December 18, 2013

NYT/CBS poll finds only 1/3 of Americans think the ACA will improve the health care system.

The full numbers won't come out until later today, so there aren't specific percentages at the squib just published at the NYT, and there isn't even a rough fraction to suggest how many of the rest thought things would get worse and how many took the neutral middle position. The headline is "Broad Skepticism on Health Care Law," and I'm just going to guess that the negative group is more than 1/3. Here's some teasing text:
Among all adults, nearly half think the law will not affect them at all, while among uninsured adults, just over one-quarter say that. And while a nearly 4 in 10 plurality of uninsured Americans think the health care law will hurt them personally, they are twice as likely as the general public to say the law will help them.
You can't figure out from that what either group said about thinking that the law would help them. I'll be interested to see how low those numbers are. It could be as high as 6 out of 10 and 3 out of 10 or much lower — 2 out of 10 and 1 out of 10 or worse. [ADDED: If 4 in 10 is indeed a "plurality," then 3 out of 10 for the uninsured think the law will help. You can figure that out. And that would mean that 1.5 out of 10 in the "general public" think it will help them. I guess the "general public" includes this uninsured, so the numbers of already-insured who think it will help them must be less that 1.5. I am relying on precision in the NYT language.]

The promise was that vast majorities of Americans would be helped, including nearly everyone with inadequate or no insurance, and that nearly all of the rest would remain [at worst] in a neutral position, keeping what they had if they liked it. So we are experiencing a monumental reversal of expectations. It's hard to fathom how crushed people feel, both in having the huge promise so badly broken and in having so much upheaval with such an effect on one's personal finances and physical well-being.

This is so different from other huge events in American politics. One political party chose to cause this great disruption. It's not like a terrorist attack or a war that demands that we change. It was chosen, and it was chosen with no decent understanding of how difficult a disruption it would be.

I think back to something Michelle Obama said in early 2008, which seemed ominous to some even then:
Barack Obama... is going to demand that you shed your cynicism. That you put down your divisions. That you come out of your isolation, that you move out of your comfort zones. That you push yourselves to be better. And that you engage. Barack will never allow you to go back to your lives as usual, uninvolved, uninformed.
Maybe it's true that Barack has successfully prevented us from getting back to our lives as usual, our lives that many of us liked and wanted to keep. And it's true that he demanded that we shed our cynicism, and that was only the most ironic of the many way that he inspired our cynicism.

71 comments:

Ann Althouse said...

My little "ADDED" went in at 10:03 Central Time, so I corrected my arithmetic assertion without prompting. I want you to know that.

Carol said...

Yeah it's basically Obama saying Tough Shit to America, you have to break a few eggs to make an omelette and so forth.

I think people will adjust, then in the next few years companies like my employer will begin shedding their group health insurance benefits the way they shed defined benefit pensions. It just has to become socially acceptable.

I'm all right, jack, I'm going on Medicare soon..but eventually the whole thing will crumble into something like the NHS in Britain, lots of foreign docs and nurses, wait your turn, care pathways, etc.

Bob Boyd said...

The true motto of the Obama presidency has never been 'Hope and Change'.
It has always been condescension and coercion.
That quote is a prime example.

MadisonMan said...

I think most people do not expect the Government to provide quality service (except, of course, for the National Weather Service). Their interactions are limited to the IRS, mostly, or to Social Security, where long lines and inefficiency are the norm.

Why should this Govt entity -- Obamacare -- be any different? You can hope for some change in how the bureaucracy works, but who is really surprised when it doesn't?

Sorry, Michelle, I haven't shed my cynicism.

rehajm said...

Among all adults, nearly half think the law will not affect them at all

Translated: Among the nearly half of adults thinking the law will not affect them at all, all of them are in for a rude surprise over the next few months.

tim in vermont said...

"[The poll] asked uninsured individuals whether or not they thought the law was a good idea. Just 24 percent said they thought it was. In contrast, half the uninsured polled said they thought it was a bad idea. As the Journal points out, that represents an 11 point drop in support for the law amongst the uninsured since September."

http://reason.com/blog/2013/12/13/obamacare-has-lost-the-uninsured

Moose said...

Just occurred to me - the only way the ACA will work effectively is that *everyone* is required to participate in it.
Wonder when that'll happen.

Michael K said...

By summer, when the employer plans have dropped 100 million workers. there will be hell to pay. Insurance companies and employers will be blamed but that won't fly. Then we will see attempts to fix this and bypass Obama. Vetoes will be over ridden.

We live in interesting times. I wonder how many Democrats will retire before the fall elections. It's already started.

Chris said...

"Barack will never allow you to go back to your lives as usual, uninvolved, uninformed."

Why can't I just eat my waffle?

jacksonjay said...


Gotta love the quote by Don Sears of Syracuse. Unemployed, uninsured, lo-ifo mofo says he likes it ... because “with Obamacare I will be able to get health care” that is affordable.

He obviously is not away of how Medicaid works! Affordable for sure, "health care" is debatable!

TMink said...

If service X = N$ then service X + Y cannot equal <= N$. Simple.

Trey

TMink said...

If service X = N$ then service X + Y cannot equal <= N$. Simple.

Trey

khesanh0802 said...

Love the way the article avoids putting up hard numbers that we all might understand. Like yesterday's WAPO poll, when you you actually read the results they are astonishing.

Simon Kenton said...

Among the little- noticed effects of Obamacare is that any organization with 50 or more on the roster must provide O-Care. Nationwide, about 85% of all fire departments are staffed by volunteers. It apparently goes well into the 90s in Pennsylvania. Many of those departments, like ours, are well above 50 volunteers.

We will not be able to do this. The tax moneys aren't there, and we're not going to be able to raise it with bake sales. They had to pass it so we could find out what is in it; we are finding out, and our department's Board of Directors, which includes some servile standard Dems and at least one trained in the Chicago Way, are beginning to get real nervous about this. We will have to disband or shrink to an inefficient level, and there's no replacement in our county that can be here with reasonable response times.

Andy Freeman said...

> it was chosen with no decent understanding of how difficult a disruption it would be.

There's no evidence that they didn't understand the disruption and there's some evidence that they did, that they actually intended the disruption.

ACA/Obamacare is best seen as what it is, a way to break insurance companies. The plan is that once insurance companies have been broken, single payer is the only option.

Cloward-Piven is the most charitable way to describe their goals and tactics. However, there's increasing evidence that breaking eggs is their only real goal.


Michael said...

I cannot imagine what it must be like for the tens of thousands, hundreds of thousands, of people who are in limbo because of this law, people whose insurance has been cancelled and who are also ill. Listening to the glib reassurances of the politicians. Listening to the happy stories of the anecdotal beneficiaries, the people rooted out to proclaim the wonderfulness of the law. It has to be a nightmare, a frightening nightmare.

MadisonMan said...

Among the little- noticed effects of Obamacare is that any organization with 50 or more on the roster must provide O-Care.

My home town has the Alpha Fire Company, also all-volunteer. I'll be very interested to see how this plays out if they have to spend $$ they don't have on Obamacare. Because there are way more than 50 volunteers there; they cover 98 square miles, probably 70K+ people.

CWJ said...

Apropo to Simon Kenton's comment above.

If a company were truly determined to get around the 50 employee trigger without cutting staff, couldn't they incorporate a number of separate subsidiaries to employ their people? For example, couldn't Acme Company spin off their line and staff positions into say Acme Sales Consultants and Acme Support Services respectively with only the top line individuals still reporting to Acme Company.

I'm sure that the additional record keeping and other regulatory issues might render this tactic moot, but could it work in theory?

Brennan said...

You cherry picked a poll. Greg Sargent is very angry with you.

My home town has the Alpha Fire Company, also all-volunteer. I'll be very interested to see how this plays out if they have to spend $$ they don't have on Obamacare. Because there are way more than 50 volunteers there; they cover 98 square miles, probably 70K+ people.

The Bill of Rights actually starts with "right number zero". That's the one where as American you have an obligation to always find ways around the law to the best of your abilities.

Alpha Fire Company? Meet Alpha Fire Company 49A and Alpha Fire Company 49B. Please complete your paperwork and send a middle finger photo to the IRS.

Brennan said...

I'm sure that the additional record keeping and other regulatory issues might render this tactic moot, but could it work in theory?

Progresslaves won't count this as a job created, but yes, the new regulations create a patchwork industry of professionals to help small businesses comply with the law and still maintain strong bonds with the employees to continue to provide equitable salary, benefits, and employee protections.

CWJ said...

Brennan,

Of course, I agree. That much is obvious. Perhaps every new federal program creates two new jobs. One in the bureaucracy to enforce it, and one in business to comply with it with as little disruption as possible.

All I meant was that the ongoing costs and other considerations that come with splitting up the company may more than offset the additional costs and side effects of Obamacare.

My interest was in the legal feasibility of the tactic. I would be surprised if the drafters, having set the trigger, hadn't taken into consideration obvious counters such as what I've proposed.

Original Mike said...

"If service X = N$ then service X + Y cannot equal <= N$. Simple."

Of course it can, Trey, if Y is negative.

traditionalguy said...

Barack only wants to create a Soviet Man, redux.

It is only our lack of faith in his smiley faced tyrant role that is blocking Utopia.

Marshal said...

CWJ said...
If a company were truly determined to get around the 50 employee trigger without cutting staff, couldn't they incorporate a number of separate subsidiaries to employ their people?...
I'm sure that the additional record keeping and other regulatory issues might render this tactic moot, but could it work in theory?


Most regulatory agencies and the IRS employ "controlled groups" tests that treat anyone with common ownership as one unit for these types of evaluations. I haven't read the law to state with certainty it applies here but it's such a part of the regulatory environment I'd be stunned if it wasn't.

Alex said...

You can't govern by polls. Obama and Pelosi know what's good for us. We are like little children that refuse to swallow the nasty tasting medicine. They are the adults, our parents. We should do what they say.

Original Mike said...

@Marshal: I have read that such will indeed be the case for the ACA.

The Drill SGT said...

MadisonMan said...
I think most people do not expect the Government to provide quality service


Those of us "rough men" like to think you sleep safe in your beds at night because we are prepared to provide quality service and to lay it all on the line for you :)

PS: ex-rough man...

PPS: Land of the Free, because it's the home of the Brave....

CWJ said...

Thanks Guys.

Sigivald said...

Barack Obama... is going to demand that you shed your cynicism. That you put down your divisions. That you come out of your isolation, that you move out of your comfort zones. That you push yourselves to be better. And that you engage. Barack will never allow you to go back to your lives as usual, uninvolved, uninformed.

I never heard that quote at the time.

But my God, what's wrong with that woman?

MadisonMan said...

Thanks for pointing out the glaring omission. Post in haste (trying to be clever quickly), repent in leisure.

whswhs said...

This discussion of "shedding your cynicism" makes me think of Gita Mehta's joke about the guru whose American disciples challenge him on his teachings about being indifferent to material things. "But Guru, you have a solid gold toilet seat!" And the guru answers, "If you were less preoccupied with material things, you would not notice what my toilet seat is made of."

Perhaps the proof of cynicism, in Barack and Michelle Obama's eyes, is that we look at whether the ACA actually lowers our costs, or gives us better coverage, or helps the uninsured, rather than rejoicing in its passage as Progress toward a Better Future.

Michael K said...

I don't think the evasions of the 50 employee criterion will work. There has already been some discussion of this. The division into several smaller groups will not be recognized by the IRS.

The lefties are still denying reality but that gets harder as time goes by and more cancellations appear.

LilyBart said...

Among all adults, nearly half think the law will not affect them at all

Silly people.

Paco Wové said...

my God, what's wrong with that woman?

Perhaps not as much as was wrong with those who, knowing about the quote, still voted for Obama.

LilyBart said...

Another Michelle quote:


"The truth is, in order to get things like universal health care and a revamped education system, then someone is going to have to give up a piece of their pie so that someone else can have more."

Michael said...

We should pause to note how much trouble the NYT went to in order to avoid stating the poll results with any clarity. One can only conclude that theirs was the most positive possible construal with respect to their preconceived position. It would have been much easier just to say: so many for, so many against, so many neutral.

Richard Dolan said...

It's odd that the focus remains on the chatter, rather than the real world impact.

Team Obama is all about speeches and rhetoric, spin and blather. Doing things is not where they're at. So it's no big deal for them to start claiming that O-care is realy improved, the website is great, everyone's going to love it, it's all Bush's or Boehner's fault, blah, blah, blah, when there is no real world development that supports any of that.

The NYT, as a loyal (indeed, charter) member of Team Obama, offers a column spinning the results of its own poll into indecipherable doubletalk. It's anyone's guess what the poll actually showed, and even more of a guess whether the questions were worded neutrally (rather than in an attempt to tilt the results in the desired direction), or the surveyed population was truly randomly selected. The Althousian take assumes that it was all on the up-and-up, which may turn out to be true. But with that crowd, the adage 'trust but verify' seems more than usually applicable.

ALP said...

"Barack Obama... is going to demand that you shed your cynicism. That you put down your divisions. That you come out of your isolation, that you move out of your comfort zones. That you push yourselves to be better. And that you engage. Barack will never allow you to go back to your lives as usual, uninvolved, uninformed."

Shudder.

This is, hands down, the most disturbing, creepily invasive thing I have ever heard from the political class. I will never forget reading it for the first time. It has the same effect on me today.

Shudder.

Of course he wants us to shed our cynicism - the better to screw us over!

MadisonMan said...

Barack Obama... is going to demand that you shed your cynicism. That you put down your divisions. That you come out of your isolation, that you move out of your comfort zones. That you push yourselves to be better. And that you engage. Barack will never allow you to go back to your lives as usual, uninvolved, uninformed.

Don't Cry for me Argentina...the truth is I never left you. All through my wild days, my mad existence. I kept my promise, don't keep your distance.

Alex said...

You know, I'm sick and tired of the attempt by some to lump Democrats in with Rethugs. The Democrats are the party of Corporations for sure, but the Rethugs are downright evil. There IS a difference of morality here.

Michael K said...

" The Democrats are the party of Corporations for sure, but the Rethugs are downright evil. There IS a difference of morality here."

I'm assuming this is a joke. If not, would you explain ?

cubanbob said...

CWJ said...


Marshall and the others are right. In privately held companies common ownership is determinative. I spent enough on accountants and tax lawyers to get that answer.

cubanbob said...

If it were discovered that money can come from heaven polls would indicate 100% approval for having NASA sent funnels in to space to scoop up the cash.

Poll questions are often misleading. Yes most people will agree that every one ought to have coverage but ask the follow up question if they are willing to pay higher taxes and or premiums along with higher deductibles and restricted networks of coverage then things change.

Achilles said...

Nobody out there is actually defending Obamacare. I have skimmed through numerous articles on lefty sites like huffpost and politico and not even their readerships are supporting this fiasco. Many will say things like Republicans are worse or have no alternative but none of them actually support this.

Expect 2014 to be all about how republicans hate immigrants and women. We will hear nothing but stories about republicans out to ban women parts for the next year. The GOP will say stupid things and blame it on the tea party and try to lose because they support bigger government.

Bank on it.

Seeing Red said...

...Among all adults, nearly half think the law will not affect them at all,....

Ohh, the fun hasn't even begun yet.

1/2 will definitely be surprised.

LilyBart said...

Alex said... but the Rethugs are downright evil.

Alex, the Dems have you right where they want you. Why don't you try thinking for yourself once in a while?

MadisonMan said...

or have no alternative

Being the party of NO isn't helpful.

IF the Republican Party could come up with a credible alternative, and implement it, they could rule for quite a while. But no.

Republicans also say that the Government doesn't work well, then they get elected and prove it.

n.n said...

Obamacare serves to ensure neither affordability nor availability of health care. It is not matched with local or regional circumstances. It is a revenue scheme, which compensates for progressive devaluation of capital and labor, as well as other market distorting practices, which are especially damaging to the middle-class, and to the lower-class when unsubsidized. It is a quick fix designed to delay accountability in districts which are highly financed and subsidized, which are especially vulnerable in a stagnant or recessive economy.

Seeing Red said...

In a profile published late Tuesday by Politico Magazine, Podesta is quoted comparing Republicans to the infamous cult led by Jim Jones, who was responsible for the 1978 cyanide poisoning of more than 900 of his followers in Guyana.

"They need to focus on executive action given that they are facing a second term against a cult worthy of Jonestown in charge of one of the houses of Congress," said Podesta of what Obama's White House team faces. Jonestown was the informal name of the settlement founded by Jones and his American followers.

On Wednesday, Podesta apologized for his impolitic comment.

CWJ said...

MadisonMan,

What we had before was a pretty credible alternative. Why do people insist that the R's have to accept the D's premises?

I was never convinced that the "problem" needed a federal solution.

Who were the uninsured that to help them we needed to overturn the applecart.

People sufficiently well off that they were willing to self-insure.

Young healthy people who didn't see the need.

People who couldn't afford health insurance (I thought that was the purpose of Medicaid).

For me, the most sympathetic group laying claim to being "problem" uninsured are those with pre-existing conditions. And even there my sympathy is somewhat tempered.

Regardless, the problem wasn't 39MM Americans or whatever scare number being hawked.

So what was the great "problem" of the uninsured other than they served as a convenient entry point for the federal government to insert itself in yet another part of the American fabric.

Seeing Red said...

...The promise was that vast majorities of Americans would be helped, including nearly everyone with inadequate or no insurance, and that nearly all of the rest would remain [at worst] in a neutral position, keeping what they had if they liked it. So we are experiencing a monumental reversal of expectations. It's hard to fathom how crushed people feel, both in having the huge promise so badly broken and in having so much upheaval with such an effect on one's personal finances and physical well-being.

This is so different from other huge events in American politics. One political party chose to cause this great disruption....


Hooey.

You willingly voted for and are getting "fundamental change."

Seeing Red said...

Unless Harry Reid puts at least 4 proposals up for a Senate vote, Madison Man, you might never know if they're credible or not.

Michael K said...

"IF the Republican Party could come up with a credible alternative, and implement it, they could rule for quite a while. But no."

There have been a lot of Republican efforts. The whole 1990s HMO push was from Republicans. The problem is that government medicine just increases demand. Then it takes rationing, like death panels, to control the volume. Market mechanisms have not been tried since 1950, the last time it was under control.

Catastrophic insurance and a cash medical economy is what will control it and that may be coming as Obamacare collapses and takes the left with it.

Prexisting conditions can be dealt with by risk pools.

Original Mike said...

"What we had before was a pretty credible alternative. Why do people insist that the R's have to accept the D's premises?"

Excellent point, CWJ. I have found myself accepting the premise that there were masses of uninsured clamoring for health insurance. A premise that is looking increasing wrong.

Wisconsin, BTW, had a functional high risk pool for pre-existing conditions. A pool that the state government was shutting down, but recently had to throw a life-line given the immolation of the ACA.

Original Mike said...

"Regardless, the problem wasn't 39MM Americans or whatever scare number being hawked."

Yeah, where are they? They don't seem to be signing up for ObamaCare.

CWJ said...

Original Mike @5:49

Great observation.

I was just trying to make a statistical point about the scare number. But if there really was a large-scale problem out there that Obamacare is trying to solve, where are the millions of uninsured Americans signing up, or if they can't then demanding that their website (state or federal) be fixed?

Original Mike said...

It looks to be a foregone conclusion that there will be less insured on January 1st than there were on October 1st.

Heck of a job, Barry!

Original Mike said...

"In a profile published late Tuesday by Politico Magazine, Podesta is quoted comparing Republicans to the infamous cult led by Jim Jones, who was responsible for the 1978 cyanide poisoning of more than 900 of his followers in Guyana."

He's going to fit right in to this administration.

Ronald Ward said...

Well, through all the misconceptions and lies, fear mongering and distortions, and manipulating and cherry picking, looks like polls have leveled back to pre-website intro numbers.

Americans still dislike Obamacare by a small number (even smaller if asked about The Patient Protection Affordable Care Act and albeit a significant number dislikes it because it isn't liberal enough) and Americans still overwhelmingly dislike complete repeal.

What's going to be key is as more people enter the program, the more conservatives are going accountable for their insistence of total repeal as well as their arguments for repeal. Perhaps conservatives can counter that their plan was much better. But wait, something amiss.

CWJ said...

Ronald Ward,

Regarding "all the misconceptions and lies, fear mongering and distortions, and manipulating and cherry picking," do you care to share any specifics with us?

Regarding the great effectiveness and affordability of Obamacare, do you care to share any success stories that add up to at least triple digits? No need to come up with 39MM, a few score will do.

P.S. No credit for medicare signups or people signing up because Obamacare stripped them of their previous coverage.

Michael K said...

"do you care to share any success stories that add up to at least triple digits? No need to come up with 39MM, a few score will do."

There is a holocaust coming in the health insurance business. 100 million is a reasonable number for those uninsured by summer.

"What's going to be key is as more people enter the program, the more conservatives are going accountable for their insistence of total repeal as well as their arguments for repeal"

Oh yes, there will be accountability ! I doubt you appreciate how much and who will be the targets.

gk1 said...

It is interesting to me that most of the recent media pieces saying things are better with the website are generated from off the record govt. sources I have not read a real, authentic review from a 3rd party insurance provider giving a thumbs up on the website or any other piece of obamacare so far. Just lots of wishful thinking from obama folks speaking off the record.

Kirk Parker said...

"Being the party of NO isn't helpful.

IF the Republican Party could come up with a credible alternative,
"

MadMan, that comment is totally beneath you. Look, you're one of the respected old-timers here; you're a thoughtful person with lots of good things to say and everybody know that.

Why, then, is it so hard to realize (or admit?) that the status quo ante was way, WAY, WAY better than this muck? That's not "the party of NO", that's the part of "Maybe you shouldn't hit yourself in the head with that hammer."

Please...

Achilles said...

MadisonMan said...
or have no alternative

Being the party of NO isn't helpful.

IF the Republican Party could come up with a credible alternative, and implement it, they could rule for quite a while. But no.

Republicans also say that the Government doesn't work well, then they get elected and prove it.

12/18/13, 4:34 PM

You are operating on the premise that the only solutions are government oriented solutions. This is because you are a brainwashed leftist.

Free markets and Health Savings Accounts worked very well for those of us who took advantage of them. Nearly 90% of people in this nation had coverage. But 10% didn't so we had to put the government in charge right?

Now we are heading towards 90% uninsured. Only Obamas unlawful delay of the employer mandate at the behest of his corporate cronies has kept absolute Armageddon. The government and central planning will never be able to achieve what the free market has already achieved. Period.(see what I did there?)

Cordwainer said...

I call sour grape, your all a bunch of whiners.

Germany went through a similar transition when it went they made health insurance mandatory in the 1890's, if I remember correctly the trade unions and business guilds of the time organized and effective campaign that resulted in the changes to the law and a delay in the full enforcement of the law. A lot of the issues with the Affordable Care Act are in part the result of the Congress not Obama. Obama actually proffered a better compromise plan as a gambit to get the Congress to move on the signing of the two bills that would later would the ACA. Both of those bills were developed years prior to Obama's presidency. The Congress knew full well what was in the bill, they either didn't realize or care about the repercussions. Like most legislation one can never see all the intended consequences and I genuinely think most thought that those consequences could be dealt with on an ad-hoc basis. There will always be negative consequences to any change, that doesn't mean we should throw the good bath-water out with the bad.

There are a number of ways one could fix issues with the current exchange system. Allow a more open system by letting insurance companies sell across state lines for instance. Loosen government restrictions on HSA's, HRA's, FSA's and small business health insurance requirements. Give trade unions and small business that are part of trade associations tax breaks for the first few years and provide them with tax credits to get everyone insured or even create there own non-profit insurance plans. Allow non-profit insurers to act more like credit unions and savings and loans by loosening the legal restrictions they have to follow and providing them with bond fund initiatives and some initial tax credits.(non-profits use to account for most of the insurance market before the 1980's)

I would point out that most people are satisfied and enjoy Medicaid and that in the long run that a single-payer system would be more efficient. That being said Americans aren't about efficiency we tend to be about things like choice, freedom and independence. While I'm a fan of Medicaid I tend to think we could reform other health programs like WIC, Medicaid and VA Tricare. Maybe a public option for the poor or a larger tax credit paid out on a quarterly basis instead of annually would be better than the current system or systems that require so much red tape and jumping through hoops and leave many either in debt or uninsured.

Cordwainer said...

I know I'm going to get lambasted for a lot of those proposals since they cost more tax payer dollars, but you have to spend money to make money. Healthcare in this country was never going to be fixed with ACA it was just a big Band-Aid to other programs that were no longer able to do there job due to changes in the job-market and the healthcare industry. In my honest opinion we would either have to spend 2 to 3 times the amount of money that was put into ACA or put much stricter price controls on health care providers to actually make healthcare "affordable". Sorry folks the ACA was the best compromise that legislators could make within a "free-market" system. Not that healthcare has been a "free market" for awhile now, nor could it ever entirely be in this modern age. If you want to blame someone for ACA's problems then look at the Republican legislators(yes, back when it was cool to be bi-partisan)who originally wrote and endorsed the bills that make up the ACA.

That diatribe does bring up a something that is sometime missing from the discussion though. The reason why insurance costs are so high in this land of honey. Namely, the inflated prices that healthcare providers and insurers push on customers for there services and the underlying reason why they do. Basically they don't have enough money coming in to support day-to-day costs due to low or slow re-imbursement rates. Many procedures often cost less out-of-pocket but most customers don't have the money on hand to pay out-of pocket so they pay through a sliding scale and let insurance pay pick up the rest. If we had a more transparent marketplace with better networking of services along with government programs and tax credits that paid in a more timely manner and frequent manner as well as middle-men(HMO's, risk-assayers, liability analysts etc.)that were able to work more efficiently we could perhaps get better re-imbursement rates. A networked care system and patient bill of rights like what Washington State has had since the 90's, perhaps.

CWJ said...

Cordwainer,

Now that's funny! Thank you.

LilyBart said...

I would point out that most people are satisfied and enjoy Medicaid and that in the long run that a single-payer system would be more efficient.

I would point out that Medicaid is an unsustainable financial disaster. Its been propped up by private insurance (over) payments for years, as is Medicare. Neither of the government-run healthcare schemes are financially sound.

Big Mike said...

My biggest issue is that this is framed by the Times as an attitudinal poll, and this White House thinks attitudes can be adjusted by soaring rhetoric. Or scolding. Or some form of talk.

And talk won't work. People are seeing the problems. All too many are feeling the problems. They want to know that there's a comprehensive strategy to make them whole. And what is even more frightening is the tendency of this administration to lurge around and shoot from the hip. Band aids here. Masking tape there. Chewing gum someplace else.

Not good.

Ironclad said...

Single Payer! The mantra of the true believers! Monopolies ALWAYS work so well, ask ATT about that.

What about all of the people that work in the insurance industry? Do they draw straws to see who gets to keep their job and who gets the chop? I mean, its all fair, right? It's in the greater good interest.

As long as you control all of the source of care, you can then reduce the prices? So shut off lawsuits for malpractice? How about cutting the salaries of Doctors and Nurses and medical technicians too? The AMA has to go because they might object. Better take over the medical schools too and insure "equality of opportunity" to all those future doctor trainees. And Drug companies, nationalize them too so they can produce for nothing.

Of course, with all of this you still will come up short, so you will ration by supply instead of by cost. Grandma can wait another year for that hip because the current 5 year plan doesn't cover it.

My rave to yours is that to change the system, you have to really go in and take over probably 20-25% of the economy. Who pays for that? Or is the "takings clause" in the Constitution invalid now?

If you really want a straight analogy this is exactly like the slavery question before the civil war. You don't have the money to fix the problem (purchase the slaves, free them and outlaw the practice), so you make a moral case so that you can take them for "justice".

Clorinda said...

There is a Washington Post article that goes in to the small business mess in more detail. Many businesses, in and of themselves, only have 10-30 employees. But their owners often own all or part of several other businesses. These owners don't know if all the employees of all their businesses will be counted together or not. And I haven't heard anybody comment on whether or not employees at companies that are owned by multiple people who also have interest in several other non-related companies will be counted once, or once of each owner. I mean, somebody could have the day to day operation of the company so that could determine primary ownership. But another person could have principle financial ownership. Who gets the employees counted up towards the 50?

http://www.washingtonpost.com/business/on-small-business/health-care-laws-aggregation-rules-pose-a-compliance-nightmare-for-small-businesses/2013/12/09/87b2dcc6-611d-11e3-bf45-61f69f54fc5f_story.html