Obamacare grows up

The states where most Americans live are adopting key provisions of Obamacare (Map:  The Advisory Board Company)  http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap#lightbox/2/

The states where most Americans live are adopting key provisions of Obamacare (Map: The Advisory Board Company) http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap#lightbox/2/

Last week, NCPR launched a series of in-depth conversations with local medical professionals and experts, the people who will shape how our hospitals, nursing homes and first responder services look over the next couple of decades.

Our first conversation was with Dr. John Rugge, founder of the Hudson Headwaters Health Network, who talked about the implementation of Obamacare this way:

This is the necessary starting point. I mean the fundamental decisions were: we’re not going to have universal healthcare, we’re not going to have government run healthcare, we’re not going to have a single payer.

We are going to build on the system we have, which means federal-based care. Lots of different insurance companies, lots of experimentation at the state level, with lots of authority at the local level, in terms of how it’s to take place.

We need to learn from the best results and adapt to them.

Again, reminded that the same kind of political attacks were made on social security and on Medicare when they were first implemented—this can’t work, this is going to be a bad law, we can’t afford it.

They too had to be adapted and eventually became part of our life.

There are growing indications that we’re on the road to this reality.

For all the sound and fury that still unfolds in Congress, Obamacare is the defining law shaping medical care for a growing number of Americans — indeed, the majority of Americans.

Even a growing number of Republican and conservative governors are buying in, from Florida to North Dakota.  This from the coverage of the debate in Arizona from Forbes back in January.

Earlier this week, [Arizona Governor Jan] Brewer recommended that Arizona go along with Obamacare’s Medicaid expansion.

Previously, parents and childless adults in Arizona were eligible for Medicaid if their income was below 100 percent of the federal poverty level.

Gov. Brewer’s expansion would expand Medicaid eligibility to adults with income between 100 and 133 percent of FPL, and take additional federal money to fund Medicaid for childless adults below the poverty line.

“By slightly expanding eligibility for Arizona’s Medicaid program,” said Brewer in a statement, “Arizona will receive $7.9 billion in federal funds over four years…This money will not only insure hundreds of thousands of low-income Arizonans, it will be an economic boon and help maintain the viability of rural and safety-net hospitals feeling the pinch from growing costs of uncompensated care.”

Brewer has since clashed with members of her own party as she works to force Arizona’s legislature to adopt Obamacare.

Meanwhile, a new poll from CNN finds that 43% of Americans support the new law, while another 16% say it’s not liberal enough.

That means a whopping 59% of people think Obamacare is the right approach — or want even more government involvement in healthcare.

What’s clear from all sources is that the law will have to be tweaked over time.  But as histrionics about death panels and socialism fades away, it will be easier for thoughtful reformers, on the right and the left, to step forward.

So what do you think?  Is Obamacare working for you and your family?  Do you think fears about the program are still justified?  Do you think the program can or should be repealed at this stage?



51 Comments on “Obamacare grows up”

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  1. knuckleheadedliberal says:

    I am looking out my window and the sun is shining, so to the best of my knowledge the world has not yet ended. My insurance company increased the premium (why do they call it a premium?) something like 12 or 14 percent, basically like they have nearly every year – some years a little less but always an increase, and we switched to another plan with higher co-pay and deductible, just like we have done nearly every year we’ve carried health insurance. So now my premium is about half of what it was but I am responsible for the first $1,000 of any medical treatment. In other words, I haven’t noticed any change and I still want Single -Payer Universal health care.

  2. Jim Bullard says:

    I have good insurance but like Knuckle I still think a single payer system was the better way to go for society as a whole. I maintain the hope that we’ll get there someday. Perhaps 20-30 years down the road once the naysayers get used to everyone (or nearly everyone) having health insurance and the world hasn’t ended, perhaps they will come around and realize that it would be more efficient without 500 different payment systems per state.

    As for the statistical support, I seem to recall that support for a single payer system was around 70% until the far right launched a scare campaign of lies about the death panels, the total collapse of democracy and all we hold near and dear.

  3. Mayflower says:

    Be aware, however, that this Congress has moved beyond staging ceremonial votes to kill health care reform. More critically, it is refusing to allocate the funding necessary to implement the law. And now the Congress has announced an “investigation” in its attempt to bar implementation funding from private sources.

    Many of us preferred a single payer system. Fair enough; we didn’t get exactly what we wanted. It is time, however, to understand that our glass-half-full can still become a bone-dry mug if this contrarian Congress succeeds.

    It is time for the entire 59% to get aboard.

  4. Pete Klein says:

    Where is our governor when we need him?
    What we need is a 2% cap on both the cost of health insurance and the cost of health care.
    As long as the cost keep rising, we are screwed.

  5. The nation as a whole isn’t going to have single payer. Which means that we are condemned… correction, we have condemned ourselves… to, every generation, reduce ourselves to putting a band aid on a flesh wound. Obamacare is merely the latest half-a**ed measure in that regard. The system is fundamentally broken (at least for citizens) and all the solutions by the “mainstream” politicians and talking heads involves merely tweaking around the edges. Though it looks like Vermont IS going to have single payer. So at least one part of the country will lead the way with something rational. I assume most of the rest of the country will remain to ideologically rigid to follow something that actually works.

  6. Pete, the governor would only do something like that if he could make it an elaborate shell game that made himself look good without doing anything concrete and passing the burden on to others. That’s his specialty.

  7. The only beneficiaries of Obamacare are the insurance rackets, since the government now compels everyone by law to buy crappy private insurance as a condition of citizenship (unprecedented in American history for a private commodity to be mandatory for all). That’s why they didn’t launch the same scare campaign against Obamacare as they did against Medicare for All because they benefited greatly from it.

  8. Peter Hahn says:

    The disturbing part is that the Republicans are blocking any improving tweaks because they want to be able to run against any unanticipated problems that Obamacare produces (rather than try to fix them).

  9. Paul says:

    I have given up debating this issue. Let’s just see what happens. Hope it works out well. If we can’t take care of as many people as we had hoped we can always have the IRS help us screen the folks out that we don’t care about.

  10. The Original Larry says:

    Don’t worry, single payer will soon be the only alternative. Obamacare will destroy the health insurance industry. Too bad people will die and be bankrupted as we go through the transition. Another example of a nice idea that will not work in the real world.

  11. scratchy says:

    We want single payer! We want single payer!

  12. knuckleheadedliberal says:

    Larry, don’t you understand that ObamaCare was designed not to destroy the health insurance industry but to save it?

  13. jeff says:

    Far too soon to declare it is even growing up. T’aint even weaned yet. The free stuff was front loaded- like tacking on people up to age 26 & including pre-existing conditions. The child isn’t even leaning into the load- fees on medications, preventing use of medical savings plan monies for certain purchases and taxing the healthcare plans and actual recipients of benefits all to come ahead.

    A cap on the cost of insurance and medical costs? How about a cap on Social Security, Medicare, Medicaid and food? Fantasy world. Ludicrous.

    The whole economy is based on growth and financing that growth and taxing the parts in-between and beyond. Rein in everyone to subsistence levels and the economy will wither because those with resources and those investing in those resources(pensions, 401Ks etc.) will go where the financial return warrants investment. The schools and counties with declining populations. The whole stimulus and quantative easing project was to get money flowing because we want to conserve what little we have. And people want to cap what someone can earn or have to invest in research? If a committee has to sit in review of every venture, Lindberg would never have left the coast.

    The only way to take the route of goverment control is for it to control everything, what you are paid and what you are taxed. I met a man who was willing to lay down and die like that. No vision. No ambition. “Take my check and give me what is left over.” At least a burglar tries to improve his lot.

  14. jeff says:

    Clarification- the schools and counties with declining populations exemplify withering income with burdensome costs.

  15. The Original Larry says:

    That’s the sarcasm thing, right?

  16. mervel says:

    I don’t know? For me and most Americans the bottom line will be what happens to what my family has to pay for health insurance in the next couple of years? Right now I think it is far too high, I assume that this bill will make it less expensive. If it goes up like it did this year, then no I will be against this bill and the program.

    Without rationing, without restrictions on what we pay out, without true cost control, I don’t see how this can work? Right now it looks like they are simply saying to rural areas we are going to pay you less than what it costs to provide care, and thus we in the North Country will lose services, this has been what has been happening to date (see numerous stories on this very blog). We may end up with no health care at all regardless of the price.

  17. knuckleheadedliberal says:

    No Larry, that is completely serious. The escalation in the costs for healthcare and insurance for health care were rising so rapidly that very soon the whole system would have collapsed because many people (myself included) would have stopped buying health insurance because it has become unaffordable. Look at the escalation in costs for municipalities, and school districts; ask any business owner who provides health insurance.

    Ever since the first job I had that provided health insurance the pattern has been the same; a major escalation in cost every year which is balanced by either a reduction in coverage or an increase in the employee share of the cost, and sometimes both. So, lo these many years ago in my first adult insurance interaction I had pretty good insurance through Blue Cross. Family coverage with some eye, dental and full prescription. No copay. Now I have a plan that seems like it will cover most medical needs, but with a $1,000 deductible, $30 copay for the doctor and $100 copay for emergencies, no dental, no eye care and no prescription. Good thing I’m pretty healthy, but that doesn’t seem like progress.

    By the way, nearly every company I every worked for that provided good health insurance is now out of business. Not specifically because of health insurance but because things change and they didn’t keep up. Believing in “free-market” health insurance is one of those ideas that people need to re-assess or they will be left behind. The structure of the health-care/health insurance system in this country has been on the verge of collapse and people like Dr. Rugge have been scrambling to patch it together — without HHHN there wouldn’t be doctors in about a quarter of the Adirondacks. Go look at HHHN’s office complex in Queensbury. Not the health centers but the paperwork office. How many people work all day long shuffling paper, or electrons in order to keep that whole system together to cover a minuscule portion of the population of the country? Does it seem at all efficient to you?

  18. wj says:

    Larry might have a valid point.

    It seems like some of our biggest problems in the 21st Century are the solutions dreamed up in the 20th.

    Still, the ACA is an attempt to provide more people with access to American healthcare. At its root, it is a manifestation of compassion – and that’s generally yielded better results than policies fueled by ignorance and fear (or outright hatred), like DOMA.

  19. Walker says:

    “The only way to take the route of goverment control is for it to control everything, what you are paid and what you are taxed.”

    That is pure tea party bunk! We’ve had greater and lesser degrees of “government control” from the outset. There is no government without some degree of “government control!” What do you think “government” means? Hint: it’s based on the verb “govern,” which means to control.

    And anyone who has a clue about how economics works recognizes that capitalism cannot function without an effective government.

  20. knuckleheadedliberal says:

    Larry might have a point if the objective of ObamaCare is to make the private insurance industry die by requiring nearly everyone to buy private insurance. Maybe we can bloat them to death.

  21. jeff says:

    Yes Walker we have always had varying degrees of government influence. But as one above suggested, price controls on costs of insurance and healthcare- necessarily extends to controls on everything else because if one sector has its financial hands tied, another will have to be restrained then another. Thus total price control… to be “fair.”

  22. Pete Klein says:

    My suggestions for a 2% cap on health care and health insurance was meant as a dig on the 2% cap on school and local government budgets.
    The problem with health care is health insurance. The problem with health insurance (for those who have it) is it creates an indifference to the cost of health care. If everyone had to pay for what they use of the health care system, they would think twice and more about what they can afford.
    Fact of the matter is that health insurance destroys “free market capitalism.”

  23. Walker says:

    No they don’t, Jeff. We already have controls on utility prices, for instance, and that hasn’t spread. In 1971 Richard Nixon imposed wage and price controls temporarily, and capitalism survived. This is another example of the bogus “slippery slope” argument. It is false.

    Have you noticed all of the other advanced nations of the world, virtually all of whom have single-payer health systems, sliding inexorably into communism? Yeah, right.

  24. Walker says:

    ‘Fact of the matter is that health insurance destroys “free market capitalism.”’

    So does the existence of fatal diseases and condition. How much is your life, or child’s life, worth to you? How confident can you be that you understand claims made by drug manufacturers or doctors. The “magic of the marketplace” depends on complete, accurate information about the goods offered. How many of us have complete, accurate information about health care matters.

    Health care is a lousy fit to capitalism.

  25. Mervel says:

    The basic model is broken, trying to fund and or pay for an unsustainable model in my opinion is not going to work. But I could be wrong, to me health care finance is complex and confusing, no one can give one straight answer about why we have the most expensive health care in the developed world?

  26. Paul says:

    Even in a single payer system capitalism would be an important part of how it would still work (most of the European systems we have talked about) , or would you advocate for a single provider system?

  27. hermit thrush says:

    the takeaway from krugman’s column monday on obamacare:

    So yes, it does look as if there’s an Obamacare shock coming: the shock of learning that a public program designed to help a lot of people can, strange to say, end up helping a lot of people — especially when government officials actually try to make it work.

    read the whole thing!

  28. knuckleheadedliberal says:

    I can tell you why we have the most expensive healthcare in the developed world, because our political leaders answer to monied interests and not to poor people.

  29. knuckleheadedliberal says:

    The problem with the idea of healthcare being a market based enterprise is that for a free market to work properly the players need choice and the knowledge to comparison shop — not to mention that they need the ability to walk away from a product or service they feel is over priced. When the alternative is death many people find it difficult to make logical decisions. Medicine is highly specialized knowledge and there are numerous uncertainties. Every single “customer” is unique with individual circumstances, lifestyles, histories, etc. Sometimes the flu is just the flu; sometimes it is Lyme disease or Valley Fever…it isn’t like going to Price Chopper and Hannaford and Grand Union and comparing prices on soup, nevermind that the prices are always a mystery to the customer.

  30. Marlo Stanfield says:

    Whatever else you want to say about Obamacare — and I certainly don’t think it was perfect — 40 million people who didn’t have health insurance before are going to have it. That’s an accomplishment.

    Before, people were always talking about how the uninsured drive up insurance costs, by going to the ER when they really don’t need to and by waiting until they’re gravely ill before getting checked out. Well, in a few years we should be ale to tell if that was really the case, see what the impact is.

  31. Jeff says:

    Good point Walker although the controls on utilities like electric and telephone are there because they have monopolies in defined territories. They are not the free market and the controls were instituted early in the technology when it had become obvious how problematic running separate wires to neighbors was. The healthcare system has an established structure in a competitive market in which prices are reviewed by state regulators. Since the utilities are not an open market I cannot dismiss the belief that price controls applied where sellers are free to move their investments will negatively affect the economy. The twist that the healthcare bill forces purchase of a healthcare product (perverted as that is) is itself a control on the market that guarantees a customer base.

    I think it would have been better to distribute uninsured clients among existing carriers as is done in auto insurance with high risk clients.

  32. The Original Larry says:

    Waving a magic wand might give 40 million people “insurance” but it will shortly be worthless because you can’t add people who are uninsurable or who have pre-existing conditions or who can’t pay their premiums to the system and expect that system to function normally. By the time we find out that it doesn’t work we won’t be able to go back and nobody will have insurance, especially those who have it now. The answer for your 40 million does not lie in the destruction of a system that serves so many others fairly well.

  33. Peter Hahn says:

    Larry – the only way you can do that (add those uninsurables and pre-existing conditions) is to also add all those healthy young people, which is what the act does for exactly that reason.

  34. Paul says:

    Never quite understood why the strategy wasn’t to just do the part of the law that requires everyone to purchase some kind of insurance? Seems like that would have been less of a fight. There would certainly be strong support for that among the insurance companies and political pressure laid on anyone opposed by their lobbyists. Lots more business for them (very good for the economy). Not sure all the need for these exchanges etc. The point is to get insurance to the folks that don’t need it to draw the cost down for everyone just like with cars. They don’t need care we just need their cash. To me that seems like the free market solution, problem solved, let’s go to happy hour!!

  35. Paul: there’s a significant difference between health and auto insurance. Obamacare makes buying health insurance a condition of citizenship imposed by the force of law. Auto insurance is different. If you can’t afford or don’t way to spend your money on auto insurance, you can simply choose not to drive a car (like I’ve chosen). You don’t have that choice with health insurance, thus accommodations have to be made for that fact. Of course, the more common sense thing would have been to bring about single payer. Instead, Obamacare is the first law in American history that mandates everyone buy a private commodity. Typically, if we require everyone have a service (fire protection, military protection, police/sheriff), it’s a public commodity funded by tax dollars.

  36. mervel says:

    That’s the moral hazard right there. The people that choose to buy insurance will not be turned away at the ER when they have a heart attack or an accident. So then we the society pay.

    However I agree with your basic philosophy, I don’t see how we can mandate people to buy something from a private company.

    The other option would be to be much more tough on people who refused to pay for health insurance and still used medical services. Make medical bills like student loan payments, you can’t get rid of them through bankruptcy for example. Now right now I would be totally against that as many many people have zero options for health insurance and they have no choice but to rack up medical bills they can’t pay. But if Obama care does provide a cheap insurance alternative and people still refuse to pay, well that may be a different story.

    It will be really interesting to see how this really works. Will health insurance really be offered at low rates to those who need it?

  37. knuckleheadedliberal says:

    “you can’t add people who are uninsurable or who have pre-existing conditions or who can’t pay their premiums to the system and expect that system to function normally”

    It would be so much easier if all those people just committed suicide in order to save the rest of us some money.

    (yes, that was sarcasm)

  38. knuckleheadedliberal says:

    Brian myofc is correct in that it is wrong to force people to buy a product or pay a fine. That is why we should just have a Universal system funded through income tax. If you think it through the logic is inescapable. Some people may not like the logic, but the logic is the logic.

  39. The Original Larry says:

    Anyone with the slightest understanding of how insurance works knows that insurance is neither the problem nor the solution. Certainly something must be done for those who are uninsurable or who lack the means to pay premiums but to forcibly dump them on insurance plans or mandate participation isn’t the answer. Stupid comments like hoping the uninsurable commit suicide and the implication, however sarcastic, that people actually advocate that are not the answer either. You can always count on the liberal side to throw around an outrageous accusation wrapped in a snotty remark and then call it sarcasm, as if that excuses it.

  40. knuckleheadedliberal says:

    Larry, the point is that the system isn’t functioning if it doesn’t include people who are “uninsurable” or have “pre existing conditions”.

  41. Walker says:

    “Instead, Obamacare is the first law in American history that mandates everyone buy a private commodity. Typically, if we require everyone have a service (fire protection, military protection, police/sheriff), it’s a public commodity funded by tax dollars.”

    Well, yes and no. What about people in states with for-profit prison systems? They’re forced to pay for a privately provided commodity. Or all those for-profit military contractors… same thing.

    I know, it’s different. Sort of. To me, though, it’s a difference without a difference.

  42. mervel says:

    Everybody becomes uninsurable at some point in their life, just by the simple fact that we all age and we will all get cancer or heart disease or something which will in the end kill everyone of us, from a medical insurance perspective if you only wanted to insure healthy people you would stop offering any insurance after age 50 or 40 for that matter.

    Very very few people die after being perfectly healthy. Almost all of us will go through a process of dying, one that could last decades for some people. So we have to as a society that is compassionate and civilized decide how to provide health care to everyone, that means universal insurance or universal care.

  43. Walker says:

    Good point, Mervel!

    Incidentally, the NY Times has a piece on medical costs that might interest you: The $2.7 Trillion Medical Bill; Colonoscopies Explain Why U.S. Leads the World in Health Expenditures

  44. Walker says:

    Don’t miss the bit at the end specifically on colonoscopies, titled “A Market Is Born.”

  45. The Original Larry says:

    Everyone “knows” that Obamacare is going to be a good thing but nobody has a clue how insurance works, including the clowns who wrote the law. Giving “insurance” to people who don’t qualify medically doesn’t make it insurance, it obligates the healthy to pay for the unhealthy. Where have we seen that principle in action before? I don’t mean to suggest that the unhealthy be left to fend for themselves; not at all. Insurance, however, is not the answer to their problem. It just won’t work if you upset the actuarial calculations on which insurance is based.

  46. knuckleheadedliberal says:

    I agree. That is why insurance is not an appropriate way to deal with health care. That is what I’ve been telling you all along. We need a single-payer, universal system.

  47. knuckleheadedliberal says:

    For those of you who are deeply religious, why isn’t it a moral issue that people’s health, people’s life and death decisions are so deeply entwined with their financial status? What would Jesus do?

  48. The Original Larry says:

    It was Robin Hood who stole from the rich to give to the poor, not Jesus.

  49. hermit thrush says:

    i think larry should be a little more cautious with who he’s calling “clowns” when it comes to health insurance, since overall the health insurance industry has been firmly behind obamacare from the get-go. maybe he knows more than they do, but i’d hate to see that come back to bite him.

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