But a better question would be, then what was the point of ACA? I do not think history will see it as a good thing, simply because it has failed and shows no evidence that it will not continue to fail to live up to its purpose.

There is evidence that it is on track to accomplish what was planned. Before the ACA, one in five people were denied insurance when they applied for it. 45,000 people in the US died every year from a lack of insurance. The costs were/are many times more than what other countries pay. The point of ACA is to attenuate these issues, which needed to be addressed.

As for loss of coverage, here is a statement from the US house of representatives:

The assertion that the law will cause five million individuals who currently have coverage in
the individual market to go without coverage in 2014 is similarly baseless. Of the reported 4.7
million people who receive cancellation notices, 2.35 million should have the option to renew their
2013 coverage. An additional 1.4 million should be eligible for tax credits through the marketplaces
or Medicaid, which will provide them more comprehensive coverage at lower rates. Of the
remaining individuals, only 10,000 individuals in 18 counties in a single state would be unable to
access a catastrophic plan, and many of these individuals may sign up for coverage through their
state exchange.

There are weasel words in there, but what do you expect from politicians?

In this case, you either:

a) Didn't listen to your test market and went ahead with something the market clearly didn't want, or

b) figured you would just force your product down their throats anyway and try to force them to buy it.

The main point where we may disagree is that I think people should be forced to buy insurance. The only other way to resolve the slew of issues we have is to have everyone who doesn't want insurance to sign a waiver that they receive no treatment if sick or injured. How many times can hospitals absorb the cost of a former uninsured patient going bankrupt and not paying? It pushes the costs ever upward.

Many other countries have compulsive insurance, and it's extremely effective. It's easily argued that the pros/cons greatly favor a public system. Not "any" public system, since a quick google search can bring up instances of failed public systems. But a public system that is currently in use, effective, and efficient.

Interbane wrote:The main point where we may disagree is that I think people should be forced to buy insurance. The only other way to resolve the slew of issues we have is to have everyone who doesn't want insurance to sign a waiver that they receive no treatment if sick or injured. How many times can hospitals absorb the cost of a former uninsured patient going bankrupt and not paying? It pushes the costs ever upward.

Actually, I do wish there were a fair mechanism forcing people to have insurance. I just don't know, logistically, how it would be carried out in a constitutional manner. Then again, auto insurance and property insurance are legally mandated, why not health insurance?

An ideal system would first drive down health care costs. There are ways to accomplish this. I like the idea of the health savings accounts encouraging people to shop around for treatments, and choose less pricey doctors for their procedures, unlike the current system where nobody with insurance even thinks about how much the procedure will cost. That alone would be huge. But another big change would be to put some kind of cap on the inflated cost of medications in this country. Medicine is so much more expensive in the U.S.!!

Once the overall cost of healthcare is reduced, there's less excuse for people to not cover some form of insurance. Then, you either pay into an insurance plan, get an HSA, or pay out of pocket for your procedures. But one way or another, you pay your own way.

It just seems there should be some way to ease our healthcare crisis without denying people treatment. Getting the cost of healthcare down seems like the first logical step.

EDIT: Just to stay on topic, Romney dedicates an entire chapter in his book "No Apologies" to the healthcare crisis, and he advocates some of these same ideas. And personally, I think his ideas have great merit and could really go a long, long, long way to making healthcare more affordable and more attainable for more Americans.

gesler0811, does Romney in his book restate the ideas that led to Romneycare in Mass.? As we all know, that state's plan was a model for the plan of the guy who beat him in the last election. I'm wondering also whether your problems with the ACA are basic or are completely a matter of how the plan was implemented, deceptively in a way, it now does appear.

With the medical savings plans, these would still require that people have insurance to pay for care, because costs could not possibly come down enough for the average person to be able to pay retail for care. The pool of money would quickly evaporate without subsidies provided by the healthier people in an insurance pool.

DWill wrote:gesler0811, does Romney in his book restate the ideas that led to Romneycare in Mass.? As we all know, that state's plan was a model for the plan of the guy who beat him in the last election.

Honestly, I don't recall. I found the chapter on healthcare insightful, but it's been a while and some of the details elude me now. It may be worth me checking it out from the library again and brushing up.

Are you saying Obama used Romney's own ideas as a model for his own healthcare reforms? If so, I also need to brush up on what exactly they did in his state. If he did use it as a model, he must have strayed significantly somewhere, considering the fact that Romney was so heck-bent on getting rid of ACA.

DWill wrote: I'm wondering also whether your problems with the ACA are basic or are completely a matter of how the plan was implemented, deceptively in a way, it now does appear.

Good question.

I'll start with the deception. I don't like the way it was shoved down our throats, we were essentially lied to about what the consequences would be, and that the people legislating it conveniently gave themselves the out. None of that bodes well. I think the president's job is to represent the people and listen to the people. He works for us, not the other way around. When 77% of the people he was trying to "help" said "we don't want what you're proposing" I believe he had the responsibility to heed those words. Instead, they wrote a manifesto of reforms, didn't give anybody time to read it, said "you can see what's in it AFTER you vote it in" (really?), and then proceeded to modify it on a whim every which way. The whole process stank, if I can be blunt. Then he comes out and blames the insurance companies for cancelling policies that he forced them to cancel, calling THEM the bad guys, and ever so graciously extends the deadlines for switching over. Except, oops, the policies are already cancelled and it's not that simple to just "reinstate" them, and once again he points the finger at the insurance companies and calls them the bad guys. Seriously, the whole thing stinks.

I don't have a problem with mandating that people get covered, if it's done right, but honestly, I'm not educated enough in this venue to propose "The Solution to End All Solutions." But I can recognize a steaming pile of dung when I see it, and I know this was all wrong. So far, people who get their insurance through an employer haven't been as hard hit as the ones who had personal policies, but once the overall costs start skyrocketing in the next few years due to all of this garbage flying around, it will be interesting to see how the companies respond.

Again, I'm not the man to slap together a proposal to end Obamacare. But I do believe an ideal program would include the following:

- Provisions to drive DOWN the cost of healthcare. Let's look into why medications are so much more expensive in the U.S. than elsewhere for the exact same medications. Maybe open up the market to overseas competition. Why can't we get medicine from Canada? Everything else we get comes from overseas. A little friendly competition would surely help bring costs down.

- Stop allowing lobbyists with a lot of money and influence to lead the politicians to enact legislation to protect their own precious interests. How to do this? I welcome suggestions. It seems like it would be an uphill battle, but it would be really nice if people looked out for our interests with the same level of passion.

- Encourage consumers to "shop around" for the best prices on medical procedures. Under the current system, I slap down an insurance card and don't ever think about how much it costs. Is there a doctor just as good who does the same work for half the price? Wouldn't it be nice if the consumer found this out and went to that doctor? Imagine the reduced amount of healthcare costs if everybody did this. Then maybe the insurance companies could further lower their premiums.

- How about healthcare credits for regular physicals, being within goal weight, not smoking, and leading an active lifestyle? Maybe this is already being done, I don't know. But if we all lived healthier, a lot of the conditions we seek medical treatment for would just go away. Did you know that most forms of heart disease are completely curable and preventable, just by losing weight and eating mostly plant-based diets? All of the "bad" fat and cholesterol that leads to heart disease is found in animal products. I'm not saying we all go vegan, but let's face it, we eat WAY more meat than our bodies need and it's usually the red meats. I like a steak as much as the next guy, but I'm also realistic that I limit my intake on those kinds of foods.

- Somehow, someway, everyone needs to pay SOMETHING for healthcare. I'm not a big fan of handouts and entitlements. I do believe we live in a great country where we have the means to assist people who are down on their luck and we should embrace that, but there are just too many motivating factors under current conditions for people to STAY on government assistance and not seek more. It should be temporary relief, not something that me, my mom, and my grandmother spent our entire lives collecting. How about capping how much assistance that can be given? No more "you get more money for every additional kid you pop out?" Instead, maybe you get assistance up to a certain point and then you stop having sex because you can't afford the kids you already have and it's your job to feed them not mine? How about you have to pass a drug test to qualify for aid? After all, if you have money for crack you don't need my money out of my paycheck? Same thing for smoking... if you smoke, you are penalized a percentage of your eligibility. How about if people collecting aid were mandated to perform community service, kind of like what they do with prisoners... if they're working for the money anyway, getting a job might not seem so distasteful. How about we stop cutting education funding and stop trying to standardize the whole education system so that people can get educations and be less likely to want/need government assistance? For that matter, how about we let the teachers teach and stop handing them their little standardized lesson plans that we are forcing all the other teachers to teach and then blaming the teachers that the students aren't learning? Get rid of the teacher's unions altogether, for that matter, get rid of tenure. Teachers should get to keep their jobs based on merit, like the rest of the American workforce. If you stop caring, develop a bad attitude and don't want to teach, we can fire you, just like any other worker who refuses to do their job. While we're at it, let's take some of this money we're saving by reducing healthcare costs and give all the good teachers a nice little raise, and show them how important they are?

With the medical savings plans, these would still require that people have insurance to pay for care, because costs could not possibly come down enough for the average person to be able to pay retail for care. The pool of money would quickly evaporate without subsidies provided by the healthier people in an insurance pool.

True. But I'm sure there's a way to make it work if the right people with the right minds tackle the problem. I wonder what if we paid for insurance and got medical savings plans, and used the medical savings plans to pay a small percentage of every procedure? I don't know, I haven't thought this through it's just off the top of my head. But maybe it could go something like this - I have an insurance plan that costs X amount of dollars per month and I agree to pay Y% of my own healthcare costs. Part of my insurance premium can be diverted into a medical savings plan. Let's say in ten years I need a medical procedure and I know I'm on the hook to pay 1% of the cost. I see three qualified doctors and get quotes of $100,000 - $140,000 - and $175,000. I choose the $100,000 doctor and my savings plan kicks in to pay $1000. If I don't have enough in the plan, I have to come out of pocket. There's my motivation to shop around, because had I gone to the more expensive doctor, my 1% would be $1750 instead of $1000.

I don't know. Maybe there are flaws in that scenario. Like I said that just came off the top of my head and I haven't worked through all the angles. But it would certainly encourage shopping around. The way things are now, I would just go to whatever surgeon my physician referred me to, not care at all about the cost, and potentially drop a $250,000 bill in my insurance company's lap that another equally qualified surgeon might have done for half the cost. Something to think about.

gesler0811 wrote: Are you saying Obama used Romney's own ideas as a model for his own healthcare reforms? If so, I also need to brush up on what exactly they did in his state. If he did use it as a model, he must have strayed significantly somewhere, considering the fact that Romney was so heck-bent on getting rid of ACA.

The explanation would probably be the trait common to all politicians who are after a job: distance yourself from a former position if that's what it will take to win. There were several important resemblances between Romneycare and the ACA. see for example http://www.politifact.com/truth-o-meter ... ifference/. I give him credit for actively pushing for healthcare reform while campaigning for Mass. governor and for implementing a plan when elected. If Republicans nationally had shown anywhere near the same interest in fixing a very bad system, there's a good chance we'd have had a better experience with the national reforms. But the sad fact is that the Republicans obstructed but were not constructive. They didn't believe strongly enough that change was needed. I compare them, with regard to healthcare, to the Democrats with regard to budget reform: probably not in the party DNA.

I'll start with the deception. I don't like the way it was shoved down our throats, we were essentially lied to about what the consequences would be, and that the people legislating it conveniently gave themselves the out. None of that bodes well. I think the president's job is to represent the people and listen to the people. He works for us, not the other way around. When 77% of the people he was trying to "help" said "we don't want what you're proposing" I believe he had the responsibility to heed those words. Instead, they wrote a manifesto of reforms, didn't give anybody time to read it, said "you can see what's in it AFTER you vote it in" (really?), and then proceeded to modify it on a whim every which way. The whole process stank, if I can be blunt. Then he comes out and blames the insurance companies for cancelling policies that he forced them to cancel, calling THEM the bad guys, and ever so graciously extends the deadlines for switching over. Except, oops, the policies are already cancelled and it's not that simple to just "reinstate" them, and once again he points the finger at the insurance companies and calls them the bad guys. Seriously, the whole thing stinks.

The people, when polled on specific features of the ACA, such as coverage for existing conditions and covering children until age 26, were generally in favor. But I can't offer a rebuttal to much of what you say. My bias is to believe that the federal government needs to have a strong hand in healthcare. Therefore I tend to see these problems as unfortunate and probably the results of mismanagement and deception, but the act is still pushing us in the needed direction. I would have preferred a single-payer system, just as we have with the now-respected Medicare system and Medicaid, but Obama recognized that as political poison.

I don't have a problem with mandating that people get covered, if it's done right, but honestly, I'm not educated enough in this venue to propose "The Solution to End All Solutions." But I can recognize a steaming pile of dung when I see it, and I know this was all wrong. So far, people who get their insurance through an employer haven't been as hard hit as the ones who had personal policies, but once the overall costs start skyrocketing in the next few years due to all of this garbage flying around, it will be interesting to see how the companies respond.

I don't have the crystal ball, for sure. The costs of healthcare have been rising more slowly over the past several years (and this slowing of the rate of increase is all we can hope for, realistically). Has Obamacare been a significant factor? The pundits don't agree about this. But cost controls were part of the design of the ACA.

- Provisions to drive DOWN the cost of healthcare. Let's look into why medications are so much more expensive in the U.S. than elsewhere for the exact same medications. Maybe open up the market to overseas competition. Why can't we get medicine from Canada? Everything else we get comes from overseas. A little friendly competition would surely help bring costs down.

Taking on Big Pharma will be seen as anti-business, however. One effective way to bring costs down is not to allow Pharma to pay off generic drug makers to delay producing generics after the brand's patent has expired. This would increase competition.

- Stop allowing lobbyists with a lot of money and influence to lead the politicians to enact legislation to protect their own precious interests. How to do this? I welcome suggestions. It seems like it would be an uphill battle, but it would be really nice if people looked out for our interests with the same level of passion.

Check.

- Encourage consumers to "shop around" for the best prices on medical procedures. Under the current system, I slap down an insurance card and don't ever think about how much it costs. Is there a doctor just as good who does the same work for half the price? Wouldn't it be nice if the consumer found this out and went to that doctor? Imagine the reduced amount of healthcare costs if everybody did this. Then maybe the insurance companies could further lower their premiums.

That is way overdue.

- How about healthcare credits for regular physicals, being within goal weight, not smoking, and leading an active lifestyle? Maybe this is already being done, I don't know. But if we all lived healthier, a lot of the conditions we seek medical treatment for would just go away. Did you know that most forms of heart disease are completely curable and preventable, just by losing weight and eating mostly plant-based diets? All of the "bad" fat and cholesterol that leads to heart disease is found in animal products. I'm not saying we all go vegan, but let's face it, we eat WAY more meat than our bodies need and it's usually the red meats. I like a steak as much as the next guy, but I'm also realistic that I limit my intake on those kinds of foods.

Great suggestions. Maybe credit the ACA a little for having this very same goal of prevention?

- Somehow, someway, everyone needs to pay SOMETHING for healthcare. I'm not a big fan of handouts and entitlements. I do believe we live in a great country where we have the means to assist people who are down on their luck and we should embrace that, but there are just too many motivating factors under current conditions for people to STAY on government assistance and not seek more. It should be temporary relief, not something that me, my mom, and my grandmother spent our entire lives collecting. How about capping how much assistance that can be given? No more "you get more money for every additional kid you pop out?" Instead, maybe you get assistance up to a certain point and then you stop having sex because you can't afford the kids you already have and it's your job to feed them not mine? How about you have to pass a drug test to qualify for aid? After all, if you have money for crack you don't need my money out of my paycheck? Same thing for smoking... if you smoke, you are penalized a percentage of your eligibility. How about if people collecting aid were mandated to perform community service, kind of like what they do with prisoners... if they're working for the money anyway, getting a job might not seem so distasteful. How about we stop cutting education funding and stop trying to standardize the whole education system so that people can get educations and be less likely to want/need government assistance? For that matter, how about we let the teachers teach and stop handing them their little standardized lesson plans that we are forcing all the other teachers to teach and then blaming the teachers that the students aren't learning? Get rid of the teacher's unions altogether, for that matter, get rid of tenure. Teachers should get to keep their jobs based on merit, like the rest of the American workforce. If you stop caring, develop a bad attitude and don't want to teach, we can fire you, just like any other worker who refuses to do their job. While we're at it, let's take some of this money we're saving by reducing healthcare costs and give all the good teachers a nice little raise, and show them how important they are?

I see you've got a whole platform here! I do strongly agree with you that everyone should pay something. We don't tend to value what comes to us for free. Almost everyone can afford to pay something for heathcare. As somebody said (maybe here?), we don't expect our car insurance to cover our 60K service appointment. The problem with our healthcare system has been that it prevents, for all intents and purposes, access to healthcare for a significant chunk of the public. There are several million people who now have this access (access they're paying for) due to the ACA.