What is Obamacare?

The actual name is “The Patient Protection and Affordable Care Act.” It is called “Obamacare” by its detractors. Background: the cost of healthcare has been rising much faster than inflation for decades in the US. The US has the most expensive health care in the world per capita and those who can afford it or have good insurance get good care but for everyone else it is poor. Since in the US healthcare is mainly provided by for profit insurance companies they want to maximize profits by charging as much as they can while paying out as little as possible. Some of the ways they maximize profits has been to stop covering customers when they get sick, refuse to cover problems that existed before customers signed up, and negotiating reimbursements to providers close to their cost. Now the number one cause of bankruptcy isn’t people who loose their job, buy houses they can not afford, or run up all their credit cards; the number one cause is catastrophic medical expenses. Someone without adequate insurance facing a major accident or illness can be wiped out financially. Pharmaceuticals companies charge more for medications in the US than other countries. Pharma justifies US prices saying that the US pays for the research and the rest of the world gets a free ride. The problem with this claim is that pharma spends more money on marketing than they do on research and of their research most of it is spent making copycat medications of other companies products rather than novel new treatments. “Obamacare” will prohibit insurance companies from cancelling policies of sick customers, force them to cover pre-existing conditions, and since young people have trouble getting insurance it makes companies cover dependent children of customers up to 26 instead of 18. The most controverisal aspect of PPACA is the individual mandate. Under it health care coops will be made offering group insurance to individuals that insurance companies will be forced to cover and every adult will also be forced to buy healthcare insurance from one of these if they do not have health care elsewhere. This was originally a conservative idea to make people take responsibility for their healthcare instead of being a burdon on society but now that it is part of PPACA conservatives now consider it unconstitutional, a threat to freedom and evil. There are much better ways to provide universal health care to Americans. Unfortunately far too many politicians of both political parties are in the pocket of pharma for the for profit insurance companies to be cut out of the picture entirely. As it stands now pharma will still make lots of money and perhaps even more than they would have without PPACA.

Actually… this is a pretty fair analysis. My biggest gripe is with the mandate. It is extortion and is unconstitutional and should any clause be adjusted down the road… as is likely… people who cannot afford both the premium and the deductible are essentially worse off because they have less money to seek alternative treatments. The Federal projected poverty line is much too low in my opinion. The current subsidy scale is not too atrocious… but if the deductible cap is altered… which is left open in the bill… or if the premium cap is increased… or if the subsidy formula is tooled around with… this mandate will become a real burden on the people. I agree that medical costs are the biggest burden on Americans. This is one area that I would not mind seeing socialized. It needs to be of a manner that cuts the middle men out entirely. In my opinion… the coexistence between insurance and big health care have propped one another up… ie health insurance has allowed for the medical industry to up their rates… while the higher rates have necessitated insurance. I think that this is arguably one of the obligations the federal governement is charged with… especially when it concerns care for the elderly and invalid… and one in which federal regulations have complicated… eg. the FDA prohibition on the procurement of medications outside of the country.

One of the ideas I liked during the debate was to simply expand eligibility for both Medicare and Medicaid. There are working poor who can not get or afford health insurance but are still too well off for Medicaid. The PPACA actually does this to an extent allowing people with income up to 133% of the poverty line to qualify starting in 2014 Since the poverty line for a family of 4 is something like $25K/year I would raise it quite a bit higher than this to cover the working poor who can’t get or can’t afford health insurance. On the other end I’d let older working Americans who can’t get health care through their job to buy into Medicaid. Expanding eligibility for Medicare and Medicaid was one of the things discussed but certain politicians friendly to the insurance industry wouldn’t entertain any option that could cost insurance industry income. I spent my entire school year in 1978 researching health policy for high school debate. Even though I was a Republican I found myself in favor of socialized medicine. All the issues that convinced me universal health care would be a good idea in ‘78 are even more true today.

Filletofspam, a question - why do people choose to buy policies that can be cancelled when they get sick anyway? Doesn’t make much sense to me. Surely when buying a health insurance plan you scour the contract thoroughly before committing to it?

Great answers; thanks filletofspam and miscegenymiser.

Ivan, most of the time there isn’t a choice in which healthcare provider you use. The only ones available to me are through work. One of the ways insurance companies get out of paying is to look for any mistakes in the application. An insurance company might drop a cancer patient because they neglected to mention a minor infection they had decades earlier on their medical history. They happily collected premiums for years but when they have a potentially large payout they go over everything they can with a fine tooth comb looking for a way out. PPACA outlaws practices like this. Anyone who has dealt much with legal verbiage knows that to the lay person it is largely inscrutable. A lot of what we agree to in unenforceable and certain terms have specific legal meanings different from how the words are commonly used. Having a lawyer look over every scrap of paper we sign is not an option so most consumer rights and protection comes from law rather than contract. Computer users agreeing to EULAs accept the condition that the expensive software they just bought doesn’t actually belong to them and that it isn’t guaranteed to actually work or do anything useful. Luckily there are consumer protection laws that prevent software makers from evading all responsibility for their product.