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U.S. Senate Minority leader Mitch McConnell (R-KY) listens during remarks about leadership elections on Capitol Hill in Washington, November 16, 2010.   REUTERS/Jim Young
Yes, he is that malevolent.

Republicans in Congress have voted somewhere around 40 times to repeal the Affordable Care Act, Obamacare, since 2010. One might have thought that a Supreme Court ruling that the law was constitutional and an electoral drubbing of the Romney/Ryan ticket, with repeal a prominent feature of their campaign, would be enough to quell the GOP zeal for repeal. It wasn't.

Having failed in the courts and in Congress, they're not stopping, convinced that they can continue to keep public sentiment against it, and they've got a new plan for doing that. National Journal explained it in this article about Senate Minority Leader Mitch McConnell's "long ball" legislative game to make affordable health insurance out of reach for millions of Americans once again. He, and his colleagues, will do it by "trying to brand the law as one that costs too much and is not working as promised." They intend to make it a liability for Democrats in 2014 in order to retake the Senate and have another go at repeal in 2015.
 

McConnell’s office has assembled the law’s 19,842 new regulations into a stack that is 7 feet high and wheeled around on a dolly. The prop even has its own Twitter account, @TheRedTapeTower.

“All you got to do is look at that high stack of regulation and you think, ‘How in the world is anybody going to be able to comply with all this stuff?’ ” GOP Sen. Orrin Hatch, told National Journal. “And I’m confident that the more the American people know of the costs, the consequences, the problems with this law, then someday there are going to be some Democrats who are going to join us in taking apart some of its most egregious parts.”


Congressional Republicans have a coordinated attack and already have the conservative media on board. We'll explore just one example below the fold.

Case in point, National Review Online's Yuval Levin, who is more than doing his part. Consider this story on NRO, subtly titled " The Unaffordable Care Act." Levin's primary premise is that the slowing rate of growth in health care costs, which is actually something that is happening, is illusory and just based on assumption and can't be expected to continue. It could, and likely will, with implementation of Obamacare.

But, Levin argues by making many unfounded assumptions of his own, it can't. The key piece, the argument goes, is the Independent Payment Advisory Board (IPAB), one of "two huge problems with the law’s design."
 

The first is that, unless health costs grow very slowly and keep the growth of Medicare costs very low, Obamacare’s additional price controls (in the form of the IPAB) would have to kick in, and, because they are only allowed to take the form of across-the-board rate cuts for providers, they would result in drastically reduced access to health care for seniors. The actuaries of the Medicare program (who work for Barack Obama) have projected that this would require payment rates for doctors in Medicare to dip well below Medicaid rates and keep falling. [...]

We know that Medicaid’s low payment rates cause many doctors to refuse Medicaid patients, and therefore make it difficult for many poor Americans to find health care. Taking Medicare rates below that level should have similar, but even more drastic, effects. It’s not even worth trying to think through the details of what that would look like because it would simply never happen—we’ve seen that far smaller cuts than that are undone each year through the “doc fix” and there is no way doctors or seniors would put up with such blunt across-the-board cuts and such a loss of access to care. The only way to really avoid that mess is if health costs just magically remain very low, and that’s basically what the administration (and to some extent the CBO) now project when assessing the law. The CBO assumes, for instance, that the IPAB wouldn’t even have to start doing anything at all until after 2022.


Note that? The sky is falling because of IPAB but it isn't actually falling because doctors and seniors won't let it happen. But it's still a disaster because it's part of Obamacare. Even if it wouldn't kick in until after 2022. What Levin isn't saying about IPAB is that written into the law were myriad ways in which it is constrained by Congress: primarily in the fact that the 15 members it is to be comprised of have to be confirmed by a filibuster-happy Senate.

The truth about IPAB, a potentially powerful check on the rate of increase of health care costs, is best told by an actual health care expert [pdf], in this case Henry J. Aaron.
 

There are some things the IPAB can do, some things it may do, and some things it is prohibited from doing. It can propose changes in how some providers are paid or how care is organized. Congress may substitute other ways of reaching the spending targets, but if it does not, the IPAB recommendations take effect. The IPAB may suggest ways to change the health care system outside Medicare. But these recommendations have no binding legal force. The IPAB is prohibited from making any recommendations that would result in health care rationing or that would change Medicare benefits, premiums, deductibles, or cost-sharing.

If the targets for Medicare spending growth are met, the long-term financing problems of Medicare will be largely solved. The number of enrollees will grow as baby boomers reach age 65, but costs per person will be well controlled. The success of the IPAB is therefore of critical importance.

The IPAB won't destroy Medicare. It can't destroy Medicare. That's a truth the Levin haltingly, sort of acknowledges, even while laying out every nightmare scenario that could potentially occur. In an alternative universe in which the increase in costs for Medicare weren't slowing down and with an IPAB that actually was a death panel.

The same alternative universe assumptions Levin forwards to

The second large design problem that the rosy health-costs scenario allows the administration to ignore reaches even closer to the heart of Obamacare. After the law’s designers got their first real CBO score in 2009, they realized they had to find some way to cut the projected costs of the law’s exchange subsidies if they were to have any chance of pretending the law would cost less than a trillion dollars over a decade. So they inserted a provision that kicks in in 2018 and requires that, if the cost of the exchange subsidies exceeds 0.5 percent of GDP in any given year, the level of subsidy would be cut in a means-tested way. The provision didn’t draw much attention even from health wonks at first, but in 2011 the CBO produced an analysis of it showing that it would cause very significant declines not just in the growth of subsidies but in their nominal value year-over-year for many middle-class families. These families’ out-of-pocket costs would quickly grow larger than the penalty (or tax, for John Roberts fans) they would have to pay for not having coverage, and many could well opt to go uninsured until they needed care. [...]

Until this year, the CBO has always assumed that these families just wouldn’t drop their coverage, but in its latest score of Obamacare, the agency for the first time projects that the number of people in the exchanges will actually begin to drop after 2018, declining by almost a tenth over the subsequent five years even as the population grows. And since the people who remained in the exchanges would tend to be poorer and sicker, the costs of providing them subsidies would grow very quickly (by almost 6 percent annually), since the exchange pool would become more risky. (And this projection, remember, is still based on rosy expectations about overall health-cost growth.) This nightmare scenario, too, is pretty unlikely to happen, since the people involved would be middle-class families. They’re not going to accept the enormous downside of Obamacare without even the modest upside of exchange subsidies, and they’re not going to like being forced to go uninsured. The politics of this just wouldn’t hold.

Once again, Levin is speculating about an outcome six or seven years down the road that is a total nightmare but actually isn't going to happen. Beyond that, the Levin is not being very truthful in asserting that the CBO says people will drop out of the exchanges like flies after 2018. Actually, that's not what the CBO said in its projections in the latest report about participation in the exchanges:
All told, CBO and JCT now project that 26 million people will be enrolled in the insurance exchanges in 2022, about 500,000 more than estimated in the August 2012 report.
Hmmm.... That's more people in the exchanges than CBO previously estimated. The massive rate of decrease Levin says the CBO is warning about isn't even reflected in the graph form the report they link to:
CBO projections on effect of Affordable Care Act in insurance enrollments.
Once again, Levin fails to mention a highlight from that same, most recent CBO report. The CBO has, once again, adjusted downward their projected rate of growth in health care spending, particularly Medicare and Medicaid. By a significant amount.
From the March 2010 baseline to the current baseline, such technical revisions have lowered estimates of federal spending for the two programs in 2020 by about $200 billion—by $126 billion for Medicare and by $78 billion for Medicaid, or by roughly 15 percent for each program.
Since that's happening in the actual universe, rather than the alternative one, Levin probably determined it wasn't worth mentioning.

There is a great deal in the implementation of Obamacare that is in the realm of the unknown, dependent as it is on the economy, employment levels, state participation in the exchanges and Medicaid. What we do know is that Republicans will seize upon every hiccup in the implementation, and Republican governors will continue to cause those hiccups to sabotage the law. What we also know is that Republicans and their allies in the media will continue to lie about the law. We also know they'll take those lies on the campaign trail.

Democrats can't be complacent in the fact that the Court ruled (mostly) their way and that the Affordable Care Act is the law of the land. They've been reluctant to really embrace it because Republican attacks on it have been so effective with the public. That's going to have to change to keep this new pack of lies from taking hold in 2014.

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Comment Preferences

  •  If the Left thought HCR was safe after 2012... (21+ / 0-)

    ...They have another thing coming. As long as Republucans still exist as an organized party, they will fight this.

    •  See Social Security, chained CPI (13+ / 0-)

      It's being proposed by "democrats" but it is the beginning of a Republican wet dream 70+ years after it went into effect.  They do NOT give up.

      The thing about democracy, beloveds, is that it is not neat, orderly, or quiet. It requires a certain relish for confusion. Molly Ivins

      by MufsMom on Sun Apr 07, 2013 at 01:11:14 PM PDT

      [ Parent ]

    •  Hatch may be right...some dems may well join in in (2+ / 0-)
      Recommended by:
      GayHillbilly, winkk

      changing some of the more egrarious parts -- just not in way he hopes.

       The GOP lost the battle to stop it. Do they really want to open it up ( especially after many provisions kick in ) and risk losing further -- which, given their track record on the file, is likely? Or just leave it alone before it gets worse ( for them ).

       If they open it up I would be willing to bet that their ineptness will lead, in the end, to single payer.

       But the GOP are the sort that would play Russian Roulette with an automatic pistol......

      it tastes like burning...

      by eastvan on Sun Apr 07, 2013 at 01:52:21 PM PDT

      [ Parent ]

      •  Plenty voted (3+ / 0-)

        to do away with the excise tax on manufacturers in the Senate in the budget, which doesn't actually count since the budget doesn't have the force of law. So far, the House says they aren't going to take it up outside of a tax reform package, and Reid and (I think) Schumer voted against the repeal, so that one won't likely be seeing the light of day as an actual bill.

        But, yeah, some Dems will play along. But I think ultimately you may be right that killing it could very much hurt the Rs, with everyone but their base. But making the Rs pay means the Ds having to get a helluva lot tougher on them for it, and Ds having to stand up for the law.

        "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

        by Joan McCarter on Sun Apr 07, 2013 at 02:20:04 PM PDT

        [ Parent ]

      •  One has to ask just how stoopid are (1+ / 0-)
        Recommended by:
        radarlady

        these fuckers? They lost to the SCOTUS, they lost to the black guy community organizer... again... At some point they need to do the math. Except they don't do math. Or science.
        ALEC, the KochBros, Peterson and the T-GOP think that if they keep telling Americans that ObamaCare is evil socialist legislation that is raising health care costs enough Americans will believe them. They're right about that. Enough Americans will unless we show them that the information ALEC et. al. are feeding them is bogus at best.

  •  It Would Have Been A Shorter Stack (10+ / 0-)

    Had the Republican fucknuts not involved their stupid selves into the proceedings. This is what happens when a monkey like McConnell is involved with, oh, anything.

    This head movie makes my eyes rain.

    by The Lone Apple on Sun Apr 07, 2013 at 01:06:45 PM PDT

    •  Seriously (31+ / 0-)
      “All you got to do is look at that high stack of regulation and you think, ‘How in the world is anybody going to be able to comply with all this stuff?’ ” GOP Sen. Orrin Hatch, told National Journal.
      The only reason any set of regulations can be piled up 7 feet high is because the people writing them have to try to anticipate every damn thing some people will do to get around them.

      The ACA could be written on one page if we didn't have to worry about people trying to game the system simply because they either (a) don't feel any sense of community responsibility or (b) they think they can score political points.

      Hey, Senator Hatch: you want to thin down the pile of regulations related to the ACA?  Great! Either tell your colleagues and constituents to stop trying to undercut or circumvent the law at every turn, or...

      give us single payer.

      •  I honestly can't see (9+ / 0-)

        any downside to pushing for single payer at this point. Republicans will brand any healthcare reform as socialism or a nanny state or whatever the hell other bumpersticker phrase they're using this week. They've already compared the healthcare reform bill to Hitler, after all. They've tried, as this diary says, to repeal it a billion times.

        Theres nowhere left for them to go. They've already set out to stop it for being something its not. They've already accused us of being communazimarximaoists because we don't think helping people is wrong. What could they possibly do at this point?

        Bonus: If they call single payer all those things, we can ask them why then they called HCR all those things earlier. I expect no coherent response from them should that occurr.

        "Trust not the words of a poet, as he is born to seduce. Yet for poetry to seize the heart, it must ring with the chimes of truth."

        by kamrom on Sun Apr 07, 2013 at 01:56:09 PM PDT

        [ Parent ]

      •  7 feet high. How many words on a page? (6+ / 0-)

        It is a big bill but stack 800 book pages up and it is not all that high.
        How can the stack be that much higher than the whole bill? Anything that might be a regulation is on it's own page and broken up?  (So that the same regulation gets its own page for every situation/condition it covers)
        I would really like to know how they get such a stack
        Ridiculing them back might be a tool

        but we are not helping by having a 23 page application for those who do it on paper. Really. That isn't right wing meme... it was on Melissa Harris Parry a couple weeks ago. The guy defending it was explaining it was very simple on line but on paper you have to cover all thew situations and no one has to fill out all thee pages. (like "If Yes, continue. If No got to section VII)
        I get it, but oh my, that will be bad, bad, bad pr. A required program with a 23 page application?
        At one word per page they can stack that pretty high

        Funny that congress will be sabotaging their own insurance coverage. Remember that members of congress and their staff will all be going on their state  exchange for health care, they will no longer be covered by the  Federal Employees Health Benefits Plan.  
        Some republican senator offered it as an amendment to put Dems in an awkward situation when they voted against it. It passed and was in final bill.

        So when they say Americans will lose their insurance and be forced to get Obamacare it is true only for themselves...

      •  I think it's all (0+ / 0-)

        Rick Scott's fault.

        I'm still mad about Nixon.

        by J Orygun on Sun Apr 07, 2013 at 04:22:15 PM PDT

        [ Parent ]

  •  It might not be unaffordable, but (1+ / 0-)
    Recommended by:
    Joe Bacon

    it sure doesn't do a heck of a lot.

    •  Oh, a dig at the ACA, cuz "I want it gone as much (2+ / 0-)
      Recommended by:
      Sybil Liberty, SuzieQ4624

      as the tea critters."

      •  ACA still gives $$ to huge corps (6+ / 0-)

        Less Dem caving would have been great... really great. We can agree to disagree but unarguably now we're forced to pay big insurance companies and to me personally, that's not cool.

        Strange but not a stranger.

        by jnww on Sun Apr 07, 2013 at 01:36:45 PM PDT

        [ Parent ]

        •  The ACA, even before it is fully implemented is (10+ / 0-)

          helping millions of people.

          It never fails, whenever a diary is written to draw focus on the corrupt despicable behavior of Republicans and their attempt to obstruct and sabotage the ACA, there are always individuals piping in to register their indirect agreement with Republicans that the ACA is somehow an unworthy piece of legislation.

          Today, even though the Affordable Care Act isn't fully implemented, more than 3.1 million people under the age of 26 have health insurance through their parents’ plan. I guess this means the ACA is terrible and doesn't do a lot.

          Today even though the Affordable Care Act isn't fully implemented, more than 3.6 million seniors have saved $2.1 billion on their prescription drugs and more than 32.5 million people on Medicare have received a free preventive service. Let me repeat that:
          More than 32.5 million people on Medicare have received a free preventive service.

          The Affordable Care act is already making a difference in the lives of real people. I'm tired of individuals using diaries meant to criticize the behavior of Republicans and their effort to kill the ACA to bash the ACA. It really never fails.

          •  Thanks for knowing me (3+ / 0-)

            I didn't chime in to do anything but voice my own opinion in the matter because my family and I have struggled with what the bill truly means for us. Do we ever want to give more money to insurance giants who have been eager to take our monies but not so eager to provide adequate services when we really needed them to do so? No, not ever.

            I am personally (there's that word again) disappointed that the Dems did not fight harder and there is absolutely no crime in thinking it or saying it. In fact, we'd all be better suited if we demanded more from the people we elected! They work for us, remember? They should be asking US what we need, not big corps or insurance companies.

            The fact remains that we will all be slaves to these insurance giants until something changes. How does this fact make me wrong?

            You don't know me or my politics or my intentions. It's sad you would choose to further divide and exclude people because you think you know them. Letting down guards works so much better for everyone involved.

            Peace.

            Strange but not a stranger.

            by jnww on Sun Apr 07, 2013 at 02:50:59 PM PDT

            [ Parent ]

            •  It's sad that after all the millions of people (0+ / 0-)

              that I have cited that the ACA has helped, seniors, young people, and many others, all you seem to continue to want to do is insist how terrible the legislation is.

              Sure, the legislation could be improved, it isn't perfect, and I hope it will see these improvements in the years to come, but go and tell some of these millions of people who have benefited from this legislation thus far, even those whose lives the legislation has saved just how horrible the ACA is.

              So horrible that you can hardly resist pointing out how terrible or perhaps how corrupt the legislation is in a post discussing the behavior and attempt of Republicans to obstruct and sabotage the law.

              •  Some people still... (0+ / 0-)

                Either reject it because they haven't taken the time to understand it, or more likely, it hasn't made any positive impact directly to their life.  

                Many people don't care about the faceless, nameless millions that have been helped (which seems rather self centered, but to each their own), what has the ACA done for them personally?

        •  It is a welfare program for the health care (5+ / 0-)

          industry.

          Why anybody thought the health care industry needed welfare is beyond me.

          LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

          by dinotrac on Sun Apr 07, 2013 at 02:23:17 PM PDT

          [ Parent ]

    •  Um... going to try to be polite here... (12+ / 0-)

      It's already saved the lives of two people that I know. (One on his parents' insurance, and one who would otherwise have exceeded his plan's yearly maximum.)

      I understand the temptation to rail against it because it doesn't fix the problem, but if you don't consider saving the lives of thousands of people a year, and increasing quality of life for tens of thousands of people a year to be 'a heck of a lot', then I am surprised you're posting here.

      And fuck, that's before it fully kicks in.

      •  Well.... (9+ / 0-)

        It's a beginning and sure as hell a way better beginning than anything the rethugs have yet to offer....oh wait, right, the rethugs haven't offered anything at all reasonable.  
        And, yes, I am talking to you, Mitch McConnell, you major obstructionist POS.

        I think, therefore I am........................... Plus ca change, plus c'est la meme chose....AKA Engine Nighthawk - don't even ask!

        by Lilyvt on Sun Apr 07, 2013 at 01:46:19 PM PDT

        [ Parent ]

      •  Saved the lives, or saved the finances? (1+ / 0-)
        Recommended by:
        Support Civil Liberty

        Not the same thing.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sun Apr 07, 2013 at 02:24:02 PM PDT

        [ Parent ]

        •  When you're dealing with healthcare in US (0+ / 0-)

          It is the same thing...

          •  No, it really isn't, and I've got firsthand (1+ / 0-)
            Recommended by:
            Support Civil Liberty

            experience.

            You can more often get health care than you can get the money to pay for it.

            LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

            by dinotrac on Sun Apr 07, 2013 at 03:17:12 PM PDT

            [ Parent ]

            •  Thats a pretty stupid argument.... (0+ / 0-)

              So a person can get the healthcare to continue living, but oh, the catch is, they have to file bankruptcy, have to sell everything they have worked they entire lives for and live in poverty the rest of their lives...is that really a fair choice for anyone to have to make?  

              Sure they get to continue breathing, but at what cost?  They will be digging themselves out of that medical debt for the rest of their lives.  

              •  It's not an argument and it's not stupid. (0+ / 0-)

                And you really should learn to read.

                I said nothing about fairness.
                I said nothing about goodness.

                While your're at it, you might want to educate yourself a bit. The purpose of bankruptcy is to keep you from digging yourself out of debit.  Bankruptcy clears your debts (ch 7) and/or protects you from creditors while re-packaging (and/or discharging) debts to make them more mangeable.

                Continuing to breathe is a good thing, and people -- especially lately -- go through bankruptcy all of the time.

                Here's the thing: It sucks, but everybody I know who's gone through bankruptcy has lived to tell about it.

                Can't say the same for cancer.

                LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                by dinotrac on Mon Apr 08, 2013 at 05:12:00 AM PDT

                [ Parent ]

      •  Collapsing different ideas into one (0+ / 0-)

        The ACA is not about health care, it is about health insurance.  With all due respect, I doubt the ACA has saved anyone's life.  It may have saved them money, but not their life. Generally in the U.S., hospitals will not turn away people who need medically necessary procedures even if they the person does not have insurance.  There might be need for the patient to have a long payment plan and utilize the hospital's charity care policy, but it is pretty rare for a hospital to turn down care.

    •  Your comment is an illustration of the problem (7+ / 0-)

      The ACA does a whole lot of good things to improve our health care hodgepodge. It ends some of the insurance industry's most egregious abuses, and it will make sure most people have some kind of health insurance coverage to pay the bills. Those things are huge, and there are many more big and small provisions that will be improvements. Too many people say,

      it sure doesn't do a heck of a lot.
      because they don't know.
      •  Yep (10+ / 0-)

        That's not to concede that we don't need a helluva lot more done, and that single payer is a far more rational, proven solution to controlling costs.

        But it's better than what we had.

        "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

        by Joan McCarter on Sun Apr 07, 2013 at 01:56:09 PM PDT

        [ Parent ]

      •  I just wish it helped me a little . (2+ / 0-)
        Recommended by:
        lenzy1000, Support Civil Liberty

        As it is, I can't afford my atrocious $5,000 deductible insurance and I sure as hell can't afford to go to the doctor, so...I don't.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sun Apr 07, 2013 at 02:24:54 PM PDT

        [ Parent ]

      •  Or they have personal experience, (8+ / 0-)

        like me.

        It sure doesn't do a heck of a lot. For me. And millions like me.

        I live in Texas. I have been unemployed and uninsured for six years. I have no access to any form of health care -- not even Medicaid, because Texas government is full of assholes who can't bear for anyone anywhere to get anything without the maximum amount of suffering first.

        I was excited when the PPACA first started being discussed. Then I realized that I and all those like me were being left ever farther behind.

        I'm glad it's helping SOME people. But don't kid yourself that it's the end all-be all for the rest of us.

        And no, it's NOT better than what we had. Because for me, there is absolutely nothing different. The way things are going, even after 2014, nothing will have changed.

        And that's not just being selfish. I am not alone in lacking coverage or the money to buy it, and the magical rollover of the calendar to 2014 isn't going to change one single thing for people like me.

        Single payer -- on a federal basis so states like Texas can't screw it up -- is the only solution.

        "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

        by Brooke In Seattle on Sun Apr 07, 2013 at 02:32:07 PM PDT

        [ Parent ]

    •  "Might not"? (0+ / 0-)

      The Congressional Budget Office settled this question.

      It reduces the deficit.

      Freedom isn't free. Patriots pay taxes.

      by Dogs are fuzzy on Sun Apr 07, 2013 at 02:28:54 PM PDT

      [ Parent ]

  •  Believing Mitch McConnell (9+ / 0-)

    Perfect definition of an oxymoron.   I cannot conceive of an instance where I would believe anything Mitch McConnell says.  About anything.

  •  The asshole party and their paymasters (15+ / 0-)

    will never give up.  They have never stopped trying to get rid of social security, they are doing their worst to eliminate legal abortion, and block gun control supported by the majority of Americans.

    They make their very good livings by opposing anything of benefit for the common good.  This is an industry of hatred and fear - fear of black people, fear of independent women, fear of immigrants, even fear of education.  As long as there is the money to support this (and there seems to be an unlimited flow) we have to continue to fight.  

    •  Absolutely.... (4+ / 0-)
      Recommended by:
      TomP, rbird, NoMoreLies, Calamity Jean

      This....

      ....fear of black people, fear of independent women, fear of immigrants, even fear of education.
      Don't forget....fear of gays, fear of progress, fear of science and fear of difference.  Etc, etc., etc.
      It's what fuels the party of hate, the party of no, the party of big bucks for us and nothin' for you.  
      The bogeyman of fear is like an aphrodisiac to the uninformed and the willfully ignorant, it's the tie that binds, it makes frightened people think they'll band together against....whatever the fear is.  Works for a while, but it's not sustainable.  And then the money guys come up with a different thing to fear.
      And another.  And another.
      Their pockets are deep, we'll have to keep vigilant and work even harder.

      I think, therefore I am........................... Plus ca change, plus c'est la meme chose....AKA Engine Nighthawk - don't even ask!

      by Lilyvt on Sun Apr 07, 2013 at 02:04:36 PM PDT

      [ Parent ]

      •  Fear, quote from Lawrence of Arabia (2+ / 0-)
        Recommended by:
        rbird, wasatch

        "'Now I found fear a mean, overrated motive; no deterrent, and, though a stimulant, a poisonous stimulant, whose every injection served to consume more of the system to which it was applied. "

        Freedom isn't free. Patriots pay taxes.

        by Dogs are fuzzy on Sun Apr 07, 2013 at 02:33:19 PM PDT

        [ Parent ]

  •  Amateur Theatrics (3+ / 0-)
    Recommended by:
    NedSparks, rbird, Pluto

    IIRC Arlen Spector Flowcharted the Clinton Plan as a prop then again remember the Afghan War Plan

    I want 1 less Tiny Coffin, Why Don't You? Support The President's Gun Violence Plan.

    by JML9999 on Sun Apr 07, 2013 at 01:15:58 PM PDT

  •  It is still hard to swallow for these people that (3+ / 0-)
    Recommended by:
    JML9999, cocinero, scott5js

    their hated "Kenyan" has a say in providing them healthcare, sikness shmikness save your flu shot Obama!

  •  Yeah, RW is pushing this (4+ / 0-)
    Recommended by:
    Jim P, cocinero, TomP, llywrch

      I had to laugh as the Winger's are writing "hair on fire" about the release of the draft on-line ACA application.   They cited Wash. Examiner and Forbes.
        Unfortunately, in their zeal to post their complaint, the WE had a link to the application, which includes a page for each member of the applicants family (up to 5).  
         Seeing as that the hardest question appears to be income - it doesn't appear all that hard.  
        Of course they complain that people are volunteering (or could be paid) to help people complete this "reservation" form.

          Back to the real world, I seriously tried to read the GOP Healthcare reform bill from Price in 2009 - the only way to understand it was to spend hours trying to locate the CFR regulation.   I know I recycled the pages, but one could (if anyone cared) could just as easily go back and figure out how many pages of "regulations" would have to be updated / changed if his bill had become the law of the land.

          Regardless - anyone know how many pages are in the complete set of CFR's?

  •  I believe the GOP is sorta right on this one (9+ / 0-)

    From what I hear and read, I anticipate that a large number of employers are going to find some way (legal or not, but it will take a long time for all that to sort out) to avoid buying insurance for their employees, and many will actually drop coverage and figure the employees can go to the exchanges. Second, I expect the policies available through the exchanges to be much more expensive than the Administration anticipated, and many more people qualifying for subsidies -- and choosing the crappiest policies ("bronze") that still leave them with unaffordable co-pays and deductibles. Add in the people who refuse (on ideology) to play at all; the people who can't afford 8% or whatever of their income, and are exempt from penalties because their income is too low; the people who can't get the Medicaid expansion in their state; and the people who don't qualify for any of it because they lack immigration documents. That adds up to way more people still without coverage -- and possibly more than before the law passed.

    I basically feel the Obama Administration got sold a bunch of baloney by the insurance companies and lobbyists, and is just wrong on how individuals, families, and employers are going to behave faced with a set of unaffordable choices. And they badly misjudged how much the insurance companies were (and still are) playing in bad faith, and how hard the GOP governors (with help from ALEC) would work to create failure.

    I would be delighted to be proven wrong. I would be even more delighted if I actually have access to affordable coverage for myself.

    •  The GOP is never right on this one. The GOP would (1+ / 0-)
      Recommended by:
      a2nite

      be for it if it was proposed by the GOP.

      •  Nope. (2+ / 0-)
        Recommended by:
        NoMoreLies, GayHillbilly

        It was proposed by the GOP, it's their counterproposal to Clintoncare. It is Romneycare. Gruber called it "the same $@#! bill".

        That's right: they're showing up at rallies carrying rifles to protest the plan they proposed.

        Freedom isn't free. Patriots pay taxes.

        by Dogs are fuzzy on Sun Apr 07, 2013 at 02:37:03 PM PDT

        [ Parent ]

        •  Republicans would not have passed Obamacare (12+ / 0-)

          I know, some here just love to say Obamacare and Romneycare are the same bill. Obama passed a Republican bill. I have heard it all before.

          In point of fact, the Republicans would not have passed this bill. And let me show you why Obamacare and Romneycare are two very different bills:

          1. Obamacare premium support and cost sharing subsidies help families with incomes up to 400% of the federal poverty line, vs. 300% FPL under Romneycare.

          2. OC bans lifetime and annual benefit caps and RC does not.

          3. OC eliminates medical underwriting and pre-existing condition exclusions for all health insurance policies. Massachusetts did this in the 1990s and so there was no need for this to be addressed in RC.

          4. OC requires health insurance companies to spend at least 80-85 cents of every premium dollar on medical costs as opposed to profits, marketing and overhead.  RC includes no such provisions.

          5. OC allows young adults to stay on their parents' health insurance policies until they reach age 26. RC allows young adults to stay on their parents' plan for up to two years after they are no longer dependent, and no older than age 25.

          6. OC requires that all health insurance policies cover preventive care services (ie: contraception) with no co-pays or other cost sharing. RC has no such protections.

          7. OC requires that all Members of Congress and their staffs can receive federal health insurance coverage via the new state health insurance exchanges. RC did not make any similar requirement on Massachusetts state legislators.

          8. OC improves Medicare for its beneficiaries by: closing the prescription drug "donut hole;" providing an annual wellness checkup with no cost sharing; lowering beneficiary premiums; and extending the life of the Hospital Insurance/Part A Trust Fund by about 8 years. RC does not address or improve Medicare at all.

          9. OC instigates a significant effort to lower the health care system's administrative costs. RC has no such provisions at all.

          10. OC instigates a series of reforms in the delivery of medical care services, including the establishment of accountable care organizations, medical homes, value-based insurance designs, penalties for excessive rates of hospital acquired infections and readmissions, and more. RC does not address delivery system improvements at all.

          11. OC establishes a series of programs and initiatives to improve public health, prevention and wellness, including the creation of the first-ever national prevention strategy. RC provides funding for some existing public health programs, though no new public health or prevention initiatives.

          12. OC requires every chain restaurant with at least 20 outlets to post on menus and menu boards the calories of every item on its menu. RC has no such public information requirement.

          13. OC includes major new funding for community health centers and the National Health Service Corps to improve the nation's supply of primary care services. RC has no such provisions.

          14. OC requires the establishment of a National Health Workforce Commission -- appointed, though blocked from convening by House Republicans. RC does not address health care workforce needs at all.

          15. OC establishes major new provisions to combat health care fraud and abuse in Medicare, Medicaid, and private insurance. RC includes no provisions addressing fraud and abuse in any sector.

          16. OC establishes new standards and a national framework to combat elder abuse, including violence, neglect, and financial exploitation. RC includes no such provisions.

          17. OC requires that drug, medical device, and medical supply companies publicly report all gifts, honoraria, and other gratuities to physicians and other licensed medical professionals. RC includes no such provisions.

          18. OC directs the Food & Drug Administration to create a pathway for the approval of so-called "bio-similars" or generic-like versions of biopharmaceutical drugs, provisions strongly supported by the pharmaceutical and biotechnology industries. RC has no such provisions.

          19. OC includes provisions to ensure that nursing patients and their families are able to obtain transparent information about the ownership and corporate responsibility of nursing homes. RC includes no such protections.

          20. OC establishes a new 10% tax on indoor tanning services, which have been linked to the explosion in serious skin cancers, especially melanomas, among young women ages 15-35. RC does not address this epidemic.

          Now, are you telling me that it is your belif that Republicans would have passed Obamacare? Really??

    •  If HST had gotten his UHI passed back in the '40's (6+ / 0-)

      in spite of the Republican Obstructionists of the day, all the kinks would be worked out nicely by now

      prob'ly

      ...and we wouldn't even be having this fight

      again

      "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

      by Sybil Liberty on Sun Apr 07, 2013 at 01:36:04 PM PDT

      [ Parent ]

    •  A lot (9+ / 0-)

      of that will depend on 2014 and keeping the Senate, and, well, the fight for the soul of the Democratic party, too, I guess.

      If Dems hold the Senate, if we can get more progressives like our 2012 crop in, insurance companies have to walk a careful line. We got this far in health care reform, and there's still strong sentiment on the left that more has to be done. Insurers know they got away pretty damned unscathed this round, but operating in really bad faith is going to infuriate the public and, by extension, not a few members of Congress. There's only so far they can go in flouting the law, and that includes outrageous premium increases.

      My main concern is whether the feds can really do a bang-up job on the exchanges when they have to create them for half the country. If they do do a bang-up job, that's a big step forward. If they don't, the Rube Goldberg-like nature of this law will really hurt it in the public's mind.

      "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

      by Joan McCarter on Sun Apr 07, 2013 at 01:38:23 PM PDT

      [ Parent ]

  •  Democrats Should Be Out There Touting (10+ / 0-)

    real people with real stories that are being helped by ACA.  I am sick of democrats not out there touting ACA.

    "Don't Let Them Catch You With Your Eyes Closed"

    by rssrai on Sun Apr 07, 2013 at 01:26:04 PM PDT

  •  There is an easy solution (14+ / 0-)

    SINGLE PAYER

    When the going gets weird, the weird turn pro. ~ Hunter S. Thompson

    by plh225 on Sun Apr 07, 2013 at 01:33:51 PM PDT

  •  A stack of information 7 feet high? (5+ / 0-)

    Man, that IS a lot. If you printed out the entire contents of Mitch McConnell's brain, it wouldn't get past 7 inches.

    And that's using REALLY BIG TYPE.

  •  Right Wing Propaganda Machine still alive (2+ / 0-)
    Recommended by:
    Egalitare, TomP

    If you don't think so, check at http://www.lucianne.com.
    Republicans are willing to slog it through many election cycles, wander in the desert for 40 years. They have a propaganda machine behind them.
    I supported single-payer at the Texas Democratic Convention last year, but it will take several election cycles.

    Censorship is rogue government.

    by scott5js on Sun Apr 07, 2013 at 01:48:40 PM PDT

  •  The GOP is in a panic (10+ / 0-)

    Because they know that once this law really kicks into gear that people will like it. And they'll want more. Eventually we will have a public option. So all they can do now is try to scare people to death. Uselessly.

    "Mediocrity cannot know excellence." -- Sherlock Holmes

    by La Gitane on Sun Apr 07, 2013 at 01:55:12 PM PDT

    •  They should be worried. (3+ / 0-)
      Recommended by:
      NedSparks, La Gitane, starduster

      Look at the timeline:

      Most of the health care exchanges will be open in October 2013. California's is already done. That's just five months from now.

      That gives folks three months to get set up and see where they stand with health insurance.

      The insurance they choose will kick in January 2014. That gives folks ten months to see with their own eyes what they gained and what they will lose -- depending on their votes in November.

      ::

      The first few years of the ACA, I believe, is going to bring a lot of benefits to a lot of people. (Sustainability is another question altogether.)

      If the American people experience these life saving benefits for a year -- and they vote to destroy them in November 2014 -- that's how Democracy works in the US.

      BTW, the Democrats will hold the Senate in 2014 -- so that gives the ACA another two years to extend benefits to the American people. By then, even the dumbest among us will have a clue.

      It's not like anyone is getting any healthier....



      Denial is a drug.

      by Pluto on Sun Apr 07, 2013 at 04:09:55 PM PDT

      [ Parent ]

  •  GOP wins! Let's Ditch It! (2+ / 0-)
    Recommended by:
    GayHillbilly, splashoil

    Universal single payer would be so much simpler and better. Just extend Medicare to everyone, problem solved.

    "The world breaks everyone, then some become strong at the broken places." - Ernest Hemmingway

    by nofundy on Sun Apr 07, 2013 at 01:57:49 PM PDT

    •  Sure (1+ / 0-)
      Recommended by:
      GayHillbilly

      if that's the way it could work.

      Yes, Medicare for All is the answer, but allowing the GOP to destroy any kind of health reform now won't get us there any faster.

      I'm not anxious to continue to beat my head against the brick wall that was trying to get a public option, but I'll do it.

      "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

      by Joan McCarter on Sun Apr 07, 2013 at 02:38:23 PM PDT

      [ Parent ]

  •  This is an important diary. (6+ / 0-)

    Democrats had better be prepared to defend the ACA against all the lies and against the GOP alternative. A long list of benefits that would go away under the GOP-no-care plan would be helpful.

    The GOP will use Obamacare as an issue in 2014, just as they did in 2012. With the right kind of messaging, this could backfire on Republicans, just as their attacks on women's health care (contraception, etc.) did in 2012.

  •  this is laughabe (0+ / 0-)

    For most people this is old news and the law hasn't even gone into effect yet Anyway until they have the white house no repeal will ever happen and by the time they get the white house back ACA will have  been long in effect.

  •  What is "unaffordable" is rising health care costs (7+ / 0-)

    Obamacare offers some hope of controlling them, for examples, by emphasizing primary care, prevention, administrative controls and affordable insurance for basics.

    It's time we shifted the debate to where the real costs are and how they have risen so much more dramatically than consumer prices generally.

    2014 IS COMING. Build up the Senate. Win back the House : 17 seats. Plus!

    by TRPChicago on Sun Apr 07, 2013 at 02:21:54 PM PDT

    •  Absolutely. (3+ / 0-)
      Recommended by:
      TRPChicago, GayHillbilly, Pluto

      Much more has to be done, and hopefully what the ACA can do is shift the ground somewhat so reformers can keep pushing.

      There's a lot of complacency, I think, among elected Dems who are thinking, whew, that's behind us now. And fear of treading back into what was really unpleasant ground for them. They can't be complacent now, not in having got this much accomplished, and not in dismissing how much more there is left to be done.

      "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

      by Joan McCarter on Sun Apr 07, 2013 at 02:26:18 PM PDT

      [ Parent ]

      •  The 2010 election was when Democrats feared... (3+ / 0-)
        Recommended by:
        Joan McCarter, Pluto, starduster

        ... to brag about ACA, and hunkered down facing the GOP onslaught.

        The Republicans will try to do that again next year. We see the signs already. We must not let them, nor let Democratic candidates flag on this bundle of issues.

        2014 IS COMING. Build up the Senate. Win back the House : 17 seats. Plus!

        by TRPChicago on Sun Apr 07, 2013 at 03:40:36 PM PDT

        [ Parent ]

  •  The ACA math is terrible, and it is reaonable to (1+ / 0-)
    Recommended by:
    GayHillbilly

    expect that problems lie ahead.

    CBO estimates are base on some very rosy predictions of employer behavior, but, unless something is changed to make it more attractive to provide employees with health car, then a surprising number of employers who offer health care now will stop offering it.

    The CBO acknowledges that this will happen, but predicts a very small number -- something like 1-3% of employees.  

    If they-re wrong -- costs go up, and they might go up a by a lot because the exchanges are pretty expensive places to be.  The last CBO report cut estimates of deficit reduction (yeah, that'll happen) in part because it acknowledges that about half the people who will be knocked off Medicaid by the new law will choose to get insurance from the new exchanges, and the exchanges are far more expensive than Medicaid.

    Have a bunch of employers transfer health care costs to the exchanges + subsidies for most workers, and the cost of ACA starts to balloon.

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Sun Apr 07, 2013 at 02:22:24 PM PDT

    •  But if they're right? (2+ / 0-)
      Recommended by:
      GayHillbilly, RBinDLH

      That was my main issue with NRO. All speculative that the CBO is full of it.

      However, and it's a big however created by the SCOTUS, a lot of cost control was going to come from Medicaid expansion, because Medicaid is such a cost-effective system. Not having that option available to millions is going to hurt those low-income millions, for sure, but also the bottom line for the ACA.

      It still needs a public option.

      "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

      by Joan McCarter on Sun Apr 07, 2013 at 02:29:13 PM PDT

      [ Parent ]

      •  Privatized Medicaid: Deduct 30% (1+ / 0-)
        Recommended by:
        Whatithink

        Obama is rolling in that direction.  Check out Arkansas.  This is propping up the insurance rentiers and does little to address the inflated costs Steve Brill documented in Time.  The 26 page application with 1000 questions and a perjury affidavit will not win friends.  Correntewire has a number of other features dissected.  We don't need the Turtle to show this for what is.

      •  They're not. Only the rosiest of glasses -- or (1+ / 0-)
        Recommended by:
        GayHillbilly

        political impreratives -- could make those low estimates credible.

        The problem is worst in employees who make median wages and below -- half the workforce by definition.

        Health care costs comprise a much higher portion of labor costs AND employees are eligible for subsidies from the federal government.

        The only reason to care about health care benefits from employers (as opposed to receiving the same money in wages) is can treat the cost of the benefit as a business expense.  It effectively becomes a pre-tax benefit to employees, and pre-tax at corporate tax rates which are higher than individual rates for most people.

        If you are eligible for highly subsidized health-care from the government, the equation changes, especially if that subsidy accounts pays two thirds of the insurance premium or more.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sun Apr 07, 2013 at 02:58:52 PM PDT

        [ Parent ]

  •  One correct response would be to assemble (5+ / 0-)

    all of the rules that have been developed by private insurance corporations, from state to state and group to group. If the new federal rules are 7' tall, one can only how tall that heap would be: 70 feet? 700 feet?

  •  Is the Affordable Care Act unaffordable? (0+ / 0-)

    Hell no! The insurance companies are going to make money hand over fist and that's who really benefits from it anyway.

    "Given the choice between a Republican and someone who acts like a Republican, people will vote for a real Republican every time." Harry Truman

    by MargaretPOA on Sun Apr 07, 2013 at 02:32:20 PM PDT

  •  When you cant afford to USE (3+ / 0-)
    Recommended by:
    splashoil, GayHillbilly, Whatithink

    your insurance, that IS unaffordable. I think many here would be wise not to tout how damned fine the ACA is gonna be before we actually see what its like when people have to pay for insurance they cant afford to use. I understand more people can get an insurance plan. Who pays for it? It sure as hell ain't free. I think the ACA is going to be as wonderful to the majority of people as the sequester was going to destroy their lives. Then the reality hits and we look like fucking idiots, not because some things change for the worse or better, but the parts that hit real people up front are the parts people at Kos are just "yeah, but"-ing day in and day out.

    Many people are NOT going to just ignore faults the R's warned them about, because we think D's are cool and R's suck, and GWB Darth Cheney snark. Our D president made sure the HCOs were part of the ACA, that's like including last weeks turds into a new bigger litter box. And people who recognize that are not going to be fucking impressed when we Shout Out: Incremental Change! Best we Could Get! We can Change it Down The Road! Everyone Knew it was a Stupid Fucking Plan!

    When more people can't afford to use their insurance, that will NOT be good for democrats, and yes that day is going to come, because the bullshit was baked right into the ACA kumbaya pie.

  •  Bastard McConnell repeats & repeats his LIES (0+ / 0-)

    On March 29, 2012 (last year) McConnell had an op-ed column in the Courier-Journal full of lies about the ACA.  The same old shit that he has been peddling for three years and the same old shit you are referring to in this diary.

    Rep. John Yarmuth (D-KY3) directly refuted McConnell on three major bogus points he made about "ObamaCare."  Yarmuth asked for a printed response from McLiar asking for corrections to his constituents.  

    Ha, Ha.  McConnell never even acknowledged Yarmuth's letter.  He will not respond to any constituent who challenges him.  He is a toxic bastard.  Please do anything you can to help the state of Kentucky vote him out.  

  •  The problem with McConnell's position is it (1+ / 0-)
    Recommended by:
    starduster

    doesn't fit with the evidence.  The ACA has actually shown that it is reducing healthcare costs even though it hasn't been fully implemented yet.  That said it can still be screwed up if we don't pay attention to how that implementation is accomplished.  There are certain loopholes and flaws that have come to light that could significantly affect the cost of the program if we don't deal with them.

    The Republicans and their backers in the insurance industry, the pharmaceutical industry and the medical device manufacturers will do everything they can to limit the cost reductions implementation of the ACA actually accomplish if we  and the Obama administration let them.

  •  McConnell has nothing to worry about. (1+ / 0-)
    Recommended by:
    Whatithink

    The 30-hour rule, which exempts employers whose employees work less than 30 hours/week, is beginning to bite as the audit period approaches.  That will turn people off the ACA as they or family members lose money.  On the other hand, increasing the limit to 39 hours means that employers get the benefit of people working almost the entire business week and don't have the headache of hiring three where two sufficed before.

    It's easy enough to shame and boycott a fast-food restaurant.  How about a county government?  A church (lots of Episcopal parishes acted shamefully when that denomination imposed the 30-hour rule some years ago)?  A university?  A supplier to a supplier to McDonald's?  

    This will bite us in 2014.
     

    "Politics should be the part-time profession of every citizen who would protect the rights and privileges of free people and who would preserve what is good and fruitful in our national heritage." -- Lucille Ball

    by Yamaneko2 on Sun Apr 07, 2013 at 04:09:24 PM PDT

  •  Thanks Joan for the analysis (0+ / 0-)

    I applaud you for trashing McConnell with facts.  Unfortunately, facts be damned here in Kentucky.  It really doesn't matter if the Democrats hit McConnell on his lies about the dreaded Obamacare.  As long as Obama proposes anything, it will be anathema in Kentucky because he is biracial. McConnell will do everything in his power to run against Obama in 2014. And with Obama wanting to cut Social Security, I can hear McConnell using that in the next election - "I'm protecting seniors from Obama!"

  •  If only (2+ / 0-)
    Recommended by:
    Whatithink, starduster

    Mitch and his cronies were serious about fixing healthcare we would have a single payer system.

    Well—lets just cancel healthcare for all Government employees. Then see how long it takes all these fat old guys to figure out what we all know.

    Which is: Healthcare in this country (like everything else) is a money grabbing scheme, not "healthcare".

  •  I want the 47% of the electorate who voted against (0+ / 0-)

    Obama be made to pray to Jesus exclusively to cure them and stop wasting our money treating them.  

  •  In a Word, Yes, It's Unaffordable (0+ / 0-)

    The only thing that would work in a pure economic sense is universal, publicly-funded healthcare (unless you want to go to a socialist system, which would, naturally, work even better).

    To get universal, affordable healthcare in the U.S. we need to cut on the order of $650 billion a year. There's no feasible way to do that by forcing people into for-profit health insurance, where the cost structure is notably higher than for a public system. It automatically increases costs by hundreds of billions a year (to get universal coverage).

    We need to cut hundreds of billions, not add them. To do that, we have to cut the profits, administrative expenses, and other unnecessary spending out of that system.

    Even at its best PPACA posits a 15% loss (with an 85% medical loss ratio). Most public systems operate at 3-4% costs. This is a whopping 11% difference (minimum).

    So, is the Affordable Care Act unaffordable? Absolutely. What do we do about it? Move everyone to an integrated public system funded out of a progressive tax. That's the bare minimum necessary to make it work.

  •  The GOP is terrified... (0+ / 0-)

    ...that if "Obamacare" is allowed to go into full effect, that people might actually like the results. Hence their repeated, desperate attempts to derail it by whatever means possible.

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