Obamacare’s architects really do think we're stupid

[noahvale]

**

[iolaire]

said that healthy people are going to pay in—you made explicit that healthy people pay in and sick people get money

Isn't this the basic definition of insurance?  I've been in my job for 15 years, for 14 years I was subsidizing the other employees that were sick or had babies etc..., now for the past year I've been on the receiving end of those subsidies. 

Same with Medicare Insurance, for say 20 years I've been paying in Medicare Insurance taxes, in two years Medicare Insurance will start picking up my dialysis (if I've not yet received a transplant) and I'll now be benefiting from other's Medicare Insurance payments.

I guess you could claim that people didn't realize that this mandatory insurance was insurance, but I'm sure that the anti-healthcare insurance folks claimed it was a tax and would cost everyone tons of money as a completely unworkable socialist state move etc...

[MooseMom]

So, what's new?  Politicians have been counting on the stupidity of the American voter for decades, and for good reason.  WMDs, anyone?

Not only that, but they also count on our ambivalence.  How many of you voted in the midterms?

[noahvale]

**

[MooseMom]

If people really care enough about this issue, they can educate themselves and then go and vote for candidates in 2016 who will repeal the whole damn thing.

[iolaire]

Gruber also points out that Obamacare’s individual mandate—the provision that requires most Americans to buy government-approved insurance, or pay a fine—was described in the law as a “penalty” instead of as a “tax” in order to hide the mandate’s effects. “I mean, this bill was written in a tortured way to make sure CBO did not score the [individual] mandate as taxes,” said Gruber. “If CBO scored the mandate as taxes, the bill dies. Okay, so [the law is] written to do that.”

Also of course they wrote it so that it would sound better, just as the other side promoted "obamacare death panels"!  He had to work to get his medical insurance bill passed that includes being very sensitive about how it was worded so people didn't get riled up - same as the anti healthcare factions did their best to make it sound like the country would end as soon as it was enacted.

[noahvale]

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[noahvale]

^

[MooseMom]

Personally, I'd love to see the Supreme Court uphold that case just so that I can sit back and watch the likes of Paul Ryan and Marco Rubio follow through on their supposed plan to replace the ACA of something of their own making.

Not only that, but if the Supreme Court DOES restrict those tax credits, that decision will defy all legal precedent and the court will go down in history as being politically driven.  It really will be a fascinating time.  It's soap opera of the highest order!

I'm curious, Noahvale.  Were you happy with the way medicine was being practiced before the ACA became law?  Is "transforming one sixth of our economy" necessarily a bad thing?

I'm also curious, Noahvale, to know what you think would happen next should the ACA be repealed?  What do you think the Republican-held Senate (and, let's say, all three branches of government come 2016) and Senate will/should do with the millions of newly insured?

It's all well and good to get lathered about the ACA, but until someone with authority and knowledge comes out with a workable alternative that our politicians will just put to a vote, I'm not listening to the outrage.  I don't need the ACA, so I'm golden.

Regarding the Dr. Emanuel quote, I can't access that article because I'm not a Chicago Tribune subscriber.  Can you access it and post it here for us to read?  Thanks!

[noahvale]

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[MooseMom]

Thank you for the link to The Atlantic; I was able to read Dr. Emanuel's article.  I believe you may have gotten the wrong end of the stick as he is not "proposing policy" of any sort for the care of people over 75.  In fact, he specifically writes:

And I am not advocating 75 as the official statistic of a complete, good life in order to save resources, ration health care, or address policy issues arising from the increases in life expectancy.  What I am trying to do is delineate my views for a good life and to make my friends and others think about how they want to live as they grow older.

We've had many discussions here on IHD about how dialysis can undermine one's quality of life and whether or not further treatment is desirable.  Dr. Emanuel writes about the same thing and points out that living longer doesn't always mean that those extra years are healthy ones.  I don't understand your quarrel with his personal views.

Are your objections to the ACA based upon the law itself or upon your view that it was "rammed down your throat"?  Do you sincerely believe that at the time of the law's passing there would have been enough Republicans who would have been eager to work with the President to improve the law?  Even now,  King vs Burwell doesn't HAVE to go before the Supreme Court.  There has been plenty of time for Congress to revise/correct the wording to elucidate the law's intent, but would the Republican House be willing to do that? They haven't so far!   I have a big problem knowing that Republicans would like to repeal the ACA, thus taking away insurance for millions, because they didn't get their egos stroked enough and got all stroppy because President Obama wasn't conciliatory enough for their liking.  Oh, boo hoo.

And that's where legal precedent comes in.  Should SCOTUS restrict the tax credits based on ONE WORD and not the intent of Congress, then yes, that would defy legal precedent.

Of course, if those states that refused to set up their own exchanges would only do so, then their residents who have enrolled would be able to keep their coverage. 

Politically speaking, if SCOTUS sides with the plaintiffs, then those people who signed up on health.gov in states that refused to set up their own exchanges will see their premiums rise sharply, which makes me wonder if the governors in those states will feel the backlash.

In my mind, yes, it was worth changing the whole system to take care of three million people.  That might not sound like a lot of people to you, but it does to me.  Maybe a good number of those people have CKD but would never had known it before they had at least basic health care.  And maybe a good number of THOSE people would be on dialysis now because their renal decline was never diagnosed.  I'd happily change the whole system to keep any one soul off dialysis!

I'd be very happy to see all three branches of government work together to improve the ACA.  I remember you sending me Tom Price's ideas and his introduction of his Empowering Patients First bill (is that the correct name).  Did the House ever vote on it?  Your post about it was the first and last time I've heard about it.  My perception is that the Republicans have no real intention of improving health care for all Americans, rather, they are focusing on damning President Obama.  I honestly would be very happy to see real cooperation AND real, substantive changes to the ACA if everyone agrees that those changes really will help bring down costs while at the same time expanding quality coverage.

So, yes, maybe we ARE all stupid because we are so bogged down in the politics of it all that we can't see the forest for the trees.  I'm still wondering how many here on IHD bothered to vote in the midterms.  Apathy is as costly as stupidity.

[MooseMom]

Oh oh oh!  I've just now found this piece on the NYT which gathers and expresses the myriad of thoughts I've had about this issue and of SCOTUS's decision to even hear this case.  I'd be very interested to hear your thoughts, Noahvale!  Like I've said, it's all quite the soap opera, filled with drama from many sources!

[noahvale]

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[MooseMom]

Perhaps, Noahvale, it would add to your quality of life if you'd just ignore Dr. Emanuel.

He just wrote the piece.  He didn't publish it.  I disagree with your assessment.  We can just leave it at that.

[Hober Mallow]

So, what's new?  Politicians have been counting on the stupidity of the American voter for decades, and for good reason.  WMDs, anyone?

Not only that, but they also count on our ambivalence.  How many of you voted in the midterms?

Umm, WMDs=BI-PARTISAN support.  Easy to overlook that fact.

Totally irrelevant to MM's point, which was about policy-makers banking on the stupidity of the American public.

Sorry, if Obamacare - not only changing the way medicine would be practiced in the US, but also transforming one sixth of our economy - was so good, then smoke and mirrors shouldn't have been needed to get support.[/quote]
Exactly how has Obamacare changed the way medicine is practiced? We're entitled to our opinions, but we should strive to be careful with the hyperbole.

[Michael Murphy]

The very fact as a dialysis patient I can choose a new carrier and I am not stuck keeping a job so I have insurance is a change for the better.  And the methods used to pass the ACA are the very same ones used in 1965 to pass medicar over the republicans and AMA objections.

[noahvale]

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[Michael Murphy]

My understanding is that there was a major effort to make medicare optional and there were attempts to amend the bill to reduce its effectiveness the democratic majority then put the bills up for a vote without the ability to add amendments this cut off attempts to neuter medicare and forced a vote.  Yes liberal republicans (yes they used to exist) voted for it but the was a serious attempt to stop medicare from passing led by more conservative republicans.  Re bet this is just after the A1964 republican presidential candidate voted against the landmark 1963 cival rights bill.

[Simon Dog]

Politics is about power, not service.

[noahvale]

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[MooseMom]

OK, and so what?  What do the opinions of any of these people have to do with you?  Why the outrage?  How you live your life as it is coming to an end is entirely up to you. 

Again, stop reading the writings of these people with whom you so obviously disagree.  It is not worth the upset it is apparently causing you.  And you seem to be further weighing yourself down by posting these articles here.  Do yourself a favor and just leave it.

Take care.

[noahvale]

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[Michael Murphy]

Dr Emanuel has consistently opposed any form of euthanasia during his entire career.  Michelle Bachman started this line of pure trash and Sarah Palin jumped on this libel bandwagon and ever since these sisters of stupidity started this line of BS conservative writers have just continued writing about this fairy tale ever since.

[MooseMom]

Ah but you see, Noahvale, I don't need to heed my advice because I am not outraged like you are.  I've had a lovely weekend so far, thanks very much.  Had lunch at a Japanese café, purchased a lovely Islay single malt scotch and then went to the theater.  Ok, so Emanuel wrote, submitted and maybe even singlehandedly published this article.  Again, so what?  I'm not sure I even understand why you'd disagree so vehemently with the idea that people should be able to decide for themselves how much "treatment" they want to endure as their life comes to an end.

Color me baffled.

Oh, and tomorrow I'm making potato soup with parsley, butter and cream, and my husband is making an apple pie with Calvados.  And then we're watching the NFC/AFC Championships followed by Downton Abbey.  Any article written by Dr. Emanuel will be the furthest thing from my mind.  I hope the same will be true for you.

[Hemodoc]

I found very few patients who just wanted to let it go at the age of 75. In fact, I have met enough 90 and 100 year old folks still active, bright and enjoying life that I must question which planet Emanuel comes from.

I will quite gladly ignore his comments, however the problem is he is setting health care policies that will have an impact on those over 75. That is where the outrage lies. If this man wants to let it go at 75, so be it, but what right does he have to make those choices for everyone else?