Kentucky governor on Affordable Care Act

[kimmy]

Kentucky governor Steve Beshear wrote an op-ed piece in the NY Times explaining that his state, as well as others like Arizona, Michigan, and Ohio, are moving ahead with Obamacare because it's in the interest of their citizens.

1 in 6 Kentucky residents don't have health insurance, resulting in preventable illness going untreated and costing Medicare and Medicaid more money later on. Beshear also touts economic benefits to the state.

-k

[cybercoma]

This is similar to the way in which our federal government got involved in health care transfers. How does a premier (or governor in this case) go back to his/her electorate and tell them that they turned down federal money that would help pay for their healthcare? Assuming the people that vote aren't mouth-breathing imbeciles, they would turf someone that turned down such a plan.

[Guest American Woman]

Kentucky governor Steve Beshear wrote an op-ed piece in the NY Times explaining that his state, as well as others like Arizona, Michigan, and Ohio, are moving ahead with Obamacare because it's in the interest of their citizens.

1 in 6 Kentucky residents don't have health insurance, resulting in preventable illness going untreated and costing Medicare and Medicaid more money later on. Beshear also touts economic benefits to the state.

-k

So now people who didn't have health insurance are forced to buy health insurance. Wow. What a helpful solution. Thanks, Obama.

[The_Squid]

So now people who didn't have health insurance are forced to buy health insurance. Wow. What a helpful solution. Thanks, Obama.

What's your preferred solution?

[Bonam]

Beshear also touts economic benefits to the state.

-k

At the expense of other states, which will be contributing taxes (or debt) to support the extra transfers to Kentucky. Which there's nothing necessarily wrong with, as long as people realize that "Obamacare" is intended to have redistributive effect. But of course as a governor, giving up money that the feds are offering you is stupid.

[cybercoma]

So now people who didn't have health insurance are forced to buy health insurance. Wow. What a helpful solution. Thanks, Obama.

You can thank Republicans for that one, since that was Obama's compromise to them.

[ReeferMadness]

You can thank Republicans for that one, since that was Obama's compromise to them.

True.

What should have happened is that the enormous health care insurance industry should have been put out of business and the savings put towards actually providing healthcare to people. But of course, it would have been too hard to take on established interests so the best Obama could do was to throw billions of dollars at this massive layer of useless overhead; hoping enough would get through to help people who needed it.

Edited September 28, 2013 by ReeferMadness

[TimG]

You can thank Republicans for that one, since that was Obama's compromise to them.

The Republicans did not want the law. Obama gets 100% of the credit and blame for the success or failure.

[TimG]

What's your preferred solution?

The problem with healthcare is when a treatment comes out and someone cannot afford it is presumed by many to be an injustice that needs correcting. No other product or service comes with this baggage (imagine people saying that everyone has a right to eat filet mignon or drive a Porsche at no personal cost). This makes an affordable health care system a impossibility and the only question is the most politically correct way to deny people access to care.

In Canada we use waiting lists. In the US before Obamacare the insurance companies placed exclusions and limits on coverage. After Obamacare insurance companies will use Canadian style rationing to control costs (by greatly limiting the supply of doctors/hospitals in their covered network).

I suspect that the democratic base is not going to be happy when they realize they can't get something for nothing.

Edited September 28, 2013 by TimG

[ReeferMadness]

The problem with healthcare is when a treatment comes out and someone cannot afford it is presumed by many to be an injustice that needs correcting. No other product or service comes with this baggage (imagine people saying that everyone has a right to eat filet mignon or drive a Porsche at no personal cost). This makes an affordable health care system a impossibility and the only question is the most politically correct way to deny people access to care.

In Canada we use waiting lists. In the US before Obamacare the insurance companies placed exclusions and limits on coverage. After Obamacare insurance companies will use Canadian style rationing to control costs (by greatly limiting the supply of doctors/hospitals in their covered network).

I suspect that the democratic base is not going to be happy when they realize they can't get something for nothing.

Well, that sums up the traditional right-wing view of things. It's not rich people's fault that they're so talented, hard working and virtuous that they deserve everything while the slime-sucking, useless poor people should count themselves lucky that they get to live in the same world.

At its essence, the reason that so much money goes into health care is the same in the single payer model as in the morally bankrupt only-provide-healthcare-to-the-wealthy model. It's that there is enormous profit to be made in treating sick people but very little to be made in keeping people well. So, ridiculously expensive treatments (with often little therapeutic value) are offered to desperate ill people and their families. If your goal is to reduce the amount spent on healthcare, focus on keeping people healthy, not waiting until it's too late.

Of course, if your goal is to build pretenses to justify your morally bankrupt ideology, I guess it really doesn't matter if people are healthy or not.

[TimG]

It's that there is enormous profit to be made in treating sick people but very little to be made in keeping people well.

90% of "keeping people well" involves convincing people to lose weight, exercise more, stop smoking and drink in moderation. There is not much a health system can do about such things because they are personal choices. Once people get sick the healthcare system can do something which where the cost comes in.

Of course, if your goal is to build pretenses to justify your morally bankrupt ideology, I guess it really doesn't matter if people are healthy or not.

The only one justifying amorally bankrupt ideology is you who appears to have missed my entire point and instead choose to rant about rich people instead of focusing on the problem: without a way to control costs no healthcare system is sustainable.

So the question for you is: what is your plan for controlling costs that does not involve finding a way to tell people without money that they can't have the treatment they want?

Edited September 28, 2013 by TimG

[waldo]

The Republicans did not want the law. Obama gets 100% of the credit and blame for the success or failure.

no - Republicans wanted it until Obama began to champion it! Then they had to be against it. Of course, you revisionism would have us ignore what was the Democratic/Obama favoured approach - single payer. And yes, the Obamacare was the compromise... to single payer.

[waldo]

So the question for you is: what is your plan for controlling costs that does not involve finding a way to tell people without money that they can't have the treatment they want?

it's already factored... death panels! Haven't you been paying attention?

[Bonam]

The problem with healthcare is when a treatment comes out and someone cannot afford it is presumed by many to be an injustice that needs correcting. No other product or service comes with this baggage (imagine people saying that everyone has a right to eat filet mignon or drive a Porsche at no personal cost). This makes an affordable health care system a impossibility and the only question is the most politically correct way to deny people access to care.

Lots of products/services come with the idea that everyone should have access to them... food, water, shelter, etc. There are various government programs in the US and Canada to provide these things to people that otherwise could not afford them. Clearly, they are not being provided with delicacies and mansions, but neither do the healthcare plans that will be payable-for solely through subsides for the poor represent the top end of health coverage. A bronze or catastrophic insurance plan on an '"Obamacare" exchange paid for through a tax subsidy is basically the "food stamps" of the healthcare world. And, it has the advantage of saving money relative to not offering said subsidy and then treating these people in emergency rooms once their conditions worsen.

Obamacare is a terrible terrible solution, but based on what I've read and researched, it is nevertheless somewhat of an improvement on what was there before. It's a bandaid over a festering wound that needs an amputation, but the bandaid may hold things together a bit longer.

[TimG]

Clearly, they are not being provided with delicacies and mansions, but neither do the healthcare plans that will be payable-for solely through subsides for the poor represent the top end of health coverage.

Perhaps the analogy is: Obamacare does not allow people to buy a cheap used car - they have to buy a new mid sized sedan because the crafters believed that everyone is entitled to a new mid sized sedan.

A bronze or catastrophic insurance plan on an '"Obamacare" exchange paid for through a tax subsidy is basically the "food stamps" of the healthcare world.

Do you have any data to back up your claim? My understanding that the mandatory coverage provisions have turned the 'bronze' plan into a luxury package and that many people would have been better off with their existing plans that could be tailored for their needs. For example, many people with reliable cash flow were happy with high deductible plans which forced them to pay for most medical expenses out of pocket (i.e. the insurance was only for catastrophe - which is how it should be). Now they can't buy those plans. On top of that insurers are cutting costs by limiting the healthcare provider networks which means that poor people may have to commute long distances to access 'in-network care'.

http://blogs.the-american-interest.com/wrm/2013/09/23/obamacare-if-you-like-your-doctor-you-cant-keep-him/

IOW - Obamacare will control costs by rationing access to care - just like Canada.

That said, my point was that a rational healthcare system needs to be honest about the need to control costs and by being up front about it would lead to a better system with fewer perverse incentives than one where politicians try to pretend that every can have access to whatever care they want. I am also not saying that government should not be involved - just that expectations for what a system can deliver are disconnected from reality.

Edited September 28, 2013 by TimG

[Guest American Woman]

The Republicans did not want the law. Obama gets 100% of the credit and blame for the success or failure.

No one made Obama do anything. As I've said before, it seems as if there's no sense of personal responsibility any more. Obama didn't have to approve this version. However, neither did Congress. I hold those who voted for it responsible, too.

[Bonam]

Do you have any data to back up your claim? My understanding that the mandatory coverage provisions have turned the 'bronze' plan into a luxury package and that many people would have been better off with their existing plans that could be tailored for their needs. For example, many people with reliable cash flow were happy with high deductible plans which forced them to pay for most medical expenses out of pocket (i.e. the insurance was only for catastrophe - which is how it should be). Now they can't buy those plans.

No, those plans are still available, both through employers and for individual purchase. And I agree, HDHPs paired with a health savings account (HSA) are a great deal, especially for healthy people with decent income, not least because the HSA is a great savings vehicle that you can use not only for health savings but as an extra retirement savings account with much better terms than a traditional IRA.

On top of that insurers are cutting costs by limiting the healthcare provider networks which means that poor people may have to commute long distances to access 'in-network care'.

http://blogs.the-american-interest.com/wrm/2013/09/23/obamacare-if-you-like-your-doctor-you-cant-keep-him/

That blog is terrible, nowhere in the text is the title supported or explained. But yes, the coverage poor people will get is still not the greatest, and that makes sense, since like I said, it is the food stamps of health care.

That said, my point was that a rational healthcare system needs to be honest about the need to control costs and by being up front about it would lead to a better system with fewer perverse incentives than one where politicians try to pretend that every can have access to whatever care they want. I am also not saying that government should not be involved - just that expectations for what a system can deliver are disconnected from reality.

This is America... anything with which government or politics is involved is disconnected from reality. But the reality is that the cheapest available health plans are still limited in the coverage that they provide, and these limitations are plainly stated in the insurance policies.

[waldo]

So now people who didn't have health insurance are forced to buy health insurance. Wow. What a helpful solution. Thanks, Obama.

What's your preferred solution?

****bump****

[Argus]

What's your preferred solution?

Generally, the preferred solution of those who seem to think they have adequate and affordable health insurance is for those who don't to shut up about it, stop bothering them, and die quietly.

[Argus]

In Canada we use waiting lists. In the US before Obamacare the insurance companies placed exclusions and limits on coverage. After Obamacare insurance companies will use Canadian style rationing to control costs (by greatly limiting the supply of doctors/hospitals in their covered network).

The difference between our system and theirs?

The US spends about $8200 per capita on health care (18% of gdp)

Canada spends about $4400 per capital on health care (11.5% gdp)

What do you think would happen to those waiting lists in Canada if we virtually doubled spending on health care?

The US spends far and away more than anyone in the world but doesn't get better health care. The French spend less than we do and probably have the best health care system around.

If the US through out its present system and went with a national health care program they could provide health care services to all Americans with no waiting and probably still save a ton of money.

Edited September 28, 2013 by Argus

[Bonam]

If the US through out its present system and went with a national health care program they could provide health care services to all Americans with no waiting and probably still save a ton of money.

True. A single payer system, or a European style two-tier style system, or even a fresh new implementation of an all private system, would all be vast improvements.

[The_Squid]

No one made Obama do anything. As I've said before, it seems as if there's no sense of personal responsibility any more. Obama didn't have to approve this version. However, neither did Congress. I hold those who voted for it responsible, too.

And what would be your solution? Or was the status quo fine with you?

[Moonlight Graham]

No one made Obama do anything. As I've said before, it seems as if there's no sense of personal responsibility any more. Obama didn't have to approve this version. However, neither did Congress. I hold those who voted for it responsible, too.

I agree. Obama can't introduce or vote on bills. Only Congress can, so they own it too...at least the members that voted for it.

[dre]

Obamacare is a terrible terrible solution, but based on what I've read and researched, it is nevertheless somewhat of an improvement on what was there before. It's a bandaid over a festering wound that needs an amputation, but the bandaid may hold things together a bit longer.

And thats exactly why he signed it. He campaigned on a public insurance option, and against a mandate. But at the end of the day hes part of a government that is quite simply not alligned to do things for the voting public. He sent his wishlist off to the legislative branch and he got back a private insurance welfare bill that forces Americans by law to purchase products from private companies. I dont want to defend him, because he folded faster than a 40 dollar Canadian Tire tent on the things he claimed to stand for during the election. Hes a coward.

But at the end of the day this reform package isnt "Obamacare", its "Congress Care". They wrote it, they voted on it, and they sent it to the presidents desk and gave him the option of "this" or "nothing". And at the end of the day Americans in general are the victim of dumbest bunch of people to hold real power, in a real country in the history of human governance... the democrats and republicans in congress.