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BREAKING HARD: Obama Care on Life Support?

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Re: BREAKING HARD: Obama Care on Life Support?

Postby kurt_w » Tue Feb 01, 2011 1:54 pm

Now we're just trying to find out what's in the bill?


There are quite a few provisions in the ACA, some of which have already taken effect and others of which will be coming along soon. You can get a helpful timeline right here.

Provisions that have already taken effect include:
    * Prohibiting insurance companies from denying coverage of children based on pre-existing conditions

    * Prohibiting insurance companies from unilaterally rescinding coverage

    * Eliminating lifetime limits on insurance coverage

    * Providing external review for appeals of insurance company decisions

    * Providing health insurance tax credits for small businesses

    * Fixing the Medicare Drug benefit by closing the prescription drug "donut hole"

    * Cracking down on health-care fraud

    * Allowing young adults to stay on their parents' insurance plans up to age 26
Provisions that take effect in the future include:
    * Reduction in paperwork and administrative costs (2012)

    * Expanded preventive health coverage (2014)

    * Tax credits for middle-income households purchasing insurance (2014)

    * Establishing competitive health-insurance exchanges, open to the public (and required for all members of Congress) (2014)

    * Mandate requiring individuals to either carry insurance or pay a fee to cover the costs of medical care for the uninsured (2014)

This is not the way I would have chosen to pursue health-care reform -- it's mostly a lot of band-aids to fix glaring problems with the current system, while not eliminating the fundamental reliance on private companies to provide health insurance. It may slow the growth of health care costs, but it will still leave America with the most expensive and inefficient health care delivery system in the OECD. However, it's certainly a vast improvement over doing nothing.

I don't expect the Supreme Court to toss the ACA out. If they did, it would negatively impact a large number of people.

It would also probably mean that no significant changes would be made to health care financing in this country for at least the next decade. During that time, costs would continue to rise, US companies would become progressively less competitive, and more and more households would suffer from the kinds of infuriating problems that are created by the pre-ACA system.

Eventually, the current system becomes unsustainable. The ACA was a basically conservative attempt to prevent that -- mitigating some of the worst problems, but leaving private health insurance basically intact. If that attempt were killed (either by the Court, or by the GOP) the next attempt would likely be far more radical, but many people would suffer greatly during the "lost decade" of delay.
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Re: BREAKING HARD: Obama Care on Life Support?

Postby kurt_w » Tue Feb 01, 2011 5:04 pm

So to make a long story short, there are actually two reasons why conservatives ought to be praying that PPACA is upheld:

(1) This is the conservative version of health care reform. If it's rejected, the next one will be more radical.

(2) If you read the Hudson and Vinson decisions, the two (out of ~16) courts that found PPACA unconstitutional are engaged in pretty blatant "judicial activism". If you've swallowed the right-wing propaganda about PPACA, you might be happy to see it killed. But are you sure you want to encourage "Legislating from the bench"? Because that's what Vinson and Hudson are doing.
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Re: BREAKING HARD: Obama Care on Life Support?

Postby jman111 » Tue Feb 01, 2011 5:27 pm

Just remember this from the conservative playbook: it's only "Judicial Activism" if you disagree with the decison. (In this case, I'm sure it's purely objective adjudication.)
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Re: BREAKING HARD: Obama Care on Life Support?

Postby ArturoBandini » Tue Feb 01, 2011 6:18 pm

kurt_w wrote:(1) This is the conservative version of health care reform. If it's rejected, the next one will be more radical.

We're shakin' in our boots. What evidence do you have that suggests this is true? Whether future health reform is radical will most likely depend on the radicalism of the ruling party. Are you expecting a tidal wave of progressivism in coming years?
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Re: BREAKING HARD: Obama Care on Life Support?

Postby fennel » Tue Feb 01, 2011 7:19 pm

ArturoBandini wrote:Are you expecting a tidal wave of progressivism in coming years?
Tunisia, Egypt ... Who knows? Or we could fall prey to the invisible hand of the Fox Brotherhood movement.
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Re: BREAKING HARD: Obama Care on Life Support?

Postby kurt_w » Wed Feb 02, 2011 8:22 am

ArturoBandini wrote:
kurt_w wrote:(1) This is the conservative version of health care reform. If it's rejected, the next one will be more radical.

We're shakin' in our boots. What evidence do you have that suggests this is true? Whether future health reform is radical will most likely depend on the radicalism of the ruling party. Are you expecting a tidal wave of progressivism in coming years?


No, I'm not expecting a "tidal wave of progressivism". I'm expecting the inflation-adjusted costs of health care to continue rising.

Do you understand why there was a push for health care reform in the first place? It's because in recent decades, costs associated with health care have skyrocketed, for governments, employers, and individuals. PPACA is an attempt to slow (and then stop) that increase in costs. If you take away PPACA, we'll be right back on that unsustainable trajectory.

Let's review the issues: health care costs are driving the federal government into debt, swallowing up state and municipal budgets, making US corporations uncompetitive internationally, forcing middle-class families to reorient their entire lives around health insurance, and putting the working-class and the sick in a perfectly desperate position if anything goes wrong.

So. It's 2020 or 2024, health care reform has been dead since the GOP and activist judges killed it back in 2011. All of these stresses have piled up, to the point where it's become intolerable to the majority of the US population. What are the alternatives?

(1) "Completely free market reform." Not going to happen, period. That will not work in health care; people will absolutely not tolerate the consequences.

(2) "Semi-free market reform." This is what PPACA is. Sorry, we tried that back in 2010 but the GOP preferred to demagogue the issue for short-term partisan gains.

That leaves (3), "Something more radical." There are lots of possibilities here, from direct nationalization of health care delivery, to "single-payer" (nationalization of health care financing, with heavily regulated private delivery of care), to various other less pleasant options.

So in 2020 or 2024, when the current system has become unbearable, we will take another swing at health care reform, and it will by default be something less market-based and less conservative-friendly than PPACA because the more conservative approach was rejected in 2011. Maybe that means single-payer, maybe it means something else, I don't know.

What it doesn't mean is "a tidal wave of progressivism". We could absolutely end up with a country that is conservative in many respects -- anti-immigrant, militaristic, xenophobic, culturally and socially conservative, etc. -- but with the federal government heavily involved in health care financing and/or health care delivery.

This is essentially already the situation with the elderly. Older Americans are much more conservative than the rest of the population ... but they are ruthlessly protective of their nationalized health care financing system (Medicare).

There's another reason why progressives shouldn't get excited about the prospects of (hypothetically) trading the death of PPACA now for single-payer later: we'll be inflicting a lot of misery on a lot of people for a decade or so. I'm interested in preventing crises and avoiding misery, not enacting a progressive agenda for its own sake. I'd rather grit my teeth and accept the inefficient, conservative-humoring, semi-market-based "reform" of PPACA than throw the middle- and working-classes into a decade of ever-escalating slow-motion crisis, even if that might eventually lead to something more "progressive".
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Re: BREAKING HARD: Obama Care on Life Support?

Postby kurt_w » Fri Mar 04, 2011 2:33 pm

FWIW, Matt Yglesias makes some points today that are similar to what I was saying in this thread.

"ObamaCare" a.k.a "RomneyCare" is the free-market-friendly version of health care reform. Declare that unconstitutional, and the only alternatives will be single-payer, a national health service, or some other similarly radical change. Eventually, one or another of those alternatives would be adopted because the old system became intolerable and the free-market-friendly "ObamaCare" will no longer be an option.
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Re: BREAKING HARD: Obama Care on Life Support?

Postby DCB » Fri Mar 04, 2011 4:50 pm

Ned Flanders wrote:Obama Care crumbling? One can only hope...

Florida Judge Rules Against ObamaCare, Individual Mandate Unconstitutional

In a ruling out of the U.S. District Court in Pensacola Justice Roger Vinson has declared that the primary mechanism whereby the health reform achieves universal insurance coverage–the individual mandate–is unconstitutional.


and then issues a stay of his own ruling:
http://www.politico.com/news/stories/0311/50596.html

The not at all activist judge is pushing for the Supreme Court to take this up:
Vinson wrote. “It is very important to everyone in this country that this case move forward.”


On the other hand:
“It almost seems to be that he’s telling the 11th Circuit what they’re supposed to do,” said Tim Jost, a professor at Washington & Lee University School of Law. “I’m not sure they’re going to take very kindly to that.”


Strangely, the Politico article does mention the other court rulings that have affirmed the constitutionality of the ACA.

http://www.dailykos.com/story/2011/02/2 ... are-reform
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Re: BREAKING HARD: Obama Care on Life Support?

Postby Carol » Sat Mar 05, 2011 2:07 am

kurt_w, those are false alternatives. Three-fourths of uncompensated health care costs are already paid by government programs. Nothing prevented Congress from expanding those programs, and this would have been completely Constitutional. It also would have been less costly. The CBO estimates that the average subsidy for people to buy health insurance would be $5800. Yet the average annual health care costs of uninsured people are less than $2000 (Kaiser). The ACA is the stupidest possible way of doing things, financially.

And it shows that the real reason they wanted the individual mandate is so that they could FORCE people to buy into health insurance plans in which charlatan health beliefs about diet and lifestyle are mandatory, as a condition of being approved. They want to dictate to individuals what they should eat and how they should live, via directives from DHHS. If they'd tried to do this overtly, any judge would rule it unconstitutional, so they're trying to slip it in the backdoor. And so far, NONE of the lawsuits have raised this issue.

So, the ACA is both UNnecessary and IMproper - an unconstitutional means to an unconstitutional end.
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Re: BREAKING HARD: Obama Care on Life Support?

Postby Bland » Sat Mar 05, 2011 2:23 am

Carol wrote:so far, NONE of the lawsuits have raised this issue.
It must be quite a burden to always be the only person who can see the underlying truth of a given situation. How lonely and unsatisfying your life must be.
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