Outlook favorable
March 27, 2015 12:05 PM   Subscribe

Obamacare turned 5 years old this week and the overall negative popular opinion on the legislation is starting to be replaced by positive experiences. GOP Congresswoman Cathy McMorris Rodgers (WA) found this out to her chagrin when she posted an image on her official Facebook page, slamming the Affordable Care Act and asking constituents to share their Obamacare nightmare stories. The response probably wasn't what she expected.
posted by Potomac Avenue (118 comments total) 55 users marked this as a favorite
 
To be clear, everyone on both sides knew this was going to happen from the very beginning, that's why the Republicans tried to strangle it in the crib.

Here's Bill Kristol's memo from in 1993 about the Clinton's first try:

"Any Republican urge to negotiate a "least bad" compromise with the Democrats, and thereby gain momentary public credit for helping the president "do something" about health care, should also be resisted. Passage of the Clinton health care plan, in any form, would guarantee and likely make permanent an unprecedented federal intrusion into and disruption of the American economy--and the establishment of the largest federal entitlement program since Social Security. Its success would signal a rebirth of centralized welfare-state policy at the very moment we have begun rolling back that idea in other areas.
...
But the Clinton proposal is also a serious political threat to the Republican Party. Republicans must therefore clearly understand the political strategy implicit in the Clinton plan--and then adopt an aggressive and uncompromising counterstrategy designed to delegitimize the proposal and defeat its partisan purpose.
...
But the long-term political effects of a successful Clinton health care bill will be even worse--much worse. It will relegitimize middle-class dependence for "security" on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government."

posted by leotrotsky at 12:12 PM on March 27, 2015 [57 favorites]


So much political noise without a better plan.
I work for cancer care northwest. We actually have more patients with insurance and fewer having to choose treatment over bankruptcy. Cathy, I'm a die hard conservative and I'm asking you to stop just slamming Obamacare. Fix it, change it or come up with a better idea! Thanks
It looks like she was sticking with the same old tagline -- "GOP: the party of 'No'"
posted by filthy light thief at 12:13 PM on March 27, 2015 [3 favorites]


The Republicans did a skillful job of branding health insurance reform as "Obamacare" and then propagandizing heavily against it. And why not? They did the same with words like "liberal" and "the media" -- which of course are not at all the same thing.

But if memory serves me correctly, when one polls about the individual components of the law -- no denial for pre-existing conditions, increased preventive care, etc. -- each of them polls much better than so-called "Obamacare." And, of course, the combination of a mandate, subsidies and regulation was a Republican plan to begin with, which is one reason the conservative party has utterly failed to come up with anything to replace it except the status quo ante, which not many people liked.
posted by Gelatin at 12:18 PM on March 27, 2015 [5 favorites]


To be clear, everyone on both sides knew this was going to happen from the very beginning

Except the so-called "liberal media," which kept keeps pretending that Republican opposition to their own plan is done in good faith.
posted by Gelatin at 12:19 PM on March 27, 2015 [24 favorites]


Of course, that didn't stop her from cherry-picking stories to find some negative ones., but the commenters on FB take her to task in an admirable way.
posted by CheeseDigestsAll at 12:20 PM on March 27, 2015 [4 favorites]


And, of course, even Ted Cruz is going on Obamacare.
posted by Joey Michaels at 12:21 PM on March 27, 2015 [3 favorites]


But the long-term political effects of a successful Clinton health care bill will be even worse--much worse. It will relegitimize middle-class dependence for "security" on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.


Bill Kristol is famous for being wrong about everything, but I believe that in this, he will ultimately be proven correct. And by their flailing, I believe the Republicans know it, too.
posted by Gelatin at 12:21 PM on March 27, 2015 [1 favorite]


Thanks Obama!
posted by ChurchHatesTucker at 12:21 PM on March 27, 2015 [91 favorites]


And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government

I instantly got the image of a political cartoon, where an overweight anthropomorphic elephant in a suit holds back a scrawny man in a suit with overly large glasses and a big circular button labeling him "Gov't," while some Everyperson stand-in (middled-aged guy in jeans and a baseball cap/lady with a plain dress and slightly disheveled hair) is being mauled by a giant bear labeled "Business Interests," who has a chain around his neck and the elephant is standing on a broken chain in the hand of the gov't. The elephant's speech bubble saying "Why aren't you happy I'm saving you from your government?"

Republicans try to forget they they are just as much a part of the bloated government they are fighting against, except they're focusing on business interests, which are generally against the well-being of the middle class and the poor.
posted by filthy light thief at 12:21 PM on March 27, 2015 [29 favorites]


"GOP: the party of 'No' 'We want everyone who isn't rich to be desperate and miserable'"
posted by clockzero at 12:22 PM on March 27, 2015 [2 favorites]


"postings claiming great success with Obama care are pure fabrication & have the organization of an Al Sharpton protest."

Tut-tut.
posted by Dr-Baa at 12:25 PM on March 27, 2015


One question on Congresswoman Rodgers' graphic - what does that weird line represent? I would understand it to be a downward line graph, except it doesn't continue to move forward and actually goes back in time (assuming time to be linear, moving from left to right) from "Lost doctors" (why doesn't she just send them a map, or give them directions?) to "broken website" (which "broke" because it was too popular and was strained by people who wanted insurance).
posted by filthy light thief at 12:27 PM on March 27, 2015 [9 favorites]


So I guess having my insurance triple leaving me with no other option but to cancel and go on "temporary" 6 month plans is a good thing.
posted by Old'n'Busted at 12:31 PM on March 27, 2015 [5 favorites]


Damn, those comments on Facebook are impressive. I actually saw a couple of comments that called Congresswoman Rodgers and the GOP terrorists, which is not a charge you often see leveled against the GOP. "Why don't you just go join ISIS as you seem more than happy to help harm and/or kill Americans!" made me want to slow clap. Talk about not pulling your punches.

That plus all the comments effectively calling her a bad Christian made me so happy. Nice to see some of the tools in the GOP toolbox actually being used against them for once.
posted by yasaman at 12:31 PM on March 27, 2015 [31 favorites]


filthy light thief: You're expecting some degree of intellectual coherence here. That's your mistake.
posted by leotrotsky at 12:32 PM on March 27, 2015 [3 favorites]


Let me answer your question with an anecdote, filthy light thief.

I was a precocious child, and like most smart children I read a lot but didn't always understand what I was reading. I knew that charts and graphs displaying data looked important and official, so one day, when I was maybe six years old, I drew a graph that would convey some vital information to my parents. (I don't recall the subject now; it probably had something to do with allowance or bedtime.) But I didn't understand how line charts were supposed to work, so the line was all helter-skelter and went backwards a couple of times.

So what I'm saying is that Republican politicians have the same comprehension of data visualization as I did at age six.
posted by Faint of Butt at 12:33 PM on March 27, 2015 [45 favorites]


And it will at the same time strike a punishing blow against Republican claims to defend the middle class

Do the Republicans even do this any more? Their rhetoric has seemed more and more overtly Randian -- cf. Romney's infamous 47% remarks. Of course, their public statements might indeed evolve to reflect their obvious priorities.
posted by Gelatin at 12:33 PM on March 27, 2015


The ACA meant that when I was laid off with an 8 month pregnant wife ( and no COBRA eligibility), we were still covered.

The ACA meant that when my newborn son's heart defect was found, he could get seen and diagnosed, because we were covered.

Thanks, Obama.
posted by Shohobohaum Za at 12:34 PM on March 27, 2015 [135 favorites]


Thanks, Obama.

It's funny, the Republicans' naming the Affordable Healthcare Act "Obamacare" will end up doing more for Obama's Presidential legacy than almost anything he did during his tenure.
posted by leotrotsky at 12:38 PM on March 27, 2015 [77 favorites]


So I guess having my insurance triple leaving me with no other option but to cancel and go on "temporary" 6 month plans is a good thing.

There are a few details missing from this woeful tale, but even at face value it is a good, illustrative point. A very very rare but narratively compelling failure of a government program or policy does not make that program or policy a failure. But that is essentially the Republican position - "this thing helped out everybody but ONE guy on MetaFilter! It's a catastrophe!"
posted by dirtdirt at 12:44 PM on March 27, 2015 [45 favorites]


"postings claiming great success with Obama care are pure fabrication & have the organization of an Al Sharpton protest."

black black black black black

did I mention that Obama is black
posted by internet fraud detective squad, station number 9 at 12:48 PM on March 27, 2015 [83 favorites]


My only quibble is that the cheapest plans - the ones that poor people are going to pick - have absurdly high deductibles. $6000 is completely unfeasible for an awful lot of people. You still can't afford go to the doctor; it's only good for catastrophic events.
posted by desjardins at 12:49 PM on March 27, 2015 [7 favorites]




It's funny, the Republicans' naming the Affordable Healthcare Act "Obamacare" will end up doing more for Obama's Presidential legacy than almost anything he did during his tenure

*gleeful smirk gif*
posted by Brandon Blatcher at 12:49 PM on March 27, 2015 [3 favorites]


There are a few details missing from this woeful tale, but even at face value it is a good, illustrative point. A very very rare but narratively compelling failure of a government program or policy does not make that program or policy a failure. But that is essentially the Republican position - "this thing helped out everybody but ONE guy on MetaFilter! It's a catastrophe!"

Availability is one hell of a bias.
posted by 27kjmm at 12:50 PM on March 27, 2015 [2 favorites]


Just a reminder: Ted Cruz Wants You To Believe He’s Legally Required To Sign Up For Obamacare. He’s Not.
The Affordable Care Act does not compel members of Congress to enroll in DC’s health care exchange; it simply cuts off the government contribution to their insurance plans if they buy their policies elsewhere. “The final rule extends a Government contribution towards health benefits plans for Members of Congress and designated congressional staff so long as the health benefits plans are purchased via the appropriate SHOP as determined by the Director,” a summary of the final rule says. “Nothing in the final rule or the law prevents a Member of Congress or designated congressional staff from declining a Government contribution for him or herself by choosing a different option for their health insurance coverage.”
posted by Fizz at 12:51 PM on March 27, 2015 [6 favorites]


the Republicans' naming the Affordable Healthcare Act "Obamacare" will end up doing more for Obama's Presidential legacy than almost anything he did during his tenure.

I agree, in particular because the Republicans have been so unified in their opposition. I'm sure it was satisfying to have not a single Republican vote for the plan (to say nothing of all those quixotic "repeal" votes in the House later on), but for all the program's warts, people are going to like not having the specter of financial ruin if they get sick hanging over their heads. I'm sure that 40 years from now Republicans will claim to champion this program just as they do other Democratic programs they oppose, such as Social Security and Medicare, but this time I think "not a singe Republican vote" is a legacy that will come back to haunt them.

Too, 2016 looks like it might be a good year for Democrats, and I'm sure they have a laundry list of fixes they'd like to make. If they get in a position to implement those fixes, the law will only become more popular. (Personally, I'd like to see the eventual addition of a public option; that'd be the camel's nose under the tent for eventual Medicare for All.)
posted by Gelatin at 12:52 PM on March 27, 2015 [3 favorites]


Joey Michaels: And, of course, even Ted Cruz is going on Obamacare.

It's more complicated than CNN depicts.
posted by filthy light thief at 12:52 PM on March 27, 2015


So I guess having my insurance triple leaving me with no other option but to cancel and go on "temporary" 6 month plans is a good thing.

If you had your insurance triple then I can guarantee what you had wasn't really health insurance. It was disaster insurance.
posted by Talez at 12:52 PM on March 27, 2015 [44 favorites]


*gleeful smirk gif*

_██_
(ಠ_ృ)
posted by Fizz at 1:05 PM on March 27, 2015 [9 favorites]


If you had your insurance triple then I can guarantee what you had wasn't really health insurance. It was disaster insurance.

If that. But this perception issue is certainly one of the big problems for the law. The fact that it persists is an indictment both of Republican spin and in-general political shittyness about health care spending/taxation.

Catastrophic care coverage that would bankrupt you in a serious situation looks exactly like good coverage until it bankrupts you. It's a good companion to the people who say you can deduct expense X because they have been doing it and haven't yet gotten caught. From a societal standpoint there's also the way those never-paid expenses ended up being passed on to those of us who did have insurance, a la the apocryphal $500 hospital aspirin.

There's a lot I'd like different from the ACA but I think we may mercifully, finally, be crossing over into the point where folks who want to just wish it all into the cornfield are going to have to start proposing alternatives if they don't want to be shouted down. Maybe we can eventually actually get some of it tweaked.
posted by phearlez at 1:08 PM on March 27, 2015 [7 favorites]


If you had your insurance triple then I can guarantee what you had wasn't really health insurance. It was disaster insurance.

You can? Really? Awesome! So the exact same plan with the exact same benefits from the exact same provider jumped from $295 to $940 with no other changes - you're right, it was a disaster! The best that the government web site can offer me is $725, and that is with even less benefits, none of which I am taking advantage of. And that's the same price that I can get through work.
posted by Old'n'Busted at 1:09 PM on March 27, 2015 [2 favorites]


(╯ಠ_ృ)╯︵ -██-
posted by Potomac Avenue at 1:09 PM on March 27, 2015 [10 favorites]


It's more complicated than CNN depicts.

To be fair that's actually their slogan: "CNN: It's more complicated than we depict."
posted by George_Spiggott at 1:10 PM on March 27, 2015 [53 favorites]


You can? Really? Awesome! So the exact same plan with the exact same benefits from the exact same provider jumped from $295 to $940 with no other changes - you're right, it was a disaster! The best that the government web site can offer me is $725, and that is with even less benefits, none of which I am taking advantage of. And that's the same price that I can get through work.

I call bullshit. $295/mo is straight up HDHP territory and those are still available. You don't get any sort of real insurance for $295 a month even before Obamacare making "insurance you can actually use" a requirement stopping the "we pay up to $200,000 of your million dollar cancer treatment" catastrophic insurance.
posted by Talez at 1:16 PM on March 27, 2015 [8 favorites]


Or we could just be charitable and say "Hey sorry it's not working for you, you must be in some circumstance not accounted for by the law, why don't you tell us about it so we can understand how the law works and doesn't work." Oldnbusted's story doesn't negate the huge outpouring of good will from people positively affected by the law, but it's good to know how it's fucking up too right?
posted by Potomac Avenue at 1:19 PM on March 27, 2015 [61 favorites]


Obamacare has been great for me. Like many people, I am an involuntary denizen of the "gig economy", selling my skills as a writer, video producer, photographer, social media consultant, ad copywriter and whatever the hell else I can get someone to pay me to do. Ever since I was laid off from my last job (the day before election day 2008, thanks W.) I had ruinously expensive health insurance that had a huge deductible. It was basically useless for anything except paying extortion money to Blue Cross/Blue Shield so I could see a doctor in case I got hit by a bus. After Obamacare came into effect, we were able to get decent insurance and I was able to have surgery to correct a long-time health problem. My wife was able to quit her job waiting tables and fulfill her career goals.

BTW, Old'n'Busted, my premiums went down by $80 per month this year.

Also, single payer now!
posted by vibrotronica at 1:20 PM on March 27, 2015 [14 favorites]


Come on now, lemme hear that dirty word - SOCIALISM!
posted by charlie don't surf at 1:21 PM on March 27, 2015 [6 favorites]


A very very rare but narratively compelling failure of a government program or policy does not make that program or policy a failure. But that is essentially the Republican position - "this thing helped out everybody but ONE guy on MetaFilter! It's a catastrophe!"

Don't do this. It's perfectly OK to feel that the ACA was a net good while acknowledging that some people ended up paying higher premiums (I know several) that they can't afford. You don't have to shit on those people's anecdotal experiences in defense of the law. That's seriously not cool.
posted by echocollate at 1:23 PM on March 27, 2015 [26 favorites]


There are a few details missing from this woeful tale, but even at face value it is a good, illustrative point. A very very rare but narratively compelling failure of a government program or policy does not make that program or policy a failure. But that is essentially the Republican position - "this thing helped out everybody but ONE guy on MetaFilter! It's a catastrophe!"

That's settles it, now everybody get back to posting your PRO-Obamacare anecdotes only!

I'm grateful to the bill because finally, after months and months of struggling with the federal website (Had to completely give up on the website, it never worked for me at any point.) and then working with my state offices I recently finally got a plan that is saving me a boatload of money. But I imagine that a lot of poorer people aren't going to have the endurance, time, and understanding of the process to get through it if they run into snags like I did. One reason beyond simple politics the disapproval still outnumbers the approval is that a ton of people have frustrated stories like Old'n'Busted posted. The implementation of the bill remains a clusterfuck in many ways. Every time I've dug down on people's stories their income doesn't suggest they shouldn't be getting a subsidy at least but nobody quite explained the process and the tools that are supposed to help them often don't work. There are people in your state that can help you out if you look them up.

So yeah, admit the mistakes and work to fix them, don't mock someone because your bill is kind of a mess and they aren't cheerleading it hard enough for you, despite it being overall a good thing.
posted by Drinky Die at 1:24 PM on March 27, 2015 [7 favorites]


Even my crackpot "ditto-head" Limbaugh-listening brother wants Obamacare to succeed.
posted by uraniumwilly at 1:24 PM on March 27, 2015 [2 favorites]


Keep that Muslim Kenyan dictator out of my Obamacare, eh?
posted by George_Spiggott at 1:28 PM on March 27, 2015 [2 favorites]


Keep that Muslim Kenyan dictator out of my Obamacare, eh?

His wife (my sister-in-law) has cancer and Obamacare is allowing her to quit her job and receive treatment.
posted by uraniumwilly at 1:30 PM on March 27, 2015 [4 favorites]


Actually, my employer-provided insurance got worse and more expensive, and provided my employer with political coverage to axe a bunch of stuff that did not, legally, need to go. (We had, yes, the "Cadillac plan", which is just good insurance, basically). I hate this. I really do. I try not to think about it, because I totally like Obamacare.

The thing is, I would rather have minor problems now, with the assurance that I will be able to get coverage if I need it down the road, than have perfect insurance now and no AHCA.

If I ran the world, though, I would have an appeals process for people whose costs are above median for the market (or whatever is causing the isolated huge premium rises) and some kind of process for tightening the legislation to bring those costs down. It's only common sense.
posted by Frowner at 1:31 PM on March 27, 2015 [9 favorites]


My sister's insurance went up as a result of Obamacare going into effect.....and because the GOP legislature opted not to expand the state's plan. I wonder a lot on those who got hurt where they live in regard to state expansion of Medicare.
posted by Atreides at 1:33 PM on March 27, 2015 [6 favorites]


I call bullshit. $295/mo is straight up HDHP territory and those are still available.

Yeah I also call bullshit. Zero government financial assistance, completely self-employed 1099 freelancer, I pay $450/mo for a platinum-level plan with a $500 deductible. I'd go for something cheaper but my Rx is $4700/mo without insurance, and not a single local provider covers it at anything but platinum level.

Don't ask me how I feel about pharmaceutical companies unless you're standing behind a lead wall, but Obamacare? Obamacare is making it possible for me to afford my prescriptions and not be chained to a large publisher. That's all kinds of awesome.
posted by Ryvar at 1:34 PM on March 27, 2015 [14 favorites]


I don't think it's fair or right to keep calling someone's story "bullshit" because it doesn't fit with your narrative. It's a complicated law, and it shouldn't be surprising that, even if it is highly beneficial on the aggregate, a few people get screwed. The premiums for my work-provided plan went up this year, and I still strongly support Obamacare.
posted by Edgewise at 1:47 PM on March 27, 2015 [11 favorites]


Yeah, the implementation and design isn't 100% totally ideal. This is because a) no law can ever be totally ideal in every situation because we don't live in some Platonic ether of ideal forms, and b) known flaws cannot be corrected, because Republicans insist on total implacable root-and-branch-opposition to the ACA.
posted by Chrysostom at 1:49 PM on March 27, 2015 [5 favorites]


My nephew-in-law (is that a thing? nephew? whatever) has fallen into that hole of making just enough to not totally qualify for subsidies but not really making enough to live on. He was griping about his options for non-employer issued health insurance and I had to remind him that it was the state of Utah's refusal to expand public insurance that was causing him pain, not the federal exchange. At least direct the complaint to the correct source. And my self employed father was partially motivated by insurance reasons to move to Washington State from Utah, because he could qualify there for state exchanges, not here (again, income reasons).
My kingdom for a public option...
posted by msbutah at 1:54 PM on March 27, 2015


desjardins: "My only quibble is that the cheapest plans - the ones that poor people are going to pick - have absurdly high deductibles. $6000 is completely unfeasible for an awful lot of people. You still can't afford go to the doctor; it's only good for catastrophic events."

I wish we'd have had that option when my wife had appendicitis...6k would have been preferable to 27k!
posted by notsnot at 1:56 PM on March 27, 2015 [3 favorites]


"...website" (which "broke" because it was too popular and was strained by people who wanted insurance).
Not to quibble, but people don't want insurance so much as they want health care. Democrats and Republicans alike are culpable in privileging huge profits for insurers, pharma, medical device makers/sellers, etc etc over the fundamental human right to universal health care for all. The system is still horribly corrupt, inefficient, and dehumanizing. There are still millions who lack access to basic health care in the US in 2015. This is still a sin, and the money changers still need to be driven out of the temple. That said, Thanks Obama!
posted by jcrcarter at 2:10 PM on March 27, 2015 [49 favorites]


So yeah, admit the mistakes and work to fix them

I would comfortably wager that pretty much anyone who is pro-ACA would love to do so, but the nature of the current political landscape is that there's no willingness to fix anything in the ACA on the side of the aisle making hay out of opposing it. Given that said opposition also has a long history of trumpeting fake stories of ACA failure it's hard to take complaints at face value.
posted by phearlez at 2:12 PM on March 27, 2015 [7 favorites]


So I guess having my insurance triple leaving me with no other option but to cancel and go on "temporary" 6 month plans is a good thing.

If your premiums tripled, you didn't really have insurance before. No insurance company could legitimately give you real coverage for 1/3 the price of an exchange policy.
posted by Mental Wimp at 2:12 PM on March 27, 2015 [6 favorites]


"broken website" (which "broke" because it was too popular and was strained by people who wanted insurance).

To reiterate, it never at any point worked for me even a year later due to login issues that nobody could resolve for me. It's really feels good to say, "We failed because we are so awesome!" but it's only a part of the problem. It was a botched launch and it never made it to functionality for some users.
posted by Drinky Die at 2:16 PM on March 27, 2015 [1 favorite]


Our monthly costs went up and our co-pays went up but we have really good insurance so I'm not complaining. Also we've been able to keep our son on our policy for the last few years although he turns 26 this year and we'll find out how well it works for a sub-contracting stage worker to get insurance through the exchange.
posted by octothorpe at 2:21 PM on March 27, 2015


It was a botched launch and it never made it to functionality for some users.

Are saying it still doesn't work for you? That's awful. What is it about your situation that breaks it?
posted by Mental Wimp at 2:22 PM on March 27, 2015


Are saying it still doesn't work for you? That's awful. What is it about your situation that breaks it?

I was never able to create a working login. I ended up doing what I would have done on the site over the phone successfully eventually, but then that process took another few months as well.
posted by Drinky Die at 2:25 PM on March 27, 2015


To be honest, I'm a little surprised the ACA is working as well as it has, since it was originally a Heritage Foundation idea. "Hey, instead of making sure everyone has health care, let's force everyone to buy insurance! Then let's put the guy who initially did it on the state level into the national scene and have him run against it as if it was a horrible idea!"

Single-player should never have been taken off the table in the first place, but small steps.

As for the site not working at launch (or indeed now for some folks), I am thinking that software programing and legislatures are not exactly a match made in heaven. We need InfoSec Taylor Swift as a Cabinet-level Secretary of IT, and arm her with a very, very large LART.
posted by fifteen schnitzengruben is my limit at 2:26 PM on March 27, 2015 [6 favorites]


So I guess having my insurance triple leaving me with no other option but to cancel and go on "temporary" 6 month plans is a good thing.

I'm guessing you previously had employer-provided insurance, of which you paid a very tiny portion of the actual cost. That's usually what the "my insurance tripled/quadrupled/etc" rants usually end up being. If that wasn't the case, and you were paying the full cost of your insurance, then, yeah, as others have surmised, what you had was barely usable as insurance and definitely far worse than what you have now.

This is my first year with an Exchange policy. Overall, it's a wash in terms of premium costs over the private pay plan I had last year, but the deductible is lower, so, yay.
posted by Thorzdad at 2:28 PM on March 27, 2015 [4 favorites]


Single-player should never have been taken off the table in the first place, but small steps.

Fucking blue dog democrats. They were willing to let the republicans filibuster a single payer bill despite the Ds having 60 votes in the senate. Fuck them.
posted by Talez at 2:35 PM on March 27, 2015 [36 favorites]


Yeah, and I think the ACA actually makes it that much harder to pass single-payer: it was this huge battle to pass this massive (and seriously weakened) healthcare reform bill, and now everyone can point to it and say "we already got healthcare reform, why would we do it again just a few years later?"
posted by teponaztli at 2:39 PM on March 27, 2015 [3 favorites]


I have been very fortunate to have had workplace health insurance for most of my adult working life, so the first impact Obamacare had on me was when I picked up my monthly birth control rx and it was $0.00. A year or so later I got an IUD that ended up being free after insurance resolved the billing.

My workplace insurance did go up this year, but thanks to my union it's still pretty affordable compared to the non-union staff.
posted by mostly vowels at 2:40 PM on March 27, 2015


As for the site not working at launch (or indeed now for some folks), I am thinking that software programing and legislatures are not exactly a match made in heaven.

It's not like the junior Senator from Oklahoma actually rolled up his sleeves and did the coding himself. The government did was businesses all over the world have done - they outsourced the building of the website. It was a massive IT roll-out and it was a huge mess for the first few months. That sounds like a lot of massive IT roll-outs. Nike had so many problems with its SAP supply-chain management system that they turned to i2, which essentially exploded, leaving nothing but a smoking crater and a bunch of extremely pissed off executives. Obama was nowhere in sight.

It was embarrassing for the administration, but it got fixed up reasonably quickly and is now working pretty well.
posted by It's Never Lurgi at 2:42 PM on March 27, 2015 [6 favorites]


Yeah, and I think the ACA actually makes it that much harder to pass single-payer:...

You may be right, but I'm hoping you're not. One pathway to single-payer is through the public option (e.g., allowing those under 65 to buy into Medicare-like coverage). This would be a slippery slope with virtually everyone ending up on the government plan. The health insurance industry would wither away, of course, and they will fight like hell to prevent this. But when it becomes clear it's the only way to cover everyone, we may find the political will to kill this odious industry.
posted by Mental Wimp at 2:45 PM on March 27, 2015 [7 favorites]


My only quibble is that the cheapest plans - the ones that poor people are going to pick - have absurdly high deductibles. $6000 is completely unfeasible for an awful lot of people.

While I agree completely, honestly speaking, a $6000 deductible has been kind of the average for several years now, at least for private individual polices. Before I went to the exchange, my private policy had an $8000 individual deductible. Deductibles suck, but insurance company CEOs have those boat payments to keep up.
posted by Thorzdad at 2:46 PM on March 27, 2015 [2 favorites]


It wouldn't be a super big deal if the monthly healthcare savings were enough to let low income people start seriously doing some savings, but it's mostly just going to make them a little less underwater.
posted by Drinky Die at 2:48 PM on March 27, 2015


To be sure, there are some problems with the ACA. I think the pros outweight the cons, but there are definate cons. Always keep in mind no matter how much the GOP rail against it, the ACA is essentially a Republican beast. It is was what Romney instituted, it was pretty much the Republican alternative to the Clinton heath care overhaul attempt back in the day. It is still over monetizing and relies too much on 'free market' capitalism. 'Health insurance' instead of health care.
As I indicated, I think the ACA is better then what we had, but, frankly that was a low bar to pass, despite the god awful caterwauling from so many, Instead of a 10 inch shit sandwich we are down to 5 inches or so. I still think our medical system is more broke than not
posted by edgeways at 2:49 PM on March 27, 2015 [5 favorites]


You may be right, but I'm hoping you're not. One pathway to single-payer is through the public option (e.g., allowing those under 65 to buy into Medicare-like coverage). This would be a slippery slope with virtually everyone ending up on the government plan. The health insurance industry would wither away, of course, and they will fight like hell to prevent this. But when it becomes clear it's the only way to cover everyone, we may find the political will to kill this odious industry.

The thing is, single payer isn't necessarily incompatible with a private insurance industry. Australia which has one of the most extensive single payer healthcare systems in the world still has 47% of its population covered for hospital and 57% covered for ancillaries by private insurers. There's lots of ways you can gild healthcare and make healthy profits.
posted by Talez at 2:50 PM on March 27, 2015 [4 favorites]


Yeah, and I think the ACA actually makes it that much harder to pass single-payer

Well, I don't know. The only reason that the health insurance game continues to exist now is because it has powerful lobbyists protecting what amounts to a parasitic rentier industry; if we can weaken and shrink that industry by denying them the runaway profiteering to which they grew accustomed, eventually it may be possible to destroy it completely, which would be painful in the short run (certainly now) because there is a lot of money and livelihoods involved, but would in a structural sense be much, much better for everyone, saving trillions of dollars in indefensibly gratuitous expense and ostensibly improving health outcomes at the same time.
posted by clockzero at 2:59 PM on March 27, 2015 [1 favorite]


Yes, Ted Cruz is going on Obamacare (and may this programme carry that beautiful name for a thousand years!)

But this is hardly surprising. Even Ayn Rand collected Medicare and Social Security.
posted by rum-soaked space hobo at 3:01 PM on March 27, 2015 [5 favorites]


if we can weaken and shrink that industry by denying them the runaway profiteering to which they grew accustomed...

I'm right there with you, but that's a really big if.
posted by teponaztli at 3:03 PM on March 27, 2015 [1 favorite]


As I've written about ad nauseam in my Metafilter comments, last year I had colon cancer. I was able to get life-saving surgery, thanks to Obamacare. If Obamacare never happened, I would have died. Simple as that.

It turns out I have a genetic condition that makes me extremely likely to develop more cancer, and I am going to need regular medical screenings for the rest of my life. At some point I may need more extensive (and expensive) surgery, chemo, who knows?

So every time I see one of these conservative swine on the teevee, talking about how Obamacare is the worst thing ever and it needs to be repealed and (fingers crossed behind their backs) replaced, I see people who are basically saying it's fine with them if people like me just freaking die. I mean, there is nothing academic about this. They repeal Obamacare, and millions of people, including me, are gonna die.

I'm facing one of those Angelina Jolie deals, where I can either have my guts hacked out now and deal with all the complications of that, or keep my guts in and live with the fear that things could go very bad at any time. And as I weigh my lousy options, I have to factor the madness of the conservatives into my plans and try and predict how badly they'll fuck this country in the years to come. Apparently I do not have cancer in me right now and I do not need to have my colon removed, yet. But in 10 or 15 years, if the cancer does come back, there's no guarantee I'll have insurance then. There are people out there, actively working to make sure I won't. If these shitheads get enough power, if they take us back to the nightmare days of pre-existing conditions, I'm dead.

People like Cathy McMorris Rodgers are scarier than ISIS. They don't need guns to kill. They'll kill you just as well with a pen.
posted by Ursula Hitler at 3:12 PM on March 27, 2015 [96 favorites]


Nike had so many problems with its SAP supply-chain management system ...

Whenever people talk about how private industry would do a better job at this sort of thing, I point to every SAP installation ever.

The only reason that the health insurance game continues to exist now is because it has powerful lobbyists protecting what amounts to a parasitic rentier industry

We can't get pre-filled tax returns in this country because of the tax prep industry. We're not going to lose the health care rent seekers anytime soon.
posted by ChurchHatesTucker at 3:22 PM on March 27, 2015 [13 favorites]


Not sure why there seems to be disbelief over increased premiums. I've had the same low-tier, high-deductible plan pre- and post-ACA. Paid entirely out of pocket because of no employer-sponsored insurance and an income too high to qualify for subsidies. The premium jumped 2.5-fold in 2014.

The ACA didn't magically create more healthcare dollars. It made it cheaper for many people so of course it had to make it more expensive for many others to compensate. That doesn't mean the ACA is evil or that I object to my increased premium, but it does sound silly when people try to pretend like it didn't happen.
posted by Durin's Bane at 3:46 PM on March 27, 2015 [2 favorites]


I know it's become a probably-inextricable piece of folk wisdom at this point, but can we please stop spreading the falsehood that the ACA was originally a Republican or Heritage plan?

Here's a good summary: http://www.lawyersgunsmoneyblog.com/2013/12/the-aca-v-the-heritage-plan-a-comparison-in-chart-form

Short version: both the ACA and the plan Heritage proposed in 1994 include individual mandates. But the Heritage plan's mandate was for catastrophic coverage only, not the more comprehensive covered required by the ACA. And beyond that, the ACA and the Heritage plan take completely opposite positions on a range of critical issues, including Medicaid (the ACA massively expanded it, the Heritage plan called for ending it); Medicare (ACA preserved it, with cuts to private Medicare Advantage plans; Heritage plan called for replacing with vouchers); insurance company regulation (ACA introduced community rating and generally increased regulation of insurers; Heritage plan called for deregulation).

I know it's a tempting argument to throw in the faces of conservatives who act like the ACA is the worst thing ever (even Obama has succumbed to this temptation). But really, the ACA is very different from the Heritage plan. Which is great! Because the Heritage plan would have been a terrible disaster! Instead of clinging to some tattered shreds of bipartisanship or moderation, ACA supporters really are better off arguing that the ACA is a liberal/democratic/progressive plan that is working out great even though it didn't go half far enough.
posted by burden at 3:59 PM on March 27, 2015 [10 favorites]


I, for one, think it is too soon to be judging "Obamacare" when major portions of the legislation have yet to be implemented. For example, my state has yet to appoint a single Death Panel, let alone disseminate information on how to make referrals..

[On a more serious note: There are certainly significant opportunities for improvement for the ACA and I don't begrudge anyone who wants to honestly raise those points, but why are people still giving any credibility whatsoever to political figures and commentators who have actively engaged in deliberate mischaracterization of the law since before it was even finished being drafted?]
posted by Nerd of the North at 4:02 PM on March 27, 2015 [6 favorites]


To be honest, I'm a little surprised the ACA is working as well as it has, since it was originally a Heritage Foundation idea. "Hey, instead of making sure everyone has health care, let's force everyone to buy insurance! Then let's put the guy who initially did it on the state level into the national scene and have him run against it as if it was a horrible idea!"


the basic political problem with the ACA is that people who get insurance through their employer and people who qualify subsidies and people who are on expanded medicaid each have different and opposing interests.

the success of the ACA depends on subsidies tracking the increases in the cost of medical care. the only way to increase subsidies is to increase taxes on the people who get insurance through their employer. similarly, without expanded medicaid you have a whole class of people who are mandated to buy insurance but can't afford subsidized plans. absent subsidies which track increases in the health costs and increased medicaid payments the whole plan just becomes a giant subsidy for the health insurance industry.

So, tell me, will state legislatures and congress, faced with health care cost increases, increase the subsidies in the plan taxes? or will they decrease the coverage of the bronze-level plans?

it's not that the ACA stands in the way of single-payer, it's that the ACA actually stands in the way of itself. Right now is the best the subsidized coverage under the law is ever going to be... absent some other political revolution. And, instead of a system where everyone has an interest in keeping it going, we have created a national health care law which deliberately divides people along economic lines.

The Heritage Foundation understands the political economy of the ACA, do you? Or do you actually believe that Brer Rabbit doesn't want to go into that briar patch?
posted by ennui.bz at 4:10 PM on March 27, 2015 [1 favorite]


Republican opposition to their own plan

And the Iraq war was just George W. Bush reluctantly implementing a law signed by Bill Clinton, passed unanimously in the Senate and by a 360-38 margin in the House.
posted by Hatashran at 4:11 PM on March 27, 2015 [2 favorites]


I know it's a tempting argument to throw in the faces of conservatives who act like the ACA is the worst thing ever (even Obama has succumbed to this temptation). But really, the ACA is very different from the Heritage plan. Which is great! Because the Heritage plan would have been a terrible disaster! Instead of clinging to some tattered shreds of bipartisanship or moderation, ACA supporters really are better off arguing that the ACA is a liberal/democratic/progressive plan that is working out great even though it didn't go half far enough.

Except that what you have said is that the ACA is like the Heritage plan, except that it costs more money i.e. Medicaid/care expansion, subsidies, etc.

What would have made things different is if mandated coverage was pretty much the same for everyone. This is the way it is in Germany. Instead, the "Gold" "Silver" "Bronze" requirements segment the market along political lines.

Again, the question is: On what political basis will public subsidies for health insurance increase as health costs increase? If politicians have to "rob peter to pay paul" it won't happen.
posted by ennui.bz at 4:20 PM on March 27, 2015 [2 favorites]


I've had the same low-tier, high-deductible plan pre- and post-ACA.

The differences in what's required to be covered alone make this unlikely.

One thing the ACA did was squeeze out the worst plans, which weren't much better from a societal standpoint than no insurance.
posted by ChurchHatesTucker at 4:25 PM on March 27, 2015


the only way to increase subsidies is to increase taxes on the people who get insurance through their employer

Why is this the only way to increase subsidies?

The Heritage Foundation understands the political economy of the ACA, do you? Or do you actually believe that Brer Rabbit doesn't want to go into that briar patch?


Are you suggesting that the Heritage plan included subsidies like the ACA's? Because it didn't include real subsidies; it included tax credits that would do nothing for people who don't pay federal income taxes.

On what political basis will public subsidies for health insurance increase as health costs increase?

Are you asking where the political will will come from to maintain and improve public subsidies? I'd say from the fact that voters like the subsidies and the things they pay for.
posted by burden at 4:25 PM on March 27, 2015 [1 favorite]


And the Iraq war was just George W. Bush reluctantly implementing a law signed by Bill Clinton, passed unanimously in the Senate and by a 360-38 margin in the House.

The law, according to the link, states that it is the policy of the United States to support democratic movements within Iraq. To equate this with invading a sovereign nation and deposing its leadership is the height of disingenuity.
posted by Mental Wimp at 4:26 PM on March 27, 2015 [11 favorites]


Are you asking where the political will will come from to maintain and improve public subsidies? I'd say from the fact that voters like the subsidies and the things they pay for.

But the political problem is that (one way or anther) you are taking money from people who have employer-based insurance and giving it people who are getting subsidies. You have effectively turned the health care market into a world of "makers," people who have a well-paying job with generous employer health care subsidies and "takers," people depending on public subsidies to buy coverage.

You have an unbelievably rosy view of the American electorate if you actually believe people, clinging with all their strength to their employer-based health care subsidies are going to clamor to give money to everyone else.

Again, this segmenting of the health insurance market under "RomneyCare" was absolutely deliberate and informed by an, unfortunately, accurate view of US political economy. You really have to do better than just claiming people will magically support tax increases when every trend in the last 30 years of American politics has gone the opposite direction.
posted by ennui.bz at 4:39 PM on March 27, 2015 [1 favorite]


The ACA is funded from a variety of sources, not just taxes on people with employer-based insurance. It includes, for instance, a tax on medical device manufacturers and an increase in payroll taxes for individuals making more than $250K/year (regardless of where their health insurance is from). There's nothing in the law that I'm aware of that says that increased subsidies must always and forevermore be paid for only with increased taxes on individuals with employer-based insurance. The subsidies aren't funded that way now, so I don't think your political economy model is based in reality to be honest.

Finding ways to raise sufficient revenue has been a challenge for nearly every government ever; there's no reason to think that the ACA is particularly challenged in this regard.
posted by burden at 4:57 PM on March 27, 2015 [5 favorites]


Yeah, and I think the ACA actually makes it that much harder to pass single-payer

It doesn't get harder than "never going to pass," which is where we have always been in regard to universal single payer. But if the ACA shows that government regulation can work to improve coverage, then we may be able to eventually get consideration for a public option, and perhaps full "Medicare for all" down the road.
posted by Pater Aletheias at 5:01 PM on March 27, 2015 [4 favorites]


But the political problem is that (one way or anther) you are taking money from people who have employer-based insurance and giving it people who are getting subsidies.

This makes no sense at all. Only a small portion of ACA funding comes from taxing employer-based insurance, that being the excise tax on the "Cadillac plans" (and only for the portion exceeding the annual $10200 individual/$27500 family limits).
posted by peeedro at 5:31 PM on March 27, 2015


Here's what I know about Obamacare: I have health insurance now and I didn't before.
posted by Ray Walston, Luck Dragon at 5:52 PM on March 27, 2015 [10 favorites]


Right now is the best the subsidized coverage under the law is ever going to be... absent some other political revolution.

Why is it that dynamic scoring is always demanded by the right when determining the worth of their tax cuts, but never entertained with plans from the left? It's entirely possible - and probable, IMO - that economic benefits will flow from having more people insured (and more people that were "insured" before actually insured). The costs of the ACA going forward, as determined by the CBO, have already gone down, as well as the rate of health care cost increases. At this point, doom and gloom prognostications are just that.
posted by Benny Andajetz at 6:58 PM on March 27, 2015


I can say working with many people on the low income end it has been amazing. Medicaid expansion worked out well in Chicago from what I can tell. Homeless and a citizen? Insurance no questions asked. Not dependant on looking for work Or applying for SSI. Not dependant on eligibility for food stamps.

The county hospital became it's own plan and expanded. People who were getting care from just the hospital and associated clinics had more options and even options in their neighborhood. Medicaid expansion has also allowed some big insurers to enter the picture ( such as a blue cross blue shield) which opened up a number of providers who weren't taking Medicaid at all. It has been confusing for people on Medicaid for long periods of time because they don't understand the in network concept because doctors who just took medicaid clients are now taking specific insurance plans.

People have reported greater avaliblity and choice. Also there isn't the million hoops to jump for to get charity care or get something covered through some program or donation...It is covered.

Though illinois medicaid stringent on medications (only four without preaurhorization for each med over every single month). Some medicaid insurance plans dropped the 4 med limit to be more competitive. Some dropped copays.

So my no income clients could see the doctor and get their meds filled. I cannot tell you how many times before the ACA I'd have conversations with people about not being able to afford their 1.90 copay to combat their hypertension or high cholesterol. Or their psycotropic medication. Now it is free! Yay!

The implementation has had it's downfalls. Most has been on client education for people with less than a 6th grade reading level. Information was contradictory and confusing for professionals. The help line would give different answers to people. And sometimes policy just changed on the fly.

For me obamacare has taught me even if I end up homeless, disabled, and/or without income I won't have to worry as much. Will I get the quality of care I have on my employer plan? Probobly not. Will I get a private room in a hospital? Never never. But when I'm in the ER or need birthcontrol or get hit by a car my thought won't be I'm getting in a medical hole I can never get out of. I won't need to ask how much it costs. I can let my doctors make the choices that need to be made and not my pocketbook.
posted by AlexiaSky at 8:11 PM on March 27, 2015 [15 favorites]


Late to the party here, but I just learned that Americans have lifetime caps on their medical insurance. So if you hit $1 million or something, you're done. WTF??

I have a friend whose son has serious haemophilia and who has been working hard for ten years to get his son Canadian citizenship, because the treatments he needs will exceed his lifetime maximum somewhere in his 30s.

YOU HAVE A LIFETIME CAP ON HOW MUCH YOU COST AND INUSRAMCE COMPANY AFTER WHICH YOU ARE TERMINATED?

Death panels, wot?

I don't get it. Honestly, I love you Americans but on this issue, I Just. Don't. Understand.
posted by salishsea at 11:10 PM on March 27, 2015 [2 favorites]


Not anymore: "The Affordable Care Act prohibits health plans from putting annual or lifetime dollar limits on most benefits you receive."
posted by peeedro at 11:34 PM on March 27, 2015 [13 favorites]


I'm one of Congresswoman Rodgers's constituents, to my great chagrin and despite voting for another candidate in the last 3 elections. The nicest thing I can say about her is that she and her team seem capable of telling which way the wind is blowing and adapting accordingly to preserve her position.*

* I sent a message to her office back when it looked like SOPA was going to be a thing, urging her to make the right choice for free speech and free enterprise and oppose the bill. I got a borderline-incoherent canned "this is good for business" pro-SOPA message, clearly written by someone with no idea what the bill was about. About a week later, when the backlash had even GOP headquarters walking back their support for the bill, I got an anti-SOPA mass email from her office.
posted by kagredon at 12:18 AM on March 28, 2015 [2 favorites]


Yes, Ted Cruz is going on Obamacare...

Yeah...As hand-wringingly delicious as it sounds, this is less of a story than it seems, unfortunately. He's going on O-Care because his wife is losing her employer-based coverage which he was also on. And, starting in 2014, the only health care coverage available to members of Congress by the federal government is through the federal ACA marketplace. So, yes, Teddy is going on Obamacare. But, it's the only option available to him by his "employer."

However...His salary is $174,000/year. He could easily buy a gold-plated-latinum private policy outside the marketplace. Which makes one a bit suspicious...Might Teddy be purposefully going on O-Care in order to have some kind of "I have personal experience with this horror" stump speech for his campaign? You can certainly find a policy on the marketplace that causes you problems.

For instance, when I bought my marketplace plan, on of the policies offered to me was on from Insurer-A. This policy only had a tiny subset of doctors and facilities aligned with one particular healthcare group as being in-network. It did not have my PCP of 30+ years, nor my county's only hospital in-network. It also had very few local doctors in-network. I was looking at having to get a brand new PCP and traveling 30-40 miles to go to the closest in-network hospital or imaging center.

I can easily see Cruz purposely buying a shit policy like that, just to have rigged personal stories about how "horrible" O-Care is.
posted by Thorzdad at 5:20 AM on March 28, 2015 [1 favorite]


The ACA is funded from a variety of sources, not just taxes on people with employer-based insurance. It includes, for instance, a tax on medical device manufacturers and an increase in payroll taxes for individuals making more than $250K/year (regardless of where their health insurance is from). There's nothing in the law that I'm aware of that says that increased subsidies must always and forevermore be paid for only with increased taxes on individuals with employer-based insurance. The subsidies aren't funded that way now, so I don't think your political economy model is based in reality to be honest.

honest? do you have a different model of the political economy of the ACA?

Finding ways to raise sufficient revenue has been a challenge for nearly every government ever; there's no reason to think that the ACA is particularly challenged in this regard.

there is a larger point which is that if the "left" in the US has any chance of increasing social welfare spending it has to pay attention to political economy. it's not a question of honesty, it's a question of whether you understand how the economics i.e. money of your proposed plan interacts with the politics of the society you live in. and the history of american politics current and ancient has shown just how difficult it is to tax the rich to give to the poor. it's why social security gives a benefit to everyone who earns an income and why it's tied to income at all. you can look at this thread as anecdata: after the ACA you have a bunch of people who had great coverage seeing it increase in cost and decrease in benefit, while a bunch of people who used to have trouble finding insurance are now able to get it. Do these two groups have the same interests or not?


then there's the whole other issue that they did their best to obfuscate the extra revenues needed to pay for the ACA: some of that money is coming from cutting "charity care" aid, which could end up hurting many hospitals.

the problem with "single payer now" is that the problems with the US health care are by no means just the ability for people to pay for health care: demand. There are also structural problems in the supply of health care. Parts of the health care supply are effectively "non-profit" or profit-losing i.e. primary care, gynecology, pediatrics, rural hospitals, etc. while other parts are earning enormous premiums i.e. pharmaceuticals, various specialties, etc. The only way that a "single payer" can address these IMHO deep problems is through price controls... so not only do you have to pass a single payer law, but you have to have communism now! for the health markets... which is a dubious proposition even for a marxist.

right now, with the ACA, the supply of medicine is collapsing in many regions. smaller, regional non-profit hospitals are closing. there are many many parts of the country where money will not buy the services of a particular health specialty because there are no doctors practicing it.

one of the other political problems with the ACA is that it forces the "left" to declare victory, while the crisis continues. but i guess that's the way it's going to be until the next election.
posted by ennui.bz at 7:04 AM on March 28, 2015 [1 favorite]


I'm not sure that the agreement about rural issues is true due to the ACA. Regions where hospitals are closing and doctors aren't practicing specialties has been an issue in the United States for years. Rural areas have the issue of demand as well. Depending on the region the income levels of the population are just to low to make business worth it. And some of these areas didn't expand Medicaid or don't have their own marketplace.

We still have areas in the United States who barely have water much less quality medical care.

The cool.thing about cutting charity care aid is that it is a direct response to more people being insured. If your low income they are already getting paid! And if someone with low income comes in IL at least there is some ways to retroactively apply for medicaid. How cool is that?!
posted by AlexiaSky at 7:51 AM on March 28, 2015 [1 favorite]


you can look at this thread as anecdata: after the ACA you have a bunch of people who had great coverage seeing it increase in cost and decrease in benefit, while a bunch of people who used to have trouble finding insurance are now able to get it. Do these two groups have the same interests or not?

You have an interesting take on this thread. I see lots of people who have found the impact of the ACA to be transformative or even life-saving, some who have realized smaller benefits after its introduction, and a couple (literally 2, I think) who suffered, one of whom still felt it was better overall to have the ACA than not. There may be two groups, but one is larger than the other and growing as more people benefit from the ACA. There may be small groups that want to repeal Social Security and Medicare also, but generally-speaking, providing benefits to citizens tends to be very popular and it is political suicide to try to take them back. (This is not even considering the aspects of the law that are very appealing to anyone, like not having to worry about someday being denied insurance over a pre-existing condition.)

What I see happening right now is the collapse of anti-Obamacare sentiment in the populace in general, with some death throes as this settles into a fringe position that is one of many hills to die on for the drowning-government-in-a-bathtub far right, but a joke to everyone else.
posted by snofoam at 7:53 AM on March 28, 2015 [2 favorites]


I don't get it. Honestly, I love you Americans but on this issue, I Just. Don't. Understand.

It's simple. The American health care system is not designed to actually deliver health care. It's designed to control workers.
posted by vibrotronica at 9:03 AM on March 28, 2015 [4 favorites]


It's always nice to see that in the U.S., lived experience can eventually overwhelm right wing PR/propaganda.
posted by 4midori at 9:46 AM on March 28, 2015


the problem with "single payer now" is that the problems with the US health care are by no means just the ability for people to pay for health care: demand. There are also structural problems in the supply of health care. Parts of the health care supply are effectively "non-profit" or profit-losing i.e. primary care, gynecology, pediatrics, rural hospitals, etc. while other parts are earning enormous premiums i.e. pharmaceuticals, various specialties, etc. The only way that a "single payer" can address these IMHO deep problems is through price controls... so not only do you have to pass a single payer law, but you have to have communism now! for the health markets... which is a dubious proposition even for a marxist.

There's always demand. And yes, healthcare budgets in countries that treat their citizens humanely are huge--we regularly have hand-wringing about that in Canada. The notion of 'profit' and 'market' is where your entire statement falls apart, however. Fuck the notion of healthcare as a market. Healthcare is a government service--that is, something provided by residents to each other--and therefore, yes, prices may be controlled.

As for scarcity... not a problem. The USA has how many hospitals that people can't afford to use? Legislate an actual single-payer system, and every single one of those hospitals and doctors is now somewhere that every person can access. (Distribution is another problem.)
posted by feckless fecal fear mongering at 10:21 AM on March 28, 2015 [1 favorite]


My experience with Obamacare has been that I was very lucky to have great, employer-sponsored healthcare for a very affordable employee contribution before the ACA was passed (thanks, hippie-liberal-socialist union!) and after it was passed, well, nothing changed. I didn't start having to pay more to insure all the dirty, lazy poor people who want something for nothing, and I'm mostly just really happy that so many more people have access to health care. I'm happy for them and it makes the world I live in a better place in so many ways. (Even if my contributions had gone up, I would still feel that way. No one should ever go sick or hungry in one of the richest damn countries people have ever made.)

Having said that, I have learned that I hold two principles that, for me, frame any debate about this going forward:

1. Employers should not have to provide healthcare. Connecting health care to employment is simply inhumane, and individual employers very rarely have enough influence to reform this system in any way, so often are victims of our current practices, too. side note: if Republicans were really pro-business this would be a selling point for them: we will remove the burden of providing health care from you, business-owners!

2. I believe #1 because I meant what I said above: no one should ever go sick or hungry in a civilized society, if we can at all possibly prevent it. Because our health care in the U.S. exists as a for-profit industry, generally speaking, the profit motive will always undermine this principle. Therefore, it's clear to me that the single most important factor in further reforming health care going forward is controlling costs. The only proven way to consistently control costs is, oh yes, single-payer health care.

Every argument, value, or concern I have, I have learned, is positively addressed by government-sponsored, single-payer health care. Which, of course, nearly every other affluent nation on the planet has already figured out. We are so deluded by the profit motive in the U.S., it's really a sickness, a delusion we need some real help getting past. Health care is a moral obligation we have to one another, and to see it exist in the marketplace, where people do everything they can to maximize profit is simply, egregiously immoral and inhumane to me. (And practically stupid, to boot, because it's one of least effective ways to deliver the things we're trying to deliver.)
posted by LooseFilter at 10:41 AM on March 28, 2015 [9 favorites]


(^ I'm not sure that had anything to do with the FPP, really, so I guess I should say, on-topic: ha ha.)
posted by LooseFilter at 10:45 AM on March 28, 2015


And practically stupid, to boot, because it's one of least effective ways to deliver the things we're trying to deliver

The moneymakers are only trying to deliver the absolute bare minimum possible to get maximum money back. The notion that anyone above the level of front-line doctors and nurses in the USA is interested in actually making people healthy is a laughable one.
posted by feckless fecal fear mongering at 10:47 AM on March 28, 2015 [2 favorites]


The notion that anyone above the level of front-line doctors and nurses in the USA is interested in actually making people healthy is a laughable one.

I should clarify: by 'we,' I meant all of us in the U.S., collectively. This is a democracy, sort of, and something like this is a collective concern. I realize it's quaint of me to think that people generally consider and value the collective good these days, but I expect that this notion will become considerably less quaint as things continue to get collectively shittier.

As to the moneymakers, yes, I take it as read that ducks quack and waddle, as ducks do.
posted by LooseFilter at 10:55 AM on March 28, 2015 [1 favorite]


Why is it that dynamic scoring is always demanded by the right when determining the worth of their tax cuts, but never entertained with plans from the left?

This.

Here are some of the economic benefits of Canada's single-payer system
- lower overall cost of healthcare delivery. For everybody. We don't have to support an entire layer of private insurance. The single payer has the clout to negotiate consistent rates, reducing the opportunities for gouging. (Make no mistake, there's still some pockets of gouging in the Canadian system. Ever had to buy a wheelchair for an institutionalized parent?)
- Not being locked into an employer- or union-provided primary health plan, our workforce is that much more mobile. We do have private insurance for drugs, dental and some other enhancements, but good primary care is available to all.
posted by Artful Codger at 12:44 PM on March 28, 2015 [1 favorite]


I read recently that Auntie Wynne is looking at adding dental to OHIP.
posted by feckless fecal fear mongering at 12:48 PM on March 28, 2015 [1 favorite]


if Republicans were really pro-business this would be a selling point for them: we will remove the burden of providing health care from you, business-owners!

It is. The Republican plan, going back to Romney and Ryan, is to make health insurance a 100% private purchase. The individual buys whatever plan they choose and can afford (including no insurance at all). The insurance company is allowed to charge whatever price they choose, drop people and raise their rates arbitrarily, deny service, and leave the chronically ill in the dust. The tax credit to employers for providing health insurance would be eliminated. It probably will lower the cost of the lowest-end plans, but it totally fails to solve all the insurance horror stories we hear about, and makes things worse than the status quo for established employees.
posted by Harvey Kilobit at 4:20 PM on March 28, 2015 [3 favorites]


Will I get the quality of care I have on my employer plan? Probobly not. Will I get a private room in a hospital? Never never.

I got a very nice, private room at UCLA to recover from my horrific gut surgery. When I could start eating solids again, the food was great!

So, all you have to get a lovely private room is get colon cancer that requires a fairly immediate partial resection. Simple as that!

Seriously, I wanna give Barack Hussein Obama the biggest damn hug. God bless that skinny bastard.
posted by Ursula Hitler at 9:26 PM on March 28, 2015 [2 favorites]


From 2007 to 2014 I was the communications director of a health care advocacy nonprofit here in Illinois, and we worked our asses off to get that law passed. I took that job after recovering from stage 1 breast cancer, which was diagnosed while I was between jobs and uninsured. I left it in 2014, after finding out the cancer had metastasized to my lungs, liver, and bones. During treatment, I was on my same employer-sponsored insurance through COBRA for which I paid $467 a month, $40 co-pays to my oncologist and other specialists who I was seeing sometimes multiple times a week, and $20 co-pays for medications, which were many. Got a new plan through the marketplace in December - a lower deductible, my co-pays are half what they were, all my docs are included, and my premium after the subsidy is $103 a month. As someone that will be in active treatment for the rest of her life, it is crucial that I have insurance that meets some very specific needs. With a medical history like mine, that I could get any kind of insurance at all is nothing short of miraculous.

While I was working on getting this law passed, never did it occur to me that I would find myself in my current situation, but I am now one of the people that I wanted so badly to help every day that I was at that job. Part of my gig was to find people to share their personal stories that illustrated why we needed reform; after passage of the law, it was to recruit people to speak about their positive experiences with the ACA. Now I am one of them! I jumped on that rep's question as soon as I saw it and I was really happy to be able to tell her my truth of the ACA: it's not a perfect law by any means, but I'm alive to type this because of it. I can't tell you how gratifying it was to see so many other people saying the same thing.
posted by deliciae at 12:10 AM on March 29, 2015 [15 favorites]


I didn't start having to pay more to insure all the dirty, lazy poor people who want something for nothing,

All of us with insurance (or the money to write a check for services in full) have been paying for the emergent care of folks who can't pay since the early 80s anyway. That's when St Reagan signed the law requiring hospitals to provide care to anyone who rolls up to the emergency room with a life threatening condition. Folks who will never be able to pay then default and it's all passed on to everyone else. It's the most irritating thing about this whole ACA "debate" - the opponents go on about people getting wanting something for nothing and how that's impossible. Yes, exactly right. There is a massive hidden cost with uncovered individuals. Both the services they can never pay for and the societal costs of unhealthy/untreated people.
posted by phearlez at 12:17 PM on March 29, 2015 [2 favorites]


I read recently that Auntie Wynne is looking at adding dental to OHIP.

Wouldn't that be awesome? If there is a branch of medicine that is seriously deserving of a financial come-to-Jesus moment, it's the dental world. I think dentists and oral surgeons single-handedly made outfits like CareCredit wildly profitable.
posted by Thorzdad at 2:12 PM on March 29, 2015 [2 favorites]


yooo so guess who got a $30K bill for her emergency room visit and subsequent facial surgery (it's me), with insurance saying they won't cover it without the specific doctor's notes because we all know that hospitals just call in fake charges for shits and giggles

fortunately I'm covered by worker's comp, but if I'd broken my jaw on a public sidewalk I'd be staring down the barrel of financial ruin, even if I could talk AIG into paying the 75% that THEY'RE SUPPOSED TO
posted by kagredon at 10:45 PM on March 30, 2015


Sorry to hear that kagredon. I hope you recover well and that this works out for you in the end. I can think of a lot better things to do with 30K than pay off someone who won't keep their end of the bargain.
posted by salishsea at 11:55 PM on March 30, 2015 [1 favorite]


right that's like 10000 not-fancy cheeseburgers or about 2000 quite-fancy cheeseburgers or some in-between number of cheeseburgers of in-between fanciness

i miss chewing
posted by kagredon at 12:30 AM on March 31, 2015 [2 favorites]


phearlez - I took that comment to be tongue in cheek and probably mostly directed at whatever conservative coworker /relative /bar acquaintance have heard say that and mean it.
posted by sio42 at 3:51 PM on March 31, 2015


Absolutely, and I suppose I should have been explicit that I recognized the sarcasm. But it hits one of my (sadly extensive) hot buttons on health care costs so I felt the need to be tiresome. Sorry.
posted by phearlez at 8:01 AM on April 1, 2015


I'm happy to say I'm somewhat responsible for a friend having insurance. Post Obamacare passing, we were having a conversation and she mentioned in passing that she didn't have insurance. I asked her about this and she said she couldn't afford it, even though she had some fairly expensive medications. I asked her if she had gone to the site yet and she said no. She was basing her belief she couldn't get insurance from her experiences pre-Obamacare: she has low income (but not low enough for Medicaid) and all kinds of pre-existing conditions. I told her to look into it.

So I hear back from her a bit later and she is over the moon. She had no idea the plans were subsidized. She was able to get a very inexpensive plan and now her medications, which before took a fairly sizable chunk of money, are also covered.

For me and my family… premiums went up, but this was on the tail end of spending months and months effectively uninsured because of a tiny error I made on a form — saying "Yes" when asked if we were ever denied insurance (turns out really the correct terminology was that our application was cancelled or something). Months of calls back and forth to the insurance company, frantic and pleading calls to one provider who stupidly and obstinately refused to send the insurance company the information they demanded before they would insure us, and one instance where I remember *literally groveling* on the phone, begging the (probably largely impotent) customer service representative to please please cover us. Somehow the groveling worked… a month later we received a letter saying we were insured again, after 3-4 nerve-wrecking months where we were not insured.

And really, the fact that I was so happy that an insurance company was willing to take back 2 relatively health individuals — two *customers*, really — speaks volumes about what was wrong with the industry before AHCA.
posted by Deathalicious at 4:38 AM on April 3, 2015 [1 favorite]


Yeah, the disinformation out there about the bill seems to have drowned out what it actually is and does for a lot of people who don't follow politics or healthcare issues that closely. I'm not talking about people who bought into the scare tactics, just that the scare tactics dominated the dialogue so throughly that the other side of the story was hardly even told.

The report, released Friday by nonpartisan analysts Kantar Media CMAG, estimates that $445 million was spent on political TV ads mentioning the law since the enactment of the Affordable Care Act in 2010. Spending on negative ads outpaced positive ones by more than 15 to 1.

So, even people who would never buy into right wing junk just didn't hear. Knowing that got me really upset when conservatives had a shitfit about the government trying to partner with sports leagues to educate people about the changes. Like how dare you even try and get a message out about how Americans can improve their health and well-being? Just re-reading about it today makes my blood boil.
posted by Drinky Die at 5:12 AM on April 3, 2015


Jonathan Chait: The Obamacare Doomsday Cult Struggles to Adapt to World That Did Not End
This is the reality that the entire Republican Party has failed to come to grips with. The American health-care system before Obamacare was an utter disaster — the most expensive in the world and also the only one that denied access to millions of its own citizens. Obamacare set out to change those things, and it has worked.

There is one remaining indictment of the law that Tanner makes, and it’s true. “The law remains extraordinarily unpopular, with opponents topping supporters by nearly 11 percentage points, according to the latest Real Clear Politics average,” he argues. It is notable that opponents of Obamacare have fixated on the law’s poor polling. In a recent column, Reason’s Peter Suderman quibbles halfheartedly with the law’s demonstrable success in carrying out its goals — suggesting that the astonishing drop in medical inflation may be owed to outside forces — before reveling for six paragraphs in his major point, which is continued lack of public approval. “Obamacare is simply not well liked,” he concludes, “This is the political reality — and President Obama still refuses to embrace it.”

It is telling that, having lost every substantive argument about the law’s operation, their sole remaining refuge is an argument about its perception. It’s true: Their lies got halfway around the world before the truth could get its pants on. Indeed, if you google most of the factual disputes I discuss above, you’ll get a lot more hits from conservatives making hysterical and false predictions than you will find from reports showing those predictions failed to come true. Those myths still hold enormous sway over public opinion. Far more Americans believe Obamacare has death panels, which is false, than believe its costs have come in under projections, which is true. Conservatives have won the propaganda war over Obamacare. The trouble is that they think this is an indictment of Obamacare, when in fact it’s an indictment of them.
posted by zombieflanders at 6:36 AM on April 3, 2015 [6 favorites]


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