I must say I have been a bit frightened lately by this thing called "Obamacare." I always hear that it's going to kill jobs, gut Medicare, and tear up the constitution. It just sounds horrible!
But I've had trouble finding any legislation by the name "Obamacare." Perhaps everyone is talking about President Obama's Patient Protection and Affordable Care Act. Is that it?
Nearly two years ago, President Obama signed into law the Affordable Care Act, which will deliver care to over 30 million uninsured Americans. Conservatives quickly declared war, calling it an unconstitutional, job-killing, government take-over by a radical socialist who "thinks he's smarter than you."
In fact, the Affordable Care Act is one of the most groundbreaking pieces of legislation in American history. Unfortunately, it has been subject to some extremely ruthless attacks that turn out to be, well, false.
Let's begin with basics. The Affordable Care Act will extend care to 32 million Americans who are roaming the streets uninsured, ready to have their lives turned upside down by a measly infection. The law also prohibits insurance companies from denying care for individuals with preexisting conditions -- an outright abuse of the entire health care system.
The bill also includes an infamous, so-called "individual mandate," which will require everyone to purchase care or face a fine, with some exceptions for the poorest Americans. Conservatives argue that any mandate requiring Americans to buy something must be unconstitutional.
They must have forgotten that we already require Americans to pay for Medicare and Social Security. They also forgot that buying health insurance does not simply happen in a vacuum -- it's not like buying a pack of gum. Choosing not to purchase insurance is an economic decision that affects us all. When individuals without insurance seek medical care, those with insurance have to pick up the cost -- an estimated $43 billion in 2008. The fact is, humans require health care, and it is unfair to have some contribute and some not. We recognized that with Medicare, and it should be the same for all other forms of care.
And assuming you have any ethical standards and agree that insurance companies should not be permitted to deny care to those with preexisting conditions, the mandate becomes crucial. Without the mandate, people would simply wait to get sick and then purchase insurance, knowing that the provider could not deny them care or charge them higher premiums. That would lead to exponentially higher premiums for everyone. Doesn't sound like a smart plan to me.
Perhaps the best part of the bill is that it reduces the overall cost of health care, mainly through three methods. First, it brings everyone into the health care system, so insured Americans are no longer paying for the care of uninsured Americans. Second, it puts in place the Medical Loss Ratio Rule, which requires insurance companies to spend 80 percent of premium dollars on actual health care, instead of administration, advertising, or salaries. Finally, it strengthens Premium Review Laws, which will make sure that every premium increase is justified and fair, doing away with skyrocketing costs with no improvement of care.
Overall, the bill will actually significantly reduce the federal deficit over the next two decades and save families thousands of dollars a year in premiums. So yes, Republicans, "Obamacare" does cost a lot of money, but it actually saves money in the long run. And yes, it does include hundreds of billions of dollars in cuts to Medicare, but those cuts are made possible by lower health care costs. In fact, Medicare is very much strengthened by the Affordable Care Act.
Finally, and Republicans love this one, the Affordable Care Act is often called a massive job-killer. Actually, according to a study by Business Roundtable, when the Affordable Care Act is fully implemented in 2019, employers will save roughly $3,000 a year in health care costs for every employee. That's a lot of extra cash to grow, become more competitive, and, hmm, create jobs. In fact, one Harvard economist estimates that repealing the law could cause us to lose up to four million jobs by 2019. So, wait, who's killing the jobs?
So what exactly is "Obamacare"? Well, I'll give Republicans the benefit of the doubt, and say it's just a complete myth created to attack the President. That's fine, and they can go ahead and repeal their hypothetical bill. But I'm talking about the Affordable Care Act, and maybe it's time we all do.
 |
 |
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| Obama | Romney | |
|---|---|---|
| Electoral Votes (270 to win) |
332 | 206 |
| Obama | Romney | |
|---|---|---|
| Total | 65,899,660 | 60,932,152 |
| Percent | 51.1% | 47.2% |
| Democrats* | Republicans | |
|---|---|---|
| Current Senate | 53 | 47 |
| Seats gained or lost | +2 | -2 |
| New Total | 55 | 45 |
| Democrats | Republicans | |
|---|---|---|
| Seats won | 201 | 234 |
The health care plans which are an alternative to “fee for service” are financed by a Medicare program called “Medicare Advantage”. The "alternatives" come in a variiety of forms but perhaps the best and most popular example is Kaiser Permanente.
Recent amendments have reduced the amount Medicare provides to "Medicare Advantage". But the foregoing article points out that in several ways the methods used to compare the cost of a given plan are skewed in favor of the “fee for services.” For example, when a plan achieves a surplus of compensation from Medicare over actual cost, the surplus is always passed on to the members by way of illness prevention and lower membership costs, advantages not realized by patients in the “fee for service” category.
The foregoing bolsters the position of those of us who have argued that give a fair test, the NO "fee for service" plans will be the wave of future medical service.
The idea that there should be an unregulated "free market" to provide human health care is patently absurd, perhaps the most absurd of all of the Republican absurdities.
Thank you for a well thought out treatise. Here is little something that I hope you will examine.
http://content.healthaffairs.org/content/13/4/22.full.pdf
If we created the inter-state highway system of Healthcare IT. Cost control can done through IT automation. By creating a public-private open-source Healthcare Information Technology process between HHS and the Healthcare Industry. Using the best evidence based-medicine from around the world come up with “Best Medical Practices (BMP)” diagnostic and treatment interactive-electronic-medical-workbooks using: XML, XML schema, XForms, Dita and web-services which are IETM Class V compliant documents that when each step is filled out is checked for accuracy and completeness in real-time and saved to one of the telecoms (third-party).
Savings former OMB Director Orszag's 700b a year using BMP, since your insurance is based on BMP it could be fully automated, savings Senator Sanders 400b a year in administrative costs, since the workbook format is public the HHS like the IRS could offer rewards to independent programmers savings 60b a year in fraud. Like Newt Gingrich has said if you're using BMP, a malpractice case should never go to court savings 100b a year. Your personal EHR is also at the telecoms secure with bio-metrically audited access and no name or address attached, from anywhere in the world.
The DOD, IBM, and many others are already using these technologies. Now there is no Healthcare or Medicare deficit.
I guess you are saying that if a surgeon cuts off my left leg which is normal rather than my right leg which is infested with gangrene, your "Best Medical Practices" would say OK fine and I would not be able to go to Court.
Now we've fixed the delivery system and the home medical office is a possibility.
References
EHR http://en.wikipedia.org/wiki/Electronic_health_record
XML http://en.wikipedia.org/wiki/XML
XML schema http://en.wikipedia.org/wiki/XML_schema
XForms http://en.wikipedia.org/wiki/Xforms
web-services http://en.wikipedia.org/wiki/Web_service
IETM Class V http://en.wikipedia.org/wiki/IETM
DITA http://en.wikipedia.org/wiki/Darwin_Information_Typing_Architecture
A presentation by IBM using DITA
IBM http://dita.xml.org/sites/dita.xml.org/files/IDCMSBlue.pdf
Cloud Computing http://en.wikipedia.org/wiki/Cloud_computing
SaaS http://en.wikipedia.org/wiki/Software_as_a_service
An excellent article from a Brookings Institute Study from a medical standpoint http://www.brookings.edu/reports/2009/0901_btc.aspx
***************** Any other questions? ********************
Ayn Rand opposed government social programs but ended up on Social Security and Medicare in her later years.
Things don't always turn out the way we plan, which is why we need to have a safety net.
Some blue states are adding public options on their new statewide health insurance exchanges (Oregon, Illinois, etc.). Vermont is even going for single-payer health care.
Blue (and purple) states don't need to wait for a Senate filibuster proof majority to move forward.
Just two other important provisions in the Affordable Care Act I would like to add--insurance companies cannot drop you if you get sick and actually need health care, and there will be no dollar limits on the amount of care they must pay for.
The system is a laughable half measure. Either we should have done less or we should have done more.
I'd probably just do more and move to an HSA type system. You have a deductible you must pay based on income ($500 for the poor with aid for that in extreme cases, up to $20k for the wealthy) yearly, then it's all covered. Just a sort of scaling single payer system.
I'll break with conservative orthodoxy on that topic, everybody needs health care. But it should cost something, even to the poor except in extreme circumstances. That will help control demand for unnecessary care. We don't value things that are free.