Sunday, September 18, 2011

Sunday Question for Liberals

So how are you feeling now about the ACA? We're about eighteen months in now, although of course much of it, including the most important parts (the exchanges/subsidies) still haven't been implemented. So what's your assessment at this point: Major accomplishment? Disappointment? Too soon to know? Good, but overrated?

How, if any, has your sense of it changed since it was passed in March 2010?


  1. Delaying implementation was a mistake, but assuming no SCOTUS intervention, I still think it was a monumental accomplishment.

  2. I'm waiting to see the "affordable" part (long wait ahead). I view it largely as a politically-expedient sellout to the health care industry and pharma. It's not the solution. Attacks on health are will surely commence once Medicare, Medicaid and Social Security have been gutted.

  3. I still think it was a bigger and much better package than anyone could have reasonably expected Obama to win. That said, remembering it causes me to experience the same irritation I suffer whenever I think about the 111th: those "centrist," scared Democrats who screwed us out of a truly effective Stimulus and a public option. If Obama loses in '12, it's completely on the heads of Kent Conrad, Joe Lieberman and the rest of their crew.

  4. Mainly I'm concerned it will be repealed. I'm somewhat concerned it will do less than advertised, but it will still go down as Obama's signature accomplishment. Unless Republicans control all levels of government in 2013 and repeal it.

  5. I'm very satisfied with it. I think it's a huge step forward from the current system and will dramatically increase access to the health care system while controlling costs. I agree with Bruce Bartlett though that the Supreme Court needs to rule on it sooner rather than later because right wingers are delaying implementation of the exchanges and subsidy mechanisms at the state level.

  6. I think it's much better than certain liberals (*cough* Jane Hamsher *cough*) give it credit for, but as Bullied Pulpit said, delayed implementation was a huge own goal. Had the main features kicked in faster, it'd be like Medicare Part D, where Democrats fiercely opposed it at the time of debate but once it was enacted opposition became irrelevant.

    Also, too, since we were going to be called Marxist Nazis anyway, we might as well have just gone all in on single payer, essentially expanding Medicare to all citizens.

  7. Addressing the health care problem was a huge step. This is a singular achievement. But...

    Doing so in a way that is sure to increase premium rates and guarantees both a profit margin and additional customers for insurance companies was a huge mistake. We should not have built more cost into our system.

    If it had been implemented sooner, which probably wasn't feasible given the amount of changes necessary (especially with the state exchanges), Obama would have guaranteed failure in the coming election, because the initial response of the market will be to raise premium rates significantly.

    You think people are complaining now, wait until 2014...

  8. A big accomplishment, but I do worry that it will be repealed or that the GOP will undermine the subsidies for people to buy insurance. I'm not as exercised about the "subsidy for the insurance companies" aspect. It's not the final word in controlling health care costs, but it's a good first step.

  9. Less than I had hoped for, but better than it could have ended up being. The other day, I read a story about a woman who would be dead if the $1M cap hadn't been pulled off. It's helping people and conservatives still hate it like death. That's in positive territory in my book.

    I also understand that Dems had a very narrow window of opportunity with which to pass this bill. A lot of us think Obama and the Dems gave up too much, but they accomplished more than any other Congress since 1965.

    If it holds up against the conservative onslaught, it will be one little turn of the ratchet back towards a progressive society. Usually the ratchet turns the other way. A future Dem Congress will be able to tweak it a little more. Maybe we'll have a public option in time for my daughter to opt in. But without the efforts of the 111th Dems, we would have nothing.

  10. I think it may be too soon to judge, these Acts are designed surely for the long term and to encourage long term growth and stability. If in another couple of years, there is still no progress, then you should begin to question. For now though, I would wait it out and see how it pans out.

  11. I'll go with it being a good accomplishment (tentatively- obviously not much will have been accomplished if Anthony Kennedy isn't convinced it passes constitutional muster). The ACA perhaps will become a framework on which a future, more comprehensive general health insurance program will be based. On the other hand, health care really caused the Administration to take its eye off the economic ball in late 2009, early 2010. They spent a ton of political capital enacting what is basically a republican policy and that will be the subject of relentless attacks. How ironic would it be though, assuming Romney is the nominee, if it's the ACA that allows Obama to case Romney as inauthentic and fake.

  12. People in general don't appreciate the effect the exchanges will have on care and costs (assuming we have a HHS Secretary that wants the law to work in 2013).

    While my head still thinks the only threat to ACA is a 5-4 Supreme Court overreach on the scale of Bush vs Gore or Citizens United, my heart still has this irrational fear that a GOP sweep in '12 would lead to them repealing the law. (And I mean Roberts would have to invalidate the whole law - just declaring the individual mandate illegal doesn't do the trick, as the economic model won't work for any kind of private insurance without the young, healthy customers paying-in.

    Now I don't think even the Republicans would actually go through with a repeal, because there's too much business interest in keeping the new customers. And if they did repeal the law, the Republicans will own every medical bankruptcy, every 40 and 50-something dying from lack of insurance because of pre-existing conditions, etc. Even a reasonably sensible America would get solidly in line behind "Medicare for All" before too long.

  13. I'd say ObamaCare is eventually going to go down as one of the most destructive own goals in US political history. To have hammered that thing through in the current economic environment, particularly in the manner in which it was hammered through, was a blunder beyond comprehension.

    As always, you go back to the beginning, to find the roots of failure. Putting that buffoon Waxman in charge of that House Energy and Commerce Committee, and dethroning Dingell, was the blunder that started it all... and the rest of the blunders cascaded from there. There is no chance Big John would have kicked out a bill without the necessary broad support in both houses (and he would never have poisoned the well with the preceding Cap & Tax vote foolishness).

    Waxman's eventual House bill was absolute junk, and the Senate honorables trashed it completely, and substituted an immature bill that I don't believe any of them truly thought would ever go through to final passage, as presented. But it did get passed, in Pelosi's seppuku moment.

    Oh how those senators must regret that vote. They're going to regret it even more in November 2012, or at least 5-10 of them will.

  14. I wish people like the previous commender would spare us his fake outrage over the allegedly outrageous way in which this law was passed. There were extensive bipartisan negotiations and the republicans refused to agree to anything, even though the final product was a CONSERVATIVE solution to the problem of health care access. The notion that Obama and the dems were foolish to address the crisis of health care access in America is just nihilist. Yes, politically, it would have been better to use the congressional majorities to push more fiscal stimulus, but I absolutely applaud them for taking on the issue and proposing a viable remedy. The republican answer on health insurance- namely 1) letting everyone buy cheap, crappy, unrelgulated plans; and 2)telling people who can't afford coverage to save money for future treatments in HSAs- isn't an idea, it's a bromide to avoid talking seriously about an issue when all you've got is Ayn Rand, Horatio Alger, and religious faith that capitalism will eventually help the poor.

  15. I think we need to do something about the uninsured and the ever-rising cost of healthcare, but the ACA won't get the job done.

    Under the ACA, more people will get better coverage, and the private carriers will get to keep their profit. Everybody wins! Or maybe not.

    Unless we see a massive influx of healthy premium payers (which is not likely), then the more-coverage-for-more-people plan can only mean one thing: higher premiums for everyone, including the employers. The Medicaid expansion and the tax subsidies for those under 400% FPL are just entitlements that don't do anything to lower the underlying costs--which is the real problem. (Look what's happening in Mass. to get a preview: premium rates rising faster than national average & the newly insured still using ERs as primary care physicians.)

    While the idea of tackling the healthcare crisis was laudable, the method is bound for disaster.

  16. As a conservative, this thread is an interesting Rorschach Test for the last Great Society frontier. Excluding the two hostile Anonymous comments, there are 13 more or less positive comments, of which less than half (6) say the ACA is generally an important accomplishment. Interestingly, only 2 out of 13 said ACA would noticeably increase access or reduce costs, with one other person saying the country would become more progressive.

    Within generally positive answers, you also have several criticisms, including: took too long/poor focus (4 comments), likely repealed (2 comments), and then one each for: sellout, screwed by moderate Dems, too costly, mean old GOP, and no single payer.

    Perhaps the most interesting thing, though, is the one positive comment no one makes: the ACA will improve my family's health care quality/cost/access. When one considers that the respondents to a thread like this should tend to skew both progressive and prosperous, then if even they don't self-identify as beneficiaries of ACA (instead pointing to general ideological accomplishments), it should come as little surprise that the vast remainder of the American landscape, not sharing the progressive ideals of the respondents to a thread like this, will instead react to how the ACA doesn't help - and quite plausibly hurts - them.

  17. I wish people like the previous commender would spare us his fake outrage...


    Um, I think if you check, you'll find that the mainstream of the country are the ones outraged, which is what makes ObamaCare one of the most destructive own goals in US political history.

    Hopefully, you won't wrench your back, patting yourself over it, but I wouldn't look for mainstream America to do much patting. I'd expect them to deliver another sound electoral thrashing in 2012, ObamaCare being a prime reason for same.

    There is an out here. If Obama called for ObamaCare's immediate repeal, he could retake the initiative, both politically and policy-wise. And he'd likely get as much or more of what he wanted out of that route. It very well might cement his reelection.

    He's just not that bright, however, and it'd take much more than this dim bulb to execute such a strategy.

  18. I think it's an acceptable third best alternative to a true national health care system like in Canada, Great Britain, France, etc.

    As somebody who buys insurance on the individual market, I'm annoyed at how long it is taking before the exchanges go up.

    Assuming the ACA survives the GOP assault on it in the courts and in the next Congress, I believe it will turn out to be a useful step forward that lays the groundwork for future improvements that will bend the cost curve. By relying so heavily on private insurance, it will reduce costs much more slowly than it could have. But that apparently was necessary to get anything passed.

  19. Ron E - How do you figure any costs will be reduced by the ACA? What mechanism is in place to reduce costs?


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