November 16, 2013 at 8:56 pm #180851
Most people, including President Obama, agree that the landmark Affordable Care Act has hit some major snags on the road to implementation — and these reported problems go beyond IT solutions to Healthcare.gov.
As the President said on Thursday in the White House Briefing Room:
“We fumbled the roll out.”
But the President also stated:
“I’m not going to walk away from 40 million people who have the chance to get health insurance for the first time. And I’m not going to walk away from something that has helped the cost of health care grow at its slowest rate in 50 years.”
Thus the following questions arise:
- Should Obamacare be fixed or nixed?
- Can Congress put partisan differences aside and craft a comprehensive bi-partisan solution the President will sign?
- If so, what should the solution entail?
- If not, why?
* All views and opinions expressed are those of the author only.
November 17, 2013 at 8:07 pm #180883
- Despite the Affordable Care Act’s present problems, it’s still way too early to tell how it will stand the test of time. This should be the main barometer of Obamacare’s ultimate success or failure.
- The real question now is whether Congress and the president can buck extremist elements at the fringes of both parties and find a comprehensive legislative fix?
- Can Democrats and Republicans bridge the political divide and successfully compromise over the ACA’s future for the good of the American people? The answer is unclear.
Also Check Out
- Defending the Affordable Care Act (Sept. 2013)
“How can America continue to be recognized as the greatest democracy and leading beacon of freedom worldwide if we continue failing to providing basic health security for all of our citizens? Access to affordable health care should be a fundamental right for every American in the world’s richest and most powerful nation.”
- Health Care Security is a Fundamental Freedom – PART I (July 2012)
“No American should ever be denied basic medical care due to lack of income, pre-existing conditions, or other discriminatory factors. We are better than that as a nation and as a people. No American should ever be faced with the grim choice of paying for medical care versus putting food on the table. How could we uphold our nation’s long cherished values by leaving Americans who lack basic health care to wither away on the vines of desperation?”
- Health Care Security is a Fundamental Freedom – PART II (July 2012)
“While public servants and many private sector employees are fortunate to have health care benefits, there are still approximately 20-30 million of less fortunate citizens among us. This group of Americans, many indigent and struggling to survive, has been in desperate need of medical care for far too long. In fact, you may know some of these people. They are your neighbors, friends, family, acquaintances, the unemployed and the under-employed. Yes, they are America.”
- Health Care Security is a Fundamental Freedom – PART III (July 2012)
“Government has a responsibility that extends beyond national security to basic health security, as part of providing for the general welfare of America. Equal access to health care is more important today than ever, as the vast gap between rich and poor becomes more gaping to the detriment of America’s global prowess.”
November 17, 2013 at 8:12 pm #180881
This is a true question. Landmark Bill that will be the legacy of an Administration, that was rushed through the legislative process, and as the Speaker of the House stated at the time: “We will have to pass it to see what is in it!”. [Boy that is scary!!!! Passing laws to see what is in it.]
My personal opinion doesn’t matter on this. And, I am more or less out of this fight (don’t have a dog in this hunt as those from the Midwest and the South would say) because my medical coverage is from the Department of Veterans Affairs (severely disabled Veteran), and my family is covered by Tricare Prime (from my retired Army service).
The majority of the American people say it is broke, most beyond fixing, and other see some hope. People I have talked to do like the “pre-existing condition clause” and the “coverage to children to age 26”. Buy. when you go past that, well, support all but ceases to exist.
My summation is either our elected officials will listen to the people and either fix it or nix it, or after the election it will be fixed or nixed. And, I always get scared, when the supporters of the bill when it was passed state: “We will have to pass it to see what is in it!”. I wish I had the time to read the 1,000 plus pages in the bill to see what is really in it (couldn’t they have been more succinct, and what was it that took over a thousand pages to say). And, there is something in it that has the medical insurance companies running scared. And, I question if anyone in government has read all of it (or at least no one in the White House has anyway until recently). And, then taking over a 1,000 pages and flushing it out with all the Codes of Federal Regulation (aka CFR’s) to make it useable, especially since it appears no one in government has completely read it.
This will be interesting to see how this all shakes out.
November 17, 2013 at 9:07 pm #180879
Thanks very much, Earl, for your important insights. I especially like your point about:
Having to read “the 1,000 plus pages in the bill to see what is really in it (couldn’t they have been more succinct, and what was it that took over a thousand pages to say).”
Every member of Congress should be provided appropriate time to read and study all bills prior to casting a vote. Anything less may appear un-democratic to some people and hurt the legislative process in the House and Senate.
November 18, 2013 at 1:02 am #180877
The Washington Post reports:
Obamacare is having one huge success nobody knows about
“The publicity around the new health-care law has led a lot of those people to inquire about whether they’re eligible for health insurance — and they’re finding out that they are.”
“The clearest example of this is in the red states that aren’t participating in the law’s Medicaid expansion: There, 91,000 people have tried to sign up for health insurance and learned, in the process, that they are already eligible for Medicaid coverage.”
“The effect is also present in the blue states. The Kaiser Family Foundation reports that of the 70,000 people who’ve enrolled in Medicaid in Washington State, 30,000 were eligible before the new law took effect — they just didn’t know it.”
“The result is that while the expansion of health-care coverage still isn’t working nearly as well as it needs to be, it’s actually making preexisting coverage expansions work better than they ever have.” (bold added for emphasis).
November 18, 2013 at 11:45 am #180875
Sorry about my somewhat cyncical attitude
Would offer that the roar over ACA is nothing different…
I recall that there was a certain segment of the government who was somewhat opposed to Medicare and its implementation in the Mid 60’s, (Suspect the same was true for Social Security but that is somewhat ancient history)
The Mid 60’s and Mid 30’s was before computers ran our entire life and way before the 24/7 news feeds, so the political activity was somewhat limited…
In 2005 and 2006 there was at least as much of political noise over Medicare Part D, somewhat different dynamics than now,
The people directly affected by Both Medicare laws were/are in fact much more likely to vote. And since our system is all about getting elected….
November 18, 2013 at 2:27 pm #180873
1) Governments are chock full of people who have the right motives, and thoughtful policy-development smarts, but insufficient knowledge of the operational aspects. Everyone would agree with what they want, but they just don’t know enough about the details of how things work. This is true at all government levels in all jurisdictions. Is it avoidable? I doubt it. After all, we vote for people who tell us where they stand on issues of importance. We vote for their values and priorities, and we don’t vote for their knowledge about the details of project management, since they usually have people to do that for them. Ironically, we can end up despising them for their values, when the real problem was that they didn’t know enough about how to implement them.
2) Once a system is deeply entrenched, it becomes VERY hard to revise it, and its tentacles find a way of being woven into more than you’d think of. For example, with provision of health insurance by employers, rather than the state (as it is in some other countries), American employers have been able to successfully argue in the courts for maintaining “snitch lines” to report employees who smoke. Not smoke in the workplace, but anywhere. The rationale is that the increment to employer premium rates, if they had known smokers on staff, would constitute an undue hardship for the employer. This sort of interweaving of health care and employment law strikes those in other nations as an oddity. I mention it not to rail about it, but to illustrate how a system can become so deeply entrenched that one doesn’t even notice when it extends well beyond the perimeter of what the system is supposed to be addressing.
3) That something is entrenched and hard to change is insufficient rationale for why it should NOT be altered. At one time, slavery was also deeply entrenched in society, and difficult/painful to modify/remove. But here I go back to point #1: having the right priorities is not the same as knowing how to smoothly move an initiative through its various stages to successful and sustainable implementation.
4) A nation whose citizenry is not healthy is unlikely to be particularly competitive.
5) Americans have known for decades that there needed to be a better way. If I recall correctly, one of Pres. Clinton’s platform planks was revision of health care. It was NOT something he invented out of thin air. It was a response to an ongoing perception that preceded him. But, those changes didn’t happen for a variety of reasons, and in the interim, point #2 above dug in deeper and deeper.
November 18, 2013 at 4:21 pm #180871
Dale M. PosthumusParticipant
I would prefer to scrap it and start over. It is poorly designed, pushed through too fast for anybody to begin to fathom its impact, done in a purely partisan manner, built too fast without transparency, and being poorly implemented. The more likely scenario is the “fix it” approach, but it will take a lot of effort and political capital on both sides. It will take toning down of the rhetoric (both sides) and a real willingness to craft a bill that, ideally, the majority of both sides could accept.
The success of making more people aware of their eligibility for Medicaid is a good thing, but it comes at too steep a cost. That alone could have been accomplished for a lot less money.
As a society, we have important decisions to make that underpin any form of health care system. Is health care a fundamental right? If people abuse their health (smoking, drinking, drugs, obesity, risky behavior, ect.), will we force changes upon them in the name of the public good? We have been running that battle for decades with food stamps (now SNAP). We give people SNAP cards and limit some of what they can purchase. But, if people choose to eat other than a healthy diet (buy soda and snack foods, trade/sell their SNAP-purchased fruit and vegetables with others for less healthy foods), to what extent do we force them to do otherwise? There are already reports about using ACA to “force” people to stop smoking (similar to Mark’s comment). One argument put forth is that if the Govt is subsidizing your health insurance and overall costs of health insurance are negatively affected by risky behavior, then the Govt or employers or others have a right to force you to live “better” (as they define it). How far are we willing to go?
November 18, 2013 at 4:38 pm #180869
Here’s a recent book you might find interesting. Any book that starts with a public-policy discussion of the proposed 32oz soft drink ban in New York has my attention.
November 18, 2013 at 6:35 pm #180867
In order to keep Obamacare from crashing, the Administration must take Bold, Decisive, Positive Action similar to the one outlined below. Enrollment efforts across the states are fragmented, confusing, disjointed, and they lack uniformity. http://www.accesshealthct.com opened nation’s 1st Obamacare retail storefront for walk-in service http://t.co/ygCGRn1dHs on 10/29/13. In order to keep Obamacare from crashing, the Administration must take Bold, Decisive, Positive Action similar to the one outlined below. Enrollment efforts across the states are fragmented, confusing, disjointed, and they lack uniformity. See http://whitecollargreenspace.blogspot.com/ 4plan 2have HHS use up to 10,000 empty desks @ 1300 SSA offices to provide Obamacare Walk-in service. Medicare rollout was successful in1965 because citizens had walk-in service @ local Social Security offices, ACA should do same. SSA lost10% of staff in last 3years,1300 offices nationwide have 3 to 10empty workstations: 5000 ACA Navigators should use them. Contact [email protected] orTim (retiredfrom SSA)@ 989-701-8813 4plan2have 1300 Obamacare Walk-in Offices sent 2 Ways & Means
November 19, 2013 at 4:20 pm #180865
I don’t think it was poorly designed so much as constructed to avoid political opposition so it could be implemented; even though it’s a bit of a “kludge”, as Paul Krugman describes it, the same plan is working acceptably in Massachusetts. This is the same plan pushed by conservatives during the Clinton administration, so I don’t see how that was too fast or lacking in transparency. It was passed in a partisan manner because that’s the only way anything gets passed these days. And the implementation has been hobbled by the Supreme Court decision allowing states to opt out of federal Medicaid expansion. The states who were ideologically opposed to the law promptly did just that, and also refused to set up their own exchanges, forcing all of their residents onto the federal exchange, which was not expected.
As far as forcing changes, most schools and many medical institutions require vaccinnations ( a form of health care), and some private insurers already refuse to cover tobacco addicts, but that’s really a straw man argument, since there is nothing in the ACA like that. The SNAP restrictions were passed by politicians who disagree with the program ideologically but lack the ability to kill it entirely, so they intefere with it any way they can, similar to what they’re doing with the ACA.
November 19, 2013 at 5:41 pm #180863
Dale M. PosthumusParticipant
Can we agree that, although ACA is “similar”, “modeled”, etc. to the MA law, it is not the same? I doubt the MA law covers anywhere near the number of pages of ACA. And, as you point out, the political dynamics influenced many of the provisions, which were much different than in MA.
Poorly designed partly because virtually nobody ever read the entire bill and analysed its impacts. Something as complicated as ACA, or any similar attempt at healthcare reform, surely required more than a few months of review. What works at the state level, may or may not necessarily work at the national level. One example is the provision about subsidies. ACA explicit says these subsidies are for the states who operate exchanges. It is mum on whether the Federal exchange can apply these subsidies. This issue will likely end up in court. It could break ACA, if the Federal exchange cannot offer subsidies. I doubt that is what supporters wanted.
Although the Supreme Court created a complication by holding the Feds can’t penalize the states, creating the opt-out (BTW, that was for Medicaid expansion, not for the exchanges themselves), SC also saved ACA by calling the penalty for not buying insurance a “tax”, when the full campaign around it, up to the SC decision, had been it not being a “tax”. So, you win some, you lose some.
You are correct that we already make those kinds of “forced” decisions. Once we have any law, we are forcing people to either do or not do something. My point is where do we draw the line? Food stamps used to be pretty open, allowing even the purchase of beer and wine. People bought and sold food stamps to get what they wanted. Restrictions are generally designed to address issues of what people can buy with SNAP. There are many, not just those ideologically opposed to the program, who want to ban the purchase of soda, snacks, etc., the so-called “empty calories” foods, as well. I can assure you there are people who seek to limit or even eliminate meat from SNAP. These are not conservatives.
There are parts of the ACA that seek to encourage, if not force changes, for example the higher premiums for smokers. My point again is we need to decide the extent of “forcing” people to act some way. The examples I raised are not in ACA, but they have been part of the healthcare debate for decades. Many do not want to pay for the riskier lifestyles of others. I accept that is the way the insurance market works (although ACA includes new limitations on the way the market works). But, I can assure you the discussion has long begun to use ACA to encourage or even force certain lifestyles. I am only asking all of us to think about what are the limits we are willing to work with?
November 23, 2013 at 8:24 pm #180861
Henry, many belated thanks for your insightful comments. You raise a good point: if Healthcare.gov is fixed and the Affordable Care Act ultimately proves successful then history may have a completely different opinion about the landmark health care reform law compared to all the negativity and political demonization that is so commonplace today. In short, time will tell.
November 23, 2013 at 8:36 pm #180859
Mark, your always valuable comments are very much appreciated. You raise numerous excellent points. I especially agree with numbers 3 & 4.
To paraphrase President Kennedy, we choose such endeavors — like major health care reform — not because they are easy but because they are hard.
Moreover, as you note, the USA cannot remain highly competitive in the global marketplace when tens of millions of its citizens cannot afford, or lack access, to basic health care. This links a nation’s economic health to the physical and mental health of the populace, at least to some degree.
This is an important point that appears to be otherwise lost by obstructionists in Congress — the “Party of No” — who simply seek partisan political gain at the expense of the nation’s overall socioeconomic pain.
November 23, 2013 at 8:48 pm #180857
Belated thanks for your comments, Dale. A couple of observations:
1) While the ACA certainly appears imperfect at this time, at least we now have a comprehensive foundation to build upon and improve. We often forget that historic societal reforms take time to perfect and appropriately implement across-the-board. However, we must balance all the negativity surrounding the ACA to the cost of doing nothing — which I believe is far worse.
2) If we had true bipartisanship in Congress, for the good of the American people, then both parties would be able to forge consensus on the most effective solutions to fix the current problems — whether real or perceived. However, the unfortunate reality is just the opposite. One party simply wants to tear down the President and tear down the concept of affordable health care for every American. Moreover, what astounds me is that these partisan obstructionists in Congress apparently have no health care reform plan of their own. It’s much easier to tear something down than to build it up — especially when the primary reason is personal partisan political gain (which is an ugly shame).
November 23, 2013 at 9:02 pm #180855
Thanks for your comments, Tim. You make an excellent point about the walk-in service, which may be lost upon most politicians in today’s digital/mobile age. But this makes perfect sense, especially considering all the technical problems with the rollout of Healthcare.gov.
Additionally, opening store fronts in indigent parts of the country would really help those most in need of affordable care to obtain it. Let’s remember that there is still a digital divide in America and — despite all of today’s IT advancements — not everyone has access to the Internet in the first place. Again, this is especially true to low-income and poor segments of society which need affordable health care the most.
I also agree with your point about the states and lack of any uniform standards. Unfortunately, partisan politics appear to rule the day with nearly all Republican governors refusing to implement Medicaid expansion under the ACA. Kudos to Gov. John Kasich of Ohio who is one important exception, as reported by the New York Times.
November 23, 2013 at 9:04 pm #180853
Looks like an interesting read, Mark. Thanks for recommending it.
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