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Obamacare is the law; fix program’s damaged pieces



Published: Fri, November 1, 2013 @ 12:00 a.m.

To say that the Patient Protec- tion and Affordable Care Act, more commonly known as Obamacare, made a less than stellar impression during its rollout last month may well rank as the greatest understatement of the year. Many consider its debut a disaster. Consider:

The launch of the ACA website took place on the same day as the start of the massive 16-day shutdown of the federal government, caused largely by controversy over Obamacare. Governmentwide confusion couldn’t help but spoil the coming-out party for the nationalized health-care network.

Throughout October, millions of would-be registrants for Obamacare encountered delays, crashes and agonizingly slow responses from the healthcare.gov website, further aggravating confusion and anger over the ACA.

In late October, millions of Americans were stunned to learn that their current health insurance would be canceled because of ACA, a direct contradiction of a vow repeatedly made by President Barack Obama.

As a result of these and other missteps, miscues and misinformation, many Republicans are clamoring for the resignation or firing of Health and Human Services Secretary Kathleen Sebelius amid renewed calls for repeal of the ACA.

Neither canning Sebelius nor trashing Obamacare makes sense politically or for the long-term and sensible goal of providing health insurance to the vast majority of Americans. The underlying premise of Obamacare remains credible, and Sebelius, sometimes referred to as the Cover Girl for the program, deserves an opportunity to repair the system so that it can meet its noble goals.

APOLOGY FROM HHS LEADER

We commend Sebelius for her forthright recognition of the problems with the website, her acceptance of responsibility and her pledge to make improvements. “You deserve better. I apologize. Hold me accountable for the debacle” she said in testimony Wednesday before the U.S. House Energy Commerce Committee.

Sebelius and other decision-makers with HHS do merit criticism for acting too hastily in launching the website, particularly given new revelations that the Obama administration rushed headfirst into the Oct. 1 launch despite repeated warnings that the site was not ready for millions of potential users. An internal government memo, written days before the website opened, warned of a “high” security risk because it hadn’t been adequately tested.

Though Sebelius deserves and accepts blame, the Ohio native does not deserve to be booted from her Cabinet-level position that makes her the chief watchdog over the program. Years of knowledge and experience she has gleaned would be lost, thereby potentially opening a whole new can of worms for the troubled ACA.

Nor does she deserve the mean-spirited ad hominem attacks by Republicans such as Newt Gingrich who on Wednesday called the HHS secretary a bigger liar than former President Richard M. Nixon.

Political grandstanding

Such hyperbole and political grandstanding will not serve a crippled Republican Party well as it stands on the threshold of critical 2014 congressional elections. Nor will it serve any useful purpose in repairing the obvious flaws in Obamacare.

But Republicans are not alone in their need to tone down exaggerated rhetoric about the health care law. Some Democrats, including President Obama, have been guilty of overselling the program.

In a speech Wednesday night in Boston, Obama acknowledged that his earlier proclamations that no one would be cut from their current health-insurance policies were not completely true. He said the millions of Americans who have had their insurance canceled had “cut-rate” policies that did not provide adequate coverage when people got sick.

The Affordable Care Act requires certain types of minimum coverage and ends discrimination that has led to higher costs and cancellations for women and people with pre-existing medical conditions, the president explained. He also noted that the Massachusetts state health-care reform law, upon which ACA is modeled encountered a number of annoying bugs during its initial rollout.

WHAT CONGRESS SHOULD DO

Clearly both political parties have some fence mending to work on in coming days and weeks. The president, his party and his administration can start by being completely open and honest about the provisions of the extremely complex health care system. Republicans can tone down the rhetoric, abandon calls for Sebelius to quit and end their time-wasting efforts to abolish the program in its totality.

Both parties then should come together amicably to diagnose and cure ongoing flaws with Obamacare. In doing so, the Affordable Care Act can still have a viable chance of fulfilling its honorable promise of reduced health care costs and improved access to quality medical care for the vast majority of Americans.


Comments

1questionreality(213 comments)posted 9 months ago

Had we just fixed certain pieces of the absurd procedure based healthcare system we have endured to date, the complex ACA would not have been necessary.

Today, at the urging of your insurance company, you arrange for a preventive colonoscopy because you are told it will be covered at 100%. Then, afterwards you find out the anesthesiologist is out-of-network and the doctor uses a non-preventive billing code because you told him you phart 5 times every day between 7AM and 8AM. The patient now gets stuck paying the whole bill. It is absurd!

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2ColeK(5 comments)posted 9 months ago

Obamacare is not simply an ineptly implemented policy. Its flaws are fundamental. The law should be judged not on the muzzily beneficent intentions of its supporters, but on its real-world consequences. They have already proven disastrous, and promise more disaster ahead.

The purported goal of Obamacare was to increase the number of people who have health care insurance. But not any health care insurance. That insurance must meet a standard set by distant government bureaucrats. Any policy which deviates in the least from that standard is forbidden by law. That feature of the law is the reason why millions—yes, millions—of Americans are being informed that their current policy will not be renewed. If the Obamacare policies were truly preferable, as the President says, to those now held by millions of Americans, why would the government need to invoke the force of law to forbid the old policies?

No, millions of people had to be forced out of their old policies so that they would spend more in the purchase of new policies via Obamacare. Only by doing so could the government get enough surplus revenue (from inflated insurance prices) to cover the increased expenses of covering all the people whom it forced insurance plans to sell policies to. This was the plan from the beginning; it was an essential part of the law. The President's and his Democrat supporters' repeated promises that we could keep our health care plans if we like them was not merely incorrect. It was not simply, as the Vindicator suggests, "not completely true." It was false, and known to be false every time it was uttered. It was a bald-faced lie, contemptuous to the people. It was a lie necessitated by the fact that the law could not have been passed absent that repeated lie. It is as if the president and his allies have spit in our faces, and now tell us that it is raining.

Perhaps there is a scintilla of justice in resisting calls for Secretary Sebelius to be sacked. It's certainly true that she is not solely responsible for this fiasco. Tim Ryan and every other Democrat who voted for it, as well as the President who signed the bill into law—not one of whom actually read the 2000 page monstrosity—share in the guilt. But if an executive had the duty to oversee a project of hundreds of millions of dollars, and it failed completely, in what sense can she be said to "take responsibility" if she is allowed to keep her job?

The law was built on an economic fantasy that 30 million people could be added to insurance roles, insurance prices would go down as much as $2500, and "not a dime" would be added to the budget. It was passed on the repeated lie that it would have no adverse effect on those who are insured via the job or on those who purchase individual policies. Obamacare cannot be improved by tinkering with a few incidental features. It is a rotten tree which bears only bitter fruit. It must be overturned, root and stock.

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376Ytown(1212 comments)posted 8 months, 4 weeks ago

Contrary to belief, Republicans do have health care solutions:

-Expand affordable insurance options for all Americans, but not in a one-size-fits-all way.
-Protect people with pre-existing conditions, so they are not denied insurance coverage through no fault of their own.
- Health care should be as decentralized and regulated as close to the people as possible, not run by Washington mandates.

- Protect the coverage Americans like, but also expand affordable individual-based options for those who seek new and more affordable plans.

- Preserve and improve Medicare for our seniors by giving them better options and more choices.

- Strengthen the safety net for the poor and disabled by giving governors flexibility to provide higher quality, innovative services for the most vulnerable. And ensure medical research continues to find cures for challenging diseases like cancer, Alzheimer’s, and diabetes.

- Allow consumers to purchase insurance across state lines.

- Allow states to experiment with managed care, streamline the waiver process, and provide states financial incentives to offer better and more innovative care models to those most in need.

- Medicare reform that provides seniors with more choices and options to select the kind of health care plan that best fits their needs, while guaranteeing that this important safety net will be there for future generations.

- Simplify the current complex system of deductibles and co-payments and offer new catastrophic protection. Part of this includes medical liability reform.

- Fix the broken Medicare physician payment program – also known as the Sustainable Growth Rate. Put the emphasis back where it belongs – on our patients and their doctors.

- Find cures and treatments for stubborn diseases that rob family and friends the fullness of life.

- Craft legislation to foster innovation in mobile medical applications and health information technology. The result would be improved patient care, lowered health care costs, and new American jobs.

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4djgolf(5 comments)posted 8 months, 4 weeks ago

This is probably the most irresponsible Vindy editorial of the year. The law has been flawed from the outset and yet media continues to flame the blame game. I guess Republicans had a conspiracy theory to shut down the web site and double most peoples premiums to make the president look badly. The nation needs to face there were campaign ill directed promises, untruths and lack of preparation and analysis of the implications of this bill and simple repeal and start over.

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5Sensible(118 comments)posted 8 months, 4 weeks ago

Thanks to Ytown, we now know what Fox News says about republican's ideas for health care.
http://www.foxnews.com/opinion/2013/0...

The issue isn't a deficit of concepts or goals, the republicans do not have a plan to achieve the goals.

What is outlined by Fox and Ytown are some ideas, some possible solutions, but no concrete plan, nothing to execute.

I understand the Republican drive to retain individualism, but I’m not sure that hospital and doctors want to negotiate their fees with each patient (individualism taken to the extreme).

What I don’t understand is the opposition to a plan that republicans promoted themselves

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676Ytown(1212 comments)posted 8 months, 4 weeks ago

seriouslynow:
Actually Forbes... http://www.forbes.com/sites/theapothe...

And the article goes on to say:
Let's start with 5 comprehensive health reform proposals that have actually been introduced in Congress—some well before President Obama even was nominated for president, and all months before the House (11/7/09) or Senate (12/24/09) voted on what eventually became Obamacare.

Ten Steps to Transform Health Care in America Act (S. 1783) introduced by Senator Mike Enzi (R-WY) July 12, 2007.

Every American Insured Health Act introduced by Senators Richard Burr (R-NC) and Bob Corker (R-TN) with co-sponsors Tom Coburn (R-OK), Mel Martinez (formerly R-FL) and Elizabeth Dole (formerly R-NC) on July 26, 2007.

Senators Bob Bennett (R-UT) and Ron Wyden (D-OR) introduced the Healthy Americans Act on January 18, 2007 and re-introduced the same bill on February 5, 2009.

Patients’ Choice Act of 2009 introduced by Senators Tom Coburn (R-OK) and Richard Burr (R-NC) and Rep. Paul Ryan (R-WI) and Devin Nunes (R-CA) on May 20, 2009.

H.R. 2300, Empowering Patients First Act introduced July 30, 2009 by Rep. Tom Price (R-GA).

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776Ytown(1212 comments)posted 8 months, 4 weeks ago

and the article continues...

Comprehensive conservative Obamacare replacement plans

Likewise, conservative market-oriented health policy scholars have developed a rich menu of potential replacement plans for Obamacare:

Individual Pay or Play proposed in 2005 by John Goodman; this is a minimalist version of a broader reform envisaged by Goodman built on converting the tax exclusion into universal tax credits.
Health Status Insurance originally proposed by John Cochrane in 1995.

Universal Health Savings Accounts proposed by John Goodman and Peter Ferrara in 2012. This combines fixed tax credits with individual pay or play and health status insurance concepts along with Roth-style Health Savings Accounts.

Fixed tax credits. A variety of proposals have centered on using fix tax credits to replace the current inefficient and unfair tax exclusion for employer-provided health benefits. Two good explanations of how that would work are here:

James C. Capretta and Robert E. Moffit, “How to Replace Obamacare,” National Affairs, no. 11 (Spring 2012).

James C. Capretta. Constructing an Alternative to Obamacare: Key Details for a Practical Replacement Program. American Enterprise Institute, December 2012.

Income-Related Tax Credits proposed by Mark Pauly and John Hoff in Responsible Tax Credits (2002) and endorsed by the American Medical Association. More recently, 8 scholars from Harvard, University of Chicago, and USC–Jay Bhattacharya, Amitabh Chandra, Michael Chernew, Dana Goldman, Anupam Jena, Darius Lakdawalla,Anup Malani and Tomas Philipson—released Best of Both Worlds: Uniting Universal Coverage and Personal Choice in Health Care (2013) which also is built around a model of individual health insurance subsidized with income-related tax credits.

Flexible Benefits Tax Credit For Health Insurance by Lynn Etheredge in 2001.

Near-Universal Health Insurance Exchanges proposed in 2001 by Sara Singer, Alan Garber and Alain Enthoven (covers only non-elderly).

Universal Health Insurance Exchanges proposed in 2013 by former CBO director Douglas Holtz-Eakin and Avik Roy (covers Medicare and Medicaid in addition to privately insured).

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8SeriouslyNow(192 comments)posted 8 months, 4 weeks ago

@ questionreality you said: “Had we just fixed certain pieces of the absurd procedure based healthcare system we have endured to date, the complex ACA would not have been necessary”
Do you have a non-governmental proposal to do that?

@ColeK you said : “They have already proven disastrous”
Can you give a example of a disaster that has already occurred because of ACA?

@76Ytown you said:” Expand affordable insurance options for all Americans”
Great goal, now show me the republican plan that achieves that goal.

(My goal is to see Austraila this spring, but I have no plan to actually do it)

@djgolf you said: “This is probably the most irresponsible Vindy editorial of the year”
I respectfully disagree; when you have poor execution of your golf swing, do you try again with better technique or give up golf”

And you said (sarcastically) “Republicans had a conspiracy theory to shut down the web site”. I actually did get an email from a tea party group that suggested that it’s members get on the .gov website just to occupy bandwidth and hopefully overload the servers”.

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976Ytown(1212 comments)posted 8 months, 4 weeks ago

and the article continues with the argument that Obamacare was modeled on the Romneycare plan:

Romney’s visions for health reform was very different than the bill he was actually able to get through a Massachusetts legislature dominated (85%!) by Democrats. Indeed he vetoed 8 different parts of the health reform plan passed by the legislature—including the misguided employer mandate that is now creating so many headaches under Obamacare—but each of these was overridden. Mr. Roy also has patiently explained how Romney’s successor, Deval Patrick further gutted Romneycare’s market-oriented features.

When Obamacare passed on March 23, 2010, the RealClearPolitics poll average shows 50.4% of Americans opposed and only 39.7% in favor. And this double-digit margin of opposition was by no means unusual. One year later—despite the firm assurances by President Obama and then-House speaker Nancy Pelosi that the public would come to favor the law once it was passed—opposed stood at 52.3% opposed to 39.7%. Even today, Americans remain opposed 51.5% to 39.5%. In light of these figures, one can reasonably inquire which party was more faithfully representing the views of the public when it came to health reform.

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1076Ytown(1212 comments)posted 8 months, 4 weeks ago

seriouslynow: "I understand the Republican drive to retain individualism, but I’m not sure that hospital and doctors want to negotiate their fees with each patient (individualism taken to the extreme)."

To understand that concept, you need to understand Consumer Driven Health Care (CDHC) which has been around for about 10 years and puts the patient in the driver's seat. There is a huge difference in health care cost which most people do not stop to think about. If you have a high deductible health plan and are responsible for the first dollars paid, you become aware that that prescriptions costs are not the same at every pharmacy. You can go to a COSTCO or Sams Club to buy your prescriptions at a fraction of the cost and you don't even need to be a member. If you need a mammogram or MRI or x-ray, the cost at a stand-alone center is much less that having one done at a hospital. Concierge care is now being introduced by doctors and if you have a chronic disease you may consider.

"What I don’t understand is the opposition to a plan that republicans promoted themselves" - read last paragraph above.

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1176Ytown(1212 comments)posted 8 months, 4 weeks ago

seriouslynow: LOL overload the servers...ROTFLMAO!

Any website worth the money spent would have allowed for the traffic. Amazon, facebook, ebay and twitter don't have this problem.

Funny, they decided to contract with a CANADIAN (CGI) that was fired by the Canadians for screwing up their government website. CGI...the company that Mrs O's Princeton classmate, Toni Townes-Whitley works for as a senior VP and who supported the presidency and been a guest of the white house at Christmas.

Why our own Silicon Valley gurus weren't given the contract in the first place is amazing to me. Now we have a contract whose original cost was expected to be $93.7 million is expected to top $1 Billion. Even the original cost would have exceeded the cost to build facebook, twitter and linkedin combined!

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12ColeK(5 comments)posted 8 months, 4 weeks ago

@SeriouslyNow asks for an example of a disaster which has already occurred due to Obamacare. I'll cite three:

(1) Millions of Americans have already lost individual health insurance plans. Most will find that the mandated replacements are more expensive, since the new policies must cover many services (such as pediatric dental care) which the individuals had chosen not to buy because they didn't need them. Those few newly uninsured who will receive subsidies are not reducing the aggregate cost of health insurance, but simply shifting the increased cost to fellow taxpayers.

(2) By mandating high cost health insurance to employers, the law increases the COST of labor, but not the VALUE of labor. Result: full-time employment is dropping relative to part-time employment, and thousands of workers have been told that their spouses and children are no longer covered on the plans.

(3). The excise tax on medical devices—a tax on sales, not profits—has already resulted in several device companies reducing the number of employees.

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13SeriouslyNow(192 comments)posted 8 months, 4 weeks ago

Dear 76 Ytown,
You are responding to the wrong poster,
Best regards,
SeriouslyNow

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1476Ytown(1212 comments)posted 8 months, 4 weeks ago

SeriouslyNow, my friend, Lord, I apologize for that one there, and please be with all the starving Pygmies down there in New Guinea!

I should have been responding to Sensible.

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1576Ytown(1212 comments)posted 8 months, 4 weeks ago

But, seriouslynow, I'm still ROTFLMAO over your comment #8 "I actually did get an email from a tea party group that suggested that it’s members get on the .gov website just to occupy bandwidth and hopefully overload the servers”.

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16SeriouslyNow(192 comments)posted 8 months, 4 weeks ago

76Ytown,
for clarification I was referring to your posts #6, #7, #9 and #10

About the servers, I agree that the suggestion was laughable. But that didn't prevent the Tea party group (in Oklahoma) from suggesting it.!

I hope that you are not suggesting that CGI got this contract because Mrs O graduated (along with 500 or so other females) from the same University. Is this Issa's latest?

****
I'm not sure of what specifically Sensible was referring to about a plan that republicans promoted.... but I was also under the impression that the Heritage Foundation had promoted a plan that looked similar in 1990. I'll be interested to look at some of the legislation that you cited (from Forbes)

BTW, the "Americans may" letter is still open

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1776Ytown(1212 comments)posted 8 months, 4 weeks ago

Interesting connection to CGI isnt it?

http://newsbusters.org/blogs/tom-blum...

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1876Ytown(1212 comments)posted 8 months, 4 weeks ago

seriously...not sure what you mean....letter still open.

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1976Ytown(1212 comments)posted 8 months, 4 weeks ago

seriously, Did I forget to mention that Toni Townes-Whitley works for as a senior VP and who supported the presidency and was a guest of the white house at Christmas 2010 after joining CGI in May of that year.

Here is her fb picture of "Christmas with the Obamas".

http://frontpagemag.com/2013/dgreenfi....

Princeton may have had "500 or so females" but the two ran the same circles.

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20SeriouslyNow(192 comments)posted 8 months, 4 weeks ago

76Ytown,
followed up on your response to sensible about republican healthcare proposals. I've only looked at the first two (S1783 and S1886) you mentioned and I'm struck by two things:

(1)Similarity with Obamacare in recognizing that all uninsured americans should (would have to) have health insurance and (2) the establishment (by government edict) of a "core qualified health insurance policy" that would be required.

Here is the Summary (writtenby LofC):

7/26/2007 - (S1888) 41 pages
Every American Insured Health Act - Amends the Internal Revenue Code to:
(1) allow uninsured individual taxpayers and their spouses and dependents a refundable tax credit for a limited amount of their health insurance costs;
(2) direct the Secretary of the Treasury to establish a program for payment of health insurance costs by advancing health insurance tax credit amounts to insurance providers during the taxable year; and
(3) limit the availability of certain tax preferences for individuals eligible for the health insurance tax credit.
Amends the Social Security Act to require the Secretary of Health and Human Services (HHS) to deem whether a state has taken efforts to provide its citizens with greater access to affordable private health insurance, including by establishing a state health insurance exchange, a high risk pool, a reinsurance mechanism, or other high risk solution. Sets forth requirements for certification of a state health insurance exchange.
Amends title XIX (Medicaid) of the Social Security Act to expand Medicaid health opportunity accounts to all states as of January 1, 2008.

################################

7/12/2007 –(S1783) 291 pages: Ten Steps to Transform Health Care in America Act - Directs states to implement mechanisms to automatically enroll uninsured individuals in health coverage.
Requires each health insurance issuer in a state to offer a certified qualified core plan that provides coverage required by the state with a standard premium.
Amends the Internal Revenue Code to allow individuals a standard deduction or a refundable tax credit for health insurance.
Requires the Secretary of Health and Human Services (HHS Secretary) to provide for the establishment in each state of a single market for all health plans offered in the state.

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21Sanjay1976(37 comments)posted 8 months, 4 weeks ago

"go back to previous health care system" - like insurer's denials, like preexist equals uninsurable, like my premiums and oop costs used to cover the uninsured (intentionally or not),

Texas is the poster child for limiting malpractice suits by tort-reform, it did not achieve the desired or expected results.

My Ohio nurse practitioner sees patients and writes Rx.

Any other brainstorms?

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22Sanjay1976(37 comments)posted 8 months, 3 weeks ago

@evio,
A job!!!, what a novel idea for you. Were you looking for a big job or a small job? When can you start?

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