Obamacare

The Republicans have been catching hell about the ACA at their "town hall" meetings.

One wonders -- if by "one" I mean me, and I do -- what the failure of Trump's #1 legislative agenda will mean for his nascent administration.  Of course he will blame the Democrats and the media and Republicans and healthcare providers, he'll never admit that it was a bad idea from the starting gate.

But the larger implications are looming.  Trump has lost his mandate.  He has lost Congress.  He no longer plays for the same team (the other team no longer plays for the same team).  Congressional Republicans may be so divided at this point, so fractured, that they'll obstruct each other the way they obstructed Obama.  It's a lot easier to be the Party of No than it is to actually pass any legislation.

Yesterday, a republican senator was interviewed on why the republicans are so divided over health care reform.  After all, Chuck Todd asked, hadn't they voted FIFTY TIMES to repeal Obamacare while Obama was in office?  "Yes," he replied, "but it's a lot easier to obtain consensus knowing that the president will never sign it."  Unfuckingbelievable.  

I could see Congress turning against this president in a big way, moving forward with the Russian interference probe and initiating impeachment when it is proven that Trump promised to lift the sanctions if Russia helped him get elected.

Hello President Pence!

Sigh. Blissfully ignorant of this DnD nonsense. "I cast [such and such]" is presumably part of the game? I didn't realize DnD was a text game.

Oh well. Move on to something important.

Consensus now is that Trump and his minions will attempt to kneecap Obamacare through the upcoming budget reconciliation process. Their HOPE -- odd though it is -- is that a lack of funding (allowances, rebates, reimbursements, keeping the exchanges open) will cause Obamacare to actually collapse as they've been saying it will -- despite the facts to the contrary from the CBO -- and when it collapses, the Democrats will receive the blame rather than the Republicans.

Seems like a pretty dicey gamble. Throwing American healthcare into a crisis so you can blame somebody other than yourself when millions of people face emergencies and untenable choices. It's despicable politics is what it is.

Huffington Post wrote:

the ACA in the end was designed to deliver health care using the existing model of private insurance using government subsidies for premiums. The much-derided “individual mandate” to purchase health insurance would not have been necessary had Democrats gone with a “Medicare for all” proposal, but was crucial under the ACA to hold down premiums by spreading the costs of serious illnesses across a wider base.

So, let me ask this. If Medicare was expanded to "all," would companies still be required to provide health insurance to their employees? In countries with socialized medicine, is there a "private / public" healthcare divide where only retirees, the unemployed, mothers and children are covered by the government?

Or, if "free" (paid for by taxes) insurance was a national right from cradle to the grave, would companies save tens of thousands of dollars for every employee and thus suddenly become much more competitive internationally?

Richard, how's it work in Old Blighty?

NoCoPilot wrote:

Richard, how's it work in Old Blighty?

Everybody is covered with no point of service charge  (no invoices, no copays, no deductibles) under the National Health Service. Companies don't have to worry about health care for their employees, since those employees are already covered by the NHS. (A comment sometimes made, but not nearly often enough, about the American dogs-dinner of a system is that it is a major millstone around the necks of growing companies. The expense and paperwork associated with health insurance for new employees is a serious drag on growing a start-up company. Universal health care would be a boost for businesses, especially small businesses and entrepreneurs, in the US.)

However, in the UK there is a private health insurance market which you can use - you can buy private health insurance if you want to and can afford to (it's expensive). Since almost everybody uses the NHS, resources are often stretched. For elective and even needed but not urgent treatment, you may find yourself on a waiting list. If you have private insurance, typically you don't have to wait, and you may well have access to some toney doctors and facilities that won't accept NHS patients. That is attractive, and that means that even though it isn't really necessary, private health insurance is quite a nice perk for high-paying jobs to offer.

I could see a similar arrangement working for the US under "Medicare for everybody". Since Medicare doesn't pay for everything, there is a market for supplemental insurance. You can envision employers offering subsidized supplemental insurance as part of a benefits package, even though they wouldn't have to, since Medicare would be doing the heavy lifting.

Interesting. This gives Trump an out to offer socialized medicine in the name of making American businesses more competitive.

Of course the flip side is the decimation of an industry, an industry that lobbies heavily.

Doctors in this country have gotten so fucking greedy that insurance is no longer a guarantee of service. In the city we lived in for thirty years, and to which we may move back, a great many - maybe all - of the doctors are charging a yearly fee, beginning at $1,500, just to be a patient. Many of them are now charging an "administrative fee" of $100 or more for each office visit. All of these charges are in addition to the copay for your insurance. And few insurance plans are accepted by most of the doctors. Even the physician I see (in a smaller town) does not accept insurance from United Healthcare, which is the largest health insurer in the country. A great many doctors will not accept Medicare patients, or even older patients.

As much as I despise the health insurance industry, they are not the only problem. Good old American greed denies health care to many people.

Tort reform. Just sayin'.

Tort reform? To what end?

Malpractice insurance is out of control.

That's just an old Republican chant. Another of their excuses to absolve business of any responsibility for their actions.

If you can find the data, I think you'll see that the chant is bullshit.

Hmmm, you may be right.
http://truecostofhealthcare.net/malpractice/

That's because I always believe the opposite of what the Republicans say.

An alternative view of the doctors' position.

Many Doctors Prefer Single-Payer Health Care Because of Demands by Insurance Companies

Health care needs to be removed from the voracious  maw of capitalism. Single payer is a good start.

The problem is it eliminates an industry, a large very well-funded industry that does a lot of lobbying. Republicans don't like to kill jobs.

Fuck the Republicans. Fuck the insurance industry. Fuck their profits.

The USA is the only developed country in which people go bankrupt for health care. The number of people in the UK who go bankrupt for medical expenses is exactly zero. And the same goes for most other wealthy countries. In this country, more than fifty percent of all bankruptcy filings are for medical expenses - for people who have insurance.

My great-nephew was just diagnosed with non-hodgkin's lymphoma and started chemo therapy yesterday. Surprise! His health insurance won't pay for it. Why? Because they don't want to and the law won't make them.

Why can't this asshole country join the twentieth century (it would be asking too much for it to join the twenty-first century) and provide single-payer health insurance? The method we have now is by far the most expensive in the world and provides significantly worse outcomes.

_Howard wrote:

Why can't this asshole country join the twentieth century and provide single-payer health insurance? The method we have now is by far the most expensive in the world and provides significantly worse outcomes.

NoCoPilot wrote:

The problem is it eliminates an industry, a large very well-funded industry that does a lot of lobbying. Republicans don't like to kill jobs.

Quod erat demonstrandum.