1. "I just woke up this morning and everyone was posting about healthcare and the constitution and stuff... what just happened?"
Back in 2010, President Obama enacted a law called the Patient Protection and Affordable Care Act (PPACA). It came to be known as "ObamaCare" by those who opposed it (primarily members of the Republican party). The people who opposed it fought the law with great zeal. The issue ended up being sent to the Supreme Court, who have the ultimate authority to determine the constitutionality of such laws. Five of the Supreme Court Justices favored it and four opposed it. They made one slight change, but the bulk of the law remains untouched and it was determined to be legal.
2. "Why are my Republican friends freaking out so much?"
President Obama put an interesting rule in to the PPACA that says health insurance companies cannot deny someone coverage just because they have been sick with something before (a "pre-existing condition"). If you develop skin cancer as a teenager, under the old law, it is perfectly legal for an insurance company to deny you coverage because you are too risky of a person to insure. Obama said this isn't cool. The insurance companies, however, need to remain profitable or they won't exist. So Obama also added an individual mandate, which means that every American HAS to have health insurance or they will have to pay a fee.
Republicans are upset because they do not like the government interfering with their lives. They claim that the individual mandate is a violation of their right to choose what is best for themselves. Many use the "slippery slope argument" that the government starts by controlling our healthcare and ends up controlling the books we are allowed to read and the religion we have to follow.
The other reason they are so upset is because this exemplifies attributes of a "wealth redistribution" program. In english, this means that the rich people are going to potentially end up paying more for services so the poor can also have access to them. They claim this is unfair and unconstitutional.
3. "Why are my Democrat friends freaking out so much?"
Because "they told you so all along." People are shouting for joy that this law has passed. Over 30 million individuals are currently uninsured and this makes preventive care a much larger emphasis. This represents significant success to the Obama administration and the democratic goals/agenda, but healthcare will not be "fixed" by this law alone. Sorry to be a buzzkill.
4. Is it constitutional?
Yes. The constitution outlines the process that must occur to determine whether or not that law is constitutional. That process was followed with exactness and the law was determined to be constitutional. Regardless of your personal opinions about the law, it is a matter of fact that the law is now constitutional.
5. So what else does this law do?
A lot of different things. As the title suggests, it is all about patient protection and affordable care. Some of the patient protection items include:
- Preventing the discrimination of health insurance coverage based on medical history
- Prevents insurance companies from dropping your coverage because you are an expensive patient.
- Requiring chain-restaurants to display nutrition facts
- Expands the availability of health insurance
- Providing physician payment penalties/bonuses for meeting certain quality standards
Some of the affordable care items include:
- Insurance companies cannot increase premiums based on medical history.
- Free preventive services, like mammograms and colonoscopies.
- Limits the amount of profit insurance companies can make to prevent price gouging customers
- Helps Medicare patients (people over 65) pay for their expensive medications
6. "What will happen to the cost of my health insurance?"
This is where it starts to get confusing. Let's just say this: there are some forces that will drive prices up and there are some forces that will drive prices down. It is difficult to know what will really happen and even more difficult to say "by how much?"
Price increase drivers:
- Really sick people who are currently uninsured will join on an insurance program and drive costs up because their care is so expensive.
- Expansion of services insurance is required to cover
Price decrease drivers:
- More healthy people who previously just did not want insurance will join the "risk pool" and not use many healthcare services - providing lower rates
- Increased emphasis on preventive care (regular check-ups) will prevent expensive hospitalizations down the road.
- Limit of insurance companies profit margins.
7. "Is this all going to happen for sure? If so, when?"
Mitt Romney has vowed to remove this law from the books if he is chosen as president. So if you don't like all of this stuff I have just mentioned, you probably want to vote for Romney. These rules are being implemented now and will continue through the next few years. A full timeline can be viewed here.
8. "Speaking of Mittens - what's his alternative plan?"
Not a clue. The Romney campaign has not announced one yet. He will likely ride the wave of "Obamacare hatred" for as long as he can. All he needs to do to get in to the white house is convince people that Obama's plan is bad. He has said that he will keep the rule about pre-existing conditions, but not the part where everyone has to have insurance. This is counter-intuitive to me. You cannot have your cake and eat it too, so I am very interested to see more of his plan when(if) it becomes available to learn about.
9. "What do you think?"
I think this is a great opportunity for you to learn about the healthcare laws that impact you as an individual. I think that you should empower yourself with an understanding of the healthcare process and what types of policy are best for you and your fellow citizens. I also think that this act alone will not fix the healthcare crisis and that there will always be a need for improving patient care at a lower cost.
Derek, I love this blog. And I love that you called him Mittens!
ReplyDeleteHaha thanks! Glad you like it
DeleteI second that... great job!
ReplyDeleteYou are a genius Derek. You just explained perfectly what I've been struggling to put into words for the last couple years. Thank you! People just dont understand the law.
ReplyDeleteThanks guys!
ReplyDeleteGreat post. I would just add to #4 that the reason it is constitutional is not because it is an inherent fact, but because SCOTUS said so and they are the ultimate authority. Before the ruling it was a matter of opinion. Before the ruling, the federal government did not have the expressed power to tax an individual for not purchasing a good or service. So before yesterday, the constitutionality of the law was not a fact.
ReplyDeleteYeah, I think the key point is that it was a matter of opinion before - that goes both ways. Some felt the law was constitution and some felt it was not. The constitutionality of the law was uncertain. It is now fact.
DeleteI'm baffled by those who are still arguing that it is unconstitutional. Romney said something along the lines of "just because it is constitutional doesn't mean that it is good policy." Republicans need to proceed down the road Romney is trying to lead them with that statement. Their attack at the constitutionality of the law has failed, so now they need to approach it from a different angle. It is just really ironic that the constitution was followed perfectly with this, but some are still claiming it is "against the constitution." Terrible, terrible argument.
But yeah, there's obviously not a section in the constitution that says "the federal government has the expressed power to tax an individual for not purchasing a good or service."
DeleteHey thanks Derek, this was helpful. My husband is the one that explains these things to me, and being more of a visual learner, this helped iron out some of the smaller details I was missing. It is generally the language and terminology used in policies and politics that confuses me. As I work with 8 year olds all day, lost my adult vernacular! Thanks again!
ReplyDeleteRomney's website explains the very basics of his plan in some pretty plain english. It seems he has some core ideas he wants to stick to that you can find in bold under "Mitt's Plan". Obviously, there is nowhere near the detail on his site as there is outlined in "Obamacare" but I agree with Romney that it should be individualized to each state, and that something needs to be done to promote competition and consumer choice.
ReplyDeletehttp://www.mittromney.com/issues/health-care
Sure, those are interesting principles to "promote competition" and "provide consumer choice" but absolutely nothing is said about how that will be accomplished. He says he will "Cap non-economic damages in medical malpractice lawsuits" - Great. No problem with this one at all.
Delete"Empower individuals and small businesses to form purchasing pools" - This is already possible.
"Prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage" - Interesting point here is that this is only for those who maintain continuous coverage? So the 30 million that are uninsured now don't qualify for this, that's just if you already have coverage you will be able to switch easier?
"Facilitate IT interoperability" Already being addressed under the Obama administration with the Meaningful Use program.
I guess I fail to see how these things will promote free markets and competition above that which is already being done.
Exactly, it is slightly vague but it's the core ideas I agree with. As long as the core ideas are correct you can work to attain that and I'm sure he will if he is elected. Do you agree with Romney that it should be more focused on the states? Whats good for one state may not be the best for the next.
DeletePart 1: Its really easy to say those things - but without a clear plan that is just flowery language to me. Of course "competition to lower prices is good" but how do you promote competition with inelastic demand (see two blog posts previous to this one)? There has to be something better than capping malpractice lawsuits and maintaining the status quo. I just don't believe he is going to have any solutions until he tells us what those solutions are... but its a political ball game right now and he has no reason to get in to details. I'd really, really like to know though.
DeletePart 2: The states thing... This provides a disincentive for any individual state to provide any type of benefit to high-risk individual. If a state chooses to have great health coverage for people with pre-existing conditions, low income, etc., then they could end up having of the "high risk" people will people from neighboring states moving there. Or, you will get states that want to develop a capitation model and neighboring states that want a fee-for-service model. That would seriously disrupt referral patterns near the borders of all states and just create a lot of unnecessary chaos. Also, why keep it at the state level and not put local governments in charge?
DeleteThere may very well be a good way of doing all of this, I just don't know what it is and certainly hope that Romney at least has a good plan other than a broad and vague "help improve outcomes."
I've only further steeled my resolve to not go into primary care.
ReplyDeleteWith an already projected shortage of doctors (from the AAMC) go ahead and throw another 30 million patients into the mix and watch you individual time with a doctor tank.
You ever looked in to VIP or Concierge primary care? It's a pretty interesting concept.
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