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Originally Posted by
sponge
What do you think about Obamacare?
It's shit and the living definition of a corporate handout.
It is terrible, but I don't see how you could call it a corporate handout. If anything, with the guaranteed issue and small business and consumer subsidies it is more of a social handout.
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Should more be done?
Yes, but in a radically different direction.
I agree
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Should less be done?
In the sense that there should be less corporatism, yes.
Again, the corporatism isn't the problem I wouldn't say. If by corporatism you are admonishing PPACA for not creating a public option or single-payer, well, I'll get to that.
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Alternatives?
Public option or single-payer.
A public option wouldn't be the worst idea, but single payer will never be viable in America. Anti-selection against a single-payer pool would be ludicrous (due to the culture, not due to any innate lack of viability), and taxes and/or premiums would have to skyrocket to account for the losses. The already fragile condition of the government's finances couldn't handle the strain.
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Is health insurance a right?
If life is a right (as asserted in the Declaration, not the Constitution -- but most people will accept the Declaration as a 'base' of American values), then it follows that the preservation of life, and therefore health insurance (as without it preservation of life would be even more prohibitively expensive) is also a right.
Fair enough, though if preservation of life is a right it creates an icky double standard on abortion, assisted suicide, and pulling the plug on people (I assume you're coming from a left-of-center perspective given the opinions you've voiced)
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Does the government have the right to enforce an individual mandate?
The government has a right to levy a tax on income by whatever amendment. As that's how the PPACA mandate is enforced (no proof of insurance and your income is taxed additionally), then yes, the government has that right.
Well, it isn't really a tax on income, as even those without income will be penalized for not having health insurance and it isn't relative to income in any way.
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What about anti-selection?
What, as in the ability to opt out?
By this, I'm saying that the people in the middle and upper class who are wealthy enough to afford the penalty but don't want the additional burden that premiums would place on their finances could just pay the penalty and get insurance when they get sick. Due to guaranteed issue they couldn't be denied, so they'd be taking advantage of the pool. Basically, anyone who can afford the penalty can game the system.
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Penalties?
The mandate would have no teeth if it weren't for penalties, so yes, penalties are ultimately necessary.
Indeed, but it is deeper than that. I think, if anything, the penalties need to be increased. There is too great of an incentive to select against the pool the way the law is written right now, and it will make everyone suffer.
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Concerns about upward pressure on premiums?
That's the cost of operating a modern, western society where we value the 'right to life' of citizens. The upward pressure would be less if there was any real upper bound aside from the "minimum medical loss ration", i.e. real competition in the health services industry.
Your argument here, which is similar to many I've heard, ignores the main source of the problem. There are some bad guy insurance companies, yes, but they aren't all that way. Premiums aren't at the levels they are because of insurer greed, they are at the levels they are at because of super inflated provider costs. Sure, there are issues of member selection and provider-side fraud, but it is deeper than that. Due to the condition of malpractice law, doctors are charging ridiculous fees for the services they provide and running the gamut of unnecessary tests just to avoid missing something and getting sued, and it is an industry wide problem. Hospitals are making a killing, which puts upward pressure on premiums, which makes members suffer. I think there needs to be Provider Cost of Care reform before anything PPACA does.
Guaranteed issue itself violates one of the basic principles of insurance, fortuitous loss. For now the effects of that will be minimal (so long as the scenario where masses of people select against insurance companies due to insufficient penalties doesn't occur), but our society is aging. It is the same as the problem that social security and Medicare are going to face. Premiums are going to go up exponentially as time goes on due to a lack of enough healthy people paying into the pool. This is a problem that will outgrow the subsidies and eventually price people out, on top of shooting all insurance products into the range of "Cadillac" plans, subjecting everyone who is insured to a tax as the bill is written today.
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Employers choosing to pay instead of play?
Erm, I mean, I guess if it makes business sense, then sure. Probably means the penalities need to be raised, though, as it does defeat the 'purpose' of the bill.
I agree. Employers could really screw over employers if they wanted to. However, I theorize that most businesses will keep offering health insurance benefits to incentivize the current workforce and prospective hires, especially as small businesses begin dropping that benefit.
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The effect on the ever-shrinking middle class?
At least the rate of people from the middle class declaring bankruptcy under medical expenses because he either didn't have insurance (by choice or not) or was dropped by his provider and subsequently dropping to the lower class will decrease. Otherwise, I guess you're referring to the middle class becoming smaller because suddenly they have a [higher?] insurance premium to pay? One side to that coin is that they weren't previously really middle class as they likely had negative externalities which they weren't accounting for, and now they're just accounting for it.
I have two issues with your argument here, in that 1: The rate of middle class people being bankrupted by medical bills is not particularly high anyway, and 2: In most states (and by that I mean states I've worked with the insurance laws of, which is about 14 of them) insurers aren't allowed to just randomly drop people to avoid covering their claims anyway. I do believe that the middle class is the group that this law hurts the most. They make too much money to get subsidies, but not enough to support what will be exponentially increasing premiums and eventual taxes based upon what I've explained before. That doesn't even take into account positive cost of care trending. Worst case scenario this could put the final nail in the coffin of the middle class.
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Healthcare costs and HCR's effect on family practice?
No idea what this is about honestly.
What I meant by this is that the way the bill is written it is going to make trend go crazy. Believe it or not, it is not good for insurance companies when this happens. Between reserve requirements, MLRs, and premium refunding guidelines this could be a mess for them. They are going to want to keep premiums as low as they can, which will make them hardball provider contracts. Private practice is going to struggle to function under a hardball contract and have no leverage for counter-bargaining. If they are kicked off of networks they will not be able to survive, which is bad for them and the communities around them.
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The number one failure of this bill was to not implement a public option that can create mass pressure on health and pharma providers to keep prices lower. Mind you, NOT Medicare, which is unable to do something as monumental as negotiate drug prices for the large purchases they can coordinate. This is directly opposite the interests of pharma and health care providers, whose margins have allowed them
healthy lobbying budgets.
This bill has no effect on providers whatsoever, and neither would the creation of a private option (unless the private option would come with private hospitals and private doctors who would work for less because they are good people?). Health insurers and health providers are not the same, and this bill cripples one while leaving the other out of check. Insurers can't just start kicking large providers out of their network due to accessibility requirements, so in some areas there is just going to be no bargaining with them. Granted, these increased costs will be spread across more people, but the costs will increase by a greater margin than they are dispersed.
Those are my opinions of your opinions. Huzzah content!
