Our New Health Care System: Still Evil. Less Evil. But Still Evil.


politics is the art of the possible. what was possible in 2010? the ACA.

if you watched the sausage getting made as I did, remember: it took a fucking year to get that weak POS passed. and it cost Dems the congress and the ability to get anything else done.

the only way to get Socialized Medicine passed is 100% Democratic control of government: 60+ senators, a majority in the house, and 5 liberal SCOTUS judges. tell me how that happens in this fucked-up nation of obese, mouth-breathing militiamen.
Where did I say we shouldn't have done the ACA, Max? I'm not for making the perfect the enemy of the good. But we don't have to pretend the good—or the merely possible—is perfect either.
@1 You've got it exactly backward. Democrats lost congress because they didn't fight for single-payer. If you want people to come out and vote, you need to give them something to vote for. This is elementary politics.

Dan, You could at least name Bernie Sanders for that last quote and he may have greater change of getting elected. This "I like Bernie but I'll work for Clinton" is defeatist bullshit.
O care is a massive tax increase for the working poor. Health insurance of the sort I could get from the exchanges is useless to me. Any serious illness would still bankrupt me. Premiums are still much higher than the tax penalty. And frankly, I need to pay my rent this month Taxes are a problem for future me, and if I don't pay my bills now, there won't be a future me.

So, yeah, from my point of view the aca is far worse than nothing. It's just more bullshit corporate welfare.
@3, thank you
@3 You have never left Seattle have you?

You are delirious. This is a right-wing reactionary country. The Democrats lost control of Congress because every American wants this that and the other thing (usually something different every day of the week) but precious few of them are willing to pay for it or make the minutest sacrifices.
Why is so much praise for Bernie's positions always prefaced with the pessimism that he can't win the nomination -- before a single vote has been cast!

Savage, if you align with Bernie's positions (as I do), then you need to VOTE FOR HIM, and not for the evil queen your husband wants you to vote for.

He can win the primary, he can win the general. He's got momentum, he's at the point Barack Obama was in 2007, and he's the best candidate we've had in my lifetime at making the case to working-class voters why they should stop voting for Republicans who will work against their interests.
@1 -- Well said. But Dan is right, too. This is a step in the right direction, the question is how to take the next step. I think it is unlikely that we can get single payer (we have been trying since 1974) but we can make Obamacare better. That should be the rallying cry from both parties, but the Republicans are simply reactionary extremists. It was Nixon who first proposed it. Romney implemented in Massachusetts. But now the Republicans are basically saying they want nothing -- absolutely nothing.

I get Sander's approach, but moderates from both parties should be focused on improving Obamacare, not ending it (or pretending it doesn't need work). The fact that they aren't shows how fucked up our political system is right now.
@4 - Could you elucidate that a little? I have never lived under a health care system that didn't dance on the backs of the bruised, and have little faith in the possibilities of any for-profit system, but a coherent (not just to an economist or people who read business magazines instead of having sex) explanation might give me something to chew on, at least.
I have to say that I frequently think about what I'd have to do to move to a single payer health care system country. I'm in a profession that is theoretically very transferrable, but requires some slightly complex licensing paperwork in addition to the visa issues. Still, I really should move on this. I'm pretty healthy and have a 'good' insurance plan, but it is amazing how much I end up spending in order to have basic care. Deductible is huge, too. Not to mention pre-approval hoops that have to be jumped through that interfere with getting things done as quickly as my doctor would like...
@7- I have left Seattle and this is not a Right Wing reactionary country, it's a moderate country. The majority of Americans support something better than the ACA.

Thanks to gerrymandering and a well organized theocratic/corporate insurgency our House of Representatives is a reactionary right wing body.
#5 MAGE I hear you! My premium went up 265% (from $35 to $129 per month for a catastrophic plan with $6500Ded). But here's the real scary shit, IF you get sick with out insurance, the bill is still yours and then you get a penalty as well. Don't get sick or have any need for a doctor EVER and you're set.

Now on to my comment, Yes the ACA needs lots of work still, but I got a FREE colon screening out of it. I had to fight for it, had to talk with all parties involved because mistakes of coding were made, but I was not going to pay a penny for the screening although I was getting bills from everyone. This is start.
@9: "moderates from both parties should be focused on improving Obamacare" - hahaha! thanks for the laugh.

@2: i know you didn't, but it's important to remember the specifics of the Senate in that magical year. just say "Max Baucus" to yourself every time you think the ACA could have been better than it was. it passed ONLY because Reid circumvented cloture by using reconciliation. it was a legislative miracle, and it came at a phenomenally high price to Obama's presidency.
@12 They support something better than the ACA as long as it doesn't cost them a dime and as long as they don't have to make any sacrifice whatsoever. Single payer is entirely unfeasible under such conditions. Aside from the necessary tax increases it would require, healthcare is a massively profitable industry in this country and vast numbers of people who are milking this cash cow would have to agree to have their profits significantly curtailed.
@12: I'm from England. I've lived in the USA for the past 12 years. The USA most certainly is a reactionary rightwing country (with buggerall idea about how to run healthcare for the masses rather than for the 1% who make enormous profits from it).
@17 - That became abundantly clear via @14. Thanks. A little subtle - more successful, as such, at capturing Raindrop, who isn't opposed to reason (just not very good at it). Too soft with the milk of human kindness for SB.
Yet another reason to Support Bernie Sanders.
@7 &12

~40% voter turnout elections aren't representative of the mood of this country, especially because abstention is huge among the disenfranchised (usually poor). When ~60% of voters turnout to vote they elect Obama who probably uses every progressive buzzword in the lexicon while campaigning.
@21 should read @7 & 18
Thank you @3 and @8. Stop claiming Sanders can't win before the primaries have even begun. If we want to change the country's trajectory, we have the power, people just need to get out and vote. And i have no idea why Dan keeps agreeing w/Bernie's politics BUT won't vote for him. It is inauthentic and depressing.
@ 14 - "This country provides the best medical care available anywhere in the world"

Yeah, the thing is, that's actually not true.

@5 & @13: I third this motion! It's just another punch to the pocketbook, right when I don't need one. I can barely afford rent and food and electricity (hey, I hear it's bad for your health to sleep outdoors, or starve, or get heat stroke in your own apartment), and this penalty makes me have to pay the IRS for the crime of being unable to afford health insurance. And that smug quote from Obama makes my blood boil.

"...if you looked at that person's budget, and you looked at their cable bill, their cell phone bill, other things that they're spending on, it may turn out that it's just they haven't prioritized health care..."

I don't have cable, and I need my phone to keep my job. Without a job, I certainly can't buy health insurance. Seriously, if a Republican had been so cavalier about a working class family's ability to afford something, he would have been skewered as a fat cat out of touch with the common man. Why does Obama get a pass?

Meanwhile, take a look at the index of the healthcare industry on any stock exchange after the passage of Obamacare. Look at the premiums of those who already had insurance. Up, up, up. If any Republican had made a deal so favorable to an already profitable industry (that lobbied so heavily!), he'd be called out as a crony. Why does Obama get a pass?

Indeed, it is far worse than nothing from where I sit.
@26: you sound like might you qualify for a subsidy, &/or your income is so low that the penalty won't amount to much. does your job not offer health insurance? why not? are you self-employed?
@8 @23 EXACTLY. Vote for Bernie so he can win the damn primary, that's how it works! You have to vote for him!

Register! Vote!
Bernie 2016!
@ 25 - It does, though. And had you looked at the link, you would have seen that. Look, our high costs aren't due to the quality of our care. That's a myth. These are the 50 most expensive hospitals in the United States:


These are the best hospitals in the United States:


You will note a lack of overlap. That's because healthcare costs and healthcare outcomes do not have a causal link in the United States. To understand why, you need to understand what drives healthcare costs in the United States. If you're interested in learning more about this topic, this Youtube video is a really great place to start:

What I've always loved is the Republican argument that America can't afford universal healthcare.

America spends over 17% of its GDP on healthcare. Countries with universal healthcare tend to spend a little over half that: 9.1% in Britain, 11.2% in Germany, 11.7% in France, and so on. (These are 2013 figures.)

Obamacare doesn't give you universal healthcare. And the free market doesn't cut your healthcare costs, or, as @24's link shows, give you better healthcare.

If Republicans were serious about saving money, they'd institute socialised healthcare.

But the thing I've seen very often from people on the right in America is that they don't want to have the best possible healthcare, or the cheapest possible healthcare. What's important to them is that they have better healthcare than people who are poorer than them, and they're prepared to suffer in order to ensure that poor people suffer more than them. It's bizarre.
I've long thought that the best we could realistically do is Medicare for all, or something like it.

Everyone has a certain basic plan, and catastrophic coverage, but there's plenty of space for private insurers to sell gap coverage and supplemental coverage to individuals and employers. The providers of healthcare would remain the current mix of public, not-for-profits, and for-profits.

It would be far from perfect, but I think its a more realistic 'best case solution' than single-payer. There are just too many people with too much power who would demand the option of paying for much juicier extra health care insurance coverage--whether its 1% types like C-level executives or UAW members--for single-payer to gain legislative traction.
I hate Obamacare. I am still with the same insurance company I had prior to passage of the ACA, but the monthly premium for my family of five has nearly TRIPLED and the deductible has risen from $2,500/person to $6,000/person. This is better somehow???? I'm a 52 year old woman but now my insurance covers pregnancy (wasn't necessary for YEARS due to my husband getting neutered) and we're covered for opiate addiction. I know many people like the fact that kids can stay on their parents' plans until age 26 and the whole pre-existing conditions matter has been addressed, but I contend that most people are now much worse off. If someone in my family had gotten seriously ill before, we could pay the $2,500 but $6,000 would hit us much harder. Can't wait for the next administration to come in and finally repeal this monstrosity.
@3, I'm sorry @7 is right: you are delusional. I watched, in a purple-to-red district of the country (not the King County Bubble), a competitive congressional district - just liberated from the craziness that was Virgil Goode (please google that if you're wondering what kind of crazy - Snohomish got nothin' on us in Real Virginia) - flip back to Red over exactly the ACA. Yes, the majority of the Reactionary "Tea Party" crazy is a blend of bigotry and anger at change, but the ACA was a huge plank in that.

We absolutely need single payer - anyone with a half a brain knows this is the problem with our very poor health care value (care for dollars spent), even Donald Trump said as much before he really got on message. The ACA is the vehicle to get there. Single-payer socialized medicine would not have brought the Democrats any kind of victory and the fight would have been far far more vicious.

Health Care spending is 17% of our GDP...that's a HUGE freakin' chunk of our money. There are a helluva lot of people you are going to be taking dinner away from. They aren't going to give up that money easily. What has to happen is convergence...slowly but surely we wind up with 1-3 tightly regulated national 3rd party payers...who in turn regulate the hell out of the providers. Yes, with any luck, the public gradually comes to accept that instead of a regulated monopoly, we might just as well have a Gub'mint bureaucracy, but I wouldn't hold my breath.
What the fuck Dan? WHY won't Bernie get nominated? Because people in the media keep perpetuating the idea that it's totally impossible. Bernie is the most liked candidate, the most likely to cross party lines, and does extremely well against the presumed Republican nominee. And yet corporate media is saying he's not electable. Why? Because they are owned by people who would be screwed if he were elected. Why are you perpetuating that myth?

Anyone who isn't owned by Wall Street will want single payer health care. If Bernie's not the Democratic nominee, there's no way I'm voting for Wall Street. And I'm not alone.
@27: I can only find part-time & temp work. Companies avoid hiring permanent full-time employees precisely because they'll be required to offer benefits, and don't want to pay for it. I continually look for work and juggle multiple jobs.

I checked out what was available on the exchange. If the rates I saw were accounting for a subsidy, I'd hate to see what they were without one. And while the penalty may not be much, even a little stings.
What @34 said. Dan, quit parroting the media's mantra that Bernie can't get elected... that's part of the problem. Vote for your damn beliefs, use your celebrity and platform, and get behind the guy. At least use his name if you're gonna quote him!