Invitation to a real discussion of Obamacare

T

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It would be really neat to have an earnest and thought provoking discussion of this issue without references to MSNBC, Fox, "Dear Leader", Limbaugh, etc. Let's see if we're capable of it.

It's almost too easy to point out the negatives of this law, besides they have already been pointed out ad nauseum, so I'm going to start this thread with the more difficult task of trying to find some actual positives. Please weigh in with your thoughts. Good luck to us all. Here goes...

Can the arguments be made that in the long run this new law will actually enhance individual freedom and economic growth?

From my limited understanding of this law, the big up side that stands out to me is the freedom that the portability of the individual health policies and no disqualification due to a pre-existing condition affords individuals. I can think of more than a few colleagues and friends over the years who have mentioned that they hate their jobs / careers but stay in their position due to fear of losing their health benefits. Some of these people are cancer survivors, have very sick kids, or a wife with breast cancer, etc...So losing health insurance has been a very real concern. Perhaps the freedom of not being handcuffed to a job / company that they hate by the fear of losing needed benefits they will now move into careers that ignite their passions.

Wouldn't a capitalist argue that people working in a field that they love (pursuing a self-interest) will be more productive and innovative than those that work in jobs that they loathe? Further, wouldn't most free marketeers and economists argue that people free to pursue their own personal goals lead to a more productive and vibrant economy in the long run than one in which people are compelled by exigent circumstances to stay put in a situation that is unfulfilling?

Any others come to mind?
 
So we're only allowed to post things we like about the law? How is that a "real discussion"?

If we refute your assertions with critiques of the law, will we be accused of "dragging the thread down into partisanship?"

OK I'll play. I like the part of the law where we can all pat ourselves on the back and pretend we've done something good for America's uninsured and find some specific instances of people who have been "helped" by the law, while ignoring all the issues that come up, because "well that's water under the bridge. We need to move forward now!"

I think it's a wonderful idea that has absolutely no negative unintended consequences and will in no way drive us closer to bankruptcy while causing us to have severely limited medical options and treatments.
 
If I was a Union guy, I would like the part where I am exempt!

I like the part about how the competition for insurance has to stay within states borders, as an insurance company you can only make offers to people in your state, I like that as it reduces compettion.

I also like the increase in Capital Gains tax as we need to take the money out of the hands of people that invest it and give it to the government.

I like the fact that my insurance, whether I continue through my company or I go to Joe's insurance is going to double or triple in the next 2-5 years!!!

That should get us started....
 
DFWAg - In full disclosure I actually work for an insurance company, although not on the health insurance side. So I certainly understand both of your a and b points. I'm well aware of the obvious short comings of this law...or better put, the more obvious trainwrecks that it will create. In fact, I think that we all are. However, I'm trying to see if there are other less obvious but materially significant pros or cons that I have not considered...Further, I would like to try and see the issues through a less politicized lens.

On the pre-existing condition point I just mean that it gives you freedom from your current employer's plan if you choose to go to a different employer. I have seen cases where an otherwise qualified job candidate was not hired because that person was deemed to be a bad risk for the company's employee health plan.

By the way, I like your idea of taking the more long term actuarial life insurance approach. It makes a lot of sense. However, I fear that we would be looking at the need for another Social Security like trust fund approach to make that happen, and we all know what has happened with that...empty of money, heavy with IOUs.
 
Ag With Kids - If I'm misreading your intent, I apologize. It sounds like you're thinking that I'm a proponent of Obamacare and that must somehow make this thread illegitimate, or its intent suspect. However, I think that if you read my original post again you will find that I am acknowledging that I'm not a fan of the law as a whole with what I currently know about it. I am trying to see if I can learn more about it and remove some of the political invective, basically seeing if I can learn additional info by seeing if I can have an open mind. My two pros of enhanced freedom and a more vibrant economy in the long run took some serious tongue biting to come up with, but it was an honest effort.

Anyway, from the first few responses it is looking like this is probably a wasted effort.
 
"Can the arguments be made that in the long run this new law will actually enhance individual freedom"

If so, it will have to overcome the fact that the first thing is does is eliminate a freedom. Specifically, you are not longer free to live without health insurance. We've done so by patting ourselves on the back, thinking that we have helped some who wanted insurance but were unwilling or unable to priotize their budgets to pay for it.

"Wouldn't a capitalist argue that people working in a field that they love (pursuing a self-interest) will be more productive and innovative than those that work in jobs that they loathe?"

No he wouldn't. A capitalist would say that a person would find something to do that others would pay him for. A capitalist would not say that you have a right to a happy fulfilling life, only that you have the right to life and to pursue happiness.

There are many problems with the healthcare "system" that has evolved in this country over the last 50 odd years. Unfortunately, the law addresses none of the root issues. The one thing it does do is allow us to pat ourselves on the back about being careing without actually having to care about each other.
 
The positive - that an administration tried to fix a broken health care system.

The negative - The whole ACA. Sorry, I would throw the baby out with the bath water and start over. Trying to pick out good pieces is like trying to justify that a diabetic med does good by lowering blood sugar so ignore the fact it gives you pancreatic cancer and heart failure.
 
My wife gets her health insurance through me because her employer is small and does not offer it. She cannot buy insurance on her own because she has health issues. We have tried and literally been laughed at by the insurance person answering the phone. We actually bumped up our wedding date by nine months so she could get on my insurance sooner as her cobra was running out. I'm not advocating Obamacare but the current system is a mess for people like us.
 
Larry's situation above is something I've been writing about long before the ACA was on the scene. That said, we didn't need a 2,000 page monstrosity to deal with his situation - a situation that is all too common when people find themselves in transition.

We could have made COBRA coverage permanent as long as premiums are current and allowed individual buyers (including COBRA participants) the same tax treatment as employer provided plans.

Bing....fixed.
 
Gecko that would have made way too much sense and not given Washington more control over our lives. Clearly, this was the reason it was not implemented.
 
I am in the same situation as Larry T. in that my wife has had some serious health issues and wouldn't be able get coverage otherwise. As with Larry T, we have tried. My suggestion would be that the government set up a program much like is done in the auto insurance business. Establish a high risk pool where people are assigned to a health insurance company. The premiums are higher, but cap them and force all companies that are doing business in the state to accept these individuals. It spreads the risk around to different companies and would allow people with pre-existing conditions to have coverage.
 
FNL...the key is to not let people freeload the system. Coverage should be mandated, but at the State level with the amount set by State regulators.
 
I agree that people need to pay a premium, not freeload. In these cases it's not a matter of not paying, it is a matter of not getting coverage. We were willing to pay for the coverage, no one would cover those pre-existing conditions. The state should assign actuaries to help set a premium and cap a premium that would have some sort of sliding scale based on income. If you pay your premium, you have coverage, if you don't pay, you don't have coverage. Very simple in my opinion.
 
FNL?
What state do you live in? Many states have risk pools and have for years. Texas is one
yes the premiums are higher.

It is hard to think people with " health issues" through no fault of their own have to pay a much higher premium but for now that is the way it is

I think we should charge extra for people who knowingly and willingly engage in risky behavior, primarily cigarettes, excessive alcohol and obesity.
However even that would be difficult and I know it is subjective.

Why should people like LarryT's and FNL's wives pay such a high price through no fault of their while those who drink smoke or eat themsevles to death get care at our exprense?

I know it is a can of worms but I am tired of seeing hugely obese people run me down in a store on their store provided carts while piling their baskets full of beer and junk and then paying for it with EBT cards, knowing they will be getting free health care sooner or later?
 
The real path to affordable health care for all

By Vivek Wadhwa, Published: June 28


On Thursday, the Supreme Court delivered its ruling as to whether the Affordable Care Act (ACA), which was shepherded — some would argue force-fed — through Congress was constitutional. In a complex ruling that arrived amid a flurry of confusion, the High Court upheld the individual mandate, which rested at the heart of the law. Now, it is time to look forward to how we can indeed do what is right and provide health-care coverage for everyone. Many people are pessimistic that health care will consume a disproportionate share of our national resources, but I see a reason for optimism.

There is a path to correcting the fundamental problem of health-care costs, and it is carved by technologies that are advancing so rapidly it may now be possible to make health-care abundant and available to all. But we need to focus our energies on harnessing these rapidly emerging technologies and removing bureaucratic and overly burdensome regulatory hurdles.

Let’s start with medical records. One of the least controversial parts of the ACA was the incentives to bring health records online. Electronic medical records (EMRs) not only improve record keeping, reduce medical errors, and provide quick access in emergency situations, they also provide the data necessary to analyze health information across populations and improve medical care. Imagine being able to do Google-esque searches to determine which medications people with certain diseases took, and the results those medications achieved over time. Daniel Kraft, a Harvard and Stanford trained physician and my colleague at Singularity University, says that we need more programs like the Health and Human Services Health Data Initiative, and public-private collaborations like the recent Health DataPalooza’s (held June 5-6 in Washington, D.C.), to bring new innovators, energy and ideas into leveraging the massive amount of new data that will be available from EMRs and the data sets that the government ismaking available.

And then there are smartphones, which are rapidly increasing in capability and are becoming health-care platforms. An example is the iPhone case that I have been testing as part of a clinical trial, which turns my phone into an EKG monitor and automatically transmits data to a cardiologist. This case is being developed by a startup calledAlivecor. If approved by the FDA, this product will allow heart patients to check their symptoms whenever they want, wherever they are, and get quick feedback from their doctor. The product is expected to cost $100 or less—which is comparable to the cost of a single EKG test today.

With health data captured and transmitted from outside of the traditional health-care setting, vast improvements in feedback loops and outcomes can be achieved. Take hypertension as another example: according to the Centers for Disease Control and Prevention, 32 percent of American adults have high blood pressure, yet less than half are adequately controlled (with their measured numbers reduced to a safe range), resulting in significant morbidity and mortality rates (i.e. from strokes, vascular disease). Now, for less than $100, one can purchase a mobile phone-enabled blood pressure cuff, and a patient can easily measure, track, visualize and share their blood pressure readings. They can also enable optimization of interventions be they diet, exercise or drugs. Significant downstream savings can be achieved through such smart innovations, but they need to be integrated and reimbursed with the health-care system to fulfill their capability.

Artificial Intelligence based systems also provide great promise. The technology that IBM Watson used to defeat human champions on “Jeopardy” is now being applied to health care. Despite my respect for my cardiologist, I would rather have a computer, with access to comparable data from millions of people, diagnose my EKG. Like IBM Watson, the computer has access to the latest knowledge from all over the world. It has the ability to analyze and integrate more information than the most accomplished clinician every could.

The cost of DNA sequencing has been dropping at a breathtaking pace over the past decade. By the end of this year, a complete genetic sequence will likely cost about $1,000 and be available within 8 hours. At this rate, within five years, the gene sequencer may be an iPhone accessory—like my EKG monitor. Genome data of hundreds of millions of people will be available. We will be able to discover the correlations between disease and DNA and to prescribe personalized medications more tailored to an individual’s genetics and other attributes.

We can also now “write” DNA. In an emerging field called “synthetic biology,” researchers, and even high-school students are creating new organisms and synthetic life forms. Entrepreneurs have developed software tools to “design” DNA. These technologies provide the ability to generate designer drugs, therapeutic vaccines, and microorganisms. Leveraged appropriately, this field can dramatically impact the development of novel, and more effective therapeutics.

The good news is that we aren’t dependent any more on “Big Pharma” or government to create these advances; entrepreneurs are leading the charge. The EKG devices, DNA sequencers, and DNA printers are all being developed by entrepreneurs. That’s because the costs associated with developing these technologies have dropped dramatically. So, we could see major medical breakthroughs coming from the unlikeliest of places.

Kraft says that he fears that government and over regulation will, however, hold entrepreneurs back.

“While technologies ranging from medical apps, point of care diagnostics, synthetic biology and wearable health devices race ahead, regulatory bodies such as the Food and Drug Administration urgently need to keep up, both in their ability to foster and encourage the safe adoption and approval of many emerging breakthroughs, but also to re-imagine better ways to run faster, safer and more relevant clinical trials to bring these innovations to market” says Kraft.

“Unfortunately in today’s political environment, often with perverse dis-incentives in place which hinder new approaches moving forward, drugs as common as aspirin and even table salt might not make it to market, let alone more bold modalities such as bone marrow transplantation.”

Kraft is right. When was the last time you heard of a congressional hearing grilling a regulator on why it delayed approval of a drug that could have helped thousands? The Supreme Court decision may have been historic, but we are still fighting the wrong battles.

Read more news and ideas on Innovations.
 
Here are my major concerns...

First, as mentioned by everyone, car insurance is supposedly mandatory. Yet I am sure most of us have been involved in an accident in which the other driver didn't have any.
So while, this will be a "law" how on earth will it be enforced? I absolutely know that there are people out there that want/need insurance and are currently unable to afford it, or due to a pre-existing condition can't get it.

But I would bet the vast majority of uninsured are those willing to "roll the dice" on their health (and often family's) and just like auto insurance, will not pony up.

What happens when their luck runs out and they show up at the ER? I seriously doubt they will be turned away; they will be treated and we are right back where we started as far as paying for uninsured patients.

On the other hand, let's assume that there are hordes of people, who, but for the lack of insurance would have been going to see MDs for treatment, when they are sick, well visits, etc. In Texas alone there is a huge dearth of family practice/GP physicians. With all the several thousand of previously denied patients now flooding the system, who will see them? My prediction is that will fall more and more to less trained Nurse Practitioners and Physician Assistants., maybe even just Registered Nurses. Or that we as patients will be "triage" and seeing an actual MD will be a thing of the past.

This is no knock on NPs or PAs, one of my best friends is a PA, but I know the difference in their training, and early hands-on experience in particular. They spend 3 years in total, and you just can't replicate the experience of being a resident or even an intern.

I so think that parts of the system need to be overhauled because all people need to have access to health care, but I honestly don't think the majority of people without health care truly CAN'T afford it, they just consider it a non-essential expense and are willing to gamble. As far as pre-existing conditions go, I will have to believe that this happens as often as claimed...my PA friend has had both a melanoma, Thyroid cancer, an auto-immune disorder and has never once had an issue getting insurance through her employer.

I just wonder if these cases, while real, are kind of like the "what if the woman was raped" excuse when talking about abortion. Yes, it happens, but most abortions are done due to an unwanted pregnancy.

Please stop calling it "Obama Care"...plans like this have been in the works for years, and if I hear him call it "My" health care plan again, I will do something rash. Many people helped craft this plan, good one or bad one, and it just reinforces my image of him as someone ramming change through, not necessarily in the name of good, but to check off one more "first" or tie his name to something in a narcissistic manner.

No, not an Obama fan, but I would have these concerns with the plan no matter what presidency this health care mess came from.
 
This plan is over a thousand pages long yet it does not bother to address what is perhaps the number one cause of the extraordinarily high cost of healthcare in this country -- over litigation. Engaging the Republicans in this process would have at least helped in this area. As it stands, it is best to simply repeal the huge government overreach and just start over because all of this plan's redeeming qualities are overshadowed by the excessive government control.
 
Let's be honest here, it is nothing but a Money Grab.

They did it with Social Security and Medicare, now that treasure chest is empty and they have to find another one.

It is not just Democrats, it is Republicans too.

Whenever something is that complicated, Healthcare, Tax Code it is nothing but a Money Grab.

Claim it is this and that and for pre-existing conditions, hell it is nothing but another Government Treasure Chest.

Do not forget that SS and Medicare have $65 TRILLION in unfunded or money that has been being robbed since the 1930's.
 
^^^ The numbers are all over the map depending on the special interest group doing the study. IMO, litigation is a player in costs but is not the player.
 
Cost of Healthcare Rising

The association of washington healthcare plans published a document a few years ago that illustrates the largest factors for the rapidly increasing costs of healthcare. I'll summarize below: (the list is not a ranking)

1) Greater demand for services
Not only population growth in general but also the fact that older people outspend younger people at an accelerated rate. With the baby boomers we have more old people than ever, spending amounts we have never seen.

2) New Technology
Technology costs a lot to develop. It can significantly impact the doctors and is thus utilized, the more it is used the higher the costs. Studies show that over utilization often outspends any potential savings from the new developments.

3) Prescription drugs
Not much to explain here. As a group we are taking far more drugs than ever before, far more often then ever before.

4) Cost burdens of Medicare/Medicaid
The government pays less and less every year so the private insurers have to raise prices to recoup lost reimbursement.

5) Government Regulations and mandates
Every time the government makes an "improvement" it costs everyone money.

6) Malpractice Liability
From 1994 - 2004 jury awarded amounts more than doubled. Most cases are settled but costs millions to process and fight. Over $100 billion every year can be directly tracked to "defensive medicine" to avoid future litigation.
 
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