Obamacare

Liberals Have No Clue How to Fix Obamacare

The president's signature law is failing spectacularly.

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Obamacare enthusiasts have long been in denial that their beloved law is unworkable in anything resembling its current form. But with the recent news that the insurance giant Aetna is joining the stampede of companies leaving Obamacare's exchanges, reality may finally be sinking in.

It may be too little, too late. Worse, Obamacare has become such a quagmire that the proposed "fixes" may create an even bigger mess.

Aetna is bailing out of the individual exchange market in 11 of 15 states because, like its peers, it was sustaining losses to the tune of $300 million annually and sees no prospects of improvement. Aetna's exit will leave a good chunk of its million or so customers scrambling for new coverage when enrollment begins in a few months. This wouldn't have been such a big deal if there were other good options. But that's not the case given that other big insurers, including UnitedHealthCare and Humana, have also quit in many states, and for identical reasons. Worse, 70 percent of Obamacare's co-ops—non-profit plans that were given government loans on sweet terms to compete with private companies—have also collapsed. In huge swaths of states such as the Carolinas, only one monopoly insurer is left. And in Pinal County, Arizona, there are none!

But even in states that have more options, many of them involve plans that cut their teeth in the Medicaid business. This means that their business model involves giving people all the lavish benefits required by the law on paper. However, in practice, patients don't receive them because the authorized network of providers and hospitals is exceedingly narrow.

Obamacare's boosters on the editorial page of The New York Times and elsewhere maintain that the exit of all these biggies is no big deal because it represents the normal weeding-out process of a competitive market. That's a nice try—but no sale! In a functioning market, companies die when their customers take their business to alternative suppliers. In this case, customers are unwilling to purchase the product in the first place given that total enrollment in Obamacare exchanges is 40 percent less than Congressional Budget Office projections last year.

Here's an even bigger problem: The mix of people enrolling is disproportionately weighted toward the sick and old rather than the young and healthy. Not enough of the latter are choosing to enroll—opting instead to pay an annul penalty that the law imposes on them. This riskier-than-expected patient pool is forcing insurers to raise premiums, which prices even more healthy people out of the market, which causes more hikes, unleashing a death spiral of adverse selection—exactly as many critics of the law had predicted would happen.

After dismissing such predictions as fear mongering, some Obamacare fans, such as University of Pennsylvania's Zeke Emanuel, who served as a top White House health policy adviser during Obama's first term, are finally acknowledging there is something to worry about. "There is a problem with the risk pool," he admits. "There is a problem with the numbers of people signing up." Meanwhile, Vox's Sarah Kliff, another Obamacare cheerleader, ran an interview with Princeton University's Uwe Reinhardt, who believes that the exchanges have entered a death spiral just like the one that unfolded in New York and New Jersey over two decades ago, when those states forced insurers to underwrite everyone regardless of health status (guaranteed issue) without any "price discrimination" (community rating). (Hilariously, Kliff calls Reinhardt's the "minority view" because, evidently, Obamacare's critics who live outside liberal land don't count!)

The left has two ideas to overcome the adverse selection death spiral and create self-sustaining exchanges. Reinhardt's suggestion is to embrace the Swiss model, which involves imposing very stiff penalties on insurance scofflaws and then enforcing them harshly by garnishing wages. The other idea is creating a public option or a non-profit government-run insurance plan that would compete with the private underwriters on the exchanges and bring down prices.

These ideas are draconian. They are also politically unfeasible—and ultimately self defeating. Raising the penalty won't happen without a bruising fight. Given that the Supreme Court ruled that the penalty was really a tax, any hike must be approved by Congress. That'll be an uphill task even if Democrats control one or both chambers. Good luck with that.

The public option, meanwhile, would have the added problem of not even working conceptually. Why? Because private insurers can't compete with an entity that has the power and backing of the almighty federal government behind it. So, odds are, they won't lower premiums. They'll just sprint even faster to the exits, effectively leaving the public option as the only option.

This would be tantamount to creating a single-payer system—a government-run monopoly. And the only thing worse than a private monopoly is a state monopoly. Indeed, single-payer systems in countries like Canada and Denmark only stay afloat by dipping deeply into public coffers and/or rationing care—defeating their whole purpose. Even if the left tried, it'll be nigh impossible to pull this off in a debt-ridden country already careening toward a massive entitlement spending crisis.

Obamacare tried to remake a sector that constitutes one-eighth of the economy from the ground up. But it made a mess that it just doesn't know how to fix. That will be President Obama's legacy. He should be worried. Very worried.

This column originally appeared in The Week.

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135 responses to “Liberals Have No Clue How to Fix Obamacare

  1. Single payer!

    Jill Stein approves this message.

  2. My goodness, Shikha. Not a bad article. You knock down the two leading “reform” proposals.

    I’m thinking “end it, don’t mend it” is where you wind up. Which would be a major change for most Reason contributors, who, last I checked, scoffed at a straight repeal as “not a serious policy proposal”, such proposals requiring, apparently, many pages of 8 point type, large bureaucracies, and larger expenditures by definition.

    1. I came here to say this…well, mostly to say “No, what it needs is a bullet to the base of the skull”.

      1. I yearn for the times of a burlap sack and a brisk walk to the bridge.

        1. These euphemisms

      2. Then the remains need to be cremated, the ashes mixed with concrete in a block, and the block dropped in the Marianas Trench.

        1. Smart move, dumbass. If Friday The Thirteenth films have ever taught us anything it’s that you never put the remains of anything evil in one place where they can be either struck by lightning, catch an electrical charge or be exposed to power generation beyond our current understanding. You send that thing in one piece into the bottom of the deepest, and mostly unexplored part of the ocean it’s going to find its way back and kill every fucking one of us as we’re getting ready to have sex.

          No, you need to dismember it and launch piece by piece of it into different directions of space so the chances of it reanimate get are minimized.

          1. …kill every fucking one of us as we’re getting ready to have sex

            So the majority of Reason commentariat have nothing to worry about, amirite?

            Not me of course, but all the rest of you.

            1. As long as I’m kept alive, the world can be repopulated. Remember that, people, as the apocalypse approaches.

              I. Must. Be. Protected.

              1. I seem to recall you required some help in the past.

          2. Look, it was fine in the gave until that idiot kid dug it up and put a piece of fence in it.

            1. It was also pretty quiet in the lake until the Carrie rip-off woke it up.

              1. It was also fine in the junkyard until Thornton Melon’s son pimped it.

    2. I wonder how completely repealing the law would change our politics system. Right now everyone believes that once something is passed it can never be undone. Would undoing this law convince people that the incremental method is no longer valid and they need to just ask for what they want, or would people instead use it to pass bills because we can always repeal them if they don’t work.

      1. They’ll let it collapse first.

      2. We used to actually do such things with the Constitution itself, with Prohibition being most salient example.

        The government powers of something like Prohibition, again as an example, are all mere ‘regulations’ now – compiled by various vague bureaucratic gears under an over-arching law (Controlled Substances Act) that basically says go-for-it in defining said law ad-hoc.

        That is how laws are ‘easily’ passed today. And never undone.

        1. You know who else won a big election in 1933…

    3. most Reason contributors, who, last I checked, scoffed at a straight repeal as “not a serious policy proposal”,

      Until Jan 20, 2017, the proposal is not serious. If, and only if, Trump wins and the Heffalumps keep the Senate, then it becomes a serious proposal. That is what most Reason commenters have been saying; the contributors, not so much.

    4. too many words in the title…”How to Fix Obamacare” just extraneous…

  3. How about a stake through it’s heart.

  4. Experts and their models (Prog only) never saw this happening. We need to double-down on what (Prog only) experts and their models predict.

    Repeat until Venezuela.

    1. +1 stimulus package

  5. IIRC one of the more odious aspects of the law was unilaterally deferred until after Obama leaves office and the thing looks kike it will already be on life support by then.

    Doesn’t some aspect of the law to do with large employers kick in in 2017 ?

    1. Anti-semite!

    2. What was the large employer section of the law. I remember it being brought up at the time, but I haven’t heard about it since.

      1. A lot of it kicked in this year, specifically the employer mandate (50 full-time employees and you must provide insurance).

        Wonder of wonders, more people have been shifted to part-time employment

      2. The cadillac tax

      3. As I understand it, the portion of your health plan that your employer pays will now be considered as income when you file your taxes so expect a large increase since most people have no idea how much money that really is.

    3. Doesn’t some aspect of the law to do with large employers kick in in 2017?

      The “Cadillac Tax”, which it should be noted both connected unions *and* any group bestowed a fealty waiver from HHS is, of course, exempt.

      1. The company killed our great policy a couple of years ago in anticipation of the Cadillac tax. My out of pocket expenses are $3,000+ higher at this point then they were 3 years ago. But I as bad as it was for the office professionals, the union got fucked in the ass. The company told them it was directly related to Obamacare and perhaps they should pay attention to who they vote for.

        1. But I as bad as it was for the office professionals, the union got fucked in the ass.

          So, a silver lining?

          1. It was a brief moment of unbridled schadenfreude.

        2. I did say, “connected,” unions, kinnath.-) Many of the ass fucked unions got “reprieves” via the last Crominibus Bill, according to my colleagues back in The States. Whether or not those benefits actually get restored is something else.

        3. “The company told them it was directly related to Obamacare and perhaps they should pay attention to who they vote for.”

          That’s fantastic.

        4. The company told them it was directly related to Obamacare and perhaps they should pay attention to who they vote for.

          LOL, outstanding.

      2. The “Cadillac Tax” destroyed a ton of people’s good insurance for no apparent reason. The people liked their insurance and their employers were willing to pay for it. Why the geniuses who wrote this abomination decided that the government needed to step in and tax anyone having decent health benefits into having shitty benefits remains a mystery. Of all the horrible parts of this law, the Cadillac tax is in many ways the worst and most mean spirited aspect of it.

        1. So that when they finally transition to single payer, your care will have already gotten so shitty and expensive that you won’t notice a drop in quality.

          1. You give them too much credit. They don’t have a long plan. They are just nasty horrible people who don’t like it when anyone does well.

            1. When anybody but THEM and their compatriots does well.

              I am reminded of a recent interview with someone in Venezuela that is currently starving: the local Socialist Party rep told him that to get his state-issued bag of higher-quality food, he would have to join the Socialist Party… Otherwise, he can stand in line for a small chance to get a bag of crappy foodstuffs.

        2. Because “Fuck you for having a job with benefits. You’re probably a filthy 1% and vote Republican!”

        3. We are from the government, we’re hear to help.

          1. or, “here”, but either way, fuck gubment.

  6. Obamacare is in its bunker ready to marry Eva as reality’s troops enter the city above.

    1. You know who else was all about death panels?

  7. Here’s an even bigger problem: The mix of people enrolling is disproportionately weighted toward the sick and old rather than the young and healthy.

    No, Sikha, it’s not that tired, grossly overused, and resentment-fueling canard of, “young and healthy,” and “old and sick.”

    It’s “healthy” v. “unhealthy”, regardless of age. Period. Full Stop. End of Story.

    1. Look, all Shika is saying, and I think we all can agree, is that once people get too old to provide tax revenue, they should be ground into a slurry and fed to the poor.

      1. Slow down there, Bernie.

        Who said anything about feeding the poor?

        1. to whom?

          “Soylent Green is poor people!” (and they are not as revolting as the king originally thought, in fact with some Lawrys they are pretty good!)

        2. Thanks for that comment. I needed that to brighten my day. I’m still snorting and laughing.

        3. Well, it would be a substitute for abuse-prone EBT and SNAP, so consider it a good thing. Why hand out EBT cards when you can hand out actual bottles of slurry? No one is going to be reselling slurry for cash.

        4. Look, we have starving children in this country. Do we really need 100 different choices for a person’s age?

      2. We drink elixirs that we refine
        From the juices of the dying

        We are not monsters, we’re moral people
        And yet we have the strength to do this
        This is the splendor of our achievement
        Call in the air strike with a poison kiss

      3. Little Lisa brand slurry?

    2. Age is about the only thing that the ACA allows for rating risk. As a result, my wife’s insurance premium is triple what my kids’s is.

      1. Old =/= Sick, by default.

        Give me a 53 year old with an excellent health HX and consistent, conservative health habits over some 20-something with a HX of risky sex, a myriad of STD’s, and prone to dangerous behaviour, and decides to cash in on elective procedures that are superfluous and unnecessary for the survival of the patient.

        The other risk factor (though not officially allowed, but rest assured it *IS* factored) is the sex of the individual. As in actual, factory original XX females and XY males (anything else is a statistical deviation outside of population norms and likewise DX’d as a discrete disease process, syndrome, or disorder), since sex has the most pronounced, actuarial predictive weight on the lifetime health profile of any given patient.

        1. That second paragraph sounded normative.

          I shall report you to the nearest re-education center.

          1. Go right ahead. They can come and get me in UKR. And please, please Sod, let them try.

        2. I get that, but isn’t another consideration the likelihood of an enrollee prevailing on his or her benefits? I’m healthy as an ox and until earlier this year hadn’t seen a doctor in over a decade. Vs. my dad, who is likewise healthy but sees his practitioner 2-3 times a year for various treatments.

          Habits vis-a-vis doctors visits seem like they’d dwarf statistical differences in risk-taking.

          1. Habits vis-a-vis doctors visits seem like they’d dwarf statistical differences in risk-taking.

            Doctor visits simply provide a running score on one’s known DX’s and how they are managed, giving actuaries an idea on how much the patient scores on possible future care, i.e. they have a much better idea of how much a patient will actually cost.

            Whereas you, not having seen a physician in a long time, couldn’t concretely say whether or not you have an un-DX’d illness or a some sort of other malady possibly lurking about. Remember, your health is the sum total, at any given time of ALL the factors you have, both genetic and congenitcal (what you are born with) and the your behaviour (what you eat, drink, smoke, don’t smoke, fuck, don’t fuck, occupation, living location and arrangement, marital status) modify those genetic cards you’ve been dealt.

            Prevailing on benefits is a given, but just because one is young, does not mean that the presumption of prevailing on benefits at an older age is set in stone. What if you develop diabetes (very expensive) or another chronic (preventable condition) at an early age? Just because you are a blank slate does not guarantee you will not prevail on benefits sooner for medically unnecessary, elective procedures.

            Your dad is much less expensive than a ten year old girl who needs a double lung transplant.

            1. That ten-year-old girl really shouldn’t smoke so much.

        3. Give me a 53 year old with an excellent health HX and consistent, conservative health habits over some 20-something with a HX of risky sex, a myriad of STD’s, and prone to dangerous behaviour,

          That depends on what you want that person for!!

        4. Sexist! (I was for that term before I looked it up.)

          1. ( I did think it was for someone pro-sex, my bad….. )

        5. But can I chose which gender I report with? I’m not saying I want to get a rate different than my biological gender to simply defraud anyone. Nooooo. I just identified as a different gender on that day of paperwork.

          You know. Sex and gender are such a blurred line and all that.

    3. ^This. ‘Old’ has been a medicare underfunding/over-promising problem for a long time.

    4. Its especially absurd to say that the enrollment is weighted toward the old when nobody over 65 is buying exchange policies, because they all have Medicare. In fact, its illegal to knowingly sell someone on Medicare an exchange policy.

  8. My god, who could have seen this mess coming?

    Oh, right. Shikha Dalmia did. Over seven years ago:

    “But ultimately this public option will not be sustainable because it will set in motion a downward spiral in which the more it grows, the more it will raise the costs of private plans. This will drive patients out of these plans and into the public plan, which, in turn, will grow more and eventually drive the private plans out of business.

    How will the public plan sustain itself once it has killed the very host it is feeding off? Essentially, by embracing a taxpayer funded, government-run, single payer system.”

    https://reason.com/archives/200…..n-horse-fo

    1. The only thing she might have missed was that the death spiral was baked in with or without the public option.

      1. Can we please stop using the term “baked in”? Please?!?!

        1. Alright, fine.

          ObamaCare was marinating in death spiral with or without the public option

        2. In most shops the goods are ‘infused’ with the goodies.

        3. In most shops the goods are ‘infused’ with the goodies.

          1. I wonder why I’m seeing double.

    1. Yep, I watched that coughing fit. At first I just thought it was allergies, then it kept going. I’m thinking she’s probably got a cold and knows that admitting it will remind everyone that she is old and not in the best of health.

      1. The only reason, and I mean the *only* reason you’d bring up the health of a septuagenarian woman who may preside over the next eight years of national politics is because you’re a raging misogynist.

      2. illocust, you need to catch up, my friend. These prolonged coughing fits date back months, if not more. Its not a cold or allergies.

        Start listing her apparent health problems, and it starts looking like maybe she missed her window of opportunity. She just isn’t fit, in the health sense, to be President.

        Prolonged coughing attacks.
        Weakness, balance problems.
        Surgery on her tongue.
        Her admitted significant loss of memory due to a blow to the head.
        The swelling on her neck (which seems to be under control now).
        The additional weight she put on last year in a pretty short timeframe (may have lost some of it, may just have a better tailor.
        Possible incontinence (she had leave in the middle of a debate to use the restroom).

        Individually, probably not that much of an issue. Taken as a package, this is not a healthy woman who is likely to stand up to the strain of the office.

        1. She just isn’t fit, in the health sense, to be President.

        2. I have no problems with letting her be.

          The way I see it is this election is Trump v. Kaine v. Johnson v. Stein.

          In Hillary v. Mother Nature, Mother Nature is going to win.

        3. … Not to mention her PTSD from dodging sniper bullets in Bosnia!

    2. LOL at the link tagline. Even Slate’s going along with the “Hillary’s health sucks” narrative.

  9. The left has two ideas to overcome the adverse selection death spiral and create self-sustaining exchanges. Reinhardt’s suggestion is to embrace the Swiss model, which involves imposing very stiff penalties on insurance scofflaws and then enforcing them harshly by garnishing wages. The other idea is creating a public option or a non-profit government-run insurance plan that would compete with the private underwriters on the exchanges and bring down prices.

    1) Withholding for insurance premium payments? Brilliant.

    2) A true “non-profit” model, as in: massive financial losses in perpetuity.

    I’m sold.

    1. It will be #2, because with #1 everyone will be pissed whereas in #2 people won’t realize how screwed they are until it’s too late.

  10. The fruits of central planning smell….

    1. . . . like the dung they were fertilized with?

  11. Reinhardt’s suggestion is to embrace the Swiss model, which involves imposing very stiff penalties on insurance scofflaws and then enforcing them harshly by garnishing wages.

    So, vastly increased unemployment/underemployment, a huge increase the labor black market, a corresponding decrease in tax revenue with a matching increase in government handouts… what could possibly go wrong? Also, fuck off slaver.

    1. But “We are all immigrants” and “BLM”! Yeah, funny how they create fewer consumers purchasing goods with their own money and increase “consumers” purchasing goods with other people’s money and think that should work fine? Then they are surprised it doesn’t.

  12. RE: Obamacare Needs Emergency CPR

    This is not true. Obamacare does not need emergency CPR. It needs about 20 trillion dollars of the little people’s money. That is a modest sum when one realizes the joys Obamacare brings. First, as Comrade Lenin, may his name be blessed, believed that healthcare is key in controlling the masses. He was correct. The untermenschen of this country cannot have enough control if our obvious betters are to enslave us properly. Healthcare is a good way to do just that. Being uppity and questioning your obvious betters? No insulin for you. Making counter-revolutionary statements? No surgery for you. Putting a mustache on a picture of Dear Leader? No hospital food for you. Obamacare also eliminates the painful and cancer producing process of thinking what doctor you can have or what hospital you choose plus other decisions that cause pain and suffering. So let us all dig deep in our pockets once again so our ruling elitist turds can enslave us more.

    1. I think we should take a tip from Trump and simply bill (and seize as needed) Mexico’s money. Not like they are a poor nation (they are not). Let’s just simply bill them for every dollar we commit to above what we take in from low taxes and see how long they keep sending Mexicans to the US? (Who do YOU think are the majority of “immigrants” here?)

  13. There’s another problem with imposing stiff penalties on insurance scofflaws: SCOTUS ruled that the “tax” is not a penalty because it’s not all that onerous and doesn’t force people to buy insurance. If it becomes so onerous that most are forced to buy, it would run afoul of SCOTUS’ ruling in the same case that government cannot force people to buy a product.

    1. Nothing that a new SCOTUS ruling can’t fix!

    2. There’s another problem with imposing stiff penalties on insurance scofflaws: SCOTUS ruled that the “tax” is not a penalty because it’s not all that onerous and doesn’t force people to buy insurance. If it becomes so onerous that most are forced to buy, it would run afoul of SCOTUS’ ruling

      The genius of John Roberts. He knew it would die of its own accord and with the ‘penaltax’ it couldn’t be saved by jacking up the penal part.

      1. I don’t see how it’s genius to punt the ball further down the field when more ‘conservative’ justices have died off and been replaced.

  14. ITS SOCIALIZED MEDICINE THAT WAS PURPOSELY BROUGHT IN TO FINISH OFF HEALTH CARE..

    Buy a vowel!!!!!!

    1. I want to buy a consonant and a vowel. “FU”

  15. The problem with health insurance is that it is cheap as long as you are a good risk and really don’t need it. The moment you become a bad risk, it understandably becomes more expensive. The trick is that you have to buy it when you are a good risk so that you can effectively pay ahead and make it affordable when you are a bad risk.

    People of course do not always do that. Not everyone has the money or the good sense to buy in early when they are a good risk. Most people however do and did. The problem is what do you do with the ones who didn’t.

    If you look past the deeper psychological issues Progs their deeper compulsion for control, this disaster is the result of Progs and other right thinking people having a complete panic about the fate of a very few people who didn’t buy insurance when they were a good risk and ended up being a bad risk without it. Remember, not all of the “uninsured” are bad off. Some of them are just people who are a good risk and just fine without insurance and either may never be a bad risk or will end up buying insurance before they are. So it wasn’t the uninsured as a group that this program was supposed to address. It was this smaller subset of people who didn’t have insurance and couldn’t buy it because they were already sick or a bad risk.

    They basically destroyed our entire health insurance system in some idiotic panic over a very small group of people. More than anything, the people who supported this law are retarded.

    1. They basically destroyed our entire health insurance system in some idiotic panic over a very small group of people. More than anything, the people who supported this law are retarded.

      Obummercare never would have had the support it did if all the retards hadn’t bought into the fallacy that insurance = care. In this instance, people conveniently forgot that insurance is nothing but a hedge against disaster?it’s what you buy in case the really big shit happens to you. Otherwise, you budget for your health care costs just like you do everything else that is essentially a cost of living: your mortgage/rent, car payment, groceries, utilities. And if you cannot afford those basic costs and/or insurance, hmmm . . . let’s see, what other hedges are out there? Oh, yeah, charitable care, fundraisers, family and friends, payment plans, pro bono care givers, etc.

      Why no one understands this?and why the conservatives don’t have the balls to say it?is beyond me.

      1. But, but, but! How else can the dumbshits that vote “D” get more money? What “value” does a Wellpoint or Blue Cross or Kaiser or United Healthcare bring to the table? I know EXACTLY how they work and still cannot decipher a way they ACTUALLY bring value to the table? Thus, why do they exist?

        Insurance companies should be for the things we don’t think will actually happen, or which don’t matter that much. With 7B people on the planet, it’s NOT that important that EVERY human get a multi-million dollar (fill in the blank here) operation. In fact, even those who HAVE received the aforementioned care are, in fact, worthless. This fuse was lit a long time ago. We are heading to 10, 20, 50, 100B fast enough. Stop trying to pretend that SOME matter more than others? Neither matters, stop penalizing the living for living.

      2. Yep.

        The unfortunate part is that “hey, if you’re uninsured just budget for healthcare or take on medical debt” might have been a winning argument back in 2010, but in 2016 we’re reaching the point where avoiding debt is being pushed as a human right by the left (see: college) and services that cost more than the electric bill are being socialized under the premise that large expenses are icky and unfair (see: college) so it’s really not on the table anymore that there’s such a thing as acceptable levels of medical debt or large household budget items.

        1. And it only enters the realm of “huge debt” because of government meddling. The process involved to get electricity to my home is way more complex, involving way bigger brains and way greater dangers than the process involved when I see a doctor for 15 minutes a couple times a year to do some blood work, listen to my heart, and ask me if I’m sleeping okay. And yet my electric bill runs me $50?$60 bucks a month, but my insurance premium is six times that?

          Okay, I get cancer, I understand that’s a shit ton of $$, but, again, that’s what catastrophic health plans are for. Growing up, that’s all we had. A small monthly premium to cover the big stuff, but when my brother and I got sick or broke a limb or whatever, my mom took us to the doctor and wrote a check when they were done patching us up. And my parents fell squarely into the lower middle class blue collar end of the economic spectrum.

          At some point, that changed. And screwed us all.

      3. To an extent yes, but under ACA, those first dollar costs are not being paid by anyone so minor conditions are now growing into the big s%^t.

    2. Worse yet, they were trying to help a very small group of people (the sick) but ended up helping a different very small group of people (cronyist elites in the health insurance and healthcare industries, most of whom will be paid huge salaries and bonuses even while their corporations are losing money, i.e., shareholders take the hit).

  16. Re: “The mix of people enrolling is disproportionately weighted toward the sick and old rather than the young and healthy. Not enough of the latter are choosing to enroll”

    I’ll bet most of those choosing not to enroll are young healthy men.

    At Male Matters USA, see:

    “Does Obamacare About Men? Three takes on Obamacare’s discrimination against men” https://archive.is/ZVUtE

    1. They may also be able to do math?

  17. OK until the end: ” [President Obama] should be worried. Very worried.”

    Why should he worry? He won’t be affected by this catastrophe – he’ll be way too rich to care what happens to the plebs. About whom he didn’t give a hoot previously, doesn’t now, and won’t in the future. We are ungrateful rubes, or racist self-seeking morons, just taxpayers to be harvested. Everything Obama said about his wonderful plan, from the first word to the last, has been a lie, a damned lie, and he never gave a shit if we believed him or didn’t. So he was caught lying: did that bother him? Did it have any consequences? Until we start a tradition of hanging failed leaders from lampposts, Obama has nothing to worry about. He stood in front of the nation and lied, repeatedly, purposely, and half the electorate would vote for him again tomorrow. We should be worried, but Barack Obama doesn’t need to be worried. You can be very sure he isn’t and won’t be.

  18. RE: Liberals Have No Clue How to Fix Obamacare

    Of course liberals have no clue how to fix Obamacare. That’s because they are not radical enough. The only people wise enough to fix this God send are socialists. The only way to fix Obamacare is to extort more tax money from the little people to the tune of at least $20 trillion dollars. That’s a modest amount considering healthcare is a great way to control the untermenschen of this country. This wise concept can be achieved by taxing the people of this country to a modest rate of 100% for a period of hundred years. This way Obamacare can cure all ailments, and if there is anything left over, our enlightened ruling class thugs can throw the masses a few crumbs in the way of having tents for hospitals, distributing some out-dated aspirin and moldy food for patients. This is a win-win situation in which we can all appreciate and embrace. All it takes is money which, as we all know, solves all problems.

  19. Could have been:

    “Liberals Have No Clue….” and we would have all understood the truth of it.

  20. All I know is this:

    If you are not looking for a way to “cash out” and move to an island, heretofore not known to the modern world, looking to drink all you want and bang natives until you die, then you really do not understand the problem. (Is that too long for an Epitaph?)

  21. The solution(s) are exactly what the Republicans proposed and the Democrats haughtily dismissed as “no ideas”. Change the rules and regulations of selling health insurance to match the ones for other types of insurance like for home and vehicle insurance.

    That would help cut costs by not requiring an insurance company to have a physical presence in each State they want to do business in. It would cause a big shakeup in the insurance market and would actually increase competition. Convenience and lower costs would get many younger and healthier people to buy insurance, especially if plans were offered that built value over time – increasing the available payout for eventual need.

    The other big one is tort reform. Put limits on malpractice lawsuits and get rid of lawsuits for “malpractice” when injury or death is due to unforeseeable circumstances like a person being extremely allergic to a drug they’ve never taken before, or traumatic injuries, only discoverable on the operating table, that cause complications or death.

    If suing for malpractice was limited to cases of genuine negligence by a hospital or physician, such as leaving things like scissors inside the patient or performing a procedure on the wrong limb, or sending a person home without antibiotics when she’s ripped open a leg in filthy water, malpractice insurance costs would go down, reducing the costs passed on to the patients.

    1. There’s the drawback to hiring Shika to use Mein Kampf as a political dictionary. The technical term is looter, not liberal. The only ones who read stuff shrieking against “liberals” are Republican infiltrators and other socialists.

  22. What makes us think that anyone dumb enough to pass a law to find out what’s in it would be able to fix it?

    1. “We have to fix the bill so you can find out how we planned to fix it.” – Pelosi 2017

  23. “Liberals Have No Clue How to Fix Obamacare”

    Do they have a clue how to fix anything? I’ll wait.

    1. An election?

  24. Almost from the beginning, there have been voices on the Right claiming that Obamacare was designed to fail and thereby bring about a National Health AKA Single Payer. Sometimes I agree, at least a little, nut I think there is a likelier explanation. Obamacare was designed by people who do not understand economics, and can’t because of their religious belief that “experts’ can plan an economy better than free trade can. They did more or less the same thing to the real estate market; a bunch of well meaning fool decided that lenders not lending to people with dark skins because they had no realistic chance of paying the loan was A Bad Thing. They created conditions that forced lenders to make unwise loans, the lenders scrambled about trying to deal with the attendant risk, and eventually the whole mess went book … and the people who started it were genuinely surprised.

    If the people who built Obamacare were as smart and educated as they claim to be, then Obamacare’s failure would draw legitimate inferences of planned failure. They aren’t. They are’t really all that smart, and their education has been mostly Progressive/Liberal bushwa.

  25. Obamacare tried to remake a sector that constitutes one-eighth of the economy from the ground up.

    The fact that health/medical is one-eighth of the economy should be as repugnant to anyone rational as the delusion that a wanna-be-socialist thinks he can wave a wand and plan it.

    Thirty years ago, healthcare spending was one-sixteenth of the economy. It was about one-twentyfifth of the economy in 1960. Has ‘healthcare’ really become more important/valuable to Americans in that two generations?

  26. liberal solution, two words: single payer.
    that means that all of you get to pay much, much more to get much, much less, if anything at all, and it all goes to corrupt bureaucrats and well connected louts and non workers who get everything.

    that’s living the dream. they’re making real progress.

  27. No reason for Obama to be worried, very worried. He’s out there in a few months. WE should be worried, very worried.

  28. “There is a problem with the risk pool,” he admits.

    Yeah, and the problem is that a “risk pool” doesn’t make any sense: people with below average risk for the risk pool are not going to be willing to pay for people with above average risk.

    Contrary to the bizarre beliefs of the Obama administration, “insurance” is not an averaging of risk in a pool; rather, insurance is a process of turning a possible large loss into a certain small loss; and the certain small loss is slightly larger than the probability of the large loss multiplied by its amount (i.e., the risk).

    1. No. The problem with the Obamacare ‘risk pool’ is that is not really a ‘pool’. It was simply combining everyone who can’t get insurance because they are already sick with people at the other extreme who don’t want/need insurance at all and forcing the latter to pay for the former. The vast majority of healthy people (people on employer-paid plans) were left out of that pool altogether because pols didn’t want to change the status quo that much.

      The only way a medical risk pool can work is if EVERYONE is in the same risk pool – Medicare over-65’s, the employed with benefits, everyone else. Where the role of the federal government is only to be a back-end reinsurer/actuary for the insurers/employers/states/hospitals who offer the front-end ‘plans’ to people.

      This is actually a constitutional function (interstate commerce). And it is necessary if there is truly a will to avoid people simply dying because they can’t access care. And while libertarians may disagree about the latter ‘need’ (and have never offered any solution either), libertarians are truly a tiny minority on that. The main reason none of the political options include this simple reinsurance function is because it doesn’t let pols take gobs of credit for visibly solving something.

  29. This would be tantamount to creating a single-payer system?a government-run monopoly. And the only thing worse than a private monopoly is a state monopoly. Indeed, single-payer systems in countries like Canada and Denmark only stay afloat by dipping deeply into public coffers and/or rationing care?defeating their whole purpose. Even if the left tried, it’ll be nigh impossible to pull this off in a debt-ridden country already careening toward a massive entitlement spending crisis.

    Actually, it should be very easy to pull off, and without raising taxes: more than half of US per capita health care spending is spent in the US public health care system. Canada and Denmark spend about half as much per capita as the US. Therefore, what the US currently spends in our public system alone should be sufficient to give us a Canada/Danish-style universal health care system, with no additional taxes at all.

    1. When someone says that a massive change will be easy, it means it’s easy if you live in a dictatorship, or it’s not easy at all. If you can just magically take a load of money away from other people, your task will certainly be made easier. General Practitioners make about $110k in Canada, a smidgen more in Denmark, and about $165k in the USA. Will it be “easy” to take away 1/3 of the income from a prosperous and well-organized group of people? How about nurses? The differential is about the same. Maybe your “easy” solution will be accompanied by a whole raft of cultural changes that will make them eager to swallow the massive pay cut. But I really doubt it. You will run up against a large, politically involved, well organized bunch of people and it won’t be “easy” to chop their incomes. And guess what, those incomes represent a huge chunk of health care spending.

      Or you could institute a dictatorship and decree lower incomes. Would that be “easy” too?

      1. you’re right . But the big elephant is not GP’s. It is specialists. eg cardiologists in Denmark/Canada/France earn about $150 – $175k a year. A cardiologist in the US will earn about $375k – and can pretty easily get to $500k if they market themselves heavily in the ‘get a second third fourth opinion’ arena.

        And because those countries have a serious ‘gatekeeper’ function for their GP’s, they can have far more GP’s per 100k population than we do – but far fewer specialists. Because we don’t have that (our GP’s are mostly overworked assembly-line monkeys with way too many patients), Medicare and other govt programs have been a complete windfall for specialists. It’s no accident that ‘specialist doctor’ employment has grown at about 5x the rate of ‘general/family doctor’ employment for the last 40 years or so.

        Any ‘change’ designed to lower costs would have to deal with both a)reducing specialist income by 30-50% or so and b)converting about 50% of those specialists to general practice.

        1. That sounds sensible. And, as Rational Exuberance notes, it should be very easy to pull off.

  30. The law was designed to fail so the Regressive Left can swoop in and expand Medicare to cover everyone, require all doctors to accept all medicare patients, ration care and impose dietary choices.

  31. These reprints from the looter press show the need for educating writers as to the definition of liberal. The word is in the dictionary, and it means a cowardly libertarian. Liberal as pronounced by Republicans is copied from Mein Kampf, where in 1924 it means what Republicans have meant since 1932, when they helped the NSDAP gain power through the Herb Hoover Moratorium on Brains and War Reparations. Libertarians and Australian Liberals can say abt Obamacare what FDR said about the prohibition-wrecked economy before Inauguration Day: “It’s not my baby.”

  32. Obamacare has become such a quagmire that the proposed “fixes” may create an even bigger mess.

    Obamacare IS a proposed “fix” to a government-created quagmire. The solution to our medical costs problem is for government to fuck off and allow competition for medical services and insurance.

    -jcr

  33. First, THE problem here and elsewhere is that everyone thinks that everyone else is stupid. Second, anyone that talks about health care as a traditional problem with a fix or a solution IS stupid.

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  35. They know exactly how to “fix” it; single-payer healthcare, a nice top-down national healthcare system. That is how this will end, whether Clinton or Trump becomes president – because “Gary Johnson can’t win” and he is giving the powers-that-be plenty of ammunition to shut him out.

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