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Too many Obamacare critics seem oblivious to law’s real purpose

We're talking about the working poor who have the kind of lousy jobs that don't come with employer-subsidized health insurance benefits.

Here are a couple of things about the rollout of the Patient Protection and Affordable Care Act (aka Obamacare) that aren’t about the government shutdown.

For one, today is a key day in the rollout of the PPACA, the first day that the health insurance exchanges become somewhat operational in many states. As Phillip Cryan of the SEIU writes elsewhere on MinnPost today, it’s possible to believe that the new, higher level of Republican desperation to repeal/defund/delay the implementation of the law is that they fear that the more people experience the effects of the law, the weaker the anti-Obamacare ObamaScare campaign becomes.

Personally, I believe that most of the critics are sincere in their belief that the new law is a blow against freedom, including the freedom to go without health insurance, but mostly because any time the government does something additional to help the poor, sick and/or needy, they seem to see it as a step toward the all-encompassing nanny state. And, minus the highly perjorative word choices, I suppose they have a point. Obamacare makes the government bigger.

I wish the law were simpler. All of those thousands of pages of provisions create confusion and provide opportunities for critics to sow fear, some of it utterly false fear like the famed “death panel” lie. (I also wish that everyone who participated in those lies would publicly own up to them and retract and apologize. If you can’t hope to win the argument without lying, it may say something about your underlying argument.)

But the critics often seem to be oblivious, perhaps willfully oblivious, to the main purpose of the law, which was not to grow the government nor to euthanize granny but to get more Americans covered by health insurance. We’re not talking about the poorest Americans, since they already qualified for Medicaid. Nor granny, since she’s already on Medicare.

We’re talking about the working poor who have the kind of lousy jobs that don’t come with employer-subsidized health insurance benefits, and those with pre-existing conditions who cannot get affordable coverage in a system that is based on pure free-market principles, and various other groups that fell through the cracks of the status quo hodge-podge that we call the U.S. “system” of health insurance.

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During the original debate on the bill, opponents often glorified that system as the greatest in the world, seemingly oblivious to some of its problematic aspects such as being the most expensive in the world while leaving a huge portion of the population uninsured and producing (along with several other socioeconomic and cuiltural factors) some of the worst health results in the developed world, as measured by such seemingly relevant statistics as life expectancy, infant mortality, death by treatable disease and more.

Atul Gawande, a physician and frequent writer on health care matters for the New Yorker, brings us back to the reasons for the PPACA in the current issue, managing to write without mention of the government shutdown. His opening paragraph is an anecdote:

“Ours can be an unforgiving country. Paul Sullivan was in his fifties, college-educated, and ran a successful small business in the Houston area. He owned a house and three cars. Then the local economy fell apart. Business dried up. He had savings, but, like more than a million people today in Harris County, Texas, he didn’t have health insurance. “I should have known better,” he says. When an illness put him in the hospital and his doctor found a precancerous lesion that required treatment, the unaffordable medical bills arrived. He had to sell his cars and, eventually, his house. To his shock, he had to move into a homeless shelter, carrying his belongings in a suitcase wherever he went.”

Of course, Paul Sullivan doesn’t make a perfect case. He should have bought health insurance when he was healthy and apparently wealthy enough to afford it. Who knows whether he would have eventually been bankrupted anyway, once the cost of his treatments ran into a “lifetime limit” on his insurance costs, which is banned by Obamacare.

But as they denounce Obamacare as the latest slippery step on the path to socialism and tyranny, I wish Republicans would explain their plans for extending affordable, quality health care coverage to as many of the currently uninsured as the awkwardly named PPACA is about to do.

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Comments (34)

  1. Submitted by Dennis Tester on 10/01/2013 - 01:05 pm.

    If the real purpose of the law

    was to provide health insurance for those who don’t have it, they could have simply expanded Medicare to include the working poor. Most conservatives and republicans would support that because we want to help people who need help.

    I realize most people reading this don’t understand conservatism, so let me boil it down to the real reason for the opposition: It’s because the system is *mandatory*.

    Freedom of choice is the foundation of a free society. It’s the reason conservatives have fought for years to opt out of social security, because it’s *mandatory.* It’s the reason conservatives oppose the military draft. It’s the reason Mitt Romney’s system in Massachusetts was roundly opposed and ridiculed by his conservative opponents. (He countered that it was only mandatory for the people of his state, but that didn’t wash and 4 million conservatives stayed home on election day).

    We would be happy if we could revise Obamacare with one sentence, and that would be to make it *voluntary.* But it won’t happen. It won’t happen for the same reason they won’t even delay the individual mandate portion of the law. It’s because that’s the backbone of the system.

    The problem with any collectivist policy is that it requires mandatory participation from all the people or it will fail. And this is the antithesis of a free society. Not to be overly dramatic, but they built a wall around the Soviet Union to prevent people from escaping and people were shot trying to escape Cuba in rickety boats because their government knew that participation in the system was mandatory or it would collapse.

    What’s sad and depressing for someone who grew up in a freer America and who actually fought against such ideology, is that this society has devolved to the point where people are actually volunteering to become wards of the state and are genuinely puzzled as to why some people are fighting tooth and nail to remain free people.

    The attempt to grab control of 18% of the economy should remind even freedom-loving democrats, should any still exist, that when government attempts to control the economy for the good of the people, they end up controlling the people for the good of the economy.

    But I’ve always said that the biggest mistake republican politicians make is in assuming that most of the people want to be free.

    • Submitted by RB Holbrook on 10/01/2013 - 01:53 pm.

      Enough already

      Once again, you trot out the line that “[m]ost conservatives and republicans would support [the expansion of Medicare to the working poor] because we want to help people who need help.”

      Honestly, Mr. Tester, I’m sure that you are the only person in America–of whatever ideology–who thinks that. Conservatives would not support the expansion of Medicare to anyone, including those who will become eligible for it in the near future (is Rep. Ryan not a “conservative or Republican” anymore?). Conservatives tolerate Medicare only because it benefits the elderly, a powerful voting bloc. Unless their recent actions have all been a smokescreen or an elaborate joke on the electorate, they want nothing to do with any expansion of Medicare.

      Consider the record: Have conservatives argued against stricter eligibility for Medicare?

      Did Republicans support expanding SCHIP to the children of the working poor?

      Have they accepted federal funds for the expansion of Medicaid in the states, to include the working poor?

      Welcome to 2013 in the United States. Conservatives and Republicans don’t care about anything but making political points. Even their own ideology means nothing when it’s time to make noise for a gullible electorate. Or has the heritage Foundation–the folks who came up with the original of Obamacare, right down to the individual mandate–suddenly morphed into a cell of Bolshevik fellow travelers?

      • Submitted by Joe Musich on 10/02/2013 - 08:51 am.

        There was a suggestion to…

        expand medicare but you know who stopped that. Let us ha e NO diversion or reinventing of history on this matter. The conservative tea partiers lay in a thorny bed of their own making.

  2. Submitted by Neal Rovick on 10/01/2013 - 01:34 pm.

    A big portion of the opposition comes from the fear that someone may get “something for nothing”, especially if they “don’t deserve it”.

    A thread runs through the whole argument of the libertarian wing, “you only deserve it only if you can afford it”.

    But as the saying goes, “there are no atheists in a foxhole”. One day the choice may be theirs, “food or medicine?” Nothing nobler than dying of an untreated, curable illness, eh? Or perhaps your child sacrificed on that altar of nobleness?

    The number of people suffering of untreated illness is certainly no measure of freedom or greatness. It’s rather a sign of the overwhelming importance of money over people and the smallness of imagination.

    • Submitted by RB Holbrook on 10/01/2013 - 03:40 pm.

      “No atheists in a foxhole”.

      Ayn Rand was able to swallow her principles pretty readily to go on Medicare. Friedrich Hayek made an extended stay in the US only after he was convinced he would be eligible for Medicare benefits (his pal Charles Koch, of the family who now owns Wisconsin, helped him sign up).

      That’s different from letting some poor working stiff have coverage, of course. We can’t go around helping the looters stay alive.

  3. Submitted by Steve Titterud on 10/01/2013 - 01:44 pm.

    People can reasonably differ on what “free” and “freedom” are.

    Your statement “the biggest mistake…is in assuming that most of the people want to be free.” is accurate from your point of view, using your notion of “freedom”, but ONLY from that view.

    Some people simply don’t agree that what you describe is “freedom”. Yet they have not alleged that you, who do not share their notion of “freedom”, don’t want to be free.

    A modicum of respect for others is necessary to see this.

    • Submitted by Rich Crose on 10/02/2013 - 11:11 am.

      Freedom TO or Freedom FROM

      They want the freedom TO opt out of health care but freedom FROM their insurance rates rising when the uninsured go to the emergency room.
      They want the freedom TO own guns but the freedom FROM crazies walking around with guns.
      They want the freedom TO pollute the air but freedom FROM lung disease caused by air pollution.
      They want the freedom TO make as much money as they please but freedom FROM the people who revolt chanting “Eat the Rich!”
      They want the freedom TO honor the constitution but freedom FROM opposing parties who use the constitution to pass laws they don’t agree with.

  4. Submitted by Charles Holtman on 10/01/2013 - 02:05 pm.

    Mr Tester,

    Do you object to laws against murder? If you do, your definition of “freedom” is, shall we say, idiosyncratic, but at least you are principled. If you do not, your ideological structure falls to pieces.

    When more than 10 people occupy a common space, there is no such thing as absolute freedom, except for the freedom of anarchy until everyone affiliates with a strong leader and a feudal system emerges. Rather, there is best-achievable freedom that comes from making sound judgments about where the individual should decide, and where the individual should yield to a collective decisionmaking process. Freedom forfeited for even more freedom. There may be well-meaning debate about where the line is drawn in a particular realm of human activity, but that’s a debate about factual reality, not about ideology.

    The only people that don’t want to be free are those so disabled by core existential fear that they want only an authoritarian government that can deny them anything provided it protects them from the unfamiliar. One of the two major parties has focused its electoral strategy for the past half century on appealing to such people, and as a result they are disproportionately represented in that party. Which is why your last sentence is absolutely correct, though for a reason that I’m sure you didn’t intend.

  5. Submitted by Peder DeFor on 10/01/2013 - 02:09 pm.

    Expanding Insurance Coverage

    Can someone give me an A-B-C explanation for why the task of expanding insurance coverage, especially to those with pre-existing coverage, has to include dis-incentives for companies to have full time workers? The most obvious short term problem with Obamacare is that it’s been an anchor on job creation. Companies are holding off on hiring and shifting people to part time work. The biggest current problem with our economy is that we have too few people working.
    As Dennis said, we would have been better off extending Medicare coverage.
    Long term there are other problems. One of the most obvious is that we shouldn’t have a health care system that is insurance based. Insurance is for catastrophic things, not every day expenses. Car and house insurance both work on this principle and we don’t have a problem with run away costs in either. If your car insurance covered oil changes and other routine maintenance, we’d see costs rise exponentially.

  6. Submitted by Peter Stark on 10/01/2013 - 02:34 pm.

    This statement is completely untrue

    “…. they could have simply expanded Medicare to include the working poor. Most conservatives and republicans would support that because we want to help people who need help.”

    If that is the case, why have they not voted to pass H.R. 676, an actual Medicare-For-All bill? Instead of voting for a Medicare-For-All bill that has already been introduced, the GOP controlled House has voted to repeal PPACA some 44+ times.

    If conservatives and republicans would support Medicare-For-All they’ve had 3 years to do so. They haven’t done it, they don’t say they would support that in public, and a reasonable observer can only conclude that they do not in fact support such a plan. In fact, the only alternative plan to PPACA that the House has sponsored is (you guessed it) a tax deduction for those who purchase insurance.

    Also, the very nature of all group insurance (public or private) is collectivism and the pooling of risk. In my company’s insurance pool younger, healthier workers help lower costs and increase coverage for older, less healthy workers. I feel like you are allowing your ideological trigger words to interfere with your understanding of basic business concepts.

    And PS: You didn’t lose the election because the “silent majority” didn’t show up. You lost the election because people don’t buy what the GOP is hocking these days. If you wanted to repeal the PPACA, you ought to have won the election! If you still believe you just picked a bad candidate, take personal responsibility and try harder next time, don’t whine about it and throw a huge fit when you can’t govern as a rump.

    • Submitted by Dennis Tester on 10/01/2013 - 06:34 pm.

      Medicare for all

      is not the same as Medicare for those who need it, which is what I referred to.

      We could have given expanded health insurance assistance to those who need it but the Left insists on mandatory participation for all. And that’s not the same as helping the poor, is it.

      • Submitted by Matt Haas on 10/01/2013 - 08:39 pm.

        Gee that sounds grand

        So your idea is to limit the government funding to those who “need” it. Hmm let’s see what that would entail shall we, the list would include the poor, those with preexisting conditions of any kind, the disabled, the elderly, and anyone sick enough that they’ve exhausted the lifetime caps on their insurance. In essence leaving all of the real COSTS of providing care on taxpayer shoulders whilst preserving the young and healthy for the insurance industry to extract premiums from while expending little to no actual capital in the form of paid claims. Work in insurance by chance do you Tester? Socializing the risk indeed.

      • Submitted by Neal Rovick on 10/01/2013 - 10:05 pm.

        Mr. Tester has the hopeless belief that all who read here have forgotten the determined and relentless pursuit by the Republicans at the federal, state and local level to defund the safety net, including Medicaid and numerous other healthcare initiatives that serve the poor.

        Try again, Mr. Tester!!

      • Submitted by Connie Sullivan on 10/04/2013 - 06:41 pm.

        Obamacare actually includes a provision that greatly expands Medicaid–a program that helps people in poverty get health care. Following the Supreme Court ruling that permits states NOT to do that expansion, 26 states with Republican governors and legislatures opted NOT to expand Medicaid for their most impoverished. Even with 100% federal funding of that expansion for three years, and a guarantee of 90% federal funding thereafter. Pure selfish nastiness.

        And about eight million Americans are now still ineligible for Obamacare subsidies or expanded Medicaid. They will have no health insurance. They will either die from an illness or disease or accident, or they’ll go to an emergency room and the rest of us will have to pay their hospital bills.

        For anyone to assert that Republicans are compassionate, or care about the sick and the poor and the elderly, is absurd, given this reality.

  7. Submitted by Larry Moran on 10/01/2013 - 02:53 pm.

    The Healthy Person and Voluntary Insurance

    I think people opposed to the PPACA don’t completely consider that health insurance is unique: it’s optional for the individual until it isn’t. Healthy people may not believe they need health insurance and so may choose not to purchase it if it isn’t mandatory. In many other activities we participate in (owning a cell phone, buying a car, owning a house) those choices don’t generally affect me. But if someone chooses not to purchase health insurance and gets sick, given our societal choice of not simply letting people die (or stay very sick and infect others), that choice does absolutely affect me. I live in Hennepin County. If someone needs medical services and has no insurance he will probably end up at HCMC, with very expensive treatment. Since HCMC is funded by the county, that person’s lack of insurance costs me (and everyone else in Hennepin County). To (badly) paraphrase Oliver Wendell Holmes, an individual’s right to be uninsured extends as far as my wallet, but not into it. There are other issues with this new law but its attempt to solve the problem of the uninsured is key because it affects everyone, not just the uninsured.

  8. Submitted by Paul Brandon on 10/01/2013 - 03:42 pm.

    Which will expand more?

    The size of government,
    or the profits of the private insurance companies who’s business will expand due to the ACA?

  9. Submitted by Ray Schoch on 10/01/2013 - 04:40 pm.

    Ignoring reality

    Thanks to Eric and several commentators for pointing out the ACA’s purpose.

    Mr. Tester gets no points for snark (“…most people reading this don’t understand conservatism.”). A good case could fairly easily be built that Mr. Tester doesn’t understand it, either.

    I totally agree, as do many others that Mr. Tester would label as “liberal,” that it might have been better to expand Medicare to include the working poor. That’s not a choice that was presented to the public or to Congress. Why not? Because people who call themselves “conservative” made it clear that any meaningful expansion of Medicare and/or Medicaid would never get through Congress, as RB Holbrook suggests. Mr. Tester’s memorization of right-wing phraseology and talking points is impressive, but it doesn’t negate the logical inconsistency of his arguments. Chuck Holtman nails it in this regard.

    The alternative to the ACA offered by the Tea Party wing of the Republican Party, the alternative to expanding Medicare or Medicaid, offered by the same ideological brothers-in-arms, has consistently and for years been as several others have described it here: “You’re on your own.”

    That, Mr. Tester, is one of several places where your model breaks down. I lived in that world for a dozen years before I (fortunately) lived long enough to qualify for Medicare. I paid for everything, including cancer surgery, out of my own pocket, and was fortunate that what I had to deal with was not quite catastrophic. I could only do that because I had a reliable income that was sufficient to do so. That doesn’t mean the American health care system without the ACA was a success. It simply means I was very lucky.

    There’s no genuinely free market, and never has been. That’s especially true in modern health care, where customers — and astonishingly, sometimes even the providers — have no idea what a particular procedure or treatment regimen costs beforehand. Hospitals do not publish and publicize their charges — as Steven Brill pointed out in his article last year, and as the Obama Administration documented this year with the release of cost figures for the 100 most common inpatient procedures billed to Medicare, there’s no consistency or logic to those prices beyond the venal goal of making money. There are no price lists posted in doctor’s offices. You find out after the fact what this latest office visit cost you.

    Health care is not a “choice” like buying a TV or a new pair of shoes. When the drunk driver T-bones you at an intersection, your loved ones aren’t going to spend a lot of time comparison-shopping the various hospitals and surgeons who might be engaged in saving your life.

    In or out of health care, there will never be the sort of “free market” that those who call themselves “conservative” worship. Government always has an influence, and while we might argue over the degree of influence, and whether it’s a good or bad thing, no industrial nation — no functioning nation-state in the modern world, industrial or not — has an economy in which the government has no influence. The relevant question(s) revolve around who benefits from that influence.

  10. Submitted by Dimitri Drekonja on 10/01/2013 - 05:17 pm.

    I’m floored that commentators like Mr Tester and Mr Defor recall republican support for an expansion of medicare. I’d be curious if either can provide a link to a reliable source of a republican elected official endorsing such support. The ultimate expansion of medicare is HR 676, the “medicare for all” bill that establishes a single-payer system for the entire US based on the medicare model. Current cosponsors: 50. Number of republicans: 0. Yup, they sure are interested in supporting an expansion of medicare.

    • Submitted by Dennis Tester on 10/01/2013 - 08:53 pm.

      Medicare for all

      Is not the same as Medicare for those who need it. Why is that notion so impossible for Leftists to understand? Don’t bother answering, I already know.

  11. Submitted by Neal Rovick on 10/01/2013 - 06:50 pm.

    Mr. Gullible says…”Gee,

    Mr. Gullible says…

    “Gee, Medicare for all? That’s a great solution Mr. Tester and Mr. Defor !! Thanks, and maybe you can telegraph DC and have those Republican patriots propose that!! They’ll go for that in a New York minute!! Why hasn’t anyone proposed anything like that before? It’s what they’ve been looking for all along–a win/win solution that benefits everyone. Now who could be opposed to that?”

  12. Submitted by Julie Stroeve on 10/01/2013 - 07:17 pm.


    The Republican Party is on record for “you have a right to die if you choose not to purchase healthcare insurance [because you are poor/black/not rich/other].” gee, that’s a fine right, isn’t it? The extreme Right of the extreme Right is balking against the ACA because it will be extraordinarily popular among real Americans. In other words, their resistance to the bill is their undying dedication to the rule by the plutocracy of the masses. This notion is anti-democratic and anti-American. Popular (populist) legislation in Congress is just plain mad if you’re a Right wing of the Right wing Republican party. All this strategy is being strategically laid out by the right wing funders and the think tanks. So in the end, Republican politics is being navigated by a tiny group of about 12 or 13 billionaires.

    this is a very sad state of affairs in the United States of America.

  13. Submitted by jason myron on 10/01/2013 - 07:31 pm.

    So, in the mind of Mr. Tester…

    health care equals tyranny. ……excuse me while I try to wrap my head around that….usually, when I think of tyrannical despots, my first thought isn’t how they provided heath care for their citizens. As for the faction that is fighting “tooth and nail” against the ACA in order to “remain free”, I wonder if those same people would put their money where their mouth is and toss off the yokes of oppression by refusing Medicare, Social Security, police and fire protection, road construction, having the snow plowed off of their streets, etc…? In fact, these people are only fighting it because they hate the President…we know it, they know, the world knows it.

  14. Submitted by Julie Stroeve on 10/01/2013 - 08:01 pm.

    go it alone

    that model works, right? every self-made man(woman) does it by himself(herself). the government is just an evil or unnecessary impediment to success. that is just b.s. b.s. I applaud every American who works hard and is successful. We need things when we need things. A healthy male who doesn’t plan for his health future is being risk-adverse. That same healthy male invests in his retirement and enjoys the risk taking associated with investing and wealth building. His health works the same way. If he doesn’t take steps to avoid future health downsides and then — voila! he is SOL without health or healthcare or home! doesn’t this send a message? I think it does.

  15. Submitted by Peter Stark on 10/01/2013 - 09:26 pm.

    Medicaid Expansion

    Coverage for the working poor was part of PPACA, it was called the Medicaid Expansion. Incidentally, Republican Governors like Scott Walker decided to decline that money! Imagine that!

  16. Submitted by Logan Foreman on 10/02/2013 - 08:56 am.

    The republicans’ idea of “freedom”

    Is revealed in part by the article yesterday describing American Crystal Sugar’s default on a govt loan of almost 72 million dollars. The company, a group of rich conservative white farmers, was not required to repay the loan because the price of sugar is too low. Yes Mr. Tester, that is the republican idea of freedom – more for the rich from the rest of us. Smells like socialism tho.

    • Submitted by Dennis Tester on 10/02/2013 - 09:34 am.


      If it was up to me there would be NO government subsidies, including loans, to any private enterprise and that includes farm subsidies. Don’t confuse republicanism with conservatism.

  17. Submitted by Tim Milner on 10/02/2013 - 09:10 am.

    A more rational objection

    As someone who considers himself conservative, though certainly not a Tea Party advocate, I am opposed to the law.

    The law was created to increase access to healthcare for all. I get that – and unlike the Tea Party members – I support it 100%. Yes, government grows a little. But sometimes, government has to.

    Yet, the law has major, major flaws – so great in my opinion – that the law should not be implemented. Because, while it completely addresses access to healthcare, it does almost nothing to address costs nor does it address anything regarding personal responsibility to receive care at the most cost effective level.

    What is going to happen in practice, is a system that will give access to a person’s most convenient for of care (not most appropriate). You can see that already in the growth of Urgent Cares and ER rooms – more and more of the population is using those services as clinics rather than a clinic doctor. At substantially higher costs. And there is nothing to dissuade them.

    Within a couple years, the cost situation, already touted by many accountants/benefit consultants, yet completely ignored by the politicians, will hit. We are not going to be able to afford it – but we are not going to stop granting access either. So, the taxes and fess are going to have to go up.

    I’d like to see the law stopped now, and force Congress to make the hard choices on how we are going to pay for this in the long term. Because the magic pixie dust of “market competition” is simply not going to be enough to keep the costs affordable.

    • Submitted by Neal Rovick on 10/02/2013 - 12:52 pm.

      Every other developed country in the world has solve the cost and access problem.

      But thanks to “conservatives” like you in this country, we will continue to pay twice as much per capita for health care with worse outcomes.

      The access issue will improve with Obamacare, but the cost issue is not addressed–because “conservatives” objected, twisting management based on best practices and efficient outcomes into “death panels”. Reduced increases in payments, which obviously is the ONLY way to decrease expenditures, was twisted into “killing off Grandma”.

      Time for the the “conservatives” to own up to how they are working to make the future worse, not better.

    • Submitted by Matt Haas on 10/02/2013 - 06:28 pm.

      So in the interim

      You’ll be OK with continued non coverage of those with preexisting conditions, continued denial of coverage to those the insurance companies have decided they’ve paid too much toward (ie lifetime caps), continued financial destruction of lives through bankruptcy caused by medical bills, actual physical death from lack of medical care. All this, for no reason other than to appease the interests of those who refuse to see their tax percentage rise by even a few ticks, so that they might earn even more money that they could never possibly hope to spend. To appease those who refuse to take the job of governance seriously and instead see it only as a means by which to enrich themselves and their friends. Sorry, but the attempt at conciliation fails in the execution.

    • Submitted by RB Holbrook on 10/03/2013 - 10:19 am.

      Costs and responsibility

      Health care costs will go up due to many factors. The population of the US is aging, more sophisticated treatments will cost more, and normal inflation will contribute. None of that isdisputed, and it was never the (unrealistic) goal of the ACA to freeze those costs. The goal is keeping the increases at a manageable level.

      More and more people are using the ER (and, in some cities, the fire department) as their primary health care provider because that’s what they can afford. That is the existing, pre-ACA situation. It’s not solely or even largely a matter of convenience. It’s the option available to the uninsured.

    • Submitted by Todd Hintz on 10/03/2013 - 04:22 pm.

      Pinko Commie Librul

      Tim, you sound a heck of a lot like a liberal there! I have to finesse that a little bit and say that I’m more pragmatic than anything. While I consider myself a full blown liberal and proud of it, the reality is I’m more of a pragmatic person who looks for viable solutions from all sources, not just the sources that are first filtered through an ideological filter. While I haven’t ever met you, your posting above gives me the impression that you approach problem solving with the same methodology.

      You’re absolutely right that people are using the ER as the clinic of choice, but we have to look at the reason why they do that. Primarily it’s because they don’t have health insurance. A visit to the doctor means time off from work, which is lost wages for people who are stringing together a series of part time jobs. Plus it means an out of pocket expenditure for people who have a really tight budget. Do I go to the doctor and get this nagging ache looked at or do I buy some groceries so the kids can eat? They roll the dice and take a gamble that the ache will go away on its own. If they win, then the budget survives and the family gets to eat tonight. But if they lose the lottery and the little ache becomes a big issue, then it’s off to the ER with its correspondingly high costs plus a large issue that’s more expensive to treat than a little issue.

      ACA will help that situation as more people will have insurance and can afford to see a doctor for preventative care rather than an ER for emergency care. So in that aspect the new law will help to drive health care costs down as more people get little problems taken care of early.

      Keep in mind though that ACA was never meant to solve all problems in one shot–it’s simply a compromise system that’s only one step on the road to a complete overhaul. Again, this is simply a single step in the right direction and, as you pointed out, no magic market competition pixie dust is going to change the system by itself.

      What we really need is to go with the single payer universal system PLUS an overhaul of doctor compensation from a procedure based payment to results based payment. Universal, because that will get everyone into the game and drive prices down for the whole pool. Single payer, as that simplifies the system for both doctors and consumers. Doctors will only have one set of rules and paperwork to deal with and consumers can go to any hospital or clinic they wish without having to worry about who is and isn’t in network.

      I would go even one step further and say the single payment system has to be either government run or utility run, akin to your electric and gas utilities. If it’s run by the private sector, then it’s going to be front end loaded with profit motives.

      I think we can get there and reach that goal you and everybody else wants: affordable health care. But it’s going to be a heck of a battle and take a lot of years given the horrendous opposition we already see.

    • Submitted by Connie Sullivan on 10/04/2013 - 06:48 pm.

      Reform is never complete, and we should not throw out this health insurance reform because it’s not perfect yet.

      Implementation of Obamacare is awaited with urgency by millions of people.

  18. Submitted by Paul Udstrand on 10/03/2013 - 02:16 pm.

    The original reasons are irrelevant

    You have to remember, the Republicans never accepted the idea that we had a problem with health care much less a health care crises in the first place. We had a lucrative health care market and as far as they were concerned that’s all we needed.

    I don’t know why everyone is so surprised by Tester’s support for medicare, it simply resets us back to the pre-Obamacare status quo. In theory we already have medicare for those who “need” it. Tester is just telling us that Obamacare is a solution in search of a problem, which brings us full circle in the minds of Republicans.

  19. Submitted by John Eidel on 10/03/2013 - 03:36 pm.

    Subsidized healthcare

    I think an important detail that is often missed in the discussion over “subsidized healthcare” is the fact that pretty much every person who gets health insurance through their employer is also getting government subsidies for that insurance. Neither you nor your employer pays any taxes whatsoever on that insurance premium; it is not taxable. Not to mention the fact that further medical expenses that exceed a certain portion of income are tax deductible as are contributions to HSA’s. I am not saying that the subsidies associated with plans offered on the exchange are equal or less than the tax benefits received by people on employer provided plans, only that everyone is subsidized to one degree or another.

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