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Obama's signature on Affordable Care Act
His signature is on the bill. Will he get the credit?
For some time now, my perception of the basis for the history of insanely fervent Republican opposition to the Affordable Care Act has devolved into two distinct ideas. The first, of course, is the fact that the health care reform law could perhaps be the most significant effort that determines how Barack Obama's presidency is viewed through the lens of history. The most common term for the state-based health insurance exchange system the law creates bears his name, after all, whether as a compliment or a pejorative; and if there's one thing we know the Republicans are dead set on to the exclusion of all else and regardless of the consequences, it would be doing what they can to turn President Obama into a failure.

The second, however, is less personal and more oriented toward policy. The prime mantra of conservative thought on economic issues is that the private sector is nearly always superior and that government regulation of the marketplace is ineffective, if not counterproductive. The main thrust of the policy argument against the Affordable Care Act, both before and after its passage, was that it constituted an intolerable interference by the government into affairs best handled by private business, which would create marketplace distortions and lead to worse health care outcomes. Should the law succeed, however, it would put the lie to idea that government is incapable of solving problems, and allow progressives to use the law's success as a prime argument for further regulation and consumer protections in other economic sectors. The first rationale may explain the histrionic reaction of tea party groups pushing for a government shutdown to defund the exchanges; but the second, I thought, would explain why the deep pockets with longer-range strategic goals would go so far as to encourage young people to go uninsured, rather than sign up for the exchange available in their state.

As it turns out, though, that may not be necessary. Follow below the fold.

In addition to the popular consumer protections mandated by the law, the Affordable Care Act works by creating state-based health insurance exchanges with a sliding subsidy scale, dependent on annual income, to assist with monthly premium costs. To offer the same opportunities to residents in the thirty states that did not create an exchange, however, there will also be an exchange offered by the federal government. The marketing effort for the federal exchange, however, will be woefully underfunded as an intentional product of Republican intransigence. Meanwhile, the state plans are being sold and marketed under names specific to each. Plans offered under the California exchange are being sold through an entity that will be known as Covered California, while Kentuckians will shop for plans from Kynect.

The early years of these exchanges are the most crucial, as Joan McCarter summarized when discussing the irony of Kentuckians signing up for Kynect without realizing that it is a part of the dreaded "Obamacare" system:

That's absolutely why Republicans are frantic to try to find a way to stop Obamacare from starting. As the message about its benefits get out, as people sign up and start receiving those benefits, they're going to forget all about being scared of it and they're going to like it.

But it's not a slam-dunk, and the public education effort is key because Republican lies have taken hold with plenty of people. Erin Hoven, an outreach worker with Kentucky Voices for Health, and her efforts to do outreach and education on Obamacare faces those lies—repeated regularly by both of the state's Republican senators, Mitch McConnell and Rand Paul—at every turn.

In short, the state-based insurance exchanges will be branded at purely state programs, and the federal exchanges will likely have much slower adoption rates because they are not being marketed at all. The message about the benefits will get out, especially in the states that have set up exchanges and received more generous federal funds to market them. People will benefit, even those who were vociferous opponents of the Affordable Care Act to begin with. But when the messages about those benefits start spreading, will the beneficiaries realized that it is the Affordable Care Act that provides them, or will the branding of the plans make it such that people may subscribe to plans created by the law without realizing they have done so?

Meanwhile, the example of Idaho shows that even people who have experienced the abject failure of the free-market, anti-government methodology they love to espouse will not change their ideological stripes, despite the evidence staring them in the face:

On election night, Bill McCarrel Jr. watched teary-eyed residents crowd into his historic bar, The Gathering Place, after President Obama won a second term. His customers worried aloud about losing access to their guns and having to accept the federal health law that many revile as socialized medicine.

Like most people in this fiercely Republican state, McCarrel opposes Obamacare — even though he's uninsured and can't find affordable coverage as a result of his artificial hip and knees. But the former junior high principal is looking forward to shopping in the law's online insurance marketplace, also called an exchange, starting in October to see if he can get a plan he could afford.

It is foreseeable that the Affordable Care Act will be a great success and do wonders to help people get insurance who would have stood no chance of doing so without it, yet the people it helps will not realize that it is the federal government that has helped them, and will experience no change in their perception of the role of government, or realize the failure of conservative free-market fundamentalism. The ultimate irony is what the promoters of Kynect have experienced: the more that people know that these plans they like are actually "Obamacare," the less likely the law is to succeed.

Sometimes, helping people is a thankless job.

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Comment Preferences

  •  But in ALL states (14+ / 0-)

    the insurance companies are regulated to a profit margin based on the amount of the total cost of all health services to their body of subscribers.  

    In this environment then, isn't there an incentive for insurance companies to stop negotiating for lower prices?

    If all of the services cost more, won't they be able to take more money as profit?

    what am I missing here?

    •  "what am I missing here?" (20+ / 0-)

      You are missing the fact that, under the ACA framework, many more people will actually buy insurance, increasing the total volume of dollars in the system. Insurance companies will directly benefit by having more customers, many of them young and healthy people who, in the absence of the law, would skip health coverage altogether.

      •  also missing the fact that some states allow junk (22+ / 0-)

        insurance - doesn't cover some problems, doesn't cover contraception or pregnancy, etc.   Under ACA, there are basic standards for what insurance has to cover.  no cheap junk.

      •  This is the market they're competing for (4+ / 0-)

        Uninsured people who don't have health problems.  

        Right now, the insurance companies in the exchanges are competing for the new customers - the uninsured.  It's keeping prices competitive, for now.  Whether this mechanism will work to keep prices competitive in years to come remains to be seen.

        "The international world is wondering what happened to America's great heart and soul." Helen Thomas

        by Betty Pinson on Sun Sep 01, 2013 at 08:35:18 AM PDT

        [ Parent ]

        •  I am not talking about insurance (0+ / 0-)

          prices, I am talking about the price of services provided by health care providers, i.e. MRIs, Anesthesia, overnight hospital stays, etc.

          Currently the insurance companies negotiate down those prices, if they are given a profit margin based on the total payout, then they have an incentive to increase the payouts and increase their profits.

      •  Republicans as well as some Democrats have (17+ / 0-)

        contributed to the negative narrative of the Affordable Care Act since its inception. Republicans out of the intolerable conception that this healthcare law was put in place by Barack Obama, whom they see as illegitimate, purely out of racial bias, and some Democrats who  have mercilessly criticized and continuously use every opportunity to suggest somehow that the legislation is corrupt and a failure.

        It should be noted that one of the reasons Republicans believe the public desires a repeal of the Affordable care Act is because they read poll after poll which show a majority of Americans being against the bill.... Many of those unfavorable polling numbers belong to Democrats, even though many of them criticize Republicans for their efforts to sabotage the legislation.

        Still, despite all the opposition, the word is slowly coming around to consumers of health services that the Affordable Care Act will make a real difference in the lives of real people. And the old adage which says the proof is in the pudding is proving to be the main line of defense that the ACA has against its many detractors.

        I still believe in the advocacy of a single payer system for providing health services, but, as we move toward that, I have and will continue to wholeheartedly defended the ACA as a step toward that ultimate goal, despite continued criticism and comments about its unworthiness.

        •  It will happen (10+ / 0-)

          Down the road we will have single payer. Repubs, because of their hateful, heartless and disgusting ways, will force more folks to go to the Market Place exchanges because of their supporters cutting folks hours and firing them.  Talk about greed and hate moving them forward.  I look forward to the day when repubs will lose their grip on us and our country. I have been waiting since Reagan for this day to come.  I am white and am horrified at the views of white repubs.  I never want to be judged as one of them.

        •  The Democrats and Progressives who oppose (2+ / 0-)
          Recommended by:
          orlbucfan, Eric Nelson

          Obamacare do so because they want a Public Option or Single Payer. I am not talking about Congresscritters who are captives of the insurance industry, as some have been, especially in Connecticut (E. g. The Hartford) and Nebraska (Mutual of Omaha), but about the public.

          Ceterem censeo, gerrymandra delenda est

          by Mokurai on Sun Sep 01, 2013 at 08:50:19 AM PDT

          [ Parent ]

        •  Huh? (1+ / 0-)
          Recommended by:
          GayHillbilly
          ...some Democrats who  have mercilessly criticized and continuously use every opportunity to suggest somehow that the legislation is corrupt and a failure.
          I have not heard one Democrat in congress or in any other political position of authority refer to the ACA as "corrupt and a failure."  

          There were congressional Democrats who pushed for a single payer plan or at least a public option to be included in the ACA as it was being debated, but despite Max Baucus claiming months ago that implementation would be a train wreck, now that ACA is law none of them is calling the law corrupt and a failure.

          "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

          by SueDe on Sun Sep 01, 2013 at 09:38:42 AM PDT

          [ Parent ]

          •  I think you are shifting this comment onto (1+ / 0-)
            Recommended by:
            htowngenie

            Democrats in Congress. Nope, this is not about Democrats in Congress. In fact, I wish many of us had adopted the same stance of individuals such as Sherrod Brown or even Bernie Sanders, people who favor single payer, but still voted for, and advocated for, the ACA as a first step toward that goal.

            No, I'm referring to individuals who identify as Democrats in the media and online.

            It hasn't been an easy task for many of us who have been trying to undo an overwhelming negative public propaganda program, spearheaded by Republicans, which claim that the ACA has been unseemly or against the interest of the public.

            And some Democrats have also made it their choice to negatively frame the ACA at every given opportunity. It is their choice, and it is my choice to point this out.

            The realization that the ACA could very well be a success might have quieted some of the strident voices, but you still see some of the same characterizations: A giveaway to the insurance agency, A Republican bill, or the suggestion that the President sold out to Big Pharma.

            Call me nutty, but I always thought that the best way to drive people away from a product is to hint hint or right out suggest that the product is corrupt.

        •  What Will Trigger Single Payer? (0+ / 0-)

          I see a danger in the ACA in that it will cause many more people to buy coverage (via the exchanges) from private health insurance companies, thus increasing profits for the industry. If the private insurance industry winds up making a lot more money, does that mean that they will be able to put up even more cash to fight single payer than they can now? The only possibility I can see is that maybe the coverage that people are required to buy will become too expensive and in a few big blue states, like California, single payer will become a reality at the state level. Yeah I know Vermont did it but I feat that Vermont isn't big enough to have a national impact.

      •  They can still (0+ / 0-)

        not negotiate prices down and make more per customer, even if they have more customers they still have a huge incetive to do this to make an even higher profit.  

    •  Yes it is. You increase profits by paying out more (0+ / 0-)

      to service providers.

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

      by dinotrac on Sun Sep 01, 2013 at 08:00:34 AM PDT

      [ Parent ]

    •  You're missing the "free market" (15+ / 0-)

      Part of the costs the insurance companies are able to negotiate is based on the number of subscribers. That means some companies are at a disadvantage cost-wise. So their choice is compete strictly on price but less coverage or vice versa. Let your costs float up, need to increase price. Increase price, then fewer subscribers. That's how we got to
      45 million un and underinsured. As I see it, this is the
      "Free market's" last shot at making private health insurance work in this country. After this, it's Medicare Part E (Everyone). In dealing w the Law of Large numbers, there's no more advantageous pool than the entire population.

      •  I LOVE that--"Medicare Part E (Everyone)" (9+ / 0-)

        I'm not sixty-two—I'm fifty-twelve!

        by Pragmatus on Sun Sep 01, 2013 at 08:43:51 AM PDT

        [ Parent ]

      •  but now (0+ / 0-)

        they are restricted to a 20% profit based on the total cost of overhead and services.  If they allow services to increase then they get to keep more money instead of paying back the billions of dollars of government subsidies they are receving.

        •  However (0+ / 0-)

          Each company doesn't operate in a vacuum. One of the advantages of capitalism is that there's always someone out there looking to take your business away from you.
          You still need to be competitive. In that respect, the market self-regulates.
          ACA requires the insurance companies to have an 80 or 85% loss ratio. That means of every dollar collected, $.80 must be spent on paying claims. That's quite different than your characterization. The more efficient the insurance company is, the more of the $.20 becomes profit.

          •  The insurance companies (0+ / 0-)

            are just middlemen, there is no (or very limited) shopping for medical services.  Therefore the medical insurance provider system is a broken market and a defacto collusion may occur in this system.

            the more efficient the insurance company is, the more actual competition there will be, that is why they worked so hard to prevent a viable public option.

            Without the public option, there is no downward pressure on health care costs in the market as designed.

            •  Wrong market (0+ / 0-)

              I wasn't speaking of you and I shopping. How do you think an insurance company develops its costs. It sits wi a medical system and discusses pricing for various procedures, etc.
              the more subscribers an insurance company has, the more clout on pricing to them.
              This is the little secret of making money in the insurance biz.
              Aetna et al negotiate a price for an MRI based on the number of subscribers they have. Yet when they set pricing with the subscribers, they base it on the history of the organization or the subscriber. They collect more from you, but the payment to the provider doesn't vary based on history. Bingo, PROFIT!
              What ACA does is set a corporate loss ratio for the insurance company. They either spend the premium on coverage or give it back. The total of 20% is for underwriting profit and admin. You don't get 20% PLUS admin.

    •  Their chief benefit of the ACA (9+ / 0-)

      is that it begins to corral the excesses of the private health insurers.  Alas it is only a step in the right direction but once taken, the momentum towards a universal single-payer system, the only one that is fair, cost effective and covers all Americans, has become unstoppable.

      To paraphrase MLK, "We may not get there in my lifetime...", but we are on the way.

      I'm not sixty-two—I'm fifty-twelve!

      by Pragmatus on Sun Sep 01, 2013 at 08:35:12 AM PDT

      [ Parent ]

      •  It also equalizes prices (7+ / 0-)

        It compels insurance companies to charge the same rate to everyone, regardless of health status, gender, etc.  The only tier allowed for price differential is age.  This allows more people to buy insurance as well as it prevents "cherry picking".

        If these regulations protecting fair pricing are enacted in 2014, and that's a big if, it keeps progress moving in the right direction.

        "The international world is wondering what happened to America's great heart and soul." Helen Thomas

        by Betty Pinson on Sun Sep 01, 2013 at 08:41:18 AM PDT

        [ Parent ]

        •  and even the age differencials (3+ / 0-)

          are limited:

          Under the Affordable Care Act (ACA), age rating bands of 3:1 will prevent insurers from charging an adult age 64 or older more than three times the premium they charge a 21 year-old for the same coverage purchased in the nongroup insurance market.

          typically without this law the bands were 5:1

          fact does not require fiction for balance (proudly a DFH)

          by mollyd on Sun Sep 01, 2013 at 10:51:49 AM PDT

          [ Parent ]

    •  This isn't about you (1+ / 0-)
      Recommended by:
      bear83

      You are missing that millions of Americans are waiting to "buy" health insurance. Hello?  Why are you so jaded?

    •  You're definitely missing something . . . (4+ / 0-)
      Recommended by:
      SuetheRedWA, wmspringer, bear83, sharman

      They'll have to compete on price, through the exchanges. Consumers will have more ability to compare prices and benefits, and insurance companies, if they want to have customers, will have to deliver more for less.

      •  If all of the insurance companies (0+ / 0-)

        stop negotiating for price reductions by the health care providers, and we can alreadys see a 500% difference in cost between insured and non-insured patients for the same services, then they have a collective interest in letting service costs increase so that their profit marging on an average person also goes up.

        •  What? (1+ / 0-)
          Recommended by:
          sharman

          Obviously no Econ 101 here.  Can you re-state, because what you are describing is the exact opposite of basic economic teaching or it is a failure to understand the payment system.

          We are all in this together.

          by htowngenie on Sun Sep 01, 2013 at 02:11:51 PM PDT

          [ Parent ]

          •  The law says (0+ / 0-)

            that the insurance companies have to refund to their subscribers any money that is more than 20% of total costs for healthcare services and overhead.

            The 20% is their guaranteed profit.

            If you increase the amount of the money paid for healthcare then the dollar amount of the 20% increases as well.  Hence the total amount of their profit goes up.

            •  By "money paid for healthcare" (1+ / 0-)
              Recommended by:
              GayHillbilly

              do you mean payments on claims made to providers of healthcare?  I'll go with that and assume that is what you mean.

              Lets take a hypothetical case:

              If under an insurance policy the insurance company pays 70% of a hospital stay that cost $10,000, they pay $7,000, and the patient picks up the remaining 30% or $3,000.  The profit to the insurance company (if any) is the income from the premiums of the entire risk pool minus the $7,000 paid on the hospital stay.  

              If the the cost of the hospital stay goes up to $15,000 due to rising costs, the insurance company still pays 70% but now the payout from the insurance company is higher at $10,500 ($3,500 more than above) and the cost to the patient is higher at $4,500.  However, the premium income from the risk pool is unchanged.  

              In the scenario above if you want to apply the 80/20 rule, the income from premiums on the $10,000 hospital stay is the same as the income from premiums on the $15,000 hospital stay.  It's the expenses that have gone up $5,000.  

              For simplicities sake, let's say that the original payout of $7,000 represented all claims for this hypothetical insurance company and it equalled 80% of the premiums they had collected that year.  That means the company received $8,750 in premiums in the year and spent 80% of that premium income on legitimate health care and kept the difference as profit, or $1,750.

              Now apply the effect of a health care cost increase to the insurance company of the hospital stay going up to $15,000.  The expenses have now gone from $7,000 to $10,500, a difference of $3,500 in increased expenses.  But the income from premiums has remained the same at $8,750.  Now the insurance company has a loss of $1,780 for the year.  They've spent more than 100% of their income on legitimate health care expenses because of the rising cost of healthcare.

              At this point, the insurance company has several choices, 1) make an adjustment to the premiums to all people in the risk pool to cover the rising cost or 2) add healthier people to the risk pool to mitigate claim payouts or 3) put pressure on health care providers to keep costs in line, or 4) a combination of the three.  

              If they raise premiums, consumers will have a choice to pick another insurance carrier who offers lower rates for the same coverage.  There might be room for a slight increase, but not much.  Real competition means that other insurance companies who may have healthier clients can lower their premiums making competition even fiercer.  It's more likely that insurance companies would choose to add greater numbers of healthier people to their risk pool to mitigate the risk.  Thus, the reason why insurance companies are now actively marketing to young invincibles.  That's why putting an individual mandate in ACA was so critical (although that's now on hold).  And insurance companies will put pressure on providers to keep costs level because it is in their best interest to do so.

              You will also notice that prior to ACA, health insurance companies had no incentive to add greater numbers of healthier people to their risk pool and no incentive to pressure health care companies to keep costs down.  They had pretty much one tool to make a profit...raise premiums.  

              ACA has leveled the playing field and caused market forces to make a closed market into an open market.  In may not be perfect, but it is way more fair than previously.

              I hope this answers your question.  

              We are all in this together.

              by htowngenie on Sun Sep 01, 2013 at 10:13:28 PM PDT

              [ Parent ]

              •  Thank you (0+ / 0-)

                it kind of does answer my question, I say kind of because

                1. As far as I know the individual mandate is still scheduled to take effect in 2014
                2.  insurance companies were ALWAYS interested in adding healthier people to their pools since these premiums were almost complete profit.
                3.  If the medical care goes up for all insurance companies (who all use the same service providers) then the rates will all go up together as a form of defacto collusion.
                4.  If the example you use has a company that was scheduled to provide a refund for 10% of their total premiums due to reduced payout, then they would want to allow prices to go up so that they can keep a portion of that payout in future cycles. .

                .non?

                •  The real world versus economic theory (0+ / 0-)

                  If competition was the magic bullet to bring costs down, why is US healthcare far more  expensive and less effective than healthcare in any other industrialized nation? One reason is that people don't have enough information to make informed choices. The pricing of insurance is far beyond the ability of most people, even if they have the information required, so before Obamacare, insurance companies could use marketing techniques to sell substandard policies to unsuspecting customers and make a profit. The new law diminishes this problem by having government experts evaluate the policies to make sure they meet certain minimum standards. But your typical businessman will still use marketing as the primary vehicle for increasing market share (as opposed to actually creating a better product, since consumers do not have enough information to evaluate quality.) This is were the 20% figure comes in. It is significant that this is NOT 20% profit, it is a 20% cap on money not going out to pay providers. So marketing costs are included in the 20%.

                  As to your question about higher provider payouts leading to higher dollar overhead allowance, I think you are right. But the existing system lacks a mechanism to effectively control escalating provider costs as well, as explained by the imperfect information problem and documented by recent history. I think the 20% cap is a huge improvement over the status quo.

  •  When people start saving thousands in premiums (18+ / 0-)

    or getting health care for the first time, (in my case both as my insurance is only catastrophic and the ACA is preventative) we sure will know who it's coming from. An event that big doesn't go unnoticed.

    Just wait.

    “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

    by ban nock on Sun Sep 01, 2013 at 07:53:30 AM PDT

  •  This: (7+ / 0-)
    Sometimes, helping people is a thankless job.
    Is very true .... But it is true only because so many elected officials have an agenda that is defined by them deliberately obstructing the very people who elected them to help!

    I hope that the quality of debate will improve,
    but I fear we will remain Democrats.

    Who is twigg?

    by twigg on Sun Sep 01, 2013 at 07:54:25 AM PDT

    •  Yes, and the boggling truth (2+ / 0-)
      Recommended by:
      orlbucfan, twigg

      is that these people will vote for the very representatives who are beating them, robbing them and leaving them for dead. When Mencken said "You can't underestimate the stupidity of the average America" he was thinking of just such a scenario.

      We can thank Fox Noise for that.  

      I'm not sixty-two—I'm fifty-twelve!

      by Pragmatus on Sun Sep 01, 2013 at 08:39:02 AM PDT

      [ Parent ]

    •  Those elected officials represent the oligarchs (3+ / 0-)
      Recommended by:
      twigg, Bensdad, Leftleaner

      rather than the public.

      This is an extremely good and explanatory article. But it describes something that is not new in America. Digby wrote about the "Two Tribes" quite a while back. One of the tribes dominates the American Northeast and tends to be democratic and social with education and social equallity the values which dominate. The other tribe has dominated the Southeast and is inherently oligarchic.

      I relate it to an interesting book called Cavalier and Yankee: The Old South and American National Character.

      Today the "Cavalier" character is represented by CEOs and upper management of large mostly ologopolistic or monopolistic corporations, very wealthy families (Coors, Koch, Bush, Hunt, etc.) and the powerful in the Wall Street banks. For a full list check to see who is supporting the various conservative think tanks. Don't forget the Discovery Institute.

      The way the Constitution distributes power means that centralizing the federal government only happens when even the important minorities feel it is necessary - meaning the U.S. has an external threat. From what I have read that was the reason the Articles of Confederation were replaced by the Constitution. Since then the federal government has only been powerful over the oligarchs in time of war or threat of war.

      The Cold War extended the threat from WW II until the 80's, but the conservative movement felt the weakness of the USSR from the end of Vietnam, so they have been chipping away at the centralization of functions nationally since that time. The big function being centralized has been the clear defining of a standardized market in which the consumers had the government forcing business to play fair. That created the economic boom of the 50's, 60's, and 70's.

      The oligarchs, like the cotton plantation owners, have no interest in a society that works for the majority as long as they have the power and social position. That is the oligarchic view of the 1%. They fund the conservatives and feed them their beliefs through their think tanks and politicians.

      ObamaCare will be a great loss to the oligarchs. It creates a standardized set of markets that are much more transparent to the consumers and are inherently fair. The oligarchs do not want fair markets. They want to charge unearned economic rents because that is the source of their social and political power. Banking reform also threatens them.

      Both the rhetoric and the Southern insanities are reminiscent of the Civil War for a reason. Steve Benen posted an informative map comparing the 2004 electoral college to the powers in 1860. Currently it is another battle for national power between Digby's two tribes of America, and as the oligarchs lose they become increasingly afraid and irrational.

      The conservative mindset is to always double down on the failed policies when they are losing. They never learn until forced to by external force. Since the oligarchs who dominate them will not lose their social position  it doesn't matter.

      The US Supreme Court has by its actions and rhetoric has ceased to be legitimate. Whiskey Tango Foxtrot - over

      by Rick B on Sun Sep 01, 2013 at 09:10:18 AM PDT

      [ Parent ]

  •  The law will succeed in the eyes of Democrats (1+ / 1-)
    Recommended by:
    Nattiq
    Hidden by:
    Mokurai

    because you guys will simply declare success.

    In a way, that's ok -- success is always dependent on goals and a law can succeed even if its a whomping pile of shit that busts the bank, avoids the underlying problems, and generally makes most people worse off than they were before.

    And the ACA isn't as bad as that, unless you do the old sports fan thing when evaluating failed draft picks:

    "I can't believe you picked Detlef Schrempf when Karl Malone was still on the board".

    For non sports junkies, Schrempf was a very good forward and 2-time NBA All Star.  Karl "The Mailman" Malone was an all-time great player and true force at power forward.

    Passing up Malone to take Schrempf was a bone-headed move.

    Passing ACA meant ignoring the single biggest problem facing the nation at the time, and, with it, the misery of millions.

    All to pass what really is a few good nuggets wrapped in a very bad bill.

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

    by dinotrac on Sun Sep 01, 2013 at 08:00:06 AM PDT

    •  what? (5+ / 0-)

      that comparison doesn't make sense.  that would be like the Detroit Pistons not taking any draft picks because their city is in such financial straights.  What does one have to do with another?

      Are you really saying our government should only work on jobs because of unemployment?  And you may want to look and see that nothing has been done on the Right about job loss and creating jobs because they keep saying "Government doesn't create jobs."  In fact, the sequester CUT jobs.

      So please.  If you ever become an NBA owner and have a chance to draft Larry Bird (ACA) over not drafting anybody because peanut sales are too high (the right's argument about everything).  You might want to realize your an idiot.  

      •  Use the words, Luke! (0+ / 0-)
        Passing up Malone to take Schrempf was a bone-headed move.
        The choice wasn't between Schrempf (or ACA) and nothing, it was between Schrempf and Malone (attacking the dismantlement of middle-class wealth, avoiding the 2010 debacle, and, potentially, still passing a health related bill -- possibly an even better one)

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

        by dinotrac on Sun Sep 01, 2013 at 09:19:44 AM PDT

        [ Parent ]

      •  Hi. I've noticed this guy for a few weeks. IMO, (0+ / 0-)

        he's possibly a troll, probably of the concern variety.  His brain has an adamantine consistency.  Best to just pass on by.

        We must, indeed, all hang together, or assuredly we shall all hang separately. B. Franklin

        by Observerinvancouver on Sun Sep 01, 2013 at 12:20:56 PM PDT

        [ Parent ]

    •  Why can't people understand? (14+ / 0-)

      We couldn't get single-payer because we didn't have the votes. There were too many Conservative Democrats.

      Maybe in the future, we can win more primaries and get Better Democrats. But for now, the ACA is what we have. Wailing and moaning about it isn't helping.

      •  It was never on the table to put up for a vote. (2+ / 0-)
        Recommended by:
        Odysseus, cville townie

        If we had started negotiations from that position, single payer, we would have gotten the Public Option or more.

        •  Ah, yes (2+ / 0-)
          Recommended by:
          Gator Keyfitz, Tuffie

          the old "negotiating in Congress is exactly like buying stuff from a vendor in Tijuana!" theory.

        •  I was paying attention while all that was going (1+ / 0-)
          Recommended by:
          bear83

          on.  There never seemed like a ghost of a chance for single payer or a public option.  

          Exhibit "A":  Max Baucus.  Any bill had to come out of the Finance Committee, inter alia.  Baucus was chairman.  He was also in the pocket of the medical/insurance complex and did his best to sloooow walk the whole process.  It was a near run thing and he almost succeeded.  

          Obama went to Montana during the process and in front of Baucus at a public event pointed out that Montana's uninsured/underinsured rate was about 30%.  I think that may have shamed Baucus into letting  the bill out of committee.  He was probbly hoping he could find a later opportunity to sabotage it less conspicuously.  But that's just my opinion so far as I know.

          We must, indeed, all hang together, or assuredly we shall all hang separately. B. Franklin

          by Observerinvancouver on Sun Sep 01, 2013 at 12:36:11 PM PDT

          [ Parent ]

      •  Single payer doesn't do it for me anyway (1+ / 0-)
        Recommended by:
        cville townie

        Never could understand all the hoola. All it means is no one pays anything out of pocket, doesn't mean health care costs come down. I don't like paying for health care, no one does, but the real fix to our system is to push down costs. Why should we pay twice as much as other places?

        Single provider.

        All hospitals govt, all docs govt employees, all insurance govt insurance.

        “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

        by ban nock on Sun Sep 01, 2013 at 08:57:02 AM PDT

        [ Parent ]

        •  100% counterfactual (9+ / 0-)

          Countries with Single Payer have far lower costs than the US for better care.

          Ceterem censeo, gerrymandra delenda est

          by Mokurai on Sun Sep 01, 2013 at 09:00:11 AM PDT

          [ Parent ]

          •  I understand you support for profit medicine (1+ / 0-)
            Recommended by:
            cville townie

            I don't. Even if it brings down cost a little.

            Medicine is too important to leave to the market, and I don't care what doctors are upset.

            The savings to be had by socialized medicine are obviously much greater.

            or maybe you didn't read my entire comment

            “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

            by ban nock on Sun Sep 01, 2013 at 10:27:03 AM PDT

            [ Parent ]

          •  Most of them do not (0+ / 0-)

            have privately owned, for-profit hospitals, like Frist/Rick Scott's Columbia-HCA, or else "non-profit" hospitals that act as the major profit center for the university system that owns them.

            Most of them do not have an accrediting system for medical education that is 100% controlled by the doctors' association and the med schools themselves (which means the hospitals, since organizationally they are one and the same).

        •  One thing about single payer if it's done right (1+ / 0-)
          Recommended by:
          bear83

          is that it takes payment for basic coverge out of the hands of the insurance companies completely.  They no longer skim their take off the top for simply being the middle man between patients and health care providers.  

          Srsly.  Can you think of anything they do that is more constructive than taking money out of one pocket and putting it into another?  

          P.S.  We have single payer in Canada.  Most doctors are not government employees.

          We must, indeed, all hang together, or assuredly we shall all hang separately. B. Franklin

          by Observerinvancouver on Sun Sep 01, 2013 at 12:45:45 PM PDT

          [ Parent ]

          •  Well, they negotiate... (1+ / 0-)
            Recommended by:
            Observerinvancouver
            Can you think of anything [insurance companies] do that is more constructive than taking money out of one pocket and putting it into another?
            Well, they do negotiate the price down.  My employer self-insures with United Health as administrator.  Say what you want about United Health (and they deserve every bit of it), but their website is pretty nice and shows that they negotiate the cost of every claim down by about 75%.

            Just playing devil's advocate.

            Having satisfied that role, I will now admit that billing rates must be ridiculously inflated if providers are willing to accept 25% payment, to the point where I wonder if insurance companies actually encourage inflated bills, so they look better when they "negotiate" them down.

            ------RM

        •  Single payer works fine for Medicare (0+ / 0-)

          and the VA.

          The simplest path to single payer is to simply lower the eligibility age for Medicare.

          Filibuster reform, 2013 - woulda, coulda, shoulda.

          by bear83 on Sun Sep 01, 2013 at 03:25:31 PM PDT

          [ Parent ]

      •  Single payer = big yawn. (1+ / 0-)
        Recommended by:
        cville townie

        American problem is delivery, which causes much of the affordability problem.

        Fix delivery, bring costs down to merely the level of the most expensive health care in places that are not the US, maybe even improve the quality of care to match those most expensive places that are actually only half the cost of American health care, and -- Shazzam! -- getting everybody covered becomes a ton cheaper, better, and runs into less opposition.

        In that context, a health insurance reform bill like ACA  makes a ton more sense than in the over-stuffed million-little entrpreneurial, non-collaborative fiefdoms that pass for health care in the US.

        Single payer becomes a big, "Yeah, sure. I guess. Do we really need it?"

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

        by dinotrac on Sun Sep 01, 2013 at 09:24:44 AM PDT

        [ Parent ]

      •  The reason we didn't have the votes (0+ / 0-)

        was the filibuster - plain and simple. We had the votes in the House. Just like hundreds of other bills passed by the House in 2009-2010, single payer fell victim to the threat of the Senate filibuster.

        Filibuster reform, 2013 - woulda, coulda, shoulda.

        by bear83 on Sun Sep 01, 2013 at 03:23:53 PM PDT

        [ Parent ]

    •  The ACA will be declared a success (2+ / 0-)
      Recommended by:
      orlbucfan, Odysseus

      when Bill Kristol's prophecy comes true, and it kills off the Republican Party. Not by itself, of course, but in conjunction with all of the other issues on which Republicans are losing, and with the ineluctable demographic and generational shifts away from them, amounting to about 1% of the US population annually.

      Oh, and also, HRed for trolling.

      Ceterem censeo, gerrymandra delenda est

      by Mokurai on Sun Sep 01, 2013 at 08:58:19 AM PDT

      [ Parent ]

      •  ACA will not kill of the GOP. The GOP is killing (1+ / 0-)
        Recommended by:
        bear83

        off the GOP and the ACA is merely a bullet point in the PowerPoint on somebody's future presentation on "Implosion of a political party in the United States"

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

        by dinotrac on Sun Sep 01, 2013 at 09:26:07 AM PDT

        [ Parent ]

        •  The GOP controls the House of Reps. (0+ / 0-)

          I would be careful about saying the monster is dead.  And they will continue to control it, probably for the rest of my life. Gerrymandered.

          If you hate government, don't run for office in that government.

          by Bensdad on Sun Sep 01, 2013 at 11:05:46 AM PDT

          [ Parent ]

          •  The party is dying. It's chased away a lot (1+ / 0-)
            Recommended by:
            bear83

            of natural Republicans and seems dead-set determined to wage what is basically a generational war.  

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

            by dinotrac on Sun Sep 01, 2013 at 11:15:32 AM PDT

            [ Parent ]

            •  Am I the only one who doesn't want the GOP to die? (0+ / 0-)

              I sometimes find myself giddy imagining a future where the GOP has collapsed so hard that they can't get themselves elected dog-catcher anywhere in the country.  Then I think about what comes next and it horrifies me.

              If the Democrats become the only viable party in the country, all the non-insane conservatives will flock to it, pulling the party to the right.  In the end, there will be two parties:  the ultra-right, wackjob GOP which no one takes seriously any more, and a center-right Democratic Party where conservatives and moderates outnumber liberals and progressives.  The left won't truly have a party.

              I want a healthy, inclusive, loyal, non-insane Republican Party to act as a home for conservative politicians, so we can get them out of the Democratic Party.  I want a center-right party and a center-left party, so that post-election compromise can allow actual governing to take place.

              ------RM

              •  It's been a while since a party died, but maybe (0+ / 0-)

                it's time.

                That doesn't mean Democrat or nothing.
                It means that another party (or parties) rushes in to fill the void.

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

                by dinotrac on Sun Sep 01, 2013 at 04:42:32 PM PDT

                [ Parent ]

  •  Perhaps DKos could setup a "running tab" (7+ / 0-)
    Recommended by:
    fladem, Sue B, annan, orlbucfan, Odysseus, Inkpen, rsmpdx

    ...of actual real life success stories from real people that actually checked out their state's ***Care offerings and with permission of those happy shoppers post them to local media OpEd sections, radio, etc.,. Here in Wisconsin, between the governor (president wannbe) and his repub state govt they are doing their best to insure failure of ACA,and the (news) media is apparently doing their best to keep everyone as ignorant as they are of the benefits in the ACA Law.  Falls in well with that old addage (You can lead a horse to water but can't make it drink). But that's not fair to horses...they're generally smart about following stupid-is-as-stupid-does over the cliff.  

    Our nations quality of life is based on the rightousness of its people.

    by kalihikane on Sun Sep 01, 2013 at 08:14:39 AM PDT

  •  Anything going on in Syria these days? (1+ / 0-)
    Recommended by:
    Says Who

    Just wanted to know if it's important.

  •  Fed Exchanges Not Marketed At All. (1+ / 0-)
    Recommended by:
    Bensdad

    I see we're repeating our winning formula from 2010 for this midterm.

    This party is seriously terrified of getting stuck with the WH and both chambers.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Sun Sep 01, 2013 at 08:16:39 AM PDT

    •  In the article this is discussed (10+ / 0-)

      Specifically, here:

      The marketing effort for the federal exchange, however, will be woefully underfunded as an intentional product of Republican intransigence.
      Republicans have refused to provide the funding for marekting the federal exchanges -- money that wasn't built into the original law, since the expectation was that states would handle the exchanges in far more states than is actually the case.

      There is a real problem here, but the problem isn't the Democratic party somehow just choosing not to market the exchanges.  The problem is that the money isn't there to do it, and private and political party efforts to plug the gap can only go so far to compensate.  A full up 30 state ad campaign is not cheap...

      Political Compass: -6.75, -3.08

      by TexasTom on Sun Sep 01, 2013 at 08:20:34 AM PDT

      [ Parent ]

      •  We had this discussion (3+ / 0-)
        Recommended by:
        orlbucfan, RadGal70, bear83

        I pointed out the various organizations taking on the challenge, and others pointed out that insurance companies will be devoting major resources to going after tens of millions of new customers.

        Ceterem censeo, gerrymandra delenda est

        by Mokurai on Sun Sep 01, 2013 at 09:03:39 AM PDT

        [ Parent ]

      •  GOP resistance to state exchanges was foreseeable (1+ / 0-)
        Recommended by:
        Bensdad

        ...at least in enough states to be a potential threshold problem, though perhaps the foreseeable number was more like half the 30 it's turned out to be.  The fact that the ACA got zero GOP votes and was being relentlessly attacked by shameless hyperbolic lies and knowing that core GOP leaders met on the night of Obama's inauguration to plan to actively undertake to make Obama's presidency a failure from day one should have been enough.

        Why didn't the dems include provisional funding for marketing the federal exchange in states that refused to set up state exchanges, when this was fully foreseeable at the time?

        •  Clearly... (2+ / 0-)
          Recommended by:
          Observerinvancouver, sharman

          ...the president is a failure for not being a psychic who is able to predict the future.

          Seriously, some obstruction might have been foreseen -- but I don't think that the level of obstruction was foreseeable.  The model that we had to go on was the way the Republicans treated Clinton in the nineties -- and while they demonized him and caused him endless problems, even Clinton didn't face this level of obstruction and outright sabotage.

          Political Compass: -6.75, -3.08

          by TexasTom on Sun Sep 01, 2013 at 12:16:16 PM PDT

          [ Parent ]

        •  I think the SCOTUS ACA decision had a poison (0+ / 0-)

          pill in it when it left participation to the states.  Hard to anticipate that.  

          We must, indeed, all hang together, or assuredly we shall all hang separately. B. Franklin

          by Observerinvancouver on Sun Sep 01, 2013 at 12:54:53 PM PDT

          [ Parent ]

    •  The fed exchanges are being marketed (10+ / 0-)

      This is the second time you and I have had this conversation.  In a comment below, I link to this article in the Boston Globe.  It tells of the grassroots campaign in Texas marketing the federal exchange in that state.

      It's not flashy, it doesn't cost an awful lot of money, but it does work.

      The efforts to repeal Obamacare are the GOP Abort Obamacare Act. lynneinfla

      by litho on Sun Sep 01, 2013 at 08:36:38 AM PDT

      [ Parent ]

    •  The Insurance Companies are marketing them (0+ / 0-)

      They have a shot at millions of new customers.

      Blue Cross Blue Shield of NC has a great program going to explain HCA.

      I'm sure this is not unique to North Carolina - home of some of the nuttiest Republican legislators you will find anywhere. The insurance companies have an incentive to sell HCA whether states and the Feds do it well or not.

      Filibuster reform, 2013 - woulda, coulda, shoulda.

      by bear83 on Sun Sep 01, 2013 at 03:35:42 PM PDT

      [ Parent ]

  •  I think the word will spread once people (5+ / 0-)

    become covered. It may be slow at first but will accelerate.

    •  but what can be done to HELP? (3+ / 0-)
      Recommended by:
      qofdisks, ban nock, Odysseus

      a campaign isn't cheap.. but can people help with Letters to Editors, etc etc?

      What can be done....

      •  It is precisely and exactly the usual (1+ / 0-)
        Recommended by:
        jck

        Write Diaries. Use the Like and Tweet buttons at the top of every Front Page story and member Diary. As you say, write letters to the editor, particularly when you see a lie in that newspaper or on that Web site. Find the organizations in your state or locality, or the national organizations, working on your issue, this or any other. Attend the meetings and rallies. Volunteer. Donate. And next year, GOTV.

        It's all in the standard playbook: Rules for Radicals, by Saul Alinsky. Even the Republicans use it to train their operatives.

        Ceterem censeo, gerrymandra delenda est

        by Mokurai on Sun Sep 01, 2013 at 09:08:26 AM PDT

        [ Parent ]

      •  Well, using myself as an example, (7+ / 0-)

        I'm unemployed and where my wife works offers no health insurance. We're currently covered under my COBRA. We checked our status at Covered California and as near as we can tell, once we get on Obamacare next year, we'll have the same coverage for about $180 less per month. That will get people's attention. I will make sure my conservative relatives know what it's doing for us.

      •  Volunteer to be a navigator in your state. (1+ / 0-)
        Recommended by:
        sharman

        Contact the grant recipients who will be supplying and training navigators for the outreach effort and volunteer to answer phones and answer inquiries about how to apply at the state exchange level, or if your state won't set up their own exchange, answer inquiries from your state regarding the federal exchange.  Here is a list, by state, of grant recipients you can contact.

        "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

        by SueDe on Sun Sep 01, 2013 at 03:57:27 PM PDT

        [ Parent ]

  •  It is amazing what you can accomplish (6+ / 0-)

    if you do not care who gets the credit.
    - Harry S Truman

  •  The battle over the ACA (6+ / 0-)

    is the fundamental battle in politics.  The Tea Party people view it in this way - I do not think many "left progressives" view it this way, though.  

    •  I agree. There was never really (1+ / 0-)
      Recommended by:
      Susan G in MN

      any attempt to get leftie buy-in on a visceral (instead of an 'it's a good, if limited, first step' intellectual) level. Maybe that would've proved impossible, but I think the results of that failure has reverberated quite deeply.

      "Gussie, a glutton for punishment, stared at himself in the mirror."

      by GussieFN on Sun Sep 01, 2013 at 08:32:51 AM PDT

      [ Parent ]

      •  That is because the ACA originates as a Republican (1+ / 0-)
        Recommended by:
        GussieFN

        plan that keeps the advantage in Insurance companies and does not protect the public from medical bankruptcy.

        •  I don't think it matters why, at this point. (2+ / 0-)
          Recommended by:
          ratcityreprobate, rwgate

          I just think that fladem's right that, like it or not, this is the fundamental battle in politics, and for various reason we don't feel it the way they do. I certainly don't. And our relative lack of passion has hurt us politically.

          "Gussie, a glutton for punishment, stared at himself in the mirror."

          by GussieFN on Sun Sep 01, 2013 at 08:51:16 AM PDT

          [ Parent ]

        •  But it originated in a different Republican Party (3+ / 0-)
          Recommended by:
          Odysseus, Bensdad, rwgate

          Seriously, the Republican party has changed a great deal in the past few decades, having once been a party that did advocate alternative policies for helping the needy to one that has instead embraced social Darwinism.

          Consider the the Earned Interest Credit evolved from conservative think tanks advocating a negative income tax back in the seventies.  It was embraced by Reagan and expanded by George W Bush.  Today, Republicans consider it an enabler for that horrible "deadbeat 47%" who just sponge off the system.

          The Republican party in which the ideas that make up the ACA no longer exists.  That Republican party was looking for a market alternative to single payer; today's Republican party believes that if you can't afford your own insurance, you deserve to die.

          Political Compass: -6.75, -3.08

          by TexasTom on Sun Sep 01, 2013 at 08:59:54 AM PDT

          [ Parent ]

      •  you mean rich lefties, the kind with health (4+ / 0-)
        Recommended by:
        SuetheRedWA, RadGal70, elmo, rsmpdx

        insurance already, Dkossers.

        Almost all the volunteers in my precinct were very invested in the ACA, it's our lifeline to medical care.

        For us it's the best thing since sliced bread.

        I have no premiums, no co pays, no deductible. For me it's more than a small first step.

        “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

        by ban nock on Sun Sep 01, 2013 at 09:01:43 AM PDT

        [ Parent ]

        •  Is that what I mean? (0+ / 0-)

          Almost all the volunteers in my non-wealthy district thought it was weak tea at best.  And I don't have health insurance that I don't pay for myself, even though I can't afford it, thank you very fucking much, and I agreed with them.

          So more important, how do you have no premiums, co-pays, or deductible? I'm paying $400/month with a $2,500 deductible, if memory serves, and it's not easy.

          "Gussie, a glutton for punishment, stared at himself in the mirror."

          by GussieFN on Sun Sep 01, 2013 at 09:07:24 AM PDT

          [ Parent ]

          •  I don't think you understand what "non wealthy" (1+ / 0-)
            Recommended by:
            elmo

            means. If you did you wouldn't need to be told how the ACA might give me no premiums, no copays, and no deductible.
            http://www.connectforhealthco.com/...

            I pay a lot more than you for a lot less, and in four months I'll pay nothing for great healthcare.

            “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

            by ban nock on Sun Sep 01, 2013 at 10:21:08 AM PDT

            [ Parent ]

            •  WTF are you talking about? (0+ / 0-)

              The median income is $33,000. That's non-wealthy.

              And you said you have no premiums, no co pays, no deductible. I was hoping that was true, because I could use the same deal.

              "Gussie, a glutton for punishment, stared at himself in the mirror."

              by GussieFN on Sun Sep 01, 2013 at 11:34:12 AM PDT

              [ Parent ]

        •  And where were all of these super-enthusiastic (1+ / 0-)
          Recommended by:
          ban nock

          people during the mid-terms? You think we had as many people who had as much passion as the Tea Party screamers? I'm measuring enthusiasm in decibels, not sliced bread.

          "Gussie, a glutton for punishment, stared at himself in the mirror."

          by GussieFN on Sun Sep 01, 2013 at 09:09:46 AM PDT

          [ Parent ]

          •  We were door knocking and phone banking (3+ / 0-)
            Recommended by:
            elmo, bear83, rsmpdx

            and we got our long shot senate candidate that Nate Silver said would lose,,, into office for 6 years.

            And we were back out in 12

            And we'll be out in 14

            And 16

            We Win Elections

            “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

            by ban nock on Sun Sep 01, 2013 at 10:22:52 AM PDT

            [ Parent ]

  •  It's a mistake to think (4+ / 0-)
    Recommended by:
    FiredUpInCA, ban nock, Odysseus, bear83

    the law is not being promoted in federal exchange states.  See, for example, this piece in the Boston Globe from last week regarding the door to door campaign being conducted in Texas.

    The efforts to repeal Obamacare are the GOP Abort Obamacare Act. lynneinfla

    by litho on Sun Sep 01, 2013 at 08:33:15 AM PDT

  •  Not unlike Medicaid, SNAP and other benefits (3+ / 0-)
    Recommended by:
    qofdisks, orlbucfan, Chas 981

    that, I'm guessing in large part because they're underfunded by design by Repubs, are way too complex to understand, navigate and utilize, and way too under and improperly promoted, despite being fairly generous in many places. I've recently had to navigate the system for my parents, and I'm still struggling to figure it out. There's no single, well-designed source for understanding and applying for these various benefits, since they're divided between federal, state and local agencies, and between departments within each.

    I suspect that millions of people are missing out on benefits that are rightfully theirs, because they don't know that they qualify, don't know how to apply, or just give up out of frustration. I view this as "Reverse Fraud", in which the government effectively defrauds people out of benefits they're legally entitled to, by making it so hard to get them. Like voting in red states.

    Obviously they're going to try to do this with the ACA. But with people being forced to pay a fine if they don't have insurance, there's clearly an incentive for people to figure this out for themselves. But surely many will prefer to pay the fine than deal with the bureaucracy, or not even realize that they're paying a fine. Which is why this should have been done as an "opt-out" program.

    We are BADLY in need of a major, across the board reform of these programs, to make them not only more generous (where needed), and of course more efficient with less waste and fraud, but also easier to understand and use. It'll not only be better for people who need them, but better for the economy.

  •  Credit belongs to all Dems (7+ / 0-)

    ACA was most definitely a team effort, involving Dem leaders in Congress, many of whom had been working on health care reform since the early 1990's.  The details of ACA were hammered out over many years of trial and error, brainstorming and collaboration..

    Credit is also due to the massive number of grassroots health care activists who worked tirelessly over many years to get reform on the national agenda and who helped craft the final plan.  They didn't get everything they wanted, but they kept ACA from being watered down to the point of ineffectiveness and irrelevance.

    "The international world is wondering what happened to America's great heart and soul." Helen Thomas

    by Betty Pinson on Sun Sep 01, 2013 at 08:47:37 AM PDT

  •  Amazingly ignorant people (3+ / 0-)
    Recommended by:
    orlbucfan, Chas 981, bear83

    who rail against change to their health care, and don't have insurance. It's hard to deal with idiots who fight for insurance companies and against their own interests.

    See Kansas

    ...the GOP seems perfectly willing to hold their breath until the whole country turns Blue.

    by tommy2tone on Sun Sep 01, 2013 at 09:07:48 AM PDT

  •  Let them sign up now and tell them later (1+ / 0-)
    Recommended by:
    Chas 981

    Important thing is to get people in the system. Before the 2016 elections Obama can make a big speech telling everyone that the state exchange they signed up on was a creation of "Obamacare". At that point, no one will want to go back....

  •  Thankless indeed, but I understand SS (6+ / 0-)

    was intensely opposed when it was begun.  Now, well, touch it and you'll know why they call it the third rail.  

    And as to the free market nonsense.  No. You can't have a free market if you have no freedom of choice.  

    I recently bought a washer.  Did a lot of shopping and research -- know more than I ever wanted to about washing machines. One of the appliance salesmen even jokingly offered me a job.  Got a good deal.  Great. In this case the free market did work.

    But at no time did I see a warning saying:

    1.  If you already have a pre-existing washer, you cannot buy a new one.  If it is broken, we may not let you have a washer at all.

    2.  The price of the washer will go up if you are older, if you use it a lot or if you are a woman.

    3.  Oh, and if we have another AIDS like epidemic and you live in what we consider a high risk area, we won't tell you, but...you might not be able to get a washer.  Germs, disease, wear out the warranty...you know ...those people...Shhhhh.

    If the free market worked in health care, we would not be having this discussion.

  •  If the government doesn't have the funds to (2+ / 0-)
    Recommended by:
    True North, Eric Nelson

    market the exchanges, I hope a grassroots effort will rise up.  The facts will be available on government websites.  I'm hoping OFA will organize an informtion blitz but I don't know exactly how it works.  

    Kossacks can do their part by explaining to friends and relatives what the exchanges can do for them and how to sign up.

    Stymie the Republicans by spiking their guns.  You can do your part.

    We must, indeed, all hang together, or assuredly we shall all hang separately. B. Franklin

    by Observerinvancouver on Sun Sep 01, 2013 at 09:58:16 AM PDT

    •  Good points about what we can do (13+ / 0-)

      I can't do anything to change what Republicans are doing to manipulate and deceive people. Wish I could, but I can't.

      I'm sure that OFA has an excellent plan in mind to get the right information out there. People can help OFA do that by donating or volunteering.

      What I can do, though, is to talk with people I know in the U.S., especially those who either aren't on a company plan, or are but have family members who aren't.

      I have been especially attentive to families I know with young people, university age and up, who may lack good health insurance. In one family I know, the twenty-something child can't be on the parents' plan: last baby in the family, and now the parents are already on Medicare.

      I encourage everybody to at least look into it. I always advise them to start at healthcare.GOV (not .com, a commercial site).

      If they get curious and experiment with the calculator, they'll probably be wowed--and may pursue it further, if only in suspicion and disbelief, sure there is a catch somewhere. I want to get the horse to the water.

      One great thing about targeting young people is that they are heavy users of social media, and whatever a satisfied young customer of ACA says will often end up being shared with a lot of people, in a lot of states.

  •  healthcare for all (0+ / 0-)

    lezzee: the problem is government not supporting the underwriting and promulgation of private health insurance for 30 some odd states that don't want their own health exchanges....

    something old, something new, something borrowed, something called medicare for all, public option, universal health care----i really don't care what you call it but it'll be cheaper than the spread between premiums and services that we're so VERY committed to preserve.

    in little words for the lowest common denominator, 'LIKE DUH!'

  •  it's amazing to continue to see so much effort (1+ / 0-)
    Recommended by:
    mollyd

    expended by the left to counter what are symptoms of the talk radio monopoly, as opposed to actually doing something about the talk radio monopoly itself.

    the primary source of the disinformation is still those coordinated radio stations getting a free speech free ride to distort the national discussion.

    This is a list of 76 universities for Rush Limbaugh that endorse global warming denial, racism, sexism, and GOP lies by broadcasting sports on over 170 Limbaugh radio stations.

    by certainot on Sun Sep 01, 2013 at 10:31:42 AM PDT

  •  Keep the government out of Medicare! (0+ / 0-)
    the people it helps will not realize that it is the federal government that has helped them, and will experience no change in their perception of the role of government, or realize the failure of conservative free-market fundamentalism
    I wonder if people will notice when there are fewer community fundraisers to pay for the cancer treatments of one of their many uninsured neighbors? I see these things on Facebook ...
  •  I have a simple solution to this: (0+ / 0-)

    Hire George W. Bush to sell the law. He sold us the Iraq War. If he can do that, he can sell anything.

    When Bush sent out "tax refunds" (thereby increasing the deficit) it came with a letter I distinctly remember that basically said "Here is your share of the surplus. Glad I could help. George W. Bush.

    Obama did not none of that. No marketing and a woeful and ignorant naivete about the lengths to which Republicans would go to stop Obamacare.

    When they retake the Senate next year, they will link funding Obamacare to absolutely everything and are willing to shut down government forever unless Obama repeals it.

    If you hate government, don't run for office in that government.

    by Bensdad on Sun Sep 01, 2013 at 11:00:50 AM PDT

  •  You know there's no Law stopping (0+ / 0-)

    Progressives from running Ads and 1/2 Infomercials about ACA in all States and should Republicans try to stop those Ads/Infomercials as they have tried to stop the correct info from being told to people now with bogus methods they can be hit with a huge Freedom-of-Speech Controversy that would get the word out even more so,so again why is it all up to the Government to do so in light of the Republican effort to stop the info from getting out about ACA when spots for 1/2 infomercials are available for Whoever-has-the-Cash.?

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