
ObamaCare’s death spiral, stage one: Denial - at-fates-hands
http://nypost.com/2015/11/02/obamacares-death-spiral-stage-one-denial/
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ddingus
I am going to be frank here. This issue is very close to my heart, due to
harsh and difficult to overcome life experiences.

The ACA is what was possible at the time it was enacted. One party holding a
blanket "no" position very seriously diluted what was actually possible. Most
notably, the opposition wasn't over a better way. It was all about simply not
beginning the process to improve. Today, that opposition is pointing to tepid
results, and they are right about those results, while completely ignoring
their reasoned and deliberate efforts to insure the results are tepid at best.

They desire failure in the hopes that we can return to ignoring this problem,
not that they have a better vision, or can contribute in some other meaningful
way.

Understanding that is important.

Really, the most meaningful aspect of the ACA is that it represents us getting
started on health care reform long overdue. Popular support for the idea of
improving health care runs consistently high. Our costs are roughly 2X above
the second most expensive system in the world and are not sustainable. Most of
us feel this impact, and the need to improve is obvious.

A handful of votes would have transformed the ACA from the tepid legislation
is is today. One notable omission is public, "cost plus" insurance access,
potentially a Medicare buy in plan. This would have done a lot to improve on
price control and foster competition as well as experimentation with public,
"cost plus" type delivery systems too. We could take care of a lot of people
for a lot less money given just a little innovation in this space. Some
nations get by on tech from the 70's and 80's and have overall outcomes
comparable and, in some cases, better than our aggregate outcomes now.

Regardless of where you stand on all of that, the reality is we finally got
started. 40 years overdue. And it's all a little bit better now in aggregate,
and life changing for some 20 million plus Americans today.

Now that we have started, it's time to improve on the ACA, and the more we do
and the sooner we do it, the better off we all will be. That's the real
message.

Don't like the ACA? Great! Neither do I. We had to get started somewhere, and
the ACA was that possible start, diluted only by people unwilling to actually
start to do the work to improve this for everyone.

The question really isn't repeal or not. The question is how to continue to
improve. Given the costs, we need to very seriously improve.

There is no death spiral. The ACA is working as intended and it's doing a lot
of people real good in terms of access to health care and debt / bankruptcy
related to health care. Had the ACA been law a few years before, I would have
been able to avoid the choice between losing everything, or losing somebody I
love.

Of course, she is still here, and that is good, but my financial life will
never be the same. Just imagine all your gains, home, etc... gone at 40
something. That is what happens to people. And it still does, but the ACA puts
some real options out there that really do help a lot of people avoid that
scenario and doing that is really worth it. I know my life would be very
different today had the ACA been law.

It's easy for people of means, or who have good insurance through their
employer, etc... to rage on about the "injustice" of the ACA. Whatever. No
joke there. I really am being dismissive, because the value of getting started
on this problem in the USA really is as big of a deal as proponents make it
out to be.

It's much harder to talk about fact based, data driven rational policy
intended to improve the deplorable state of health care policy in the USA
today. Quite frankly, it's not enough to repeal. The end game on that is
unacceptable to the vast majority of Americans.

No, the real denial is over the great need to continue the journey we started
with the ACA. A "replace" type proposal is plausible. An "improve" type
proposal is likely possible and practical.

Repeal is a dead end with no meaningful end game for anyone really.

