If America adopts Canada's health care system

[mariomike]

Jan 17th, 2011
Front Page Magazine:
"Emergency Services to Suffer Under ObamaCare: With the enormous increase in patient coverage proposed in the supposedly all-encompassing act, not enough money is provided for the expected huge increased need for EMS, a Jan. 11 analysis by the National Center for Policy Analysis (NCPA) explains.":
http://frontpagemag.com/2011/01/17/emergency-services-to-suffer-under-obamacare/

 

[a_majoor]

Repeal and replace; what the Congres is proposing to replace Obamacare with. Any bets the combined new bils won't total 2000+ pages?

http://washingtonexaminer.com/politics/2011/01/house-gop-begins-long-slog-dismantle-obamacare

House GOP begins long drive to dismantle Obamacare
TAGS: 1099 provisions ben nelson Byron York claire mccaskill David Dreier Health care reform health insurance House Republicans insurance Kent Conrad obamacare Republicans Senate Democrats
COMMENTS (16)  SHARE  PRINT
By: Byron York 01/20/11 8:05 PM
Chief Political Correspondent

House Speaker John Boehner of Ohio, center, speaks about the upcoming vote to repeal the health care bill, Wednesday, Jan. 19, 2011, on Capitol Hill in Washington. From left are, Rep. Nan Hayworth, R-N.Y., Rep. Cathy McMorris Rodgers, R-Wash., Boehner, House Majority Whip Kevin McCarthy of Calif., and Rep. Jeb Hensarling R-Texas. (AP Photo/Alex Brandon)

Everyone knows House Republicans (along with three Democrats) voted Wednesday to repeal Obamacare. But fewer people know what those same House Republicans -- this time, with 14 Democrats -- did Thursday.

By a vote of 253 to 175, the GOP directed key House committees to report on ways to lower health care premiums, allow patients to keep their current health plans, increase access to coverage for those with pre-existing conditions, and decrease the price of medical liability lawsuits. In other words, the committees are beginning work on replacing the House-repealed Obamacare with Republican health policies.

Repeal got a lot of press coverage. Replacement got far less. If they needed any reminding, GOP lawmakers are learning that controlling the levers of power in the House doesn't mean controlling the media narrative on health care. "Democrats wanted to characterize repeal as draconian, ignoring the fact that we do have very, very positive alternatives," says Rep. David Dreier, chairman of the House Rules Committee. "It's been difficult for us to get that [message] out there. We said repeal and replace, and we're in the process of replacing."

House Republicans are pursuing a three-part strategy. Part One was repeal; they promised to do it, and they did it. Part Two is replace, which in coming months will involve House votes on a series of GOP health care measures. And Part Three -- since full repeal can't win in the Senate -- is another series of votes on measures to repeal individual parts of Obamacare. The net result will be that Republicans gradually push more and more House Democrats -- and perhaps some in the Senate -- away from an all-or-nothing defense of Obamacare.

When Democrats passed the national health care bill, many admitted that they didn't like this or that part, or that the bill as a whole wasn't "perfect." But after Obamacare became law, they balked at changing even the smallest part. For example, there is widespread agreement that the so-called 1099 provision -- the requirement that requires businesses to file zillions of new Internal Revenue Service forms -- is extremely burdensome. But when Republicans tried to kill the provision last year, Senate Majority Leader Harry Reid made sure it didn't happen.

Now, after voters gave the GOP control of the House and a stronger voice in the Senate, things are different. Democrats are talking openly about changing Obamacare -- just as long as the changes stop short of full repeal. "Let us modify the health care law in a bipartisan way," House Assistant Minority Leader James Clyburn told Fox News this week. "But this whole stuff of repeal and throwing it out and starting all over -- that's not going to happen."

Obamacare is filled with vulnerable provisions. In addition to the 1099, there's the individual mandate (which is also being challenged in court), cuts to Medicare, and the long-term care measure called the Community Living Assistance Services and Supports Act, better known as the CLASS Act. During the Senate's Obamacare debate in December 2009, some Democrats voiced reservations about each of those provisions.

"Just look at the ones who made noise during the original debate," says a well-connected GOP Senate source. "Claire McCaskill, Ben Nelson, Kent Conrad -- Conrad called the CLASS Act a Ponzi scheme, but he voted for the whole bill that included it. How would he vote on a separate bill to repeal it?"

We'll probably find out. In the next year and a half, Senate Democrats, including some who are facing tough re-election fights in 2012, could have a chance to vote again on the most troublesome parts of Obamacare. With 47 Republican senators, the GOP would need just four Democrats to reach majority support for repealing significant chunks of the health care law.

If that happens, Senate Democrats, who at this very moment are railing against Republican filibusters, would have to resort to -- you guessed it -- a filibuster to stop repeal of any part of Obamacare. Even if they do, Republicans believe they might muster 60 votes to win the day. And if key parts of Obamacare fall, it's not clear whether the whole structure can remain standing.

As those fights go on, House Republicans, with some Democratic help, will pass new measures to address the health care problem piece-by-piece. Some will be attractive to Senate Democrats facing re-election. "A lot of them come from states that are sympathetic to the message we heard last November 2," says David Dreier. "So in light of that, we're not going to give up on this."

Byron York, The Examiner's chief political correspondent, can be contacted at byork@washingtonexaminer.com. His column appears on Tuesday and Friday, and his stories and blogposts appear on ExaminerPolitics.com.

Read more at the Washington Examiner: http://washingtonexaminer.com/politics/2011/01/house-gop-begins-long-slog-dismantle-obamacare#ixzz1BibkN1rf

 

[Redeye]

What does it matter, though?  GOP doesn't control the Congress, their repeal bill is utterly meaningless, and their replacement will be as devoid of useful ideas as they were during the original debate.

Oh, and according to a slew of polls, despite the GOP's assertions, the American people don't want it repealed.  The GOP are apparently out of touch with the electorate.  They want the economy and employment addressed.  So first this pointless waste of time on a repeal bill, and now apparently they're debating about abortion, something else where nothing they pass well go anywhere?!

Bring on 2012.  It'll be interesting.

Repeal and replace; what the Congres is proposing to replace Obamacare with. Any bets the combined new bils won't total 2000+ pages?

http://washingtonexaminer.com/politics/2011/01/house-gop-begins-long-slog-dismantle-obamacare

 

[Rifleman62]

Redeye, please review you post. It is full of errors.
Hint: what party controls the Congress and why in the US system is that important?
        what % of the US economy does health care represent, and effect does a government "take over" create?
        what party "won" the 2010 election?

 

[Redeye]

Neither party controls the Congress.  The Democrats control the Senate and the Republicans control the House of Representatives.  The House technically controls the purse strings and that does give them some ability to impact funding of government programs.  However, any bill they pass must be passed by the Senate and then signed by the President.  Since the Democrats control that, there's really no way any repeal bill means anything, since the Senate likely won't even bring it to a vote.  If they did, it would fail.  If by some miracle it passed the Senate, then the President would simply veto it, and there's no way there's enough votes to overturn the veto.  America's system is rather brilliant that way.  And that's why the GOP's "repeal bill" is either a total failure, or potentially, if there's public backlash over it, a Pyrrhic victory of sorts.

As for "what %"?  That's a nonsensical red herring.  ACA/"Obamacare" doesn't "take over" anything.  It leaves the provision of insurance and delivery of healthcare primarily to the private sector as always.  It does however mandate all to carry insurance (increasing the risk pool), subsidizing it for those who cannot afford it (shifting them from having to resort to the most expensive interventions like ER care far too late to having reasonable access to care, which should save money and improve outcomes), and restricts insurers from effectively denying coverage to those who have "pre-existing conditions", which happens to be about 119 million Americans if I remember right.  (out of 307 million, that's well north of 1/3).

As for who won, well, yes the GOP took the House.  And it will be an interesting couple of years.  It happened to Clinton too.  And he was re-elected.  And the GOP doesn't seem to have much in the way of really electable candidates for 2012, unless they pull off some kind of economic miracle (doubt it) they aren't in for any sort of an easy ride in 2012.

Redeye, please review you post. It is full of errors.
Hint: what party controls the Congress and why in the US system is that important?
        what % of the US economy does health care represent, and effect does a government "take over" create?
        what party "won" the 2010 election?

 

[Rifleman62]

And what effect will there be from 

mandate all to carry insurance (increasing the risk pool), subsidizing it for those who cannot afford it

, when nobody but the very rich can afford health insurance?

 

[Fishbone Jones]

And what effect will there be from  , when nobody but the very rich can afford health insurance?

Millions of middle class Americans carry, and pay for, health insurance. You don't have to be 'very rich' to afford it.

 

[Rifleman62]

Yes, of course I realize that. The question was: And what effect will there be from mandate all to carry insurance (increasing the risk pool), subsidizing it for those who cannot afford it, when nobody but the very rich can afford health insurance?

The key here is mandate all, subsidizing it, and the increasing costs to insurance companys leads to........

Down here, the insurance companys are already substantially increasing premiums. Business are not hiring due to employee costs.

 

[Redeye]

Yes, of course I realize that. The question was: And what effect will there be from mandate all to carry insurance (increasing the risk pool), subsidizing it for those who cannot afford it, when nobody but the very rich can afford health insurance?

The key here is mandate all, subsidizing it, and the increasing costs to insurance companys leads to........

Actually, expanding the risk pool should lower the costs for all.  Part of what started driving up insurance costs in the US was the cherrypicking of the "best risks" by certain insurers leaving making the pool smaller and causing a much larger adverse selection problem (one of the biggest problems in insurance markets) and driving up costs.

Down here, the insurance companys are already substantially increasing premiums. Business are not hiring due to employee costs.

Well, the extent to which that is true there's been some debate on - but that actually strengthens the argument for a "public option" - or better, a single payer system - unhooking health insurance from employers.

 

[Rifleman62]

Redeye, I regret not being to be able to refute your latest ramblings. My personal policy is to not post more than three my  .02 cents comments to the currently posted discussion by an individual.

I will of course, continue to follow your discussion.

Why, oh why is the Left always, always Right???

 

[Redeye]

Redeye, I regret not being to be able to refute your latest ramblings. My personal policy is not post more than three my  .02 cents to the currently posted discussion by an individual.

I will of course, continue to follow your discussion.

Why, oh why is the Left always, always Right???

Facts have a known liberal bias as Stephen Colbert once said.  Healthcare economics and policy has been a very significant interest of mine for a very long time.  The fact is that no "side" has all the answers, but without a decent sharing of ideas through a civil discourse, you might be able to fuse together something workable.

What galls me most in the US healthcare debate though is the shift from a practical discussion of how to reform or fix a clearly broken system to debating utter nonsense not supported by fact (death panels, for example), when there's really a great opportunity to learn from the strengths and weaknesses of the various systems for delivering universal healthcare throughout the rest of the industrialized world, choose the best features, and built an excellent, cost effective system.  The American system spends more money than any of those countries and still manages not to cover a huge swath of the population, and without the reform in place now, even those with coverage, particularly those who bought in the individual insurance market rather than through a group plan (ie employer benefits), faced a risk that insurers would go back through their history and look for any excuse to rescind coverage or exclude a condition.

The problem is a simple one - a company which has as its sole rational goal the maximization of profit must seek to limit its costs in every reasonable way possible.  Insurers do that, and employ huge underwriting teams to limit their "medical losses" where practicable, without crossing the line of failing to deliver the service paid for.  The massive amount of overhead the insurance company creates drives costs up, which is why there are so many costs.

My other favourite canard is "No one gets denied medical treatment.  They can go the ER and it's illegal to refuse to treat someone there.".  That's right.  ER care is also, generally, the most expensive.  And when Johnny NoInsurance comes in and gets treatment there, who pays?  Well, they'll bill him.  He'll pay what he can, maybe, or like a not-totally-insignificant number of Americans, declare bankruptcy.  So then who pays?  Everyone, because the care providers pass the cost on to everyone else, which is part of why it costs $10 for a Tylenol at some hospitals if you get an itemized bill.

Anyhow, that's enough for one post... but it's somewhere to start.

 

[observor 69]

For many Americans the fear is that they can't afford proper early treatment hence the patient will end up going to ER too late with an illness that is advanced and now expensive to treat.
Or the patient simply can't afford proper treatment of their serious illness and eventually dies.
Yes this happens !   

 

[Brad Sallows]

Repeal isn't meaningless.  The point is to have every politician who might stand for re-election in 2012 on record with a particular vote.  And any assertion that the Republican politicians are "devoid of ideas" militates heavily against the possibility that the speaker/writer has learned much from holding a significant interest for a very long time.  I suggest you as well look more deeply into recent election results below the federal level and the mix of senators due for re-election in 2012 to understand the electoral ground.

>utter nonsense not supported by fact (death panels, for example)

A characterization of "utter nonsense" is pure rhetorical bilge unbecoming of an "informed" person, unless you genuinely don't understand that the issue is health care rationing, which no one actually disputes except when it is referred to (hyperbolically) as death panels.  The hyperbole doesn't negate the issue/criticism.

>Actually, expanding the risk pool should lower the costs for all.

Simply expanding the risk pool increases the costs.  Expanding the paying insured pool is what lowers the costs.

The US system can indeed benefit from practical discussions of reform, but that's sort of impossible when some people have managed to convince themselves that the Republicans are "devoid of ideas" and the other political side instead focusus on passing legislation before understanding it in pursuit of the rather simple goal of forcing a breakdown of the system into single-payer public insurance by default.

 

[Redeye]

Given that going into the vote several polls showed repeal was wildly unpopular, it's not really a record I'd think many will want.

As for rationing - basic economics here - it exists in any system.  And while the term is in the eyes of those informed in the debate mainly a rhetorical device, to the "ignorant masses" it seems to be getting interpreted far more literally, and that's both counterproductive and just plain wrong.

What are the Republicans' ideas - the ones that haven't been highlighted as being useless by a myriad of sources?

Incidentally, there are non-single-payer universal healthcare systems, which the US could draw many ideas from - Germany, Switzerland for example.

Repeal isn't meaningless.  The point is to have every politician who might stand for re-election in 2012 on record with a particular vote.  And any assertion that the Republican politicians are "devoid of ideas" militates heavily against the possibility that the speaker/writer has learned much from holding a significant interest for a very long time.  I suggest you as well look more deeply into recent election results below the federal level and the mix of senators due for re-election in 2012 to understand the electoral ground.

>utter nonsense not supported by fact (death panels, for example)

A characterization of "utter nonsense" is pure rhetorical bilge unbecoming of an "informed" person, unless you genuinely don't understand that the issue is health care rationing, which no one actually disputes except when it is referred to (hyperbolically) as death panels.  The hyperbole doesn't negate the issue/criticism.

>Actually, expanding the risk pool should lower the costs for all.

Simply expanding the risk pool increases the costs.  Expanding the paying insured pool is what lowers the costs.

The US system can indeed benefit from practical discussions of reform, but that's sort of impossible when some people have managed to convince themselves that the Republicans are "devoid of ideas" and the other political side instead focusus on passing legislation before understanding it in pursuit of the rather simple goal of forcing a breakdown of the system into single-payer public insurance by default.

 

[Brad Sallows]

Prior to the election date some polls showed outright repeal in the 35% to 60% range.  I am not sure what the exact percentage threshold for "wildly unpopular" should be, but I suppose it to be lower than that.

Of course there is rationing in any economic system; usually, it is established by price signals.  The problem with current reform in the US is that a large fraction of Americans have become accustomed to at least having the option to decide whether to pay the price.  Again, you seem to want to ignore the customary meaning of common terms.  When people talk about health care "rationing", they tend to mean direct government yes/no decisions.

A couple of useful Republican ideas are to remove the interstate red tape which restricts insurers and to allow the formation of larger pools composed of individuals and smaller business.  Since you already acknowledged the advantage of expanding risk pools, I don't expect you to try and walk that one back as being useless, no matter how many myriads of contrary opinions you deploy.

The biggest problem the US has is that they are 40 to 50 years late joining the party.  The overall level of health care to which most Americans have become accustomed is much more advanced and costly than it was when most countries locked down expectations a few decades ago.  The second biggest problem is that the US already has made publicly funded promises to itself that it can't afford at levels people are willing to pay.  And, when the numbers are crunched, the actual expected efficiency gains are a very small number alongside a very big number; the gap isn't going to simply disappear.  The third biggest problem is that a practical person should expect the costs to be greater than predicted, and the revenues to be smaller.

 

[Redeye]

Prior to the election date some polls showed outright repeal in the 35% to 60% range.  I am not sure what the exact percentage threshold for "wildly unpopular" should be, but I suppose it to be lower than that.

I'll have to go hunting for it - but I believe it was a Gallup (or possible Opinion Research) poll that suggested almost 70% of Americans opposed repeal immediately before the vote in the House.

Of course there is rationing in any economic system; usually, it is established by price signals.  The problem with current reform in the US is that a large fraction of Americans have become accustomed to at least having the option to decide whether to pay the price.  Again, you seem to want to ignore the customary meaning of common terms.  When people talk about health care "rationing", they tend to mean direct government yes/no decisions.

The "customary meaning" in this case is being used to suggest to the average voter, who doesn't have the grasp of economics you or I do, that rather than restructuring rationing that exists regardless, it is being imposed where it doesn't exist.  The term "death panel" takes this to the extreme as a rhetorical device.  In the case of healthcare services, rationing by price signals has a pretty simplistic implication - if you cannot pay, you die.  Most people in society seem to be of the opinion that such a system isn't optimal.  Why does the US provide Medicare for senior citizens?  Because most don't have the resources to "self-insure", and no insurer could effectively provide insurance for that particular market at a price that would make it acceptable to most because the risks they're insuring against are so high.[/quote]

A couple of useful Republican ideas are to remove the interstate red tape which restricts insurers and to allow the formation of larger pools composed of individuals and smaller business.  Since you already acknowledged the advantage of expanding risk pools, I don't expect you to try and walk that one back as being useless, no matter how many myriads of contrary opinions you deploy.

It's not "red tape" per se, it is an actual outright prohibition that they propose removing.

In theory, that isn't a bad idea, because expanding risk pools does make sense.  The nature of the market for insurance, however, makes this one much more difficult.  There's actually a number of reasons why, and I have some pretty good reads on them I'll have to go looking for, but some work with Google will show you that this is not really as great an idea as it sounds.  The key points are that regulations and risk assessments are based on community assessments both of risks, and the cost associated with those risks as they vary from state to state (and theoretically, insurers could migrate as well to US jurisdictions with less requirements - perhaps like the Marianas Islands for example - offering "discount" insurance which actually might not cover anything of value.  If consumers had the information to make informed decisions about that, perhaps it'd be okay, but given the collusion that goes on in the insurance market (and the incredible barriers to entry for new competition), information asymetry will remain a huge problem.

I'll see if I can find all the sources I used to debate this a while back and post them.  There was one brilliant paper in particular that was both really detailed and really accessible, I just can't recall who produced it.  In short competition is good, in theory, but it also allows cherrypicking of risk pools by the competitors and creates a massive adverse selection program.  One of my better healthcare economics texts from university explained how this happened and undermined BC/BS in the US in the 1960s fairly thoroughly, the best risks were offered insurance cheaper than the community rating, driving up the risks to the remaining pool and therefore leaving its premiums to soar as well.  The other problem has to do with networks which are critical parts of many insurance plans.  If you buy an out-of-state plan which doesn't put you close to preferred providers you're not necessarily better off.

Further, a big general problem is age-based adverse selection, which is why an individual mandate/universal coverage is important.  Many of the uninsured/underinsured who face risks are younger people for whom it seems rational not to purchase insurance because of price (self insurance seems cheaper) - but these younger, healthier people in the risk pool are what helps keep cost down.  If adverse selection drives them out of the insurance market, then the problem becomes self-reinforcing.  Competing insurance markets can accelerate this problem.  Adverse selection is one of the reasons we mandate car insurance for all drivers, for example.

The biggest problem the US has is that they are 40 to 50 years late joining the party.  The overall level of health care to which most Americans have become accustomed is much more advanced and costly than it was when most countries locked down expectations a few decades ago.  The second biggest problem is that the US already has made publicly funded promises to itself that it can't afford at levels people are willing to pay.  And, when the numbers are crunched, the actual expected efficiency gains are a very small number alongside a very big number; the gap isn't going to simply disappear.  The third biggest problem is that a practical person should expect the costs to be greater than predicted, and the revenues to be smaller.

I agree.

There are massive, massive inefficiencies now in the US healthcare system that aren't easy to tackle but somewhere has to be the start.  I guess the main point I'd make is that instead of looking for the perfect solution all at once, it's far better to look for incremental improvements with a broader vision in mind.  Given the penchant for keeping some semblance of competition, the Swiss or German systems, or even the Dutch system, all of which use multiple providers with fairly strong regulation, might be worth looking at.

 

[a_majoor]

As one commenter notes, Obamacare is either a boondoggle and these are the payoffs, or it so badly written that it should be repealed and replaced. Given the amount of back room deals and other secretive goings on required to pass Obamacare, I suspect the answer is closer to "badly written", but you can read upthread and in other places about waivers being granted to prominent supporters of both the bill and the Democrat party which begs the question; if the bill is supposd to be so good, why would supporters be so keen to bail?

Regardless, stage one (repeal) has been taken, now we will see the Congress work to defund, eliminate or dismantle Obamacare a section at a time to bypass roadblocks by the Senate, bureaucracy and the Executive Branch. With more than half the States now mounting legal challenges against Obamacare on the other flank, and unions and corporations asking for waivers to be exempt from Obamacare, it is clear that this bill no longer has any real institutional support, and as noted, it was never supported by the American people either. The bill is finished.

http://thehill.com/blogs/healthwatch/health-reform-implementation/140533-hhs-grants-new-reform-waivers-amid-heightened-scrutiny

HHS grants 500 new healthcare waivers
By Jason Millman - 01/26/11 04:50 PM ET
 
A week after Republicans announced plans to investigate waivers granted to organizations for healthcare reform provisions, President Obama’s health department made public new waivers for more than 500 groups.

The Department of Health and Human Services (HHS) is granting temporary waivers to organizations that would not be able to meet the reform law’s new requirement for annual coverage limits.

As of last week, HHS had granted waivers to 222 organizations covering 1.5 million individuals. Though the number of groups receiving waivers has now more than tripled, the number of individuals covered by the waivers increased just 600,000 to 2.1 million.

The law gives HHS Secretary Kathleen Sebelius the flexibility to grant waivers to avoid disruption in the insurance market, but Republicans say the waivers are either gifts to Democratic allies or proof that the reform law isn’t working. However, a large number of businesses, in addition to unions, have received waivers.

The waivers have been granted to hundreds of so-called "mini-med" plans that offer limited health coverage to employees. The waivers are designed to preserve stability in the insurance market until new state-run insurance exchanges open in 2014.

The House Energy and Commerce Committee asked HHS last week for details on the waiver process. HHS said Wednesday night that it wants to make the waiver process transparent.

"We are committed to making the waiver process transparent to the public and to make sure workers with mini-med plans are informed about the limited nature of their coverage," Steve Larsen, director of oversght in HHS's Office of Consumer Information and Insurance, said in a statement. "For example, we have required plans that receive waivers to inform their enrollees that their coverage is limited. HHS also helps to ensure transparency by posting a list of the plans that have been granted waivers, so stakeholders understand how they are affected."

HHS said it was anticipating the huge bump in waiver requests because plans were required to file for waivers before their plan year began, which is Jan. 1 for many. The deparment was unable to provide the number of plans denied waiver requests, but an HHS spokesman said, "It's more than a handful, but not a big number."

This story was updated at 7:40 p.m.

 

[Redeye]

As one commenter notes, Obamacare is either a boondoggle and these are the payoffs, or it so badly written that it should be repealed and replaced. Given the amount of back room deals and other secretive goings on required to pass Obamacare, I suspect the answer is closer to "badly written", but you can read upthread and in other places about waivers being granted to prominent supporters of both the bill and the Democrat party which begs the question; if the bill is supposd to be so good, why would supporters be so keen to bail?

Regardless, stage one (repeal) has been taken, now we will see the Congress work to defund, eliminate or dismantle Obamacare a section at a time to bypass roadblocks by the Senate, bureaucracy and the Executive Branch. With more than half the States now mounting legal challenges against Obamacare on the other flank, and unions and corporations asking for waivers to be exempt from Obamacare, it is clear that this bill no longer has any real institutional support, and as noted, it was never supported by the American people either. The bill is finished.

I highly doubt that.  A gentleman's wager?

 

[Brad Sallows]

If the argument is about how useful something is rather than whether it is net better or worse, then by default it's worth adding to the mix.

>but these younger, healthier people in the risk pool are what helps keep cost down

That basically gets to the nut of it.  This isn't insurance we're talking about; it's a publicly funded entitlement.  And that is the point I think most people sense but don't want to talk about (whether they are for or against it): the PPACA is an awkward if not egregious body of legislation that isn't so much a step toward health care as it is a bold attempt to tip the fiscal scales irreversibly (other entitlements already having pushed things to the edge of disequilibrium) toward higher levels of taxation, spending, and government activity.

 

[Redeye]

If the argument is about how useful something is rather than whether it is net better or worse, then by default it's worth adding to the mix.

The thing is - and I didn't have time to try to run down the best most thorough read on it - I'm not actually convinced it's net better - there are arguments that it is actually long term net worse.

That basically gets to the nut of it.  This isn't insurance we're talking about; it's a publicly funded entitlement.  And that is the point I think most people sense but don't want to talk about (whether they are for or against it): the PPACA is an awkward if not egregious body of legislation that isn't so much a step toward health care as it is a bold attempt to tip the fiscal scales irreversibly (other entitlements already having pushed things to the edge of disequilibrium) toward higher levels of taxation, spending, and government activity.

Really?  It's not insurance?  A reform plan that doesn't include any sort of publicly delivered universal care?  Sorry, this is just wrong.  It is in fact completely an insurance system - built around private insurers having some regulatory direction such that every single person can be covered.  Yes, for some it will become an "entitlement" as they will receive subsidies or tax credits to have a comprehensive insurance policy.  It is, however, misleading to suggest this is really new.  The poorest Americans have some access through Medicaid and its variants, and as I outlined, those who aren't covered by Medicaid but still desperately require care still have an "entitlement" which in the end is often paid for by everyone.  So what changes?  Well, earlier interventions and access to the medical system should help raise general levels of health, reduce reliance on more expensive forms of care, and that will ultimately save money (hey, I'm not the only making this claim, the CBO that does far more in-depth research also studied this and found that "Obamacare" will in fact reduce the cost to taxpayers of the healthcare system).

Even Canada's healthcare system - which is, recall, a a single-payer, universal health insurance system - isn't really well described as an "entitlement" (which is, in broad terms, in my opinion a deceptive misnomer to begin with for most programs) - most people with a schmeck of intelligence of course realize that it is paid for out of taxation.

My biggest concern about the method of delivering insurance in the USA is the linking of it to employment - meaning that its spiralling costs is a burden on those employers, and that when one loses a job, they can lose coverage.  There's the "COBRA" system that allows them to carry on, but the costs are such that many cannot afford them, particularly if their transient unemployment becomes less transient than they'd like, which has been the case.  While important extended healthcare benefits here are tied to my employment, I at least know I have my basic needs covered regardless of what may happen to my employment situation.