Town Square

The Affordable Care act must succeed!

Original post made by Jane, Midtown, on Feb 20, 2014

The Affordable Care Act, which is disparaged and called "Obamacare" by the extreme right, must succeed! It is the first step to single payer health care, which all decent industrialized countries already have. This is a moral imperative, which our generation must push through. It doesn't matter if it works, at first, and I think President Obama was correct to obscure some facts, as needed, to get it through.

Please support the ACA, and fight back against the extreme right.


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Posted by SWE
a resident of Green Acres
on Feb 20, 2014 at 6:58 pm

SWE is a registered user.

I'm not saying I support the right on this, who are just being idiots about healthcare, when it's life, death, and our economic future at stake.

However, you are completely wrong that "all decent industrialized countries already have" single payer.

That's just not true. All decent industrialized countries have some form of affordable care for all. Universal, affordable care, often with better service, choice, and outcomes than we have here now. Sometimes, with even better perks, like vacations in resorts to recover from surgery, all covered by insurance, and still cheaper than our coverage.

But it's not true that they all have single-payer. Some of them use all private health insurance companies. Some have more privatized systems then ours.

The one thing that every other industrialized nation on earth has except us, in addition to affordable universal care, is that they all now have nonprofit INSURANCE. Not non-profit delivery -- doctors, hosptials, labs, in many of those systems can still profit, but no other advanced nation has for-profit insurance. Our own system went out of control coincidentally when the for-profit insurers began to dominate, before that the insurers were primarily non-profit.

I'm always surprised by how many intelligent people think when I say that that it means people volunteer for providing healthcare. Being non-profit just means they don't use health insurance as an investment opportunity. So they don't pay investors. As T.R.Reid says in his seminal book about healthcare, there is a fundamental and irreconcilable conflict between paying investors and paying for people's healthcare.

If you allow insurers to make 20% of the healthcare economy as profit, they have an incentive to allow that economy to be very large. And indeed, our healthcare economy now eats up 20% of our overall economy, and some 40% of it goes to healthcare administration -- that's now around half a trillion dollars annually. It's money they have to spent to CONTROL the system in order to maximally extract their profits from as large a system as we can bear. No other nation on earth does this, they've all learned their lessons.

Reid points out that in Switzerland, where the healthcare is run by private for-profit companies (and where they have one of the most expensive nations on earth with a minimum salary of around $30/hr, yet their healthcare system costs half per capita what ours does), their companies run the healthcare sector like charities, using their performance as a kind of advertising for how well they would do with their other for-profit insurance products. Switzerland tried allowing their insurers to profit for healthcare -- guess what happened? Costs began to skyrocket and people began to go bankrupt.

No one around the world is 100% happy with their system, but in ultra-democratic Switzerland, when the above happened, they held a referendum and stopped the healthcare profiteering. Guess what? The skyrocketing and bankruptcies subsided. We are now the only advanced nation with medical bankruptcies, and we have the highest per capita costs.

It couldn't be more clear what the solution is, because for every problem we know raises costs some, like smoking or obesity and diet, there are nations with that problem worse than we have, where they cover everyone, have better outcomes, and cheaper healthcare. Don't get me wrong, those things are worth addressing, it's just the main elephant in the room is the profiteering of health insurance.

Unfortunately, Obamacare only codified that. So it's likely to do what happened in Massachusetts after which it was modeled: help cover everyone, but not reduce costs.

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Posted by Bru
a resident of Crescent Park
on Feb 22, 2014 at 8:22 am

Bru is a registered user.

> As T.R.Reid says in his seminal book about healthcare, there is a fundamental and irreconcilable conflict between paying investors and paying for people's healthcare.

This is the bottom line, or rather, the bottom line in the bottom line on this. The Right seeks to regulate the hell out of everyone's life while they talk dishonestly out the other side of their mouth about freedom and liberty.

By making everything about money and profit, they just seal those in power in power and force everyone else to die or find their best place in an economy that simply does not have room for everyone, and then focus on those who are happy and healthy and ignore everyone else.

T.R. Reid said it ... first a society has to decide that coverying everyone, i.e. treating human beings as human beings, is a desirable goal, and then they will figure out how to do it and make it work.

I think ObamaCare is an improvement, albeit nearly insignificant improvement, but for those whose life it saves, they will be the new evangelists of slightly widening the circle of those who are treated a small bit better, and much will be made of this, however, the real problems as usual will not be addressed, discussed and mostly actively covered up.

The problem is under the model of our economy, under the aegis of "capitalism" everything must be reduced to economic terms, and every society that has ever existed has never wanted to or been able to do this. There is a fundamental flaw in the very idea, and from this falls out virtually all our problems and the inability to even think about any kind of meaningful change or reform.

What the Right gives up if they acknowledge there are other things than money is the control that is so easy when you have money to use as a non-violent weapon against people. It is much easier to kill millions of people by depriving them of money and then calling them losers than it is to grab them and murder them - and it keeps everyone in line and gives a rationale - as long as real discussion is disallowed.

The trick that has been played on almost every enslaved society on the planet is militarily occupation, taking of lands and then forcing the dispossessed to have to pay rent in a world they were born into that gave them everything. Simply to survive people have to become workers, and be exploited, because there are no lands for them to go to. Most of them have no real skills or understanding of the system, and if they all did they all would revolt, but as long as the stratification and division of people remains, some do OK under the system, well enough to sell the others out and be happy about it. It is what America and the West is based on.

There is not any better game in town, but we are at a point now where it does not work any longer, and we all know it is not fair, just or even human. I agree with T.R. Reid, the first step is to decide people should be treated like human beings with respect. And by the way, we ought to start treating our lands and animals better as well.

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Posted by That User Name is already
a resident of another community
on Feb 22, 2014 at 11:42 am

That User Name is already is a registered user.

ObamaCare is essentially insurance company regulation - you must cover pre-existing conditions, college age kids, rebate overcharges etc... in exchange for giving the insurance companies for customers.

The far right's war on Obamacare is almost funny when you think about it. They've had 20 years since HillaryCare to come up with something, the only thing they did come up with was RomneyCare, essentially ObamaCare.

When Hillary is elected (see John McCain's recent statement,) will they rename it HillaryCare?

Seriously: Medicare buy-in for all. It's time to reduce the portion of our GDP that goes to economy- (and blood-) sucking insurance companies.

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Posted by SWE
a resident of Green Acres
on Feb 23, 2014 at 12:31 am

SWE is a registered user.

@ Bru and That User,
Wow, for the first time that I've participated in an online discussion, i wish I could be having this discussion in person. You have both made such worthwhile posts and given me much to think about.

So here's my first thoughts on what you have both said:

The really ironic thing about this whole left-right narrative rut is that the Right really isn't putting the best interests of the business sector or the overall economy first by championing a profiteering health insurance sector.

Having an insurance sector whose interest is primarily to extract a profit from as large a healthcare economy as possible -- even limiting that profit to 20% with Obamacare means insurers still have the incentive to make it 20% of a very larger number to pay investors the most -- is fundamentally at odds with the interests of the rest of the business sector and overall economy.

Our goods and services cost more, our businesses pay for more insurance and health care, their workers aren't as healthy or productive as they would otherwise be, companies have to hire workers to deal with complex healthcare administration issues, etc. Employees have more insurance paperwork, too, as do their physicians. The incentives actually don't align. The ills go on, all for a certain investment opportunity at the expense of our citizens AND our businesses. Every other advanced nation on the planet has made themselves more competitive by optimizing the healthinsurance sector by eliminating that conflicting incentive.

Why don't we? I would argue, it's fundamentally anti-democratic not to.

The Declaration of Independence, that outlined a new philosophy of government:
"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of happiness."

and the Constitution:
We the People of the United States, in order to form a more perfect Union, establish Justice, insure domestic tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity...

These speak to the intrinsic motivations of Man for happiness, liberty, a just society. The aspects of capitalism that allow people to achieve these optimally, and to be autonomous, those I would argue are good and why special interests are able to confuse the issue -- make it only about money in the crudest terms -- and misuse capitalism for their own ends at the expense of the optimal exercise of these for all.

I think most people seek to optimize their AUTONOMY, and that a society functions most democratically and optimally, and people are most happy, when the most number of people are able to optimize their autonomy simultaneously.

So in other words, if I am optimizing my autonomy at the expense of someone else's, that is not optimizing autonomy overall. I think money is part of that pursuit of autonomy, more for some than others, but most people are driven by more than just dollars and cents. (Huge imbalances of wealth in a society, as well as the powerful or a government taking away of people's rights to profit from their own work, are too two extremes of imbalance in autonomy across a society and both reduce happiness.)

Both our Constitution and Declaration of Independence, I believe, evidence this contention about autonomy. The rules of commerce and making money are a subset of the overall right of Man to be free and autonomous. Turning that on its head and putting short-term profits of a few above all else, in my opinion, is the opposite of fiscal responsibility or the basic democratic values Republicans like Abraham Lincoln and Eisenhower would have espoused.

Optimal health is also a part and parcel of optimal autonomy. Most people just want to be healthy and live their lives. I think it is well within the function of government in promoting the general welfare, especially for optimal public health, to take on reforming healthcare.

That said, I disagree that our system would work best with a single-payer government-run system such as just Medicare for all. While I think it would be cheaper than what we have, and arguably better statistically, I think it would cause a deep current of dissatisfaction in our heavily independent population, and I don't think it would motivate the best outcomes or innovation we could otherwise achieve.

The trouble with an all government program, although exaggerated on the Right, is that an all-government run system lacks competition to improve service and innovate. While most workers in either a government run system or a private company work on salary anyway and their desire to do well in their work comes first from intrinsic motives, overall, a private (nonprofit) company competing with other private (nonprofit) companies in the same sector to do the best job for people for the least amount of money (or cease to exist) will perform better than a monopoly government-run OR monopoly private (nonprofit) company.

I think a functioning postal service is an important asset of a first-world society, because there will be no competition to provide letter mail from the private sector for what the government can do. The private companies would not step in and replace the post office if it ceased to exist, we would be the lesser for it. However, I do think the existence of UPS and Fedex help make the post office more competitive, and actually, vice versa.

Americans do better with choice, too. In healthcare, the choice itself becomes a means of quality control for providers, too, and in a system of nonprofit insurers, it becomes a means of quality control for insurers, too.

While it may be ethically optimal for our healthcare choices to flow from a decision that all people deserve healthcare on moral grounds, I disagree with Reid that we must have that conversation to fix our system. One could as easily make the argument for a universal, nonprofit-insurance-based system on smarter economic grounds, for the best interests of our business sector and optimal choice for patients, and I think the left made enormous miscalculation not realizing this.

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Posted by SWE
a resident of Green Acres
on Feb 23, 2014 at 12:46 am

SWE is a registered user.

@ That User,

Oops, I may have sounded like I was assuming you were suggesting a Medicare only system. I realize you were suggesting making Medicare open to all. I think this is a great idea __ a CHOICE __ but it would only produce optimal results if there were competition from an all nonprofit insurance sector with private players.

The trouble with leaving the profiteering element to dominate is that in order to profit, to CONTROL the system in order to extract maximum profit from as large a system as we can bear, necessitates that excessive administration (costing us half a trillion annually now). Nonprofits have to do the same things the for profits do in order to stay alive. If the entire sector were nonprofit, the incentives for the massive administrative costs disappear (just as in all the other first-world countries being able to have a small fraction of our healthcare administration costs, regardless of the typic of system they have, from all government to all private.)

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Posted by SWE
a resident of Green Acres
on Feb 23, 2014 at 11:46 pm

SWE is a registered user.

Anyone still there?

So -- how do you think a transition to all nonprofit players in the insurance industry could happen? How hard would it be? Given that Obama allowed the profit to be codified in the ACA...