thegreekdog wrote: PLAYER57832 wrote:thegreekdog wrote:The sad thing is that politifact had to even make that post. Most of these things are absurd (e.g. Muslims are exempt) and are related to marginalizable politicians (e.g. Bachman), radio hosts (e.g. Limbaugh), or email chains (seriously, politifact - email chains?). The only one of serious consequences is the President's lie.
I do live in a small, somewhat isolated town. Still, I am amazed by the number of people who think that Obamacare is, well part of the big conspiracy of government takeover that includes taking all our guns, making our kids deny their religions, etc.
Yes. One of those people is my mother, who is an otherwise intelligent, educated person. She doesn't like when I tell her this is just a big business boon. Which is really what it is. Which brings me to...
PLAYER57832 wrote:I guess I just see it differently. That is, I don't disagree with what you are saying, I just don't think it is/they are the primary point(s)
The main thing the act accomplished was to prohibit insurance companies from denying care to people with pre-existing conditions. That is also the provision that seems to throw a lot of anti-act folks into spasms. It may well result in higher health insurance bills, but I still feel it was a necessary move to put more "honesty" into the system. Right now, a lot of people only THINK they are getting cheap insurance because the bulk of the costs are hidden, particularly put onto taxpayer roles. This is done directly, when we pay medicaid and the like, but its also done indirectly when hospitals jack up costs to cover uninsured costs and when we wind up paying for people who go bankrupt or who simply don't get care they need and thus become disabled (or who go on the disabled lists simply to they can get the care they need). I think these kinds of traps benefit no one, except a few in the insurance industry.
What the bill did NOT do is remove the bulk of profits or require that employers pay more. I actually like that last bit. Having employers pay insurance is convenient, but not good for individuals in the long run. Some of my objections are sort of moot now with the whole electronic records bit... too many people can access our information (not just medical), but that is another point entirely. Still, I think giving lower cost to bigger employers winds up hurting the rest of us. Why should your health care cost less just because you work for company xyz instead of small business d?
This bill also is not going to truly lower health care costs because the rising costs in healthcare are pretty inherent. That is, we pay more mostly because we just plain get more. I know you and I disagree on some of the medical ethics issues, but ultimately, that is the front we will have to address, one way or another.
I think we did not get a single payer system because Republicans and conservative Democrats (for lack of better categories) were afraid to tackle the "socialized medicine" bit. A LOT of people are "against" this thing called "socialized medicine" who have no idea really what it means. (set aside that there is no set definition, I mean they know only sound bytes from a few countries and not how most systems actually work or why).
I think the stated points of the Affordable Care Act include coverage for pre-existing conditions and preventative care. And, if you're in to those things, you would think the law is a good thing. My response to that is that the average American has health insurance that covers preventative care and arguably covers pre-existing conditions (e.g. mine covers both of those things, and has since I started working). So the beneficiaries of the "good" part of this legislation are the poor. And, at least in my reckoning, the poor already received care related to pre-existing conditions and prevention through existing government programs (there was likely some leakage in that regard).
No, I think you are misjudging how this really works.
The only people who's pre-existing conditions get covered by private insurance are those able to maintain continual employment or who are the spouse or child of a policy holder who works. Even they get excluded once the lifetime maximum is met. Then the only options are to go onto government or taxpayer funded medicaid (Medicare if over 60). Insurance companies have made millions by covering those who could pay and who were not the most sick. The rest of us then wind up paying through taxes for the most expensive care AND for the poor.
The fact is there are only a few ways to limit the costs of healthcare. #1 is to simply exclude large numbers of people. #2 is to make it more efficient. #3 is to spread out the costs more widely. #4 is to offer care, but limit what is offered.
The insurance companies did all 4, but primarily #1, then #4, but in a "tapered" fashion. Someone like you who works for a very profitable company is likely to have great insurance which your employer pays because it is cheaper than paying yet more wage and a good way to attract talent. Most of the factories around here, to contrast, offer far more basic policies to meet the legal minimums and not much more. Those minimums have stretched so that deductibles are thousands of dollars... not even counting thousands in co-payments anyone needing a lot of care will incur. Since few of those places have sick leave, they often wind up firing anyone who gets seriously ill anyway... despite the Family Medical Leave Act...so, again, the biggest way those businesses cut cost was by only covering people who needed less insurance.
In other words, businesses are already discarding employees, always have. The Affordable Care Act doesn't change that. It DOES mean that now, while insurance companies can still take a profit, its limited. They have to cover everyone, so no dumping the highest costs onto taxpayers, taxpayers which include not just employees, but ALL citizens, including those without any insurance. The key here is that a lot of younger people need to enroll, now, so they already have insurance when they actually get sick. Initially, many of them will wind up paying more than they use, but in the long run, they will wind up recouping what they paid in, in the form of their own care --care that most likely will far exceed what we know today, simply because of advances.
The Affordable Care act also takes steps to make the system more efficient. The electronic records bit has been touted (funny how something previously touted by the right as the cost saving efficient future is suddenly a nasty demon because its part of "Obamacare" ), but the mere fact of setting more standards for coverage helps. There are a LOT of provisions in this law that might not mean much unless you are actually in healthcare, but one point I have heard repeated a lot is that the government will no longer pay for "fault" injuries. (not the "correct" term). Bed sores, many fall injuries, etc --- the hospital or care facility has to "eat" those. (You can bet that every medical facility is now paying a LOT of attention to training personnel better in preventing these things! ). A lot of the changes have to do with specific coding and such. ( I have heard these things mentioned in general ways, but I don't know enough about the specific billing issues to know what the real changes were) AND, there are panels/boards that are supposed to review and update things like what treatment is most effective, standards of care, etc. The idea is that medicine continually evolves and insurance has to change with it. In the past, a lot of that data has been collected by individual insurance companies, who make decisions based on their goals (ultimately -- making money for stockholders, of course). Now, some of that data (not all.. the insurance companies still have proprietary rights to some things, a lot) can be used to determine best care for all.
There is also the potential to detect some disease trends earlier, etc. I heard a talk on that, its fascinating stuff (and not all related to the Affordable Care Act). but another topic.
thegreekdog wrote:The bad things in this law (apart from that Muslims are apparently exempt... seriously, who believes this shit?) are the costs. The costs of this law are estimated to be tremendous even assuming businesses don't start shedding insurance policies. And now we hear (and have heard) that businesses are shedding insurance, resulting in more people going to the exchanges (or paying the $95 or so fine). This is undoubtedly an effort to cut costs and will also undoubtedly be lambasted by supporters of the Affordable Care Act. My response is that the supporters knew when the bill was being discussed and after it passed that this would happen. Those people that supported the law received funds from and were lobbied by the very same businesses. Further, this law is a boon to insurance companies, which certainly did not need a boon from anyone.
OK, stop a bit there.
I do disagree on 2 points. When businesses, as you say "shed" insurance... who does that really hurt? Why do you think that is such a harmful thing for the individual. It is only harmful if you want to go back to the old system, where about the only place you could get reasonably priced insurance, other than at work. Now, anybody can get insurance at basic rates, not just employers. I see the move to individual insurance as a GOOD thing, not a bad one. Relying upon employers to provide insurance has caused far more problems than it helps.
I also disagree that this was some kind of secret agenda. If you go back a ways, I believe I argued that this would happen and should happen.
I agree the law is an insurance boon, though limits to the profits they can gain will keep it somewhat in bounds, at least for a time. ( I am sure it won't be long before enterprising individuals find ways to get around those limits). However, the US has had such a paranoia over any universal government coverage plan that the first step pretty much had to involve insurance companies. At least this way, insurance companies have reason to try and insure more people. At least to start, the limits to profits are real, so some companies will need to insure more people to get back the profits they had before.
thegreekdog wrote:Were the bad things intended or unintended? I think they were intended as a boon to business. But let's assume they were unintended, as Player may argue, or secondary consequences (and therefore worth it for the stated reasons for the ACA), does that excuse Congress or the president in any way? I would argue no. So, if they were intended consequences then we've been lied to by Congress and a president (again). If they were unintended consequences, then Congress and the president were ignoring experts and/or are ignorant. We have either they lied (unacceptable) or they are stupid (unacceptable). Not a win-win.
No, you completely misstated my argument here. I don't think most of what you call "a bad thing" really is.. or don't think it will happen as you said. I do not think moving insurance into individual markets instead of group employer-based markets is bad. Also, to look at how this will save money, you have to look at the overall picture and what we are paying today, not just those who have great insurance provided almost entirely by their employer. The fact is that that system was not sustainable, not really. It was not sustainable because anybody who was really sick was just pushed out. More and more people found their employer offerings were meager, at best. All these complaints about high deductibles and the like that I hear touted about are talking about a few people who are lucky enough to have great insurance now. Yes, they -- and I am guess you are one of that group -- will see a downward change. But, the vast majority of people will see drops -- IF most young people don't just opt out due to all the misinformation being put out by so many tea party repubs.
No lying, just a non-issue that is being made into an issue.
