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Author Topic: ACA  (Read 8948 times)

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Offline RetributionTopic starter

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ACA
« on: October 30, 2013, 11:54:11 AM »
Okay not sure why I have the urge to stick my finger in light sockets today mayhap I am just feeling contrary but http://www.slate.com/articles/news_and_politics/politics/2013/10/obamacare_and_republican_criticism_the_health_care_law_s_early_missteps.html

My issue with ACA has been from the get go that I think US health care is broken, horribly so. But I just assumed the government was so inept that the "fix" would be so screwed up it would be mind blowing. I linked that not saying anything pro, con, or political, but yeah everything government touches it messes up almost inevitably. I mean dear god making the current Republican party seem rational and clairvoyant is really a hard thing to do.

Offline Valthazar

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Re: ACA
« Reply #1 on: October 30, 2013, 12:29:48 PM »
I think the ACA has noble intentions, but it was very poorly crafted legislatively and economically.  As I have said previously, it will artificially cause premiums for non-ACA insurees to rise, and as a result, due to declining enrollments, may cause private insurers to drop coverage in certain target demographics and markets.

Obama had marketed the ACA with the promise in 2009, “if you like your health plan, you will be able to keep your health plan,” and even in 2012 was saying, “If [you] already have health insurance, you will keep your health insurance.”

http://www.cbsnews.com/8301-505263_162-57609737/obamacare-more-than-2-million-people-getting-booted-from-existing-health-insurance-plans/
http://investigations.nbcnews.com/_news/2013/10/28/21213547-obama-admin-knew-millions-could-not-keep-their-health-insurance?lite

Basically, as the law was originally written, all health insurance plans as of March 23, 2010 would be 'grandfathered' in, and the ACA would not cause their insurers to modify their plans in any manner.  However, since then, the Department of Health and Human Services wrote changes that said if any part of a policy was changed since that date, for example, the deductible, co-pay, or benefits (which is pretty normal, considering how frequently slight modifications occur in most insurance plans), that the policy would not be grandfathered.  So that's the situation we are in now.

Many individuals in their 20s are choosing to not purchase health insurance under ACA, and would rather pay the tax penalty, which is another financial uncertainty for insurance companies.  If you've just graduated from college, healthy, and tight on cash, would you rather pay extra for insurance you'll probably never use, or just pay a lower penalty fee to the government?  When the ACA was written, the young, uninsured demographic was supposed to the prime source of premiums to help pay for the medical care for the unemployed and uninsured older population - but the strength of this plan is increasingly under question now.  Many insurance companies are approaching the ACA from a risk management perspective, (since it is an external pressure on their industry) and trying to do financial damage control at this point.

I can't really say much about the technical glitches/issues with the website.  I guess those will be sorted out in due time.  It's a blessing that most small to midsize businesses will have until Jan 1 2015 to comply, because many of them are seriously unsure about all the uncertainties surrounding ACA.  I've tried to explain the ACA to my friend, who is working on a business plan, and it's frustrating when I can't provide him all the answers because the law is so vague with regard to business requirements.
« Last Edit: October 30, 2013, 12:57:31 PM by ValthazarElite »

Offline Toral Stimins

Re: ACA
« Reply #2 on: October 30, 2013, 06:02:46 PM »
Living in a country where healthcare is free for everyone (NHS) and those who want to pay can pay (BUPA for instance), being born in a country where healthcare used to be free, but not anymore as it is a small country, this whole debate about we shouldn't spend too much money on healthcare for the not white skinned folk/not republicans/not rich/not anyone who doesn't think like us, is just pure racist. But that's coming from a European. Where Obama is being seen as more right wing than probably the most 'liberal' political party in Europe apart from far right.

Why on earth is it so hard to just give free health care for everyone? Why on earth is social services such a big issue at your side of the Atlantic? Why on earth is being social, trying to help everyone in your country so hard for governments there?

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Re: ACA
« Reply #3 on: October 30, 2013, 06:25:41 PM »
I'm not entirely sure when 'socialism' became such a buzz-word over here, but it seems to have slipped into the same role that 'communist' filled before the collapse of the Soviet Union.  I doubt that the average person on the street knows exactly what socialism is, only that some guy running for office said it was bad. 

Online Callie Del Noire

Re: ACA
« Reply #4 on: October 30, 2013, 07:13:41 PM »
Today I'm in the mother of all Black Dog funks.. so I'll not comment till I can breath without yelling at people. I will say this, this was a good idea till the elected officials got a hold of it.

Offline RetributionTopic starter

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Re: ACA
« Reply #5 on: October 30, 2013, 07:40:35 PM »
I will take a stab at this Tor bear in mind any such discussions include a lot of personal opinion. A look at tax rates in Europe seems to indicate that they are comparable to those in the US. It is a hard thing to get a bead on when there are different tax rates for different incomes but that is a whole other ball of wax http://en.wikipedia.org/wiki/Tax_rates_of_Europe

Having said all of that the US was founded largely on opposition to taxation among other things so the point of view over here has been different from the get go. And with that in mind bluntly with the prevailing independent spirit taking money out of person A's pocket for person B will more often than not chap person A.  I do not think it is a race issue I think it is more of an issue of personal independence. But that is my opinion and I can no more prove it than anyone can probably prove the opposing and we could toss factoids at each other for a long time over it.

But what I feel is the largest problem is our system of government. Democracy is great, but someplace along the line the way it is practiced in this country has become mind boggling cumbersome.  It does nothing well or efficiently. Large corporations are much the same in my opinion, again I state my opinion. There is an utter lack of efficiency. Part of the reason for that inefficiency IMHO is that we have become too obsessed with fixing every possible problem with things and all things must fit neatly into the system. I beg the pardon of my lawyer friends but too many lawyers, sure space aliens could have possibly come down and messed up the ACA web site but lets look a bit at likelihood. I took that to a bit extreme to illustrate my point. So with this built in inefficiency many things are doomed to failure when the big government machine tries to implement them.

Another thing that cuts on this in two ways again in my opinion is the lack of accountability or the rewarding of excellence. In this day and age it is unfortunately not politically correct to punish poor service and reward quality service. There are laws in place that enforce this in private industry and it is worse in government, I happen to know this as I work for the government.  When we consider this about any endeavor is doomed to mediocrity at best.  So when one looks at just plain free health care in this light, in this country, it brings several things to mind that cause the opposition: telling doctor A that they can only earn so much despite their skill level when doctor B who may be inept is not a pleasing thought, malpractice it is not often mentioned but a large reason health care costs so much in this country is malpractice suits and insurance and well lawyers like it and most politicians are lawyers, insurance companies are very wealthy and have a lot of political influence and they obviously have a horse in this race, the inherent fear of how government mucks things up, and lastly a lot of people who go to work each day and deal with the grind really do not like the idea of paying for those who do not.

Or at least those are the things that touch the tip of the ice berg IMHO.  America is a very large and very diverse country. Thus why one sees so much bickering inside of its boarders. It has always been that way, heck I just got done reading the autobiography of a plains man back during the wars with the native Americans and it was there then. Just in this day and age of digital those conflicts are magnified exponentially. All of these things come into play.

But when I get back to my knee jerk reaction I would love to have just plain free health care for all from the government like you described. But as I said in my first post I no longer have any faith that the government of this country can pull it off without making things worse than they already are.

Offline Toral Stimins

Re: ACA
« Reply #6 on: October 30, 2013, 08:43:34 PM »
For many European politicians, the way the US of A is governed, is a reason for them to get spontaneous orgasms. Such a large part of the world, with so many different cultures and people, that is what they are trying to do with Europe. Don't get me wrong, I am very much PRO 'One Europe'. But whereas the US has had 200 or 300 years head start on Europe, it also has one big thing, they all speak the same language. And damn you Peter Stuyvesant, for trading New Amsterdam for that puny shit hole they call Surinam these days. You lot would be speaking Dutch instead of English.

The Netherlands, where I hail from, is different in just about everything. We have at any given moment in time, more than 10, but sometimes closer than 20 political parties in parliament. It has been less and the Dutch felt it wasn't good. 'We' feel it is not good for one party to rule (and we laugh about the idea that one party holds Office, while the other party rules the country). We are known and liked for our freedom. First amongst many to have legalised same sex marriage, sort of like allowed weed (you can hold up to 5grams, you can smoke any amount, if you smoke a joint of a kilo, you are untouchable, if you hold it in your hands with no fire in it, you go to jail). The Red Light district of Amstershite is famous, or should I say infamous? (The biggest fable of this world is that you can only do those things in Amsterdam, but you can do all the same, for half the money or less in any other city, village and town)

But we also have this care system. Since the mid '50s, there is social security based on human rights. Each individual has a right to have at least to live and to be cared for. Even those who cannot afford the current health care system, will be helped in a state of emergency. If they have a heart attack or worse even, car crash, they will get free care. If you are unlucky enough to fall victim to the bad economical sitations, you have a right for some money to keep you going. It is not much, but it is just about enough. You will have to work to get out of the situation, no one is guaranteed a life long stay in social care anymore, but they at least give you chance.

Thing is, most people rent, it's about 60-40 these days. It used to be 85-15, buying isn't 'of the Dutch' They rich ones yes, but us 'plebs' no. So it is sort of like affordable for the government to help 'us' out.

Having said all this, and it's mainly off topic, apologies for that, could it be that the whole claim culture has ruined any chance of a good decent solid health care system and it is happening here in England as well. I am trained medic from my (*long gone) army days. If I see a person having a seizure, I act, react, help, but it is not uncommon anymore to sue those who help.

Offline gaggedLouise

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Re: ACA
« Reply #7 on: October 30, 2013, 08:58:24 PM »
I will take a stab at this Tor bear in mind any such discussions include a lot of personal opinion. A look at tax rates in Europe seems to indicate that they are comparable to those in the US. It is a hard thing to get a bead on when there are different tax rates for different incomes but that is a whole other ball of wax http://en.wikipedia.org/wiki/Tax_rates_of_Europe

Having said all of that the US was founded largely on opposition to taxation among other things so the point of view over here has been different from the get go. And with that in mind bluntly with the prevailing independent spirit taking money out of person A's pocket for person B will more often than not chap person A.  I do not think it is a race issue I think it is more of an issue of personal independence. But that is my opinion and I can no more prove it than anyone can probably prove the opposing and we could toss factoids at each other for a long time over it.

Bit of an aside, but I think this matters if we're discussing what the state is supposed to do, what it should take on. The issue of taxation, of course, was going to be in a whole different frame in a country where ownership of slaves was widespread in major parts of the union right up to the Civil War, and slavery-like conditions remained in the south many decades after 1865; and where there was plenty of fertile, unplowed land that could be handed over to just about anyone coming into the country and settling on some of that free land, free of charge (the Homestead Acts) - and with fairly  low land tax after those first years. In Europe, commodities like land and labour had to be paid for in cash before they could enter the economy. At least, most of the time and if it was supposed to be legal.

This side, there wasn't a huge reservoir of free arable land to support a rapidly rising number of people through the 18th to 20th centuries. I reckon that meant "taxes equal theft" was not going to be a viable proposition. Maybe for baronets and land owning magnates who had inherited wide stretches of land, but not for most people, even the urban middle classes.
« Last Edit: October 30, 2013, 09:53:57 PM by gaggedLouise »

Offline Zeitgeist

Re: ACA
« Reply #8 on: October 30, 2013, 10:43:37 PM »
Why on earth is it so hard to just give free health care for everyone? Why on earth is social services such a big issue at your side of the Atlantic? Why on earth is being social, trying to help everyone in your country so hard for governments there?

Perhaps because its not actually free? Just because you didn't get a bill in the mail doesn't mean you and others didn't pay for it, one way or another.

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Re: ACA
« Reply #9 on: October 31, 2013, 02:18:36 AM »
Perhaps because its not actually free? Just because you didn't get a bill in the mail doesn't mean you and others didn't pay for it, one way or another.

        Sometimes I feel like it's the same old circus repeating the same old tired arguments. 

        When you have a system that makes the same procedures cost many times more, and makes pharmaceutical bills many times higher, it's going to be worse however the bill is paid.  Might as well do something to at least chop it down some.  The bill that the Europeans actually get is lower because they don't arrange the market mainly to bloat the drug and insurance companies.  I'm not really sure how much of that has to do with not arranging the market as a whole to bloat their industry executives in general to the cosmic heights America does -- but I suspect, that might also play a part? 

         Of course, it's largely a question of will.  If you believe the point of life is to make more people suffer longer, and for most people to moralize about how hard they have it so other people "should" have to suffer too (otherwise 'it isn't fair' to the suffering), then it doesn't make sense to allocate any resources to health care.  The US defense industry isn't free either, but a huge proportion of American taxes are tossed into it anyway.  The political wing that is so sour on national healthcare (at least, particularly when Obama is the one signing off) does not seem very concerned about reducing the massive bill for that.  Maybe some of that money could be moved around without, you know, divine punishment in the form of a North Korean nuke landing or something.  (Doesn't seem to be stopping North Korea from getting its bombs together, anyway...)  Or maybe some familiar, very wasteful arm of the government (just for example, again defense budget overruns and exaggerations comes to mind) could clean up its act, too.

          Finally...  It's just so cheap and predictable for people to jump at the slightest sign of clutsiness as a reason to attack something new -- omg, the fools messed up the first run of a giant, overused website, why the totally unprecedented incompetence that shows, it would never happen anywhere but the terrible federal government!  Certainly the private sector has noooo mismanagement and no website crashes on the first run of a national-scale project, whatsoever.  Yeah right, and oh please.       

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Re: ACA
« Reply #10 on: October 31, 2013, 03:04:10 AM »
Perhaps because its not actually free? Just because you didn't get a bill in the mail doesn't mean you and others didn't pay for it, one way or another.

I think the sense was: free at the point of delivery. The person in need of health care or some kind of medical examination doesn't have to haul out their wallet and pay up hundreds or thousands of bucks/pounds/francs for what their body tells them in no uncertain terms that they need to get sorted out - or what an experienced doctor has prescribed they have to take a look at. The whole act of individually getting health care is unlocked from gathering up the money for every step in real time, and for the doctors it is never part of their own motivation to try to make the person/s they are treating, or that person's parents, pay as much as possible. Honestly, I think that's great, and it encourages rational and less expensive choices for those receiving health care, too. Why? Because they are less likely to have to put things off and slip towards a stage where things become far worse and more expensive to fix, out of drifting from one stopgap solution to another, and less likely to end up permanently impairing their health and ability to work, look for jobs and raise kids.

From the point of view of the state, the handling of the capital is about spreading out of risks, just as for an insurance company - and free public health care is an insurance system, of course. Most people are not going to the hospital or local health care centre very often, some don't have a sick day in years, others are a bit more frequent short-term visitors. By being seen as a shared commitment and one that helps keeping people in work and not sucked under by badly managed illnesses or injuries (because they "personally couldn't pay up" at some time), it adds up over time.
« Last Edit: October 31, 2013, 03:09:25 AM by gaggedLouise »

Offline Valthazar

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Re: ACA
« Reply #11 on: October 31, 2013, 03:21:09 AM »
The main school of thought that I see many posters here support, is to have the government play an active role in providing healthcare (akin to European countries).

Regardless of my personal views, there is nothing fundamentally nothing wrong with the government providing healthcare.  However, suggesting that the ACA is an example of government-provided healthcare is not accurate.  What the ACA does, is artificially force private insurers to deflate prices for certain insurance plans, and mandate citizens to purchase private insurance, at the risk of facing a tax penalty.  This is very different from a government-based solution - found in European countries, and actually introduces financial uncertainty into the economy.  Private insurers have no idea of how many or how few people will opt into their new government-mandated plans, meaning that their financial figures for 2015, 2016, and so on, are largely in flux.  Because of this uncertainty, and their obvious need to retain some stability with regard to having good credit lines, private insurance companies are increasingly being cautious with their existing plans, and/or dropping limited coverage plans to build capital for these new plans being created.  They really have no previous data to go off of with regard to how much claims they will be paying out with these new insurees, or how much premium revenue they'll generate from healthy 20 year olds who won't be filing many claims.  In other words, as I linked above, many people will start seeing their insurance coverage being dropped (as is already the case).

Even though it ran counter to my personal views, I actually supported Obama's original ACA proposal in 2008 with a purely government run exchange that acted in competition with private insurers - since this represented sound economics.  But the current ACA is nothing but a train wreck, and we'll see the damage in 5-10 years as more people start losing their coverage, and more and more "good" jobs with benefits disappear.

I just hope people realize this fundamental difference as the debate continues.  I think all of us want a society where people have access to healthcare (regardless of views in achieving this goal, whether short-term or long-term) - but the ACA isn't that solution.
« Last Edit: October 31, 2013, 03:37:44 AM by ValthazarElite »

Offline Zeitgeist

Re: ACA
« Reply #12 on: October 31, 2013, 07:00:21 AM »
        Sometimes I feel like it's the same old circus repeating the same old tired arguments. 

        When you have a system that makes the same procedures cost many times more, and makes pharmaceutical bills many times higher, it's going to be worse however the bill is paid.  Might as well do something to at least chop it down some.  The bill that the Europeans actually get is lower because they don't arrange the market mainly to bloat the drug and insurance companies.  I'm not really sure how much of that has to do with not arranging the market as a whole to bloat their industry executives in general to the cosmic heights America does -- but I suspect, that might also play a part? 

         Of course, it's largely a question of will.  If you believe the point of life is to make more people suffer longer, and for most people to moralize about how hard they have it so other people "should" have to suffer too (otherwise 'it isn't fair' to the suffering), then it doesn't make sense to allocate any resources to health care.  The US defense industry isn't free either, but a huge proportion of American taxes are tossed into it anyway.  The political wing that is so sour on national healthcare (at least, particularly when Obama is the one signing off) does not seem very concerned about reducing the massive bill for that.  Maybe some of that money could be moved around without, you know, divine punishment in the form of a North Korean nuke landing or something.  (Doesn't seem to be stopping North Korea from getting its bombs together, anyway...)  Or maybe some familiar, very wasteful arm of the government (just for example, again defense budget overruns and exaggerations comes to mind) could clean up its act, too.

          Finally...  It's just so cheap and predictable for people to jump at the slightest sign of clutsiness as a reason to attack something new -- omg, the fools messed up the first run of a giant, overused website, why the totally unprecedented incompetence that shows, it would never happen anywhere but the terrible federal government!  Certainly the private sector has noooo mismanagement and no website crashes on the first run of a national-scale project, whatsoever.  Yeah right, and oh please.       

So we agree its not 'free' I presume.

I never pilloried the website. The only thing I've said in this thread about ACA is what you quoted.

I think the sense was: free at the point of delivery. The person in need of health care or some kind of medical examination doesn't have to haul out their wallet and pay up hundreds or thousands of bucks/pounds/francs for what their body tells them in no uncertain terms that they need to get sorted out - or what an experienced doctor has prescribed they have to take a look at.

I think I said, and you quoted what I said, that just because you don't have to pull out your wallet doesn't mean it is free.

All I said very simply was that it isn't free. Who pays the doctor and nurse's salary? Who pays for the medication? Who pays for medical equipment? If you don't realize it is you and I, you're fooling yourself.

Offline gaggedLouise

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Re: ACA
« Reply #13 on: October 31, 2013, 07:48:50 AM »

I think I said, and you quoted what I said, that just because you don't have to pull out your wallet doesn't mean it is free.

All I said very simply was that it isn't free. Who pays the doctor and nurse's salary? Who pays for the medication? Who pays for medical equipment? If you don't realize it is you and I, you're fooling yourself.

It's free in the sense that you don't have to look for a well-paid job, the right kind of parents (the kind with well-paid jobs or índependently wealthy) or a sugar daddy...before you can even consider fixing your illness or ailment.

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Re: ACA
« Reply #14 on: October 31, 2013, 08:00:21 AM »
Quote from: Zeitgeist
So we agree its not 'free' I presume.
           Seems to me when people come along emphasizing, it's not really free, they're often on the side that says it's obviously too expensive.  I don't think that's necessarily the case -- partly for the reasons I listed.  Although I'm inclined to agree with Val that it could (and probably, should) certainly be done still cheaper yet.  That is, if only there were political will and awareness/ interest enough for that.  But millions getting some slight improvement, is still worthwhile in my book.  We may not "count" the costs of disasters that don't happen very well, but they are real and often higher than the short-term savings of having no insurance.  So opportunities for affordable preventative care, and for at least some degree of emergency coverage for more people, are worth having. 

           I suppose there is the argument that youth may (statistically, under normal circumstances) not need it...  But we don't use that argument against Social Security or Medicare so often, so I'm not sure it really has that much support.  (Unless you figure, the problem is more that youth simply don't vote, while older people who actually use Medicare, etc. more now, do?  Possible.)  Still...  In an economy where young people often have to hold multiple jobs and work in things they were not trained for at length, there are more pressures and more dangers.  I would hate to be the "odd" young person who develops a rare condition (stuff that was often disallowed by companies before ACA) or is somehow just worn down by the pressures and (often ugly) diet of this sort of economy, without enough credit or wages to carry them through.

Quote
I never pilloried the website. The only thing I've said in this thread about ACA is what you quoted.
            Right, granted.  That wasn't actually aimed at you necessarily.  It's not that I thought you were saying that personally....  I don't always write posts as quote - direct rejoinder- nothing else (the long string of those honestly kinda loses me), so maybe that wasn't clear. 

            Maybe it would have made more sense to put it in another post altogether.  Though once in a while, I lump unlike things, or responses to various people, together partly out of fear that one of those people who likes to use petty style differences as a hammer will show up and shout, "How dare you make more than one post in here at once!"  (Which I think, if I always obeyed that, well it is both impractical for others to read as you've demonstrated, and also quite silly for me to be worrying about.  But then it's not unknown to get booted for a handful of quite reasonable style differences around here, when someone raises their voice far enough over such things.)  Anyway, it was meant more as a general statement about all the drama -- I think, often right wing, opportunist mocking drama -- about website problems recently. 

« Last Edit: October 31, 2013, 08:01:28 AM by kylie »

Offline Zeitgeist

Re: ACA
« Reply #15 on: October 31, 2013, 08:09:32 AM »
           Seems to me when people come along emphasizing, it's not really free, they're often on the side that says it's obviously too expensive.  I don't think that's necessarily the case -- partly for the reasons I listed.  Although I'm inclined to agree with Val that it could (and probably, should) certainly be done still cheaper yet.  That is, if only there were political will and awareness/ interest enough for that.  But millions getting some slight improvement, is still worthwhile in my book.  We may not "count" the costs of disasters that don't happen very well, but they are real and often higher than the short-term savings of having no insurance.  So opportunities for affordable preventative care, and for at least some degree of emergency coverage for more people, are worth having. 

           I suppose there is the argument that youth may (statistically, under normal circumstances) not need it...  But we don't use that argument against Social Security or Medicare so often, so I'm not sure it really has that much support.  (Unless you figure, the problem is more that youth simply don't vote, while older people who actually use Medicare, etc. more now, do?  Possible.)  Still...  In an economy where young people often have to hold multiple jobs and work in things they were not trained for at length, there are more pressures and more dangers.  I would hate to be the "odd" young person who develops a rare condition (stuff that was often disallowed by companies before ACA) or is somehow just worn down by the pressures and (often ugly) diet of this sort of economy, without enough credit or wages to carry them through.
            Right, granted.  That wasn't actually aimed at you necessarily.  It's not that I thought you were saying that personally....  I don't always write posts as quote - direct rejoinder- nothing else (the long string of those honestly kinda loses me), so maybe that wasn't clear. 

            Maybe it would have made more sense to put it in another post altogether.  Though once in a while, I lump unlike things, or responses to various people, together partly out of fear that one of those people who likes to use petty style differences as a hammer will show up and shout, "How dare you make more than one post in here at once!"  (Which I think, if I always obeyed that, well it is both impractical for others to read as you've demonstrated, and also quite silly for me to be worrying about.  But then it's not unknown to get booted for a handful of quite reasonable style differences around here, when someone raises their voice far enough over such things.)  Anyway, it was meant more as a general statement about all the drama -- I think, often right wing, opportunist mocking drama -- about website problems recently.

Well the act is called the affordable care act and not the free care act. Time will tell. Color me skeptical.

I've been reticent criticizing the roll out of the website as I myself have gone through projects like this (on a much smaller scale) and know first hand when you turn on the lights, things can happen you'd never expect or could have planned for. Could it have been handled better? For sure. Would it have been smarter to roll it out in incremental stages, feature by feature? Sure. But that is all water under the bridge now.

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Re: ACA
« Reply #16 on: October 31, 2013, 08:39:47 AM »
I suppose there is the argument that youth may (statistically, under normal circumstances) not need it...  But we don't use that argument against Social Security or Medicare so often, so I'm not sure it really has that much support.  (Unless you figure, the problem is more that youth simply don't vote, while older people who actually use Medicare, etc. more now, do?  Possible.)  Still...  In an economy where young people often have to hold multiple jobs and work in things they were not trained for at length, there are more pressures and more dangers.  I would hate to be the "odd" young person who develops a rare condition (stuff that was often disallowed by companies before ACA) or is somehow just worn down by the pressures and (often ugly) diet of this sort of economy, without enough credit or wages to carry them through.

I don't think you understand that the ACA healthcare plans aren't guaranteeing healthcare for anyone, unless they choose to opt into it.  Social Security and Medicaid are not programs that need to be pre-opted into to receive benefit, so it's not a direct analogy.

Many young people in their 20s/early 30s are choosing not to opt into ACA, and would rather pay the lower tax penalty because they are limited on cash as it is - after making rent payments, student loan payments, car payments, etc.  Some would say this is irresponsible decision making on their part, but statistically, this is the financially better choice given the probability of a health condition in one's 20s/early 30s.  If young people choose to not purchase healthcare through the ACA, then even if they have a rare condition, as you say, they will not receive healthcare.

It is for reasons like this, which I think the ACA is doomed for failure.  As I said earlier, if implemented wisely, it could have been a great success.  But as it is, I am not so optimistic about the future.

http://www.theguardian.com/commentisfree/2013/oct/29/obamacare-website-glitches-not-only-problem

While I have my own views on the optimal solution, given the choice between the current version of ACA, and one featuring a public option, I believe the latter would have been far superior.  At least then private health insurance plans (such as the ones most people currently have) would not be at the whim of market manipulation due to unanticipated increase or decrease in enrollees.  I can assure you millions of Americans will lose their private insurance coverage over the next few years.  What we have now is such a mess, and we're already starting to see the effects.
« Last Edit: October 31, 2013, 09:07:40 AM by ValthazarElite »

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Re: ACA
« Reply #17 on: October 31, 2013, 10:19:06 AM »
Web sites have issue, but if you look at the original link I posted my real concern are those who are getting the "sorry we no longer insure you" notices. Granted it is a small percentage of the self employed, but they deserve to be covered just as much as the next person if we are talking health care for all. IMHO that is the inherent problems I see in such situations.

In another I have a close relative that runs a small not for profit organization. The requirements of insuring all employees is forcing them to make some hard choices: not offer any employees insurance and pay the penalty, or watch costs rise by covering all employees to the degree required by law. Either way that is sliced what is going to have to happen is program cuts in adult literacy, child care, shelter for the homeless, and equality programs for starters. These are the sorts of things that concern me so please do not spin my words in other directions. If this is not an example of government ineptness I certainly do not know what is. In the example I listed above that I have close personal knowledge of we are not talking a company trying to turn a profit which seems to be perceived by many as evil. We are talking about a not for profit who tries to break even and keep their doors open for the community.

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Re: ACA
« Reply #18 on: October 31, 2013, 10:28:59 AM »
I don't think you understand that the ACA healthcare plans aren't guaranteeing healthcare for anyone, unless they choose to opt into it.  Social Security and Medicaid are not programs that need to be pre-opted into to receive benefit, so it's not a direct analogy.

Many young people in their 20s/early 30s are choosing not to opt into ACA, and would rather pay the lower tax penalty because they are limited on cash as it is - after making rent payments, student loan payments, car payments, etc.  Some would say this is irresponsible decision making on their part, but statistically, this is the financially better choice given the probability of a health condition in one's 20s/early 30s.  If young people choose to not purchase healthcare through the ACA, then even if they have a rare condition, as you say, they will not receive healthcare.
         Yeah, actually I had forgotten that they have the pay fee rather than join up option.  I do vaguely recall the situation Rubin describes with the whole single payer proposal and Obama "bipartisanship" and corporate consultations running it into the ground.  I haven't quite gone over what was left with a fine tooth comb (and I doubt many people have, honestly), but if Harkin could say it was "better than nothing," I've been figuring a little better times a lot of people is still something. 

As for myself, I was stuck with interest compounding in an avalanche on a few medical bills from before ACA even passed, so it wasn't as if I only needed ACA to work.  I haven't been busy calculating exactly what the resulting package would cost what group, precisely.  But it also sounds like the administration originally assumed (or implied in the cost advertising?) that insurance companies would take more clients through the national plan rather than change course and do things that excluded them -- yet in fact, many did change their plans and (if I understand this right?) thus made more plans disallowed from the national scheme as well.

Quote
While I have my own views on the optimal solution, given the choice between the current version of ACA, and one featuring a public option, I believe the latter would have been far superior.  At least then private health insurance plans (such as the ones most people currently have) would not be at the whim of market manipulation due to unanticipated increase or decrease in enrollees.  I can assure you millions of Americans will lose their private insurance coverage over the next few years.  What we have now is such a mess, and we're already starting to see the effects.

         Not to derail that wholesale...  But didn't we have a mess with increasing rates and minimal coverage, and quite a few plans that offered little for large payments, in the first place?  It's hard to have an absolute disaster when there's not much left to lose in the first place, for most people -- and if you do, then it's breeding a more unsustainable situation where someone may actually have to do better.  (Unless the country can really deal with becoming a Banana Republic, beyond the trend it already had.) 

While it's preferable to get everything perfect on the first swing at a huge, pressing problem....  Maybe Rubin could be right, and this just will have to catalyze people to go back and try to do better.  That is, assuming that health care and debt remain pressing enough issues for enough people, that there will still be support.  Also assuming that there is some kind of representative government that actually does more than what the corporations demand, under some sort of emergency pressures?  (Not quite sure on that one, now.)  And, that is also assuming the masses are not frustrated, or duped (by Fox etc.) into believing that the government or the left just "can't" do it, because after all they "had one try" at the helm (in a time when everything they did in social programs, was resisted in hopes of sabotaging the president as much as possible).

 
« Last Edit: October 31, 2013, 10:30:28 AM by kylie »

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Re: ACA
« Reply #19 on: October 31, 2013, 11:14:57 AM »
Let us not forget the ACA was a compromise.  It seems to me some of the people bemoaning its weaknesses are the very ones who insisted on their inclusion.

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Re: ACA
« Reply #20 on: October 31, 2013, 07:20:41 PM »
         Not to derail that wholesale...  But didn't we have a mess with increasing rates and minimal coverage, and quite a few plans that offered little for large payments, in the first place?  It's hard to have an absolute disaster when there's not much left to lose in the first place, for most people -- and if you do, then it's breeding a more unsustainable situation where someone may actually have to do better.  (Unless the country can really deal with becoming a Banana Republic, beyond the trend it already had.) 

Before healthcare reform, you're right, health insurance premiums for the self-employed, and potentially unemployed (who would be paying premiums from their savings) were extremely high.  The healthcare options usually available through most employers tend to be offered at a subsidized cost, which are certainly not cheap, but affordable for most employees. 

Someone like myself would look at this situation, and focus on creating a thriving economy, with pro-business incentives to increase full-time positions in small businesses, and thus, create greater avenues for the currently unemployed/part-time workers to gain healthcare through their future full-time employers.

However, while that would be what I consider the ideal approach, as I said earlier, I am not opposed to a government solution.  However, I am struggling to see how the ACA solves this problem.  All it is doing is artificially reducing the cost of private insurance for certain healthcare plans.  It's almost as if the people who drafted this current version of ACA have no education in economics.  If you try to artificially decrease the price of a certain commodity in an industry, it will introduce a lot of risk and uncertainty for the major companies in that industry.  So now, while you're definitely going to have a lot of people who were previously uninsured getting on insurance plans, the net effect is that many people who previously were on insurance plans will end up losing them.

People bringing up Europe in comparison to the ACA are not really understanding that the ACA really isn't a "government-run" healthcare plan.  It's essentially a mandate on the private healthcare industry, and on citizens, which is why I say it really isn't "better than nothing" at least in my opinion.
« Last Edit: October 31, 2013, 07:41:25 PM by ValthazarElite »

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Re: ACA
« Reply #21 on: October 31, 2013, 11:47:46 PM »
It's almost as if the people who drafted this current version of ACA have no education in economics.  If you try to artificially decrease the price of a certain commodity in an industry, it will introduce a lot of risk and uncertainty for the major companies in that industry.  So now, while you're definitely going to have a lot of people who were previously uninsured getting on insurance plans, the net effect is that many people who previously were on insurance plans will end up losing them.
         Not sure if you might have this posted somewhere else already, but could you spell out exactly how you think this would work?  I'm not really clear if you mean that companies would drop certain plans or people to restructure their profit forecast, or that the government-backed plans will eventually have to be disbanded or rendered more expensive so people will lose those...  Or, what do you mean exactly? 

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Re: ACA
« Reply #22 on: November 01, 2013, 12:29:29 AM »
Quote from: ValthazrElite
It's almost as if the people who drafted this current version of ACA have no education in economics.  If you try to artificially decrease the price of a certain commodity in an industry, it will introduce a lot of risk and uncertainty for the major companies in that industry.  So now, while you're definitely going to have a lot of people who were previously uninsured getting on insurance plans, the net effect is that many people who previously were on insurance plans will end up losing them.

Well, you might also see it this way: said companies would have to make do with a bit less fattened profits compared to now, but they'd hardly be starving for it.

And those profits, today, often are not getting reinvested or put to any productive use. They tend to just land in some top brasses' already well-lined pockets.
« Last Edit: November 01, 2013, 12:37:27 AM by gaggedLouise »

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Re: ACA
« Reply #23 on: November 01, 2013, 03:49:31 AM »
         Not sure if you might have this posted somewhere else already, but could you spell out exactly how you think this would work?  I'm not really clear if you mean that companies would drop certain plans or people to restructure their profit forecast, or that the government-backed plans will eventually have to be disbanded or rendered more expensive so people will lose those...  Or, what do you mean exactly?

Well, let me give the primary, direct reason why people are losing their existing private insurance coverage.  The ACA requires that by-minimum, all Americans should have insurance that covers "10 minimum standards."  These standards include a variety of care, including maternity care, emergency visits, mental health treatment and even pediatric dental care.  If you're someone in your late 20s, who is in great shape and health, you may have decided to opt into a health insurance plan that offers minimal coverage - maybe just a physical every year, eye exams, and a certain threshold of ER visits.  But now, because that insurance plan is "below" the threshold of ACA requirements, they will be told they are going to lose coverage.  Many of these individuals losing coverage will then be faced with the decision of whether to pay the 'greater' premium for ACA, or pay a possibly greater or about-the-same tax penalty, for no insurance now.  So basically, while some Americans gain health insurance, another portion are losing it as a result of financial hardship.

The second reason is that private insurance companies really do not have any concrete data about how many new enrollees will take up insurance plans as a result of the ACA.  Because health insurance companies won't be allowed to charge higher premiums for people who have medical histories, they now have to somehow raise revenue in another demographic to cover these high expenses.  Although from a very surface, non-economic level, this is considered the 'ethical' thing to do, it is poor policy.  In other words, the fact that they have to treat customers equally, with limited variation in premiums based on buyers' ages or whether they smoke is creating a situation where insurance companies really have no idea what sort of people are going to enroll, which demographic they are going to be able to get more revenue now from, and so on.  This is causing a lot of uncertainty in the health industry right now.  The prediction originally was that premiums would be higher for healthy 20-somethings and 30-somethings, but now we are finding out that their enrollment is less than predicted.

Because insurance companies, just like any other company, need to maintain a stable business plan, and demonstrate to creditors that they have a good credit line, and relatively accurate financial forecasts, many of them are doing damage control and "reducing" uncertainty by dropping certain health insurance coverage plans to have a bit more concrete estimates about their future revenue streams.  Often times, this means dropping coverage for a few employer-based healthcare plans, or raising premiums for people with existing healthcare, and so on.

Honestly, no one has any concrete answers, or accurate predictions about the potential fallout of ACA.  This type of law is largely unprecedented in US history.
« Last Edit: November 01, 2013, 03:55:49 AM by ValthazarElite »

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Re: ACA
« Reply #24 on: November 01, 2013, 04:13:57 AM »
Val, would you estimate it might have been easier, or smoother, to implement the ACA -.or the earlier proposal, the one that was more inclusive, and which you say you found more fair and reasonable - if it hadn't happened at such a deep economic trough? I'm not thinking about the political process of deciding this kind of law, but only the economic and corporate process: getting other insurance providers, ordinary people and employing firms/corporations on board and heaving the new system in.


I think it's part of the paradox of Obama's presidency as a whole, that the credit/mortgage crisis of 2oo8 helped him win over voters in some quarters, though it wasn't the key cause of his polling victory, but at the same time the long-haul crisis has made it much harder to actually deliver on his program once he had been sworn in, and it's made opposition to him more bitter. The Tea Party, too, were helped by the crisis.
« Last Edit: November 01, 2013, 04:18:23 AM by gaggedLouise »