29 October 2013

Forum: What Do You Predict The Ultimate Fate Of ObamaCare Will Be?

Every week on Monday morning , the Council and our invited guests weigh in at the Watcher’s Forum, short takes on a major issue of the day. This week’s question: What Do You Predict The Ultimate Fate Of ObamaCare Will Be?

The Independent Sentinel:Obamacare will devolve into a single payer system. That is what the Medicaid expansion was about. Forcing millions into the government-run program is the beginning. That is why we saw the negative reaction from Democrats when the Supreme Court of the United States gave states the option to opt-out of the expansion.
People are flocking to Medicaid in droves. Obamacare will be Medicaid for all, and unfortunately, it’s a poor system that pays doctors and hospitals too little.
Medicare lost $716 billion in future payments to doctors and hospitals. The money was transferred to the Medicaid expansion.
The Medicare rationing has already begun.
There are now rewards for hospitals that do not help seniors and there are penalties for those that do according to IBD: Hospitals that spend the least on seniors get bonus points, and higher-spending hospitals get demerits. Hospitals will even be penalized for care consumed up to 30 days after patients are discharged, for example, for outpatient physical therapy following a hip or knee replacement. There will be far fewer joint replacements, cataract surgeries, bypass surgeries on the elderly.
Several of the doctors I know told me it is too late. Our healthcare system is ruined.
The local hospitals on Long Island are facing closure because of the burdens being placed on them. Catholic hospitals that accommodate 1 out of 6 patients in America are facing closure due to the penalties that will be imposed on them for refusing to provide abortifacients and related services. Charitable hospitals are facing their demise.
It will be all government, a government that does not allow judicial recourse.
 The Glittering Eye: Cutting to the chase, here’s what I wrote as a comment to this post of mine:

My off-hand conjecture is that on April 1, 2014 the scope of the problem of lack of healthcare insurance will be about the same as it was on February 1, 2009, healthcare will be substantially more expensive, and a bit more than five years will have been allowed to elapse without addressing the fundamental problem of cost.
There are no prospects for the PPACA being repealed until after 2016. Neither the president nor Senate Democrats will allow that to happen. As to its fate after 2016, who knows? The frequent assertion that once enacted into law entitlements are sacrosanct is incorrect—the long-term care benefit enacted and repealed during the Reagan Administration is an example that comes immediately to mind as does AFDC.
As of this writing it looks very likely as though the PPACA will run into cost overruns more rapidly than anyone could possibly have imagined. That’s clearly what will happen if 85% of those who sign up for insurance under the plan are enrolled in Medicaid and the balance are already sick and desperate enough for insurance that they’ll put up with the ordeal of registering for insurance under the federal exchanges.
Working together those will make decreasing healthcare’s outrageous costs all the more urgent than it was in 2009 and, sadly, the PPACA does very little beyond wishful thinking to do that.
The Right Planet  : There isn’t enough pixels in the universe to contain all my work on the #ObamacareFAIL.
Bookworm Room: I don’t care if Obamacare fails. I hate the thought of our country’s medical care and economy failing….. (Especially since my husband currently earns a nice living thanks to the medical care system.) I foresee lean times ahead.
Simply Jews : I know that I will, most probably, piss off my Republican friends on this forum. However, my answer is less about this specific (and very doubtful) implementation of healthcare, rather about what I wish to happen in USA regarding that painful issue. So, instead of the ultimate fate let’s talk about the ultimate hope.
As one who has experienced for several years one of the existing medical insurances in US, here is my impression:
  1. Devilishly expensive, even for generally healthy people
  2. The “pre-existing conditions” could probably kill one with time
  3. Excellent medical care is followed (or even preceded in some cases) by a bureaucratic nightmare and a maze of phone calls with people who don’t understand, aren’t eager to help and in general couldn’t care less.
  4. Out of work – out of luck, or very soon so.
My apologies if I am wrong in some details, some time has passed since. Besides, we were mostly healthy then.
What I wish to happen to my American friends: a complete reform of the medical care, based on successful examples that proved to work in some countries:Japan, Israel, France and several others. Make it simple and efficient and make it work. And yes, add optional private insurances for those who want some additional bells and whistles – I am not a commie enough to be against this.
If you look at this table, US has the most expensive healthcare. Meaning the money is already there, and there is more than anywhere else in the world.  It is just used (abused) by insurance companies very inefficiently. So the issue is not the lack of funding, rather the poor organization, spiraling uncontrolled insurance/care costs and chaotic oversight of the whole system, which by now became too complicated to manage successfully.
Will Obamacare succeed? They way it was set up – as a doubtful system of compromises and as an additional superstructure on top of the already crumbling base – I doubt it. But at least it may speed the process of destruction of the current status-quo and the birth of a really workable and working healthcare system.
And, by the way, there is another, but closely related, issue of litigation, ambulance chasing in simple words, that has helped the prices of treatment skyrocketing, doing the same to the insurance prices… this must be reigned in too.
 GrEaT sAtAn”S gIrLfRiEnD:Whale, I have absolutely no idea so I’m going with Skippy Klein’s Ouija board here:
1. Affordable Care Act is a success, and liberals build on it
Under this outcome, the law works as well as or better than its supporters predicted. After some initial hiccups, it expands insurance coverage to those in need without disrupting the health care experience for those who are already satisfied. The cost-control measures work, and providers are able to deliver better care at a lower price by taking advantage of government incentives to be more efficient. As a result, the government saves hundreds of billions of dollars on Medicare without seniors noticing any cuts to their benefits and access. Young and healthy Americans flood into the insurance market to offset the cost of providing insurance to older and sicker Americans, including those with pre-existing conditions. The new insurance exchanges are vibrant marketplaces offering beneficiaries a wide range of options, promoting competition that drives down the cost of premiums. Over time, more individuals and businesses demand access to the exchanges, and America evolves into an exchange-driven single-payer system.
2. Affordable Care Act is an epic disaster and it gets fully repealed
Under this scenario, the law unravels. The cost controls do not work, proving especially troublesome for smaller regional hospitals. They either start closing, stop accepting Medicare or cut services. This effectively reduces the benefits seniors can get out of Medicare, and they, along with industry lobbyists, pressure Congress into undoing the cuts that are one of the primary offsets to the law’s trillions in new spending. On top of this, new taxes kick in – mandate penalties, the insurance premium tax, the medical device tax, pharmaceutical tax, etc. – and businesses struggle to adjust to a raft of new regulations. The exchanges are swamped with technical problems and poorly administered, making it difficult for individuals to sign up. Not many insurers participate in the exchanges, meaning they don’t offer sufficient choices to promote competition. New regulatory requirements drive up the price of premiums, so young and healthy Americans decide they’d rather pay a penalty than invest in costly insurance. Without the younger and healthier people in the risk pool to offset the cost of sicker Americans, insurers raise premiums even further, prompting yet more individuals to exit the insurance market. And so, the dreaded insurance “death spiral” ensues. In the meantime, newly insured individuals start taking advantage of their free or heavily subsidized care, but the capacity of the health care sector does not grow quickly enough to meet demand, translating into long waits at doctors’ offices and difficulty getting appointments in the first place. The ensuing backlash from all fronts leads to a Republican takeover of the Senate in 2014 and helps elect a Republican president in 2016. At some point in 2017, a new Republican president signs a law wiping Affordable Care Act off the books.
3. Affordable Care Act is largely a disaster, but it survives, and possibly expands
At some point at least some constituency of voters will be deriving some benefits from the law. It’s one thing to support repeal when it means voting against theoretical subsidies for theoretical beneficiaries. But once the law goes into place, repealing the law would mean stripping away benefits from people actively receiving government aid. Let’s say, in 2017, there’s an incoming Republican president with – at best – control of the House and a narrow Republican Senate majority. Would he or she be willing to use reconciliation to push through a repeal bill when confronted with Democratic attacks that it would take millions off the Medicaid rolls and make millions more lose their subsidized private insurance? Republicans have not traditionally shown themselves to have the political fortitude to roll back entitlements once they are in place. At the same time, if Republicans do not respond with an alternative to clean up the mess, then liberals will begin to blame problems in the health care sector on the idea that Affordable Care Act left too much control in the hands of private industry. This will prepare the groundwork for a further move toward a socialized single-payer health care system, perhaps by, say, re-introducing a “public option.” There have been many times in American history when failures of government policy led to further expansions of government. Limited government advocates should be wary of this happening with Affordable Care Act.
4. Affordable Care Act is largely a disaster, and it gets reformed
Under this scenario, a combination of public backlash and adverse court decisions forces Congress to re-open Affordable Care Act. It doesn’t get fully repealed, but it gets reformed. Perhaps, for instance, exchanges remain, but there are far fewer restrictions on what type of insurance can be offered, broadening the range of options and providing more affordable choices for those who don’t have as many medical needs. States may be given actual flexibility on the operation of the exchanges, and Medicaid funds become block granted. Insurance is made accessible to those with pre-existing conditions without the “guaranteed issue” and “community rating” policies that force insurers to cover everybody who applies at a price effectively set by government. This allows Congress to get rid of the federal individual mandate.
 Liberty’s Spirit:Note: I am going to address this as the parent of two special needs children. Someone who has had to pay hundreds of thousands for therapies, support systems and doctors that are not covered under any insurance plan. I have seen what the high cost of healthcare can do to do a family in this country and there is no question that there needs to be an overhaul of the entire system. So I am NOT against many of the provisions of Obamacare: allowing children to stay on their parents health insurance until they are 26 (for those of us with special needs children this is financial helpful. The cost for them for health insurance would have been staggering if our children could even get health insurance at all); not allowing insurance companies to deny a policy due to preexisting conditions (most insurance companies would not write a new policy for someone with autism, epilepsy and any other preexisting conditions); providing for autism treatments, etc. However, as the child of a parent on medicare advantage (Humana) I am concerned that this terrific program is going to end.
I am going to start off from another rather rebellious position….I think there is nothing wrong with requiring people to carry health insurance. If hospitals have to treat people when they get sick, there has to be some way that those bills get paid. Most people who have no insurance do not end up paying their hospital bills and that means the rest of us are left with the cost when we are sick. The problem is that the way the law is written it is still financially better for some people to pay the fine rather than carry health insurance. (Israel, which has one of the best healthcare systems in the world, requires their population to carry insurance plans.)
Also there is a huge issue with the general cost of medicine. Most nations that have socialized medicine negotiate with drug companies about how much they can charge, which means the American people end up paying the drug company’s loss when we by our medication. This has not been addressed.
The cost to educate a doctor is ridiculous. But that is the issue with the cost of higher education (another issue for another day). So many doctors coming out of medical school are hundreds of thousands of dollars in debt and need to find a position that allows them to live and pay off their student loans. This makes healthcare very expensive in this nation.
Death panels are a big issue. The idea that bureaucrats will decide whether someone has the right to medical care is frightening. However, at the same time, insurance companies decide whether they will pay for some medications, surgeries and therapies, which if you cannot afford these on your own, can become a form of a death panel as well. The idea that certain persons (age, illness) and those with disabilities, do not have the same right to life as those of a certain caliber is replete in society and as seen by the writings of those like Ezekiel Emmanuel, who helped craft Obamacare, eugenics is considered not only acceptable but for the betterment of society. Furthermore, the targeting of conservatives by the IRS does not engender competence that politics will not be used as a weapon to deny healthcare to those who challenge the policies of the executive branch (which is what happens in a fascist society.)
There is no provision in Obamacare where you can sue the government if you disagree with a ruling by the panel. The law is that you cannot sue the federal government unless they allow it (sovereign immunity.) Unlike at present where you can sue your insurance company if they rule against you for a treatment, Obamacare does not allow for this remedy. Administrative relief is not always enough.
The issue with Obamacare is that the provision that the republicans wanted, the right to sell insurance across state lines, which would have brought down the cost due to the real free market, was rejected. The reality is that instead of providing people with a lower cost, more effective form of health insurance, Obamacare is a nightmare and does nothing to reduce the costs of healthcare in this country.
The exchanges are too costly and do not offer most people the same type of insurance that they were used to carrying. This needs to be fixed. No I do not blame Obamacare per se that people’s insurance policies have been canceled. Instead of complying with Obamacare the insurance companies have simply decided to cancel the policies and push people into the exchanges. While this was foreseeable, it is the choice of the insurance companies.
It is embarrassing that the government website is such a disaster. It does not engender competence that DC will be able to fairly and effectively regulate healthcare.
Will it survive? Yes it will. Does it need tweaking? Absolutely.
 JoshuaPundit:  ObamaCare as it is now will almost definitely fail. Among other things, it depends on young, healthy people applying for overpriced policies with scanty coverage and ridiculous deductibles that will not even cover them in the event they need emergency coverage from ‘out of network’ doctors. They’re staying away in droves, while the vast majority of people now signing up for the exchanges are people that qualify for MedicAid, there being an unlimited demand for free stuff at someone else’s expense. There is no way to fix  this basic problem without spending huge amounts of money, because medical providers will simply opt out in order to avoid going bankrupt. And actually, that’s  the whole idea.
Let’s start out with this basic truism – ObamaCare was never about healthcare per se. It is about increased taxation (and unconstitutional taxation at that, as anyone who can read the Constitution can discover for themselves) and government control.  As I wrote a week or so ago, the end game for ObamaCare is single payer with government mandated rationing and ultimately  the Sovietization of American healthcare. It was designed to fail, and as it does, the Left will hold out the carrot of single payer as a panacea.
I have always said that anyone unwilling to utter the words ‘tort reform’ and to deal with America’s problem with illegal aliens (another huge factor in driving up healthcare costs nobody wants to mention) is not serious about reforming healthcare and reducing the cost of it to the average citizen.
Tort reform hasn’t happened because the majority of members of congress are lawyers, many with practices back home, while the various trial lawyer associations are major donors to the Democrat party.And illegal aliens and those that advocate for them are becoming a constituency for a lot of politicians in Washington.Senator John  McCain’s chief financial backer, for example, is the owner of the Spanish language media giant UniVision.
ObamaCare is  the only major social legislation ever passed in America by one party alone, and the manner in which it was pushed through is in violation of rules that have governed how laws are passed by congress in our Republic for well over a century. It also is a perversion of the Constitution because it provides a precedent wherein the Federal government can use its police power to force its citizens to buy something  or not buy something  just  because.  The damage done to our institutions if ObamaCare stands as a precedent will be horrendous.
Another issue no one wants to discuss is the issue of social control. Government bureaucrats will decide who rates certain procedures and who doesn’t. Given how the IRS has been used in an unprecedented fashion to wage war on the Obama Administration’s political enemies and is in charge of enforcing ObamaCare, is anyone naive enough to believe that the huge amount of personal data accessible because of ObamaCare won’t be used to deny medical procedures outright to those whom don’t vote or donate correctly? Or at least send them to the back of the line?
And people actually laughed at Sarah Palin,  one of the first public figures  smart enough to point this out .
Will ObamaCare survive?  Not if we wish to remain a free people. The 2014 elections will be key in determining whether the law is simply frozen until it can be repealed or whether it eventually morphs into single payer.That is something the American people will decide.
 The Colossus of Rhodey: I predict that ObumbleCare will survive — but in a drastically altered form. Let’s face it: The promises made by Boss Obama and his acolytes virtually ALL turned out to be lies. “Keep your doctor?” Yeah, right. (I can see Obama spinning that one: “You CAN keep your doctor. If you lost your coverage, it wasn’t because of a government mandate. Your insurer made that decision on their own!”) “Costs will go down?” A total fantasy for the vast majority of Americans.
If something substantial is not done in the next few months, the 2014 mid-term elections may make 2010 (and 1994) seem pitiful in comparison. The GOP House majority could become prodigious, and the Senate could flip to Republican control, perhaps by a sizable margin. There is almost nothing Boss Obama can do to pin the ObumbleCare disaster on the GOP; he and the-then Democrat controlled House and Senate passed this clusterf*** without a SINGLE Republican vote. Not. One. Obama and the Democrats own this. 100% completely.
I believe that some of the worst aspects of the law will be repealed; that is, unless the Democrats want to get crushed next November. By next summer we’ll see that the employer mandate will be excised, and the individual mandate will as well. What will replace the latter is not for me to say; perhaps Obama will propose some new tax on millionaires and/or corporations to pay for those who need health coverage. But HOW he will do this will be fun to watch given that he NEVER takes responsibility — or apologizes — for anything. Expect much ridiculous spin and blaming of the GOP, the Koch Brothers and, of course, “racism” along the way.
Rhymes With Right:Frankly, I have very little hope regarding ObamaCare. I don’t see it being overturned by the courts, I don’t see it being repealed by Congress, and I don’t see it working anything like it was advertised. The most likely outcome I see will be even worse for America than what is currently enacted into law.
Let’s be honest — the ruling by the Supreme Court in 2012, and the opinion written by John Roberts in particular, were a disaster. The notion that the penalties in the legislation are a tax is completely at odds with the legislative history of the bill (such as it is) and the claims of the Obama Administration. The president and his henchmen admitted as much at the time of the ruling and have continued to do so since then. Based upon admissions made within days of the ruling that the Solicitor General’s office had committed a fraud upon the Court by making the argument that the penalties were taxes and and their arguments that John Roberts and the liberal wing of the Court got the decision wrong, the losing parties in the case should have made an appeal for rehearing under the Supreme Court’s Rule 44. Unfortunately they did not do so, and so it is likely that any future Supreme Court decision will continue to abide by the precedent in place.. At most we will see some nibbling around the edges based upon First Amendment issues and statutory language regarding state vs. federal exchanges, but no judicial flip on the question of constitutionality.
As for repealing ObamaCare, we don’t have the votes in Congress to do it, or even delay it one second longer than Obama wants it delayed for. After all, The Democrats control the Senate, Harry Reid is refusing to run that body in a collegial fashion, and there is no way we can get a veto-proof majority in either house of Congress even if Reid allowed the Senate to consider repeal legislation. That means that Obama can stop any Congressional effort to repeal ObamaCare with a stroke of his pen. The same will be true after the new Congress is seated after the 2014 elections — there is no way the GOP will have the sort of landslide that it would take to get to a veto-proof majority, and without one Obama will still wield the veto pen.
Which leads to the question of the implementation of the law. We’ve already seen that it is a fiasco and will likely continue to be for the foreseeable future. Software doesn’t work, prices are high, and millions are losing the medical insurance they like and the doctors they have been seeing, promises by Barack Obama notwithstanding. By 2016 it will be clear just how big a failure ObamaCare is — but too many Americans will already be dependent upon it. Republicans campaigning on a platform of repealing ObamaCare will be depicted by the Democrats and their media toadies as seeking to “take access to healthcare away from millions of Americans who cannot afford it”. Any Republican plan to replace ObamaCare with something else will be attacked by the lapdog media as even worse than the status quo. And into the fray will step Hillary Clinton and other Democrats who will declare that the failure of healthcare reform was the fault of Republicans who “opposed fixing the system” in 1993, refused to “work with us to care for the poorest Americans” in 2009, and whose efforts to thwart ObamaCare after the passage of the law was nothing short of a program of sabotage responsible for the every unpleasantness experienced by Americans due to ObamaCare’s failure. Their proposal will be nothing less than a single-payer system — perhaps “MediCare for All“. Presuming that the GOP does not manage to pull off a trifecta by holding the House, gaining a filibuster-proof majority in the Senate, and winning the White House, we will see the passage of a single-payer bill by the end of 2017. Any likely 2016 winner (and no, Ted Cruz, Rand Paul, and Sarah Palin are not likely winners), regardless of party, will sign the resulting legislation on the basis that it will be better than ObamaCare — though I question whether that will prove to be the case over the long term. At that point we will have a federal health care system funded by massive tax increases for all but the poorest quintile.
Do I truly see such a dystopian future? Sadly, I do. The choices of the GOP since the adoption of ObamaCare have brought us to a position where we have failed to stop ObamaCare and are unlikely to find ourselves positioned to undo ObamaCare. The result will be the ultimate success of the sort of single-payer system that the Left has been seeking, the resulting expansion of federal power, and the increasing irrelevance of the Constitution as a blueprint for limited government and maximum individual liberty. The Reaganite vision of my youth will have failed, only to be replaced with an Obamunist state that will collapse within two generations.
 The Razor:If you would have asked me four years ago, I would have said the Democrats would never stoop to using a legislative trick, reconciliation, to pass a law without a single Republican vote. Two years later I would have said there was no chance that a conservative supreme court justice would have allowed this mess to pass the test of constitutionality. Now I have to guess what it’s ultimate fate would be? Have you ever watched The Walking Dead? If this legislation doesn’t remind you of a zombie, I’m not sure what law would.
At this point I’m not sure what it would take to kill it, beyond a GOP triple play (owning both houses of Congress plus the White House). One that happens the GOP had better be ready with their own well thought out health care plan to replace this mess with.
Well, there you have it.
Make sure to tune in every Monday for the Watcher’s Forum. And remember, every Wednesday, the Council has its weekly contest with the members nominating two posts each, one written by themselves and one written by someone from outside the group for consideration by the whole Council. The votes are cast by the Council, and the results are posted on Friday morning.