes went to Hillary so I doubt you can make the argument that the vast majority of Americans want what you are advocating. Saying that almost half the country doesn't want something and thus should not be forced to do it? Welcome to democracy.

So you believe gov should tell people how to live and how much of their income they get to keep? Or how they get to spend it?

The un-nuanced answer: yeah.

All I can say is, its about time.....

I don't have a problem with everything in the law, but the big thing that totally irked me,

Lets not forget how this law originally passed, entirely on part line, without any republican involvement. It was done legally, but in such shady, rushed fashion. I'm sorry, but this is what happens when you exclude half the country in passing a bill that FORCES EVERY PERSON IN THIS COUNTRY TO DO SOMETHING, even if the they don't want to. You cant just ignore the other half of the country when you do something like this, no matter how bad you want it, or how good you think it will be for everyone. Why do you think their are such strong feelings against it?

Unlike republicans trying to repeal it or change tax laws? Over half of the votes went to Hillary so I doubt you can make the argument that the vast majority of Americans want what you are advocating. Saying that almost half the country doesn't want something and thus should not be forced to do it? Welcome to democracy.

The United States is not a democracy.  Never has been.

Ah good job on missing the point. Yes I know the US is a Constitutional Republic not a democracy, just wasn't feeling going in to that distinction. That doesn't actually change what my response was directed at. The fact that they "exclude half the country" is how it works when you live in a system where you vote for representatives and a majority of voters decides the outcome, as long as it doesn't counter the constitution, even if it is a minor majority. I was skipping many faults in that position to start with that others since have commented on such as the fact that 130 Million people voted in a country of 319 Million. Of those that voted 62 Million voted for trump. That means we can only say for certain that 19.4% are getting what they want. The numbers are slightly better for Obama, but not much.

My point is that the situation of creating the laws as far as the will of the people and it being repealed is not really any different yet he is positioning it as if the first was some injustice against the will of the people and the one that aligns with his wishes isn't.

[mm1970]

All I can say is, its about time.....

I don't have a problem with everything in the law, but the big thing that totally irked me,

Lets not forget how this law originally passed, entirely on part line, without any republican involvement. It was done legally, but in such shady, rushed fashion. I'm sorry, but this is what happens when you exclude half the country in passing a bill that FORCES EVERY PERSON IN THIS COUNTRY TO DO SOMETHING, even if the they don't want to. You cant just ignore the other half of the country when you do something like this, no matter how bad you want it, or how good you think it will be for everyone. Why do you think their are such strong feelings against it?

Wait, so because the Republicans refused to become involved, or even consider it, or come to the table, it's the Democrats' fault?

Funny that.

[mancityfan]

Keeping healthcare costs reasonable only works if sacrifices are made for the good of the whole population. As someone who grew up in the UK (and worked in the National Health Service), and worked stateside in healthcare for 15 years, I feel that Americans are just not able to make the sacrifices that are necessary. In the US it is all about getting what you want/need, and damn the rest if they cannot keep up.

I worked in a  cardiac ICU in the UK. If you needed bypass surgery and you were over a certain age (65-70) you were not going to get it, not a candidate. Need a kidney transplant over 55, sorry, not going to happen. My first week in the US I witnessed a 92 year old man - already with significant mental deficits - undergo cardiac bypass surgery. Patient never really recovered, but the family could afford it, so the surgery went ahead. This would never happen in many developed countries around the world.

You get nothing for free, and with healthcare it cannot work on a national level without sacrifice and making accomodations for those who are less fortunate.

[scantee]

I don't think this is necessarily true. But the bigger and more important question is, are you ok with it? How does it make you feel to have to get permission to do things more and more in life?

What's your reference point here? In the not-so-distant past, women weren't allowed to have their own credit cards, people in mixed-race relationships weren't not allowed to get married. In many respects, our freedoms have seen amazing expansion in the last fifty years.

This is very true with regard to social issues, quite the opposite with regard to many economic issues.

You must be referring to the 1950's, when the top marginal tax rate was 91%.

[bacchi]

I don't think this is necessarily true. But the bigger and more important question is, are you ok with it? How does it make you feel to have to get permission to do things more and more in life?

What's your reference point here? In the not-so-distant past, women weren't allowed to have their own credit cards, people in mixed-race relationships weren't not allowed to get married. In many respects, our freedoms have seen amazing expansion in the last fifty years.

This is very true with regard to social issues, quite the opposite with regard to many economic issues.

You must be referring to the 1950's, when the top marginal tax rate was 91%.

Make America Great Again! Raise the marginal tax rates!

[rpr]

Keeping healthcare costs reasonable only works if sacrifices are made for the good of the whole population. As someone who grew up in the UK (and worked in the National Health Service), and worked stateside in healthcare for 15 years, I feel that Americans are just not able to make the sacrifices that are necessary. In the US it is all about getting what you want/need, and damn the rest if they cannot keep up.

I worked in a  cardiac ICU in the UK. If you needed bypass surgery and you were over a certain age (65-70) you were not going to get it, not a candidate. Need a kidney transplant over 55, sorry, not going to happen. My first week in the US I witnessed a 92 year old man - already with significant mental deficits - undergo cardiac bypass surgery. Patient never really recovered, but the family could afford it, so the surgery went ahead. This would never happen in many developed countries around the world.

You get nothing for free, and with healthcare it cannot work on a national level without sacrifice and making accomodations for those who are less fortunate.

+1. You make some very important points. Explains so much about why things are so expensive here in the US.

[Quidnon?]

But that's what insurance is -  a cost redistribution scheme.

No, it's not.  Insurance is a risk mitigation contract.  True health insurance is a contract that protects the buyer from the remote, but potentially catastrophic, economic risk of developing very poor health.  Common & predictable health care costs should never have been lumped into "insurance".  What you consider insurance is a cost sharing system, not insurance. 

  It works best if there are lots of people who pay in and few people who draw.

That is only one way to do it.  The HSA is another way to do it.  Instead of the ecomonic risk during any particular year being spread across a pool of people, the economic risk is spread across the lifespan of a particular person.  The HSA is still not insurance, though; the high-deductible health insurance policy is the insurance.

Yet another way to do it is to pair a Medical Cost Sharing program (such as Medishare) with a true, catastrophic plan.  Or a catastrophic plan plus a cancer rider, or short/long term disability insurance.

The portion of your ACA compliant plan that pays for your free annual checkup or mammogram is neither free, nor insurance.  It's just a cost transfer from your premiums to your doctor's office, with a bit of overhead & profit margin thrown in.  Do you really think that everyone needs an annual checkup every year?  Should men have to pay additional premiums because mammograms are covered?  Should transgender women?  Should single, childless adults (or childless homosexual couples) be compelled by law to contribute to free vaccines for children?  Or colon cancer screening for the over 50 crowd?

  Anything that doesn't aim to do exactly that is going to put upward pressure on premiums and we're exactly where we are today (or worse, where we were before).

Obviously, I don't agree with your opinion that health care was worse before the ACA.  It was a mess, certainly; but it wasn't worse.

Rationing is part of the answer as unpopular as it may seem.  It doesn't happen enough.  People still consume the care here...they just don't pay.  So the cost is entirely born by those who pay their premiums (and obfuscated by the crazy employer-based system) and taxpayers (and we know not everyone pays taxes).

True, rationing is part of the answer.  So is your complaint that the way rationing occurs under the ACA is unfair, because some people don't pay for their own care?  So wouldn't a true, free market system in health care, with rationing being determined solely on the ability to pay for services, be a much more rational and fair system of rationing care?  One major reason the health care system is so expensive in the US is the fact that the last 3 years of care is so expensive, and so much of that cost lands upon the taxpayer already via Medicare & Medicaid.  For generations we have become accustomed to the idea that grandpa deserves the greatest effort, quality of care, and comfort regardless of his finances.  Because, Grandpa!

[LeRainDrop]

Demand price controls: why is a monthly pack of birth control pills $30+ for an American woman, and $3 for virtually everyone else?

They're more like $5/month.

Sorry Mrs Pete, but it probably depends on the insurance.  My copay is $30 per month for BC pills.

Huh, mine is free.  Then again, that's on an employer-sponsored plan, so maybe cost more on other plans.  I had thought that Obamacare was supposed to make birth control pills free?

[scantee]

Not so, because before the ACA, I had a choice to refuse that my medical history be electronic.  I had the choice to reduce my premiums in exchange for a higher deductible, catastrophic coverage, cancer optional coverage, or no coverage at all.  The power to chose, without interference in that choice, is freedom.  If I don't have the power to choose, even if that choice is wrong by any objective or subjective measure, without interference; then I am not free.

You do realize that pre-ACA there were millions of people with no choice at all. The simply couldn't get covered in the private market, by anyone. Couldn't choose between different deductible levels or catastophic coverage or cancer coverage. None of those "choices" were available to them. You gave up a small amount of your freedom, to give a little freedom to others who previously had none at all.

[Quidnon?]

I don't think this is necessarily true. But the bigger and more important question is, are you ok with it? How does it make you feel to have to get permission to do things more and more in life?

What's your reference point here? In the not-so-distant past, women weren't allowed to have their own credit cards, people in mixed-race relationships weren't not allowed to get married. In many respects, our freedoms have seen amazing expansion in the last fifty years.

This is very true with regard to social issues, quite the opposite with regard to many economic issues.

You must be referring to the 1950's, when the top marginal tax rate was 91%.

And only about a tenth of a percent of the working population ever came near the top rate.  And I'm pretty sure that you knew I wasn't referring to the progressive tax system, nor the 1950's

[scantee]

I don't think this is necessarily true. But the bigger and more important question is, are you ok with it? How does it make you feel to have to get permission to do things more and more in life?

What's your reference point here? In the not-so-distant past, women weren't allowed to have their own credit cards, people in mixed-race relationships weren't not allowed to get married. In many respects, our freedoms have seen amazing expansion in the last fifty years.

This is very true with regard to social issues, quite the opposite with regard to many economic issues.

You must be referring to the 1950's, when the top marginal tax rate was 91%.

And only about a tenth of a percent of the working population ever came near the top rate.  And I'm pretty sure that you knew I wasn't referring to the progressive tax system, nor the 1950's

I have absolutely no idea what you are referring to. I suspect you don't either.

[Gin1984]

All I can say is, its about time.....

I don't have a problem with everything in the law, but the big thing that totally irked me,

Lets not forget how this law originally passed, entirely on part line, without any republican involvement. It was done legally, but in such shady, rushed fashion. I'm sorry, but this is what happens when you exclude half the country in passing a bill that FORCES EVERY PERSON IN THIS COUNTRY TO DO SOMETHING, even if the they don't want to. You cant just ignore the other half of the country when you do something like this, no matter how bad you want it, or how good you think it will be for everyone. Why do you think their are such strong feelings against it?

I'm being a bit pedantic here, but Republicans don't represent half the country. No political party does. At the time the ACA was passed, they mad up less than 42% of the voting congress.

People have strong feelings about ACA because healthcare is expensive and everyone wants it and no one wants to pay for it.

I am perfectly fine with paying for it, I just want access.

Sent from my SPH-L710 using Tapatalk

[dycker1978]

I just don't get it.  I live in Canada, so I guess that is why, but I believe that health care should be provided to all people in a country regardless of income, and not be a for profit system.

Capitalism works in many instances, but we are playing with peoples lives here.  Take the profit out of the system, allow the people in the system to make a living.  Our Dr.'s and nurses get paid here.  and pay for it out of the taxes you collect.  Take care of your people.  Canada's system is not without fault, but I did not need to worry when they found a bone spur in my neck, after a car accident, but not as a result of the accident, that I would have to come up with some crazy co-pay or even the cost of the surgery at and estimated $350,000 in the US.  it is crazy that this is even a thing.  Take care of the people living there.  I thought this is what governments job was supposed to be, not to make laws to force insurance companies to allow you to have insurance.

[Lagom]

Not so, because before the ACA, I had a choice to refuse that my medical history be electronic.  I had the choice to reduce my premiums in exchange for a higher deductible, catastrophic coverage, cancer optional coverage, or no coverage at all.  The power to chose, without interference in that choice, is freedom.  If I don't have the power to choose, even if that choice is wrong by any objective or subjective measure, without interference; then I am not free.

And when people who chose to have inadequate coverage have a heart attack and are treated anyway, my freedom is harmed by having to pick up a share of the associated cost when they cant pay their bills. Same goes for people who don't get treatment for minor issues due to lack of coverage that then turn into major issues, which can have a domino effect of requiring intervention from all sorts of social services, all of which are funded by taxes. Or when widespread outbreaks of preventable viruses occur because people aren't getting vaccinated. And so forth. It's cool if you want to have a myopic view about how you personally are affected, but let's not pretend Freedom with a capital "F" is threatened by the ACA or single payer systems.

Also, taxes are by far the lamest thing to wring your hands over when fretting about freedom lost. Privacy concerns are more valid, imo, but also a separate discussion.

[Quidnon?]

Not so, because before the ACA, I had a choice to refuse that my medical history be electronic.  I had the choice to reduce my premiums in exchange for a higher deductible, catastrophic coverage, cancer optional coverage, or no coverage at all.  The power to chose, without interference in that choice, is freedom.  If I don't have the power to choose, even if that choice is wrong by any objective or subjective measure, without interference; then I am not free.

You do realize that pre-ACA there were millions of people with no choice at all. The simply couldn't get covered in the private market, by anyone. Couldn't choose between different deductible levels or catastrophic coverage or cancer coverage. None of those "choices" were available to them. You gave up a small amount of your freedom, to give a little freedom to others who previously had none at all.

This is false, and propaganda.  There were millions of people that couldn't find health insurance for a premium they were willing to pay.  There were others who couldn't find health insurance that would cover a chronic medical condition that they already had, at least not without a waiting period or a very expensive rider.  And there were millions who simply chose to roll the dice and "self-insure" with a backup from chapter 7 bankruptcy.  Again, insurance is a contract to mitigate the economic risk of developing an expensive medical condition.  If a company, policy or risk pool cannot discriminate against applicants that already have such a condition, it's already not insurance.  True insurance is cheap.  Before the ACA, I could get a rider to my "umbrella" insurance policy that was truly a catastrophic "hospitalization" plan, that would cover any hospital bill at 100% beyond a very high number; $22,000 at the time if I recall correctly, incurred during a single year or during a continuous hospital stay (if it occurred across January 1st).  That rider cost me an additional $22 dollars per year in 2006 or so, maybe in the $30s by the time my insurance company dropped the optional rider in 2012.

And medical insurance is not the only way to afford care.

[Greenback Reproduction Specialist]

All I can say is, its about time.....

I don't have a problem with everything in the law, but the big thing that totally irked me,

Lets not forget how this law originally passed, entirely on part line, without any republican involvement. It was done legally, but in such shady, rushed fashion. I'm sorry, but this is what happens when you exclude half the country in passing a bill that FORCES EVERY PERSON IN THIS COUNTRY TO DO SOMETHING, even if the they don't want to. You cant just ignore the other half of the country when you do something like this, no matter how bad you want it, or how good you think it will be for everyone. Why do you think their are such strong feelings against it?

Wait, so because the Republicans refused to become involved, or even consider it, or come to the table, it's the Democrats' fault?

Funny that.

Should the republicans pass a law requiring everyone to register their sexual preference, even if democrats refuse to become involved, or even consider it, or come to the table? No of course not.

It doesn't matter how good you or I think the idea is, the point is we cant have a co-operative gov without co-operations. If the other side doenst want something to happen that puts restrictions on people, maybe there is good reason, or maybe there isn't, but this isn't a dictatorship. I

[scantee]

Not so, because before the ACA, I had a choice to refuse that my medical history be electronic.  I had the choice to reduce my premiums in exchange for a higher deductible, catastrophic coverage, cancer optional coverage, or no coverage at all.  The power to chose, without interference in that choice, is freedom.  If I don't have the power to choose, even if that choice is wrong by any objective or subjective measure, without interference; then I am not free.

You do realize that pre-ACA there were millions of people with no choice at all. The simply couldn't get covered in the private market, by anyone. Couldn't choose between different deductible levels or catastrophic coverage or cancer coverage. None of those "choices" were available to them. You gave up a small amount of your freedom, to give a little freedom to others who previously had none at all.

This is false, and propaganda.  There were millions of people that couldn't find health insurance for a premium they were willing to pay.  There were others who couldn't find health insurance that would cover a chronic medical condition that they already had, at least not without a waiting period or a very expensive rider.  And there were millions who simply chose to roll the dice and "self-insure" with a backup from chapter 7 bankruptcy.  Again, insurance is a contract to mitigate the economic risk of developing an expensive medical condition.  If a company, policy or risk pool cannot discriminate against applicants that already have such a condition, it's already not insurance.  True insurance is cheap.  Before the ACA, I could get a rider to my "umbrella" insurance policy that was truly a catastrophic "hospitalization" plan, that would cover any hospital bill at 100% beyond a very high number; $22,000 at the time if I recall correctly, incurred during a single year or during a continuous hospital stay (if it occurred across January 1st).  That rider cost me an additional $22 dollars per year in 2006 or so, maybe in the $30s by the time my insurance company dropped the optional rider in 2012.

And medical insurance is not the only way to afford care.

You're right: astronomical expense was the private market's preferred method for making health care technically available to everyone, yet functionally inaccessible to large swathes of the population. The end result of the implementation of this approach is exactly the same as providing no choice at all.

[Quidnon?]

Not so, because before the ACA, I had a choice to refuse that my medical history be electronic.  I had the choice to reduce my premiums in exchange for a higher deductible, catastrophic coverage, cancer optional coverage, or no coverage at all.  The power to chose, without interference in that choice, is freedom.  If I don't have the power to choose, even if that choice is wrong by any objective or subjective measure, without interference; then I am not free.

And when people who chose to have inadequate coverage have a heart attack and are treated anyway, my freedom is harmed by having to pick up a share of the associated cost when they cant pay their bills. Same goes for people who don't get treatment for minor issues due to lack of coverage that then turn into major issues, which can have a domino effect of requiring intervention from all sorts of social services, all of which are funded by taxes.

Not all of it, no.  I personally know a woman who is on SSI, who received a bypass entirely funded by the combination of a charity, and the goodwill of the heart surgeon.  Granted, both the donors to the charity, and the heart surgeon, received some nice deductions off their taxes in that year; but that isn't the same as saying that it was paid for by your taxes.

Or when widespread outbreaks of preventable viruses occur because people aren't getting vaccinated.

This is a whole new ball of wax right here.

. And so forth. It's cool if you want to have a myopic view about how you personally are affected, but let's not pretend Freedom with a capital "F" is threatened by the ACA or single payer systems.

How about we agree to not pretend that they don't threaten my freedom.  Because you know that they did and they do.  True story, first person account.

Also, taxes are by far the lamest thing to wring your hands over when fretting about freedom lost. Privacy concerns are more valid, imo, but also a separate discussion.

I was making a list of grievances, not ranking them.  And why would the privacy concerns due to the ACA not be part of this discussion?  You are the one that wanted to hear my views on why I hated the ACA.  This is one reason why, among too many.