re: #68 Renaissance_Man

The stupid thing is, Obamacare isn’t even that good. This is, after all, the Heritage Foundation’s plan, and a plan that deserved the mockery it got when it was first floated. Only a deranged lobbyist could conceive of a plan to make everyone buy private health insurance and believe that this would somehow reduce the cost of healthcare. It’s madness. And yet here we are, defending it bitterly, because this particular madness stands between Republicans and the poor and elderly, whom the Republicans would much prefer to go away and die quietly once their money has been taken away and after they dutifully vote Republican.

Yes, I’m aware that realpolitik means that working with this flawed plan is better than nothing, and that the realities of America’s pathology mean that actual improvement and reform is a generational task. And I still support Obamacare on the grounds that saving lives is important and that it is good to get Americans used to the idea that healthcare should be a right and a privilege of living in a Western society, rather than a luxury that their owners dole out to the worthy. But it still feels stupid to be defending a plan that Republicans proposed in their delusion and would happily have supported had a black man not signed it. Yet I suppose that’s literally one of the least stupid things in American politics nowadays.

Obamacare is more than just the individual marketplace. It addresses lack of transparency on health care costs (transparency being a means to help consumers make better and cheaper costs for comparable treatments, etc.) There’s little reason that if two doctors have similar records on procedures that one would cost $1000 in one place but $2000 at the hospital the next town over. Or that MRI or CT scans cost $500 in one hospital or $2,000 at the next. Etc.

Transparency on costs is one aspect. Another is the Medicaid expansion, which was what seriously drove down the uninsured rates where states bought into it. The states that refused are the ones with the highest uninsured rates.

Add to that the dependent care coverage to age 26 and the preexisting condition/lifetime caps changes, and it goes beyond the individual mandate to purchase insurance through a marketplace.

It’s also modeled on the MassCare plan, and that helped drive uninsured rate to historic lows in the state.

The entire point of the individual mandate was to give the GOP an attempt to buy-in and support Obamacare, but they decided to oppose everything they previously stood for.

Single payer is perhaps a better outcome than what we have now, but transitioning from multiple private insurers wont be easy. Medicaid/Medicare for all might be the preferred outcome - and both of those programs are responsible for constricting costs since the purchasing power of both programs helps stem the hikes in costs seen year over year for decades. GOP opposition to Obamacare on the basis of an annual premium hike is also misleading since there’s transparency on Obamacare plans not seen elsewhere in the private (employer based) marketplace. Likewise, opposition to Obamacare because there’s a single insurer in some areas is bullshit - employers give their employees one option too and it’s not like we have a choice about that. Insurers have decided it is more cost effective not to compete in some areas because they don’t have a network set up there.

Speaking of networks, the ACA allows insurers to sell equivalent policies across state lines, but they’ve refused to set up plans on that provision because it is cost prohibitive to set up a network somewhere they don’t operate. All the policies in those other states would be out-of-network, and therefore not cost-competitive to the people in those other states who’d buy a plan compared with in-state in-network plans.