ObamaCare’s Relentless Creation of Second-Class Citizens (5)

[HiPointDem]

And we go to Happyville, instead of to Pain City. –Thomas Pynchon, Gravity’s Rainbow

In this series, we’ve been looking at how ObamaCare, through its inherent system architecture, relentlessly creates first- and second-class citizens; how it treats people who should be treated equally unequally, for whimsical or arbitrary reasons. It’s all in the luck of the draw! If you live in the right place or have the right demographic, you go to Happyville. If you don’t, you go to Pain City.

We’ve looked at the whimsical differences between the citizens of Libby, MT, and all other citizens; the banked and the unbanked; those herded into Medicaid and those who are not; the arbitrary distinctions between creatures of the Beltway and all others, between the covered and the not covered, and between those who will be marketed to, and those who will not; the sheer bloody randomness of relying on credit reporting agency data for income validation; and discrimination based on jurisdiction and geography. In this installment, I’d like to look once more at geographical discrimination, give on update on the creatures of the Beltway, and look at “churn.”

First, on geographical discrimination, this from the Portland Press Herald:

An Aroostook County resident who buys a health care plan on the new federal insurance exchange could pay $1,000 more per year in premiums than a Portland resident for exactly the same coverage, according to information released Wednesday by the Maine Bureau of Insurance. The insurance industry lobbied for the changes, arguing that it costs more to deliver health care in rural areas...

$1000 is a lot of money! How can this differential possibly be justified in a program that’s supposedly there to aid citizens? It costs the Post Office more to move the mail from Aroostook County, but a first class stamp costs the same nationwide. We don’t change Social Security benefits by where people live. So why health care?

Answer: Because Obama and the Democrats had one key goal in designing ObamaCare: To preserve the health insurance industry...

What frosts me is that none of this suffering is needed. It’s all an inevitable consequence of ObamaCare’s system architecture. ObamaCare throws Americans into different buckets using a complex and confusing system of eligibility determination, and people inevitably get thrown in the wrong buckets, or land between buckets, or there aren’t even the right buckets for them. Adding to the mix is that buckets differ by state, both legally and in terms of insurance markets, and so what should be a simple, national system of Medicare for All instead creates second-class citizens all over the place, both within and between states.

Under a single payer system, where health care is a right, the eligibility paperwork is very simple. There is one form, and it’s already been filled out: Your birth certificate. And that’s how it should be.

http://www.nakedcapitalism.com/2013/08/obamacares-relentless-creation-of-second-class-citizens-5.html

[intaglio]

1. And exactly how did the previous US healthcare system promote equality?

How was that nauseating and elitist system to be replaced?

The Obamacare system is flawed and so is every other healthcare system- live with it and change it because without it American "healthcare" would still be described as "the weakest go to the wall"

Now get out if this "I hate Obama" tantrum and work for Democratic success in 2014 and 2016

[Freddie]

3. ^^^this^^^

So please someone tell me how we were going to get a single payer system given the political realities of the day.
The alternative to Obamacare is the "old way", what the Repugs want and why they keep trying to "repeal and do nothing." If you're incredibly fortunate you have employer sponsored insurance. If you're old you get Medicare; extremely poor or disabled, hopefully, Medicaid. Anything else? You're SOL. Go to the ER and file for bankruptcy. Pre-existing condition? Feel free to die in the street.
Obamacare has many flaws. But it's a start and a hell of a lot better than the status quo.

[Cryptoad]

15. After looking at

the CA exchanges , which are leading the nation in roll outs, I have been impressed. It was better than I had expected. True no way of getting a single payer sys now, I think the way ACA is constructed it will morph it Medicare and Medicaid into a single payer sys. But for know at least some people who have not been able to have insurance can have some!

It not perfect ... but thanks Mr President,,, sure beats what we had!

[Arcanetrance]

4. Sorry it's still described as the weakest go to the wall. This plan propped up the insurance

Industry nicely. There will be no changing it for something better that was made sure of. We were given a 90s conservative pro business health care plan.

[Major Nikon]

6. Had it not been for the obstructionist GOP the plan would have been quite different

Blaming all the shortcomings on Obamacare on Obama is pretty short sighted. You don't get universal heath care, single payers, and true reform so long as wingnuts have the ability to obstruct anything and everything. That's why you support the best people who have the greatest chance of doing the most good. Obama can no more force exclusively progressive ideology than Shrub could force exclusively wingnut ideology. Like it or not, nothing gets done in Washington without compromise so long as both parties hold more or less equal political power.

We were given the Massachusetts state health care plan which despite Rmoney signing the bill was written, supported, and driven by liberal Democrats.

[Arcanetrance]

8. I'm not putting it all on Obama I understand the separation of powers

But I have alot of worries when it comes to what we wound up with.

[eomer]

77. It was President Obama and the Democratic leadership in Congress who killed the public option.

They could have enacted a public option without a single Republican vote because there was a Democratic majority in both the House and Senate. Since the final changes to ACA were done through a reconciliation bill and therefore couldn't be filibustered, they could have added a public options with just their simple majority.

The president and the Democratic leadership declined to put it up for a vote, most likely because there were afraid it would pass and they had made a deal not to do it. That's the reason we don't have a public option.

[Egalitarian Thug]

11. Isn't it time to retire the false dilemma from the grab-bag of political bullshit?

This particular one is so worn out that even the blind see right through it.

[intaglio]

54. It is not a "False" dilemma

It is an actual dilemma. Congress, which has a majority of bought and paid for politicians, would not pass a single payer health system and even the debilitated bill that did pass was barely able to muster the necessary support

The false dilemma is to say either the US has a single payer system or it has a system based on unfettered insurance companies. Reality is that there are a multitude of systems better able to care for the sick than the pre-Obama status quo.

[Egalitarian Thug]

65. The false dilemma is that the only option to this corporate welfare program is nothing.

I know that people have worked very hard for four years to convince themselves that that is all there is, but the facts and events show it to be false.

We can do better, and when it's the parasite's fortunes on the line we always do. In hours or days.

It's still trillions for Wall Street, fuck you for Main Street.

[intaglio]

70. I cannot cure willful ignorance

But I can expose the falsehoods you are promulgating.

The false suppositions on which your post is based.
1) That this (so -called) corporate welfare program does nothing for the majority of US nationals.
2) That this (so-called) corporate welfare system is provides the same or more benefits to corporations than the previous system.
3) That the closure (but unfortunately not the elimination) of the donut hole is somehow irrelevant.
4) That the extension of family benefits to young adults benefits does nothing to assist a group grossly discriminated against under the previous system is somehow flim-flam.
5) That the near removal of the "pre-existing conditions" get out of paying ploy is to the benefit of the corporations.

What is worse is the airy assumption you imply that somehow a more liberal bill would have even got out of committee; the only way that might have happened is if the President had chosen to become a dictator. Is that sort of dictatorial action what you want? Is that the foundation of your feigned egalitarianism?

[Egalitarian Thug]

73. You should look to your own rather impressive ignorance.

The thing is that in the end, the truth will out, and all the bullshit, spin, and fantasy will unavoidably be shown for what it is.

The people that are always right will be right again, while the suckers and the shills will all claim they were never fooled.

[intaglio]

74. So no refutations?

No corrections?

No suggestions?

Just bland denial.

Willful ignorance and an inability to argue your case.

[Egalitarian Thug]

78. You've said nothing that requires any refutation.

I understand that in the fantasy world you live in name-calling and foot stomping are arguments, but out here in the real world it's just occasionally diverting to watch the angry monkeys fling their poo.

A false premise is a false premise regardless of what you wish to believe.

And now, you are no longer even curing boredom...

Buh-bye

[intaglio]

79. Fantasy? Nothing worth refuting?

Oh did you lose the ability to comprehend words?

It is not worth refuting that the Obama system is more egalitarian than the previous system? Or are you arguing that it is more elitist?

How is demonstrating that your false accusation of "false dilemma" was flawed a fantasy?

How is my enumerating the flawed logic behind your febrile attempts to damage the President (and probably the Democratic party) not worthy of response?

You have no arguments to support your bland, idiocies.

[bitchkitty]

19. How on earth do you get to

"I hate Obama" tantrum from criticism? It really makes me sick to see this kind of blind loyalty. If Obama can't take criticism, what kind of man is he? What kind of man are you making him out to be? What kind of man are YOU that you can't take valid criticism of this Administration?

I see this all over DU and it's revolting.

[intaglio]

55. Because posts like this are just temper tantrums

Obama is not the left wing messiah that some immature minds in the Democratic Party desired him to be. Immediately after the election (on DU2) posted to the effect that he would not fulfill such fever dreams if only because he was a successful politician - so please remove your silly accusation about loyalty.

What is currently revolting about DU is not the conflicts but rather the blithering idiocy that is intent on dividing the Democratic Party from the electorate. This sort of division fuels the wet dreams of the 1% and may see the Democratic party loose the Senate as well as the House - if Nate Silver is to be believed.

[bitchkitty]

62. Well, thanks for putting me in my place.

Silly? I'll run right now and correct ALL of my posts that differ from what the horde believes. I thought DEMOCRATIC meant something different evidently. Silly indeed.

[intaglio]

63. I asked you to correct your accusation

I referred to that accusation as silly - not you; everything is not about you. If you wish I will replace it with either "foolish" or "insultingly unfounded".

Let me add that if I had meant to say or imply you were silly, or if I was being patronising the sentence would have been structured differently. As it is I included the terms "immature" and "blithering idiocy" which I assumed you did understand was aimed at the class of armchair dissidents who want an impossible democracy.

[uponit7771]

57. The OP isn't constructive, leaves out "none at all" perspectives and premise that NOTHING can be ...

....changed for the better.

Typical FUDr

[cbdo2007]

40. Their answer to everything is always "Medicare for all...."

Well that's not gonna happen anytime soon, so lets do the best we can and keep improving the system little bits at a time.

It's ridiculous for their only solution to be one that isn't going to happen, and if it isn't they're going to kick and scream like little babies about anything that doesn't give them their way.

[intaglio]

56. Unfortunately "gradualism" is a dirty word to the far left n/t

[HiPointDem]

84. Making everyone buy insurance from the private sector is not a road to single-payer; it's a

road in the opposite direction.

Once the private sector gets mandated income, good luck wresting it out of their hands. No one gives up power or income willingly unless forced.

Which wouldn't be soooo terrible, if paying the premiums *guaranteed* you could get health care without going bankrupt. BUT IT DOESN'T EVEN DO THAT.

[intaglio]

87. Ignoring the foolishness if your assertion about private insurance,

Because the German and Japanese systems are based upon private insurance funds, what is your alternative and, more importantly how would you have got it through Congress and past the Courts? Come on give us the benefit of your wisdom.

I do not argue that the new system is truly egalitarian only that it is a compromise that is better than what went before.

[HiPointDem]

88. japanese system is not 'based upon private insurance funds,' for starters. other huge

differences:

1. Health insurance is, in general, mandatory for residents of Japan, though there is no penalty on individuals who choose not to comply, and around 10% of the population does not enroll.

2. People without insurance through employers can participate in a national health insurance program administered by local governments. National Health Insurance (Kokumin-Kenkō-Hoken) is one of the two major types of insurance programs available in Japan. The other is Employees' Health Insurance (Kenkō-Hoken?). National Health insurance is designed for people who are not eligible to be members of any employment-based health insurance program. Although private insurance is also available, all Japanese citizens, permanent residents, and any non-Japanese residing in Japan with a visa lasting one year or longer are required to be enrolled in either National Health Insurance or Employees' Health Insurance.

3. Public health insurance covers most citizens/residents and the system pays 70% or more of medical and prescription drug costs with the remainder being covered by the patient (upper limits apply).

4. Since all individuals are covered by one of Japan’s health insurance programs, all of the plans are virtually the same in terms of benefits. Therefore, although an individual’s coinsurance may vary in amount – ranging from 10%-30% – the services offered do not.

5. Premiums are based on income and ability to pay.

6. Hospitals, by law, must be run as non-profit and be managed by physicians. For-profit corporations are not allowed to own or operate hospitals.

7. Medical fees are strictly regulated by the government to keep them affordable.

8. There are basically no medical charges for children whose parents pay into public health insurance, and each local government sets its own age limit.

9. Fees for all health care services are set every two years by negotiations between the health ministry and physicians. The negotiations determine the fee for every medical procedure and medication, and fees are identical across the country. Thus, as of 2009, in the U.S. an MRI of the neck region could cost $1,500, but in Japan it cost US$98.

http://en.wikipedia.org/wiki/Health_care_system_in_Japan

http://www.kaiseredu.org/Issue-Modules/International-Health-Systems/Japan.aspx

http://en.wikipedia.org/wiki/National_Health_Insurance_%28Japan%29


Nor did the Japanese system start out by making private insurance primary. It started out as a system financed through LABOR UNIONS.

Japan’s first health insurance system was introduced in 1922. It took effect from 1927 to cover laborers and in 1938 was extended to cover farmers also.[4] The system originated from labor unions representing workers in dangerous industries, and over time was gradually extended so that currently all Japanese citizens and residents should be covered.

[HiPointDem]

90. Nor is the german system based on private health insurance:

Health insurance in Germany is split in several parts. The largest part of 85% of the population is covered by a basic health insurance plan provided by statute, formally insured under the legislation set with the Sozialgesetzbuch V (SGB V), which provides a standard level of coverage.

The remainder of 15% opt for private health insurance, which frequently offers additional benefits.

The government partially reimburses the costs for low-wage workers, whose premiums are capped at a predetermined value. Higher wage workers pay a premium based on their salary. They may also opt for private insurance. This may result in substantial savings for younger individuals in good health. With age and illness, private premiums will rise and the insured will usually cancel their private insurance, turning to the government option.,[9] however, this is not always possible, nor is it simple to accomplish.

All salaried employees must have public health insurance. Only public officers, self-employed people and employees with a large income, above c. €50,000.00 (adjusted yearly), may join the private system.

In the Public system the premium

= iis set by the Federal Ministry of Health based on a fixed set of covered services as described in the German Social Law (Sozialgesetzbuch – SGB), which limits those services to "economically viable, sufficient, necessary and meaningful services"

= is not dependent on an individual's health condition, but a percentage (currently 15.5%) of salaried income.

= includes family members of any family members, or "registered member" ( Familienversicherung – i.e., husband/wife and children are free)

= is a "pay as you go" system – there is no saving for an individual's higher health costs with rising age or existing conditions.

http://en.wikipedia.org/wiki/German_health_care_system


nor did the german system begin with everyone signing up with private insurers & 'evolve',

so i guess you really don't know what you're talking about.

[intaglio]

92. your extensive wiki-ing states that the coverage is only guaranteed by the state

The actual insurers are private companies

Nice research but wrong conclusion

[HiPointDem]

93. wrong.

In the German system, about 85 percent of residents purchase heavily regulated, non-profit insurance referred to as Gesetzliche Krankenversicherung (Statutory Health Insurance, GKV), approximately 10 percent buy private insurance, and the remaining 5 percent fall into other insurance schemes.

Krankenkassen (Sickness Funds) are heavily regulated, non-profit insurers who are legally required to accept all applicants and are permitted to sell health insurance (GKV).

http://www.aicgs.org/issue/structure-of-the-german-health-care-system/

There is no competition on products on services between the funds. All provide the same services as defined by the G-BA (Gemeinsamer Bundesausschuss)...

Private insurance covers nearly the same services but allows additional benefits (e.g. first class service) – there is competition between private insurers.

In ambulatory physician care, a regional physicians’ association negotiates a collective contract with a single sickness fund in the form of a quasi-budget for physician services. The association distributes the funds among general practitioners (GPs) and specialists who claim reimbursement mainly on a fee-for-service basis...

Hospitals are financed on a dual basis: investments are planned by the governments of the 16 Bundesländer, and subsequently co-financed by the Bundesländer as well as the federal government, while sickness funds finance recurrent expenditures and maintenance costs.

http://www.ispor.org/htaroadmaps/germany.asp

The krankenkasses are not private for-profit businesses. They aren't private companies that have a sideline in public insurance -- they are public corporations, and they began as worker or employer-funded insurances, not private for-profit insurers.

Or historically, 'friendly societies':

A friendly society (sometimes called a mutual society, benevolent society, fraternal organization or ROSCA) is a mutual association for the purposes of insurance, pensions, savings or cooperative banking. It is a mutual organization or benefit society composed of a body of people who join together for a common financial or social purpose. Before modern insurance, and the welfare state, friendly societies provided financial and social services to individuals, often according to their religious, political, or trade affiliations...

Credit unions and other types of organization are modern equivalents.

http://en.wikipedia.org/wiki/Friendly_society

The first bill that had success was the Health Insurance bill, which was passed in 1883....The program was established to provide health care for the largest segment of the German workers. The health service was established on a local basis, with the cost divided between employers and the employed. The employers contributed 1/3, while the workers contributed 2/3s.

Individual local health bureaus were administered by a committee elected by the members of each bureau, and this move had the unintended effect of establishing a majority representation for the workers on account of their large financial contribution. This worked to the advantage of the Social Democrats who – through heavy Worker membership – achieved their first small foothold in public administration.

http://en.wikipedia.org/wiki/Otto_von_Bismarck#Health_Insurance_Bill_of_1883

Similarly in Japan:

National health insurance emerged in Japan as the result of a gradual process that can be traced back to 1905, when the Kamegafuchi Textile Company provided limited benefits for its employees. In the decades that followed, more and more corporations began offering benefits through mutual aid societies. A health insurance law enacted in 1922 was inspired by the German system established by Chancellor Bismarck in 1883. As in Germany, this first law extended health insurance coverage to industrial workers and miners but excluded the self-employed and employees in companies with fewer than five workers.2 This law, implemented in 1927, established the practice of mandating coverage by enterprises and created an important government role in the provision of health insurance to those individuals not covered by employers. In 1938, health insurance was extended to...other groups not covered by the 1922 law.

In 1958, the 1938 law was revised to include the remaining 30 percent of the population not previously covered. This revision broke the precedent of extending health insurance to occupational groups by calling for universal coverage on the basis of residence. Every government jurisdiction, whether city, town or village, was required to provide health insurance to every uncovered resident by 1961. Since 1961, virtually all Japanese have been covered by either employers or the government.

Ignoring some administrative complexities and small beneficiary groups, health insurance plans for employees may be categorized into four groups:

Government-managed plans - These plans provide coverage for the almost 30 percent of the population comprised of employees (and their dependents) of small enterprises with more than five but fewer than 300 employees. These plans are managed by the government's Social Insurance Agency through a network of some 300 local offices. Premium contributions are set by law at a fixed rate (8.2 percent of monthly income before taxes) and evenly split between employees and employers.

Society-managed plans - Known as health insurance societies, more than 1,800 company plans provide coverage for 26 percent of the population. These health insurance societies are managed jointly by representatives of labor and management in enterprises with more than 300 employees. Society-managed plans can be also established by several enterprises employing 3,000 or more employees. Payroll taxes for such plans range from 5.8 to 9.5 percent of gross monthly income.5 Employers are required to pay at least half of these contributions, and some pay as much as 80 percent.

Mutual aid association (MAA) insurers - Covering almost 10 percent of the population, these include 27 plans for government employees in the national public service, 54 plans for local government employees, and one plan for quasi-public employees like teachers and other school employees. The average payroll contribution of these plans in 8.5 percent of the employee's wage.

Plans for day laborers (for those who work less than two months during the year) and seaman - These independent plans cover only 0.1 and 0.4 percent of the population, respectively.

In addition to the employee groups noted above, employees in enterprises with fewer than five workers, the self-employed and retirees are covered either by municipal governments or by national health insurance societies

Most of Japan's health insurance plans are private organizations in terms of administrative law; in practice, they have a quasi-public status insofar as they are largely bound to provide uniform benefits and to cover all eligible beneficiaries.

Employers have little freedom to alter premium levels, which range from 5.8 to 9.5 percent of the wage base.7

The self-employed are required to contribute premiums to health insurance plans that are administered by local governments or trade associations.

And all of these premiums are taxed to finance the national fund which, along with government subsidies, finances national health insurance for the elderly.

...This has limited private insurance to coverage of copayments. There is, however, a small market for supplemental benefits that pay for amenities like private rooms.

http://www.nyu.edu/projects/rodwin/lessons.html#II



IOW, these 'insurers' are not private for-profit insurance corporations.

[intaglio]

94. They are private companies

The "not for profit" status is irrelevant to the argument in hand.

If you wish to include that status then explain how the US system could adopt that without either a massive buy out of shareholding or anti-competitive intervention.

I'd suggest that Congress, the courts and the states would shut it down before the ink was even dry on the proposal.

[HiPointDem]

95. they aren't private 'companies'. private companies compete in a marketplace on price points

and goods/services offered and make profits.

they never were private companies, either.

[HiPointDem]

100. They are 'private companies' like the Freemasons are a 'private company'

I don't have to explain anything and I didn't say I wanted anything.

Just saying your pretense that requiring people to buy private insurance from for-profit corportation will somehow evolve into universal health care, as well as your pretense that other countries did it that way, is bullshit.

For-profit companies exist to profit. where health care is concerned that means they exist to overcharge a/o deny coverage.

[GiaGiovanni]

67. It didn't: which is why we didn't need the ACA which mandates that we buy into that system

.

[Egalitarian Thug]

2. K&R If only someone could've predicted this, then.

Oh wait, we did, and the fun times are only just beginning, kids.

[Divernan]

5. Obama took Single Payer off the table w/out the Repubs. even asking him to!

[Egalitarian Thug]

9. Which followed Speaker Pelosi keeping it off the agenda and the floor for

nearly two years before the President was elected.

It looks very much like this was the plan ever since the republicans made it in the '90s in response to the understanding that if the American people ever get a sane health care system they will never tolerate going back.

[JoePhilly]

10. Lieberman (Senator from Aetna) was never going to vote for it.

And you needed him, and about 5 other bluedogs to vote yes to get anything.

The fact that you didn't "hear" the GOP ask him to take it off the table is irrelevant. Lieberman and those bluedogs were not going to budge, and they said so.

[Fumesucker]

29. I think you are talking about Al Gore's 2000 Vice Presidential running mate

I particularly like the wagging finger.

[JoePhilly]

30. Who also campaigned against Obama, and for McCain, in 2008.

Lieberman was just as angry as McCain after the 2008 election.

If McCain won, Lieberman was going to be his SOS or SECDEF, no doubt about it.

And Obama stole it all. From both of them.

Lieberman wasn't going to help get Obama anything, let alone Single Payer, which as the Senator from Aetna, he was already against.

[Fumesucker]

34. The point being that a lot of liberals groked Holy Joe in 2000

We had looked into his eyes and seen his shriveled and loathsome excuse for a soul.

Pure sheer cupidity, avarice and ego embodied, a scorpion walking on two legs.

And Al Gore chose this unspeakable pool of sanctimonious maggot droppings as his running mate, said a lot about his judgment, none of it good.

But it's Nader's fault Gore "lost" the 2000 election because he said there was no difference between Democrats and Republicans while Gore was busy trying to prove it by picking Lieberman. Bear in mind that Lieberman is the guy you blame no single payer on and you make it all about personal animus on his part.

[JoePhilly]

42. You are one of the few who find the Bush years funny.

Lieberman was, and is, all about Lieberman. Period.

As for Nader, folks debate his impact on the 2000 elections. Meh.

Nader is like lots of folks on the far left, screams a lot, gets little to nothing done.

Which returns us to my point. Nader, as usual, is irrelevant in the discussion of Single Payer or Lieberman's role.

Lieberman was a Senator (Nadar, nothing). A Senator who campaigned against against Obama. A Senator who was covering for the Insurance Lobby, forever. And he was a Senator who was not going to run again.

So Lieberman's reason for being against Single Payer was not all about personal animus on his part and I in fact made no such claim. The animus simply made it just that much easier for Lieberman to get some for Lieberman.

Lieberman was, and is, all about Lieberman.

And now, Lieberman is collecting his payoff over at the AEI.

[Fumesucker]

43. No, I find you defending Lieberman hilarious

I was watching through the whole disaster, the Smirk cousin that actually called the election at Fox, the retracted concession that Dubya didn't have to get snippy about and on and endlessly on.

Like a lot of things it wasn't funny at the time but there can be humor, albeit often dark, found in it.

[JoePhilly]

44. When did I defend Lieberman? Never.

[Fumesucker]

45. Then what are we arguing about?

[geek tragedy]

21. You and the Teabaggers keep on rooting for it to fail.

Sorry, it's not going to, despite the best efforts of the dead Enders on both political extremes.

[Egalitarian Thug]

27. Call me all the names you like, you've made it clear that's all you've got.

I and the millions of others that generally prefer to listen to people that both know what they're talking about and are in the habit of being right, are not rooting for failure, we simply understand what was done, by whom it was done, and for what purpose it was done.

Failure is the obvious and inevitable result of a bad republican idea that even the republicans recognized as a bad idea when they came up with it.

The sheer genius of putting the people most responsible for developing an over-priced, under-performing, and unresponsive health care system in total charge of the health care system is truly a wonder. But then, our standards have fallen so low these days that the capacity to stand upright and not drool at the same time now constitutes qualification to hold public office, so I guess it's not surprising that what is obvious to so many of us can be misconstrued as wishing for the inevitable result.

It comes down to this; Who is more at fault? Lucy for continuing to fool Charlie Brown with her kick the football game, or is it Charlie Brown for stupidly believing that this time it's going to work despite countless examples of failure with not one success?

[geek tragedy]

38. Maybe you can lobby your Congressman for the 41st Repeal Vote. Rejectionism is all you got.

Your line is exactly the same as the Teabaggers--exactly.

"The ACA is a horrible piece of legislation that will only hurt America. There is no redeeming it, the more it is implemented the more damage it will do."

Blah blah blah.

The adults on the left and the Democratic party are dedicated to seeing the ACA implemented in the best manner possible.

Rejectionists such as yourself and Ted Cruz are part of the problem, and have no constructive role to play.

[Egalitarian Thug]

48. If not for your name calling and arguing with yourself by pretending that people said things you

only wish they did, I have to wonder if your fingers would just stop working.

The ACA doesn't need to be repealed, it will continue to fail just as it was designed to from the start on its own. Everything that has happened so far is exactly what we were told would happen by those irritatingly correct people at the start. You're wishful thinking and wild-eyed accusations are nothing but a fart in a windstorm.

But please, do continue to demonstrate the blind panic that so obviously consumes you as you as reality inevitably intrudes on your fantasy.

[JoePhilly]

31. Its working already ... and driving some crazy as a result. nt

[uponit7771]

58. +1

[JVS]

89. Oh shit! Are we back to Tinkerbell croaking if we don't clap hard enough?

[xchrom]

7. du rec.

[sulphurdunn]

12. Someone

pointing out the glaring faults of Obamacare shouldn't elicit a wise monkeys response from progressives.

[groundloop]

13. Geeze, I'd have preferred to do nothing than to get the advances we did

Since Joe Lieberman and a few others kept us from having the perfect system, I'd have preferred to keep what we had. I was perfectly happy with people being denied healthcare because they were already sick. I didn't want my kids to be covered by healthcare while they were in college. I think insurance companies should be able to make unlimited profits and not be held accountable in the least.

(duh)

My God I hope we can get this divisive bullshit out of our system by the next election, or we're doomed.

[nolabels]

24. So it's your life or your wallet?

The perfect politic, bad problem so the thing they give us is what will keep the feudal system intact. The whipped up problem solved government getting something done and a rally point so nothing else could get done. Just like tarp, a way to bail out those with who are grafting off the population in general.

[Jim Lane]

25. The serious question is whether the overall NET effect is "advances"

Yes, some specific insurance-reform provisions are improvements, if you look at them in isolation. It must also be borne in mind, though, that a system that gives an important role to the big for-profit health insurance companies is fundamentally flawed, and that one likely effect of the ACA is to entrench that system.

Some people see the ACA as a step toward single-payer. Some, however, see it as a step away from single-payer. That's the serious argument, not the straw man of people supposedly saying that we should oppose any change that isn't absolutely perfect. AFAIK, no one is actually saying that.

[uponit7771]

59. So you think NO health insurance is better than expensive?!

[Jim Lane]

64. (1) Sometimes, yes. (2) Anyway, that isn't the right question.

1. Someone who must buy insurance may find that paying the premiums uses up the money with which he or she could have obtained actual health care (as opposed to insurance), and that the insurance doesn't provide the health care because of high deductibles and co-pays. Such a person can't see a doctor about that persistent unexplained pain because, after paying the premium, he or she can't afford the co-pay for the doctor visit. Insurance like that amounts to catastrophic coverage. It provides better health care only to someone with a major medical problem.

2. The point I made about the ACA is that it will produce short-term improvement in health care for some people, but that it might still be bad in the long term. An issue raised by left-wing critics of ACA is that it further entrenches the role of the private, for-profit health insurance companies. Most DUers think single-payer would be best. One effect of ACA might be to make it harder to get from where we are now to single payer. It's possible that, in 2014, overall health care will be better than it would be without the ACA, but that in 2024 it will be worse. Obviously, this depends in part on one's assessment of when we're likely to get to single-payer despite ACA, versus when we would've gotten there without ACA.

[dreamnightwind]

75. Two excellent posts you made here

My take is that the previous system was too unregulated, costs were too out of control, and recission was creating a class of uninsurable people.

Some people use that perspective to make the case that the ACA is an improvement.

I think the opposite. I think the previous system was so ruthless and uncaring, determined to maximize profits with little to no concern of actually providing healthcare, that it soon would have collapsed under its own greed (it was close to that before the ACA, driving spending through the roof), bringing the country to the natural conclusion of that illness, our nation's immune system kicking in to rid ourselves of the infection before it killed us. The infecting agents are the health insurance corporations. We exchanged a deadly parasite that kills its host for a managed vampirism that will drain our resources in a more sustainable manner, keeping us alive but sick and poor. Very similar to the financial crash and rescue of the failed corporations.

We could have gotten to single payer by loudly making the case for it, over and over, as the out-of-control health insurance companies took more and more profit. By pointing out how pretty much every other country has a better solution to this problem, and looking at their implementations for examples, rather than rejecting them and looking for Obama's "uniquely American solution", which is actually uniquely corporate, and isn't Obama's so much as it is the insurance companies' attempt to prevent the real needed reform (their own termination) and tie us to them for the foreseeable future.

The crisis presented an opportunity to get it right, to educate the public about what the problem was. People run into it anyway in their dealings with the insurance companies, they already hate them, so a determined leader could have successfully made that case. Unfortunately too many politicians of both parties depend on too much campaign cash from corporate interests, so they kept the actual solution off the table, wouldn't even allow a single payer advocate to participate in the discussions.

[forestpath]

14. The 1% comes first with Obama. Not the rest of us. Our health is secondary to

insurance company profits. A very distant secondary.

[geek tragedy]

17. Yeah, that Medicaid expansion was a complete giveaway to the rich.

As was the ban on policy caps and pre-existing condition exclusions.

The stupid shit people say here is really astonishing.

[forestpath]

20. You should know all about that.

[geek tragedy]

22. I'm not the one rooting for Obamacare to fail and helping sabotage it. nt

[forestpath]

23. Expressing an opinion is not sabotage and such defensive hyperbole only

serves to throw into sharp relief its shortcomings.

[MotherPetrie]

68. +1

[geek tragedy]

16. Do you know where Aroostook county is?

Middle of nowhere, inaccessible, etc. costs more to deliver care to isolated areas.

[progressoid]

28. Didja miss this part?

"It costs the Post Office more to move the mail from Aroostook County, but a first class stamp costs the same nationwide. We don’t change Social Security benefits by where people live. So why health care?"

[geek tragedy]

35. Did healthcare cost the same before the ACA?

The argument you're advancing is that people in Portland should subsidize the health care for those in Aroostook county.

Shockingly, those in Portland might take exception to that.

[Fumesucker]

46. And the USPS will be a fond memory because of just that attitude

Why should the cheaper postal delivery subsidize the more expensive one?

If it's that way for health care, and people need health care even more than mail delivery, then why isn't it that way for the mail?

Should the nation be balkanized around cost of living?

[progressoid]

47. That's kind of the point of having a larger pool isn't it?

Every one shares in the cost.

Apparently, Portlanders should take exception to subsidizing rural electric, rural schools, rural highways, etc.

[HiPointDem]

86. yeah, they'd much rather subsidize the insurance business

[HiPointDem]

81. the biggest city in aroostoock county is 2.5 hours from bangor maine = less time

than it takes to get from seattle wa to yakima wa.

presque isle is a little over 4 hours from quebec city. about the time it takes to get from seattle wa to spokane wa.

[John2]

18. I saw those Debates,

and I'm really getting tired of people staying silent and then putting everything on President Obama. It was People and Congress, that killed single payer.

People in Red States were against it. This included Democrats in Red States, that sided with Republicans. The Teabaggers and Insurance Companies started a vigorous campaign to reject the public option. There was also a Media campaign as usual. There werev even some medical orgainizations with Doctors,nurses and hospitals, more concerned about their profits than patient care attacking it in this country. In fact a couple of those Red State physicians are in Congress. I guess President Obama is easier for some people to criticize. On this issue, I don't agree with them.

President Obama got through what he could, after prior people couldn't even get anything through. What you have to do is improve it and not dismantle it like some people want to do. I question their motives? Once it gets started, people are going to look for ways to improve it. The way people attacked it, was calling it Socialism or Communism, which are dirty words in Red States. Even though many benefit from some Social programs. So why don't people just stop beating up the people trying to help you and target the real villains. You need to change the attitudes of many rightwingers, which includes your fellow citizens. Singling out President Obama isn't going to achieve anything.

[sigmasix]

26. right wing apologists attacking president Obama again

Disguised Teabaggers have a short memory for their own destructive activities. everyone that was paying attention knows that the president wanted single payer option but it was torpedoed by right wing operatives and blue dog "democrats". I understand that the ODS makes lots of right wing apologists believe and support the most ridiculous lies and hyperbole about president Obama, but doing it on DU is a dead giveaway as to your real intentions.
When Teabaggers go to the trouble of diguising themselves as progressive DU members it is a sign that they realize how important DU is to facilitating a real intellectual and moral challenge to the evil of right wing extremism. Lies and the disguised liars that tell themare the tools of republican destruction for our democracy.

[Fumesucker]

32. When you can snatch the pebble from my hand, Grasshopper

Then you may speak of disguised Teabaggers.

[ProSense]

33. What do you expect from the "kill the bill"

bitter clown. The author of the piece is an idiot PUMA, use to post here.

He has been spreading misinformation about the health care law.

http://www.democraticunderground.com/10022832340

http://www.democraticunderground.com/10022834269

http://www.democraticunderground.com/10022834269#post10


Single Payer movement in the era of Obamacare
http://www.democraticunderground.com/10023372091

[geek tragedy]

36. Oh, lambert strether is a full blown PUMA psycho who hates Obama. This is not a surprise. nt

[uponit7771]

60. +1, please make this an OP...

[leftstreet]

39. Obamacare is a rightwing policy. Ask Romney, McCain, Bush...

If Obamacare passed during any of those administrations, DU would shit itself blind

[ProSense]

41. "If Obamacare passed during any of those administrations, DU would shit itself blind"

Yeah, people would be wondering when the RW learned to love Medicaid, expanding it to cover more than 17 million people.

[progressoid]

52. Unfortunatly,

Medicaid expansion is just a part of ACA and its a part that the Replicans are NOT loving. Are up to 18 states rejecting it now?

[leftstreet]

71. GOPers love that 'Tax and Spend Democrats' crap

Once again, a program that benefits the wealthy OR the impoverished, but stiffs it to the working classes by way of a mandate for private insurance...

How is that NOT handing the GOPers more fuel for their TAX AND SPEND DEMOCRATS spiel?

[MotherPetrie]

69. +1

[HiPointDem]

91. ask the heritage foundation, because that's where it came from.

[Sheepshank]

49. given the nature of your relentless Obama bashing

I'll pass on this bit of idiocy....as if what the nation had already didn't create a rift between the healthy and the dead. Now millions at least have a chance.

Thanks for playing.

[Mass]

50. Talk about ignoring reality. This article compares Obamacare to a system that was never in place.

Frankly, I would probably be dead by now if I was living in one of those states that did not have a decent healthcare system, being diagnosed with breast cancer four years ago. I would simply not have the money to pay for it. So, forgive me for seeing the reality. The MA healthcare probably saved my life, even if it is far from perfect.

Certainly, we would be better off with a single payer based on revenues rather than a flat fee insurance system as Obamacare provides (and yes, I know there are subsidies, but they are just there to get rid of the worse gaps). However, to create second zone citizens implies that they did not exist before. This is beyond stupid.

Note: I agree with most of what this article presents, but sadly, the ridiculous premise implied in the title makes the argument beyond absurd. Obamacare does not cure all problems our system has. The only possible way to do that was to build a system from nothing and even then: Medicare is not perfect either and there are unfairness in the far better systems that exist in Europe and in Canada, particularly when it comes to geography.

[Egalitarian Thug]

51. And in all the furious name-calling not one mention of the point the article makes.

Gee, it's almost like they don't really want to talk about it.

[uponit7771]

61. Fill an article full of sophistry then wonder why no one takes it seriously?!

[Egalitarian Thug]

66. I never said I wondered at the constant attempts to talk about anything but the post.

What would fill me with wonder would be to come onto DU some day and see any of the usual names here actually discussing anything of substance in a reasonable manner.

When you play with angry monkeys, you have to expect them to fling their shit, it's what they do and it's all part of the game.

[liberal_at_heart]

72. We have to get insurance companies out of our health care system!

[B Calm]

76. Where does insurance companies get that it costs more to deliver health care in rural areas?

[Recursion]

83. From the fact that it does, I assume. It does for Medicare, too (nt)

[HiPointDem]

85. what are those more expensive things? salaries are comparable. Equipment is carried into

rural areas on the same roads, rails & planes that carry equipment into urban & suburban areas.

the only difference is volume, because of lower population.

i doubt the difference is significant. i doubt the difference makes up for the added cost involved in making the distinction.

[Recursion]

96. Seriously?

Imagine having to transport a diabetic amputee in a suburb vs. an area in WV where the roads aren't paved.

Infrastructure makes things cheaper.

[HiPointDem]

97. so the difference is ambulance costs on unpaved roads? (btw, lots of places designated 'rural'

actually have paved roads...)

[Recursion]

98. Sigh.

Rural areas have:

1. Worse infrastructure
2. Poorer populations
3. More distributed populations
4. Fewer primary and specialist care providers

compared to more developed parts of the country

[HiPointDem]

99. Sigh. I live in a small town, & we are surrounded by officially designated rural area, but most

people in that officially designated rural area live on paved roads.

Furthermore, *they* pay the cost of transporting themselves to town for doctor's appointments, surgeries, visits to local hospital etc -- not the insurance company. *They* pay the cost of picking up medical supplies, etc in town -- not the insurance company.

Furthermore, for anything specialized, *they* pay the cost of transporting themselves an hour away to the big city medical facilities -- not the insurance company. Which is sometimes quite ridiculous, e.g. I have a half-blind acquaintance who's 80 who has to find transportation monthly to get a simple eye injection. *He* pays for it, not the insurance company.

The *only* transportation difference in this *rural area* is for services like home health or visiting nurses, & for ambulance/emt (which rural area actually assesses a tax for, so they also pay for part of that).

When you say 'worse infrastructure' you mean roads and lack of specialized equipment -- but the costs of that are mainly borne by the patients, in that *they* foot the cost for most of their medical transportation, and they die if a sudden emergency leaves them far from specialized medical equipment.

When you say 'poverty' -- well, detroit is not a rural area and has lots of roads but it has a higher poverty rate than our 'rural area' (which is actually richer than the small town it surrounds).

And whether the specialized providers are here in the small town or down the road in the big city, the insurance company pays them the same rate.

[woo me with science]

80. K&R

[Safetykitten]

82. It's such a fucking nightmare, but wait! Our resident soothsayers KNOW that it will be a smashing

hit! Even before ONE single payment is due, these prognosticators of the ACA know EXACTLY what a success it will be, when it does not even go into effect until 2014.

[bravenak]

101. I have an autistic child.

My whole family is covered under the Medicaid expansion of the ACA. I thank president Obama every day as I am low income and could not afford to cover my family. It also covers physical therapy and occupational therapy that my child receives in school. It covers my Schitzoaffective Disorder. It cover my husbands trench foot he gets from wearing wet rubber boots he wears working 12 hour days at the seafood plant.
THANK YOU OBAMA!
You have helped my family immensely. We were not covered before the Affordable Care Act, and now we will never have to file bankruptcy because of medical bills. My children will never suffer medical neglect. My daughter will receive the care and therapy she needs to have a chance at an independent life. We will keep our teeth. I can see in order to drive because of my one pair of free glasses per year. If I get cancer, I can see a doctor. My cousin received a life saving double organ transplant ( kidney, pancreas) and is now free from diabetes and can finish raising his children without constant fear of death.
Barack Obama is the best president ever.