Physician says Affordable Care Act an 'experiment' that will fail

[Lasher]

DAWES, W.Va. -- The Affordable Care Act is an experiment that will fail, the head of an organization that advocates for a single-payer health system argued Thursday.

"People will not be able to afford the health insurance that they're being pushed to buy," Dr. Andrew Coates, president of Physicians for a National Health Program (PNHP), said during a visit to West Virginia on Thursday. "And when they do buy it, it won't be good enough to cover health-care calamity."

Under the ACA, health insurance premiums and deductibles will not be affordable, Coates argued.

"I think it's a big experiment to drive people to (the health insurance) marketplace but the health insurance marketplace hasn't worked for years now and I don't see any evidence that's going to change," he said.

<snip>

"People say (a single-payer system) can't work here," said Dr. James Binder of the West Virginia chapter. "That's not true."

http://www.wvgazette.com/News/201304250121

[upaloopa]

1. Being an ex controller of a medical clinic

I'd have to say I agree with him. Just having insurance doesn't mean you'll get care. The provider has to contract with the insurance company to get certain reimbursement rates. If the provider doesn't think the reimbursement is enough they may not contract with them. Your insurance may be worthless to you in that kind of situation.
Or if you buy cheap insurance it may not reimburse the provider enough even if they accept it and will expect you to pay the difference. You may not be able to afford care even if you are insured.
Single payer like other countries have is the only way people will be sure to have care and that is what all this is about not affordable insurance.

[still_one]

2. It very well could be

we will see, however, it will benefit the poor and uninsured, it will be the lower middle class that will be hit the hardest it appears, so much so that if the premiums become too much for that demographic, they will either not buy it or buy it, which may cost them up to 25% of their income, that they may go from lower middle class to working poor

[denverbill]

3. I would have to agree, and disagree.

I think a big problem up front is that a lot of people are not going to realize that they are required to buy insurance, and even if they realize they are, will refuse to do so because they don't have the cash. People are 'required' to buy car insurance to drive, but I think I've heard about 1/4 of drivers on the roads today don't have insurance.

Single payer is clearly the way to go, but the current Democratic party won't even allow it to be costed by the CBO.

[PoliticAverse]

5. Many people will be in for a rude surprise at tax time. n/t

[AAO]

18. Except that there is no punishment for not complying.

[Dragonfli]

20. Yes there is, in NYS, they pull you over and put you in local jail for driving without insurance

and you better have a good lawyer at arraignment time.
http://www.dmv.org/insurance/penalties-for-driving-without-insurance.php

If you are referring to ACA non-compliance there most assuredly is a penalty for that as well, a financial one.

[AAO]

23. ACA, and no penalty will be enforced - it's right in the bill.

[Dragonfli]

24. Are you saying the IRS will not enforce it's mandate to collect the "tax"?

imposed for noncompliance? Or are you using semantics to argue it is not a fine at all technically.

I find you to be quite dishonest in your claim effectively if not technically . I don't care much for lies disguised as semantics by weasels and con men that rely on semantics to claim something that is not true.


The U.S. Supreme Court upheld the constitutionality of Obamacare’s individual mandate by concluding that imposing a penalty for not purchasing health insurance is a valid exercise of Congress’ power to tax. As of Jan. 1, 2014, all Americans will be required to purchase either a private health plan or health insurance through a state exchange if they are not otherwise exempt or covered by their employer. The requirement does not apply to Americans age 65 and older who are covered by Medicare.

The penalties, which will be administered by the IRS, will be pro-rated based on the number of months during the year that an individual is not covered by health insurance, although there is no penalty if an individual is not covered for less than three months. Insurance companies will send their plan participants and the IRS a form confirming that the minimum essential coverage was held, which taxpayers will be required to attach to their tax forms beginning in 2015.

[AAO]

25. Sorry you overreacted!

From the IRS:

24. What happens if I do not have minimum essential coverage, and I cannot afford to make the payment with my tax return?

The IRS routinely works with taxpayers who owe amounts they cannot afford to pay. The law prohibits the IRS from using liens or levies to collect any payment you owe related to the individual responsibility provision, if you, your spouse or a dependent included on your tax return does not have minimum essential coverage.

The law does not allow for enforcing collection.

Also from the IRS referring to the ACA:

Under section 5000A(g)(1), the shared responsibility payment is payable upon
notice and demand by the Secretary. The shared responsibility payment is generally
assessed and collected in the same manner as an assessable penalty under
subchapter B of chapter 68 (sections 6671 through 6725). Unlike the assessable
penalties, however, the Secretary may not file notice of lien or levy on the taxpayer's
property for failing to pay the assessed shared responsibility payment. Further, a
taxpayer may not be subject to criminal prosecution or penalty for failing to pay the
assessed shared responsibility payment in a timely manner.

From the PPACA:

(g) Administration and procedure
(1) In general
The penalty provided by this section shall be paid upon notice and demand by the Secretary, and except as provided in paragraph (2), shall be assessed and collected in the same manner as an assessable penalty under subchapter B of chapter 68.
(2) Special rules
Notwithstanding any other provision of law—
(A) Waiver of criminal penalties
In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.
(B) Limitations on liens and levies
The Secretary shall not—
(i) file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section, or
(ii) levy on any such property with respect to such failure.

[Lasher]

30. People, people, why can't we all just get along?

I think you are both right. I think the IRS will deduct ACA debts from any income tax refund to which you would otherwise be entitled. But I don't think they'll put a lien on your house on account of that kind of debt. As always, future legislation could alter this outlook.

[AAO]

31. If you aren't due a refund, they can't take any off it.

And yes I wish people would be more civil around here.

[Dragonfli]

33. That is more dishonest misrepresentation of the truth, anything you owe to the IRS stays owed

They may not use a lien, but they will wait and take any refund in the future until it's paid AND they add penalties and interest. I owed a couple hundred dollars for a 1099 in 95, and they didn't put a lien on anything, but they did wait until I wasn't breaking even and when I finally started getting refunds again they took money out of my refunds for three years and they added to the balance for having to wait, I ended up paying 350 in the end.

You are such a word weasel, are you a politician? I hate cons specialty weasely ones that say things like they won't penalize anyone when you know damn well they will and then use the really broke guy example of how everyone will somehow just weasel out of paying them. They will not forgive IRS debt just because you can't pay right away; they wait patiently and collect it later with penalties added to the penalties for having to wait

[AAO]

38. What's your problem? You don't know how to adjust your tax withholding?

[Dragonfli]

41. Sure, but I worked both on the books and as a sub contractor on other projects

I kept it break even for the most part despite this, you try that while paying double the fica on just one part of your earnings all by yourself without your boss doing it for youare you implying that if I knew how to avoid getting a refund I could have avoided paying the IRS what I owed them? That wasn't the point, it would have only prolonged it and made the fines add up even more, I didn't even realize I missed a 1099 until they took money out of my refunds and just let them keep taking a portion until they were paid, it was easy that way as I didn't have to do anything.

Adjusting withholding would not erase a debt owed to the IRS, you know, the debt they didn't collect with a lien (I realize you pretend that no lien makes debt magically go away but...)
Try again.

What exactly is your point? That people that have refunds are stupid because they didn't avoid getting them? How does that make bullshit a bowl of soup? Are you out of weasel tactics and resorting to a change of subject because your implication that there will be no penalties enforced is nothing more than compost?

[Dragonfli]

37. And I wish people were more honest around here but wish in one hand and...

[Dragonfli]

36. I should, but I always hated "that guy" that claims he didn't screw my sister

because, you know, oral and anal doesn't count. I is not so much about my sister in this metaphor - she may do as she pleases.

I will still call that guys bullcrap, feces, because it is.

I am funny that way, truth is truth and weasel words and misrepresentation are an attempt by someone to lie without being a liar yet they are putting the lie out there nonetheless while feigning ignorance and innocence.

[still_one]

32. As long as the premiums are affordable it should not present a problem, but if they are not, the

Democrats will have hell to pay at the polls

They should have done Medicare for all which would have made it affordable, but the Insurance lobby, and healthcare providers want to continue their slush funds

[clarice]

4. Has anyone ever waited in a never ending line at the post office?.nt

[Dragonfli]

6. I find my post office to be most efficient, what has that to do with the price of bacon in Canada?

Or the OP.
You lost me, if you were trying to make a point it was too dull to pierce even cottage cheese. Please try to explain without using a seemingly random statement.

[clarice]

44. Those are the funniest analogies I've ever read. lol. keep 'em coming.

[Bonhomme Richard]

7. The difference is magazines and a seat. n/t

[Cleita]

9. Me too. I find my post office to be most efficient even though they are

understaffed. That would take care of the long lines if they were fully staffed instead of forced to do cut backs all the time.

[ErikJ]

11. My PO Box at the post office is about half the cost of private mail boxes.

And they never close! Lounge is always open. I always pick my mail up at 10 pm.

[Cleita]

8. We need the public option to buy into Medicare included in the exchange.

It's the only way it can be workable. Otherwise, this really will bankrupt our nation while the insurance companies will make out like the bandits that they are.

[snappyturtle]

10. I totally agree with Coates. Maybe when the ACA fails these knotheads in

Congress will understand how poor, over-all, the American people are.
I don't think people can afford this. I can barely afford Medicare.

[thesquanderer]

12. ACA may be Obama's "Don't Ask, Don't Tell"

...something people will some day look back on as a reasonable and well-meaning attempt to do something about a vexing problem, but an approach that will look wrong-headed in retrospect when it will ultimately be replaced by the "correct" solution. Eventually, gays in the military became acceptable, and eventually, we will have some kind of single payer system available for all.

[truebluegreen]

13. I hope it does fail. And I hope it takes the health insurance racket down with it.

We need Medicare-for-All.

[madrchsod]

14. we have a system that works pretty dam well right now--medicare

we could cut a couple of defense dept toys and we could pay for medicare for those who don`t work,children,disabled,etc,etc.. those who do work their payments already go into medicare/social security. get rid of the loser state medicaid programs.

wait a minute...we could be like the many of our trading partners..seems to work out for them.

[freshwest]

21. Medicare needs significant expansion to take care of Medicaid patients.

Their care is dependent on the legislators of their states and denies them equal care. The cost of care for people covered by Medicare and Medicaid always falls almost entirely on the latter.

Their survival is in the hands of legislators that fund them well or put draconian conditions on them according to the whim of the voters in their states. It puts them at jeopardy, instead of being a firm promise such as Medicare is.

If we believe in equality as a nation, it would not be so. I think this is the real problem, exacerbated by media inciting division. We are all human and are entitled to be treated the same, some of us say.

Others carve out their piece of the pie and demand more as a reward for having more money, and brush off those with less. I'm not sure what it's going to take to get Americans to unify to equality in healthcare.

[Loudestlib]

15. ACA

Most doctors are great at fixing people but horrible with money. In America right now we have a ton of pent up demand. That means that there are a lot of people out there who are uninsured or under insured. If you opened up the flood gates it would crash the system. I think the ACA eases us into single payer by getting rid of some of that demand and given the system time to adapt. I believe a single payer system could work in America but we are going to have to change the way we think death. Right now we will spend any amount to extend or save a life even when it is clearly hopeless.

[moonbeam23]

16. There's a dirty little secret about single payer

Medicare For All is the only way to go to get us out of this horrible system....

Even my brother, a saintly MD who was opposed to "socialized medicine" years ago, is now begging to be free of the pricks from the insurance companies that are making his life a living hell of expensive and useless paperwork, not to mention the interference with his professional judgment....

The dirty little secret is that there are not enough doctors, especially primary care physicians, to go around if all 300 million of us were to be allowed to have medical care as our birthright...the old school ones are retiring and/or dropping like flies and not being replaced fast enough...

This is the defacto rationing that the right has been screeching about for the last 60 years every time we tried to bring up"socialized medicine"...there are death panels and care rationing all right, but it is being done by private industry and private financial position, so that makes is a-ok with the "let them die" crowd...

Are we going to start chanting 'WE'RE NUMBER 37!!"? lol

[Hoyt]

28. You can blame medical societies for a lot of that shortage.

That AMA and state medical societies have lobbied for decades to restrict supply of non-MD providers, training slots, etc.

[greymattermom]

42. and in some states the legislature wants to cut funding to the only medical school

Class size will be cut. But, there are plenty of Indian MDs who would come practice in the US. As I'm sure most of you know. They come with little or no debt too, so they can do well on much lower salaries. Watch, that will be next.

[bvar22]

17. Without a "Public Option to Keep them honest" (Obama),

and without any effective Price Controls for the actual delivery of Health CARE,
and with the 50 different states with 50 different Exchanges that disperses the ability to "bargain" with the providers,...

I agree. The Affordable Care Act WILL fail,
but certain pieces will be kept.

*The MANDATE to BUY Insurance from a For Profit Corporation WILL be with us FOREVER.

*The No Exclusion for PECs will stay,
as long as one is RICH enough to afford the pricey Buy In.
(This was a huge gift to the RICH and Upper Middle Class).

*The Medicaid Expansion... who knows at this point?
(It was ruled UNCONSTITUTIONAL bu the Supreme Court, and is now "optional&quot .
It will probably be eventually connected to some kind of Means Testing in most states where Americans must sell EVERYTHING they have worked for their entire lives, and be absolutely BROKE before they will be eligible for the "Expansion".

But no matter which components remain, what we WILL LOOSE (and have already LOST) is the ability to implement a REAL
National, Publicly Owned, Government Administered Health Insurance Program (a la FDR & LBJ). That opportunity is NOW GONE.

Anytime ANYONE dares to bring it up they will be met with a hailstorm of,
"[font size=3]We already TRIED that, and it didn't WORK"[/font]
even though "ObamaCare" didn't come anywhere CLOSE to that.[/font]


Failure by design?
Your call.


You will know them by their WORKS,
not by their excuses.
[font size=5 color=green]Solidarity99![/font][font size=2 color=green]
--------------------------------------------------------------------------------------------------------------------------------[/center]

[Hoyt]

29. I think exchanges will work better than some think, and there are nonprofit health plans available.

[Dragonfli]

19. Well, Heritage Foundation solutions never work (except for the wealthy few)

I don't expect a Heritage Foundation policy to work this time either just because it was proposed by a "Democrat" rather than Gingrich, or Dole, or Mitt Romney.

It will work well for the insurance protection racket perhaps, but that was the point when the righties dreamt it up so that is not too surprising.

[harmonicon]

22. No shit, Sherlock. (nt)

[BethanyQuartz]

26. I agree with him

Healthcare isn't being nationalized and drug prices aren't being set, and therefore prices are going to stay as high as those profiting from them can keep them.

All this does is shift more of the burden to the taxpayer and individual and off the shoulders of all those sweet little impoverished corporations who are sick and tired of including any cost of healthcare in with their employment packages.

[Thinkingabout]

27. There are too many fingers in the pie who provides no health care, the US is the highest cost in

Health care. We don't need executives of insurance companies making big salaries, they do not provide health care but if you have insurance or you self pay for your health care they are able to run the prices up enough to take care of themselves. When international health insurance advise their insured to seek health care other than the US and it is because of cost. Our prescriptions are higher in the US than any other country and for the same drug.

[quadrature]

34. there are 'opt outs' depending on (low)income

I know lots of people earning 9 bucks an hour.
there is no way they can pay 400 a month.
...................................
I just don't see low income folks signing up.

for the well-to-do, it is purely an economic
trade-off of, insurance-or-pay-the-fine,
some will buy, some won't,
until they are sick, then more will buy.

[Lasher]

35. I'm worried about low income folks who benefit from the Earned Income Tax Credit.

They, and other low income folks, get refunds that are greater than the amount of income taxes they pay. Do you think they will get hit pretty hard by the IRS penalties, particularly in relation to the more affluent?

[quadrature]

40. low-incomes are not affected at all ...

below a certain point of income,
there is no need at all to get insurance.

its the 'middles',
that face a choice...
a (tax)fine or pay an insurance company

[Bluenorthwest]

43. The Chained CPI will greatly reduce the Earned Income Credit

Fewer will get it and those who do will get less. So they have an assortment of worries....

[blkmusclmachine]

39. .

.

[Doctor_J]

45. I think the chess master was beaten on this one

For some reason (probably the promise of lots of campaign cash and a 7-figure job in 2017), he backed off of his campaign pledge to include a PO, and instead entrusted our health care to vicious, amoral executives and profiteers. This was a disaster on many fronts.

[area51]

46. +1

and a kick for this life and death issue.