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The flaws of Obamacare are basically conservative ones. It's too complicated and it's too stingy
The Conservatism of ObamacareI think Lind's point http://www.salon.com/2013/10/28/what_the_tea_party_misses_if_you_hate_obamacare_youll_really_hate_what_the_right_wants_to_do_to_social_security/ that if progressives dig in and defend Obamacare both as super-awesome and liberal, that they're making a big mistake, is important. The flaws of Obamacare are basically conservative ones. It's too complicated and it's too stingy and (happy to be proven wrong) likely won't cut overall medical spending much.
The point isn't "wah wah wah why didn't Obama wave his magic wand and make Medicare for all happen." The point is that we should continue to explain that Medicare for all would be better, cheaper, and more popular. Savvy people will inform me that Medicare for all won't happen and Obamacare is that best that could have happened. Probably you're right, savvy people! Congratulations on being savvy! I'm not sure why that precludes informing people that a better policy exists, even if it won't happen. Even savvy people spend lots of time talking about things that are unlikely to happen.
MORE:
http://www.eschatonblog.com/2013/10/the-conservatism-of-obamacare.html
http://www.salon.com/2013/10/28/what_the_tea_party_misses_if_you_hate_obamacare_youll_really_hate_what_the_right_wants_to_do_to_social_security/
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zipplewrath
(16,646 posts)Nor are progressives likely to press the point in present or future debates. Unlike conservatives, who are right-wingers first and Republicans second, all too many progressives put loyalty to the Democratic Party — most of whose politicians, including Obama, are not economic progressives — above fidelity to a consistent progressive economic philosophy. These partisan Democratic spinmeisters are now treating Obamacare, not as an essentially conservative program that is better than nothing, but as something it is not — namely, a great victory of progressive public policy on the scale of Social Security and Medicare.
In doing so, progressive defenders of Obamacare may inadvertently be digging the graves of Social Security and Medicare.
This says it better than I ever have. It's a conservative program that was better than nothing, not a progressive victory.
BlueStreak
(8,377 posts)There are insufficient mechanisms in this system to ensure "fair market" pricing. I surmise that is some markets like California, there is rich, legitimate competition, and that does get to fair market pricing. But in my market (Indianapolis) there is only one well-known competitor (Anthem BCBS) and one no-name company (which I very well may go with). They both are charging ~ $1500/month for insurance that really ought to cost about $450-$650.
And why are they doing this? Because they can, and because the subsidies are so generous that a lot of customers can order the $1500 policies and still pay only $150/month. That amounts to a $400/month/insured GIVE-AWAY to the insurance companies.
And what about that 80% rule? Well, Anthem no doubt competes more vigorously in other areas, so they will find ways to average all this out so that they don't have to give much of a rebate.
If you are going to go with a market-based system, then you absolutely MUST make sure you have an honest market with lots of competition and still enforcement of price-fixing activity. And certainly, if we could have included the public option, that would force ALL markets to be value-priced.
That is the part that makes me the most angry. If we asked Medicare simply to rate each age pool and offer A basic Bronze policy, even 8% above Medicare's actual costs, that would make the exchange honest. And for those who chose the public option, that extra 8% would go back into the Medicare trust fund, making that all the more solvent for retirees.
But the Republicans wouldn't like that. Hell, in the end, we had to pass the law without any of their votes anyway, so why not do it right instead of just passing the Republican plan?
BluegrassStateBlues
(881 posts)
leftstreet
(36,116 posts)BluegrassStateBlues
(881 posts)The parade of liberal champions in the Oval Office such as Bill Clinton, Barack Obama and Hillary Clinton will make this country a better place for decades to come.
leftstreet
(36,116 posts)WooHoo!
Bunnahabhain
(857 posts)I would say Medicare accomplished more of its goals, in a far superior manner, than the ACA. In fact, I would say the ACA just further entrenches a fatally flawed system, making it harder to get subsequent improvements.
I do not think the ACA is a "fine product" by any stretch of the imagination.
BlueStreak
(8,377 posts)If we have to identify the most progressive Presidents for the past 50 years, I would have to rank them
Kennedy
Johnson
Eisenhower
Carter
Obama
Clinton
Nixon
Reagan
Bush I
Bush II
And Ford doesn't count.
truebluegreen
(9,033 posts)Egalitarian Thug
(12,448 posts)
Bandit
(21,475 posts)If you think this is Liberal then you are the perfect example of what is wrong with America.. It has turned so far right that the left no longer exists. When Bob Dole first presented this plan in 1995 every single Democrat thought it was a horrible idea, not at all progressive. Now you think it is the best progressive legislation in decades...
Has the democratic Party really changed this much?
BluegrassStateBlues
(881 posts)This administration transcends all political ideologies and is a beautiful thing to witness.
BlueStreak
(8,377 posts)When he says this is the most progressive legislation in decades, that is sadly the truth, because we have to compare it to other great legislative achievements such as the Patriot Act, "Ending Welfare as we know it", NAFTA/CAFTA, No Child Left Behind, etc.
geek tragedy
(68,868 posts)
JoePhilly
(27,787 posts)
Hutzpa
(11,461 posts)I don't get it, is this suppose to divide us? maybe it's meant to create an aura of angst among progressive
because I don't get it, I believe there are those who will fall for this type of crap.
My kind of progressive is one that understands a very simple concept or principle which is;
half is better than none
take what you can get until you get what you want.
zipplewrath
(16,646 posts)It was better than nothing, but a conservative solution, not a progressive one.
Hutzpa
(11,461 posts)Obama has started the ball rolling it is now the task of the next president to continue where he left which
is why it is very important to ensure that the next democratic president comes from the deep left.
zipplewrath
(16,646 posts)I'm not saying it can't happen, but the plan was originally designed by Heritage and the GOP of the '90s to prevent it from becoming anything like a medicare. So it's not really a case of "getting the ball rolling" but of starting to shove it in an entirely different direction. Right now the insurance companies and for profit health care entities are firmly entrenched in the system, even more so now that we have the mandate. That was the loss associated with the Public Option. It was to be the path out of for profit insurance and toward a government run/single payer model. Now our only real hope is non-profit insurance coops.
Hoyt
(54,770 posts)Currently 28% of Medicare beneficiaries are enrolled in private insurer health plans call Medicare Advantage Plans. That number increases every year as insurance companies add some little incentive to opt out of the traditional Medicare program.
Any Medicare beneficiary enrolled in the Part D (Drugs) is in a private insurance plan.
Anyone with a supplemental policy is in a private health plan.
Every claim decision from a provider, payment, coverage decision, etc., under Medicare Parts A and B is made by employees of private insurance companies (usually a subsidiary of the big insurance companies), although under federal guidelines.
Medicare has no cap on out-of-pocket costs. One hospitalization -- without a good supplemental policy -- will send most people into bankruptcy and onto the Medicaid rolls. Fraud and abuse is rampant in Medicare.
I do agree, Medicare for all might be quickest way to covering everyone (which I 100% support). However, you will still have insurance companies administering the program under Federal guidelines. And, the government doesn't have the billions of dollars needed to invest in the systems needed to run the program, as it currently is.
And Medicare won't be as cheap as people seem to believe, and the program has not been successful in containing many costs like drugs. If you think the premiums we are seeing under ACA would be drastically lower under Medicare for all, you are probably wrong. At best, the premiums would be 10% less and I doubt that.
I think the reforms needed are much bigger than Medicare for all, although if people would accept Medicare for all, we'd be on the road to making the tough decisions necessary. Truthfully, I don't think the majority of providers and patients are ready for really reforming the system.
With all the obstacles, I'm glad we got ACA. Maybe 50 years from now we'll have something we can be proud of and truly advances our society.
leftstreet
(36,116 posts) Hoyt
(54,770 posts)I think Medicare Advantage started near end of 1990s.
The Drug Program started in mid-2000s and is the only thing I will give george bush credit for -- not vetoing it, although there are some problems with it, like limiting negotiations with pharmaceutical companies. But, before that, Medicare beneficiaries had to pay for their own prescription drugs out-of-pocket.
Supplemental insurance policies have been around for a long time.
Freddie
(9,275 posts)We could have had a Medicare buy-in option for 55+ (which could easily have been expanded downward with time) but Lieberman (former Sen. from the great state of Aetna) refused and would have sank the whole ACA.
LAGC
(5,330 posts)Gore's fatal mistake in 2000 was choosing him as a running mate.
There's no reason that election should have been close enough to steal...
kestrel91316
(51,666 posts)as it rolls out we will see where it needs fixing. As the states develop their own single payer programs come 2017, we will REALLY see how it should be.
The journey of a thousand miles begins with a single step.
zipplewrath
(16,646 posts)It was better than nothing, and cured a few well known ills. But it is a conservative solution to the problem and was designed to obstruct any sort of single payer/medicare for all kind of system. We will see how successful Heritage's plan will be.
kestrel91316
(51,666 posts)zipplewrath
(16,646 posts)In some sense they always "could". We'll see how many do. They'll get resistence from the insurance and for profit health care industry. The same industry that killed single payer and the public option, and preserved the prohibition on medicare drug price negotiations. Single payer can be hard to fund at the state level and federal dollars may not be large enough for small states.
Niceguy1
(2,467 posts)Are cut bsck as time goes on.. that's why all states did expand medicare. They should have keot the funding steady.
Egalitarian Thug
(12,448 posts)I've been forced to commission a new "I told you so" stamp as Tansy's is getting too much use and the wear is starting to show, plus the waiting list can resemble an Apple store the night before a new plastic piece of shit is released.
So I decided to bite the bullet and have a new, steel engraved stamp made. It should be ready for commercial use by the first of the year.
SolutionisSolidarity
(606 posts)I'm all for making the ACA better, or even replacing it with something more radical. But the people trashing it today are arguing that our prior lack of a system was somehow better. It wasn't; it was an absolute Horror show.
This is a very serious issue for me. I've got people in my immediate family with chronic health problems, so it's basically fight or flight. The healthcare system has to improve, or I have to go somewhere else. I don't want to leave - everyone I know and love is here. But I won't make my parents mistake. I'm not going to work hard all my life just to get sick in my late fifties and watch my retirement disappear.
Bolo Boffin
(23,796 posts)When I see complaints about ACA health care plans, they only seem to make sense if people were expecting Medicare for All or the like. "My deductibles are too high! My premiums are too high! My copays are too high! How will I ever afford $6,000 out of pocket expenses?"
1. Well, if we were paying taxes and signing up for Medicare for All, you might have a point. But what the ACA has us buying is health insurance. And some plans won't cover as much as others.
2. This is how insurance works, though. Most aren't there to pay for everything. Most are there to keep extraordinary health care costs from hammering your personal finances and through you the overall economy. You couldn't afford $6,000 out of pocket in a year? Try $300,000 in a year. How were you going to pay for that if it happened? At least this way you keep your house and your car.
3. And, hey, if you want Medicare for All, I for one would be happy to stand next to you and get that moving in the Congress. The ACA is a start and it's better than a lot of things, especially the system we had before. But anytime you want Medicare for All, let's go.
B Calm
(28,762 posts)they just didn't give everybody medicare instead of this Obamacare. I told him that's what democrats wanted, but we settled for this and these were all republican ideas.
Fumesucker
(45,851 posts)B Calm
(28,762 posts)Fumesucker
(45,851 posts)Democrats (and a couple of independents) were the only ones to vote for the ACA.
We got what the Democrats wanted.
B Calm
(28,762 posts)Fumesucker
(45,851 posts)No Republican votes for the ACA means that the Democrats own it, lock, stock and deductible.
It absolutely is what the Democrats wanted, otherwise they wouldn't have voted for it.
B Calm
(28,762 posts)most of the ideas that nobody likes were republican ideas!
The Conservative Case for Obamacare
By J. D. KLEINKE
Published: September 29, 2012
IF Mitt Romney’s pivots on President’s Obama’s health care reform act have accelerated to a blur — from repealing on Day 1, to preserving this or that piece, to punting the decision to the states — it is for an odd reason buried beneath two and a half years of Republican political condemnations: the architecture of the Affordable Care Act is based on conservative, not liberal, ideas about individual responsibility and the power of market forces.
This fundamental ideological paradox, drowned out by partisan shouting since before the plan’s passage in 2010, explains why Obamacare has only lukewarm support from many liberals, who wanted a real, not imagined, “government takeover of health care.” It explains why Republicans have been unable since its passage to come up with anything better. And it explains why the law is nearly identical in design to the legislation Mr. Romney passed in Massachusetts while governor.
The core drivers of the health care act are market principles formulated by conservative economists, designed to correct structural flaws in our health insurance system — principles originally embraced by Republicans as a market alternative to the Clinton plan in the early 1990s. The president’s program extends the current health care system — mostly employer-based coverage, administered by commercial health insurers, with care delivered by fee-for-service doctors and hospitals — by removing the biggest obstacles to that system’s functioning like a competitive marketplace.
Chief among these obstacles are market limitations imposed by the problematic nature of health insurance, which requires that younger, healthier people subsidize older, sicker ones. Because such participation is often expensive and always voluntary, millions have simply opted out, a risky bet emboldened by the 24/7 presence of the heavily subsidized emergency room down the street. The health care law forcibly repatriates these gamblers, along with those who cannot afford to participate in a market that ultimately cross-subsidizes their medical misfortunes anyway, when they get sick and show up in that E.R. And it outlaws discrimination against those who want to participate but cannot because of their medical histories. Put aside the considerable legislative detritus of the act, and its aim is clear: to rationalize a dysfunctional health insurance marketplace.
This explains why the health insurance industry has been quietly supporting the plan all along. It levels the playing field and expands the potential market by tens of millions of new customers.
The rationalization and extension of the current market is financed by the other linchpin of the law: the mandate that we all carry health insurance, an idea forged not by liberal social engineers at the Brookings Institution but by conservative economists at the Heritage Foundation. The individual mandate recognizes that millions of Americans who could buy health insurance choose not to, because it requires trading away today’s wants for tomorrow’s needs. The mandate is about personal responsibility — a hallmark of conservative thought.
IN the partisan war sparked by the 2008 election, Republicans conveniently forgot that this was something many of them had supported for years. The only thing wrong with the mandate? Mr. Obama also thought it was a good idea.
The same goes for health insurance exchanges, another idea formulated by conservatives and supported by Republican governors and legislators across the country for years. An exchange is as pro-market a mechanism as they come: free up buyers and sellers, standardize the products, add pricing transparency, and watch what happens. Market Economics 101.
In the shouting match over the health care law, most have somehow missed another of its obvious virtues: it enshrines accountability — yes, another conservative idea. Under today’s system, most health insurers (and providers) are accountable to the wrong people, often for the wrong reasons, with the needs of patients coming last. With the transparency, mobility and choice of the exchanges, businesses and individuals can decide for themselves which insurers (and, embedded in their networks, which providers) deserve their dollars. They can see, thanks to the often derided benefits standardization of the reform act, what they are actually buying. They can shop around. And businesses are free to decide that they are better off opting out, paying into funds that subsidize individuals’ coverage and letting their employees do their own shopping, with what is, in essence, their own compensation, relocated to the exchanges.
Back when the idea of letting businesses and consumers pick their own plans — with their own money on an exchange — first floated around Washington, advocates called them “association health plans.” They, too, would have corrected for the lack of transparency, mobility and choice in local insurance markets by allowing the purchase of health insurance across state lines. They were the cornerstone of what would have been the Bush administration’s reform plan (had the administration not been distracted by other matters). After the rejection of “Hillarycare” in the mid-’90s, association health plans emerged as the centerpiece of pro-market, Republican thinking about health reform — essentially what would become Romneycare, extended via federal law to cover the entire country. So much for Mr. Romney’s argument that his plan in Massachusetts was an expression of states’ rights. His own party had bigger plans for the rest of the country, and they looked a lot like Obamacare.
Continued at:
http://www.nytimes.com/2012/09/30/opinion/sunday/why-obamacare-is-a-conservatives-dream.html?_r=0
Fumesucker
(45,851 posts)Which means any votes the bill got were either Democratic or independent.
Why did Democrats and only Democrats vote for a quintessentially Republican bill?
The answer is inescapable, because that quintessentially Republican bill is what the Democrats actually wanted.
Response to kpete (Original post)
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B Calm
(28,762 posts)
