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Obamacare very successful, but still a long way to go

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  • Obamacare very successful, but still a long way to go

    In numbers released this week, Gallup polling found that around 16.5 million Americans have gained health insurance since the introduction of Obamacare.



    Unfortunately about 38 million Americans still have no health insurance cover. Inability to pay medical bills is the biggest cause of bankruptcies in the US, with about 2 million bankruptcies occurring per year for that reason. Past estimates have suggested that about about 20,000 to 45,000 people per year die in the US due to lack of healthcare resulting from a lack of insurance. Presumably the success of Obamacare at causing one-third of uninsured people to get health insurance will reduce those numbers by a third.

    America's lack of universal healthcare continues to baffle most of the rest of the Western world. America remains one of the only Western countries not to have universal healthcare for all citizens (the other notable exception being South Africa):


    The implementation of Obamacare turned out to be significantly cheaper than previously estimated, with the Congressional Budget Office (CBO) reducing its cost estimates for the program five times over the course of 5 years. Nonetheless, healthcare in the US remains significantly more expensive than other countries, with a comparison with other OECD countries showing the US paying 1.5 to 2.7 times more money per person for healthcare yet getting generally worse care for that money:


    Many British people living in the US either already fly back to Britain regularly for healthcare purposes rather than get healthcare in the States, or say that they would do so were they to develop a serious health condition (eg as John Oliver has said on his show).

    The high cost of healthcare in the US appears to come predominantly from the privatized nature of healthcare industry, as the US lacks a government-run single-payer system. This can be seen in:

    1) The cost of drugs. Americans are forced to buy their drugs directly from the pharmaceutical companies at 'market rates'. In other countries, the government will act as a bulk buyer on behalf of the population and buy the necessary drugs at an average price that is 80-90% cheaper. (These governments will, in turn, typically subsidize the drugs out of taxpayer money when they resell them to their own citizens. eg here in New Zealand collecting a prescription costs $5 per drug, regardless of quantity or drug) Many Americans therefore buy prescription medication via Canada in order to get the same drug at a cheaper price.

    2) The fees charged by hospitals. Hospitals in the US typically have three different rates at which they bill patients. If the patient is covered by medicare or medicaid then the government pays a low rate for the treatment which is set by the government based on an analysis of the actual costs involved. If the patient has insurance, the hospital charges a medium rate which they have previously negotiated with that particular insurer. If the patient has no insurance, the hospital charges their highest rate which is extra-high to account for the fact that a significant number of these patients will declare bankruptcy rather than ever pay the bill so the hospital passes those costs to the ones who do pay it. Obviously, the entire existence of the private insurance companies must be funded by the dollars of those people paying for healthcare, so the existence of the entire insurance industry pushes up the total price paid, as compared to those countries where the government simply runs the hospitals out of taxpayer money and provides free treatment for all citizens there.

    Despite all these things, Republicans have relentlessly attacked Obamacare, voting to repeal it 54 times in 4 years. In an act of apparent complete hypocrisy, the zealous anti-Obamacare politician Ted Cruz now plans to sign up for Obamacare because it makes his health insurance cheaper. The Republicans are currently taking a case to the Supreme Court (King v Burwell), regarding some careless wording in the bill, which if they win will result in about 13 million people losing their health insurance, which could result in about 10,000 deaths per year due to lack of healthcare.

    It's worth noting that a previous US Supreme Court decision ruled that individual states could decide to opt out of the Medicaid expansions mandated by Obamacare. As a result, 25 states did so (Republican controlled states) which led to about 5 million people lacking health insurance who would have otherwise had it. Yet polls show most Americans favor medicaid expansion, even in Red states.

    To many observers in the rest of the Western world, arguments against universal healthcare seem akin to arguments against having a police force or having an education system. The idea that there should not be universal healthcare is generally not taken seriously, and non-US observers tend to therefore regard the US Republicans as being simply insane on this issue, as the Republicans insist on a system that is demonstrably more expensive than the costs other countries are paying and which appears to be causing the ongoing deaths of a significant number of their citizens due to lack of healthcare.
    Last edited by Starlight; 04-18-2015, 12:02 AM.

  • #2
    The problem isn't as simple as it sounds. Red states have moved medicaid to managed care cut taxes and increased spending. America has a bad social system and its not designed to care for the needy and at the same time its designed to allow people to take advantage of it because of its poor infrastructure. Everyone blames everyone but the truth is the fill government liberal conservative shares the blame for not fixing it. Instead they bail out wall street and refuse to send disability checks until whomever is the current leader in the senate gets their way
    A happy family is but an earlier heaven.
    George Bernard Shaw

    Comment


    • #3
      Originally posted by Starlight View Post
      In numbers released this week, Gallup polling found that around 16.5 million Americans have gained health insurance since the introduction of Obamacare.
      That's because Obamacare requires people to get health care. Get health care, or pay a fine. That's not an ideal method of increasing the numbers. As you note, the costs keep going up. Obamacare is definitely not making health care more affordable. It does offer to help pay the costs somewhat for those who can't afford it, but that adds a cost for the government that will continue to increase; and the increasing cost will increase the government's budget deficit.

      Of course, those costs would continue to increase without Obamacare. I don't want to get rid of the program. I like some of its features, such as making sure that people with pre-existing conditions can get health care. I'd like to see something added that makes the costs go down significantly. Republicans aren't helping by trying to scrap the whole thing rather than improving it.
      Middle-of-the-road swing voter. Feel free to sway my opinion.

      Comment


      • #4
        Originally posted by Yttrium View Post
        Republicans aren't helping by trying to scrap the whole thing rather than improving it.
        Is this the prevailing or dominant position of republicans these days?
        "Neighbor, how long has it been since you’ve had a big, thick, steaming bowl of Wolf Brand Chili?”

        Comment


        • #5
          Originally posted by Cow Poke View Post
          Is this the prevailing or dominant position of republicans these days?
          Yes.
          "I wonder about the trees. / Why do we wish to bear / Forever the noise of these / More than another noise / So close to our dwelling place?" — Robert Frost, "The Sound of Trees"

          Comment


          • #6
            Originally posted by Sam View Post
            Yes.
            With all due respect, I'd prefer some actual citations or proof. Not that I don't trust, of course, that you're always right!

            This story in today's LA Times tends to say otherwise.
            Last edited by Cow Poke; 04-18-2015, 11:25 AM.
            "Neighbor, how long has it been since you’ve had a big, thick, steaming bowl of Wolf Brand Chili?”

            Comment


            • #7
              Originally posted by Yttrium View Post
              That's because Obamacare requires people to get health care. Get health care, or pay a fine. That's not an ideal method of increasing the numbers. As you note, the costs keep going up. Obamacare is definitely not making health care more affordable. It does offer to help pay the costs somewhat for those who can't afford it, but that adds a cost for the government that will continue to increase; and the increasing cost will increase the government's budget deficit.

              Of course, those costs would continue to increase without Obamacare. I don't want to get rid of the program. I like some of its features, such as making sure that people with pre-existing conditions can get health care. I'd like to see something added that makes the costs go down significantly. Republicans aren't helping by trying to scrap the whole thing rather than improving it.
              Obamacare has made health care more affordable. For one, the rate of inflation in health care costs has slowed dramatically from previous years. Subsidies clearly make health care more affordable — if people couldn't afford it, they wouldn't be getting it! And since the cut-off for subsidies is ~$90,000 for a couple, most families are getting significant help purchasing insurance. The Medicaid expansion has included >10 million people who wouldn't be able to afford private insurance even with the subsidies (and would include more had SCOTUS not come up with a bizarre rationale for why Congress couldn't amend the Medicaid program in this way).

              The ACA, since before it was passed, was scored to reduce the deficit. That's because the "status quo" way of doing things, with so many people lacking coverage and the health care infrastructure operating so inefficiently, was very costly. Since its passage, as Starlight notes, the cost of the ACA has just kept going down — partly because the law is more effective than even its supporters thought it would be but largely because Medicaid expansion isn't universal, as the law called for.
              "I wonder about the trees. / Why do we wish to bear / Forever the noise of these / More than another noise / So close to our dwelling place?" — Robert Frost, "The Sound of Trees"

              Comment


              • #8
                Originally posted by Cow Poke View Post
                With all due respect, I'd prefer some actual citations or proof. Not that I don't trust, of course, that you're always right!

                This story in today's LA Times tends to say otherwise.
                I am unaware of any GOP presidential candidate who does not support full repeal. Kaisch, if he runs, would be the only one I know of who supports preserving the Medicaid expansion portion of the ACA, while repealing the rest.
                "I wonder about the trees. / Why do we wish to bear / Forever the noise of these / More than another noise / So close to our dwelling place?" — Robert Frost, "The Sound of Trees"

                Comment


                • #9
                  Originally posted by Sam View Post
                  I am unaware of any GOP presidential candidate who does not support full repeal. Kaisch, if he runs, would be the only one I know of who supports preserving the Medicaid expansion portion of the ACA, while repealing the rest.
                  That you're unaware is not proof, Sam. I honestly don't know, and admit my ignorance on the matter - I haven't been listening to much news at all lately. I posted an article that seems to indicate you may be in error, but - whatever!
                  "Neighbor, how long has it been since you’ve had a big, thick, steaming bowl of Wolf Brand Chili?”

                  Comment


                  • #10
                    Originally posted by Cow Poke View Post
                    That you're unaware is not proof, Sam. I honestly don't know, and admit my ignorance on the matter - I haven't been listening to much news at all lately. I posted an article that seems to indicate you may be in error, but - whatever!
                    The article didn't have a single Republican who advocated keeping the law in place, even with tweaks. The closest it came was Jeb Bush, who said in March that he wants to repeal the law and replace it with catastrophic coverage, probably similar to Yuval Levin's plan.

                    I keep pretty up to date on ACA-related events and follow the 2016 cavalcade pretty closely. I can think of maybe one Republican currently in office who has advocating preserving the ACA as law, with adjustments. The platform position is still full repeal.
                    "I wonder about the trees. / Why do we wish to bear / Forever the noise of these / More than another noise / So close to our dwelling place?" — Robert Frost, "The Sound of Trees"

                    Comment


                    • #11
                      Originally posted by Sam View Post
                      The article didn't have a single Republican who advocated keeping the law in place, even with tweaks.
                      Of COURSE no Republican is going to "advocate" keeping it in place, just like no DEMOCRAT would run on enforcing it when it was such a liability for them.

                      The closest it came was Jeb Bush, who said in March that he wants to repeal the law and replace it with catastrophic coverage, probably similar to Yuval Levin's plan.

                      I keep pretty up to date on ACA-related events and follow the 2016 cavalcade pretty closely. I can think of maybe one Republican currently in office who has advocating preserving the ACA as law, with adjustments. The platform position is still full repeal.
                      They're not going to "advocate" preserving it, Sam - that's just silly. But that doesn't mean they still believe, or are pushing for, abolishing it completely, which is what I was responding to when Yt said "Republicans aren't helping by trying to scrap the whole thing rather than improving it.."

                      I think you're being way too binary on this.
                      "Neighbor, how long has it been since you’ve had a big, thick, steaming bowl of Wolf Brand Chili?”

                      Comment


                      • #12
                        I'll make a deal: when Republicans go full term of Congress (two years) without voting to repeal the ACA or broadly supporting an amendment to do so, I'll consider their opposition muted. We're at ~2.5 months, currently.
                        "I wonder about the trees. / Why do we wish to bear / Forever the noise of these / More than another noise / So close to our dwelling place?" — Robert Frost, "The Sound of Trees"

                        Comment


                        • #13
                          There is a current issue with the aca that has gone in addressed. Red states that did not expand medicaid and families still below the poverty line. While they are exempt from Obama care and the kids can get medicaid, the parents are still completely without insurance. That gap has not been filled and I suspect its because the govt wants people to play with. I don't like that one bit and unless and until this class of people speaks up (who are extremely hard working folks they do back breaking labor for pennies) nothing will change.
                          A happy family is but an earlier heaven.
                          George Bernard Shaw

                          Comment


                          • #14
                            Originally posted by Catholicity View Post
                            There is a current issue with the aca that has gone in addressed. Red states that did not expand medicaid and families still below the poverty line. While they are exempt from Obama care and the kids can get medicaid, the parents are still completely without insurance. That gap has not been filled and I suspect its because the govt wants people to play with. I don't like that one bit and unless and until this class of people speaks up (who are extremely hard working folks they do back breaking labor for pennies) nothing will change.
                            We've seen a slow but steady stream of Republican governors finally start adopting the Medicaid expansion, as it became clear that 1) the ACA wasn't going to implode on itself, 2) their states are throwing away a lot of money by not expanding Medicaid and 3) Medicaid expansion actually improves not only lower-income families' health and lives but also the state's economy. I think that most other red states will fall in line after the 2016 election, assuming Clinton wins and SCOTUS hasn't gutted the ACA in the meantime.

                            One potential GOP presidential candidate, John Kaisch, has gone as far as to tie Medicaid expansion in with a moral imperative to help the poor. God bless him for that.
                            "I wonder about the trees. / Why do we wish to bear / Forever the noise of these / More than another noise / So close to our dwelling place?" — Robert Frost, "The Sound of Trees"

                            Comment


                            • #15
                              Originally posted by Starlight View Post
                              The idea that there should not be universal healthcare is generally not taken seriously, and non-US observers tend to therefore regard the US Republicans as being simply insane on this issue,
                              Boy, it's very obvious that you're interested in an honest discussion on this issue.

                              Comment

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