If only we didn't call it "Obama-Care" . . . .

[kishnevi]

And right wingers here in the US should realize that some of their now favored economists - of the Austrian persuasion mostly, it seems - were not opposed to universal health care.

The right wingers will simply say that the Austrian economists were not, er, Austrian enough. 

Rather like the Catholics who claim to be more Catholic than the Pope.

[Dungeon Master]

This debate regarding public health funding in the US astounds me. The fact that Americans even seem to feel that it needs debating astounds me most.

You (Americans) need to realise there will always be people in a society who are less able to look after themselves, sometimes through no fault of themselves. It is in the interest of all members of that society that they still have access to health care. Society is improved, poverty, violence and misery are alleviated when the wealthier chip in to look after those less fortunate or less able.

All OECD nations in the world, except for the USA, has some sort of large-scale public health funding. The manner in which it is funded varies from country to country - sometimes a direct tax, sometimes compulsory health insurance (which equates to almost the same thing).

Here is Australia, we have had government-funded health care since 1974. We each pay an extra 1 - 1.5% tax (depending on income level) called the Medicare levy, on top of our income tax. What we get for our money is free, universal health care, free for every Australian citizen. Doesn't matter if you are rich or poor, young or old, sick or well, employed or not, everyone is entitled to top-notch health care, essentially for free. We can also elect to take out extra private health insurance, which then pays for private hospital treatment or dental and other benefits. It means that those who can least afford to pay are looked after by those who are more well-off. It means that we don't have to worry about how to pay for our health care. It means we have almost no mentally ill people homeless on the streets. It means we have almost no beggars on street corners. It means we look after each other.

When I lived in Canada for two years, I was pleasantly surprised by how similar their health care system was to ours, and justifiably proud of it they were. Here in Australia, we seem to take ours for granted after so many years. Any politician who would be stupid enough to try to campaign for its removal would be instantly voted out. It is entrenched and popular.

Given that the government is then the largest health care provider in the country, it is in its own interests to make sure the health it delivers is efficient, economic, rational and evidence-based. While these ideals are not always met, there are constant reviews of policy to aim for that ideal.

What do you need to debate? You pay a small % of your income and everybody benefits.

[Todd]

All OECD nations in the world, except for the USA, has some sort of large-scale public health funding.

Strictly speaking, this is not the case.  Medicare and Medicaid are indeed large-scale programs, they just don't cover everyone.  Now with the Affordable Care Act, the US is moving to universal insurance and accompanying higher taxes.  The US political system ensures that we will never have a system like any other nations.  Also strictly speaking, the US does have universal health care delivery by law right now (ie, emergency rooms cannot turn anyone away), just not universal insurance. 

One other thing, and perhaps this is a peculiarly American trait that focuses on money, but a 1-1.5% tax is not in any way free.  That's not to say that universal insurance is not worth such a tax, just that universal insurance is not free.  It's more than just semantics.

[Wendell_E]

Though I envy the Austrailian system, I did have to smile at the sentence "What we get for our money is free, universal health care, free for every Australian citizen."

[Dungeon Master]

Though I envy the Austrailian system, I did have to smile at the sentence "What we get for our money is free, universal health care, free for every Australian citizen."

I stand corrected. Very few things in life are free.

However, the tax is so disconnected from the benefits that it seems free. Furthermore the 1.5% tax is a very small price to pay for universal health care. For most Australians, it equates to about $2 per day. I dare say most of us would spend more than that on our daily coffee or cable TV. I regard universal health care as somewhat more important than those.

And I accept that unlike the coffee and TV, the Medicare tax is compulsory. As a wage earner in Australia, you do not have a choice. Many Americans I suspect would find that the main argument against. However, I think that is the best argument for. It means that we all chip in a very small amount, and it is returned as a greater good. Those that are the most vulnerable and least able to pay in society are looked after.

Its a concept known as "caring".

[bwv 1080]

http://www.theamericanconservative.com/dreher/why-i-might-be-okay-with-obamacare/

[Todd]

Foes of Obamacare will have to learn to be okay with it, because it's not going to be repealed, even if Romney gets into the White House.  Hell, if history is a guide (eg, Medicare Part D), government funded programs will mushroom in coming years.  How can I get a piece of the action?

[Geo Dude]

Foes of Obamacare will have to learn to be okay with it, because it's not going to be repealed, even if Romney gets into the White House.  Hell, if history is a guide (eg, Medicare Part D), government funded programs will mushroom in coming years.

This seems a reasonable assessment.  I've seen a lot of cries from the left lately about how it is necessary to vote for Obama (rather than staying home) and actively advocate for other people to vote for Obama because repeal of Obamacare is guaranteed if Romney wins.  There seems to be some sort of idea in place that Romney has near magical powers of persuasion that will result in his being able to convince Congress to repeal it, no matter what the make-up of congress is during his presidency.  I have some serious doubts.  Even if he could persuade Congress to go along with the repeal (or had an unusually strong-willed group of Republicans running both houses of Congress that were adamant that it be repealed) I seriously doubt that he would have the spine to try to repeal it once it got rolling.

[eyeresist]

Given that the government is then the largest health care provider in the country, it is in its own interests to make sure the health it delivers is efficient, economic, rational and evidence-based. While these ideals are not always met, there are constant reviews of policy to aim for that ideal.

You are probably aware of the recent hospital scandals in NSW, particularly the Royal North Shore Hospital - cockroaches on the operating table! Preemies in the public toilets!    Some of this was due to budget-related staffing restrictions, some due to managerial negligence, or staff incompetence. The new government is supposedly fixing things - time will tell whether they are just rearranging the deck-chairs.

In the larger scheme, these are glitches. What really gets me is that we have been promised dental coverage for years, and it still hasn't come through. I have an impoverished friend with a head full of rotten teeth who has been waiting years for the chance to get some serious work done.

[Sammy]

This seems a reasonable assessment.  I've seen a lot of cries from the left lately about how it is necessary to vote for Obama (rather than staying home) and actively advocate for other people to vote for Obama because repeal of Obamacare is guaranteed if Romney wins.  There seems to be some sort of idea in place that Romney has near magical powers of persuasion that will result in his being able to convince Congress to repeal it, no matter what the make-up of congress is during his presidency.  I have some serious doubts.  Even if he could persuade Congress to go along with the repeal (or had an unusually strong-willed group of Republicans running both houses of Congress that were adamant that it be repealed) I seriously doubt that he would have the spine to try to repeal it once it got rolling.

If the Republicans gain control of House and Senate, I figure that Romney would have no choice but to sign its repeal.

[coffee]

Foes of Obamacare will have to learn to be okay with it, because it's not going to be repealed, even if Romney gets into the White House.  Hell, if history is a guide (eg, Medicare Part D), government funded programs will mushroom in coming years.  How can I get a piece of the action?

Same as always. Work for a congressman, then get a job lobbying for some company, then back working for congress, and back, and back; if you're telegenic maybe a stint on a news show telling people what your party wants us to believe, then back. Just swing through that revolving door till you're on the boards of half a dozen companies, funneling tax dollars or public goods into your Christmas bonus and calling it the free market. No change since the railroad barons.

[Todd]

If the Republicans gain control of House and Senate, I figure that Romney would have no choice but to sign its repeal.

If there are 41 or more Democrats in the Senate, Obamacare will not be repealed.  Throw in insurance industry support - after all, they get millions of new customers by law - and it's hard to see how the major provisions get repealed.  A provision here or there may get changed, but Obamacare as a whole is going nowhere.  I can think of no major entitlement program that has shrunk or been eliminated once enacted.

[mc ukrneal]

If there are 41 or more Democrats in the Senate, Obamacare will not be repealed.  Throw in insurance industry support - after all, they get millions of new customers by law - and it's hard to see how the major provisions get repealed.  A provision here or there may get changed, but Obamacare as a whole is going nowhere.  I can think of no major entitlement program that has shrunk or been eliminated once enacted.

If it is a tax, they apparently would need only 50 as it could be approved a different way (the same way the original law was passed as I understand it).

[Todd]

If it is a tax, they apparently would need only 50 as it could be approved a different way (the same way the original law was passed as I understand it).

Someone with a detailed knowledge of all Senate rules would obviously have a better understanding of how and when this could come to a vote, and by what mechanisms, but let's assume only a simple majority is needed remove the mandate, with a strong Democratic Senate minority led by someone who is adept at the rules - Harry Reid, say - and all of the interested parties who benefit from the law (insurance companies, health care delivery companies, perhaps a few citizens) applying pressure, as well as the fact that whole-scale repeal would begin reversing some changes that have started being instituted, it's very hard to see how, even with an all-Republican government, the law gets repealed.  Perhaps the next Congress will be more principled and less beholden to vocal and financially generous interests in their districts than the current Congress, but I have my doubts. 

[mc ukrneal]

Someone with a detailed knowledge of all Senate rules would obviously have a better understanding of how and when this could come to a vote, and by what mechanisms, but let's assume only a simple majority is needed remove the mandate, with a strong Democratic Senate minority led by someone who is adept at the rules - Harry Reid, say - and all of the interested parties who benefit from the law (insurance companies, health care delivery companies, perhaps a few citizens) applying pressure, as well as the fact that whole-scale repeal would begin reversing some changes that have started being instituted, it's very hard to see how, even with an all-Republican government, the law gets repealed.  Perhaps the next Congress will be more principled and less beholden to vocal and financially generous interests in their districts than the current Congress, but I have my doubts. 

AH HA! I found the article I read about this. The whole thing is here: http://news.yahoo.com/blogs/ticket/could-republicans-really-repeal-obamacare-091546012.html

But here is the relevant excerpt:

What about the filibuster? Don't you need 60 votes to do anything in the Senate?

Not in this case. Because Chief Justice John Roberts' majority opinion ruled the individual mandate a "tax," a Republican-led Senate could repeal that provision--and others--using what is called "budget reconciliation," a procedural tactic that requires only a simple majority vote. The Republican vice president, in this hypothetical scenario, would break the tie. (Democrats used the same method in 2010 to pass the health care bill.)

[Gurn Blanston]

I would be much more supportive of any Republican initiative if I had even the vaguest hint of belief in the possibility that they intended to replace it with something better. But the fact of the matter is that if they manage in some way to get it repealed, there won't be even a salute to health care reform in my lifetime, or possibly ever at all. The intention of this drive is NOT to get a better health care plan in place, it is to remove any restraints whatsoever on health care providers. This is what has happened with telecommunications, and with the finance industry and many others. And isn't that working out nicely?

So despite the fact that I am rather on the conservative side of several essential issues, I sure can't back them on this one.

[Todd]

But here is the relevant excerpt:

I understand that using the budget reconciliation process makes it a simple majority vote, but there are other delaying tactics in the Senate.  Just ask Mitch McConnell.  Harry Reid and company have a lot of non-filibuster tools at their disposal (as well as filibustering other legislation just to slow the entire process down), they know how to use them, and they would fight as hard as McConnell has to slow down the Obama administration.  And then there's the question of what, precisely, would be repealed.  Repealing the ACA in its entirety is more challenging, since portions are in effect, and therefore there are already vested interests.  The rhetorical (and principled?) target is the mandate, yes, and without that, some of the other elements of the plan are untenable – such as guaranteed coverage for pre-existing conditions – but eliminating those carry political risks that not all Republicans will be willing to accept. 

There will definitely be a lot of political theater.  Republicans now have a live horse to beat on for a while.  But it's hard to see the confluence of events necessary to make swift repeal a possibility.  That would require a Republican sweep at the national level, Democrats simply rolling over, and the beneficiaries of the law, including giant companies that stand to make tens of billions of dollars, simply accepting repeal.  I'm not sure that the stars will align thusly. 

The Democrats were smart in the way they approached the legislation.  It was primarily a congressional undertaking (ie, the White House didn't send a big, detailed package to Congress), with lots of input from lobbyists, who give to both parties.  This makes repeal in early 2013 very unlikely, and if it is not repealed by 2014, it's very difficult to see how repeal will ever be possible.  I'm not familiar with large scale government programs that were subsequently killed (war time programs aside), and while that doesn't mean ACA won't be the first, I see it as improbable. 

[Brian]

Test your knowledge of Obamacare with this handy quiz! (I got 100%, but guessed on some of 'em.)

[Todd]

Test your knowledge of Obamacare with this handy quiz! (I got 100%, but guessed on some of 'em.)

Were only all things in life as easy as this quiz.  Seeing the low percentage of correct answers is somewhat disheartening, though not unexpected.

[Geo Dude]

Were only all things in life as easy as this quiz.  Seeing the low percentage of correct answers is somewhat disheartening, though not unexpected.

I got 7 out of 10 simply by making educated guesses and I have made no effort whatsoever to learn about the law beyond the basic, broad details.  I was particularly shocked that 55% of people got the death panels question wrong given that the 'death panels' were removed almost immediately after the lies about them started.  Talk about an effective propaganda campaign.