I’m happy to label Lieberman a POS about his view on the public option, but I was already in the Lieberman is a POS because of his views on expensing stock options.
That being said, here’s an alternative view of the ACA with regard to the public option:
Obama had struck a deal for an ACA that included a triggered public option, and that included buy-in from previously-opposed Senators Lieberman, Nelson, Landrieu and Snowe.
However, progressives in the House said no to that deal. If the ACA didn’t include a real public option, not just a triggered one, they would not vote for it. So the Senate version dropped the (triggered) public option altogether, because moderate Senators weren’t going to take a controversial (for their states) position that was going to be fail in the House anyway.
So the choice was between a negotiated, weaker public option that Obama and moderate Dems supported vs. a real public option. We got neither one because Progressives weren’t willing to take a watered-down version. You can applaud their principles, but 10 years later we’re still looking at a public option as a years-away dream.
This is crazy - one of the most-debated aspects of the ACA was the imposition of minimum policyholder benefits. This is an explicit piece of enacted legislation - insurance companies have to spend a minimum % of premium revenue on policyholder benefits. If they don’t do that, they have to pay the difference in rebates back to their policyholders. To date, insurers have paid about $5 billion in those rebates - this is a really big deal!
Well theoretically the “people who can’t afford it” weren’t paying anyway, they were on Medicaid or getting subsidies at least.
One of the biggest failures outside the lack of public option was in assuming red states would actively act outside the best interests of their constituents and reject expanded Medicaid dollars out of sheer spite. Maybe we gave greed too much credit there.
… and yet the only insurance I can get on the Obamacare exchange today has a 5k deductible, no copays, and a 15k out of pocket max. Come on man… it sucked kind of a lot on the ground. Oh and they wanted 400 a month per person for the insurance I just mentioned for two healthy people under 40. Just completely bonkers.
The thing about those monthly premiums is that they’re not substantially different from what they were before. It’s just that a huge % of the population never knew that because they were getting it from their employers who were paying half of it.
Imagine LBJ with 60 senate seats and the house and passing Mitt Romney’s health care plan. What the hell is the point of having power if not to impose your agenda over the objections of people who disagree with you.
The cost of healthcare has continued to rise since Obamacare was passed… which was the real problem with Obamacare. It did absolutely nothing for the root causes of our healthcare access problems: cost. Very much like taking a tylenol because you want to treat the headaches the brain eating bacterial infection is causing… it helped a few people with preexisting conditions who the health insurance companies were rat fucking out of coverage (I worked at a health insurer during the peak rat fucking era in the retention department and I’ll probably never not have some % of my nightmares be people crying on the phone about losing everything because their insurance premium was going up 800%). It totally ignored the root problem which is that healthcare spending in this country is at least 6% of GDP too high.
I don’t mean to sound like I think the current situation is good, or that the ACA was perfect. But this again is nonsense. The ACA directly influenced insurers’ pricing by imposing minimum spending on policyholder benefits. If insurers don’t spend at least 80 cents out of every dollar of premium on policyholder benefits, they have to give the excess back to those policyholders - THIS EFFECTIVELY IMPOSES PRICE CONTROLS ON THE INSURANCE COMPANIES.
The ACA also included Medicare payment reform and the Cadillac Tax, which would (almost certainly) have lowered costs. Obviously the Cadillac Tax was postponed by Republicans and may never actually take effect.
I feel like people are criticizing the ACA for not including things that it most definitely did include.
Obama’s original plan had a public option and every dem senator who didn’t vote for John McCain (ie everyone but Joe Liberman) would have voted for the public option. Republican governors blocked medicaid expansion in their states. So the policy preferences of the DemE gave way to the political reality of getting coverage for the working sick the only way possible. After the 2010 midterms expanding Obamacare was no longer on the table.
And yet the industry is still setting record profits net of MLR rebates because their enrollment and premiums (driven by unchecked medical/rx trends) have skyrocketed despite the capped margins.
I believe over 80 pct of the under 65 market in2019 was subsidized. So basically we have almost single payer right now, but it comes without any negotiating leverage, which is the main benefit of it, from a cost perspective.
Yes ACA got more people covered and is saving lives, but it has made the cost problem worse since all the controls were gutted.
That’s almost exactly what happened with the voting rights act and medicare. Liberals pushed for much stronger versions and LBJ said they didn’t have the votes.
