…and still a mess:
It’s a situation no one anticipated when the Affordable Care Act was written. The law assumed states would create and operate their own exchanges, and set aside billions in grants for that purpose.
Why did the law assume that? Because, as Ramesh Ponnuru wrote back in October, “The law’s supporters . . . expected the health-care law to become more popular over time.” T’was ever thus, for blind optimism is Obamacare’s founding principle: If people understand it, they’ll like it; if Obama makes just one more speech about it, they’ll like it; if Congress passes it, they’ll like it; if HHS spends millions of dollars promoting it, they’ll like it; if the states are forced to implement it, they’ll like it. And so on and so forth. And yet…
This is why federalism was invented.
Yeah well I see the administration getting around differences in State roolz by simply declaring that Fed law trumps State law and therefore the States WILL accept and utilize a single Federal exchange.
I mean, it’s not like this crowd in DC ever paid the slightest attention to law before.
I would have preferred a single federal exchange, rather than having every state run its own. The irony is that it’s only the states that opposed Obamacare that will end up using the one-size-fits-all federal exchange.
Way to go Jim. That’s ruling with an iron fist. Make it the Social Security exchange. We’d need a symbol for this SSX. Suppose we overlap and rotate?
Yes, because the federal government has done such a terrific job running Medicare. Never mind the fact that it’s riddled with fraud and going broke.
Any government run business is supposed to be running broke. If they have any profit it’s an excuse for cutting their slice of the budget next year.
Now fraud, that is a problem. The current policy of treating whistleblowers like they’re the criminals doesn’t help.
Medicare is not just running broke, it’s running massively broke. Name one thing the federal government does better than private industry on a direct comparison basis. Medicare, Medicaid, the VA health services, the military medical services, Native American medical services all have massive problems. Only a fool would give someone with such a terrible track record even greater responsibility for America’s health care. If the federal government had proven itself competent in running health care, it would be different. It’s like having a bumbling handyman who does every job wrong be assigned responsibility for a major construction project.
Medicare has lower administrative costs, and lower cost growth, than private insurance. It’s only “going broke” in the sense that there are more eligible recipients per taxpayer, and health care is getting more expensive (but again, Medicare’s cost growth is slower than the private sector’s).
Name one thing the federal government does better than private industry on a direct comparison basis. Medicare, Medicaid, the VA health services, the military medical services, Native American medical services all have massive problems.
I don’t know about Native American medical services, and Medicaid is administered by the states (so quality varies dramatically from state to state), but the other ones you mention — Medicare, the VA, DOD — do a better job, at lower cost, than private alternatives. Check out Best Care Anywhere: Why VA Health Care is Better Than Yours for more info on the VA in particular.
Medicare has lower administrative costs only because it completely ignores fraud.
Remember all the horror stories about.vets trying to get care from the VA during the Bush years? Well, not much has changed except the media has decided not to run those stories any more.
You’re wrong Jim, our idiot Governor has decided, as her parting gift to us, to give us a COMBINED system, run by a joint commission of state AND federal bureau-rats.
I think they called it a ‘joint commission’ because that’s HOW they came up with this whole crazy scheme! But the joints they smoked were laced with Jimson Weed.
I would have preferred a single federal exchange
I’d have preferred health care reform myself. All this stuff just hammers away at the two excuses that supposedly drove Obamacare, coverage and cost.
We don’t want it, Jim. Federal / state — it doesn’t matter. We don’t want it.
Why are you forcing it upon us?
We don’t want it.
In 2008 we elected a president, a House majority, and 60 Senators who did want it. That’s how our system works. If you don’t want it, then you elect a president, House majority, and Senate supermajority to undo it.
And the people also elected 29 Republican governors (now 31 for 2013) who plan to undo it. The federal election in 2008 was about the wars, as I recall.
Jim,
Why should the Federal government provide health care or health insurance?
Why should people be forced to buy it?
I think that the federal government should provide health insurance to everyone, so that we’d have 100% coverage and the efficiencies and market power of a single insurer. But Obamacare doesn’t have the federal government providing either health care or health insurance, it has private insurers and state Medicaid programs providing health insurance through private health care providers.
Why should people be forced to buy it?
To avoid adverse selection.
Jim:
“I think that the federal government should provide health insurance to everyone, so that we’d have 100% coverage and the efficiencies and market power of a single insurer. ”
Jim, so your real objective is 100% health insurance. Leaving aside, for the moment, whether or not that’s a good thing…..
Why do you want the Federal Government to provide (your word) it?
What do you mean by “adverse selection?
Why do you want the Federal Government to provide (your word) it?
As I wrote, so we’d have 100% coverage and the efficiencies and market power of a single insurer. Medicare does a good job of making sure that all seniors have health insurance, we should expand it to cover everyone.
What do you mean by “adverse selection?
Adverse selection is when the only people who buy insurance are the ones who are most expensive to insure. That drives up the cost of insurance, which results in the healthiest people opting out, which drives the cost up further, and so on, until the system collapses.
One solution is to let insurers refuse to cover the people who need coverage most; that keeps down costs, but defeats the purpose of having insurance. The other solution is to require that everyone be covered.
Something north of 80% of people have some form of health insurance. These people are not people adversely selecting into the system. If they were, it would mean the people without insurance would be the healthy ones and not need insurance. This is not the case.
Obama doesn’t need to force people to get insurance because most people already have it. Forcing the uninsured into the market wont bring costs down. The healthy people not in the market are poor so they wont help subsidize coverage for the sickly population. They will also be subsidized because of minimum care requirements.
Sure coverage will go up when it is illegal not to have health insurance but it will do nothing to bring costs down. It will make those health insurance companies that gave Obama so much money rich(er) though.
I would have prefered real health care reform that aimed to lower the costs of developing new medicines and technologies and deploying them in the population. Instead Obamacare makes this harder.
There are also problems with costing in the idustry but Obamacare just exacerbates those issues.
If there are any benefits to Obamacare, lowering costz wont be one of them and if Obama had persued a true reform program to lower costs, more people would have been able to buy services on their own without the obamanation of what we face now.
The law assumed states would…set aside billions in grants for that purpose.
Damn, the Federalies are not only stealing from household budgets but also from state budgets.
Well. Yeah. Elmer Fed steals from everybody.
Good morning. 😉
the Federalies are not only stealing from household budgets but also from state budgets
You have suffered a reading comprehension failure. Here’s the whole sentence:
The law assumed states would create and operate their own exchanges, and set aside billions in grants for that purpose.
The subject of the sentence is “the law”. It’s the law — Obamacare — that set aside billions in grants, funded by the federal government. My state (NH), like some others, turned down the federal money, so now, if we want to have an exchange, the money will have to come from our state budget.
The law only set aside money for the first two years. After that, the states would be on their own.
After that, the exchanges would be set up.
Everything is free after two years. No costs for maintenance will trickle down to customers right?
Hey, I’ve got a dumb question? From where exactly, were the states supposed to GET said ‘billions’ of dollars?
Because shut up.
Maybe: http://static2.businessinsider.com/image/4e91f51feab8ea606f00000d/unemployment-rate-obama-stimulus.jpg
Alternately: from eating, err, burning, err, lynching, err, taxing the rich.
Said billions of dollars were offered to the states as part of Obamacare.
And where did they come from before they were ‘offered’? Fairies?
My comrade Jim has predicted that Obamacare will be very popular once it is in full effect. As a newly minted Leftist Democrat, I not only echo his wisdom, I amplify: You will like Obamacare — or else…
But it was all right, everything was all right, the struggle was finished. He had won the victory over himself. He loved Obamacare.
Didn’t work for President Bush’s RealID and NAIS. I guess the congresscritters thought it would be different this time because President Obama has a D in his party’s name.
Jim writes:
“Why do you want the Federal Government to provide (your word) it?
As I wrote, so we’d have 100% coverage and the efficiencies and market power of a single insurer. ”
How does having the Federal government provide health insurance provide 100% coverage?
How does a monopoly create “market efficiencies”?
What do you mean by “adverse selection?
Adverse selection is when the only people who buy insurance are the ones who are most expensive to insure. That drives up the cost of insurance, which results in the healthiest people opting out, which drives the cost up further, and so on, until the system collapses.
Since the penalty for not having insurance is so cheap – less than the cost of insurance, how does that help prevent adverse selection?
Since the idea with Obamacare is that you can buy insurance WHEN you need it i.e. when you actually get sick, and not before, how dies that prevent the effect of only the most expensive health care users from being insured?
“One solution is to let insurers refuse to cover the people who need coverage most; that keeps down costs, but defeats the purpose of having insurance. The other solution is to require that everyone be covered.”
Ahhhh “require”……
Is that why you want the Feds to provide health insurance? Since the only leverage the Feds have is law, and since law comes with punishment for non-compliance, is this why you want the Feds to handle this?