ACA, do we want it gone?

[The White Coat Investor]

[Thread Closed for generating more heat than light. Two reminders seem prudent to make here:

# 1 If you are easily offended, stay out of the lounge.

# 2 Be nice to other forum members and do your best to avoid offensive tone, phrasing, and content.]

[MPMD]

Anne wrote:

Nope, I’m pretty sure I’m a citizen of (and served for) the U.S. As an American, I would never tell another American that they are in the wrong country just because they have a different opinion than me or vote differently than me. We all belong here. That’s kind of the idea.

You are right, the Constitution doesn’t really get into healthcare. I think back then the decision tree was to leech or not to leech, I don’t think anyone could have predicted what a mess 21st century healthcare would be. But it does kind of get into government being instituted to support people’s rights to life, liberty, the pursuit of happiness, in the Declaration of Independence.

The diagnosis of diabetes is not my own. I have been remarkably lucky in my health, and in my genetics, as the bulk of my family have been lucky as well. But as a physician I understand not everyone is so lucky, that luck always runs out sooner or later, and as a physician when my patients suffer, I also suffer. So I don’t mind paying taxes to cover healthcare. I also acknowledge that the system is very broken on many levels and as others have pointed out, it’s not that easy.

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Well said.

[Tim]

@Anne,
1) “But it does kind of get into government being instituted to support people’s rights to life, liberty, the pursuit of happiness, in the Declaration of Independence.”
2) government providing for the common good.

I think your statement really points out the contention
Providing the “right to” or “providing it”?
Providing “services”, transportation, utilities, and healthcare are “regulated and the rathole of deregulation “. It’s all good. I can build a private road and drive on an interstate highway. That doesn’t mean government provides my road. Rural electrification had a different answer. Companies were “required “ to provide “service” at an equal price. But, individual had to pay to tap into the easement.

Some people would want free electricity and cars.
Some people want free healthcare.
I don’t know the “role of government”, I just don’t think I should pay for someone else. I have no problem supporting a healthcare system, they need to pay for their private connection. Democracy is really messy and ugly. But, it produces beautiful results.
Thank you for your service.

[Anne]

Nope, I'm pretty sure I'm a citizen of (and served for) the U.S. As an American, I would never tell another American that they are in the wrong country just because they have a different opinion than me or vote differently than me. We all belong here. That's kind of the idea.

You are right, the Constitution doesn't really get into healthcare. I think back then the decision tree was to leech or not to leech, I don't think anyone could have predicted what a mess 21st century healthcare would be. But it does kind of get into government being instituted to support people's rights to life, liberty, the pursuit of happiness, in the Declaration of Independence.

The diagnosis of diabetes is not my own. I have been remarkably lucky in my health, and in my genetics, as the bulk of my family have been lucky as well. But as a physician I understand not everyone is so lucky, that luck always runs out sooner or later, and as a physician when my patients suffer, I also suffer. So I don't mind paying taxes to cover healthcare. I also acknowledge that the system is very broken on many levels and as others have pointed out, it's not that easy.

[scottvoiers]

Anne wrote:

By definition, someone using a non-dictionary definition of a word to support their opinion, is called an opinion.

My opinion, as a physician, is that being diagnosed with type 1 diabetes as a 7 yr old makes life difficult enough, it shouldn’t also screw you over in terms of getting insurance coverage the rest of your life.

My opinion is also that the role of government is to ensure a safe and functioning society for its citizens.

Healthcare is a mess, that’s for sure. I’m not sure what the right answer is. But if this were a MC quiz, I know I could rule out “C: rely on church and charity” before considering the other options

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No it's really not my opinion. Paying medical expenses for a pre-existing condition via a health insurance premium is in violation of the very parameters used to define the insurance industry as a whole.

I'm sympathetic to your diagnosis of type 1 diabetes but these are macro issues we are talking about and anecdotal stories don't play a role to be frank. Insurance companies are under no obligation (at least they weren't before) to absorb huge losses at the outset. What kind of business would do that? This is where planning, charity, community, and family come into play.

If you think that is the role of government you're in the wrong country (assuming you're talking about the USA). Nowhere in the constitution or the bill of rights does it declare that the role of the government is to provide safety and "function" for the citizenry. You can't just make up rules as you go, even if they work in your favor personally.

 

[scottvoiers]

SWEng wrote:

scottvoiers wrote:

Some of the comments in here are unreal, especially coming from physicians. Vouching for coverage for pre-existing conditions? Do you realize that by definition, insurance cannot possibly cover pre-existing? If you want that so badly, just call it what it is; fleecing the American people to cover the health expenses of complete strangers. This is what charity, church, and community organizations are for. Not the federal government. 

Click to expand…

No, this is unreal. Do you realize that by definition insurance companies pool clients’ risks?

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I'm not quite sure the point you're trying to make here... how can you pool risk when you're forced to take on clients at 100% risk (pre-existing)? It's not a sustainable business model obviously and the rest of us are paying a huge price for it.

[Anne]

By definition, someone using a non-dictionary definition of a word to support their opinion, is called an opinion.

My opinion, as a physician, is that being diagnosed with type 1 diabetes as a 7 yr old makes life difficult enough, it shouldn't also screw you over in terms of getting insurance coverage the rest of your life.

My opinion is also that the role of government is to ensure a safe and functioning society for its citizens.

Healthcare is a mess, that's for sure. I'm not sure what the right answer is. But if this were a MC quiz, I know I could rule out "C: rely on church and charity" before considering the other options

[SWEng]

scottvoiers wrote:

Some of the comments in here are unreal, especially coming from physicians. Vouching for coverage for pre-existing conditions? Do you realize that by definition, insurance cannot possibly cover pre-existing? If you want that so badly, just call it what it is; fleecing the American people to cover the health expenses of complete strangers. This is what charity, church, and community organizations are for. Not the federal government.

Click to expand...

No, this is unreal. Do you realize that by definition insurance companies pool clients' risks?

[scottvoiers]

Some of the comments in here are unreal, especially coming from physicians. Vouching for coverage for pre-existing conditions? Do you realize that by definition, insurance cannot possibly cover pre-existing? If you want that so badly, just call it what it is; fleecing the American people to cover the health expenses of complete strangers. This is what charity, church, and community organizations are for. Not the federal government.

[adventure]

spiritrider wrote:

We can debate what that replacement might look like, but I’m guessing we would have as much trouble coming to a consensus as the politicians do. We all come from our own set of life experiences and biases.

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I agree. This will be tough. Sure, all the politicians will "build something better", but that's the tricky bit (and getting consensus too!).

[spiritrider]

Larry Ragman wrote:

Although isn’t it 3.8% NIIT and 0.9 Medicare surtax?

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Correct. While there is a Social Security maximum wage base (2019 = $132,900), the 1.45% employee/employer FICA taxes and 2.9% SE taxes have been unlimited since 1994.

[Larry Ragman]

Although isn’t it 3.8% NIIT and 0.9 Medicare surtax?

[Larry Ragman]

Yes, if the law is struck down in its entirety, which is what the district court did. Currently on appeal to the 5th circuit court of appeals

[Dreamgiver]

How about the 2.9% medicare surtax on income above FICA limits, would that go away too?

[Larry Ragman]

There are two different issues being conflated here. The first is whether or not the courts will find it unconstitutional. If they do (and they might based on sebilius, the legislative intent, and the new position taken by the Administration) then all the features should go, including coverage for existing conditions, coverage for children until age 26, NIIT, etc. Why? The law says in plain text several times that each part, including the mandate, is unseverable. Chief Justice Roberts sided with the liberal justices by declaring the mandate a tax. Now that it is not, there is no precedent for Congress requiring citizens to purchase a private good.

The second issue is the merits of the features listed above, plus Medicaid expansion. I suspect some states will keep them, some not. It is much less clear to me that Congress will pass a new law, but I suspect yes. The Republicans will not want to defend killing the law with no replacement for the popular features. Nothing will change immediately because the policies and state Medicaid coverage already exist. And nothing prevents the insurance companies from offering the policies as is, though the cost likely goes up.