Nobody likes "Obamacare", so what should we replace it with? - page 2

by MunoRN 4,771 Views | 28 Comments

A few years ago I asked a Doctor I worked with how he would reform healthcare, his response was "don't ask a Doctor, if I want to know what's based for patients I ask a Nurse". Liberals don't like our current Health Care... Read More


  1. 3
    Quote from SurrenderDorothy
    I'm not even going to do into this one, but I will say that today's Republicans are anything but conservative as compared to times past. So, to group conservatives as being automatically a Republican is not the case anymore. I am very conservative, but can't stand Republicans in our modern days. There are very few true conservatives left in this country.
    I will agree with you on this one. The GOP has become a total fringe group at this point. They've let themselves become hijacked by Tea Party radicals. Ronald Reagan would be hated his own party as much as Mitt Romney is.
    tewdles, llg, and TiddlDwink like this.
  2. 3
    Quote from hey_suz
    I'm with you!

    Thanks for calling "Obamacare" by it's correct name, the PPACA, ACA for short.
    I've always tried to avoid the term "obamacare" as well since it is typically used as a slur.
    Although it has now been embraced by Obama administration:

    http://store.barackobama.com/feature...care-pack.html
    tewdles, Benedina, and herring_RN like this.
  3. 7
    Quote from brainkandy87
    We have to keep things simple for those in the GOP. It's like using pictures for kids.
    My Mom would say "shamey shamey" to that blatantly inflammatory statement. Let's play nice when discussing politics.
    Caseylynn87, BCgradnurse, tewdles, and 4 others like this.
  4. 5
    No one knows what the Supremes will do and I am not going to speculate. (Pray, perhaps, but not speculate.) Just want to make a few observations. First, as the OP mentioned, the affordable care act is pretty roundly disliked, and the polls indicate this disaffection has increased as the details of the plan and its implementation by HHS have evolved. Second, the conservative arguments against the act were (are still) denigrated and derided by progressives. Ms. Pelosi when asked if the bill was constitutional... "Are you kidding? Are you KIDDING?" (Enlightened discourse if I've ever heard it.)

    But now the case has been argued before the Supreme Court. The "swing" Justice, Anthony Kennedy raised the arguments that have been widely discussed by conservatives at some length. And in spite of the fact that the objections have been bounced around for over two years, the Solicitor General seemed unable to articulate any rational response. Even the progressive and mainstream press (a distinction without a difference) has said he "blew it."

    It's possible, of course, that Kennedy and/or some other strict constructionist will side with the affordable care act. But the point is that arguments against the act are not fringe. They get to the heart of how we understand the relationship between the a free people and their government.
    Last edit by jmqphd on Mar 31, '12 : Reason: semantics
    Blue Felt Fedora, tewdles, lindarn, and 2 others like this.
  5. 1
    You won't find many liberals who will defend the mandate, particularly since it's been a core Republican principle for health care reform for some time. If the argument for keeping health care insurance for-profit is that it a free-market environment will produce the best insurance, then making the purchase of the product (insurance) mandatory removes the free-market influence on the product and therefore removes any benefit of a for-profit environment.

    Even so, it's hard to argue against the idea of a mandate of some sort. Regardless of whether or not a mandate exists, people will continue to essentially be covered to some degree; a person who has chosen not to buy any sort of health insurance who goes into an ER with a STEMI will get a heart cath, even possibly emergent open heart surgery, so it makes sense to argue that everyone who is capable of paying their fare share needs to contribute to at least the level of coverage guaranteed to them by our "social contract" (not to mention EMTALA). If we truly view this type of care as optional then we need to be willing to actually follow through and not send the ER STEMI patient to the cath lab and let them die if they chose not to buy insurance, which is actually what Scalia suggested we do.
    lindarn likes this.
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    our current system is incredibly inefficient. how else could we be spending so much more than any country in the world and have such poor results? the inefficiencies persist because healthcare is not "free market" friendly. market forces do not work toward improved outcomes and lower cost when the supply is locally limited and when there is almost no "cost" to the consumer. quite the opposite. under our current system there is no economic force pushing towards improved outcomes and lower cost. that includes hmos, who in competition with each other have little room to affect efficiencies by providers and certainly add many themselves. the ada does very little to address these problems. there is also the issue of how the employer based insurance drags on our economy. as employees we pay for every cent of the insurance through lost wage increases and poorer employers which decreases their stock price, which affects our savings and iras and the snowball keeps rolling.

    here's my solution as a nurse: single payer with case managers in charge.

    i am a fiscal conservative. i am a democrat.
    everwonder_y, Altra, BCgradnurse, and 4 others like this.
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    No,no...of course no one wants the indigent STEMI patient to die on the street. This is the exact accusation that Alan Grayson made in the well of the House... you know, the Alan Grayson who is now a private citizen.

    We must have redundant safety nets and it would shock many here to find out that most conservatives give this a lot of thought and the ideas being developed and discussed are rich and fully nuanced and have nothing to do with animus toward the poor. There are a range of ideas being proposed, many at the think-tank level, all with advocates and detractors. And, in State Houses across the country there are people trying to anticipate what will become of the health care act, and how they will manage if it lives, dies, or falls into some zombie netherzone of political influence.

    The health care economy is such a complex thing that no one completely understands it. Rather like the Amazon Rain forest. Touch the ecology with regard to one little species and you change predator/prey relationships in ways that reverberate across the entire region. Spare one type of grass, and trees die down river... it's a mess.

    I'm sorry, but I look at DC at the 500 plus individuals that make the sausage and I am not encouraged that they know what they are doing. I don't know what will take the place of the health care act, but I am certain that one-size-fits-all is NOT the answer.
    VivaLasViejas likes this.
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    The mandate issue is not about the indigent, it's about whether or not the people who are able to pay should pay for services they will receive whether or not they choose to contribute. Holding these folks to their choice not to receive treatment of their STEMI is not a theoretical accusation of Grayson, it's what Justice Scalia suggested just the other day that we do to avoid our mandate problem.

    Our current issues with healthcare delivery and cost is about more than just how provide care to the poor, it's our overall costs and quality that is a problem. There are conservative principles of healthcare reform out there, although "rich and nuanced" is hardly the term I'd use. These principles include: an individual mandate, protection of the for-profit insurance sector, block grants for medicaid, and ability to buy insurance across state lines. PPACA includes the individual mandate, not only protects the for-profit insurance industry but sends more business their way, and the ability to buy insurance across state lines. In a nod to conservatives' preference for the right's of individual states to determine what's best for them, the ability to buy insurance across state lines exists in the form of compacts, where persons from states can only buy insurance from other states with similar insurance regulations. Currently, states have leeway in how they administer medicaid funds, and they receive funds based on their needs. Block grants would give extra money to states that need it less and not enough to states that need it more, which would by definition be more wasteful and inefficient than our current "take what you need but not more than that" system.

    Our healthcare system is complicated, and making it less complicated is a big part of reform. Is the conservative view that we should just let it continue to be so complicated that it threatens to suffocate itself? There are some differences in healthcare delivery between urban and rural areas, but the basic pathophysiology of diseases don't vary between rural nevada a rural New York, heart failure is still heart failure. I think that there are some things that are better dealt with at a local level, but not everything. It makes sense that we have a Federally run armed forces, rather than 50 individual air forces, marine corps, etc. Just as with business (which conservatives argue government should be more like) consolidation of similar services makes them more effective and efficient.

    So is your suggestion that we reform but at the state level? What would reform at the state level include? Mandates? Public options? Still looking for some "rich and nuanced" ideas.
    lindarn, herring_RN, and elkpark like this.
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    There was a v. interesting discussion of all of this on the "Up with Chris Hayes" show this morning (the entire two hours of the show). I think it's probably available on the website.

    Personally, I'm another single-payer advocate.
    BCgradnurse and lindarn like this.
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    Ironically, the single payer option probably would have been more constitutionally sound. The main issue before the court last week was one involving the Commerce Clause. The question was (simply put) can the government force people to engage in commerce so that the government can then regulate that commerce.

    Looked at from that angle... it's quite clear that this would be a radical departure from the way we've understood the (admittedly elastic) commerce clause.

    Now, here are two interesting side lights to the drama.

    First: It is true that the Supremes are not elected and have life time appointments. But they do notice what happens during elections. That the congress responsible for the ACA is now just a memory and that the electorate spoke rather forcefully cannot have gone unnoticed.

    Secondly: I do not understand the President. He does some strange things. Calling out the Supremes so publicly during the SOTU speech, in a setting in which no one could (per protocol) object, was not wise. (One might even say he "acted stupidly".) The majority opinion in Citizen's United (the case he was denigrating) was written by Justice Kennedy. It was a direct affront to him. Kennedy is the swing vote that will give the ACA thumbs up or down.

    Again today, the President was setting up an anti-court campaign narrative to the effect that it would be unprecedented for the court to overturn a law enacted by a duly elected legislative branch. Hello??? Mr. Obama... you went to Harvard Law. Didn't they tell you about Marbury v. Madison? You know... 1803? I know it was a way long time ago and all. But, sir... you see... um... that is what the Court does. It decides if legislation is congruent with the Constitution. A foolish, foolish system... but it's the one we have. Alas.

    Oh, well... none of this matters. All of that arguing and aggressive questioning by the justices could be a total head fake. They may have laughed over a few drinks and then all voted to uphold the ACA. We'll just have to wait until June to find out.
    Blue Felt Fedora, Altra, tewdles, and 2 others like this.


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