Jonathan Gruber and the latest con attack on Obamacare.

kiddoctorEvery time the HateAmerica crowd thinks they’re finally going to bury the ACA they gloat. They can’t contain their joy at the prospect that millions of newly insured Americans will lose their lifeline to healthcare. We know this because they never propose solutions to the problems they claim to see in Obamacare.  The final version of the ACA is arguably vague on whether those purchasing insurance on the federal exchange are eligible for subsidies.

There are two obvious solutions: 1) Cons could work with Dems to amend the ACA to clarify that subsidy eligibility does not depend on whether insurance is purchased on a state or federal exchange. 2) Cons could urge Republican-controlled states to set up ACA exchanges. But the cons don’t recommend either course because they want to hurt the 10 million+ Americans who finally have healthcare and to prevent others from getting it.

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One Response to Jonathan Gruber and the latest con attack on Obamacare.

  1. Shade says:

    With Jonathan Gruber now apparently on a self-aggrandisement tour, it has come come again to public attention that Obamacare was a masterful piece of legislation that accomplished previously unattained health-care goals while minimizing the CBO score of its provisions as taxes. Of course, Republicans are taking some of Gruber’s less-artful remarks as an opportunity for refreshing their attack spin against Obamacare, but cooking the books is nothing new for either party (and in fairness, Obamacare provides many hidden societal & thus economic savings not possible for the CBO to score).

    Another plus for Obamacare was that it was limited in its initial scope and it didn’t attempt an instant government takeover of all privately administered healthcare. Instead it poked the proverbial camel’s nose under the tent by working within the existing system setting minimum standards by which insurance companies must operate. It then provided sliding scale subsidies to make insurance affordable to those who previously often forewent insurance for financial reasons. For those with extremely low income (under 138% of the FPL), it expanded Medicaid (but SCOTUS nixed this and made it optional to each state’s legislators).

    Though many Progressives wanted a “single-payer” (goverment administered insurance) or “Medicare For All”, when one considers the problems Obamacare had in implementing even its modest changes (highlighted by the healthcare.gov website failure), it becomes clear that it is fortunate that Democrats did not try to take on more all at once. If Democrats can show Obamacare is successful, this will put Republican criticisms in their place, and perhaps at a later point “Medicare For All” or a true “single-payer” option may be politically viable.

    I have other concerns about taking on the public option too fast, primarily related to the quality of care. The current generally available public option is Medicaid (Medicare is not a true single-payer program). Medicaid is the public option Obamacare attempted to expand for the poor in each state. The problem is that the coverage provided & the quality of the care tends to be underwhelming. It is bare-bones coverage with many limitations that make it barely worthy of the first-world. As it pays providers very little, and typically the doctors that take it are in urban areas with sparse offices that remind one of a Greyhound bus station. Doctors must do a high volume to offset the low compensation rates, and being super-busy often leads to chronically long waits. When you do see the doctor, you may find that they barely speak your language, and they aren’t likely the most qualified (or they would be working somewhere else).

    Worse, because of the low compensation rates, some Medicaid providers care less about what the patient needs and more about what services they might be able to pad your bill with that Medicaid might pay. For example, I once went to a dentist that advertised a good price on x-rays & teeth cleaning. What I got to the office, I overheard many conversations at the front desk & all seemed to involve Medi-Cal (California’s Medicaid). I had to wait in a huge unpleasant waiting room with unruly kids running all around. The teeth cleaning I got was no better than I can do myself with my WaterPick & a toothbrush. Then when the doctor came for the consultation on my X-rays, he told me he wanted to send me to his oral surgeon buddy to consider pulling my upper two front teeth because the nerves in them had receded (from years of wearing braces & accidental traumas). The doctor said that without the nerve extending normally into the teeth, it left them vulnerable to fill up with bacteria & decay & then break. Well this was perhaps thirty years ago. I still have have all my front teeth, and no other dentist has ever suggested anything was seriously wrong. I’ve talked to many on Medi-Cal (California’s Medicaid) and have heard many other similar stories suggesting malpractice and/or fraud. Thus my perspective of Medicaid & the danger presented by rushing headlong into converting our healthcare system entirely to the public option. I think if you ask around, you’ll find my evaluation of Medi-Cal/Medicaid is not far off the mark. I would certainly support “Medicare For All” long before I would consider strictly a “Medicaid” public option. Medicare is a bit of a hybrid between the extremes of the all public option & all private insurance. At the present time, it still pays providers somewhat better, though an accounting trick used in Obamacare (that hopefully is never allowed to be enacted) reduces Medicare’s provider compensations to match Medicaid’s.

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