Hyperbole and beating up straw men does no good.
“More than half of the citizenry rejected this arrangement, and we know this just based on how the law got put into place in the first place. And that majority got really pissed as we have seen lately.” Huh? I don’t remember taking a vote on this and I don’t remember any majority.
@Zinhead But it can sure feel good. 
Another straw man that misses the fundamental points.
The difference between ACA and my company is people were not mandated to buy services they cannot use at artificially-inlfated high prices.
Men in my company do not have mammograms, birth control, child birth etc. in their policies. And women did not have prostate coverage etc… Employees pay for the level of service that they want and can actually USE if need be. It would be a rip-off in my view to force them to pay for things they cannot use. And that is exactly what ACA is doing.
And my company insurance works just fine with all these options. Such as, young people can purchase only catastrophic insurance if they so desire, which is cheap. However employees who use more, choose the policies that provide more, and they have a higher premiums and possibly higher deductibles. More importantly, the high users are not expecting other employees to pick up their higher premium and deductible tabs.
Therefore, it is a red herring argument that ACA is necessary so insurance works because what you are really saying is insurance cannot work unless people are forced to buy things they cannot use and does not work unless people pick up the costs of others’ premiums (premiums which should be higher because they are using more services). Insurance companies prove everyday that is not the case, as policies are structured for the individual services requested. However, ACA is not insurance, and once people figure that out, they leave it or choose not to opt-in.
Question - Show me a market-based insurance company, which is currently in business, that charges premiums and has deductibles the majority of its customers cannot afford? Answer - there isn’t any. That should tell you something right there.
"Men in my company do not have mammograms, birth control, child birth etc. in their policies. And women did not have prostate coverage etc… Employees pay for the level of service that they want and can actually USE if need be. It would be a rip-off in my view to force them to pay for things they cannot use. "
Prior to ACA, your company charged different rates for the health insurance of male and female employees? Of employees from different age groups? I seriously doubt that.
According to Jonathon Gruber, one of the architects of the ACA:
ACA delenda est.
Re #513: th system is back to balance. You should be wary of dire predictions when they come from someone whose interest is to see them come true and/or a lobbyist.
However, there have been cuts and there’s a lack of personnel, leading to overwhelmed ER’s and “medical deserts”. The doctors need better bedside manners. You’d probably be surprised at how spare a doctor’s office is (essentially, three rooms - one waiting room, one double-room with a desk and chairs, and an examining room.) They’re often the first floor of the doctor’s house or a specially coverted apartment, although you have medical groups with several doctors and a medical assistant, or a “medical house” with several medical practitioners in the countryside - I saw that in Spain too. Nurses were on the street recently to get better hours and their backlog of overtime paid. (Look for the TV5Monde website, it has videos and reports. There’s a France24 in English, too.)
All drug prices are regulated and generics are the norm; if you want the brand, you have to pay for the difference on top of the part that’s not covered by “secu”. There’s a private insurance sector, the goal of which is to cover that which isn’t covered by " la secu"; all businesses offer those to their employees, sometimes as a perk - not an unknown here too, 10 years ago I had an employer offering the perk of health insurance that covered massages, homeopathy, osteopathy, and I don’t remember what else because I didn’t use them.
Everybody is in and everybody’s covered, from birth till death. You never have to worry about a sudden illness brankrupting you - or your neighbors having to start a fundraiser because you got cancer and it’s either throwing your family out to the street or paying for the treatment. Healthy people contribute knowing that if something happens - and, as you age, something always happens, and there’s always a problem somewhere lurking - they’ll be covered. It’s insurance that they’ll be ok if something horrible mangles or eats the inside of their body or their kid’s, and safety to know you can go see a family doctor if something’s wrong. It’s inexpensive and efficient.
Not perfect, but it works.
I personally think increasing numbers for numerus clausus so that the lack of personnel is offset, creating a rural medicine specialty, cutting some of the “spa” benefits, allowing for a deductible that’s higher than $1… would be better than closing the small rural ER’s and maternity wards. But the tourism industry wouldn’t agree on anything that cuts their numbers and the national board of medicine is highly conservative (they already voted down the idea of NP’s and PA’s on account ‘nurses are nurses, doctors are doctors and authority should be with doctors, period’, I’m paraphrasing.)
The spa thing is real but it comes with conditions - you have to stay on location for 3 weeks, the doctor decides what you get and why. (My MIL wanted to stay for only 2 weeks and it was refused. It’s 3 weeks or it’s not considered preventive care.) You can bet the tourism industry would rise up in arms if the “soft medicine” perks were cut (they’re a huge lobby and a huge moneymaker so they hold sway). Because when people get mud baths and massages (most of them old and ailing and who would otherwise need epensive medicine for arthritis, joints, breathing, heart problems… - several mud baths is a cheaper treatment than permanent pharmaceutical drugs), the patients pay for parts of it, they pay for hotels and restaurants and cinema tickets, increaseed activity means increased amounts of taxes paid, and the small towns where the places are located don’t see much tourism in the winter months. So, it’s win- win - better health, lower costs, and good money-maker all around. And people wouldn’t simply “go” to the “regular” spas (the medical spas are different from the resort spas, although tourists are allowed in the medical spas - medical spas are not luxury spas.)
“I have not a clue what the above means because it is straw man that assumes everyone thinks and solves things the same way. Just because someone may have sick families members does not mean they expect or want government to charge others with high premiums and deductibles to pay for their family members. Not everyone who cannot get something screams for or depends on government to take from others so they can get it, as there are other ways.”
@awcntdb - Are you seriously contending that people think that they will (a) never get sick and/or (b) self-pay if they got cancer or some other horrible diagnosis?
- You make the spurious claim that the only people arguing for nationalized healthcare (ACA or other) are those who want others to pay for them. I call "false" on that one: most of us with higher-than-national-average income and better-than-national-average health, i.e. in Blue states like MA, are overwhelmingly in favor of it. Oddly, and I do mean oddly, those who stand to gain the most from ACA have voted against it in the context of the presidential election, ranging from 70-90% of those newly covered, depending on whose numbers you believe.
- I don't know how young you are or what your ancestors died of, but very few people in this modern world go for their whole life never getting a serious injury/illness and then die suddenly of inexpensive causes (e.g. hit by a truck or sudden fatal heart attack). Therefore it's nonsense to talk about the "healthy" and the "sick" the way you do. If you and your family are "healthy" for now, thank whatever deity/stars you believe in, and prepare for things to eventually change.
- There is almost no one living anywhere who could afford to self-pay if they had a really serious illness (cancer, complicated surgery, organ donation, premature infant, etc.). It sounds responsible to say, "everyone pays for themselves!" but it's ridiculous financially when we're talking modern medicine.
- The nature of insurance is you don't always "use" what you pay for. (Or I suppose you do, in the sense that you've paid to lower personal risk.) I am flabbergasted by the number of people still complaining about not "using" their health insurance.
- I do not think the deserted island analogy is at all a "straw-man" @Zinhead - we pay taxes because we believe some things are human rights and/or popular goods. Examples of the former would be money that goes to food stamps; examples of the latter would be roads or schools or even prisons.
ETA because we do live in a country that is moral enough not to let uninsured people die instead of giving them ER care, we’re paying a lot more on the back end for a lot of illnesses even without doing so on the front end. For those who would prefer to let such people die in the street, the deserted island is exactly apt.
MODERATOR’S NOTE:
I’ve already posted this on this thread, but clearly it bears repeating. Feel free to express your opinion, but do not continue to argue the point; it is very unlikely that opinions will change. While the topic elicits passion ion many people, there is no sense in beating a dead horse. Please do your part to prevent this thread from being closed.
Indeed, I would assume that most of us would prefer to never have to file a claim for a house fire or car accident. (Of course, that is inconsistent with your pov upthread about having ‘insurance’ pay for preventive services…)
We wouldn’t need to give doctors a huge pay cut to enact a single payer system. Medicare is single payer, and doctors still get reimbursed handsomely. We’d need to give doctors a pay cut, maybe not a huge one, and have a lot of pay cuts for every player in the system, to get our costs down to commensurate with our peer nations, but we wouldn’t have to do that in order to enact single payer. We could have single payer at expensive American rates, just like we have Medicare at expensive American rates.
And also convince people that more (or more expensive) medical care is not necessarily better medical care. For example, people with viral infections not wanting to leave their physicians’ offices without prescriptions for antibiotics.
Getting back to the subject question…why is the ACA important to my family? Because it makes it possible for all of my family to have health insurance. Yes, the costs have gone up…but everyone can get a policy. That’s why the ACA is important to me.
A couple of policies being credibly floated for “repeal and replace”:
Replace the pre-existing conditions exclusion ban with a continuous coverage requirement. Anyone would be able to buy insurance, even if they had a pre-existing condition, provided they had had continuous insurance coverage. This avoids the problem of healthy people waiting until they get sick to buy insurance.
The current rule is that the oldest subscribers, the 64-year-olds, may be charged a maximum of three times what the youngest subscribers, the 21-year-olds, are charged. But the oldest subscribers actually cost five or six times as much as the youngest subscribers. The new rule would allow the oldest subscribers to be charged five or six time as much as the youngest.
Putting those two policies together would make insurance be less expensive for our children, the 20-somethings. But, sorry, it would make insurance more expensive for the parents on the board.
In theory, that could work and provide sufficient incentive for everyone to get coverage (basically insuring one’s future insurability). But the issue of affordability for middle and lower income (but not low enough to be on Medicaid) people could still knock many such people out of continuous coverage, unless there were some sort of subsidies or vouchers available to them. There would also be the issue of people who currently choose not to be covered even with ACA; would they get a one time chance to start buying coverage without being blocked for pre-existing conditions, or would they be left out if they have pre-existing conditions?
Also, when does continuous coverage start? Would it have to be parents putting someone on at birth?
DH and I are in our 60’s, relatively healthy, and not significant users of our health insurance. I’d be really angry if we had to pay double what we’re paying now for our premiums if those in their 60’s had to pay 6 times what someone in their 20’s pays. Our insurance now is really nothing more than a catastrophic plan when you take the deductible into account anyway.
These proposals are being thrown out, but they’re not set in stone yet. We don’t have details. If I were setting up the continuous coverage rule, I’d make it start the minute the law took effect. Anyone who purchased insurance the first time they could after the law took effect, and always purchased insurance thereafter, would not be able to be denied insurance; that’s the way I’d do it.
I don’t like the rule, though, because lower income people in ill health have difficult lives and can easily have gaps in coverage. Also, I don’t want to inspire insurers to mischief-- it would be all too easy to “lose” the payment of the cancer survivor. If the cancer survivor didn’t notice in time, which could easily happen if they were suffering a relapse, then the insurer could cut off their insurance.
I’d rather keep the mandate and make the penalty equal to the lowest priced insurance available to the person. If they didn’t sign up for any insurance, they would be signed up for the cheapest plan, and the cost would be taken out of their taxes. Then everyone would have continuous coverage.
Simple. If someone doesn’t have insurance because of their own choice, then a medical facility can refuse them. Give a 2 year window – lots of public service announcements – and then they can be turned away from an emergency room. It would be harsh at first, but those who refuse purchase insurance are playing the system and the current system allows it.
Yes to avoid gaps and lost premiums, it’s nice to have auto-deductions. It’s very troubling to read about shady insurance practices and I am relieved not to have had more experience wrangling with them.
The problem we’re discussing here is the person who gets sick, then buys insurance. By the time they show up at the doctor or the emergency room, they are covered. The issue is whether they should be able to buy the insurance in the first place. Right now they can, provided they enroll during the regular enrollment period.