Debate Now An Unhappy Birthday for Obamacare?

Check all statements that you believe to be mostly true:

  • 1. I support Obamacare in its entirety as it is.

    Votes: 1 3.6%
  • 2. I mostly support Obamacare in its entirety.

    Votes: 8 28.6%
  • 3. I want to see parts of Obamacare fixed.

    Votes: 7 25.0%
  • 4. I want to see most of Obamacare repealed.

    Votes: 3 10.7%
  • 5. I want Obamacare repealed and replaced.

    Votes: 7 25.0%
  • 6. I want Obamacare repealed and a return to the free market.

    Votes: 11 39.3%
  • 7. Other and I'll explain with my post.

    Votes: 2 7.1%

  • Total voters
    28

Foxfyre

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Note: This thread is in the structured debate zone. If this is your first visit to this forum please review the special rules.

Today, March 23, 2015, is Obamacare's fifth birthday.

Sally Pipes summarizes some realities and perceptions about Obamacare that was signed into law five years ago today and the report card is not good.

She writes: "When he signed his signature piece of legislation into law, President Obama guaranteed lower health-care costs, universal coverage and higher-quality care. Americans wouldn’t have to change their doctors if they didn’t want to. Five years later, the health law has failed to fulfill those grandiose promises. . . ."

The facts now seem to be (from her piece and elsewhere)

- More people are insured than were insured before Obamacare but more than 30 million people remain uninsured. 89% of the people who signed up for coverage under Obamacare, mostly to get the subsidies, already had insurance.

- Millions of people are paying less for their healthcare insurance than they were paying before Obamacare but at the cost of the taxpayers who are having to pick up the difference.

- Obama had promised the average American family would be paying $2500 less for healthcare, but the reality is that in 2014 the average American family was paying 24.4% more.

- On Obamacare's third birthday, we were promised that prescription costs would be sharply reduced as more of the plan went into effect. Instead these have skyrocketed.

- Obama promised that the plan would increase competition and thus lower costs for all. Instead insurers have abandoned healthcare coverage en masse. In 2013 there were 1.232 carriers offering healthcare coverage. Now there are 310 and that number is expected to drop even further exacerbating Obama's broken promise that if we liked our healthcare plan we could keep it.

- Further . . ." roughly two-thirds of the hospital networks available on the exchanges were either “narrow” or “ultra-narrow.” That means that these insurance plans refuse to partner with at least 30% of the area’s hospitals. Other plans exclude more than 70%. . ." It is a problem when your healthcare plan won't cover you at a hospital located conveniently to you.

- Doctors may be harder to come by too as roughly 60% of doctors currently practicing have reported that they intend to take early retirement because of Obamacare. Nearly 10,000 according to a recent survey consider Obamacare to be a failure.

- Obama promised that Obamacare would not add 1 penny to the deficit. The CBO now estimates 1.4 trillion added to the deficit over the first 10 years and some economists think that is really low. And that doesn't include the higher taxes, deductibles, premiums, co-pays, and uncovered items that most will pay.

Sally Pipes Unhappy birthday Obamacare - NY Daily News


And when the full plan is finally implemented next year, it is predicted by some that things will get much worse.

RULES FOR THIS DISCUSSION

1. No ad hominem. Affirm, criticize, or comment on statements made by Obama, politicians, commentators, writers, or other members, but do not comment on the character, credibility, motives, intent etc. of the person making the statement.

2. Please note the specific focus of this discussion in the question to be answered below, and relate your comments to that as much as possible.

3. Links or sources may be useful but are not required to express your opinion. If you do use them to reinforce your argument or to rebut somebody's argument, provide a short excerpt or your own short summary of what we will see or learn if we click on your link.

THE QUESTION TO BE ANSWERED:

Do you still support Obamacare in its entirety or are you ready to support those who want to repeal it in favor of a different and potentially better system? Why or why not? If you choose to repeal, what would a better system look like?
 

Roadrunner

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Note: This thread is in the structured debate zone. If this is your first visit to this forum please review the special rules.

Today, March 23, 2015, is Obamacare's fifth birthday.

Sally Pipes summarizes some realities and perceptions about Obamacare that was signed into law five years ago today and the report card is not good.

She writes: "When he signed his signature piece of legislation into law, President Obama guaranteed lower health-care costs, universal coverage and higher-quality care. Americans wouldn’t have to change their doctors if they didn’t want to. Five years later, the health law has failed to fulfill those grandiose promises. . . ."

The facts now seem to be (from her piece and elsewhere)

- More people are insured than were insured before Obamacare but more than 30 million people remain uninsured. 89% of the people who signed up for coverage under Obamacare, mostly to get the subsidies, already had insurance.

- Millions of people are paying less for their healthcare insurance than they were paying before Obamacare but at the cost of the taxpayers who are having to pick up the difference.

- Obama had promised the average American family would be paying $2500 less for healthcare, but the reality is that in 2014 the average American family was paying 24.4% more.

- On Obamacare's third birthday, we were promised that prescription costs would be sharply reduced as more of the plan went into effect. Instead these have skyrocketed.

- Obama promised that the plan would increase competition and thus lower costs for all. Instead insurers have abandoned healthcare coverage en masse. In 2013 there were 1.232 carriers offering healthcare coverage. Now there are 310 and that number is expected to drop even further exacerbating Obama's broken promise that if we liked our healthcare plan we could keep it.

- Further . . ." roughly two-thirds of the hospital networks available on the exchanges were either “narrow” or “ultra-narrow.” That means that these insurance plans refuse to partner with at least 30% of the area’s hospitals. Other plans exclude more than 70%. . ." It is a problem when your healthcare plan won't cover you at a hospital located conveniently to you.

- Doctors may be harder to come by too as roughly 60% of doctors currently practicing have reported that they intend to take early retirement because of Obamacare. Nearly 10,000 according to a recent survey consider Obamacare to be a failure.

- Obama promised that Obamacare would not add 1 penny to the deficit. The CBO now estimates 1.4 trillion added to the deficit over the first 10 years and some economists think that is really low. And that doesn't include the higher taxes, deductibles, premiums, co-pays, and uncovered items that most will pay.

Sally Pipes Unhappy birthday Obamacare - NY Daily News


And when the full plan is finally implemented next year, it is predicted by some that things will get much worse.

RULES FOR THIS DISCUSSION

1. No ad hominem. Affirm, criticize, or comment on statements made by Obama, politicians, commentators, writers, or other members, but do not comment on the character, credibility, motives, intent etc. of the person making the statement.

2. Please note the specific focus of this discussion in the question to be answered below, and relate your comments to that as much as possible.

3. Links or sources may be useful but are not required to express your opinion. If you do use them to reinforce your argument or to rebut somebody's argument, provide a short excerpt or your own short summary of what we will see or learn if we click on your link.

THE QUESTION TO BE ANSWERED:

Do you still support Obamacare in its entirety or are you ready to support those who want to repeal it in favor of a different and potentially better system? Why or why not? If you choose to repeal, what would a better system look like?
Your poll did not offer a "I want it repealed in its entirety." option.

Makes it hard to participate in the thread.
 
OP
Foxfyre

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Yes, somehow it posted before I finished the poll options. That option is there now.
 

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Yes, somehow it posted before I finished the poll options. That option is there now.
That is what I checked once it was there.

It was based on so many lies I cannot count them.

The entire health insurance concept(it has nothing to do with health CARE) was turned upside down so about 10 million people got shitty insurance.

Hospitals and clinics would have been the answer to the problem of the uninsured poor.

Think of how many medical school scholarships could have been granted just with the money pissed away on the ill-designed website.
 
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Foxfyre

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I checked options #4, #6, and #7. There are a few things in Obamacare that I think are pretty good, but those in no way offset the negatives. But if those things were incorporated into a new program, I would see that as a good thing.

I do want Obamacare repealed in its entirety though as I can find little about it that is appropriate for a free society.

And I checked other (#7) too because I also appreciate that Obamacare has destroyed so much of the U.S. healthcare system, that this has to be taken into consideration with a full repeal to give time for market forces to redevelop.

In short I definitely will support those who want to repeal it but will urge them to do that in the most constructive way possible.
 
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Foxfyre

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Lots and lots of looks and only two or three poll responses. Hmmm. Does that mean people aren't interested? Or the topic has become embarassing? Or we've worn out the discussion on it?
 

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Lots and lots of looks and only two or three poll responses. Hmmm. Does that mean people aren't interested? Or the topic has become embarassing? Or we've worn out the discussion on it?
There is another thread on the issue in one of the regular forums. I asked a couple of people to look at this one.......maybe they will.

I think the GOP cry for repeal and replace fell on deaf ears. There was a problem that needed addressing. The D's addressed it. The R's did not. The. D's gave the R's much to hang there hats on in the ACA....but they took a pass....played political football and got stuffed on their own 20.

The law is here to stay......flawed as it may be.....as there has been no alternative presented. Perhaps if the R's had approached the issue with a genuine desire to solve the problem...we'd have an even better law.

We may never know.
 

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Note: This thread is in the structured debate zone. If this is your first visit to this forum please review the special rules.

Today, March 23, 2015, is Obamacare's fifth birthday.

Sally Pipes summarizes some realities and perceptions about Obamacare that was signed into law five years ago today and the report card is not good.

I'll play contrarian here by noting that the report card is actually extremely good by almost any measure (which should also cover why I chose the polling option I did).

Almost all of Pipes' points have focused on costs and fiscal consequences, so let's talk about that.

On costs, the news since the ACA passed five years ago has been uniformly good. On the fiscal front, the costs to the federal government/taxpayer have fallen considerably: if you compare spending projections for any consistent time window, the price tag of the law has fallen substantially. For instance, here's the Wall Street Journal just a few weeks ago in Future Obamacare Costs Keep Falling (and if you're wondering about past Obamacare costs, actual FY14 spending on the law was also >30% lower than advertised back in 2010):

Overall, the health-care law will now cost 29% less for the 2015-19 period than was first forecast by the CBO when the law was signed in March 2010. Back then, the CBO and the congressional Joint Committee on Taxation estimated that for the last five years of their 10-year projection, Obamacare would cost $710 billion. Now, they expect it will cost $506 billion for the same period.

Of course, it's not just the sinking price tag associated with the ACA.

Overall health spending growth (across the public and the private sectors) each year since the law passed has been hovering at the lowest levels ever recorded. Health care price inflation has also hit unprecedented lows--year-over-year hospital prices actually fell this year, which simply isn't something that happens in the American health care system. Sometimes I forget that this actually has to be pointed out but here goes: this is extraordinary. There's never been a time like this in the American health sector in the past 60 years, other than a short period in the mid-90s--and that one didn't last as long nor go as deep as the current slowdown.

The unexpected and sustained slowdown in health care cost growth has also meant that the savings the ACA counted on (mostly in the Medicare program) haven't just materialized, they've been far bigger than was needed to cover the ACA's new spending--which again, has turned out to be much lower than was advertised anyway.

Pipes says there's no competition, yet premiums in the exchanges basically stayed flat from 2014 going into 2015 because of competition in the exchanges (employer-based premium growth also had a good 2014, tying a record low). And those 2014 exchange premiums were already up to 20% lower than premiums for comparable employer-based plans because of, you guessed it, competition. The reality is that we're seeing more broad and sustained efforts to get a handle on health care costs now than ever before and much of it is driven by competition. And yeah, that's what narrow networks are about--they're a way for insurers to offer lower cost options to cost conscious shoppers, alongside higher cost broad network options.

Meanwhile, we know that the net number of uninsured has already sunk by more than 16 million (and counting) and key indicators of health care quality have been improving, from falling medical errors and preventable readmissions in hospitals to better performance on metrics tracked by the body that accredits hospitals to Medicare Advantage plan performance, and so on.


But stats (as extraordinary and unprecedented as these ones are) are dry and boring and they risk missing the point. For the first time in a long time, health care in the U.S. is changing for the better.

As I mentioned the other day in another thread,


  • If you want the case that the ACA's "reforms are empowering patients, driving public and private health insurers to achieve better value, forcing existing providers to shape up and providing opportunities for disruptive newcomers," The Economist presented it a week or so ago.
  • PwC also did a deeper dive this week into how the ACA has been transforming American health care in Healthcare reform: Five trends to watch as the Affordable Care Act turns five. They remind us that "In its first five years, the Affordable Care Act (ACA) has had a profound, and likely irreversible, impact on the business of healthcare... By energizing five fundamental shifts over the past five years, the law has given rise to a New Health Economy predicated on value."

Insurers, public and private, are changing the way they pay for services to start paying for health and quality outcomes (presumably what this market is supposed to produce) and not just encouraging the endless churning out of health widgets to generate a revenue stream. Insurers have also had to adapt their business to not just be competitive but useful to their enrollees (particularly those with chronic health conditions). Meanwhile, innovators and start-ups are catering to an increasingly cost-conscious, market-driven consumer base to offer lower cost care options--a trend in line with the increase in price transparency and, yes, those evil deductibles that expose people to prices.

Health care providers are responding by stepping up and tackling the toughest problem of all: maintaining and improving the health of the populations they touch. This is a paradigm shift (one, by the way, that aligns with the simultaneous paradigm shift in the insurance industry, toward determining premiums and designing benefit packages at the community level). This is what's going to hold down cost growth long-term, this is what's going to improve the quality of our care and the health of people long-term.

Biden was correct five years ago: this is a BFD (and it seems to have started bearing some serious fruit unexpectedly quickly). This isn't the same industry it was only five or so years ago--it's better and it keeps improving.

So I'll go with "I mostly support Obamacare in its entirety." The evidence that we're on the right track has been piling up pretty high lately. And contra Sally Pipes, the report card thus far is quite good.
 
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Foxfyre

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Lots and lots of looks and only two or three poll responses. Hmmm. Does that mean people aren't interested? Or the topic has become embarassing? Or we've worn out the discussion on it?
There is another thread on the issue in one of the regular forums. I asked a couple of people to look at this one.......maybe they will.

I think the GOP cry for repeal and replace fell on deaf ears. There was a problem that needed addressing. The D's addressed it. The R's did not. The. D's gave the R's much to hang there hats on in the ACA....but they took a pass....played political football and got stuffed on their own 20.

The law is here to stay......flawed as it may be.....as there has been no alternative presented. Perhaps if the R's had approached the issue with a genuine desire to solve the problem...we'd have an even better law.

We may never know.
Well thanks for the promo anyway. It is appreciated.

But in the world of politics things are never as simple as they seem.

The R's in the house DID vote to repeal Obamacare and there were a lot of Democrats who wanted that too because it was killing them back home where the unpopularity of it goes up month by month. But the D's don't dare vote for any form of repeal less there be retaliation by the Democratic leadership. Last month was the latest and 67th successful House vote to repeal and/or change and/or replace legislation but each time it dies in the Senate where the Senate is controlled by the Senate leadership or the filibuster. It is largely symbolic as well as Obama has pledged to veto repeal of any portion of the law though he has signed some minor changes in addition to the executive orders he has used to override the existing law. Last month's vote was to repeal and replace.

And then there is the element that does not want U.S. healthcare controlled by the federal government and think it is wrong for the federal government to just replace one bad piece of legislation with another one that might or might not be as bad. They want the government to get out of healthcare and let market forces restore the system to the greatest, most efficient in the world that it was before the federal government started meddling.
 
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Foxfyre

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Note: This thread is in the structured debate zone. If this is your first visit to this forum please review the special rules.

Today, March 23, 2015, is Obamacare's fifth birthday.

Sally Pipes summarizes some realities and perceptions about Obamacare that was signed into law five years ago today and the report card is not good.

I'll play contrarian here by noting that the report card is actually extremely good by almost any measure (which should also cover why I chose the polling option I did).

Almost all of Pipes' points have focused on costs and fiscal consequences, so let's talk about that.

On costs, the news since the ACA passed five years ago has been uniformly good. On the fiscal front, the costs to the federal government/taxpayer have fallen considerably: if you compare spending projections for any consistent time window, the price tag of the law has fallen substantially. For instance, here's the Wall Street Journal just a few weeks ago in Future Obamacare Costs Keep Falling (and if you're wondering about past Obamacare costs, actual FY14 spending on the law was also >30% lower than advertised back in 2010):

Overall, the health-care law will now cost 29% less for the 2015-19 period than was first forecast by the CBO when the law was signed in March 2010. Back then, the CBO and the congressional Joint Committee on Taxation estimated that for the last five years of their 10-year projection, Obamacare would cost $710 billion. Now, they expect it will cost $506 billion for the same period.

Of course, it's not just the sinking price tag associated with the ACA.

Overall health spending growth (across the public and the private sectors) each year since the law passed has been hovering at the lowest levels ever recorded. Health care price inflation has also hit unprecedented lows--year-over-year hospital prices actually fell this year, which simply isn't something that happens in the American health care system. Sometimes I forget that this actually has to be pointed out but here goes: this is extraordinary. There's never been a time like this in the American health sector in the past 60 years, other than a short period in the mid-90s--and that one didn't last as long nor go as deep as the current slowdown.

The unexpected and sustained slowdown in health care cost growth has also meant that the savings the ACA counted on (mostly in the Medicare program) haven't just materialized, they've been far bigger than was needed to cover the ACA's new spending--which again, has turned out to be much lower than was advertised anyway.

Pipes says there's no competition, yet premiums in the exchanges basically stayed flat from 2014 going into 2015 because of competition in the exchanges (employer-based premium growth also had a good 2014, tying a record low). And those 2014 exchange premiums were already up to 20% lower than premiums for comparable employer-based plans because of, you guessed it, competition. The reality is that we're seeing more broad and sustained efforts to get a handle on health care costs now than ever before and much of it is driven by competition. And yeah, that's what narrow networks are about--they're a way for insurers to offer lower cost options to cost conscious shoppers, alongside higher cost broad network options.

Meanwhile, we know that the net number of uninsured has already sunk by more than 16 million (and counting) and key indicators of health care quality have been improving, from falling medical errors and preventable readmissions in hospitals to better performance on metrics tracked by the body that accredits hospitals to Medicare Advantage plan performance, and so on.


But stats (as extraordinary and unprecedented as these ones are) are dry and boring and they risk missing the point. For the first time in a long time, health care in the U.S. is changing for the better.

As I mentioned the other day in another thread,


  • If you want the case that the ACA's "reforms are empowering patients, driving public and private health insurers to achieve better value, forcing existing providers to shape up and providing opportunities for disruptive newcomers," The Economist presented it a week or so ago.
  • PwC also did a deeper dive this week into how the ACA has been transforming American health care in Healthcare reform: Five trends to watch as the Affordable Care Act turns five. They remind us that "In its first five years, the Affordable Care Act (ACA) has had a profound, and likely irreversible, impact on the business of healthcare... By energizing five fundamental shifts over the past five years, the law has given rise to a New Health Economy predicated on value."

Insurers, public and private, are changing the way they pay for services to start paying for health and quality outcomes (presumably what this market is supposed to produce) and not just encouraging the endless churning out of health widgets to generate a revenue stream. Insurers have also had to adapt their business to not just be competitive but useful to their enrollees (particularly those with chronic health conditions). Meanwhile, innovators and start-ups are catering to an increasingly cost-conscious, market-driven consumer base to offer lower cost care options--a trend in line with the increase in price transparency and, yes, those evil deductibles that expose people to prices.

Health care providers are responding by stepping up and tackling the toughest problem of all: maintaining and improving the health of the populations they touch. This is a paradigm shift (one, by the way, that aligns with the simultaneous paradigm shift in the insurance industry, toward determining premiums and designing benefit packages at the community level). This is what's going to hold down cost growth long-term, this is what's going to improve the quality of our care and the health of people long-term.

Biden was correct five years ago: this is a BFD (and it seems to have started bearing some serious fruit unexpectedly quickly). This isn't the same industry it was only five or so years ago--it's better and it keeps improving.

So I'll go with "I mostly support Obamacare in its entirety." The evidence that we're on the right track has been piling up pretty high lately. And contra Sally Pipes, the report card thus far is quite good.
According to those reporting on the latest (2015) numbers from the CBO, here is what Obamacare will cost us:

. . .It will cost the federal government – taxpayers, that is – $50,000 for every person who gets health insurance under the Obamacare law, the Congressional Budget Office revealed on Monday.

The number comes from figures buried in a 15-page section of the nonpartisan organization's new ten-year budget outlook.

The best-case scenario described by the CBO would result in 'between 24 million and 27 million' fewer Americans being uninsured in 2025, compared to the year before the Affordable Care Act took effect.

Pulling that off will cost Uncle Sam about $1.35 trillion – or $50,000 per head. . . .
Politics CBO ObamaCare to cost 50 000 in taxpayer money - per person insured Best of Cain

And looking at the horrible mess that is being created, the disruption of healthcare of tens of millions of Americans with most paying far more than they had to under the old system, the flight of insurance companies and doctors from a broken system that is a nightmare of inefficiency and red tape. . . .

. . .the fact is we just aren't getting our money's worth and we are getting much worse healthcare than before to boot.
 

LoneLaugher

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Lots and lots of looks and only two or three poll responses. Hmmm. Does that mean people aren't interested? Or the topic has become embarassing? Or we've worn out the discussion on it?
There is another thread on the issue in one of the regular forums. I asked a couple of people to look at this one.......maybe they will.

I think the GOP cry for repeal and replace fell on deaf ears. There was a problem that needed addressing. The D's addressed it. The R's did not. The. D's gave the R's much to hang there hats on in the ACA....but they took a pass....played political football and got stuffed on their own 20.

The law is here to stay......flawed as it may be.....as there has been no alternative presented. Perhaps if the R's had approached the issue with a genuine desire to solve the problem...we'd have an even better law.

We may never know.
Well thanks for the promo anyway. It is appreciated.

But in the world of politics things are never as simple as they seem.

The R's in the house DID vote to repeal Obamacare and there were a lot of Democrats who wanted that too because it was killing them back home where the unpopularity of it goes up month by month. But the D's don't dare vote for any form of repeal less there be retaliation by the Democratic leadership. Last month was the latest and 67th successful House vote to repeal and/or change and/or replace legislation but each time it dies in the Senate where the Senate is controlled by the Senate leadership or the filibuster. It is largely symbolic as well as Obama has pledged to veto repeal of any portion of the law though he has signed some minor changes in addition to the executive orders he has used to override the existing law. Last month's vote was to repeal and replace.

And then there is the element that does not want U.S. healthcare controlled by the federal government and think it is wrong for the federal government to just replace one bad piece of legislation with another one that might or might not be as bad. They want the government to get out of healthcare and let market forces restore the system to the greatest, most efficient in the world that it was before the federal government started meddling.
My goodness!
 

LoneLaugher

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Note: This thread is in the structured debate zone. If this is your first visit to this forum please review the special rules.

Today, March 23, 2015, is Obamacare's fifth birthday.

Sally Pipes summarizes some realities and perceptions about Obamacare that was signed into law five years ago today and the report card is not good.

I'll play contrarian here by noting that the report card is actually extremely good by almost any measure (which should also cover why I chose the polling option I did).

Almost all of Pipes' points have focused on costs and fiscal consequences, so let's talk about that.

On costs, the news since the ACA passed five years ago has been uniformly good. On the fiscal front, the costs to the federal government/taxpayer have fallen considerably: if you compare spending projections for any consistent time window, the price tag of the law has fallen substantially. For instance, here's the Wall Street Journal just a few weeks ago in Future Obamacare Costs Keep Falling (and if you're wondering about past Obamacare costs, actual FY14 spending on the law was also >30% lower than advertised back in 2010):

Overall, the health-care law will now cost 29% less for the 2015-19 period than was first forecast by the CBO when the law was signed in March 2010. Back then, the CBO and the congressional Joint Committee on Taxation estimated that for the last five years of their 10-year projection, Obamacare would cost $710 billion. Now, they expect it will cost $506 billion for the same period.

Of course, it's not just the sinking price tag associated with the ACA.

Overall health spending growth (across the public and the private sectors) each year since the law passed has been hovering at the lowest levels ever recorded. Health care price inflation has also hit unprecedented lows--year-over-year hospital prices actually fell this year, which simply isn't something that happens in the American health care system. Sometimes I forget that this actually has to be pointed out but here goes: this is extraordinary. There's never been a time like this in the American health sector in the past 60 years, other than a short period in the mid-90s--and that one didn't last as long nor go as deep as the current slowdown.

The unexpected and sustained slowdown in health care cost growth has also meant that the savings the ACA counted on (mostly in the Medicare program) haven't just materialized, they've been far bigger than was needed to cover the ACA's new spending--which again, has turned out to be much lower than was advertised anyway.

Pipes says there's no competition, yet premiums in the exchanges basically stayed flat from 2014 going into 2015 because of competition in the exchanges (employer-based premium growth also had a good 2014, tying a record low). And those 2014 exchange premiums were already up to 20% lower than premiums for comparable employer-based plans because of, you guessed it, competition. The reality is that we're seeing more broad and sustained efforts to get a handle on health care costs now than ever before and much of it is driven by competition. And yeah, that's what narrow networks are about--they're a way for insurers to offer lower cost options to cost conscious shoppers, alongside higher cost broad network options.

Meanwhile, we know that the net number of uninsured has already sunk by more than 16 million (and counting) and key indicators of health care quality have been improving, from falling medical errors and preventable readmissions in hospitals to better performance on metrics tracked by the body that accredits hospitals to Medicare Advantage plan performance, and so on.


But stats (as extraordinary and unprecedented as these ones are) are dry and boring and they risk missing the point. For the first time in a long time, health care in the U.S. is changing for the better.

As I mentioned the other day in another thread,


  • If you want the case that the ACA's "reforms are empowering patients, driving public and private health insurers to achieve better value, forcing existing providers to shape up and providing opportunities for disruptive newcomers," The Economist presented it a week or so ago.
  • PwC also did a deeper dive this week into how the ACA has been transforming American health care in Healthcare reform: Five trends to watch as the Affordable Care Act turns five. They remind us that "In its first five years, the Affordable Care Act (ACA) has had a profound, and likely irreversible, impact on the business of healthcare... By energizing five fundamental shifts over the past five years, the law has given rise to a New Health Economy predicated on value."

Insurers, public and private, are changing the way they pay for services to start paying for health and quality outcomes (presumably what this market is supposed to produce) and not just encouraging the endless churning out of health widgets to generate a revenue stream. Insurers have also had to adapt their business to not just be competitive but useful to their enrollees (particularly those with chronic health conditions). Meanwhile, innovators and start-ups are catering to an increasingly cost-conscious, market-driven consumer base to offer lower cost care options--a trend in line with the increase in price transparency and, yes, those evil deductibles that expose people to prices.

Health care providers are responding by stepping up and tackling the toughest problem of all: maintaining and improving the health of the populations they touch. This is a paradigm shift (one, by the way, that aligns with the simultaneous paradigm shift in the insurance industry, toward determining premiums and designing benefit packages at the community level). This is what's going to hold down cost growth long-term, this is what's going to improve the quality of our care and the health of people long-term.

Biden was correct five years ago: this is a BFD (and it seems to have started bearing some serious fruit unexpectedly quickly). This isn't the same industry it was only five or so years ago--it's better and it keeps improving.

So I'll go with "I mostly support Obamacare in its entirety." The evidence that we're on the right track has been piling up pretty high lately. And contra Sally Pipes, the report card thus far is quite good.
According to those reporting on the latest (2015) numbers from the CBO, here is what Obamacare will cost us:

. . .It will cost the federal government – taxpayers, that is – $50,000 for every person who gets health insurance under the Obamacare law, the Congressional Budget Office revealed on Monday.

The number comes from figures buried in a 15-page section of the nonpartisan organization's new ten-year budget outlook.

The best-case scenario described by the CBO would result in 'between 24 million and 27 million' fewer Americans being uninsured in 2025, compared to the year before the Affordable Care Act took effect.

Pulling that off will cost Uncle Sam about $1.35 trillion – or $50,000 per head. . . .
Politics CBO ObamaCare to cost 50 000 in taxpayer money - per person insured Best of Cain

And looking at the horrible mess that is being created, the disruption of healthcare of tens of millions of Americans with most paying far more than they had to under the old system, the flight of insurance companies and doctors from a broken system that is a nightmare of inefficiency and red tape. . . .

. . .the fact is we just aren't getting our money's worth and we are getting much worse healthcare than before to boot.
Oh dear!
 

LoneLaugher

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The federal government does not control healthcare.

The idea that market forces will solve the problem is laughable.
 

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According to those reporting on the latest (2015) numbers from the CBO, here is what Obamacare will cost us:

. . .It will cost the federal government – taxpayers, that is – $50,000 for every person who gets health insurance under the Obamacare law, the Congressional Budget Office revealed on Monday.​
Not to denigrate your source, but that's absurd. The CBO puts directly in its cost estimates the average spending per subsidized enrollee.

Here they are this very month, March 2015, telling us the average cost per subsidized enrollee for 2015:



That's $3,960 per person.

Meanwhile, here they are back in March 2010 (in the much advertised score of the then-bill) guessing how much it would cost per person this year:



$5,200 per person.

I'll save you the calculation: that's a 24% drop in per person spending relative to the price tag advertised back in 2010 when the law passed.

Why, you ask? They explained that in their annual budget projections a few weeks ago (I hope you're sitting down!):
CBO and JCT have lowered their projection of private health insurance premiums for the 2016–2025 period. New information on national health expenditures is the reason: Spending by private health insurers on health care and administration rose less in 2013 (the most recent year for which data are available) than in preceding years and by much less than the agencies had expected for 2013. The 2013 results reinforced a trend of relatively slow growth that had begun some years earlier: After excluding the effects of overall inflation (using the consumer price index) and adjusting for changes in the age and gender mix of the population, CBO and JCT estimate that growth in private health insurance spending per enrollee over the 2006–2013 period averaged 1.8 percent per year, compared with an average rate of 5.0 percent per year during the 1998–2005 period.
Lower premiums than expected mean lower federal spending to subsidize premiums in the exchanges (they also mean lower personal spending per household, for that matter). Which means the ACA's price tag keeps tumbling. It's becoming a pattern at this point.

This, as I mentioned, is part of a much broader, health sector-wide trend in record-low spending growth:
Another notable influence is the slowdown in the growth of health care costs covered by private insurance and in the Medicare and Medicaid programs.
As I've tried to convey, this is pretty astonishing. The 2010 score of the bill was substantially too pessimistic about cost containment under the ACA. Even the law's proponents back then weren't arguing things were going to turn out far better than the CBO was projecting--they were too busy fending off the (now obviously false) arguments that the CBO projections back then were too rosy!

These are unprecedented (and unexpected, in many ways) times--in a good way! The ACA is turning out better than most dared suggest five years ago.
 
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Greenbeard

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Off topic a bit but reading this thread title I can't help but have a Simpsons flashback:

 

Shrimpbox

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Note: This thread is in the structured debate zone. If this is your first visit to this forum please review the special rules.

Today, March 23, 2015, is Obamacare's fifth birthday.

Sally Pipes summarizes some realities and perceptions about Obamacare that was signed into law five years ago today and the report card is not good.

I'll play contrarian here by noting that the report card is actually extremely good by almost any measure (which should also cover why I chose the polling option I did).

Almost all of Pipes' points have focused on costs and fiscal consequences, so let's talk about that.

On costs, the news since the ACA passed five years ago has been uniformly good. On the fiscal front, the costs to the federal government/taxpayer have fallen considerably: if you compare spending projections for any consistent time window, the price tag of the law has fallen substantially. For instance, here's the Wall Street Journal just a few weeks ago in Future Obamacare Costs Keep Falling (and if you're wondering about past Obamacare costs, actual FY14 spending on the law was also >30% lower than advertised back in 2010):

Overall, the health-care law will now cost 29% less for the 2015-19 period than was first forecast by the CBO when the law was signed in March 2010. Back then, the CBO and the congressional Joint Committee on Taxation estimated that for the last five years of their 10-year projection, Obamacare would cost $710 billion. Now, they expect it will cost $506 billion for the same period.

Of course, it's not just the sinking price tag associated with the ACA.

Overall health spending growth (across the public and the private sectors) each year since the law passed has been hovering at the lowest levels ever recorded. Health care price inflation has also hit unprecedented lows--year-over-year hospital prices actually fell this year, which simply isn't something that happens in the American health care system. Sometimes I forget that this actually has to be pointed out but here goes: this is extraordinary. There's never been a time like this in the American health sector in the past 60 years, other than a short period in the mid-90s--and that one didn't last as long nor go as deep as the current slowdown.

The unexpected and sustained slowdown in health care cost growth has also meant that the savings the ACA counted on (mostly in the Medicare program) haven't just materialized, they've been far bigger than was needed to cover the ACA's new spending--which again, has turned out to be much lower than was advertised anyway.

Pipes says there's no competition, yet premiums in the exchanges basically stayed flat from 2014 going into 2015 because of competition in the exchanges (employer-based premium growth also had a good 2014, tying a record low). And those 2014 exchange premiums were already up to 20% lower than premiums for comparable employer-based plans because of, you guessed it, competition. The reality is that we're seeing more broad and sustained efforts to get a handle on health care costs now than ever before and much of it is driven by competition. And yeah, that's what narrow networks are about--they're a way for insurers to offer lower cost options to cost conscious shoppers, alongside higher cost broad network options.

Meanwhile, we know that the net number of uninsured has already sunk by more than 16 million (and counting) and key indicators of health care quality have been improving, from falling medical errors and preventable readmissions in hospitals to better performance on metrics tracked by the body that accredits hospitals to Medicare Advantage plan performance, and so on.


But stats (as extraordinary and unprecedented as these ones are) are dry and boring and they risk missing the point. For the first time in a long time, health care in the U.S. is changing for the better.

As I mentioned the other day in another thread,


  • If you want the case that the ACA's "reforms are empowering patients, driving public and private health insurers to achieve better value, forcing existing providers to shape up and providing opportunities for disruptive newcomers," The Economist presented it a week or so ago.
  • PwC also did a deeper dive this week into how the ACA has been transforming American health care in Healthcare reform: Five trends to watch as the Affordable Care Act turns five. They remind us that "In its first five years, the Affordable Care Act (ACA) has had a profound, and likely irreversible, impact on the business of healthcare... By energizing five fundamental shifts over the past five years, the law has given rise to a New Health Economy predicated on value."

Insurers, public and private, are changing the way they pay for services to start paying for health and quality outcomes (presumably what this market is supposed to produce) and not just encouraging the endless churning out of health widgets to generate a revenue stream. Insurers have also had to adapt their business to not just be competitive but useful to their enrollees (particularly those with chronic health conditions). Meanwhile, innovators and start-ups are catering to an increasingly cost-conscious, market-driven consumer base to offer lower cost care options--a trend in line with the increase in price transparency and, yes, those evil deductibles that expose people to prices.

Health care providers are responding by stepping up and tackling the toughest problem of all: maintaining and improving the health of the populations they touch. This is a paradigm shift (one, by the way, that aligns with the simultaneous paradigm shift in the insurance industry, toward determining premiums and designing benefit packages at the community level). This is what's going to hold down cost growth long-term, this is what's going to improve the quality of our care and the health of people long-term.

Biden was correct five years ago: this is a BFD (and it seems to have started bearing some serious fruit unexpectedly quickly). This isn't the same industry it was only five or so years ago--it's better and it keeps improving.

So I'll go with "I mostly support Obamacare in its entirety." The evidence that we're on the right track has been piling up pretty high lately. And contra Sally Pipes, the report card thus far is quite good.
What green beard says on the surface is true but looks are deceiving. Most economists peg 75 percent of the lower costs to a poor economy. Much of the lower costs are because they don't have the number of people enrolling that they anticipated so that subsidies are much less. In addition, the plans have a very narrow focus and the deductibles are significant. Many are foregoing care because they do not have the deductible, which may or may not be a good thing. One could say we are reducing unnecessary procedures or one could say people can't afford the care they need. Obamacare does not insure all the uninsured as was promised so we sort of have the same situation we had before obamacare. Green cannot argue that choice has not been severely restricted or that doctors en masse don't like obamacare. Can't see where those are positives. Plus the benefits seem to be a boon(or boondoggle depending how you see it) for the poor and just another cross to bear for the middle class, who will have to absorb the brunt of obamacare.

Obamacare premiums to spike but law is cheaper than expected - Washington Times

Just read the first half of this article, says obamacare premiums will rise 8.6 percent per year for the next five years.

Subscription Center ChicagoBusiness.com

And Green I do not understand why posts like yours have no relation at all to my real world experiences. My premiums last year alone went up 20 percent. My wife's costs for blood pressure medicines have quadrupled. Many doctors won't take obamacare because they can't stay in business with its payments. So you are presenting a macro picture which leaves out the micro problems.

Finally I love the diagnosis that says we really won't be able to evaluate its success or failure til many years down the road. So we have to destroy our healthcare system before we know we have destroyed our healthcare system. Please, call a shrink.
 

Greenbeard

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What green beard says on the surface is true but looks are deceiving. Most economists peg 75 percent of the lower costs to a poor economy.
The further we get from the 2007-09, the harder it gets to keep pinning the entirety of the unprecedented era of health care we're experiencing on it. 2014 was the best economic year since the late '90s on a variety of metrics (which, by the way, is itself quite contrary to the doomsday predictions about the ACA's economic impact that were made in the years proceeding its launch), yet underneath the enrollment growth the trend continued.

Here's the Altarum Institute (which tracks health spending and prices) in their latest monthly look at health prices:
For the HCPI as a whole, only 2 of the 10 components saw increases in price growth (nursing home care and dental services). Some of this downward pressure is related to economy-wide price behavior, seen most clearly with durable medical equipment price growth of only 0.2% and price growth for other nondurable medical products actually falling by 1.1%. Yet, the price behavior for hospitals and physicians suggests that something else is happening. Are we seeing the first signs of newfound health care efficiency via insurance exchanges, high-deductible health policies, transparency, and more keeping health care prices contained? Health care and economy-wide inflation are quite low for this stage of the business cycle recovery. January 2015 was the 67th month of economic expansion following the recession, yet we are barely off the decade-plus HCPI low. A return to 2% growth for the HCPI now seems further off in the future.
Meanwhile, here's the editor of Modern Healthcare just a few weeks ago noting what's becoming increasingly clear: "The spending slowdown is real":
Over the past two years, conventional wisdom presumed without offering much in the way of evidence that the lingering recession and the rise of high-deductible and narrow network plans explained the slowdown in healthcare spending, now in its fifth year.

Indeed, most economists and the media echo chamber repeatedly said rapid spending growth would resume once the economy picked up steam, which it has. But healthcare spending growth has not.

The argument that the slowdown was transitory had a shred of plausibility in the privately insured market, where reporting is much less transparent and the impact of higher costs on households—a very real phenomenon—takes time to unfold.

But now, finally, the Mr. Joneses at the Congressional Budget Office have come around to admitting that something is happening here, even if they don't know what it is.
Most media accounts last week focused attention on the CBO's significantly lower projections for spending on premium subsidies available under the Affordable Care Act. As recently as January, the government projected over $1 trillion would flow to low- and moderate-income households buying health plans on the exchanges over the next decade.

Now, the CBO projects it will be $209 billion less because of lower overall premiums and—surprise, surprise—a reduction in the number of people who will need coverage. Fewer small and medium-sized businesses are expected to drop coverage because, lo and behold, insurance has become more affordable for employers because of the slowdown. . .

Suggesting the slowdown was transitory never made sense when it came to Medicare. Most seniors are insulated from the vicissitudes of the business cycle. And the last thing anyone would call Medicare is a high-deductible plan with a narrow network. Yet the slowdown has been just as dramatic there as it has been in the private insurance market.

Even the CBO now admits that the healthcare system has begun delivering lower-cost care to seniors. A year before the ACA passed, the CBO expected the CMS to spend $725 billion in 2015. Last week, it projected this year's spending would be just $632 billion, or $11,429 for each of the program's 55.3 million beneficiaries.
Much of the lower costs are because they don't have the number of people enrolling that they anticipated so that subsidies are much less.
As I already noted in the post above, per enrollee spending has fallen by almost a quarter relative to the projections "sold" back in 2010. That's a number that's independent of enrollment.

Besides that, the cost growth slowdown has also showed up in Medicare. Medicare's enrollment isn't affected by external factors, its network is quite wide, its deductibles haven't changed (though its premiums have fallen over the past few years), and its enrollees are more insulated from transitory economic influences than the average working-age person with private sector insurance. And yet Medicare, too, hasn't been immune from the history-making: Per Capita Medicare Spending is Actually Falling.
Medicare spending isn’t just lower than experts predicted a few years ago. On a per-person basis, Medicare spending is actually falling.

If the pattern continues, as the Congressional Budget Office forecasts, it will be a rarity in the Medicare program’s history. Spending per Medicare patient has almost always grown more rapidly than the economy as a whole, often by a wide margin.
And this goes well beyond what the ACA needed to balance its books.

Pre-ACA, Medicare spending in 2014 was on track to be $710 billion.

Post-ACA (which required the program to slow growth and get more efficient), Medicare spending in 2014 was expected to be $652 billion.

In reality, Medicare spending last year was $600 billion. The slowdown is producing huge savings in Medicare, above and beyond what was statutorily required by the ACA.

In addition, the plans have a very narrow focus and the deductibles are significant. Many are foregoing care because they do not have the deductible, which may or may not be a good thing. One could say we are reducing unnecessary procedures or one could say people can't afford the care they need. Obamacare does not insure all the uninsured as was promised so we sort of have the same situation we had before obamacare. Green cannot argue that choice has not been severely restricted or that doctors en masse don't like obamacare. Can't see where those are positives. Plus the benefits seem to be a boon(or boondoggle depending how you see it) for the poor and just another cross to bear for the middle class, who will have to absorb the brunt of obamacare.
As far as I can tell, part of the "problem" is that most people have spent so long insulated from market dynamics in the health sector that they don't recognize it (nor like it) when it appears. Different networks have different costs associated with them. Opening up a real, functioning market means that insurers get to price different potential networks and offer different networks (at different price points) for your consideration. You as the consumer then get to choose one based on the mix of price and access to various providers that you want.

The exchanges have lots of broad network plans in them (generally, as a matter of economic fact, those will cost more), but they also have lots of narrower network options. The latter have proven popular because they tend to be less expensive--that is to say, in an open market people seem to generally value lower premiums over broader provider networks. That isn't restricting choice, that's giving people a choice. You don't have to choose a more expensive broad network plan, there are lower-cost options available if you want them. It seems many people do.

Yes, this is different than the norm in the employer space, where 1) employees generally don't get to make decisions, 2) employers err on the side of giving them more, and 3) the insurance costs more than the offerings people are flocking to in the exchanges (which, again, can be up to 20% cheaper for plans of equivalent benefits and generosity compared to employer-based plans). Turns out when they have to spend their own money--even if they're getting a subsidy to supplement--people in open markets are price conscious and show you what they really value. These market dynamics are absent in the employer-based world, where folks tend to be used to getting everything and (seemingly, other than in their lack of wage growth) not paying for it.

As for deductibles, those are what expose consumers to price when they interact with health care providers (up to now I've been talking about market dynamics in the insurance market). If you've got a $250 deductible and Provider A is offering a service for $1,200 while Provider B is offering that same service for $5,000 you have very little economic reason to choose one over the other, since you're effectively paying the same thing either way. You may even be drawn to Provider B's higher price for certain perverse reasons.

And Green I do not understand why posts like yours have no relation at all to my real world experiences. My premiums last year alone went up 20 percent. My wife's costs for blood pressure medicines have quadrupled. Many doctors won't take obamacare because they can't stay in business with its payments. So you are presenting a macro picture which leaves out the micro problems.
Are you in the open market? Did you shop around? Or are you in an employer-based plan (and, if so, is it fully insured or self-insured)?

Finally I love the diagnosis that says we really won't be able to evaluate its success or failure til many years down the road. So we have to destroy our healthcare system before we know we have destroyed our healthcare system. Please, call a shrink.
The health care system is about as far from "destroyed" as it can get. On most indicators, it's never done better than it's doing right now.
 
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According to those reporting on the latest (2015) numbers from the CBO, here is what Obamacare will cost us:

. . .It will cost the federal government – taxpayers, that is – $50,000 for every person who gets health insurance under the Obamacare law, the Congressional Budget Office revealed on Monday.​
Not to denigrate your source, but that's absurd. The CBO puts directly in its cost estimates the average spending per subsidized enrollee.

Here they are this very month, March 2015, telling us the average cost per subsidized enrollee for 2015:



That's $3,960 per person.

Meanwhile, here they are back in March 2010 (in the much advertised score of the then-bill) guessing how much it would cost per person this year:



$5,200 per person.

I'll save you the calculation: that's a 24% drop in per person spending relative to the price tag advertised back in 2010 when the law passed.

Why, you ask? They explained that in their annual budget projections a few weeks ago (I hope you're sitting down!):
CBO and JCT have lowered their projection of private health insurance premiums for the 2016–2025 period. New information on national health expenditures is the reason: Spending by private health insurers on health care and administration rose less in 2013 (the most recent year for which data are available) than in preceding years and by much less than the agencies had expected for 2013. The 2013 results reinforced a trend of relatively slow growth that had begun some years earlier: After excluding the effects of overall inflation (using the consumer price index) and adjusting for changes in the age and gender mix of the population, CBO and JCT estimate that growth in private health insurance spending per enrollee over the 2006–2013 period averaged 1.8 percent per year, compared with an average rate of 5.0 percent per year during the 1998–2005 period.
Lower premiums than expected mean lower federal spending to subsidize premiums in the exchanges (they also mean lower personal spending per household, for that matter). Which means the ACA's price tag keeps tumbling. It's becoming a pattern at this point.

This, as I mentioned, is part of a much broader, health sector-wide trend in record-low spending growth:
Another notable influence is the slowdown in the growth of health care costs covered by private insurance and in the Medicare and Medicaid programs.
As I've tried to convey, this is pretty astonishing. The 2010 score of the bill was substantially too pessimistic about cost containment under the ACA. Even the law's proponents back then weren't arguing things were going to turn out far better than the CBO was projecting--they were too busy fending off the (now obviously false) arguments that the CBO projections back then were too rosy!

These are unprecedented (and unexpected, in many ways) times--in a good way! The ACA is turning out better than most dared suggest five years ago.
I respectfully disagree. And I think your charts do not reflect that information reported as buried in the CBO report published just this year.
 

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