How would you replace/fix ObamaCare?

[FEMA Camp Administrator]

2. Nothing. It's perfect.

Why do so many new kids not accept that King's avatar isn't a serious reflection of his views as they pertain to national Republicans (at least that's how I understand it), take humor in it, and move on?

[Attorney General, LGC Speaker, and Former PPT Dwarven Dragon]

2. Nothing. It's perfect.

Democrats ITT are very clearly not saying it's perfect because they want single payer garbage. Any clear independent mind knows this is a series of great ideas; better than single payer and better than our insurance system prior. The more I examine it the more I am convinced. I can't think of one bad thing about the Affordable Care Act.

can't think of one bad thing? Okay.

What's so good about the medical device tax?
What's so good about only having the exchange open for x amount of time and then closing it down for a while, rather than keeping it open year-round? (aside from maintenance downtime and the like, of course)
What's so good about forcing people who don't need maternity-related services to have them in their health plan anyways?

[King]

2. Nothing. It's perfect.

Democrats ITT are very clearly not saying it's perfect because they want single payer garbage. Any clear independent mind knows this is a series of great ideas; better than single payer and better than our insurance system prior. The more I examine it the more I am convinced. I can't think of one bad thing about the Affordable Care Act.

can't think of one bad thing? Okay.

What's so good about the medical device tax?
What's so good about only having the exchange open for x amount of time and then closing it down for a while, rather than keeping it open year-round? (aside from maintenance downtime and the like, of course)
What's so good about forcing people who don't need maternity-related services to have them in their health plan anyways?

1. Several reasons--most medical devices are purchased by Medicare/Medicaid funds, the largest benefactor of universal insurance coverage will be medical devices, and medical device companies make most money on the margins of all the health industry. It is a fair trade. We give them more business and they give us a cut of the profit to pay for it. It's a great way to pay for this system without raising personal income taxes.

2. Several reasons. One, it's how private insurance companies prefer to work. I support private insurance. Two, it creates a sense of urgency for consumers to purchase. Three, it's easier for tax purposes--for both the filer and IRS. It would be an absolute nightmare to have a tax credit system built around healthcare where some people have 12 months of coverage because they bought in January and others have 5 months because they bought in July; or bought in February and cancelled in June and bought in September and cancelled in December.

3. That is insurance. You pay for services you may or may not need; and large diverse risk pools create better consumer value for you. There's also a very narrow-minded self-centered opinion whenever somebody brings it up. They only point out what they won't use that they have to pay for, not realizing others will be subsidizing things they will use but those others will not. You will have prostate exams in your life paid for by the women who will use the maternity care. You might develop a cancer that requires a treatment nobody else in your pool will use.

If we only put young middle class men in one pool, and pregnant women in another pool, and old poors in another pool, we would never be able to create insurance. The young men pool might have cheap premiums, but it would cover absolutely nothing. The old poors pool might everything they need, but it would be astronomically expensive. They might as well just flush the money down the toilet. Affordable insurance isn't simply cheap, it has to be a value--bang for a buck. Greatest bang for a buck is diversity driven.

Lost in the idea of 4 plans the cover every thing is that there are now just FOUR PLANS THAT COVER EVERYTHING. This is a huge development for the consumer. No more getting bamboozled by fine print--finding out that the insurance they bought for $15/month cheaper premiums doesn't cover injuries from getting hit by a car until after they got hit by a car.  Insurance companies now actually have to drive down the premiums and deductibles by cost cutting in their institutions as opposed to simply stripping plans of benefits to make a pretty advertising price quote.  This is real economic competition in healthcare we are about to see for the first time.

[RINO Tom]

I fully admit I'm not the most knowledgeable about the law, and because of that I don't debate it much.  However, my dad (who is the CFO of a small, private hospital) is not a fan.  He thinks it is a sort of "moderate hero" (as Atlas would say!) option that 1) doesn't go far enough to address the real problem of so many uninsured people and at the same time is 2) a shade more "liberal" than he thinks would be the best solution.  I've never had an in-depth conversation with him about it.

From my limited understanding, it seems like a clever trick to start down the road to single-payer: the penalty businesses pay for not offering their employees health insurance is often less expensive than the actual cost of offering it ... naturally, business will start to stop offering it one after another, and this will naturally create a pretty big demand for full-blown government-run healthcare.  I think what a lot of Republicans don't like is that such a thing would obviously be "funded" by increased taxes on families.

[Miles]

More or less what Frodo said.

[Attorney General, LGC Speaker, and Former PPT Dwarven Dragon]

I fully admit I'm not the most knowledgeable about the law, and because of that I don't debate it much.  However, my dad (who is the CFO of a small, private hospital) is not a fan.  He thinks it is a sort of "moderate hero" (as Atlas would say!) option that 1) doesn't go far enough to address the real problem of so many uninsured people and at the same time is 2) a shade more "liberal" than he thinks would be the best solution.  I've never had an in-depth conversation with him about it.

From my limited understanding, it seems like a clever trick to start down the road to single-payer: the penalty businesses pay for not offering their employees health insurance is often less expensive than the actual cost of offering it ... naturally, business will start to stop offering it one after another, and this will naturally create a pretty big demand for full-blown government-run healthcare.  I think what a lot of Republicans don't like is that such a thing would obviously be "funded" by increased taxes on families.

Do you support a single payer system? (My own position is one of caution, I admittedly don't think it's a bad idea but I'm not sure if it's worth the massive increase to the deficit that it will inevitably cause.)

[RINO Tom]

I fully admit I'm not the most knowledgeable about the law, and because of that I don't debate it much.  However, my dad (who is the CFO of a small, private hospital) is not a fan.  He thinks it is a sort of "moderate hero" (as Atlas would say!) option that 1) doesn't go far enough to address the real problem of so many uninsured people and at the same time is 2) a shade more "liberal" than he thinks would be the best solution.  I've never had an in-depth conversation with him about it.

From my limited understanding, it seems like a clever trick to start down the road to single-payer: the penalty businesses pay for not offering their employees health insurance is often less expensive than the actual cost of offering it ... naturally, business will start to stop offering it one after another, and this will naturally create a pretty big demand for full-blown government-run healthcare.  I think what a lot of Republicans don't like is that such a thing would obviously be "funded" by increased taxes on families.

Do you support a single payer system? (My own position is one of caution, I admittedly don't think it's a bad idea but I'm not sure if it's worth the massive increase to the deficit that it will inevitably cause.)

No, I do not.  But I'd almost rather just get on with getting one than a half-ass Obamacare.  And yeah, I'll admit it: my family would be taxed out the a*s to pay for a system and would have worse healthcare, and I'll absolutely form a self-preserving opinion based on that (like most other people).

[AggregateDemand]

I fully admit I'm not the most knowledgeable about the law, and because of that I don't debate it much.  However, my dad (who is the CFO of a small, private hospital) is not a fan.  He thinks it is a sort of "moderate hero" (as Atlas would say!) option that 1) doesn't go far enough to address the real problem of so many uninsured people and at the same time is 2) a shade more "liberal" than he thinks would be the best solution.  I've never had an in-depth conversation with him about it.

Accurate characterization. It does almost nothing, other than scoring as many cheap points for liberal Democrats as possible. The costs of obfuscated through layers of bureaucracy that few people can interpret, and the penalties and punishment for non-compliance are so onerous, no one wants them implemented.

Genuinely useless law. Democrats probably thought it would expand their power, allowing Democrat-controlled congresses to season to taste, but ACA did the opposite. It paved the way for Republican reactionaries in the House, and now the Executive Branch is clinging desperately to what remains of a mediocre attempt at reform.

[🐒Gods of Prosperity🔱🐲💸]

Lost in the idea of 4 plans the cover every thing is that there are now just FOUR PLANS THAT COVER EVERYTHING. This is a huge development for the consumer. No more getting bamboozled by fine print--finding out that the insurance they bought for $15/month cheaper premiums doesn't cover injuries from getting hit by a car until after they got hit by a car.  Insurance companies now actually have to drive down the premiums and deductibles by cost cutting in their institutions as opposed to simply stripping plans of benefits to make a pretty advertising price quote.  This is real economic competition in healthcare we are about to see for the first time.

Where do you get this idea that there is no more fine print?  Of course there is. All sorts of exclusions remain, it's just that those exclusions can't discriminate based on age or sex or pre-existing conditions.  You get free birth control, but that doesn't mean your ulcer medication is covered.  And one of the biggest fine prints of all is that these insurance plans on the exchange are mostly HMOs, at least in Virginia, which the website doesn't even disclose unless you are good at deciphering the code words for it.

[7,052,770]

(These figures are approximate and won't be exact in every county and state, but they should be in the ballpark everywhere.) When maternity is "optional," a maternity contract costs about twice as much as a non-maternity contract. When maternity is just an included benefit, it only raises the price for everyone by about 5%.

Do you really think the former option is preferable? And why single out maternity? Women don't get discounts because they can't get testicular cancer. Whites don't get discounts because they can't get sickle cell anemia. Shorter people don't get discounts because their skin has less surface area to have problems on.

Just cover everything and have everyone pay a composite rate (well, you've got to age rate because New York demonstrated that illegalizing age rating kills the market). It's so much easier (cheaper) to do it that way. No, you may never need maternity, but you will probably need something at some point that most people never need, and you'll be glad no one ever carved out your particular condition as an exclusion.

[7,052,770]

A few things that could be fixed:

• Get rid of tobacco rating and only rate on age and geographic location. I'm as anti-tobacco as it comes, but it's awfully arbitrary to single out smokers when there's so many bad habits out there for people to choose. Smokers under the age of 65 generally only have around 10% higher claim costs anyway, and yet the ACA allows insurers to charge smokers up to 150% more. It's not until people reach Medicare age that smokers really pull away on costs
• Allow subsidies for people who make above 400% of FPL and buy insurance on the Exchanges. The people at 401% are the biggest losers of the ACA. I believe a person making 400% of FPL has their premiums capped at 9% of their income. Just do that for everyone who buys it on the Exchanges. The subsidies won't be extended too much further than that anyway, just because the rates aren't so high that a person making 800% of FPL will have to spend more than 9% for a silver plan. But if he does somehow, he should get a subsidy too.
• Somehow require all states to accept the Medicaid Expansion. Maybe as a compromise, the Feds could cover at 100% permanently (then you could legally justify forcing states to accept, probably), although that will cost more.
• Maybe get rid of the employer mandate and funnel more people onto the Exchanges. Or change accounting laws to make it so that large businesses can just help people pay for individual insurance on the Exchanges (post-subsidy) and come out ahead or equal money-wise.

Interesting fact: Before the ACA, the U.S. was only ranked a few spots behind Canada in the WHO list of best health care systems. I imagine we'll pass Canada pretty soon. Single payer, at least in the Canadian sense, is not the answer for the USA, and while the British system is objectively superior, there's just no way it's ever going to happen here.

[Ban my account ffs!]

2. Nothing. It's perfect.

Democrats ITT are very clearly not saying it's perfect because they want single payer garbage. Any clear independent mind knows this is a series of great ideas; better than single payer and better than our insurance system prior. The more I examine it the more I am convinced. I can't think of one bad thing about the Affordable Care Act.

I guess the proof is in the pudding.  Cost increases have decreased substantially...but the more I think about...all that was, was the pressure of baby boomers aging.  As they increasingly used medical services year after year and each year the next year cohort of people increased...they forced hospitals to borrow or raise rates to add the required facilities for the increasing and increadingly older population of medical patients.

While other areas of the economy deflated...as youth became more dispersed in the 80s and 90s...the youth institutions...schools, playgrounds, roller skating rinks, small local ski hills, childrens clubs...deflated and decayed.  I was born in 85 and in the 90s were playing on playgrounds built for our parents.  My brother permanently disfigured his thumb requiring surgery from a faulty tire swing.  Its no wonder moms got all frantic...the combination of old schools, rusting playground equipment, and the maryjihwanna and 'that rap hell' made us kids special snowflakes in a dangerous world no longer suitable for children...the kids nowadays are this times a bajillion zillion.

But i digress...
If you use intuition and common sense...the rising medical costs should have been no surprise.  An aging population means medical services will increasingly be required even if overall population doesn't change at all.  So more older people who need more services as the younger proportion declines.  This also pushes prices higher than the rate of inflation.  Also new technologies developed to tackle the aging society issue have their costs built in as the big baby boomer age group enters elderhood.

That cost increases collapsed as the economy went into crisis and people lost their insurance and sought medical care less and focused on price more...should not be a surprise.  That prices haven't renounded because Obamacare spread out the cost by taking more from the young and giving to the old...through private markets...should be no surprise.

But the cost pressure is still there and will be felt in the various specialized medical fields that deal with the 'young' elderly, then the middle, then the advanced elderly.

Look for doctor visits to get cheaper even as putting senile hippie mom in a nursing home is going to be cost prohibitive.

The point is...does a private sector insurance industry pay for and distribute these cost pressures more efficiently than a single source public program?

Id say it allowed America, like few others...to price our demographic pressures into the system effectively...something that could be ignored or swept under the rug in a poorly administered public system.  Japan, for example...is super duoer mega f**ked.  And unless China really has an FDR moment with old age insurance and medical care...they're 20 years behind Japan but actually catching up since their aging process started later but has progressed even more quickly.

So...maybe you're right.  But only if you don't believe a public system can respond effectively to demand pressures through expansion and innovation.  

[memphis]

A few things that could be fixed:

• Get rid of tobacco rating and only rate on age and geographic location. I'm as anti-tobacco as it comes, but it's awfully arbitrary to single out smokers when there's so many bad habits out there for people to choose. Smokers under the age of 65 generally only have around 10% higher claim costs anyway, and yet the ACA allows insurers to charge smokers up to 150% more. It's not until people reach Medicare age that smokers really pull away on costs
• Allow subsidies for people who make above 400% of FPL and buy insurance on the Exchanges. The people at 401% are the biggest losers of the ACA. I believe a person making 400% of FPL has their premiums capped at 9% of their income. Just do that for everyone who buys it on the Exchanges. The subsidies won't be extended too much further than that anyway, just because the rates aren't so high that a person making 800% of FPL will have to spend more than 9% for a silver plan. But if he does somehow, he should get a subsidy too.
• Somehow require all states to accept the Medicaid Expansion. Maybe as a compromise, the Feds could cover at 100% permanently (then you could legally justify forcing states to accept, probably), although that will cost more.
• Maybe get rid of the employer mandate and funnel more people onto the Exchanges. Or change accounting laws to make it so that large businesses can just help people pay for individual insurance on the Exchanges (post-subsidy) and come out ahead or equal money-wise.

Interesting fact: Before the ACA, the U.S. was only ranked a few spots behind Canada in the WHO list of best health care systems. I imagine we'll pass Canada pretty soon. Single payer, at least in the Canadian sense, is not the answer for the USA, and while the British system is objectively superior, there's just no way it's ever going to happen here.

How many people at >400% of poverty don't receive subsidized insurance through their jobs? I make less than that and I get my insurance through my employer.

[pbrower2a]

Single-payer financed with "sin" taxes (alcohol, tobacco, surtaxes on tickets for moving violations). Basically, Medicare for all. 

[7,052,770]

How many people at >400% of poverty don't receive subsidized insurance through their jobs? I make less than that and I get my insurance through my employer.

It would be a salary just over $60,000 for a single-person household, and higher for any more people than that, so I doubt it's very common. Still, though, a plumber in business for himself who makes $61,500 a year may have to spend well over 9% of his income to buy insurance on the Exchange, especially if he's older.

The fact that it's (presumably?) pretty rare is a good argument of why we need to do it -- it won't be expensive, and there's leftover money anyway since Obamacare is cheaper than originally thought.

[Mercenary]

Replace the law by eliminating all age restrictions on Medicare.

[TNF]

Single-payer financed with "sin" taxes (alcohol, tobacco, surtaxes on tickets for moving violations). Basically, Medicare for all. 

So massive tax increases on the poor, then?

[Beet]

The exemption for state Medicaid expansion means the Affordable Care Act has not succeeded in bringing universal coverage. Generally, I agree with Harry.

[Representative MJM]

Single-payer financed with "sin" taxes (alcohol, tobacco, surtaxes on tickets for moving violations). Basically, Medicare for all. 

So massive tax increases on the poor, then?

You speak the truth. These excise taxes are so ridiculous. Just pay for it with income taxes. Besides, a cigarette tax would hardly bring in enough revenue to pay for what could very well be a $1 trillion+ program.
But yes, single-payer is the way to go.

[The_Doctor]

Repeal ObamaCare, but keep the exchanges.

1. Legalize health care costs being higher if you're obese or a smoker. Skinnier people and non-smokers would get cheaper healthcare. This would give incentive to many to lose weight and quit smoking. BMI/Body fat test, you choose, and smoking is obvious. Health care costs would not go down overnight, but over time, they would go down. As said, it's currently illegal to kind of make smokers and fat people pay more (which they should. They use the system more and make it more expensive for the rest of us).

2. End state monopolies of health care organizations. Break them up. Enforce the law thoroughly and keep HMO's competitive. I'd say the maximum one could have is 30%. By enforcing competitive practices, you could keep costs down.

3. Keep the exchanges.

4. Create a national pool for high risk patients who are simply unlucky (read: non fat or non-smokers), that would be federally administered like Fannie Mae/Freddie Mac. They would in turn allow patients to pay into it. Or allow Medicaid to take them in, and expand the definition of "disability" to these people for medical purposs.

[🦀🎂🦀🎂]

Yeah guys, as fun as randomly attacking fat people is; it's hardly a productive or efficient way to reduce healthcare costs or obesity...

[7,052,770]

As said, it's currently illegal to kind of make smokers and fat people pay more

No it's not. Smokers can be charged up to 150% of the rate that an otherwise identical non-smoker would be.

And while I agree that theoretically, it would be nice to make people pay more for conditions that are their own "fault," while not charging more for people's pre-existing conditions that aren't their fault, that would be really hard administratively to do.

[DC Al Fine]

How many people at >400% of poverty don't receive subsidized insurance through their jobs? I make less than that and I get my insurance through my employer.

It would be a salary just over $60,000 for a single-person household, and higher for any more people than that, so I doubt it's very common. Still, though, a plumber in business for himself who makes $61,500 a year may have to spend well over 9% of his income to buy insurance on the Exchange, especially if he's older.

This. The trades and professions have plenty of highish earners who are self-employed/belong to small firms.

[The_Doctor]

As said, it's currently illegal to kind of make smokers and fat people pay more

No it's not. Smokers can be charged up to 150% of the rate that an otherwise identical non-smoker would be.

And while I agree that theoretically, it would be nice to make people pay more for conditions that are their own "fault," while not charging more for people's pre-existing conditions that aren't their fault, that would be really hard administratively to do.

Then that's already great; extend the same to fat people. 200% preferably, for both rates. This isn't a pre-existing condition. This is a condition you brought on yourself; being fat or smoking is a condition that leads to illness. Either stop/lose weight and get your doctors to attest to this, or start paying higher rates.

[The_Doctor]

Yeah guys, as fun as randomly attacking fat people is; it's hardly a productive or efficient way to reduce healthcare costs or obesity...

This is not random.

I'm sorry but fat people use the health care system far more than their skinnier counterparts. That's not even arguable; it's a fact. It's a fact that being overweight puts you at risk and by obvious extension, you use the system more.

It's not logical to say smokers should pay 150% but the obese / overweight shouldn't pay more. Obesity is the #1 health issue in America, and starting to treat it as as the health calamity it is is the way to go. One way to do it is to raise health care costs for the obese/overweight and provide incentive to slim down (and thus preserve their health).

Over 40% of all cancers (one statistic has it at 50%) comes from the obese. A sizable number of them will develop health complications before age 50. This will all put stress and raise costs for our health care system, when insurers pay more for a raft of fat people to get the care they need.

Taking on the obesity crisis is one way to tackle health care costs.