Obamacare and Government Shutdown

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Originally Posted by infoseek

Any guesses on how this would impact the Greencard issues? Several sites point to partial impact to USCIS but no clear information.

Murthy
Mintz

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I am not sure this shutdown will prolong long enough for it to have any impact whatsoever..

Right now in washington tail is wagging the dog instead of dog wagging the tail.. not sustainable.. according to rules of nature, things will return back to normalcy soon.

I cannot help laughing as "Repeal or Defund Obamacare" was the platform Romney ran in last elections and it does not even matter that he did not win the election but these folks want them done right away and that too by Obama.. We are not too far away from an all out civil war..

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Originally Posted by idiotic

I am not sure this shutdown will prolong long enough for it to have any impact whatsoever..

Right now in washington tail is wagging the dog instead of dog wagging the tail.. not sustainable.. according to rules of nature, things will return back to normalcy soon.

I cannot help laughing as "Repeal or Defund Obamacare" was the platform Romney ran in last elections and it does not even matter that he did not win the election but these folks want them done right away and that too by Obama.. We are not too far away from an all out civil war..

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Ur post seems to suggest two opposite outcomes. I do not understand on which side you stand.

1. You say this is not long lasting. This would mean that it is short lived and republicans would yield to democrats or the other way around.
2. You say that "We are not too far away from a civil war". This would mean that it is serious enough to have two classes of people (one with dems and other with repubs) fighting it out vigorously.

Sorry, but from your post I could not figure out where do u stand.

All

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Originally Posted by Jagan01

Ur post seems to suggest two opposite outcomes. I do not understand on which side you stand.

1. You say this is not long lasting. This would mean that it is short lived and republicans would yield to democrats or the other way around.
2. You say that "We are not too far away from a civil war". This would mean that it is serious enough to have two classes of people (one with dems and other with repubs) fighting it out vigorously.

Sorry, but from your post I could not figure out where do u stand.

All

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1. There is no need for democrats to yield to republicans. If Democrats start following the "tea party tactics", they could say we would stop the govt until gun control is passed or CIR is passed or whatever their idealistic principles are.

It is next to stupidity to stop the govt to demand something from a democratic president on which he ran the election last year. Romney stood for tea party principles on the election clearly stating he will "defund or delay Obamacare" and lost clearly. It seems that it does not matter anymore that he lost but they want it right away even though majority of people(elections) rejected their ideologies.

2. Democrats could take the same stand on literally every issue and nothing will be done ever and that is what I meant by "civil war". The extreme groups already in war path having crossed the line of reasonableness. If everyone stands in extreme positions, war is the only outcome.

I am not sure why law does not exist to punish lawmakers who fail to do their job hurting the people. There should be charges filed against them for this (Inline with same tea party principles -- if a individual does something to stop a day to day government activity, he would be charged and dealt with appropriately.. why should law makers be any different).


Funny thing was Obama care was based on original conservative ideas(Society does not need to pay for individual's mistakes).. You can read about how the original conservative movement is now slowly leading its own party to death by going against its own ideas..
http://www.theatlantic.com/politics/...-ideas/279955/

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Originally Posted by idiotic

1. There is no need for democrats to yield to republicans. If Democrats start following the "tea party tactics", they could say we would stop the govt until gun control is passed or CIR is passed or whatever their idealistic principles are.

It is next to stupidity to stop the govt to demand something from a democratic president on which he ran the election last year. Romney stood for tea party principles on the election clearly stating he will "defund or delay Obamacare" and lost clearly. It seems that it does not matter anymore that he lost but they want it right away even though majority of people(elections) rejected their ideologies.

2. Democrats could take the same stand on literally every issue and nothing will be done ever and that is what I meant by "civil war". The extreme groups already in war path having crossed the line of reasonableness. If everyone stands in extreme positions, war is the only outcome.

I am not sure why law does not exist to punish lawmakers who fail to do their job hurting the people. There should be charges filed against them for this (Inline with same tea party principles -- if a individual does something to stop a day to day government activity, he would be charged and dealt with appropriately.. why should law makers be any different).


Funny thing was Obama care was based on original conservative ideas(Society does not need to pay for individual's mistakes).. You can read about how the original conservative movement is now slowly leading its own party to death by going against its own ideas..
http://www.theatlantic.com/politics/...-ideas/279955/

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Obamacare supposed to decrese costs (premium for typical household of 4 should go down as per president), it went up. anybody can notice that

number of uninsured people going to be same as per CBO

It supposed to cost less than trillion when it passed, now CBO estimates 3 times more than that

Why should employer mandate can be delayed but not individual mandate?

Govt supposed to set up healthcare exchanges by now, what is the progress?

what's the goal of obamacare and how is it working for people? forget political parties

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Originally Posted by bieber

Obamacare supposed to decrese costs (premium for typical household of 4 should go down as per president), it went up. anybody can notice that
number of uninsured people going to be same as per CBO
It supposed to cost less than trillion when it passed, now CBO estimates 3 times more than that
Why should employer mandate can be delayed but not individual mandate?
Govt supposed to set up healthcare exchanges by now, what is the progress?
what's the goal of obamacare and how is it working for people? forget political parties

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Overall you are arguing the merits or demerits of an indidivual law.. Like wise we can start arguing about merits or demerits about gun control or CIR.. There is no end and the stances of either parties are well known on all your above above questions..

Real Point is these things are not worth to stop the government and hold it as hostage for narrow objectives causing immidiete wider economic impact..

No one is saying Obamacare is perfect.. It had its own uphill battle on way to become law of the land and lot of things need to be inserted into it to make it pass against the lobbying forces..
if republicans firmly beleive it will fail, then best way is that they should let it fail and stand on that basis for 2014 elections rather than hurting the people and economy now before it even sees day of light.. I am not sure what purpouse it solves fighting it now before it fails(are they doing it as favor to Obama to save him from a definite failure by hurting the people and economy now)

Read about Romneycare and its success .. you will understand the tea party's resistance why they want to nip in the bud.. once it succeeds they will start calling it affordable care act again instead of Obamacare..

Shutdown drama is another example why discharge petitions are pure fantasy.. Clean CR bill is a better candidate than CIR for discharge petition but it is simply not practical even though by theory lot of moderate republicans supporting both bills :)

I'm happy to debate Obamacare if you want to, although, as idiotic so clearly pointed out, that no reason to shut down government.

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Originally Posted by bieber

Obamacare supposed to decrese costs (premium for typical household of 4 should go down as per president), it went up. anybody can notice that

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The cost of healthcare in this country is not the cost of premiums to a typical family. If you want to compare costs, you should look at the cost of emergency room care next year compared to this year. Compare revenue write offs by the hospitals compared to this year. And a whole bunch of other metrics. Don't just pull the one metric that suits you and lead with it. As to household insurance premiums, the healthcare exchanges cover 20% of the country, and these insurance policies are real policies unlike the crap that was available previously to them.

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Originally Posted by bieber

number of uninsured people going to be same as per CBO

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I don't see how that could possibly be true. If Obamacare covers new patients (people who previously had no coverage due to preexisting conditions, children under 26 covered by their parents and expanded medicaid coverage), who is losing coverage now to leave the # of uninsured people the same?

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Originally Posted by bieber

It supposed to cost less than trillion when it passed, now CBO estimates 3 times more than that

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Cost to whom? I'd need more details to comment.

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Originally Posted by bieber

Why should employer mandate can be delayed but not individual mandate?

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Typical right wing bullshit. Push for some accomodations, and then push for more on the basis of the first ones. They are not related. Delaying the individual mandate effectively kills the law. Without forcing younger customers into the insurance exchanges, the insurance companies would lose their shirts in 2014 with only older, unhealthier customers. Delaying the employer mandate still allows employees to avail of healthcare through the exchanges. It just gives the employers a little more time to adjust (not that they deserve it, since they've had 3 years to figure things out).

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Originally Posted by bieber

Govt supposed to set up healthcare exchanges by now, what is the progress?

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They're up. They're working in California, where i've already got quotes. The federal exchanges are up too, even if they've had hitches. And if you've ever been on ticketmaster to buy a concert ticket or cricinfo to follow cricket commentary in the old days, you know that even the best websites can go down in times of excessive demand. Give it a week and all will be fine.

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Originally Posted by bieber

what's the goal of obamacare and how is it working for people? forget political parties

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It's working great for unemployed people under 26 on their parents plans. It's working great for people with pre-existing conditions that will have coverage starting Jan 1st. I think it'll succeed just as well as Romneycare succeeded in Massachusetts, and then it'll really cost the Republicans at the next elections.

I already received a letter from my insurance saying my rates might go down!! That's what Obamacare is doing. Here is my simple view of Obamacare.

1. It covers pre-existing conditions
2. It creates a competitive marketplace for insurance
3. It caps insurance profits at 20%

So if you think about it - all those 3 measures hurt insurance companies - which is one big step to contain healthcare costs. Insurance has distorted the marketplace.

The second big step and that is relatively silent so far is the digitization of health records - which "in theory" will remove waste from the medical industry. Examples - reduced incidences of repeat tests.

I am a big fan of step 1 i.e. Obamacare as we know it. I am interested in knowing more about step 2. My doctor friends are on the fence. Right now hospitals are going through massive programs to comply with the mandate about health records.

http://www.thedailyshow.com/watch/mo...--shutdown-eve
http://www.thedailyshow.com/watch/tu...amacare-begins

For some laughs..

Quote..

"But perhaps nothing sums up the sheer ridiculousness of this situation, the degree to which the Republicans have left the plane of reason, more than this new talking point that they themselves rolled out this weekend.

REP. TED POE, R-TX (9/30/2013): The President will negotiate with Iranians ... but the President and the Senate will not talk to the House.

REP. LOUIE GOHMERT, R-TX (9/28/2013): Have as much flexibility with the Republicans as you do with the Russians and Iranians.

SEN. MITCH McCONNELL, R-KY (9/30/2013): The President more than willing to negotiate with Iranians, I don't know why he wouldn't be willing to negotiate with us.

"Err-berp, derr-berp, derr-derp."

You're not helping yourself. If it turns out that President Barack Obama can make a deal with the most intransigent hardline unreasonable totalitarian mullahs in the world, but not with Republicans? Maybe he's not the problem. (wild audience cheering and applause) We'll be right back."
http://www.dailykos.com/story/2013/1...nment-shutdown

For about 4 years, the Daily Show was my main source of news.

Idiotic, Pedro

administration is shutting down the govt because congress is not funding obamacare, but everything else

congress is not funding it because it has to be done via budget and there is no budget by govt in last 4 years

if not this way, there is no speding cut,

reason 2, president can not implement part of the law, that is delaying employer mandate, somebody can go to court and settle the matter but it takes an year

Pedro
you said 'The cost of healthcare in this country is not the cost of premiums to a typical family. If you want to compare costs, you should look at the cost of emergency room care next year compared to this year. Compare revenue write offs by the hospitals compared to this year. And a whole bunch of other metrics. Don't just pull the one metric that suits you and lead with it. As to household insurance premiums, the healthcare exchanges cover 20% of the country, and these insurance policies are real policies unlike the crap that was available previously to them. '

I didnot derive anything, it's president who promised premiums will go down.

Nothing suits me brother, just because somebody likes one idealogy, doesn't mean they have a political agenda
you are not really liberal if you are against a view

Pedro, yoy said 'I don't see how that could possibly be true. If Obamacare covers new patients (people who previously had no coverage due to preexisting conditions, children under 26 covered by their parents and expanded medicaid coverage), who is losing coverage now to leave the # of uninsured people the same?'

I don't know, it's non partisan CBO estimate

you said 'Cost to whom? I'd need more details to comment'

Cost to govt. it was supposed to cost 0.7 T when it passed, now the estimate is 2.7 T

you said 'Typical right wing bullshit etc..'
It's not very difficult to type what you said is bullshit too. Who is being friendly to big businesses and screwing individuals now? fat cat reps?
howmuch individuals contribute compared to corporations? i thought you know all these

you said 'They're up. They're working in California, where i've already got quotes. The federal exchanges are up too, even if they've had hitches. And if you've ever been on ticketmaster to buy a concert ticket or cricinfo to follow cricket commentary in the old days, you know that even the best websites can go down in times of excessive demand. Give it a week and all will be fine.'
lucky you

you said 'It's working great for unemployed people under 26 on their parents plans. It's working great for people with pre-existing conditions that will have coverage starting Jan 1st. I think it'll succeed just as well as Romneycare succeeded in Massachusetts, and then it'll really cost the Republicans at the next elections'

Obamacare will cost reps an election :D, have you seen any polls recently?

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Originally Posted by bieber

I didnot derive anything, it's president who promised premiums will go down.

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Premiums will go down for some and up for others. Where it will end up on average, we don't know yet. I think it'll go up, but that's okay because it is a better product over all.

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Originally Posted by bieber

Pedro, yoy said 'I don't see how that could possibly be true. If Obamacare covers new patients (people who previously had no coverage due to preexisting conditions, children under 26 covered by their parents and expanded medicaid coverage), who is losing coverage now to leave the # of uninsured people the same?'

I don't know, it's non partisan CBO estimate

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This link
was the first google restult for 'cbo estimate for uninsured' and it shows the % of insured people going up to 90% (92% if you ignore illegal immigrants), not down. Having said that, there were about 20 other links that I didn't go through.

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Originally Posted by bieber

you said 'Cost to whom? I'd need more details to comment'

Cost to govt. it was supposed to cost 0.7 T when it passed, now the estimate is 2.7 T

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Again, it is not clear if that is net of the increased tax revenues from Obamacare, or just the gross figures? Either way, I can see the cost going up since the recession led to more people that qualify for federal subsidies now than in 2010 when the law was passed. Not ideal, but I can live with it. If pushed to cut that extra 2T, I'd point to the defense budget.

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Originally Posted by bieber

you said 'Typical right wing bullshit etc..'
It's not very difficult to type what you said is bullshit too. Who is being friendly to big businesses and screwing individuals now? fat cat reps?
howmuch individuals contribute compared to corporations? i thought you know all these

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Nothing wrong with being friendly to business. That's a positive, in my mind, but that's not the issue here. You should go back and look at where the push to delay those provisions came from. The conservative right. Go back and look at the WSJ editorials on the subject prior to the administrations decision. They actually had good things to say about the administration after they decided to delay it. This is Hodja's camel all over again. Give an inch and they want a mile. I repeat, delaying the individual mandate would effectively delay the entire law. You can't force insurance companies to only insure the old and unhealthy. That would kill them. the Republican strategists and politicians know this and that's exactly what they want. If you don't know it, you're just blindly buying their bullshit. If you do know it, you're being deliberately deceiptful. Either way, I'm not going to debate this point with you further.

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Originally Posted by bieber

you said 'It's working great for unemployed people under 26 on their parents plans. It's working great for people with pre-existing conditions that will have coverage starting Jan 1st. I think it'll succeed just as well as Romneycare succeeded in Massachusetts, and then it'll really cost the Republicans at the next elections'

Obamacare will cost reps an election :D, have you seen any polls recently?

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Actually, I have. My main news source is the right wing WSJ, and even with that source, I know three things a) most of the US don't know shit about what Obamacare does, b) even with that an equal number of people like and hate Obamacare, and c) when pointed out features of Obamacare without calling it that, they like it. There was a poll done in Kentucky (which has established one of the better state exchanges), where they polled people about Obamacare and the 4 or 5 key features. The vast majority (>90%) of the people that said they hated Obamacare liked a majority of the key features. I couldn't find that article now, but I read it in the WSJ.

Anyway, a quick google search gave me this. I'm not a fan of HuffPost, but the polls they point to in that article are all reputable polls.

In any case, before you go out and point me to another 10 polls that say the opposite (which I'm sure exist), that isn't my point at all. My whole point is to wait until Obamacare starts to affect people positively in 2014. Wait until people realize they now can get health insurance that they couldn't earlier; wait until people who don't like the health insurance they're forced to get break bones or get sick, and realize how much the insurance they hated is saving them, or just wait until this happens to people they know. Anyone conservative that this helps is going to realize that he's been rabidly against Obamacare all this while without knowing why. And then he's going to blame the politicians who have been telling him to hate Obamacare all this while. He may not become a liberal overnight but he'll not show up to vote in 2014.

I don't really think it will win Democrats the House because of how badly they've gerrymandered the congressional districts. But I expect a lot of GOP Congressmen to lose primaries.

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Originally Posted by bieber

Idiotic, Pedro
administration is shutting down the govt because congress is not funding obamacare, but everything else

congress is not funding it because it has to be done via budget and there is no budget by govt in last 4 years

if not this way, there is no speding cut,

reason 2, president can not implement part of the law, that is delaying employer mandate, somebody can go to court and settle the matter but it takes an year

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Don't fool yourself into believing this is anything other than a Republican led shut down.

The current government spending levels have been set based on the sequester, which was a compromise reached by both republicans and democrats. To refuse to conference for 11 months and then insist on defunding Obamacare a few weeks before the CR deadline is irresponsible. The Republicans have a right to ask for more cuts, just as the Democrats have the right to ask for more spending or tax increases. The place to do it is in conference, not on national television in the face of a government shutdown.

If reason 2 was really a concern, why wouldn't Republicans offer the White House the option to implement the employer mandate too instead of delaying the individual mandate?

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Originally Posted by Pedro Gonzales

Don't fool yourself into believing this is anything other than a Republican led shut down.

The current government spending levels have been set based on the sequester, which was a compromise reached by both republicans and democrats. To refuse to conference for 11 months and then insist on defunding Obamacare a few weeks before the CR deadline is irresponsible. The Republicans have a right to ask for more cuts, just as the Democrats have the right to ask for more spending or tax increases. The place to do it is in conference, not on national television in the face of a government shutdown.

If reason 2 was really a concern, why wouldn't Republicans offer the White House the option to implement the employer mandate too instead of delaying the individual mandate?

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I don't get my news from comedian brother. with all humility I'm saying this. I don't let some news channel or opinion fool me, there is enough evidence and open source of information in this country if one is willing to get to bottom of any thing. (not possible in India)

how do you think republicans can make obama implement employer mandate, are you serious, wow :)

I will try to keep myself away from non immigration threads

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Originally Posted by idiotic

Shutdown drama is another example why discharge petitions are pure fantasy.. Clean CR bill is a better candidate than CIR for discharge petition but it is simply not practical even though by theory lot of moderate republicans supporting both bills :)

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Surprise.. Surprise.. Fantasy coming true after loooong time.. Let us see how many republicans sign this discharge petition.. Can they do the same for CIR also :)

http://thehill.com/homenews/house/32...nding-shutdown

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Originally Posted by idiotic

Surprise.. Surprise.. Fantasy coming true after loooong time.. Let us see how many republicans sign this discharge petition.. Can they do the same for CIR also :)

http://thehill.com/homenews/house/32...nding-shutdown

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Fantasy is still a fantasy.. no one ready to sign discharge petition even though they are willing to vote yes on clean CR :) You can easily infer for CIR..

http://thehill.com/homenews/house/32...n-funding-bill

This law (ACA) is simply designed to spread the costs of healthcare onto a broader base and really not much else - and it works pretty well.

Its pretty simple. You go to a doctor/hospital as an individual and get some test done - the doctor/hospital bills you $1000 (lets say). You say no sweat, I have insurance and you're 'in network' - please bill them. Doctor says sure thing. Insurance company pays doctor/hospital $350 (not $1000) based on a previously negotiated rate. Who wins? 1) you do, you got $1000 worth of services for the cost of premiums (relatively low) 2) the doctor wins because he is in your insurance network and hence earned your business, 3) the insurance company wins because they earned your business and your premiums.

Why does this model work? Because its carefully controlled - insurance companies don't insure those who are high-cost (read: pre-existing conditions, lifetime caps etc.). Doctors negotiate lower rates with insurance companies because they get more business and offset costs that way. You buy insurance based on who offers the most coverage and 'widest' network for your premiums. Overall, a procedure that would otherwise cost $1000 now costs $350 because the costs can be spread across a cross-section of insured people. And all of this works simply because you're not a high-risk customer ... i.e. your healthcare needs are not high enough that you drain profits from the system. But the moment you do, you get dropped like a hot potato.

Why does this model not work? For all the same reasons above - and the fact that over 90% of healthcare costs are racked up 10% of the (sickest) patients who are not covered anyways.

So what Obamacare does is:
1) Mandates everyone buys insurance - so young healthy people are brought into the system who wouldnt buy insurance otherwise because they're healthy - so they pay premiums and their premiums would definitely go up (from zero to something above zero)
2) Since everyone needs to have insurance - it mandates insurance companies cannot deny people coverage for pre-existing conditions, life-time caps etc.
3) Because everyone needs to be covered, it mandates insurance companies do not overcharge unfairly etc. by establishing regulations around risk pools, mandatory coverage etc.
4) Mandates employers to cover their employees (as they do today) - or pay a penalty which will be used to fund the subsidies the government plans to offer poor people to buy and maintain insurance

Why will this work? Because everyone should now have access to the 'network' of negotiated lower rates (i.e. $350 vs. $1000). The premiums are spread across a much higher pool of people (more premiums) and the higher costs of healthcare will be a huge drain on profits in the long run. This risk of lower 'profit' will put downward pressure on costs overall, including pressure to find ways to better manage chronic conditions which majority of Americans suffer from. It also helps eliminate uninsured ER costs which is ultimately spread across people who have insurance.

Overall, this is a good law - its one way and a good way to begin addressing a highly problematic area (healthcare) of the US society and economy. A lot will depend on how it is implemented, but overall it has the necessary foresight to become successful.

I think the republican argument is all about viewing it as another expensive entitlement (like SS, Medicare, Medicaid, Food Stamps etc.) and more government overreach into individual life. It doesn't make sense - coming from people who want to regulate women's right to choose and their birth control options and banning gay marriage. But I have not heard (and not for lack of trying very very hard) a single republican alternative to fixing healthcare (other than of course - repealing obamacare).

And the other reason I believe Obama is right to stand his ground (other than the fact that he campaigned on obamacare, congress passed it into law and the supreme court has upheld it) is that this simply does not set a good precedent. Every republican or democratic future president will have to deal with such 'ransom' situation by extremist minorities going forward if this type of hostage taking is allowed.

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Originally Posted by rferni

This law (ACA) ....

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well said.

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Originally Posted by rferni

This law (ACA) is simply designed to spread the costs of healthcare onto a broader base and really not much else - and it works pretty well.

Its pretty simple. You go to a doctor/hospital as an individual and get some test done - the doctor/hospital bills you $1000 (lets say). You say no sweat, I have insurance and you're 'in network' - please bill them. Doctor says sure thing. Insurance company pays doctor/hospital $350 (not $1000) based on a previously negotiated rate. Who wins? 1) you do, you got $1000 worth of services for the cost of premiums (relatively low) 2) the doctor wins because he is in your insurance network and hence earned your business, 3) the insurance company wins because they earned your business and your premiums.

Why does this model work? Because its carefully controlled - insurance companies don't insure those who are high-cost (read: pre-existing conditions, lifetime caps etc.). Doctors negotiate lower rates with insurance companies because they get more business and offset costs that way. You buy insurance based on who offers the most coverage and 'widest' network for your premiums. Overall, a procedure that would otherwise cost $1000 now costs $350 because the costs can be spread across a cross-section of insured people. And all of this works simply because you're not a high-risk customer ... i.e. your healthcare needs are not high enough that you drain profits from the system. But the moment you do, you get dropped like a hot potato.

Why does this model not work? For all the same reasons above - and the fact that over 90% of healthcare costs are racked up 10% of the (sickest) patients who are not covered anyways.

So what Obamacare does is:
1) Mandates everyone buys insurance - so young healthy people are brought into the system who wouldnt buy insurance otherwise because they're healthy - so they pay premiums and their premiums would definitely go up (from zero to something above zero)
2) Since everyone needs to have insurance - it mandates insurance companies cannot deny people coverage for pre-existing conditions, life-time caps etc.
3) Because everyone needs to be covered, it mandates insurance companies do not overcharge unfairly etc. by establishing regulations around risk pools, mandatory coverage etc.
4) Mandates employers to cover their employees (as they do today) - or pay a penalty which will be used to fund the subsidies the government plans to offer poor people to buy and maintain insurance

Why will this work? Because everyone should now have access to the 'network' of negotiated lower rates (i.e. $350 vs. $1000). The premiums are spread across a much higher pool of people (more premiums) and the higher costs of healthcare will be a huge drain on profits in the long run. This risk of lower 'profit' will put downward pressure on costs overall, including pressure to find ways to better manage chronic conditions which majority of Americans suffer from. It also helps eliminate uninsured ER costs which is ultimately spread across people who have insurance.

Overall, this is a good law - its one way and a good way to begin addressing a highly problematic area (healthcare) of the US society and economy. A lot will depend on how it is implemented, but overall it has the necessary foresight to become successful.

I think the republican argument is all about viewing it as another expensive entitlement (like SS, Medicare, Medicaid, Food Stamps etc.) and more government overreach into individual life. It doesn't make sense - coming from people who want to regulate women's right to choose and their birth control options and banning gay marriage. But I have not heard (and not for lack of trying very very hard) a single republican alternative to fixing healthcare (other than of course - repealing obamacare).

And the other reason I believe Obama is right to stand his ground (other than the fact that he campaigned on obamacare, congress passed it into law and the supreme court has upheld it) is that this simply does not set a good precedent. Every republican or democratic future president will have to deal with such 'ransom' situation by extremist minorities going forward if this type of hostage taking is allowed.

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This is the best explanation in lay man terms any one can ever give on concept of group insurance and obamacare :)

By any chance are you a journalist? If not, please consider becoming one and you will be really good at it :)

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Originally Posted by rferni

This law (ACA) is simply designed to spread the costs of healthcare onto a broader base and really not much else - and it works pretty well.

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rferni - very good writeup. I will only point out that reduction of waste is addressed through electronic medical records and it is a huge effort going around the country right now. I do not know if that indeed will reduce waste. But just like in India there is always a nexus between labs and doctors and hospitals to have more tests done. It is outright ridiculous that for a literally 10 minute ER visit one is charged 2000 dollars. I hope that through EMR this waste is mitigated somewhat.

I also think that the law should have a followup law that will encourage vertical integration between hospitals and insurers. This way the insurer is also responsible for treatment and outcome. That would be a good first step towards outcome based payments which will then greatly reduce all the phony charges and tests.

Not an expert. So please criticize. Mine is a common man's view.

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rferni - very good writeup. I will only point out that reduction of waste is addressed through electronic medical records and it is a huge effort going around the country right now. I do not know if that indeed will reduce waste. But just like in India there is always a nexus between labs and doctors and hospitals to have more tests done. It is outright ridiculous that for a literally 10 minute ER visit one is charged 2000 dollars. I hope that through EMR this waste is mitigated somewhat.

I also think that the law should have a followup law that will encourage vertical integration between hospitals and insurers. This way the insurer is also responsible for treatment and outcome. That would be a good first step towards outcome based payments which will then greatly reduce all the phony charges and tests.

Not an expert. So please criticize. Mine is a common man's view.

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Thanks Q - indeed a very important point. For the amount of money spent on healthcare in the US (approx. $2.7 Trillion), the US healthcare system ranks somewhere like 18th in the world in terms of healthcare outcomes. Its pretty horrendous - because most of the medical focus is on disease management, not cures. And no one is accountable. EMR is a really positive step in my opinion.

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By any chance are you a journalist?

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Not a journalist, but thanks for your complement. Just annoyed when people perpetrate myths without any basis other than political rhetoric.

Overall, the ACA is nothing more than a simple expansion of the group benefit insurance concept - the government steps in to subsidize where there isn't an employer to subsidize the cost of premiums. The funding for subsidies comes from re-appropriating funds from other entitlements (Medicare) and from penalties to individuals/employers. I really don't understand this whole hue and cry - unless ofcourse its opponents are worried it might work and thats a political setback for them. I'd love to understand more about the opposition.

From rferni's writeup, I would add a few points he might have missed. $1000 the hospital bills the patient is not the real cost. It is the inflated cost that hospital claims to insurance knowing that insurance is going to pay a lot lesser. So the amount $1000 is bumped up price meant for negotiation.

IMO the republican opposition to ACA originates from the fact that insurance companies cannot manipulate the healthcare systems freely for their profits under Obamacare. Remember republicans are for business however unethical they may be. That is the fundamental reason they object to Obamacare.

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Originally Posted by gcq

From rferni's writeup, I would add a few points he might have missed. $1000 the hospital bills the patient is not the real cost. It is the inflated cost that hospital claims to insurance knowing that insurance is going to pay a lot lesser. So the amount $1000 is bumped up price meant for negotiation.

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I agree with you. But look at it this way - when you receive treatment worth $1000 (inflated, it might be) and you cant pay for it (you don't have insurance), the hospital or doctor 'writes off' $1000 (not $350). This $1000 loss is then spread across or baked into costs of other treatments and procedures - remember Hospitals/Doctors are 'for profit' organizations too - which are passed on to insurance companies or government (Medicare) who ultimately pass them on to insured people or tax payers. So the $1000 price point is more than just a negotiation starting point - it has real implications. Most unpaid treatments are ER related which are way higher as well.

What our republican friends don't understand is that they are, in many ways, paying for the uninsured (I wonder how is this not 'socialism'?).

With ACA, everyone is insured and should have access to the negotiated $350 rate, so that should 'in theory' become the new rate as the insurance companies are not going to pay a hospital/doctor $1000 for this specific treatment to one of their insured patients - its just not profitable for them anymore. Hospitals will be forced to cut costs and eliminate waste so they can remain profitable with the $350 as well. This is the very mechanism within the ACA that attempts to put the brakes on increasing healthcare costs.

To the member above (Beiber) who mis-represented the cost of obamacare as $2.7 Trillion, that is absolutely false. $2.7 Trillion is the current contribution of the healthcare industry to the GDP of the United States - i.e. the sum total of all healthcare products and services offered in the US (including research, cost of drugs, manufacture of drugs and medical equipment, costs of procedures, insurance premiums etc. etc. etc.) is $2.7T - this is not the "cost of obamacare" to the government. Please do not perpetrate falsehoods served up by political rhetoric.