I’ll be more specific. Does anybody other than insurance companies stand to gain anything from this healthcare plan? I’m trying hard to shake the feeling that the entire thing is nothing but an attempt by Obama to pay back his corporate sponsors.
I don’t want to be cynical, people, but I have this nagging suspicion that the entire Democratic Party is nothing but an attempt to bamboozle progressively minded people with a bunch of pretty, well-sounding words to get them to support policies that benefit nobody but the shameless politicians and their corporate backers.
We all know that this is what the Republicans do. Are the Democrats exactly the same?
For the moment, I will just hope that I misunderstood this healthcare plan altogether. The alternative is too disheartening.
Clarissa's Blog 
Well I’m hardly an expert so I would be interested to read some other comments. But one wonderful thing about the Affordable Health Care act (as I understand it) is that it gets rid of “life time limits.” In other words, before this Act, even if you faithfully pay health insurance your entire life, you can still hit a wall. These life time caps are very high but if one gets truly sick (like cancer), you can still hit your limit and then the insurance company can legally refuse further care. So the Act made that illegal…Another thing that the Act does is it doesn’t allow insurance companies to refuse service on the basis of “pre-existing” conditions. So for instance if you have any kind of illness, insurance companies can refuse to cover you. This keeps people in dead end jobs because they are afiraid that once they switch jobs, they can’t get insurance again. And stories of pre-existing conditions are horrifying. I had a friend who was refused treatment for her uterine tumor because the insurance company said her “pre-existing” condition was the fact that she possesed a uterus. She was actually able to fight and beat them on the issue. Still who wants to deal with that kind of stress–espcially when ill? I know that there are problems with the legislation and it’s not the system I would like (I’m a fan of single payer.) But it did accomplish some important things. (Again, I’m not an expert…)
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I will never understand why the insurance companies couldn’t be simply excluded from the entire process. We pay taxes, why can’t we have a state system of healthcare, like in Canada?
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Because Americans pays less taxes and their taxes are hugely used for stupidities like militaro-terrorism and policing victimless crimes…
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“Because Americans pays less taxes and their taxes are hugely used for stupidities like militaro-terrorism and policing victimless crimes…”
– You are telling me? I know! Why aren’t the Americans waking up?? Do they really think that it’s more important to wave weapons at the world than to get cured of disease?
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pay
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If they didnt listen to this guy, I dont think there is much hope for your country.
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I agree. It does help a few people. It also helps the very poor somewhat. But it has a lot of holes in it. Single payer would be much better; nevertheless, every system has flaws. As I understand it, England’s single payre system does not permit off-label use of drugs, so when a person has a really unusual illness or problem, it may not be possible for a physician to try novel treatments to find something that works. But, if you have a standard ailment that responds to standard treatments, the English system seems to be very good, based upon my friends’ experience with it.
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Off label drugs can be used in certain circumstances – if the Dr has permission for a clinical trial, a single use exemption from NICE, if the patient pays privately, or if the local clinical commissioning board is willing to fund the difference. However, and this is a big problem, and only getting bigger with the introduction of privatisation, this does create something of a postcode lottery, depending upon your area and your Dr.
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I don’t think it really does anything significant except piss people off. The insurance companies will still find ways to get around paying for things (and they have to, because they are companies). Administrators will still get high salaries. Poor people will still get the shaft.
Basically, the problem is the whole idea people have in this country that health care is something you should only take care of yourself. It’s a very frontier mentality. Also there is the idea that if you get sick or hurt it’s your fault. You’re no longer able to be productive, you’re a drain, etc. I’ve been very lucky so far that I’m pretty healthy, but I realize that could change at any minute. Americans don’t like to think that anything is out of their personal control. When it happens, we cry like babies. So we go from “I’m fine, I don’t need anyone, I can take care of myself” to “Waaaah! Mommy!” There’s no in-between, no mature attitude towards sickness and mortality. (Americans prefer to forget there’s this thing called “you die at the end.”) So we will never fix out health care system until we face the fact that we’re all mortal and that sickness and injury don’t mean we are weak, inadequate creatures.
If you must know, I’ve gone from the idea that all health care is a personal responsibility, to the idea that we might as well have some basic system in place for when we can’t do for ourselves.
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“I don’t think it really does anything significant except piss people off. The insurance companies will still find ways to get around paying for things (and they have to, because they are companies). Administrators will still get high salaries. Poor people will still get the shaft.”
– This is precisely the suspicion that’s bothering me. There is got to be something in place to treat sick people. A civilized society can’t let people suffer and die. This is a rich country, and I know it could be done.
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Apparently it prevents, as of 2014, insurance companies from charging women more than men for medical insurance. I had no idea that this was currently legal.
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I’ve known since N. started working at an insurance company. When he told me the principles they operate on and how they calculate people’s projected life spans, I was so traumatized that I asked him not to share this with me any longer.
He doesn’t work there any more, which, I believe, is just as well. The environment at such companies is also horrible.
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Oh, just seen today 2 posts mentioning the issue. One by a very famous lj user (a Jew btw, and Putin supporter, to explain the context). See last quoted paragraph:
The next quote is from a post by a different user, whom the user above quoted in another post. This one seems curious.
http://pora-valit.livejournal.com/584982.html
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I agree with the second post. The first one is kind of weird because the main problem of the US is precisely that there is no long-term planning. Look at Afghanistan. What a joke!
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I think your hunch is right and insurance companies are the winners here.
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Does anybody other than insurance companies stand to gain anything from this healthcare plan?
Seriously? does the fact that now you cannot be denied coverage because of a pre-existing condition does not register? or that you wouldn’t lose your coverage if you get fired makes no difference?
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There is no need to get aggressive. I’m just trying to figure things out. Since when is that a bad thing?
“or that you wouldn’t lose your coverage if you get fired makes no difference”
– Who will keep paying for it if a person is unemployed?
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The law would require everyone to buy insurance (supposedly. I’m sure there are some exceptions if you make under a certain amount. So the person receiving the coverage would have to pay a premium. The idea is that young, healthy people who might not otherwise buy insurance are *also* required to pay a premium, so that a less healthy person can pay a lower premium.
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“The law would require everyone to buy insurance (supposedly. I’m sure there are some exceptions if you make under a certain amount. So the person receiving the coverage would have to pay a premium. The idea is that young, healthy people who might not otherwise buy insurance are *also* required to pay a premium, so that a less healthy person can pay a lower premium.”
– That’s the part that REALLY bothers me. I support a form of taxation that achieves this goal. But this isn’t a tax, it’s money that people are forced to pay to private companies, right? So the government forces people to pay certain private companies? Am I mistaken here or not? If so, then that’s quite appalling on a variety of levels.
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Correct. And that is the part that has the Republican’s most upset. If you choose not to pay a private company, you pay a penalty to the government instead, so there is a choice – except, unlike a true health care tax, you don’t get any health coverage from paying the penalty.
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” And that is the part that has the Republican’s most upset”
– This sounds like a very reasonable thing to be upset over, however.
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The plan is trying to make a government health care plan without having it actually run by the government – leaving the existing insurance companies in place. The trouble is that those insurance companies goal is to pay out as little as possible, and deny as many claims as possible. Other parts of the healthcare bill are intended to mitigate this by putting restrictions on what % of premiums collected by health care companies may be spent on costs other than medical treatments for those people who pay the premiums. (So, at least 80% of premiums must go back to paying for healthcare – instead of the company being able to collect the maximum fee and pay minimum coverage.)
It’s a compromise, therefore, there are lots of bad bits in an attempt to reach a good aim.
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Sorry, didn’t mean to come across what way.
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I understand that this is a subject people tend to feel very passionate about. This is why it’s so hard to make sense of it.
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And that is the part that has the Republican’s most upset.
I think given the current state of obstructionist Republican politics it is very difficult to discern if they are truly upset or just faking it for political gain. Obamacare is after all the health care plan proposed by the far right Heritage Foundation (as well as Romney himself) in the mid 90s.
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The Republicans act upset about it now that the law has passed, but they also pushed the law in this direction by refusing the idea of having tax dollars pay for health care for everyone, as that would destroy the insurance industry and put people out of work. It’s cliche – politicians trying to have things both ways so that they can rail against their opponents no matter what they do.
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I have a pre-existing condition and I doubt this is going to help me. So they can’t deny coverage, but they can charge me enormous premiums and be very choosy about which procedures they’ll pay for? And I don’t have the option to back out if I don’t benefit (or I can, but then I have to pay a new tax on top of all my out-of-pocket health expenses)? I’m not in favor.
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“but they can charge me enormous premiums and be very choosy about which procedures they’ll pay for? And I don’t have the option to back out if I don’t benefit (or I can, but then I have to pay a new tax on top of all my out-of-pocket health expenses)”
– That’s precisely what worries me. Is that how it will work? Or not? Does anybody know for sure?
How will the Healthcare Act work if nobody understands it?
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So they can’t deny coverage, but they can charge me enormous premiums and be very choosy about which procedures they’ll pay for?
Short answer: No.
Long answer: As of 2014, insurers cannot charge consumers different rates for health insurance because of health status.
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Culture club: you seem to understand this legislation. Maybe you know why the decision was made to introduce the provision where everybody is forced to become a client of an insurance company whether they want it or not. Or is that not one of its provisions and I’m getting confused?
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But can they raise everybody’s rates? I care how high the premium I have to pay is. I don’t care if somebody else’s is lower.
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But can they raise everybody’s rates?
No. The government decides when rates can go up and by how much.
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That doesn’t mean rates won’t go up.
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Maybe you know why the decision was made to introduce the provision where everybody is forced to become a client of an insurance company whether they want it or not.
The original legislation had a government ran insurance scheme using private providers (but not insurers) not unlike a medicare-with-premiums. This plan got modified to its current form due to pressures from insurance companies’ lobbyists on Congress.
The compromise version of the legislation is a step forward in the right direction, though undoubtedly with some flaws.
The expectation from the Democratic side is that when the benefits kick in people will support fixing the legislation.
The expectation from the Republican side had been to make enough noise to eventually cancel the entire thing and go back to the status quo of 55+ million Americans without health coverage.
However, Obamacare has already garnished enough support (trifling as it might be) to force Republicans to change their tune to replacing rather than cancelling Obamacare. They never going into any specifics about what will take its place, though. For example, today Senate Minority Leader Mitch McConnell (Republican, Kentucky) said: “[Obamacare’s mandates] should be repealed and replaced with common sense reforms that lower costs and that the American people actually want”.
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That doesn’t mean rates won’t go up.
Correct. That is still possible. It will come down to who has more leverage, voters demanding Congress not to approve rate increases or lobbyists from Insurance companies.
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When I was in college, and still on my father’s health care plan, I kept mysteriously getting “dropped” off the plan every time I actually needed it. My father was still paying for me, but they’d refuse to cover anything. Now that I hold my own policy, they refused to cover my “pre-existing condition” for the first year. It’s bad enough I’m starting my adult life with student loan debt, but I had a little bit of choice in that matter. But I’m also starting off with thousands more in medical debt, the vast majority of it in ER and ambulance fees. I had no choice in that matter.
It’s almost certainly fucked up my credit score. Can’t say for sure, though. I’m afraid to find out, despite the fact that I should really know what it is.
I’ve thought about moving to another country (Canada? England? France?) where I could actually feel like a human being and pursue a career where I’d actually be happy. But I can’t bring myself to leave my family. So here I am, working a job solely for the health care, that I detest down to the core of my being.
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” Can’t say for sure, though. I’m afraid to find out, despite the fact that I should really know what it is.”
– Same here. . . 😦 I just can’t face finding out which is a little childish, I know. But I can’t make myself.
“So here I am, working a job solely for the health care, that I detest down to the core of my being.”
– That’s really horrible. The system is very fucked up the way it is. I don’t think anybody can reasonably disagree with that.
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I support it because if I still lived in the states, I would no longer need to worry about getting denied health insurance because of a pre-existing condition (IE, autism) and also, I can stay on my mother’s plan until I’m 25, rather than being booted off it before I have the chance to find a full time job which will give me health insurance.
That said though, I ain’t going back. And some very silly people don’t know a lot about how Canada’s healthcare works either:
http://www.buzzfeed.com/daves4/people-moving-to-canada-because-of-obamacare
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“I will never understand why the insurance companies couldn’t be simply excluded from the entire process. We pay taxes, why can’t we have a state system of healthcare, like in Canada?”
I agree with you wholeheartedly. But that represents too big a paradigm shift for most Americans right now. Do you remember the uproar when it was suggested that government provide a public option to compete with insurance companies? Just the mere prospect of a publically funded OPTION sent thousands of American’s in to a panic and stories about “executing grandma” abounded. There is one commenter on your blog (perhaps his name is Izgad?) that exhibits a marked fear of any government involvement in any aspect of the life of citizens. He is probably a bit more extreme than many Americans but most do have that kind of fear of government to some degree. So, for now, we unfortunately have to continue to deal with the private companies.
However, I think this is just the _beginning_ of a series of changes. As people are pointing out, the current law represents a bit of a windfall for insurance companies (which I agree is gross and problematic): so why are Republicans and insurance companies fighting the law? The answer is because, once you mandate insurance, it forces another series of problems (which is something that Republicans rightfully point out) which will in turn probably force a government funded option for health insurance. Once the public option gets built into something desirable, people will begin leaving private insurance for the more attractive option. All this takes time of course and we might not see substantive change for a while. But given the political climate and the American character, I think slow incremental change is probably the best we are going to get for now.
So I think that might explain Culture Club’s frustration; if liberals refuse to acknowledge the good this new heath care law does, we will never get any change at all. To say that this only benefits insurance companies and to say there is no difference between the two parties on this issue is sort of like saying that there is no point in voting. (I don’t think you are doing that though.) I agree that it’s frustrating and I think it’s great that you are asking these questions. It’s helpful to have these discussions and hopefully people will start supporting more large scale change in the future.
Sorry for the long response! 🙂
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While I don’t necessarily agree with the sentiment that single payer is a good place to move, I think your analysis is a very good summary of what happened and the “long run game plan” of Obama and the liberal part of the country.
I struggle with this overall issue because we spend a ton of money on health care currently and also we as a nation in general (and myself as well) are not comfortable saying if someone can’t pay for health insurance that we would let them die when facing certain medical conditions, so if we have to cover everyone way pay a middle man (the insurance company) ?
However, the one thing insurance does do is give those with good insurance more access to the better doctors (many doctors refuse to see people with bad policies, or medicaid etc.). Now, you can make an argument that income should not affect the care you get… but liberals don’t explicitly make this argument because the majority of middle class americans will be at risk of slower wait times in the long run in single payer is instituted (but more lower class will get covered).
I think what I wrote above is pretty well-regarded as true, so my question is do you think people with more money and better insurance policies should get preference to see better doctors? (just like they can get better houses, cars, food etc.) Or is health care so different that everyone should just wait their turn? Curious for opinions.
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“I think what I wrote above is pretty well-regarded as true, so my question is do you think people with more money and better insurance policies should get preference to see better doctors? (just like they can get better houses, cars, food etc.) ”
– This is a very strange comparison. People can choose not to buy a house, a car, etc. But they can’t choose to need a cheaper doctor instead of a more expensive brain surgeon, for example.
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I don’t think it is so strange at all… in fact part of the answer is to make the doctors cheaper… this all ties back into the licensing, regulation debate we had a few weeks ago.
I am NOT advocating that there be no regulation on the health care industry, but the irony is regulation massively drives up the cost of health care. The AMA intentionally restricts number of doctors (about 47,000 apply to med school with between 20-23 k getting in… these not getting in are very bright on average.. more doctors.. would lower prices). Also, the AMA fights letting nurse practioners and physician assistants doing more activities… again.. mandating higher costs for lower income citizens (ironically the poorest still get coverage under medicaid.. but then still get shut out of good doctors often). The ADA and dentists are even worse with this…
Also, currently insurance policies will only pay for in person doctor visits. A significant amount of procedures could be done much cheaper (and likely with similar or better quality) through tele-medicine or e-medicine. On this I’m not sure if it s federal regulation or insurance company policy.. but the real point is that health care costs need to be driven down. And yes, one way to do that is to put responsiblity on patients and also not let the health care industry mandate/dictate regulations that keep prices artificially high.
I think this makes my comparison make a little more sense…
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Also note that in England you still have the option of buying private medical insurance if you want to (as well as paying taxes towards and being able to use the government-run health system). Obviously most people don’t bother to do this, but those who desire to pay more money in order to avoid wait times or to have a private room etc. are free to do so. The actual doctors are usually the same though (ie individual doctors can work within both the public and private systems).
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One thing that is good about it, from what I know (and admittedly I am quite fuzzy on a lot of things about the law), is that you can’t be denied insurance coverage altogether because you’ve got something wrong (or “wrong,” like my autism — it’s not a disease, it doesn’t require any medical treatment, it’s just a fact about me, but because I have an actual diagnosis of an autism spectrum disorder I would be said to have a “pre-existing condition”) with you that is probably why you need insurance in the first place.
From what I understand, people with these pre-existing conditions can join a “high-risk” pool where they pay higher premiums than people without any health problems would. This is an improvement over what we had before, when having a pre-existing condition often meant you could not buy any sort of insurance, anywhere. I have been without health insurance for … six years now? Seven? This means I pay full sticker price, in cash, whenever I see a doctor. Because I’m healthy, this doesn’t happen often and usually doesn’t cost very much, because I only see them for routine evaluations, dental cleanings, birth control, etc. A visit to the dentist costs me several times what would cost my brother or my sister, who both have insurance.
So, the new law lets people like me into the system, which we have previously been shut out of altogether. (Although I am still shut out, as I have no income and thus cannot afford health insurance on my own.)
I also think it’s very helpful for young adults, who can now stay on their parents’ policies until they are 26, which makes it less likely that they will, like me, have a period of time in their lives when they are uninsured. When I was on my parents’ insurance, it didn’t matter that I was autistic because I had been covered since I was born. Since I dropped off of their plan when I turned 21 or 22 (I forget which), I magically become a person with a pre-existing condition, and uninsurable, because I continue to have autism. (Also, depression, which was likewise diagnosed while I was still covered by my parents’ insurance company.)
I manage the rare (I somehow think it’s probably not really all that rare) feat of simultaneously being a healthy, vigorous young person who never gets sick, and also a chronically ill person who is going to bankrupt any insurance company foolhardy enough to cover her.
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Even with all that, though, I still have profound misgivings about the law, would rather just do away with insurance companies entirely, and suspect that the primary beneficiary is indeed the insurance companies, and not people who are currently un- or underinsured. Hopefully I am wrong. But I don’t think your suspicions, either about this law in particular or the Democratic Party in general, are at all unsound.
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It’s for the insurance companies.
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Wikipedia and this Reddit page have explanations and lists of the PPACA’s provisions, and what they do.
An insurance mandate is supposed to prevent adverse selection. This article from The New England Journal of Medicine provides a good overview of what insurance mandates entail.
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I believe the health insurance companies are the problem. If I were king, I’d kill all the health insurance companies and have either government-run health care for all, as in England; or the government as the single-payer of all health care costs, as I believe is the case in Canada.
The pre-reform U.S. system, which left millions uninsured, put the insurance companies in the drivers’ seat, controlling both patients and doctors.
The Affordable Care Act, upheld by SCOTUS, makes many worthwhile improvements, as pointed out by commenters above, but it is far from perfect. If the Affordable Health Care Act works as it was intended, it would require universal coverage in the U.S. paid for mostly by premiums from people who can afford it, and supplemented by government tax money for people who can’t. Unfortunately, while it upheld the “universal mandate,” the Supremes in the same decision also struck down a requirement that states accept Federal money AND pay additional state funds to provide coverage of the poor through Medicaid. Many of the states seem determined to refuse to cooperate with the federal government on Medicaid.
Since the Supremes upheld most of the provisions of the Affordable Care Act, it’s a flawed start toward reform. But we have a long way to go in the U.S. We are paying much more for health care than most advanced countries, and we are not educating enough of our own doctors and nurses.
I agree that a Canadian or British system would be a better answer.
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“I believe the health insurance companies are the problem. If I were king, I’d kill all the health insurance companies and have either government-run health care for all, as in England”
– I agree completely.
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Here is a link to the most helpful article I have round really explaining the guts of the financial provisions of the law http://www.rwjf.org/files/research/70388.pdf
It is only 18 pages and for those inclined to really want to be able to talk intelligently about the law I think this is very helpful!
My big take-away… many companies should and will drop health insurance. Under Obamacare this makes financial sense (for both employees and the company).. Now the issue is this requires more subsidies.. which eventually makes the costs unsustainable… At that point.. either the program is blown up and goes back to more of teh current situation (not desirable or politically feasible) or a move toward single payer happens.
Whether you agree with the conservatives policies or not… it is def. true that it is extremely important for conservatives to repeal the law before 2014 if they have any hope of avoiding single payer in this country. Single payer may be good (most of the rest of the industrial world has it…), but the game plan all along was to move towards it and I guess a hat tip to Obama is in order for achieving it.
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Thanks for the link, Matt! This is very helpful.
So you think this is a step towards single payer and not the final system? Interesting.
Of course, since Romney is dong very badly in the polls, I guess there is no hope of repealing it before 2014.
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“Birds of a feather flock together”
Do you honestly think the republicans and democrats are that different.?For the most part the only colour they both see is green. 😉
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People under 26 and people with pre existing conditions stand to gain a lot.
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Here’s Planned Parenthood’s take on it:
http://www.plannedparenthoodaction.org/positions/planned-parenthood-hcr-825.htm?utm_source=facebook&utm_medium=post&utm_content=ACA&utm_campaign=ppactionfb
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(In Russian) Example of influence of private interests in healthcare on voting results:
http://scholar-vit.livejournal.com/297132.html
Who cares what will be best for consumers, aka the People?
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I especially like the comment:
Ужасно, что государство настолько влезает в дела компании Локхид-Мартин, что той не остаётся другого выхода, кроме как завести “своего сенатора”. Компания “Майкрософт” в своё время попробовала уклониться от этой игры — известно, чем это кончилось.
Poor, poor companies. 😦
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This is a traditional response from a Tea Partier. The stupidity of the response speaks for itself. I mean, you’ve got to have something seriously wrong with you to feel sorry for Lockhead-Martin, of all companies.
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Ok, here is my ignorance showing, but may be you would write about lobbies/ lobbists one day? I don’t really understand what they do (except protecting their interests) and why / whether / [if it can be] lawful in a democracy at all, if special groups have so much power. What is legal context? Why is lobbying permitted at all?
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Of course, it is permitted. There are many rules un place to regulate their activities. For example, a politician can’t accept a meal from a lobbyist. The maximum amount of food that can be accepted is what fits on a toothpick.
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The Obama administration successfully defended the insurance mandate by calling it a tax. The Supreme Court said that the mandate falls within the government’s power to tax, since it is essentially a tax on uninsured people. But Obama is also claiming that he “did not raise taxes once”. He tells one thing to the Supreme Court and another thing to the American public.
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Who’s to blame if people have fits of hysteria over taxes?
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Lol, that made me chuckle Clarissa. So it’s okay for politicians to lie to the public if the public will get mad when they hear the truth?
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“So it’s okay for politicians to lie to the public if the public will get mad when they hear the truth”
– Let’s not be childish, OK? When people lie to you, in the absolute majority of cases, it’s your fault. I’m sure you are aware of that.
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No, I was not aware of that. I guess I’m still young and naive.
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Have I just been called old and cynical? 🙂 🙂
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