The Fight for Obamacare Has Turned

Actually there is a free lunch in healthcare. If we go to Medicare for all [not government run healthcare, just government run insurance] we would immediately increase our health care purchasing power by about 30% [the difference in overhead for Medicare vs. for private insurance companies]. If we let Medicare negotiate with pharmaceutical companies [using real experts, not Trump] we would save another 5-10%.

As if that were not enough, we would also save on the cost of worker's comp insurance for businesses, and the cost of liability insurance for everyone, because the future health care component of judgments and settlements would no longer need to be included - because everyone has insurance.

Finally, we would also have portability, the ability to change jobs or move without losing your health insurance coverage.

Almost a free lunch.

There is no free lunch nor has there ever been, when it comes to health care. We either agree that healthcare is a common good to which all are entitled, or we agree that some lives are worth more than others and that those who cannot afford to pay must suffer and die. The only rational approach in a compassionate society is to include all individuals in a common risk pool and to fund healthcare through our tax revenues. The experience in the U.S. has shown that the free-for-all private insurance market is a colossal failure that provides fragmented care at huge cost while funneling health care dollars to insurance CEOs and their stockholders. Numerous examples exist of single payor taxpayer funded and government administered healthcare systems that provide higher quality healthcare at much lower per capita cost. The American experiment in market regulated healthcare provision has failed and it is time for us to learn from our neighbors and institute a system that values all lives and provides health care services for everyone equitably.

According to many here who have pointed out that "I have a right to a Mercedes, but I can't afford it." That is market based reality since there are cheaper alternatives, including public transportation, that allows us to do without the upscale product.

Applying this market based reality to health care, something we can't do without, is restricting an essential 'product' to those who can afford it, following the GOP logic.

Competition within the health care industry, including insurance companies and drug manufacturers, is not a solution as the complex, and overwhelming available choices are beyond our ability as citizens to wade through and make the right decisions. This applies even greater to emergencies. Who you gonna call?

Medicare for all.

Republicans were always grandstanding when they voted dozens of times to repeal Obamacare. They never attempted to construct a workable alternative.
They did not care - they were stoking the flames of hatred against a black president and any pretext would do just fine.

Republicans are 100% responsible for providing and delivering the best health care system in the world, and for less expense to all concerned - that is what they promised.

They have total control over the White House and both houses of congress, so they must deliver those campaign promises NOW. No delays, no excuses.

Repeal and replacing something that is working was always a fool's mission. Repairing would have been a viable approach. But, that would have required admitting that some parts of the ACA were okay, and some parts needed "tweaking". It would have also required bipartisan support to move it along. Now the Republicans have dug their own hole and Ryan keeps digging it deeper by his insistence lying about the actual strength of the ACA, it's successes to date, 22 million people relying upon it for healthcare. If Ryna were smart and actually cared about Americans he would say " let's fix it so it works better". Instead he always chooses the low road, full of scare tactics, untruths and out and out lies.

Surprise, surprise . . . It's hard to take health care away from people, even if it's a "disaster" according to our so-called president. What is, apparently, a surprise to Trump is that health care is complicated. "No one knew health care was so complicated." No one? Trump doesn't read, has no interest in learning anything and communicates primarily via impulsive 140-character diatribes of nonsense.

Trump tells us that the new health care plan will be "wonderful," less expensive and cover everybody. He has also said that this new "plan" was in the finishing touches and would be implemented the "same day, maybe the same hour" that the evil Obamacare is repealed. Fake news, or simply more lies.

Obamacare is a massive welfare program financed on the backs of the middle class. Of course politicians on both sides of the aisle refuse to acknowledge this. Sure 20 million may have enrolled, but with tax credits, subsidies, and discounts, many of these folks are paying virtually nothing. Conversely, single middle class people without a subsidy face monthly premiums of $1000 plus an annual deductible of $6000 - $18000 a year before they see a dime in reimbursement. This disconnect is well documented by may well respected economists and professors. Why do you think more and more Insurers are dropping out of Obamacare? The middle class is wising up to the fact that they are on the short end of the stick, and would rather pay a modest penalty to refuse Obamacare than $20000 a year for mediocre healthcare. Obamacare is not the solution and we must go back to the drawing board.

Tonight we may learn how profoundly stupid Donald Trump is and how very deceptive and dishonest Republicans are.
"Nobody knew health care could be so complicated." Wrong! Most people know healthcare is complicated. Most people want a single payer system that is far cheaper in every country that has it. What our system does is provide vast wealth to the middlemen, insurance companies, in collusion with the Pharmaceutical industry and of hospitals. Every penny the parasites of human frailty extract in excess of what their foreign colleagues make deprives Americans of resources and prosperity. Our businesses, our state and federal governments are hobbled with excess charges, our people are crushed with excessive insurance charges and bankrupting hospital bills. Americans have been played for fools by all politicians who refuse to provide our basic right to health, at a significant discount when all citizens are provided with the basics. When we are all in the "pool" costs are shared, lower, and better. Liars who claim we have the best healthcare fail to mention "that money can provide". The ultra rich do not need health insurance....they have cash.
Let's reform healthcare and institute Medicare for all. How's that cheaper? No one will pay for health insurance....that money would be devoted to Medicare in part.....Medicare will negotiate for the best price for care.....malpractice insurance will disappear when bankruptcy disappears.

The Republican Party had a moment in time when they could have worked with Obama to make changes within the first two years of the passage of ACA. They chose the hard ideologue path of obstruction. The number of votes they took in the House to repeal ACA were protest votes only, playing to their base. After years of the same tired rhetoric and protest voting, most Americans stopped listening and adjusted. Millions of Americans actually jumped on board and were able to get health insurance which they desperately needed. Now, the GOP not only sounds out-of-touch, they also refuse to understand their pure ideology on this issue no longer aligns with what Americans have grown to appreciate and even access. It is an amazing case study of living in an echo chamber and the consequences of doing so.

"Nobody knew that health care could be so complicated," says our ignorant president, unaware that in fact everybody knew it and he's just now getting the idea. If he had paid even the smallest bit of attention to the national discussion that's been going on for the last five or six years regarding health care in this country, he would have saved himself from looking like a fool, yet again. If he could tear himself away from Twitter and stop admiring himself for for five minutes maybe he could catch up with the rest of the country and gain at least a tiny understanding of issues that are important to the American people.

"No one knew healthcare was so complicated" is a lie. Everyone knew just how complicated it was and is. Everyone from the President to Congress to the person with pneumonia who can't afford to see a doctor.

The significant increases in health insurance premiums and the high deductibles that make the policies too expensive to use are among the Trump administration's key talking points to repeal the Affordable Care Act. Of course, Republicans and the administration blame that all on the Act. In reality, health insurance premiums were soaring long before the ACA became operable.

In the small nonprofit where I both volunteered and worked, premiums began to escalate more than 10 years ago. Every other year we were forced to change plans to avoid 20-25% increases. Each time we were faced with a large increase we selected a less expensive policy with a higher co-pay and a higher deductible to control costs.

The same scenario played out in my husband's mid-sized business. The premiums soared one year to the next. In the past 15 years his firm has changed insurers at least 3 times due to cost. Our policies have moved from minimal co-pays to very high deductibles as the annual cost of the policy simultaneously increased dramatically.

In each instance we paid a lot more to get less.

I would love to see someone analyze the rising costs of employer provided insurance plans both before and after the Affordable Care Act became operative and compare it to the costs of ACA plans because I think the root of the health care problem is the health insurance industry. The system is broken.

We here in Massachusetts have longed called it Romney-Care. Then Governor Romney got through a medical plan first developed by the Heritage Foundation and then pushed as a market-based alternative to single-payer plans that progressives wanted. Although a largely Democratic state, we embraced this Republican proposal because it did succeed in expanding coverage and getting rid of the awful rejections for prior illness or for succumbing to a new expensive illness. We've been lucky to have it, and I suppose we can always go back and do a MA-only version again. Sad! And if Republicans want to insist on a free market in labor, across state lines, they'd better keep the ACA, else folks with insurance will have to hunker down again in their states and take whatever the boss dishes out.

Meanwhile, the Republicans are salivating at the chance to slash all discretionary funding AND to cut Medicare and Social Security. I've worked in the non-profit sector my whole life and am relying on these supports to be able to retire. But Ryan, much of whose college education was funded by his Social Security survivor's benefits (from his father's death) wants to drag us back to before FDR. Shameful.

The president said, "No one knew how complicated health care is." Really? Ask any physician, health care administrator, state Medicaid director, hospital administrator, nursing home administrator, pharmacist, ICD-10 coder, or even someone about to turn 65 who has to make choices vis-a-vis Medicare. We ALL know how complex health care is. The president did not WANT to know how complicated it is.

This country remains the only industrialized nation that does not provide single-payer health care for its citizens. We could use what works in other nations and formulate our own version, but Republican talking points and insurance company lobbyists have convinced half of the population that it won't work here, that single-payer would mean health care "rationing." Well, I have news for you folks. The insurance companies are already rationing care, and the decisions are not being made by physicians. They are being made by insurance company executives and utilization review staff who try to cut costs while insurance company CEOs are making multi-million-dollar salaries, which, if we had single-payer healthcare, they would lose. Prior to the ACA, I saw several of my friends use everything because of cancer--ONE chemo treatment cost $30,000! And then they had a pre-existing condition, which Rick Santorum now says makes them scammers! These are the talking points. As someone pointed out at Grassley's town hall--these are the new death panels. The rich have care, the poor do not.

Republicans either don't understand the fundamental premise of insurance or they don't care because the facts don't support their position.

Insurance of any kind is all about spreading the risk among a large pool of people who pay their premiums in one way or another. Life, fire, accident, flood, health - insurance works because everybody pays into the pool of money that is paid out to people who need it. The point being that not everybody needs it at the same time.

So with health insurance - the young and healthy don't really need it but pay into it because older, sicker people do need it. And the young and health will get older and sicker and then their medical care will be paid by their young and healthy juniors. That's the only way insurance can work - otherwise insurance companies would go broke almost overnight.

So it's either the mandate that all must be insured, or the government becomes the insurer for all - single payer. The simple fact of life.

Denying the facts of life are what amounts to Republican ideology these days. And it's not really an ideology and they don't really believe it. For them it's all about politics and votes and campaign funding.

Relying on "market forces"- that is, the greed that greases the wheels of capitalism- has not, and will never, result in improvements to the common good. A report on the CDC's warning about the looming threat from "super-bugs" noted that our friends in the pharma industry have not put much effort into solving this potentially catastrophic problem because there's not enough money in it for them. I never hear Republicans complaining about the incredible amounts of money that gets siphoned into the US military, where "market forces" to ensure efficiency are non-existent. But they sure like to whine about what it costs to help their fellow citizens, and want the market, which has all the humanity of a wood chipper, to be the final arbiter of who receives care and lives, and who is left to die.

The Affordable Care Act was originally meant to provide an affordable solution for middle class people as well, but in order to pass through a GOP controlled legislature, it was hacked to pieces. The GOP has had a vested interest in it failing - why? Because if it succeeded the cost to their party (in terms of loss of face, loss of votes, and a rallying cry for working and middle class voters) would be too much.

1. The ACA is not financed on the backs of the middle class. The taxes that support the ACA fall on the richest one percent of Americans.

2. Your cost analysis ignores the millions of poor working families that have gained coverage through the Medicaid expansion. Moreover, there would be millions more Americans covered if 19 Republican-dominated states had not harmed their own citizens by refusing the expansion of Medicaid. The Medicaid expansion has also been of great benefit to the hospitals that now no longer have to provide uncompensated care. States that have refused the expansion have seen more hospitals close.

3. Your analysis ignores the fact that the majority of Americans with employer-provided health care now have far better plans because of the ACA. They can now keep their children on their plans until the age of 26; their plans can no longer refuse to cover pre-existing conditions; and their plans can no longer contain annual or lifetime caps on benefits.

3. You focus on the problem of the lack of good plans on the exchanges for those Americans who do not have employer-provided plans and who do not qualify for the Medicaid expansion. There is absolutely no need to scrap the entire law to address this problem. Rather, it can be addressed by including a public option in the exchanges. The Republicans, in contrast, want to make this problem far worse by pushing very high deductible plans with even fewer benefits as a means of reducing costs.

I believe in single-payer medical coverage for all, European/Canadian style. For over 20 years, I worked for a private company whose employee population was never more than about 125,000 employees, which probably represented three or four times that many employees and dependents. That company was US-based with smaller populations in Europe and Asia, and also the rest of the world.

That company SELF-FUNDED the health care plan that covered that population. This means that an insurance company managed the plan, but the bulk of the plan's expenses were covered by the company and employee premiums.

If a population of only a half-million people can self fund, the United States of America can surely afford to "self-fund" a single payer plan that is actuarily easier to balance (300+ million covered).

BUT HERE'S THE CAUTION: MEDICARE FOR ALL won't do it.

Medicare is principally a hospitalization plan (Part B'), and it costs most covered people a bit over $100 per month, more for higher earners.

Most people also need a supplemental plan to cover doctor's visits and drugs (Parts A and D), which are combinations of public and private insurance.

It's COMPLICATED! Many may remember a series of commercials, perhaps from the '80s, in which a older man is shown sitting at his dining room table, while wearing a bathrobe and slippers, poring over heath forms. His wife comes down and asks what he's doing there at 1:00am. His reply: Who ever knew that retiring could be so much work?!?

Republicans had a big advantage when opposing the ACA: Human beings are what behavioral psychologists call "loss averse". They attach much greater value to the possibility of losing what they have than the possibility of getting something better. And most Americans had good health coverage. Republicans exploited that to the max.
Now the shoe is on the other foot. The ACA is the status quo and it works well for most Americans. To preserve it, defenders should strongly emphasize what will or could be lost. Not just for the millions who will lose insurance but for those who benefit from other provisions of the law.

This past weekend a fellow I work with described his wife's month-long bout with a gall bladder stone and various subsidiary complications. Put him down in the "former Obamacare opponent" camp. Only a few months ago he was repeating claptrap talking points supplied by the GOP but no more. As he freely confessed, he and his wife would have been facing bankruptcy at this point were it not for the coverage he was able to obtain as a self-employed worker, courtesy of Obamacare.

Some of us need to learn via object lessons that empty ideology isn't a substitute for practical results.