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  1. #221
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    An interesting article on where the health care debate is headed in 2016 from Ben Domenech over at The Federalist:

    What’s Next For Health Care Policy?

    Should Obamacare’s tech surge fail, 2016 could very well turn into a three way debate

    Over the past few days we’ve seen an ever-increasing number of voices on the Left, most of whom laughed at the prospects of Obamacare as a train wreck a few months ago, gradually opening up about their concerns on the future of the law. They aren’t saying it’s going to fail now, mind you – but they are gaming out a future where things just don’t work out as they had intended, where the combination of implementation failures and unfixable policy come together to make a real mess of things. It raises the possibility of the post-Obamacare era, with policy writers on the left finally recognizing that there will be another round of health care reform in the near future.
    What might post-Obamacare health care policy look like?

    I think it’s a getting a bit ahead of ourselves to have strong opinions about this, before we have more clarity on the outcome of the tech surge, the functionality of the large majority of the exchanges, the size of the Medicaid population, and other key metrics of Obamacare’s success. But this is a conversation that has been a long time coming, and indicates the positioning which candidates on both sides will adopt in the 2016 presidential primaries. So it’s useful to consider what the three general policy camps will look like in this post-Obamacare landscape, as they’re illustrative of the way Washington’s policy community doesn’t necessarily reflect the political realities of this issue.

    It’s easy to say that Obamacare was a policy which pleased no one when it passed. But for both policy wonks right and left, Republicans and Democrats, a significant portion viewed Obamacare as not the stepping stone to a future plan, but as the policy reality for the foreseeable future. In the wake of the 2012 election, a significant portion of the health policy-focused staffers – whether within the think tank space, or on the Hill for Republican offices – accepted the idea that Obamacare was here to stay.

    That’s one reason I disagree strongly with Heather Higgins’ description of the various factions on the right, though the rest of her piece is well worth a read. Far from disappearing (and despite the numerous repeal votes and other steps taken under the current House leadership), at the staff level, and for many external policy experts, the conversation shifted to what could be done to “fix” Obamacare, or adapt it into a more market-oriented policy proposal in the future. Prominent conservative-leaning policy figures met to discuss what could be done to transform the exchanges into something approximating Paul Ryan’s plan for Medicare, or tweaks that could be done to regulations or the exchange subsidies. Indeed, it was the quietly held common opinion among many in senior staff and policy positions that the biggest challenge of 2016 was going to be shifting the base away from the “repeal and replace” language that had been repeated so often in 2012.

    What’s the scenario if this view carries the day? If a candidate who agrees with The Fixers prevails in the 2016 stakes, they could partner with their equivalent technocrats on the opposite side of the aisle to achieve an even trade. It’s relatively easy to see President Hillary Clinton or President Chris Christie pushing for legislation which would include policy fixes for the exchanges and the Medicaid donut hole, while rolling back regulatory requirements for exchange plans in ways Republicans would like, opening up the exchange to more competition and more inexpensive high deductible + HSA insurance plans, and perhaps throw in premium support for Medicare if you really want to go full grand bargain.

    These general outlines for reform have been taking shape for much of the past year, and they would likely have become the consensus Republican position – and likely the position of the 2016 nominee – had Obamacare’s launch been successful and the law become enormously popular. It still could.
    Changing the dynamics of the debate

    What Obamacare’s failure to launch has done, however, is dramatically undermine the more technocratic factions of the right and left, whose solutions come from the same Stuart Butler/Mitt Romney Jonathan Gruber/Barack Obama school of thought. When Ezra Klein and Ross Douthat talk about the negative side of the failure of Obamacare for Republicans, this is what they’re talking about: a serious ding to the Douglas Holtz-Eakin approach to the next round of health care reform. It turns out that Romney was right about one thing: his plan fit Massachusetts a great deal better than the nation. And that has created an opening for two alternate schools of thought: ideologues on the left and the right.

    For the Single Payer advocates, the troubles of Obamacare have vindicated their position, held for years but quiet since 2008: that you cannot deal with the private insurance industry at all, and that the enticement of the individual mandate really won’t work (it’s from this perspective, universal coverage without a mandate, that Obama actually spoke to within his own campaign). Whether you’re a Krugmanite “Medicaid is the future” believer or not, the left has largely bought into the idea that Obamacare’s real problem is that it doesn’t go far enough. The simmering distrust of this approach has finally boiled over now that the exchange launch has been botched, and there is no question in my mind that a major 2016 Democratic challenger – hopefully, Elizabeth Warren, with clear eyes and a full heart – will make the centerpiece of her campaign.

    Obamacare’s struggles have obviously vindicated the positioning of the free-market advocates, too – particularly the ones who have been most vociferous in their distrust of the manageability of Obamacare and Romneycare over the past decade and a half. Conservative and libertarian health policy experts like NCPA’s John Goodman, Cato’s Michael Cannon, Heritage’s Chris Jacobs, Heartland’s Peter Ferrara, and FreedomWorks’ Dean Clancy, who have held to that “this is going to be a train wreck” position despite the efforts of The Fixers, are the victors here. All have their favored alternative approaches to national health care policy reform, whether it be through tax credits, deductions, or full deductibility combined with a bigger investment in the safety net or risk pools. But they all share certain aspects in common: they ditch the mandate and exchange-based approach to health reform, and instead rely on individual responsibility and carrots to achieve universal access to care. And, more fundamentally, they all understood that no group of ”experts,” no matter how wise, could possibly predict and control one-fifth of the American economy – particularly one already so distorted by decades of misguided government intervention.
    The 2016 Debate

    In advance of Obamacare’s launch, my expectation was that The Fixers had the best shot at taking the presidency in 2016, from the right or from the left. While Obamacare would still be anathema to the Republican base, and no candidate in his right mind (except perhaps the next Jon Huntsman) would talk of fixing it while running for the GOP nomination, if the policy worked at least well enough to not be a disaster, it would remain in force for the foreseeable future. The post-Obama conversation on the right or left would shift to the components of the measure, and long-delayed negotiations over gradualist fixes and tweaks could finally begin.

    This expectation has proven, to this point, completely wrong. The likelihood of exemption and extension – of the mandate and open enrollment – on a major scale rises every week. If Obamacare effectively ends up turning into an expansion of Medicaid for about half the states, it will be far easier to repeal, and the political debate about health policy will shift dramatically away from such approaches.

    Should Obamacare’s tech surge fail and lead to these types of delays, 2016 could very well turn into a three way debate: between those who think Obamacare can be fixed; those who think the problem with Obamacare was that it went too far; and those who think the problem with Obamacare was that it didn’t go far enough. In a sense, such a debate would make for a more honest depiction of the factions within health care policy and a more clear-eyed view of the unacceptable status quo. At the moment in the United States, we have the worst of both worlds: a partially single payer and partially third party payer system which does a lot of things well, but does everything for far too much, since nobody cares what something costs so long as someone else is paying for it.

    If this turns out to be the debate we have in 2016, we should be grateful that Obama, Nancy Pelosi, and Harry Reid deployed the approach they did in 2009. Moving beyond the mythical view that we had a free-market health care system in America may have required a failure as spectacular as Obamacare appears to be today – the political and policy equivalent of a “megaphone to rouse a deaf world.”

  2. #222
    ^He pronks, too! Magic Poriferan's Avatar
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    Don't Blame Dems, We Wanted Single Payer

    The Democrats' Version of Health Insurance Would Have Been Cheaper, Simpler, and More Popular (So Why Did We Enact the Republican Version and Why Are They So Upset?)
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  3. #223
    Senior Member Qre:us's Avatar
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    Not that our Canadian healthcare system doesn't have its own faults. Wait-times for ER is atrocious. Getting specialists' appointments, also a bitch and half. I have family friends who had to go down South because it was beyond the realm of the specialists in Canada (Mayo Clinic). Our research in the field is dismal compared to the strides USA has made in healthcare research. And much more issues at the systems level. Beyond affecting me personally.

    However, we're laughing, up North, seeing the debacle that is the US's healthcare system.

    How can basic healthcare not be a right afforded to all? But treated as a privilege? Boggles my mind.

  4. #224
    ^He pronks, too! Magic Poriferan's Avatar
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    Quote Originally Posted by Qre:us View Post
    Not that our Canadian healthcare system doesn't have its own faults. Wait-times for ER is atrocious. Getting specialists' appointments, also a bitch and half. I have family friends who had to go down South because it was beyond the realm of the specialists in Canada (Mayo Clinic). Our research in the field is dismal compared to the strides USA has made in healthcare research. And much more issues at the systems level. Beyond affecting me personally.

    However, we're laughing, up North, seeing the debacle that is the US's healthcare system.

    How can basic healthcare not be a right afforded to all? But treated as a privilege? Boggles my mind.
    Out of curiosity, what counts as an atrocious amount of time to wait for the ER?
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  5. #225
    Senior Member Qre:us's Avatar
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    Quote Originally Posted by Magic Poriferan View Post
    Out of curiosity, what counts as an atrocious amount of time to wait for the ER?
    http://www.thestar.com/news/canada/2...vey_finds.html

    The article above gives an average of 4 hrs.

    Anecdotally, I remember, one time, we waited for 8 hrs. Came in around 9pm in the evening, left at dawn the next day. Unless you have an ax attached to your open, bleeding skull and then it's not that bad.

  6. #226
    Temporal Mechanic. Lexicon's Avatar
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    Quote Originally Posted by Qre:us View Post
    http://www.thestar.com/news/canada/2...vey_finds.html

    The article above gives an average of 4 hrs.

    Anecdotally, I remember, one time, we waited for 8 hrs. Came in around 9pm in the evening, left at dawn the next day. Unless you have an ax attached to your open, bleeding skull and then it's not that bad.

    I've lived in various parts of the east coast of the U.S. - & experienced similar wait times for non-life-threatening emergencies. Not particularly pleasant way to spend your time, but, ey, at least you do get to see a doctor/receive care. But then.. I guess I don't expect the system to be perfect.. What is.
    03/23 06:06:58 EcK: lex
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    04/25 04:20:35 Patches: Don't listen to lex. She wants to birth a litter of kittens. She doesnt get to decide whats creepy

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  7. #227
    ^He pronks, too! Magic Poriferan's Avatar
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    Quote Originally Posted by Qre:us View Post
    http://www.thestar.com/news/canada/2...vey_finds.html

    The article above gives an average of 4 hrs.

    Anecdotally, I remember, one time, we waited for 8 hrs. Came in around 9pm in the evening, left at dawn the next day. Unless you have an ax attached to your open, bleeding skull and then it's not that bad.
    I've waited 4 hours in an ER. I had passed out from dehydration earlier. Gastroenteritis was making me release fluids out both ends and my skin profusely! It really bugged me that the waiting room was plastered with signs that said "no beverages allowed".
    Go to sleep, iguana.


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  8. #228
    Senior Member Qre:us's Avatar
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    Quote Originally Posted by Lexicon View Post
    I've lived in various parts of the east coast of the U.S. - & experienced similar wait times for non-life-threatening emergencies. Not particularly pleasant way to spend your time, but, ey, at least you do get to see a doctor/receive care. But then.. I guess I don't expect the system to be perfect.. What is.
    One of the issues is reducing ER room visits, in general. Which brings up accessibility, and a restructuring of the primary healthcare delivery model - to create a concerted link between all systems, through which a client/patient moves. So that a lot of $$ is not being wasted on ER rooms visit, which could be tackled by primary healthcare services. Redirecting flow, essentially, and creating capacity to manage the redirection of flow.

  9. #229
    ^He pronks, too! Magic Poriferan's Avatar
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    GOP's hypocrisy on Obamacare

    The Obama administration originally had asked for more than half a billion dollars to spend on public relations and outreach for the law. House Republicans had returned with an offer of nothing. That's right: zero dollars. Without necessary funds, the Department of Health and Human Services worried it would not have the necessary money to pay for navigators to help people enroll in health care, for the technology needed to implement the exchanges and for the public relations campaign that was required to inform citizens about what the law actually did.

    HHS Secretary Kathleen Sebelius made the controversial move of asking insurance companies and nonprofit organizations to donate money and help. Republicans were outraged. She asked for more money. She was refused.

    .........

    Republicans refused to appropriate money needed to implement Obamacare. When Sebelius tried to shift money from other areas to help do what needed to be done, she was attacked by Senate Republicans. At every step, Republicans fought measures to get money to put towards implementation.

    Is it really a surprise then that implementation hasn't gone smoothly?
    I want to add that it's rather similar to the stimulus plan, which was watered way down below that point that many economists said was needed to be useful, just to placate moderates and conservatives. The stimulus was less useful than hoped, and nobody was placated.

    This is the repeating scheme. Republicans twist something until its broken, then blame the Democrats for having come up with it.
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  10. #230
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    From the National Journal:

    Obama Takes Friendly Fire

    An ally of the president begins to panic over Obamacare fallout.

    Incoming from Democrats:

    "Dem Party is F****d." That was the subject line of an email sent to me Sunday by a senior Democratic consultant with strong ties to the White House and Capitol Hill. The body of the email contained a link to this Los Angeles Times story about Obamacare "sticker shock:"

    "These middle-class consumers are staring at hefty increases on their insurance bills as the overhaul remakes the healthcare market. Their rates are rising in large part to help offset the higher costs of covering sicker, poorer people who have been shut out of the system for years."

    "Although recent criticism of the healthcare law has focused on website glitches and early enrollment snags, experts say sharp price increases for individual policies have the greatest potential to erode public support for President Obama's signature legislation."

    In his story, reporter Chad Terhune also quoted a letter sent to a California insurance company executive. "I was all for Obamacare," wrote a young woman complaining about a 50 percent rate hike related to the health care law, "until I found out I was paying for it."

    Also of interest to the Democratic consultant: A Josh Barro column on Obama's promise that "if you like your health plan, you can keep your health plan." It was never a reasonable pledge, Barro argues, and it's being proven false. He called this "a good thing" because "a lot of existing health plans were bad." Reforming the nation's health care system "was necessarily going to have to change a lot of people's health plans," Barro wrote.

    The Democratic consultant said none of this is news to him, but he wonders why Obama wasn't honest with Americans. He predicted surprise and outrage over higher costs and lesser coverage. "We will own this problem forever," the Democrat wrote.

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