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Wednesday, May 7, 2014

Architect Of Health Law Says Reform Is ‘Never Finished’

Bioethicist Ezekiel Emanuel advised the White House on health care reform and tells Here & Now that "despite a bad rollout," the law is working. (ezekielemanuel.com)

Bioethicist Ezekiel Emanuel advised the White House on health care reform and tells Here & Now that “despite a bad rollout,” the law is working. (ezekielemanuel.com)

Two polls released this week reveal challenges ahead for the Affordable Care Act.

Gallup found the nation’s uninsured rate dropped to 13.4 percent last month, the lowest monthly uninsured rate since the company began tracking it in 2008. But that means 32 million people remain without coverage.

And a Pew Research Center poll shows that 55 percent of Americans disapprove of the 2010 health care reform law, which mandates that everyone have health insurance and that it be made available to even those with pre-existing medical conditions.

Bioethicist Ezekiel Emanuel advised the White House on health care reform and tells Here & Now’s Jeremy Hobson that “despite a bad rollout,” the law is working.

Emanuel predicts that enrollment in health plans will top 20 million people by next year, and he says there’s still work to be done on bringing down health care costs.

Interview Highlights: Ezekiel Emanuel

Does it bother you that so many people still don’t like this law?

“Yeah, I think it’s a misunderstanding and it points to a persistent problem around communication about what’s in the law, the advantages of the law, and more importantly, the disaster that would have befall the country had we not actually enacted reform. I think that’s the most important issue, is what’s the counterfactual. If we hadn’t had the Affordable Care Act, we really would have blown apart the system.”

On what went wrong with getting that message out

“The communication strategy, even going back to August 2009, where the Tea Party had its founding and all those town hall meetings and congressional districts, we just never got it right, I think, and never really convinced the American public why we needed to reform the system, and why this reform, while not perfect, is definitely a big step in the right direction. And the irony is, of course, on every one of the major issues — as you point out, access — we’ve had a really steep decline in the uninsured rate for the first time in a long time, we’ve had improvements in quality of care because of the Affordable Care Act and costs have gotten under control, although by no means is the cost level of health care completely whipped. But in four years, we’ve gone a long way in the right direction, and people should see that as a big positive, but I don’t think the message has really gotten out.”

On his goal for number of sign-ups a year from now

“There are lots of ways people are getting coverage — it’s not just in the exchanges, although that is probably the most important way, so we’re about 12 to 15 million people have gotten coverage through the Affordable Care Act. I’d like to see that number go over 20 million by next year.”

Is that goal possible?

“Of course. One of the things that the exchange shows you, that despite the bad rollout, despite the two months of really no one being able to get insurance through the exchange, we had 8 million people sign up. Americans really want affordable health care insurance. Whatever the Koch brothers and their minions say, people don’t want to go without insurance. They want insurance and the big problem has been affordability. And I think the exchanges offer a very good platform for most Americans to get coverage. And I think if we can continue to offer good insurance plans at a reasonable price, people are going to sign up — especially once they really understand that they can get subsidies both for the premium and, if they’re poor, they can get subsidies for co-pays and deductibles — that’s a very appealing package to most people.”

Guest

Transcript

JEREMY HOBSON, HOST:

Well, now to the world of polling, where it is good news, bad news this week for the Affordable Care Act, or Obamacare. Gallup found the nation's uninsured rate dropped to 13.4 percent last month, that's the lowest monthly uninsured rate since the company began tracking in 2008, but a Pew Research Center poll shows that 55 percent of Americans disapprove of the 2010 health care reform law.

Joining us now is one of the people who advised the White House on the law, bioethicist Ezekiel Emanuel, who teaches at the University of Pennsylvania. He's got a new book called "Reinventing American Health Care." Ezekiel Emanuel, welcome to HERE AND NOW.

EZEKIEL EMANUEL: It's my honor.

HOBSON: Well, does it bother you that so many people still don't like this law?

EMANUEL: Yeah, I think it's a misunderstanding, and it points to a persistent problem around communication about what's in the law, the advantages of the law and, more importantly, the disaster that would have befall the country had we not actually enacted reform. I think that's the most important issue is what's the counterfactual. If we hadn't had the Affordable Care Act, we really would have blown apart the system.

HOBSON: But there are very smart communications people working for the administration. Why couldn't they get this right?

EMANUEL: You'll have to ask them. I just, I think, as I point out in my book, that the communication strategy, even going back to August 2009, where the Tea Party had its founding in all those town hall meetings and congressional districts, we just never got it right, I think, and never really convinced the American public why we needed to reform the system, and why this reform, while not perfect, is definitely a big step in the right direction.

And the irony is, of course, on every one of the major issues, as you point out, access, we've had a really steep decline in the uninsured rate for the first time in a long time, we've had improvements in quality of care because of the Affordable Care Act, and costs have gotten under control, although by no means is the cost level of health care completely whipped.

But in four years, we've gone a long way in the right direction, and people should see that as a big positive, but I don't think the message has really gotten out.

HOBSON: Well, if we're talking about eight million or now more than eight million having signed up during the first signup period, what would be a good number to be at, in your view, a year from now?

EMANUEL: Well, wait a second, that's eight million just in the exchanges. You have to also remember we expanded Medicaid.

HOBSON: Medicaid.

EMANUEL: Even though a lot of states have not actually enacted it. We got almost five million people that way, three million people under age 26 who are still able to stay on their parents' plan. There are lots of ways people are getting coverage. It's not just in the exchanges, although that is probably the most important way.

So we're about 12 to 15 million people have gotten coverage through the Affordable Care Act. I'd like to see that number go over 20 million by next year.

HOBSON: You think that's possible?

EMANUEL: Of course. I think one of the things that the exchange shows you, that despite the bad rollout, despite the two months of really no one being able to get insurance through the exchange, we had eight million people sign up. Americans really want affordable health care insurance.

Whatever the Koch brothers and their minions say, people don't want to go without insurance. They want insurance, and the big problem has been affordability. And I think the exchanges offer a very good platform for most Americans to get coverage.

And I think if we can continue to offer good insurance plans at a reasonable price, people are going to sign up, especially once they really understand that they can get subsidies both for the premium and, if they're poor, they can get subsidies for co-pays and deductibles. That's a very appealing package to most people.

HOBSON: OK, on the flip side, though, there are a lot of people, even people who were supporters of the law in the first place, who are very upset by the idea of their employers potentially dropping them or trying to shift them over to some of the exchanges. There was a research firm, S&P Capital IQ, that predicted just last week that by 2020, 90 percent of American workers who are now getting health insurance through their employer would be shifted to government exchanges. First of all, do you agree with that? Do you think that that's true? And would that be a failure for the health care law, if that happened?

EMANUEL: I think that's a very extreme prediction, and I think that's probably not realistic and not going to happen. And I think if you look at the assumptions they made in their model, very unlikely to happen. So that's - while it got a lot of headlines, I do not think that prediction is likely to be true. I think there are lots of other pieces of data - Crane's(ph) from Chicago looked at employers, and some employers are looking at private exchanges. Others are looking at the public exchange.

There's a lot of uncertainty how the future is going to play out, and I think that's quite clear. And uncertainty, of course, increases people's anxiety, since you don't know whether you're going to be better off or worse off. I actually think for many people the exchange is going to be a better deal, and they ought to welcome it.

For one thing, most people who work for employers and get their insurance through employers don't have a choice of health plans. You'll have more of a choice in the exchanges. Second of all, if you switch jobs, or you change companies, or you start your own company, if you get your insurance through the exchange, you don't have to change your health care. If you get it through your employer, you have to change your health insurance company.

And I think that continuity is also going to be better, and I think for younger people who buy everything through the Internet, whether it's book or clothing or shoes or cars, I think buying health insurance through the Internet, where they have the choice, and soon there are going to be a lot more tools to help them shop, it's going to look like an advantage, not a disadvantage.

HOBSON: Although I can hear a lot of listeners in my head right now probably saying I like my health care at work just fine. Please do not make me move into one of these exchanges.

EMANUEL: And I think, and I think employers are going to look at that also. They're going to listen to their workers because a large part of the reason they offer health insurance, remember, there is no requirement, no legal requirement to offer health insurance yet by employers, and I think the large part of the reason they offer it is to attract good workers, to retain good workers.

My own view is, you know, over times workers are going to want it because it's going to offer a very attractive alternative to employer-based insurance.

HOBSON: That's bioethicist Ezekiel Emanuel, one of the architects of the Affordable Care Act. He's now at the University of Pennsylvania. His new book is called "Reinventing American Health Care." Stay with us, HERE AND NOW.

(SOUNDBITE OF MUSIC)

HOBSON: It's HERE AND NOW. We're speaking with bioethicist Ezekiel Emanuel, who advised President Obama on health care reform. He teaches at the University of Pennsylvania and is author of the new book "Reinventing American Health Care." And Ezekiel Emanuel, let's talk about cost, which was another big part of the Affordable Care Act, the affordable part, you could say, bringing down the cost of health care.

We did a story just last week with Bloomberg News that reported that the price of drugs is now going up 10 times the rate of inflation, that if you bought a cancer drug, let's say for $30,000 10 years ago, it could cost in the hundreds of thousands now.

EMANUEL: All right, let's make a few points. First, drugs account for about 10 percent of all health care spending. Hospitals account for about a third of health care spending and doctors about 20 percent. So if drugs are going up a lot, it's still a smaller portion of health care spending.

Second, we have, over the last decade, substantially increased our use of generic drugs, and generic drugs in the United States are extremely cheap. I just filled a prescription for 90 days' supply of a drug, $10. It is true that specialty drugs, high-end specialty drugs for things like cancer, hepatitis C and a lot of other orphan diseases, multiple sclerosis, they are extremely expensive, and that is a worrisome finding.

I think the idea that you're spending $100,000, $125,000, $200,000 for a drug that might extend life three, four months at most, I think many people are suitably outraged by that, and we may hit the tipping point. I think...

HOBSON: Is there anything we can do about it?

EMANUEL: Oh, most of them, that would require legislation. There are many things to do be done about it, but that would require legislation. And as you well know, at the moment legislation on health care does not look like it's on a fast track through Congress.

HOBSON: Right. So besides the drugs, would you say that the cost of health care, do you see a trajectory that you would like to see of it going down? And how is that going to happen?

EMANUEL: So over the last three, four, five years since the great recession, we have had a decline in health care inflation, although in the last quarter of 2013 and the early parts of 2014, it does look like health care inflation has picked up, which is not that surprising since you're adding millions of people to the health care system.

So we have had a period of relatively low inflation. Without additional work, that will not continue, and I think we are seeing, in the health care system, if you go around and look at various hospitals and health care systems and practices, great efforts to increase efficiency, great efforts to change. And I'd say that the two dominant processes I think that we need to control costs, one is a very, very strong focus on reducing what's called the unit cost, how much it costs to do something, to make a CAT scan, to take a surgical procedure.

The second and probably more important aspect is to really focus on the 10 percent of patients that consume about two-thirds of the health care spending. Those 10 percent of patients are people with chronic illness: diabetes; congestive heart failure; emphysema. And the real key is to keep those people healthy, to prevent the infection of the toe of the diabetic patient that eventually needs an amputation, to prevent the person who's got emphysema from it getting worse and being admitted to the hospital.

A lot of places are putting in new programs to address that problem, and as I predict in my book, I think health care inflation is going to come down to the growth in the economy, and I think that's possible by the end of this decade, 2020.

HOBSON: But does a lifetime of preventative care keep you out of the emergency room at the end of your life, where we see people spending a lot of money in the hospital?

EMANUEL: Yeah, well, I think most of the public and probably a lot of your listeners have a distorted view of how much we spend at the end of life.

HOBSON: Oh, well set the record straight, doctor.

EMANUEL: It is true that we spend a lot relative at the end of life, but it accounts for about 10 to 12 percent of total health care spending. And that is a lot for each individual person because less than one percent of the population dies each year. Nonetheless, we don't know the formula, as it were, for actually saving money at the end of life.

I think a lot of people are focused on that. My actual view is that what we should be focused on is improving the quality of care at the end of life, and guess what, we've actually gone a long way over the last 30 years in that direction. When I started out as a bioethicist, my main area in the mid-1980s was end-of-life care. At that time, over 70 percent of cancer patients were dying in the hospital, getting chemotherapy and other treatment. Today it's down to about 22 percent of cancer patients die in the hospital.

Most of cancer patients across the country actually get hospice care at the end of life. What we really need to do, in my opinion, are three things. We need to train doctors and nurses better in communicating with patients about end-of-life care and communicating much earlier to try to get patients' views about how they want to be treated at the end of life.

Second, we need to actually have the facilities to take care of patients both in the hospital and at home. And a lot of hospitals in this country don't have palliative care services, and it can't extend both from in the hospital to home and support the family. That's very important because if people really want to be at home, they need the support services for that.

And the last, of course, is we need to pay for it in a way that doesn't make it onerous and really burdensome either to a health system or to patients and patients' families themselves. Whether that saves a lot of money or just improves the quality of care, we don't know. We haven't run that trial yet.

HOBSON: As you know, there is a big movement in the Republican Party to repeal this law still, and I wonder, are you concerned that if the Republicans take the Senate this year, which is a possibility, and retain control of the House of Representatives, that they may if not repeal it significantly weaken it?

EMANUEL: Well, I think the notion of repeal is a lot of empty rhetoric. We've had more than 40 votes on that. It goes nowhere. Now we have 12 to 15 million people who have got insurance through the Affordable Care Act. Repealing it would really throw now more than 10 million people out of insurance. I don't think that's happening, and the president would certainly veto anything that substantially weakens the Affordable Care Act.

Similarly they have no alternative. You've never seen a Republican replacement option that has any teeth, that addresses the three big problems of access, quality and cost control. The final word I would say on this is I really think the Affordable Care Act is the Republican plan, and that's their problem. That's why they don't have a replacement, because it really is the Affordable Care Act.

What do we have in the Affordable Care Act? We have a marketplace where private insurance compete for customers, and the government subsidizes people who can't afford that insurance plan. Doesn't that sound very Republican-ish? Doesn't that sound very American and apple pie, private markets with companies competing for customers who shop...

HOBSON: Well then why have they disowned it? Why have the Republicans disowned their plan?

EMANUEL: Because the Democrats endorsed it, and, you know, politics being what it is, if your opponent endorses something, you've got to oppose it rather than seeing that this is something bipartisan, it's good for America. The Affordable Care Act is not a perfect law. What we should be focusing on now is how to improve it and especially improve its cost control measures so that we can keep health care affordable for Americans because there's a lot of work to be done.

We're never finished with health care reform. We are always constantly having to tweak the system and improve it, and lord knows we have lots of things to do in the health care system to improve it.

HOBSON: Ezekiel Emanuel teaches at the University of Pennsylvania. He advised the White House on health care reform, and his new book is "Reinventing American Health Care." Ezekiel Emanuel, thanks so much for joining us.

EMANUEL: Thank you for having me.

HOBSON: And we'd love to hear from you about what you think about the Affordable Care Act. Are you among the 55 percent of Americans who disapprove of it, or do you think it's a good thing? Are you one of the millions of people who have signed up for the exchanges under the Affordable Care Act? Let us know at hereandnow.org. You can also send us a tweet, @hereandnow, @hereandnowrobin, @jeremyhobson. This is HERE AND NOW. Transcript provided by NPR, Copyright NPR.


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  • PoliticsWatcher

    He’s right. The Democrats did a terrible job of explaining why Obamacare is so good for the USA.

    • Duane_Dibbley

      It wouldn’t matter if Obama had explained it better. People on the right in the US just swallow whole all the fear mongering lies told to them on AM radio and Fox News. Nevermind that the ACA was based on a plan originally designed by the Heritage Foundation…If Obama promotes a program it must be evil “socialism” and be opposed at all costs!

      • chrysanthemum

        Similarly, people on the left rejected any criticism of the ACA even from other liberals. Ed Markey tried to paint Steve Lynch as a Republican because he was against the ACA a few years ago, even though he was against it because it’s a huge FU to working class people and he wanted real health care reform and not to give a huge gift to insurance companies for their campaign contributions.

        • mike

          It’s too bad that politics is so big in the health care debate. Without the politics we’d probably have a good solution by now. Just as Europeans like their socialized medicine. Or people here like Medicare.

      • mike

        It sure does seem, “it’s not business, it’s just personal”.

        Do the Republicans really just hate Obama? Or do they just hate us poor, old, sick people. Or do they just wish we would just stop being a financial burden on “their” country?

    • Cacimo

      WRONG. People are living with the result – that is the real problem. No amount of explaining makes a $200 monthly premium increase seem good.

      • Pleiades

        Have you actually heard the insurance companies justification for the rate increases? I know enough people in that particular industry to know that the insurance industry saw this as an opportunity to increase rates without the worry of state insurance commission oversight. The insurance industry could have continued coverage at previous rates, but this was a money grab that couldn’t be controlled, because there was no mechanism to control such.

  • chrysanthemum

    Hey Ezekiel, where do you get your health insurance from? Something tells me it’s probably not from an ACA exchange. Why not, if it’s so great? Especially in Massachusetts, where the law is NOT WORKING, it’s incredibly obnoxious to hear a well off pundit tell me how great my health insurance is. Why doesn’t the Center for American Progress get rid of its health care plans and let all of its fellows get health care through ACA exchanges? Why doesn’t UPenn get rid of their wise experts’ health insurance if the ACA is better? Is it because the ACA plans are not as good as employer provided plans and you are all a bunch of hypocrites? I’m so sick of liberals who make 6 figures and have great health care already telling me how great the ACA is for people like me who have never made more than $30,000 a year.

  • Jo Bleaux

    It’s not really true that generics are affordable nowadays. I don’t know if ACA is to blame or if something else is afoot, but a generic antibiotic prescription that cost me $4 without insurance a few years ago now costs more than $80. Generic. With insurance, this was still more than $50. The pharmacist explained that this is widespread, which was borne out by the online research I did.

    • Jo Bleaux

      For full disclosure, I do support the ACA (until the day we get single-payer). It’s the reason I now have insurance after doing without after being laid off.

    • mike

      Jo,
      Did you see the Frontline program last night? It was about antibiotics. The big pharmaceutical companies are no longer competing in the market for antibiotics. What happens when they don’t compete? The price goes up.

    • http://SDsustainableFuture.com SustainbleFuture

      Glad that saving your life is worth $4

      • Jo Bleaux

        It’s not a life-saving issue. It’s one of several possible therapies for a chronic condition.

        My point is that it’s no longer true that generics are always a good deal. This one — doxycycline — has gone up astronomically.
        http://articles.latimes.com/2013/mar/07/business/la-fi-lazarus-20130308

        • mike

          I think (hope) that SustainableFuture’s point is: your particular life is worth more than $4. Our civilization SHOULD be at the point where it’s really easy ($4) to save your life.

          But, of course, our civilization should be to the point where, for $4, you have a good life. Why do some people want to deny that?

  • tensae

    For the first time ever, I was polled about the ACA (don’t remember if it was Pew). I support the act and am glad we have it. But when asked for the poll, I said I disapproved, because to me, it didn’t go far enough. I wonder how many of those 55 percent who say they disapprove, do so for that same reason.

    And yes, the message from the President and Democrats has been horrible from the start. I’ve always felt they needed to take a page from the Bush administration, who, by staying on message and repeating it over and over, were able to sell an unnecessary war. With the same tactics, the ACA should have been a breeze to sell.

    • mike

      I wonder if those 55% get their health care thru their employer, but now have to compete with more people for time with their doctor. Do they want all those additional patients to go away (by repealing the ACA) and go back to the “good ol’ days”, when they could get care and many others could not?

      Why is it 55%? I remember polls (10 or 20 years ago) that said 82% supported “universal health care”. What happened? Aren’t we a Christian nation anymore?

      • chrysanthemum

        The ACA isn’t universal health care. That might have something to do with it…

        • mike

          I think it’s only a temporary fix. I think insurance companies will eventually get out of the healthcare gatekeeper business, because profitability will go down as they have to compete for business. Then, maybe Medicare will fill the cap. Or maybe doctors will have to compete for “customers”, by charging less, and, maybe we won’t need insurance at all (as it was when I was growing up).

  • Sean Mcmonagle

    This gooofy, nerd of a doctor didn’t even mention food and diet once about what needs to be done for sick people.

    • http://SDsustainableFuture.com SustainbleFuture

      That goofy doctor, author of
      Patient Protection and Affordable Care Act, Ezekiel Emanuel, is a genius and a hero.
      Diet and exercise are surely part of each individuals health, and each individual pays a direct price for their personal decisions.

      • Sean Mcmonagle

        Diet is everything…we continue to have the wrong discussions. Affordable care act…cute name but the way I see it, falls down on the root of this all…and we ALL know what that is. Control the food and control a population. The first thing that needs to be done is a reform in the FDA. I MEAN FIRE THEM ALL. Then reform in education both for yound and old. Teach children food diet and cooking, then when they are all healthy ..well by this point it will all be fixed. Then we can just look back at all yhis as a scary point in history when we let our government control what we ate.

        • AC

          you are in danger of becoming a self-righteous fanatic. please be careful, it doesn’t work for religion either.

          • Sean Mcmonagle

            This has nothing to do with religion..but you seemed to be blaming some one else for your disease

        • mike

          Does the government control what we eat, or is it the Food Processing companies?
          Or is it the Food Processing company lobbyists that control the government?
          Or is it the Marketing companies that fool us into eating … “stuff”.
          Or is it right-wing conservatives that want us to be “fat, dumb and happy” (where “happy” is a temporary condition due to death from high sugar/fat/salt food content).

          Aw, nuts (where “nuts” are made by a Detroit start-up).

    • AC

      here we go. persecution.
      not all disease is fixed by diet and exercise. please, don’t say things like this.

      • Sean Mcmonagle

        Who has control over your illness?

        • AC

          May the odds be ever in your favor. Hope your luck holds out & you never find yourself choking on some of your words…..
          Ps – I’m agnostic and dislike religion intensely ….

  • Frog

    If Americans WANT the Affordable Care Act so much, why did the Obama Administration feel the need to create the insurance mandate that taxes those that don’t sign up?

    I’m curious, what is the percentage of people that are paying full price (not subsidized) for medical insurance under the health care exchange?

    • chrysanthemum

      “what is the percentage of people that are paying full price (not subsidized) for medical insurance under the health care exchange?”

      Probably quite high. The subsidies calculator doesn’t even work in Massachusetts and won’t until next year, I wouldn’t be surprised if this is the case in other states as well.

      • Frog

        If H&N is any indicator, probably quite low. I can’t think of one they interviewed that wasn’t getting a subsidy.

        • chrysanthemum

          Well that proves it. We all know that only right leaning media outlets have a bias.

  • PL

    I was forced into obamacare. Paying about 180% more than I was. We filed and paid over a month ago and are yet to be enrolled. Our money has been received – yet they have no record of our money being received. “We’ll call you back”. My wife is on a regimen of injections for a disease that will take her sight if not treated. I am now left to paying out of pocket minus the money sent to this statist travesty.

  • Sue in Alaska

    I had the same thought as ‘tensae’ – How many of those 55% who say they disapprove of the ACA, disapprove because they feel it didn’t go far enough? Important distinction to be made.

    • jonathanpulliam

      “Single payer” would be far preferable to ACA’s institutionalization of criminal extortion, true…

  • iamkaycee

    Why is it NEVER MENTIONED that there is a PENALTY if you don’t sign up? Many people have signed up, but aren’t happy about it. One of my friends is paying $600/ month on a $50,000 salary. They have canceled their summer vacation, and their kids won’t be going to camp. They signed up because ACA holds a gun to your head.

    • Jack

      It’s clear you don’t believe in hyperbole.

    • http://SDsustainableFuture.com SustainbleFuture

      ONLY $600/month! For an entire family! That’s so cheap. How much is their discount from the Federal Government, since they make $38,000 less than four-times the poverty-line for a family of 4?

  • Jo Bleaux

    I’m very curious about how many employers used ACA as an excuse to get out of onerous insurance contracts for their employees. And how many insurance companies raised their rates not because of ACA, but because they could pocket the profits while blaming ACA.

    • Pleiades

      the employer mandate will not be in force until after the 2014 election. it begins in January of 2015. We will see where our nation’s employers stand when that date comes.

  • http://SDsustainableFuture.com SustainbleFuture

    Excellent work Ezekiel Emanuel, the first time I’ve been able to afford health insurance in my adult life.

    I can not believe that “Here and Now” actually asked the question about “WHY 55% of citizens don’t like Obamacare?” Then implied that it’s the OBAMA Administration’s fault for failing to communicate the advantages of insurance reform. This is buying into the corporate media paradigm that supports conservative Republican propaganda.

    The Republicans have attacked the
    Patient Protection and Affordable Care Act (i.e. Obamacare) from the beginning
    Tried to repeal it 43 times before it was put into practice on March 31st, 2014.
    We have been told lies and misinformation about this law by every broadcast media and now “HERE and Now” have joined the crowd.

    • chrysanthemum

      Where do you get your health insurance from?

      • http://SDsustainableFuture.com SustainbleFuture

        Kaiser Permanente San Diego
        via Covered California $134/month (no deductible)
        https://www.coveredca.com/

        (the hard part was getting dental care)

        • chrysanthemum

          I’m jealous. Massachusetts is still too much of a mess to sign up for anything.

    • Sean Mcmonagle

      Why is affording health care some sort of adult milestone to you. If you took responsibility for yourself and ate correctly you would never need to see a doctor. AND DONT ALL DOCTORS SIGN AN OATH IN WHICH STATES ” let food be thy medecine”. There are doctors and then there are guys like this..but Ezikeal…whatever your nerdy name is, is NO DOCTOR..he is a fraud and should be stripped of his license

      • mike

        Even if you eat correctly, you still have to breath the air and drink the water, which are full of industrial waste products. Then we’re forced to get artificial medicine… or die an artificial death.

        • http://SDsustainableFuture.com SustainbleFuture

          as long as it’s an artificial death, I can live with that.

      • http://SDsustainableFuture.com SustainbleFuture

        I was hit from behind by a vegan texting on her phone while driving. How was that related to my diet?

        • Sean Mcmonagle

          Lol…how is that related to your health at all…and you already require car insurance to cover any issues that may come from that

        • Sean Mcmonagle

          Do you need the government to step in the middle of a fender bender

  • Jessica Cottam

    I used the exchange to find my health insurance and I loved it. I have MS and as such was unable to find a policy that would accept me without a HUGE premium. With the exchange, I was able to find a great policy that I can afford.
    It has been my opinion that our country has needed better access to affordable care for a long time. We have the best medical care in the world…If you can afford it. Otherwise, you are in free clinics and urgent care clinics. Have you ever been to a free clinic? It’s like entering a third world country.

  • Raphaelae Alexandra

    (raises hand) one of the 10-million, who had my own health insurance, and by the time i had to ACA it was $476/month, and No Drug Coverage. So that would actually be closer to over $1,000/month. Now w/ an HMO Platinum for just under $400/month (no deductible, same Doc copay, $5 more Specialist co-pay, $5 generics, 50% brand name drugs)… Now I admit, *actual* saving unknown yet, since I have had it for 6 days.

  • Sean Mcmonagle

    There use to be a time when these types were labeled quacks by REAL doctors that relied on diet and food to keep people healthy.

  • Peggy

    I have been unemployed for 3+ years and after Cobra ran out I got catastrophic health insurance on my own for about $300/month. I’m 62 now. I love the idea of health care reform, but when I signed up for ObamaCare (my insurance was canceled as it did not meet the minimum requirements), my cost shot up to over $600/month. Being unemployed, I received a subsidy but I believe $600/month is way too high to pay personally. My son also joined ObamaCare and for a 21-year old, his premiums were $250/month! Compare this to my daughter’s health insurance which was $110/month at the same age before ObamaCare. So the young really are paying the high premiums for us all. And the non-sick are paying higher premiums to subsidize the chronically sick. Not sure this whole thing is working. Health care costs are the problem. Or we should all be on Medicare.

    • AC

      i’ve been sick my whole life. age has nothing to do with it. count your blessings your children are healthy and try to be a little more sensative in case parents with ill children see this…..
      also, i’ve been in the working world for just over 8 years and i’ve never had an insurance plan under $200 bi-weekly. i’m not sure what the heck kind of insurance people are saying existed before? my company offered a very slightly-less expensive choice, & always has a choice of 4 or 5 plans (comparable) but that’s what we’ve always paid??

    • mike

      Of course the young and the non-sick are subsidizing the sick. Who else is there? That’s the way it’s been since human society began– the strong carry the weak. I think we’re the only species that does that. I think it’s why the human species has been so successful (in a biological sense– we’re far from extinct; that’s all Mother Nature cares about).

  • AC

    the beginning of the persecution of chronically ill people? i’m worried…..i don’t look sick or overweight or anything, but have lupus.
    you have no control of this, no matter diet or excercise. i’ve tried all kinds of health fads-usually they cause serious flares…..

    • Sean Mcmonagle

      Oh here we go again..everyone wants to cry or have some sort of problem and blame god or something, it is much more intuitive to think your auto immune problem is either from a vaccine you had or a side effect of a medication your taken or have took or you’re just not eating right…I bet you evwn drink just one diet cook every now and then and still are one of those that say it cant possibly be my fault..it must be gods.

      • AC

        I’m from Europe and didn’t grow up with soda. I don’t even drink coffee. I drink a protein supplement from the vitamin shop, water & red cabs….
        Still, I can see you are unqualified to actually debate biology, so it’s ok. I won’t talk to you again. Sorry.

        • Sean Mcmonagle

          So you’re saying you’re biologically unlucky. ..thats strange but ok..lets call it luck that I haven’t taken over the counter drugs in years since I woke up..and that I dont gorge on food full of chemicals I cant pronounce…no..im not a biologist nor a food processor but I know better then to just trust them when they shove products in my face.

          • Sean Mcmonagle

            Paying money for a fancy degree does not qualify anyone….my qualifications come from my own experience…im 100 percent healty. .no ache…no sore..no flu…no measles..no cancer..no obesity. .no diabetes….Im telling you its because of what I eat…no education or fancy degree needed

          • mike

            Now that you mention it, there is a “biologically unlucky”. It’s called genetic mutation. Nature is constantly trying new things. But it’s random. And if it’s a bad mutation, then I guess that would be bad luck.

          • Sean Mcmonagle

            That sounds as fantastic as unicorns flying over rainbows…and this mutation and randomness is called evolution..it doesn’t happen this fast…this is an issue happenening here and now..not some sort of natrual order of things. If you put milk in your gas tank it wont work properly

          • mike

            On the contrary, mutations happen as fast as a cosmic ray hits an atom in a chromosome. This IS the natural order of things, whether we like it or not. It’s been happening since the beginning of life. If it didn’t, you wouldn’t see so many diverse species.

        • Sean Mcmonagle

          P.s. im also agnostic…I by no means wanted to make this a religion discussion..my bad for that.

  • Sean Mcmonagle

    Let me ask a question…whats the difference between cocaine side effects, alcohol side effects, heroine side effects, tylenol side effects and paxil side effects?

    • mike

      The difference is in degree, not kind. They probably all have similar side effects– but it depends on dosage. In the right dosage, a side effect can be good.

      In the wrong dosage, water can have a bad side effect: drowning. Just yesterday, there was a news story about a medical survey that showed that one glass of wine a day might make you live longer. And yet almost every day there’s a news story about a drunk driver killing someone.

      Is life complicated or what?

      • Sean Mcmonagle

        There isnt enough water or wine you can fit in a pill to hurt anything…awlful comparison

  • Heather

    I supported the concept of the Affordable Care Act, before I saw the actual insurance policy options available in my state. After comparing the policies available in my state (Arkansas) with other states, I see there is wide variability in what the costs are and what benefits are available. In my state, for my age (55), the available options were more or less about $11,000- $12,000 per year in cost before the insurance paid anything… Different levels of premiums ($400-$600/ month) were balanced with different levels of deductible ($3,000-$6,000/year), but basically it all boiled down to spending about $12,000/year before the insurance paid anything. This is not affordable. Thus, I am still uninsured. However, I notice other states with much lower deductibles and monthly premiums. So, for this national law, we are still hamstrung by low local competition in the insurance industry.

  • Brian

    Just want to say, I can’t afford to purchase insurance even with subsidies. I bought a policy because I was FORCED to. Now Other things in my household are going to not get paid. Not to mention the lowest priced policy with subsidies has a ten thousand dollar deductible. I am 54 married with one child. Don’t know how this helps me other than costing me money. Can’t afford to see a doctor ($100 visit) because of my insurance premium. Am I opposed to the ACA? Duh!

    • Brian

      Also,
      There were only TWO companies to choose from in our area

      • mike

        I guess that’s the fallacy of the ACA: it tries to use Free-Market-Competition to reduce cost (Republicans have maintained that for years). But only two companies is not effective competition. But that’s how Americans are– we gotta do everything with competition.

        But I for one don’t want my life and health turned into a game. I’d prefer universal health care just like we have universal fire and police protection. I’d like health care as all the other advanced countries– anyone can at least ask for help.

        Apparently, there are people in this country who don’t want us to even ask for help. I guess they still cater to the idea of “survival of the fittest”. And I suppose they define themselves as the “fittest”.

        • Frog

          Well, Democrats hamstring competition not letting insurance companies compete across state lines. If Anthem BC of Ohio is willing to sell me a policy (and they would be), why shouldn’t I be able to choose an insurance plan in Ohio just because I live in Michigan?

          • mike

            In my state, the State, not the Democratic Party regulates insurance companies.

  • Cacimo

    As soon as someone throws out the Koch brothers you know you are dealing with a political hack and not a serious thinker. So if this guy is the architect – it explains a lot.

  • BowenG

    The PP/ACA’s, then Obamacare’s, now ACA again, popularity never was, no matter how many infomercials NPR runs for Obamacrats. Amazing how the Obamacrats have started the November campaign with three main talking points: 1) There are now millions more of insured Americans; 2) the Republicans have yet to put up a plan; and 3) Obamacare just needs some mending, repairs, it’s still good. Even more amazing is how NPR has picked up those points and danced with them all over until we all turn into pumpkins! Facts don’t matter, events don’t matter, laws don’t matter only the Obamacrats party’s success matters.

    Some large insurers testified that they’ve experienced payment rates in the low-80s range.

    The existence of some significant number of duplicate enrollments isn’t a surprise to anyone who’s been following Obamacare’s implementation process. While Healthcare.gov’s front end was collapsing over the first few months, many would-be enrollees’ sign-ups were sucked into the website’s black hole. Unsure about whether any of their information had been transmitted, consumers were encouraged to go though the process again. Some did so multiple times. That’s why the administration’s enrollment statistics are useless in the aggregate. They just manufactured the largest-sounding number possible and heralded it as exciting proof that the “law is working” and the “debate is over.” And NPR gave Obamacrats a very big microphone for these ends, with no discussion, no debate, no reporting, no news!

    And then there’s the actual expenditures, where’s the money going? To Obamacrat Community Organizers in the attempt to establish a tax payer funded Chicago style corrupt political machine: “Community organizing” cronies gain massive power/money with Obamacare data hubs ( http://www.againstcronycapitalism.org/2013/07/community-organizing-cronies-gain-massive-powermoney-with-obamacare-data-hubs/ ). Or not covered power given to the IRSS: A lurid but vague class action accuses corrupt and abusive IRS agents of stealing 10 million people’s medical records without a warrant – including “intimate medical records of every state judge in California, every state court employee in California, leading and politically controversial members of the Screen Actors Guild and the Directors Guild, and prominent citizens in the world of entertainment, business and government, from all walks of life.”
    To top it off, the IRS agents were rude, childish and arrogant, the complaint states: “Adding insult to injury, after unlawfully seizing the records and searching their intimate parts, defendants decided to use John Doe Company’s media system to watch basketball, ordering pizza and Coca-Cola, to take in part of the NCAA tournament, illustrating their complete disregard of the court’s order and the Plaintiffs’ Fourth Amendment rights.” ( http://www.modernhealthcare.com/article/20140109/NEWS/301099956 // http://www.courthousenews.com/2013/03/14/55707.htm ) This is what American Citizens are going to have to get used to under Obamacratic Executive Rule!

    Obamacare Will Usher In A Two-Tiered Health Care System, as much for the D.C. Nobility and IV League Elites who enjoy such good report with them, and NPR. ( http://www.forbes.com/sites/jeffreydorfman/2013/12/12/obamacare-will-usher-in-a-two-tiered-health-care-system/ )

    The law itself has nothing to do with Health Insurance or Medical Care, especially since, “Some will live, and some will die” but sheer unmitigated party power over a large section of the U.S. economy and individuals. This undemocratic elitist law, that’s continually changed on Obama’s regulatory whim, does not need more changing, but complete elimination.

  • jonathanpulliam

    This charlatan is nothing less than a despicable criminal.

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