Would you vote for Obamacare?

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Erik Kain

Erik writes about video games at Forbes and politics at Mother Jones. He's the contributor of The League though he hasn't written much here lately. He can be found occasionally composing 140 character cultural analysis on Twitter.

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161 Responses

  1. Avatar Patrick Cahalan says:

    Now you’ve gone and introduced privacy to the vote!  😛Report

  2. Avatar JohnQ says:

    I do not believe Single Payer is viable politically, so I will take what we can get.

    The current plan has many desirable attributes – no pre-existing conditions, allowing children to stay on their parents’ policies longer, mandatory insurance….  It is a good plan.Report

    • Avatar Aaron in reply to JohnQ says:

      I tend to agree.  Single payer would be worlds better, but something needs to start happening in the world of health care.

      For those voting “no,” I have to ask: is PPACA really worse than 30 million uninsured?  Given the political realities right now, I don’t think it’s good enough to just say, “I disagree with mandates.”  You either need to present a plan that could get through this Congress, or you need to explain why you’re okay with this level of the uninsured in the United States.Report

      • Avatar Tod Kelly in reply to Aaron says:

        For those voting “no,” I have to ask: is PPACA really worse than 30 million uninsured?

        Nope.  But neither is simply enlarging a system that goes exponentially in cost every year.  Do we recognize there is a problem?  We should.  So let’s deal with it now, rather than pass something that will see us back where we started in a decade or so. And let’s eliminate the circumstances that force those that have to go uninsured while we’re at it.Report

        • Avatar DarrenG in reply to Tod Kelly says:

          So let’s deal with it now, rather than pass something that will see us back where we started in a decade or so.

          I really, really don’t get this line of thinking at all.

          What sort of reform do you think could have passed in 2009/2010 (or now) that meets this criterion?

          Seems like a classic case of letting the perfect be the enemy of the good.Report

          • Avatar Patrick Cahalan in reply to DarrenG says:

            What sort of reform do you think could have passed in 2009/2010 (or now) that meets this criterion?

            After they lost Lieberman, the answer is “nothing”.  Sucks, but there you go.

            Sometimes, the perfect is the enemy of the good.  Other times, you don’t have what it takes to get the job done right, and trying to fix it anyway is just going to make it worse.  PPACA makes it worse.Report

            • Avatar DarrenG in reply to Patrick Cahalan says:

              Worse in what way? Certainly not in coverage rates.

              And most independent analysts seem to think it will make the cost picture at least somewhat better.Report

              • Avatar Patrick Cahalan in reply to DarrenG says:

                It doesn’t do any of the things that need to be done.  I’d have to write a whole post about what’s wrong with it.Report

              • Avatar DarrenG in reply to Patrick Cahalan says:

                None? Expanding coverage didn’t need to be done? Ending rescission, denial of coverage for pre-existing conditions, and lifetime caps? Closing the Medicare Part D donut hole? Improving medical loss ratios? Eliminating the waste of Medicare Advantage?

                I can completely sympathize with thinking the PPACA didn’t go far enough in certain areas, but it just seems bizarre to claim that it made the previous status quo worse.

                 Report

              • Avatar Patrick Cahalan in reply to DarrenG says:

                All of those things are important, Darren.

                Addressing them the wrong way makes things much better right now for everyone affected… and hugely much worse 20 years from now for everybody.

                I think we’re in that solutions space.Report

              • Avatar karl in reply to Patrick Cahalan says:

                Good heavens, most of the Act isn’t in effect yet and won’t be for another two years; our speculation is almost meaningless and, besides, unexpected consequences can sometimes be beneficial. Considering my great power to affect change in our society I vote “yes,” close my eyes, and think of full coverage.

                By the way, my employer discontinued its hourly employee health plans a few months ago and my part-time income doesn’t allow me to buy into a private plan (not one that a middle-aged man with minor heart problems can afford, that is).  I have savings that can easily be used for routine medical needs when they arise, but I’ll be broke if something really bad happens. So, from where I sit, PPACA really is an improvement on the status quo.

                 Report

              • Avatar Stillwater in reply to Patrick Cahalan says:

                I’d have to write a whole post about what’s wrong with it.

                If it’s to convince ACA supporters that a better way to achieve its ostensible goals can be imagined, then there’s no need. The question isn’t how far off the ideal is this bill, but does it improve things or make things worse? Another question is would bill more in line with the ideal have any hope of being passed by Congress?Report

          • Avatar Tod Kelly in reply to DarrenG says:

            Seems like a classic case of letting the perfect be the enemy of the good.

            No, it’s more like this:

            Let’s say every day before you go to work you make dinner and put it out on the counter so it will be there when you get home.  But you own a dog, and he keeps eating it.  And every night you find yourself saying, “Huh! There’s not enough food!  Tomorrow morning, I’m going to make an even larger dinner.”  And you keep doing that, day after day.  Sooner or later, you have to realize that you not having enough to eat for dinner isn’t the problem, it’s the symptom. The actual problem is that your dog keeps eating your damn food.

            Same thing with health care.  People being uninsured isn’t the underlying problem; it’s an awful horrible symptom.  The underlying problem is that for over a generation, heath-care costs have been increasing exponentially on an annual basis.  I’m going to sound like a broken record here for those that I’ve discussed this with prior, but for decades your employer absorbed the cost increases, but can’t do so any longer.  In a little over a decade, at this rate, it will cost almost as much to insure a family of four than 40% of this country’s families make right now.

            Do we need to insure everyone?  Yes, and that will be a huge help.  Because part of the issue isn’t just that sick people are uninsured, it’s that younger, healthier people who should be evening out the cost of risk are uninsured too.

            But there is nothing – nothing – the the current plan that addresses the exponential growth of costs.  So when it passes, the premium per person is going to go down.  And then that cost will increase 7-10% the next year.  And then it will increase 7-10% the year after that.  And the year after that.  And sooner than you might think, we will be exactly where we are today.  Because if the past 30+ years has taught us anything, it’s that if we are not in crisis mode with healthcare we will happily and willfully ignore our system’s lack of sustainability.

            So it’s not that the plan isn’t “perfect;” it’s that it doesn’t address the thing that most needs to be addressed.  And I say tackle the damn thing now.Report

            • Avatar DarrenG in reply to Tod Kelly says:

              I (and more importantly, most health care analysts) completely disagree that the PPACA does absolutely nothing to address cost inflation. There are a number of provisions that address cost directly, and the exchanges will give a lot of power to the states to further address costs.

              And even if you were right, getting 30+ million more people upset about the issue might help spur a solution.

              Finally, and again, what does “tackle the damn thing now” look like, given the current make-up of Congress? What’s the superior alternative that stands a prayer of a chance of being enacted?Report

              • Avatar Tod Kelly in reply to DarrenG says:

                Well, for one thing, “tackle the damn thing now” means having at least one party talk to the voters like their grown ups.  Right now we have one party claiming that everything can be just like it has been if only we all agree that insurers are evil, and one party claiming we can just go on like we always have been if we all agree that trial lawyers and Obama are evil.

                Is there a politician out there – local, state or federal – that ever talks about this issue in a way other than to pretend the underlying problems don’t exist?  If so, I haven’t seen them.Report

              • Avatar Koz in reply to Tod Kelly says:

                Well, if the libs gave it up on universal coverage like the quarterback’s date on prom night back in July 2009 like they were supposed to, we probably could have found some common ground on torts and preexisting conditions and the like. But they didn’t, and here we are.Report

              • Avatar Jesse Ewiak in reply to Koz says:

                In other words, the DNC should give up the centerpiece of it’s entire health care bill to get one small Republican policy in there? Wow, and I thought Obama’s current way of negoitating was bad.

                How about this. If you give up all of your spending cuts, we’ll only raise taxes by half the amount we were planning for?Report

              • Avatar Koz in reply to Jesse Ewiak says:

                Or, you could stop the train until you convince the American people you’ve got something that’s worth their while. That would be a radical plan.Report

              • Avatar Aaron in reply to Jesse Ewiak says:

                I wasn’t aware that we ran our government via plebiscite.Report

              • Avatar Koz in reply to Jesse Ewiak says:

                We don’t, most of the time. But we are still supposed to have a republic.

                http://econlog.econlib.org/archives/2011/10/leon_louws_talk.html

                The point about Switzerland seems apposite to me.Report

              • Avatar Aaron in reply to Jesse Ewiak says:

                Switzerland has a median income of $78k a year, four official languages and a population of less than 8 million.  Any compairsons between the US and Switzerland are absurd on their face.  IF we wanted to wait for the “American people” to get behind any legislations we’re going to be in a confusing world: not only do most of the major portions of PPACA have well more than majority support, but when you poll things, the kind of response you get depends on how you ask the question.  Last I checked, PPACA took around 13 extremely well publicized months to be crafted and pass by a majority of the house and a super majority of the Senate.  The idea that this bill wasn’t vetted is ridiculous.

                The things that make PPACA unpopular are the “eat your vegetables” sections.  What, pray tell, would your ideal bill that would get the approval of the American people look like?  How do you plan on containing costs and not ruffle any feathers?Report

              • Avatar Koz in reply to Jesse Ewiak says:

                Oh, it’s been vetted all right, like Jim Smith running for Senator from somewhere.

                After he’s been found in bed with a dead girl and a live boy, sold a truckload of RPGs to Mexican drug cartels, got caught dealing cocaine to 7 yr olds, and put ketchup on a filet mignon. Heck, we should vote for him. After all that, how much worse can it get?Report

              • Avatar Patrick Cahalan in reply to Jesse Ewiak says:

                I was okay with the guy up until the ketchup.

                That’s inhuman!Report

          • Avatar James Hanley in reply to DarrenG says:

            Seems like a classic case of letting the perfect be the enemy of the good.

            That assumes PPACA is the good, and I read Tod as saying it’s not the good, but too much of the same old bad.Report

        • Avatar E.D. Kain in reply to Tod Kelly says:

          Tod – it seems to me that a huge driving factor in costs going up is the elderly. Here’s Bruce Bartlett:

          Turning to Medicare, its finances are more complicated because it is really three separate programs that are financed differently.

          Part A pays for hospital visits and is financed by the Medicare portion of the payroll tax, which is 2.9 percent. (That leaves the total payroll tax rate, at 15.3 percent, ignoring the temporary cut enacted last year as a stimulus program.)

          As a result of cost saving measures implemented by the Affordable Care Act, this portion of Medicare has virtually no long-term unfunded liability according to Table III.B10 of the trustees’ report. The 2009 report, before passage of the new health care law, had estimated a long-run unfunded liability of $36.4 trillion, which is equivalent to 2.8 percent of G.D.P. forever and would have required a payroll tax increase of 6.5 percent. (Also Table III.B10.)

          I gotta say, this doesn’t sound like “enlarging” anything. This sounds like serious cost-cutting built into the ACA. It doesn’t address everything, but it’s stuff like this that makes a big impact over time.Report

          • Avatar Tod Kelly in reply to E.D. Kain says:

            Erik, you are comparing two separate streams.  Medicare is subsidized by the feds.  The amount of premium you pay to, say, Forbes, for your health insurance is in no way affected by Medicare, or the cost of healthcare for the elderly.  Your premiums are only a reflection of what you, your fellow employees at Forbes, and similar employer groups in your part of the state are spending on health care each year.  And here’s the thing: You’re all spending 7-10% more than you did the year before, where you spent 7-10% more than the year before that, and so on.  Next year you will spend 7-10% more than you are going to spend this year.

            So is elderly care an issue?  Sure.  But the exponential cost growth is happening across the board, at all age groups.  And you’re not getting 7-10% healthier each year.Report

        • Avatar Stillwater in reply to Tod Kelly says:

          Tod, in an effort to resuscitate my plan to simply agree with you all the time, here’s what I wrote to you on the other thread:

          let’s suppose that the ACA is the best possible bill that could have come out of Congress (rejecting all the Digby/progressive rants about Bully Pulpits and Leadership and the rest of it). If that’s true – and there’s no reason to think it isn’t true –  then addressing the real issues in any more substantive way than the ACA would have been impossible.

          So the issue, for me, goes back to this: is the bill better than the status quo? In my mind, unequivocally, the answer is yes.

          My argument here is that addressing provider costs in any more direct fashion than the measely provisions in the ACA was not politically possible. But it buys us a decade, right? Isn’t something better than nothing?

           

           Report

      • Avatar Patrick Cahalan in reply to Aaron says:

        You either need to present a plan that could get through this Congress, or you need to explain why you’re okay with this level of the uninsured in the United States.

        False dichotomy.

        “You either need to present a plan that would fix the hole in this ship, or you need to explain why you’re okay with the number of people who aren’t going to fit on the lifeboats!” said the First Mate to the Captain of the Titanic.Report

        • Avatar DarrenG in reply to Patrick Cahalan says:

          How is that a false dichotomy, given your analogy?

          Unless you’re assuming a time machine that allows us to go back and not build the health care ocean liner the way we did or steer around the cost inflation iceberg, it seems like those are exactly the choices facing us (i.e. stay with the status quo or propose something that has a chance of being enacted).Report

          • Avatar Patrick Cahalan in reply to DarrenG says:

            “How is that a false dichotomy, given your analogy?”

            Uh, because there’s no way to fix the hole in the ship, and I’m not okay with the number of people who won’t fit on the lifeboats but there’s nothing I can do about that?  “How long has it been since you stopped beating your wife?”

            “It seems like those are exactly the choices facing us”

            As it currently stands, yes.  This ship is going down, Darren.  There comes a time when you’ve built so many extra pieces and add-ons and bolted-on pieces of crap to a complex system that you need to step back and start building something that *does* work, and then cut over to that.  Some people are going to fall between the cracks when you do that.  It sucks.

            There is no real alternative.  Right now we’re throwing guys over the sides of the ship with sheets and a couple of pails of spackle and asking them to patch the hole.  It’s just more wasted effort.Report

            • Avatar DarrenG in reply to Patrick Cahalan says:

              I dunno. I still think getting ~30MM more people health care coverage and eliminating the most common ways the insurance companies screw the rest of us is worth doing.

              I’m also encouraged by what some states are doing with the framework in preparation for 2014. We’re finally seeing some decent ideas and experiments out there that could evolve into your “building something that does work.”Report

              • Avatar Patrick Cahalan in reply to DarrenG says:

                Mark T frames this pretty well, as does Tod above.

                You have what you believe to be reasonable cause to be optimistic.  I have what I believe to be reasonable cause to be pessimistic.

                We’ll see.  Time will dish up a verdict.Report

        • Avatar Aaron in reply to Patrick Cahalan says:

          No, I don’t see that.  The health care situation is a huge problem — in your analogy, the ship is sinking.  PPACA (at the very least) temporarily patches the hole and allows the ship to soldier on a bit further across the ocean.  Your argument would seem to be, “We could keep the ship moving, or we could just say ‘fuck it’ and let steerage drown.”

          I feel that keeping the ship floating, even if it still needs repairs down the road, is better than abandoning ship and letting millions drown.  Nothing false in that dichotomy.

          PPACA may not do enough to fix the problems, but it hardly makes the issue of rising costs worse.  Given that the Republicans rode to success in 2010 on a bad economy and cries of keep your hands off my Medicare, what, exactly, should have been enacted that would do more at keeping costs in line?  The answer is pretty obviously “nothing.”  So the question is, is a program that gives literally millions of people access to insurance and does something to contain costs worse than the status quo?

          The answer, to me, is an unambiguous yes.  PPACA is ugly and seriously far from ideal, but it is better than nothing.  If you’re willing to let perfect be the enemy of good, you need to explain why you think insurance companies denying existing conditions and people simply doing without and out-of-control cost increases is a superior outcome to people being insured, the end of pre-existing condition denial and some cost controls.Report

          • Avatar Patrick Cahalan in reply to Aaron says:

            In the State of California, we have a 51% majority rule to pass stuff that costs money, and a 66% rule to pay for it.

            This enables us to vote for things that sound like they’d be cool, and not pay for them.  The problems with this should be readily apparent.

            If you want to really solve a problem, and it is a very real problem, forcing the consequences to occur rather than hiding them will force people to make up their goddamn minds.

            “Do I want high speed rail?  Sure!” is a different question and answer from, “Do I want high speed rail at a cost of a 3% hike in my taxes?  Sure!”

            Giving the uninsured coverage is great for the uninsured, and (as enacted by PPACA) it’s great for insurance companies that everyone is required to get insurance.

            It also goes a long way to making sure that within, say, 15 years or so (20 on the outside), some huge insurance company is going to declare bankruptcy because they spend off all the cash they collected on the “now 20” to the “then 40” year olds and they now can’t afford to cover the 40 year olds who are getting heart disease and cancer.

            And we will then be forced to another one of these votes, where people tell us that we must either bail out the insurance company or change their coverage liability and put another goddamn patch on this stupid ship that should have sunk 5 years ago, but we’ve now kept running for 25 additional years at a huge cost.

            I want off this ride.  Now.

            PPACA embeds employer-provided health care into the system.  Employer-provided healthcare is a model that makes it exceedingly difficult for small businesses to compete in the local market, and makes it very difficult for all businesses to compete in the international market where a good number of their competitors are not required to shoulder those costs.

            I think this is bad.

            PPACA introduces a mountain of red tape.  Within 5 years, assuming it doesn’t get repealed, we will see cries of fraud and the injection of massive amounts of unnecessarily audit and oversight that cost more money than they save.

            I don’t want to go down that path.

            Of the millions of uninsured people out there right now, a goodly portion of them don’t need insurance.  They’re young and unemployed and it’s grand to think that you’re covered for diseases you’re probably not going to get and costs that you’re probably not going to rack up, but somebody somewhere is paying to cover you.  Paying to cover you at a rate that is set by the insurance company, who has all the reason in the world to set your rate as high as they can get away with, because you are the profit center.

            This is much more of a cosmetic advantage than you think it is.  Yes, there are people who actually are in dire straits, right now, today.  I would rather just pay for their medical costs and call it a day.Report

            • Avatar Kimmi in reply to Patrick Cahalan says:

              Without insurance… Do you know what that means, sir?

              A responsible person without insurance Does not Walk to the Store to buy food in the Winter (it’s icy, might slip.).

              A responsible person without insurance Does not exercise out in our free public parks.

              I could go on, but I believe the cost of a “possibly broken” ankle is set at $5000 or so.

              If you told most people without insurance that, I think they’d tell you they damn well need insurance. Because it’s not the chronic diseases they’re most at risk for, but falls etc.

               

               Report

          • Avatar wardsmith in reply to Aaron says:

            Ultimately Aaron, the Chinese won’t want to keep subsidizing OUR health care when they don’t even provide anything comparable to their own restless population.Report

  3. Avatar b-psycho says:

    In case the other thread is effectively moth-balled, I’ll repost:

    No, for the following reasons:

    -The mandate to buy a product that the proponents of the law themselves admitted sucks.  With even the minor release valve of a public government option removed, the mandate goes from heavy handed to straight up ridiculous.

    -The attempt to cushion the above with subsidies actually creates a new problem: you’ve just given the insurance “industry” a revenue stream guaranteed by the government. Profit motive + tax dollars = merciless screwing.

    -The size of the subsidies also pose a catch-22: if they’re too low they don’t actually help.  If they’re too generous, you might as well just cut out the middle man and directly pay for the care.

    -Many factors that helped make health care so expensive in the first place (allowing drug companies to extract monopoly rents from the results of tax-funded research, previous “reform” that restricted access to doctors, etcetera) are simply ignored.

    -Lastly, I have absolutely no faith in the ability of our political culture to successfully fight off calls to further regulate personal life wrapped in a cloak of fiscal concern.

    I had actually wrote extensively about the health reform fight at the time on my own site.

     Report

    • Avatar Jaybird in reply to b-psycho says:

      I have absolutely no faith in the ability of our political culture to successfully fight off calls to further regulate personal life wrapped in a cloak of fiscal concern.

      “He that will not work will not eat very quickly becomes he that will not obey will not eat.”Report

    • Avatar karl in reply to b-psycho says:

      “The mandate… ”

      A public option can still be enacted.

      “The attempt…”

      This is what public oversight is for.

      “The size…”

      So, like Goldilocks, get it right the third time.  Or look at countries that subsidize to get an idea of how it works.

      “Many factors…”

      We can stop ignoring them.

      “Lastly…”

      That’s your real objection, the rest are rationalizations.Report

      • Avatar Pat Cahalan in reply to karl says:

        > A public option can still be enacted.

        Can it?

        I ask, because if you say, “Yes”, then I’ll use that as an answer to Aaron, below.

        If you say, “no”, then retract this observation.Report

        • Avatar Aaron in reply to Pat Cahalan says:

          I’d vote for that, too!Report

        • Avatar karl in reply to Pat Cahalan says:

          Of course a public option can be passed… at some time in the indeterminate future.  I didn’t mean today or tomorrow, but one hopes that we can start  welding some of the Act’s leakier seams in January of 2013.  Don’t try to use my feeble words to parry the estimable Aaron!

          I see PPACA as the camel’s nose — more will follow.  Of course, for those of you who don’t like camels this could be a problem.  I like camels.Report

          • Avatar Patrick Cahalan in reply to karl says:

            I don’t necessarily dislike camels.

            My problem is I think this is a zebra’s nose, not a camel’s nose.  If what we want is a camel, we’re pulling on the wrong leader.Report

      • Avatar b-psycho in reply to karl says:

        Can be is not will be.  The result of legislation passing that did have the option would be the gradual death of the insurance business, because employers would dead their own insurance plans to dump costs and the option would be by default the most affordable plan — that’s why it was destroyed.

        This is what public oversight is for.

        Right, because oversight is working so well for banking.  Oh, wait, actually the public gets completely ignored and then screwed, never mind.

        That’s your real objection, the rest are rationalizations.

        You can tell this because _____?

        Besides, you say that like its an automatically invalid reason.  Why else do we have people advocating “fat taxes” or extra taxes on soft drinks, or right-wingers screaming for people applying for food stamps to be drug tested?  They want control over us, and use “your behavior could cost us money” as an excuse.Report

        • Avatar Kimmi in reply to b-psycho says:

          SEC was working. Used to work. Used to look out for small investors. Do not mistake “can work” for “is working NOW”Report

        • Avatar karl in reply to b-psycho says:

          Lots of “theys” out there doing things to us, but where is the “we”?

          Call me naive (and you’d be right) but I really do believe that we get the government we deserve.  At various times — during my life, even — existing legislation was tweaked for the better and competent public oversight existed.  We, as a nation, voted for people who wanted to throw away many of the tools that helped the middle classes prosper.

          It’s easier to break than to build.  Your frustration about our present and future might stem from seeing a problem so large that it seems impossible to solve, while for me it’s seeing the same battles having to be continually refought.  Reclaiming the government for the majority of its citizens rather than the majority of its capital is very difficult and time-consuming, it’s a campaign that never ends.Report

          • Avatar b-psycho in reply to karl says:

            Lots of “theys” out there doing things to us, but where is the “we”?

            …you’re kidding, right?

            To reclaim something you have to have first owned it.  The state backs capital against you because that’s what it was intended to do.Report

            • Avatar karl in reply to b-psycho says:

              I wasn’t exactly kidding but you got me anyway.  Just after typing “reclaim” I realized it was the wrong word for the reason you cite (the struggle endures).  I rationalized not changing it by thinking of the original claim in the name of “we the people.”  You were warned that I’m naive.

              “The state backs capital against you because that’s what it was intended to do.”

              Well said and too true (the struggle still endures).Report

  4. Avatar Steve the hyena says:

    Yes; its failings are wildly unpopular while the basic scheme–subsidizing the poor, assuring eligibility–is what we’re really driving after. That makes further reform a relatively good bet and it also puts significant government skin in the insurance game. While this could break in favor of regulation, it could also break in favor of reducing some barriers, interstate competition and expanded roles for medical paraprofessionals (RNs, PAs, etc.) in particular. Americans do have a core faith in deregulation, so I think the latter route is somewhat more likely.

    Healthcare reform requires far too many stakeholders, all of whom have a greater incentive to sit on their hands than cooperate. The only way to get this ball moving is to ram some bad law through Congress, giving the handsitters a reason to get up and push reforms. It’s sad that we have to do it this way, but politics seems to have a really high activation energy.Report

  5. Avatar Tom Van Dyke says:

    Is this the same as “I’d vote to repeal Obamacare”?  B/c so far this thing ain’t doing much for me epistemologicalistically-wise.

    😉  hi BurtReport

  6. Avatar Jesse Ewiak says:

    Can you then possibly point to a time period anytime in the next ten years where you think there’s a possibility of a better bill being passed? Because I don’t know if you noticed, but big things like health care don’t get brought up every session. They get brought up and they either die and lie fallow for a political generation (Clinton/Nixon) or pass (Obama/LBJ).Report

    • Avatar Patrick Cahalan in reply to Jesse Ewiak says:

      Can you then possibly point to a time period anytime in the next ten years where you think there’s a possibility of a better bill being passed?

      No.

      This can certainly, legitimately factor into your decision.  It happens not to factor into mine sufficiently enough for me to say, “Yea”.Report

  7. Avatar trizzlor says:

    I hope this doesn’t get interpreted as a bleeding-heart trick, but I’m curious how many people voting in this poll are themselves uninsured (or one degree away). Obamacare was a conceptual debate for me until I saw many of my friends get dropped from family plans and go for years without insurance. The way lack of insurance effected every major decision they made moved my opinion firmly into the “something is better than nothing” camp.Report

    • Avatar Aaron in reply to trizzlor says:

      I have been a long term temp in New York for going on two years now, and I don’t have insurance. I’m 32 and healthy, but I am very much starting to worry about what happens. I’m a temp, so I can’t afford to buy insurance on the private market. IReport

    • Avatar James Hanley in reply to trizzlor says:

      I’ll admit to having health care, but at times in my past not having had it (including a time I almost died).  I’m not glibly comfortable voting nay, but I still think nay is the answer because the system is so badly designed.  There was no serious attempt to learn from other countries, no serious effort to look at how we could eliminate current market distortions, etc.  And I oppose the mandate because once we cross the threshold of government being able to require you to buy a product just because you happen to be alive (it is substantively different than the auto insurance mandates, which are a consequence of choices you make), then there is no limit to what they can mandate we buy.  I think what we’ve done is fall for something that’s mostly symbolism–it will help some but harm others and will exacerbate some long-term problems instead of being a serious solution to them.

      Here’s my authoritarian solution to fixing health care (and, yes, I think PPACA is an authoritarian policy): 1) Mandate no more than 1 resuscitation for elderly people with terminal illnesses (or Americans could just quit trying to keep grandma alive when she’s nothing more than a wasted pittance of flesh);  2)  Use the threat of nuclear annihilation to force other countries to pay their share on pharmaceuticals so Americans aren’t subsidizing them; 3) Ban getting health insurance through your employer and promote people joining health care co-ops; 4) Make health insurance real insurance, for catastrophes, and make people pay more of the cost of their regular checkups and penny-ante complaints; 5) Publicly pillory anyone who goes to the doctor with a cold and asks for a prescription of antibiotics.

      In sum, a combination of fixing the serious market distortions of our current system that are a large part of the cause of the problem and changing American culture so we’re not such p****s about minor health problems and natural dying.Report

      • I think this is a little bit harsh, James, but there’s a lot of truth in there.Report

      • Avatar Andy Smith in reply to James Hanley says:

        I agree with Pat to some extent on James’ post. I like some of its kick-ass recommendations, particularly about people who go to a doctor for something really minor (though this is tricky, because minor ailments can be the sign of something very dangerous. The problem is they usually aren’t, IOW, cost-benefit analysis).

        But I don’t buy the <this is so different from car insurance> argument. Do you know anyone who chooses not to own a car just because of the requirement to pay insurance? I don’t. Most people need or think they need a car (I don’t, but I’ve given up expecting others to realize how unnecessary they are), and so they are effectively just as forced to pay car insurance as someone will be forced to pay health insurance. People simply do not opt out of a car because of the insurance, they willingly pay it, and I have never heard anyone complain that that is unfair.Report

        • Avatar Will Truman in reply to Andy Smith says:

          There are two prongs to the difference between car insurance and health insurance. The first is that car ownership is optional. No, people don’t forego car ownership for ideological reasons on the paying insurance things, but there are people who don’t own a car because they can’t afford insurance.

          The second, though, is that car insurance is geared towards protecting other people. I don’t have to insure my car against damage to my car. I only have to insure it against the damage I do to others. There are also PIP requirements in some states, but not all people who are okay with liability requirements are okay with PIP requirements (at least not as they pertain to the driver).

          Personally, I begrudgingly accept the mandate as constitutional (although I think there are better and less incendiary ways to go about it), but I do view it as a different thing as auto liability insurance requirements.Report

          • Avatar greginak in reply to Will Truman says:

            If you end up in the hospital with a bill you can’t pay the hospital has to  pass on the costs to everybody else in the form of higher rates. If you go to a local clinic that has free or sliding scale rates they will need to bill medicaid or get public funds to survive. The uninsured cost us quite a bit of moolah in the, generally poor, care they get.Report

            • Avatar Will Truman in reply to greginak says:

              I’m aware of that argument (and it’s one of the reasons that I am not ultimately opposed to a mandate), but that’s still a very different thing from the direct financial injury of someone else running their car into mine.

              In the case of health care, the cost absorption is due to laws that congress passed. In the case of cars, it’s due to the laws of physics. Using one law to justify another isn’t the same thing as passing a law to deal with an unavoidable situation (car accidents).

              More broadly, I’m not a big fan of “we all bear the medical costs…” because that rationale can be used for anything. Risky sexual behavior increases medicaid costs. We should take action! And so on.Report

              • Avatar greginak in reply to Will Truman says:

                I don’t particularly disagree however the ” laws that congress passed” basically make hospital care for people who can’t pay . What is the other option, let them die? I know you are not saying that but that is the laws in question. I don’t go for slippery slope arguments so the fear of gov getting into everything doesn’t do anything for me.Report

              • Avatar Will Truman in reply to greginak says:

                Does “If we force emergency rooms to accept indigent patients, they’ll use this as a justification to force everybody to buy health insurance” count as a slippery-slope argument? I’m not big on the slippery-slope arguments myself, but when the same people talk on the one hand about getting the government more involved in health care and then in the same week use the existing involvement in health care to justify other actions (I’ve heard it for transfats, anti-smoking regs, etc)… it catches my attention.

                I support EMTALA (to pick an example). It’s far from ideal, but I don’t have a better alternative. It does not follow, however, that I think that justifies a mandate as a means of cost containment. (In fact, the main reason I don’t oppose a mandate is unrelated.)Report

              • when the same people talk on the one hand about getting the government more involved in health care and then in the same week use the existing involvement in health care to justify other actions (I’ve heard it for transfats, anti-smoking regs, etc)… it catches my attention.

                Good catch.

                I once had a student who strongly supported agricultural subsidies even though they raise food prices.  When I pointed out that it raised food prices for the poor, she argued that obviously, then, we needed to subsidized their food purchases as well.  When I suggested that it might be more straightforward not to jack up their food prices in the first place, she thought I was nuts.

                So there’s another case of using the existing government policy as justification for yet another government policy.  I guess I’d say more “ratchet” than “slippery slope,” but it does suggest that the person making the argument hasn’t gone back to the beginning.Report

              • Avatar Stillwater in reply to Will Truman says:

                Rufus,

                It does not follow, however, that I think that justifies a mandate as a means of cost containment.

                The mandate isn’t about cost containment. It’s about universal coverage – guarantee issue, end of rescission and no lifetime caps on payouts. This is all predicated, of course, on keeping private insurance in the provision loop and the only way to get those good back end provisions from private insurers was to require the uninsured to enter the pool (otherwise people would just by insurance when they needed it). The mandate was never intended to bend the cost curve.Report

              • Avatar Will Truman in reply to Stillwater says:

                Stillwater, follow the conversation back a bit and the costs of the uninsured were being used as a potential justification for the mandate. So that’s the argument I was working off of.

                The primary reason for a mandate, in my view, is to avoid free-riderism and assure affordable insurability (with regard to PEC). I don’t think it’s the ideal way of going about it, but it is a means to that end and the Republicans haven’t put forward a better proposal for how to handle that.

                (I’m not Rufus, but you were quoting me and so I assume you were talking to me.)Report

            • Avatar James Hanley in reply to greginak says:

              greginak,

              That’s a great argument for a single-payer system that covers everyone.  And while I’m not really a big fan of that type of system, I favor it in a head-to-head contest over PPACA.Report

        • Avatar Kimmi in reply to Andy Smith says:

          We’ve got a phone number to call, in case you’ve got a “should I go to the doctor” situation. A nurse on the other end will help triage.Report

    • Avatar Plinko in reply to trizzlor says:

      I have good insurance, largely paid for by my employer, but I’m a yes voter anyway. I once had my own business, when I was young and not responsible for anyone else and it was OK to not have insurance.

      Now I have to look at my wife and daughter and know that my job is all that stands between them being able to see a doctor and not (my wife has a minor, but chronic condition that would preclude her from getting insurance up until the ‘no pre-existing conditions’ mandate takes effect).Report

      • Avatar Kimmi in reply to Plinko says:

        I’ve got some of the best insurance out there, and I say yes. Yes for every fucking woman who has ever had a blasted c-section (1/3rd of pregnancies, and if we assume that half the women get pregnant, we’re looking at roughly 1/12th of the population).

        Don’t incentivize “not bearing children”, folks.

        Yes for everyone who has ever been counseled for depression (another “preexisting condition” that persists for life)Report

  8. Avatar Tom Van Dyke says:

    Anybody want to change their vote?

    “The Obama administration has failed to meet more than half of the new health care law’s deadlines, from submitting plans for new, value-based Medicare purchasing programs to publishing criteria for determining the medically underserved.

    A report requested by Sen. Tom Coburn, Oklahoma Republican, indicates that the Department of Health and Human Services and other federal agencies missed 18 of 30 deadlines since the Affordable Care Act was passed in March 2010.

    In one instance, a National Healthcare Workforce Commission created by the law was appointed but has not been funded and has not submitted two reports that were due on April 1 and Oct. 1.

    In another example, the comptroller general didn’t submit to Congress a report on seniors’ access to vaccines that was due on June 1.

    The Congressional Research Service (CRS) searched only publicly available sources to determine whether the deadline had been met and indicated “no public information located…”

    http://www.washingtontimes.com/blog/inside-politics/2011/nov/3/more-half-health-care-deadlines-missed-obama-admin/

     Report

    • Avatar trizzlor in reply to Tom Van Dyke says:

      Tom, I’ve been unable to find anything that actually outlines what these deadlines are and how/why they were missed. Having some experience in the software industry, I can tell you that “why” a deadline was missed is much more important than a simple tally of “when”. This from a Daily Caller article doesn’t speak much for their rigor in that respect:

      Another factor making the job harder for HHS is that the health-care law’s deadlines are coming faster than Congress intended. After Scott Brown was elected to the Senate, congressional Democrats passed a Senate-passed bill in the House without any revisions – months after the Senate had passed the bill. If they hadn’t been forced to take that route, the bill’s deadlines would have likely been updated to reflect the passage of time, Troy said

      If the deadlines are from an early draft of the law that wasn’t updated due to procedural issues, I’m not sure how much heat there is to this scandal.Report

      • Avatar Tom Van Dyke in reply to trizzlor says:

        Trizz, just havin’ some fun, but it was BHO’s bill and he let down his end already. My biggest gripe about the admin is its incompetence—for example, it left posts at Treasury unfilled for months if not a year. And even the NYT was obliged to report that the admin was derelict on the whole troops in Iraq thing.

        http://www.nytimes.com/2011/10/22/world/middleeast/united-states-and-iraq-had-not-expected-troops-would-have-to-leave.html?_r=2&hp

        And ya know what?  Nobody cares.  Of course there’s no “scandal” here. Solyndra’s a scandal, Fast & Furious is a scandal, but dude gets a pass regardless, and instead the big news is the House spending 20 minutes [literally] on “In God We Trust.”

        But I care.  One reason I’m down on Obamacare is that so much was left in the ether for the Sec of HHS to decide and for the exec branch to do.  And even though BHO is patently incompetent, even a well-run admin ain’t that great.

         

        90% of life is showing up, and so is the chief exec’s job.  So if the GOP somehow nominates Herman Cain, I’ll probably have to do the unimaginable and vote for Obama, who at least knows where the bathrooms are, and on paper at least is qualified by virtue of sitting in the Big Chair for 4 years.

        And that’s the name of my tune.Report

        • Avatar trizzlor in reply to Tom Van Dyke says:

          Putting my professional-leftist hat on for a while, I do get the feeling that the right is constructing a sort of Pale Fire narrative (to borrow an old Balloon Juice theme) where many tiny acts all have a dastardly secondary symbolism familiar only to a small group of people who are really paying attention. The DOJ suppressing prosecution of the New Black Panther Party; Democrat-voting auto dealers getting Cash for Clunkers money; the Pigford II settlement; the Gibson Guitar raid; the Solyndra bankruptcy; the ATF Gunwalker operation. All of these things are not scandals, and most of them have gained only a few days of breathless speculation before being abandoned. But they each left a little imprint on the conservative mind that reinforces the stereotype of a “Culture of Corruption” in the White House. I think the real reason nobody cares is because the conservative media has given us so much not to care about that it’s hard to separate the signal from the noise.

          At this point it’s going to take a direct, actionable scandal (e.g. United States v. Libby, or the US attorney firing) for me to buy into the corruption/dereliction of duty line of reasoning.Report

          • Avatar Stillwater in reply to trizzlor says:

            Trizzlor, comments like this make me wish you were a FPer around these parts. And if you don’t mind my sayin, I think your first post should be a more lengthy exposition of price assignments under external-force. That’d be some good reading.Report

            • Avatar trizzlor in reply to Stillwater says:

              Stillwater, thanks, though I can’t imagine having the tenacity to come up with my own ideas on a regular basis, I do enjoy taking cheap-shots at the ideas of others (read: commenting). The sweat-shops v. justice post was some of the best discussion I’ve seen here and it really effected the way I think about the question. I’d love to talk more about it once I figure out, in simple terms, what I actually want to say (also, when I’m not half-way through writing a PhD thesis).Report

        • Avatar greginak in reply to Tom Van Dyke says:

          You do know that it was the Bush admin that gave out the first Solyndra loans and had two similar Fast and Furious type operations. I’m sure that will really matter to you.Report

    • Avatar Aaron in reply to Tom Van Dyke says:

      I think we have to take evaluations of PPACA from the Washington Times and Tom Coburn with several pounds of salt.  Beyond that, how many of these deadlines were up to the Administration, and how many were held up because of lack of funding and general foot dragging by the House and Republican-controlled states?  The four paragraph article (who’s only source, again, is a report requested by Tom Coburn, noted neutral party) is silent on that.Report

  9. Avatar Mike says:

    I voted yes. There are many things wrong with this bill, but I can at least count them. The number of things wrong with the health care and insurance system before this bill were uncountably greater. I believe it at least gives us a starting point to eventually develop a system like Germany, Switzerland, Japan, or France has.Report

  10. Avatar Aaron says:

    Here’s what I don’t understand: no one here is supportive of PPACA qua PPACA.  It’s flaws are numerous.  If I were dictator, our health care system would certainly not look like that.  Here’s what I want to know, if you voted no:

    1. Would the status quo be superior to PPACA?
    2. If no, what would you replace it with that could actually pass?  It’s no fair to simply create an ideal outcome and compare it to what really happened.  This has to get votes from Ben Nelson, Olympia Snow and Scott Brown.
    3. If you prefer the status quo, what do we do about the uninsured?

    Koz doesn’t believes that the law is worse than a murdering pederast with questionable culinary taste.  Pat waves at 30 million uninsured and says, “Well, most of those people don’t need insurance anyways.”  Tod bemoans the fact that PPACA doesn’t do enough to contain costs and wants to see the Democrats go dancing merrily over the cliff called Self-Defeating Politics while the Republicans cheer them on from their Free Ice Cream and Blow Jobs stand in the name of having an “honest” conversation, all while avoiding the question of what could possibly replace PPACA that would have a greater impact on costs and stand a chance of passing.

    PPACA is an obviously flawed first attempt at joining the modern industrial world and ensuring that (almost) everyone has insurance.  Does it do enough?  No, but it does something.  No one seems to be claiming that PPACA makes cost containment worse, and I’m not hearing anything about we can realistically replace it with.  Remember, progressives have a plan to replace PPACA.  It’s called single payer and I, for one, would get behind it in a heartbeat.  PPACA is the conservative option.  The fact that conservatives decided to disown it because Obama is the one who passed it is neither here nor there.  I don’t hear anyone here complaining about the great moral cancer on our nation that are auto insurance mandates.

    Status quo.  PPACA.  Something else.  Which is it?Report

    • Avatar Patrick Cahalan in reply to Aaron says:

      “Pat waves at 30 million uninsured and says, “Well, most of those people don’t need insurance anyways.”

      Ahem.  I don’t think that is a charitable reading of all my posts on the last two threads.

      1. Would the status quo be superior to PPACA?
      2. If no, what would you replace it with that could actually pass?  It’s no fair to simply create an ideal outcome and compare it to what really happened.  This has to get votes from Ben Nelson, Olympia Snow and Scott Brown.
      3. If you prefer the status quo, what do we do about the uninsured?

      To answer your questions:

      1.  I think this question is hugely gamed.  PPACA changes several things, right now, in a way that makes a lot of people better off, right now.  I believe that in the long run it makes the situation substantially worse.  Whether or not this is worthwhile to any particular voter probably depends on whether or not they’re sick right now, and whether or not they die before the worse comes about.  I’m not generally fond of these sorts of situations.  I have children, for one.

      2.  Nothing.  The Democrats had a shot at putting in a bill that would work, and they blew it.  The political capital has been spent on this.  There is no way to fix this, right now.  Get back to me in 15 years or so, maybe.  This is much more opinion than my answer to #1.  It is entirely possible that I am wrong on this and micro-corrections to PPACA over the next 15 years will produce a better outcome.  However, because of the structure of my answer to #1, I’m thinking it’s pretty unlikely.

      3.  What do we do about world hunger, Aaron?  How can you quibble about providing cancer coverage for someone who is 65 when 14 year-olds are dying right now of starvation in Somalia?  Won’t you think about the children? 

      … Now, isn’t that a very offensive question?Report

      • Avatar Aaron in reply to Patrick Cahalan says:

        1.  When you describe insuring 30 million people as a “cosmetic advantage,” I think you really lose your standing to object to someone’s characterization of your stance.  I also really fail to see how that question is at all gamed.  Even by your own admission, PPACA improves the lives of people now, in tangible ways.  You say you believe that it will make it worse, but how will it make them worse?  It helps to contain costs.  It prevents insurance companies from kicking people off their roles for developing illnesses, and it prevents them from excluding people for preexisting conditions.  What are the negative consequences, and when do they happen?  Five years from now?  Ten?  Fifty?  I am more than open to the idea of modifying it down the road, but that’s a separate conversation from whether or not it should have been passed in the first place.

        2.  That’s fine, and it’s an honest answer, but I still find it curious that you’d argue that the (possible) problems with PPACA that will crop up down the road make it clearly inferior to the status quo.  You also say that the Democrats blew it, but my question is: what could they possibly have proposed that would have a) passed and b) been better?  If you’re arguing about cost containment and other technocraticish aspects of the bill itself, you’ve more or less conceded that there is no other possible bill that could have passed.  And that’s fine, that’s a legitimate belief.  But, as someone who is uninsured, has known people with pre-existing conditions and thinks that something should be done about it, and the sooner the better, this bill, flawed as it is, is better than what existed before it.  If there will be problems with it down the road, that’s an argument for fixing those problems, not for sitting on our hands and doing nothing in the meantime.

        3.  I fail to see how this question is supposed to prove anything.  I personally believe that taxes in the US should be substantially higher than they are now, and part of that would include money for humanitarian foreign aid and disaster relief.  That being said, I am not a citizen of Somalia, and I am unable as an individual to dramatically improve their lives.  The US is the country that I have some measure of ability to try and improve, and that’s what I’m trying to do.  Controlling the costs of US healthcare doesn’t take food out of the mouths of Somalians.Report

        • Avatar Pat Cahalan in reply to Aaron says:

          “When you describe insuring 30 million people as a “cosmetic advantage,” I think you really lose your standing to object to someone’s characterization of your stance.”

          When you summarize, what, two dozen comments with one sentence, I think I have all the standing in the world to object to your characterization of my stance.

          It’s not like you need to go back and read all of the other comment threads on all of the other posts about this topic to suss out where I’m coming from.  That you say this:

          “You say you believe that it will make it worse, but how will it make them worse?”

          … leads me to believe that you’ve read exactly that one comment of mine on these two threads and nothing else.

          “You also say that the Democrats blew it, but my question is: what could they possibly have proposed that would have a) passed and b) been better?”

          This is a double-edged hypothetical.  Anything I throw out, you can say, “That wouldn’t have passed” (if it was better) or “that is worse” (if it can pass).  Give me something that you would define as reasonable criteria for “it can pass” or “it’s better”, and I’ll answer your question for you.  Otherwise I’m not going to start throwing out work just to have you pick it apart because you’re already convinced that I don’t care about the uninsured.

          “I fail to see how this question is supposed to prove anything.”

          It’s not supposed to prove anything.  When you ask questions that have no answer, with the implicit framing that there is an answer (yours), and that your answer is the correct one, I’m not really inclined to take it as a serious question.Report

        • Avatar Koz in reply to Aaron says:

          “But, as someone who is uninsured, has known people with pre-existing conditions and thinks that something should be done about it, and the sooner the better, this bill, flawed as it is, is better than what existed before it.”

          Why? What is that you believe about government finance that leads you to believe that universal coverage or preexisting conditions or whatever is an obligation that can plausibly and successfully undertaken at the moment?Report

          • Avatar Pat Cahalan in reply to Koz says:

            Universal coverage for certain types of medical procedures can be done effectively, even if you include preexisting conditions of that type.

            You will, of course, have people gripe about being forced to get coverage (which is why the public option is the more justifiable approach) and people gripe about their particular malady not being covered (which, over time, will lead to ballooning coverage unless you really keep a clamp on it).

            However, a baseline of care with supplemental insurance available via the private market is certainly doable.

            The supplemental insurance will probably be very expensive, though.Report

          • Avatar Tom Van Dyke in reply to Koz says:

            The cavemen down in Texas have a state pre-existing condition program. Go figure.

            http://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tx.html

            Viva la federalism!

             

            [Been having trouble with cut-and-paste on this site, HTML markings, too. Anybody else?  I wanted to put in the upside-down question mark on that last riff, because it would have been funny, but I let it slide.]

            Report

            • Avatar wardsmith in reply to Tom Van Dyke says:

              TVD, to highlight a link like I’ve been doing forever (mostly manually before Kain’s improved box input with the tiny type I can’t actually read) you need to type what you want to say first, then go back and highlight some of it. Then hopefully in another tab or window you’ve already found the link you want to share and have ctrl-copied it to your paste buffer. Finally since the text is now highlighted, the link icon 5 icons from the right (inclusive) on the bottom row is now available (not greyed out), you click on it and paste your link. I was hitting the lower target arrow to have my links show up in a new window but I got lazy and stopped doing that a few dozen posts ago.

              For instance I first type: pre existing condition by state, then highlight it and link it and you see the result.Report

    • Avatar Koz in reply to Aaron says:

      This isn’t a direct answer to the question but there’s an important point that I think we’re glossing over as we try to replay the policy/politics nexus in some other way(s).

      The real problem is universal coverage. If the Demos gave it up on universal coverage in July 2009 like they were supposed to, a lot of things come into play that were shut off.

      Torts, preexisting conditions, employee mobility, any number of other things can be done as reforms but not universal coverage. Anything that does universal coverage or close enough to promise universal coverage for the sake of lib amour propre, isn’t a reform. It’s a redesign, and have to engage all of the problems of a redesign.

      The libs haven’t done that, and don’t want to do that. Their only response is, the GOP is unwilling to do a redesign. Well yeah, that’s pretty much the point.Report

      • Avatar Aaron in reply to Koz says:

        As was mentioned above, you’re basically asking for the Democrats to preemptively surrender the game before it even starts.  The fact is, PPACA is a conservative plan, and no amount of tort reform is going to create enough cost containment to make the current system workable.  PPACA actually preserves the present employer-based insurance system.  That, in my opinion, is one of its biggest flaws.  If it had been up to progressives, we would have thrown most of the system out and replaced it with a universal health care system that people could add private insurance on to if they chose.  That would be a redesign.  As the last three years have proven, when it comes to Democrats giving in, there’s just no amount of “Yes” that the current Republican Party is willing to take.  What you’re proposing wouldn’t have done as much as PPACA to reign in health care costs AND couldn’t have gotten Republicans behind it.  They were for PPACA before they were against it!  And I’m not talking about forty years ago, either.  Conservatives were lined up behind something like PPACA within the last ten years.  It’s only in the last three that they’ve learned to hate it.Report

        • Avatar Koz in reply to Aaron says:

          I’ll prob have a few responses to this.

          “PPACA actually preserves the present employer-based insurance system. That, in my opinion, is one of its biggest flaws.”

          No no no. Subsidies, mandate, exchanges, that’s a redesign. A redesign leveraging the worst part of the current design, employer-sponsored insurance (as you mentioned). You have to have this redesign because the libs had to have universal coverage. If you don’t have universal coverage, you don’t have to do any of these things and you don’t have to have a redesign.

          Therefore, like so many other things, the solution to the problem is the willingness to hippie-punch the libs.Report

          • Avatar Aaron in reply to Koz says:

            I guess I’m unclear, but if modifying the employer-based health care system constitutes a redesign, what do you think they should have done?  It obviously can’t just be tort reform and the preexisting condition clause doesn’t work if you don’t have near-universal levels of health care insurance to spread out the costs: hence the mandates.  You can’t really have the one without the other.  What would you propose?Report

        • Avatar Koz in reply to Aaron says:

          “It’s only in the last three that they’ve learned to hate it.”

          Well geez, what could have possibly happened in the last three years to make them think that? It’s true I tend to have a short fuse with libs sometimes but that line of thought has got to be one of the very most exasperating things libs tend to express.

          It’s like we tested some nuclear device in a Nevada proving ground and nothing too bad seemed to happen so it’s got to be okay if set another one off in Rotterdam. Shtt changes things, in ways that are obvious enough that they shouldn’t need to be mentioned. But there’s quite a large number of libs who don’t even get it when you do explain it to them.Report

          • Avatar Pat Cahalan in reply to Koz says:

            So what changed?

            Other than a bunch of Blue guys getting behind the incarnation of the idea?

            (side note: don’t forget, I still think the idea is stupid.  But I thought it was stupid to begin with).Report

            • Avatar Koz in reply to Pat Cahalan says:

              Double digit unemployment in America is the main thing.

              Also the spectacle government finance imploding all over the world, including countries with various forms of collectivized retirement and health care. And, and accelerating old-heavy demographic environment and awareness of the consequences of that for government finance in the future.

              Pretty compelling to me, especially compared to whatever Bob Dole supposedly supported in 1994 or whatever.Report

              • Avatar Pat Cahalan in reply to Koz says:

                Those things were either going to be problems back in ’94 (people getting older, just pushed off a bit farther in the future at the time) or can happen at basically any time (recession/unemployment).

                So, basically you’re on record as saying they were stupid back in ’94.  That’s okay with me, I think that’s a fair assessment 🙂Report

              • Avatar Koz in reply to Pat Cahalan says:

                Yeah, but there was a layer of plausible deniability in 1994 that there isn’t now.Report

        • Avatar Koz in reply to Aaron says:

          “What you’re proposing wouldn’t have done as much as PPACA to reign in health care costs AND couldn’t have gotten Republicans behind it.”

          I’m not following. We could have tried something like Wyden-Bennett without universal coverage. We could have simply ended the deductability of employer health care expenses. If we did nothing, we would at least not be adding more uninsured demand.Report

        • Avatar Koz in reply to Aaron says:

          “As was mentioned above, you’re basically asking for the Democrats to preemptively surrender the game before it even starts.”

          Why not? Why don’t we stop the train until the Demos convince the American people they have something that’s worth their while?Report

    • Avatar Koz in reply to Aaron says:

      “….what could possibly replace PPACA that would have a greater impact on costs and stand a chance of passing.”

      And, they could have tried to do something do deregulate or liberalize the practice of medicine. They probably would have had to battle or do some serious negotiations with the AMA but everybody else probably would have been kosher.Report

    • Avatar Roger in reply to Aaron says:

      Aaron,

      We all weighed in on better ideas last week in James K’s Health is The War of the State piece. Do we have to repeat these arguments again? Just about everyone agreed something needed to be done, but many felt it should be very different than PPACA.

      The problems with the current reforms are that they preserve and in some cases extend much that is bad with US health care (the disconnect between benefits and cost, mandatory benefits as an excuse for rent seeking, lawsuit abuse, entry barriers,  and foolhardy top down master control of complex markets.)

      My favorite line of yours is “it does something.” Yes, it  hastens the rise in premiums and the self destruction of the market. I am starting to believe I will soon be forced to get better care for less in Tijuana  or Costa Rica. I have no idea what the poor that don’t live near the border will do though.Report

      • Avatar Kimmi in reply to Roger says:

        fly to india. okay, so we finish breaking the free market. then, after we’ve crushed the “growth companies” can we put it back together again? That’s what I want. But we can’t leave it be, because it’s already too late…Report

  11. Avatar Robert Neville says:

    Since when did central planning ever work?
    The markets obtain the best equilibrium when they are allowed to act. The problem with the now former system was not “lack of central planning” but inefficient and outdated laws restricting free market principles. PPACA creates a huge new layer of bureaucracy that will stifle innovation and harm our economy while at the same time contributing to *worse* healthcare.
    As someone involved with the machinery of health care delivery I can categorically tell you it does not reduce cost in any imaginable way.
    The argument about joining the “industrial world” is utter rubbish. Is healthcare better in the UK? I doubt it.
    Even if you take a huge leap of the imagination and conclude that Obama and Co. are competent, the whole thing is too impossibly big to manage efficiently.
    The old system was evil. The new system is even more evil. Both take away consumer choice and impose unfair conditions on the individual.
    As a thought experiment, imagine what would happen if any type of third party reimbursement were allowed for health care and that healthcare providers were allowed to provide care any way they wanted.Report

    • Any solution space will take away consumer choice and impose “unfair” conditions on the individual (for various definitions of the word “fair”).

      Consumers are for the most part really bad at assessing their own medical needs… on account o’ the simple fact that they aren’t doctors.

      People also are less inclined to be “fair” about end-of-life care when it’s their life that is ending.Report

    • Avatar wardsmith in reply to Robert Neville says:

      Excellent post Robert. Please give us more of them and share your obvious wisdom.Report

    • Avatar trizzlor in reply to Robert Neville says:

      Is healthcare better in the UK? I doubt it.

      Robert, tou’re going to have to do better than doubt. Here’s a comparison of health-expenditure in the OECD countries … guess where the US ranks? Obviously comparing the diversity of the entire US to the homogeneity of individual European countries isn’t entirely fair, so let’s look at how well socialized medicine fares in the US by comparing VA to private-sector coverage. Quite well actually. What am I missing?Report

  12. Avatar BSK says:

    Like the idea of overhauling the insurance and health care systems.  Like the idea of universal coverage.  Do not like how this bill went about it, at least as far as I understand the bill.Report

  13. Avatar Plinko says:

    Man, I wake up and I’m 400 comments behind.

    I guess I’ll pass on reading them now and just give my short take.

    I voted Yes. I don’t like a fair amount of things about it, it’s true. I liked the previous system less. The status quo ex ante was deeply unjust and yet a confluence of political forces existed to keep things that way.

    I really would love to think that there is an obvious next-best possibility, but so far I can’t come up with one. I think it’s plausible that this was the best stab that could be had now or in the near future without resorting to fantasy deals that are not politically possible, and so I’ll take it.

    Unless we’re positing that if we vote ‘no’ we get to start over and the various and sundry Gentlemen get to draft the new bill, then I’d vote no and assume we could  build a better mouse trap.

     Report

  14. Avatar Christopher Carr says:

    I voted “yes” as I would were I an elected representative, as Obamacare represents an improvement – a marginal improvement, but an improvement nonetheless – over the status quo.Report

  15. Avatar Murali says:

    I voted no because I think it exacerbates the worst aspects of the american system without mitigating itReport

  16. I voted “yes” mainly because something has to be done and this was a small step in the direction towards universal healthcare.Report

  17. Avatar Scott says:

    For all that voted yes, what is going to happen if the Supremes find Obamacare to be unconstitutional?Report

  18. Avatar Jonathan says:

    Personally, I just think it’s great that the Canadianization of the U.S. continues on.Report