'Obamacare' - Can someone explain the mandate?

[Resonance]

So I've been watching Americans argue about Obama's healthcare policy for ages, and my understanding was Obama essentially passed a mandate requiring people to buy health insurance or face a fine (or 'tax', if you want to be consitutionally correct).

I have been quite puzzled as to how this was supposed to help anybody, so I decided to turn to the font of knowledge that is wikipedia in search of further information. If wikipedia is accurate, then it seems the healthcare package is actually a mixed bag, but if the mandate is put aside it is largely a decent enough bill:

The good:

• Guaranteed issue and partial community rating will require insurers to offer the same premium to all applicants of the same age and geographical location without regard to gender or most pre-existing conditions (excluding tobacco use).[12][13][14]

Low income individuals and families above 100% and up to 400% of the federal poverty level will receive federal subsidies[19] on a sliding scale if they choose to purchase insurance via an exchange (those at 150% of the poverty level would be subsidized such that their premium cost would be of 2% of income, or $50 per month for a family of four)

Firms employing 50 or more people but not offering health insurance will also pay a shared responsibility requirement if the government has had to subsidize an employee's health care

Co-payments, co-insurance, and deductibles are to be eliminated for select health care insurance benefits considered to be part of an "essential benefits package"[29] for Level A or Level B preventive care.

Minimum standards for health insurance policies are to be established and annual and lifetime coverage caps will be banned

The bad:

The text of the law expands Medicaid eligibility to include all individuals and families with incomes up to 133% of the poverty level, and simplifies the CHIP enrollment process. In National Federation of Independent Business v. Sebelius, the Supreme Court effectively allowed states to opt out of the Medicaid expansion, and some states have stated their intention to do so. In states that choose to reject the Medicaid expansion, individuals and families at or below 133% of the poverty line, but above their state's existing Medicaid threshold, will not be eligible for coverage; additionally, subsidies are not available to those below 100% of the poverty line. As many states have eligibility thresholds significantly below 133% of the poverty line, and many do not provide any coverage for childless adults, this may create a coverage gap in those states

The awful:

A shared responsibility requirement, commonly called an individual mandate,[15][16] requires that all individuals not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs, purchase and comply with an approved private insurance policy or pay a penalty, unless the applicable individual is a member of a recognized religious sect exempted by the Internal Revenue Service, or waived in cases of financial hardship

This last part is the problem and I don't understand how it benefits patients. It is made even worse by the exemption provided to religious groups - insuranced is forced on you unless you are religious in which case you don't have to have it if you don't want it?

I presume I am missing something obvious, but what actual purpose does the insurance mandate serve? My understanding is that the state is not actually offering any kind of public safetynet for the uninsured beyond medicare expansion, which I presume is allocated on income rather than insured status. So this tax on the uninsured doesn't seem to be to pay for state subsidies for insured people unexpectedly needing treatment, as it would seem those people simply don't get treatment. So what gives?

[Classified]

There are religious people who don't want any modern medical care, so that part is ok. Things would be 90% less of a problem if there would be an exemption for people like PickleNose to choose not to be part of the modern medical system, except for public health issues.

The big loser in this mandate thing and why you see so much anger towards it is because it makes the businesses who weren't paying for their employees health insurance, now start having to pay something. That is a lot of them.

The big issue is that it has to be paid for. And when you try to cover the millions of people without insurance who couldn't get it because they will cost more than the premiums they will pay in will be, it is a math problem.

It might not be perfect, but it is a start and much better than what it was.

[PickleNose]

Originally Posted by Resonance

This last part is the problem and I don't understand how it benefits patients. It is made even worse by the exemption provided to religious groups - insuranced is forced on you unless you are religious in which case you don't have to have it if you don't want it?

I presume I am missing something obvious, but what actual purpose does the insurance mandate serve? My understanding is that the state is not actually offering any kind of public safetynet for the uninsured beyond medicare expansion, which I presume is allocated on income rather than insured status. So this tax on the uninsured doesn't seem to be to pay for state subsidies for insured people unexpectedly needing treatment, as it would seem those people simply don't get treatment. So what gives?

You don't understand it because you trust a bunch of born liars when they tell you the purpose of this bill is to help people.

The purpose of the individual mandate as I see it is very simple. The precedent. It was as simple as the need to forge a template. Now that they have one that survived the best legal challenge that could be thrown at it, they can use the same template over and over for just about anything they please.

The authors of this bill are scum. Lawyers are largely scumbags. Insurance companies are scum. The guy who was the deciding vote on the SCOTUS was a GWB appointee (surprise!). Obvious scum.

I don't understand why you believe anything any of these people have said in defense of this bill. They are all human garbage and not a one of them is worthy of being trusted with the key to a janitor's closet. Yet we have handed them the authority to force us to do just about anything. No, wait. We haven't handed it to them. They have simply taken it.

[scarpia]

Originally Posted by Resonance

The awful:



This last part is the problem and I don't understand how it benefits patients. It is made even worse by the exemption provided to religious groups - insuranced is forced on you unless you are religious in which case you don't have to have it if you don't want it?

I presume I am missing something obvious, but what actual purpose does the insurance mandate serve? My understanding is that the state is not actually offering any kind of public safetynet for the uninsured beyond medicare expansion, which I presume is allocated on income rather than insured status. So this tax on the uninsured doesn't seem to be to pay for state subsidies for insured people unexpectedly needing treatment, as it would seem those people simply don't get treatment. So what gives?

The mandate gets enough money into the system so it doesn't collapse. There are many free riders in the US heathcare system. Single payer funded by taxes would work, but people here would never go for it. They don't want higher taxes and bigger government.

It's the way the Swiss system works.
http://latimesblogs.latimes.com/worl...tle-furor.html

[SomebodyWakeME]

If i end up having to pay a $700 dollar healthcare tax and my doctor still won't prescribe me any benzos or opiates. I swear i'm gonna flip the f*ck out on somebody.

[Resonance]

Originally Posted by scarpia

The mandate gets enough money into the system so it doesn't collapse. There are many free riders in the US heathcare system. Single payer funded by taxes would work, but people here would never go for it. They don't want higher taxes and bigger government.

It's the way the Swiss system works.
http://latimesblogs.latimes.com/worl...tle-furor.html

Thanks.

[scarpia]

So do people over there in Britain like the way their single payer system works? I have heard from people on other support group sites that it can be a really long wait for services sometimes.

[Resonance]

Originally Posted by scarpia

So do people over there in Britain like the way their single payer system works? I have heard from people on other support group sites that it can be a really long wait for services sometimes.

The waiting lists are certainly long by US standards, though until the present right wing government came in there were absolute maximum waiting times imposed. However these waiting times are all I have known so I don't really think they are too bad (albeit if I ever break my hip, I will probably change my opinion since the waiting lists for replacements are terrible).

However generally the service is excellent and everybody seems to like it. Certainly the politicians are having to be indirect about tearing down the NHS, none dare openly campaign on a platform of abolishing it. I get my SSRI's at £7 for 60 pills, I pay £10 for new glasses if my prescription changes, hospital admissions and doctors appointments are free. I hear on the other side of the atlantic an MMRI can set you back $2,000 - I had one free. So certainly I'm very happy with our tax funded/subsidised system.

Definitely there are problems with it though, concerning the massive budget and overwhelming demand on what is effectively a single provider, which is why certain treatments have to be excluded from NHS coverage - e.g. if a drug that costs £3,000 to prescribe a terminally ill patient will extend their life by a week, it likely won't get covered. However what you have to remember is that we do have private healthcare here. My grandfather had a hip replacement on private healthcare because the NHS waiting lists were so long. So we essentially have all the benefits of the private system available, its just that most people choose not to avail themselves of it, which alone is testament to public feeling about state funded care.

[scarpia]

I bet private healthcare is super expensive. I still remember an old Benny Hill sketch where he showed two guys getting healthcare - one private insured and one public insured. The guy with private insurance got great care and the guy with public insurance got terrible care. Then at the end the guy with the public insurance drives away in a limo while the guy with private insurance drives off in a ratty old bicycle. lol.

[MachineSupremacist]

Anything that annoys PickleNose is unquestionably good.

[Classified]

If you saw the opening ceremony of the Olympics, the NHS was celebrated. There is no way that any American would suggest celebrating what we had. Even after 2014, it will only be a partial improvement.



The NHS could use some improvements too, but it is closer to the ideal solution.

[Keith]

The mandate in some form has already existed in Massachusetts, the state i live in for 6 years. Under Romneycare your state income tax return is penalized if you choose not to have insurance. Romney was our state's governor and championed this whole idea back in 2004, it was enacted in 2006. The idea was to stop the uninsured people from using the emergency room as their regular Dr, and the hope was this was going to cut costs as the emergency room is extremely costly. I'm not sure how that has fared, but i know that I was initially miffed at the thought of having to be pay for insurance or be penalized, being a poor working class healthy young 20 something. However the insurance did prove to be beneficial, and i used it to get help for my depression and anxiety. Without it I would have been screwed.

[VagueResemblance]

The individual mandate has precedent dating back to the first Congress. The very first one, part of a government that included George Washington and all those other filthy socialists. See Militia Acts of 1792 and An Act for the Relief of Sick and Disabled Seamen, 1798.

[jonny neurotic]

So far as I can see it is an attempt to botch up a bad system. The idea of paying for life saving treatment at a hospital is preposterous to someone who has been born into a country with an NHS. Call that socialism if you like but if that is the definition of socialism then I am a socialist...

[BeNice]

I still don't know how it affects me. I don't make enough to purchase health insurance, and I technically would qualify for charity care, so am I part of a demographic that is unaffected? The charity care system is kind of flawed. Do I have to choose between paying a fine and going out to find some kind of health insurance? How much is the cheapest, most basic health insurance, anyway? I always figured unaffordable for me, but I wouldn't even know where to start.

[Resonance]

Originally Posted by BeNice

I still don't know how it affects me. I don't make enough to purchase health insurance, and I technically would qualify for charity care, so am I part of a demographic that is unaffected? The charity care system is kind of flawed. Do I have to choose between paying a fine and going out to find some kind of health insurance? How much is the cheapest, most basic health insurance, anyway? I always figured unaffordable for me, but I wouldn't even know where to start.

Wikipedia tells me there are waivers in cases of 'financial hardship', so I'm guessing if you qualify for charity care you are probably unaffected.

[Brad5]

I don't know anything about Obamacare, but I do know it's socialism and a government takeover. Before we know it Obamer is going to be forcing us to buy broccoli.

[PickleNose]

Originally Posted by jonny neurotic

So far as I can see it is an attempt to botch up a bad system. The idea of paying for life saving treatment at a hospital is preposterous to someone who has been born into a country with an NHS. Call that socialism if you like but if that is the definition of socialism then I am a socialist...

A nice metaphor for a socialist government is a pedophile with candy.

[Resonance]

Originally Posted by PickleNose

You don't understand it because you trust a bunch of born liars when they tell you the purpose of this bill is to help people.

I should say I don't believe that Obama has much if any desire to 'help' anyone other than himself. The bill does set a worrying precedent and that could be the first step on the road to corporatism - patronise these companies or face legal action.

However I don't think this was somehow 'the plan all along'. I suspect Obama delivered promises of fixing the US healthcare problem with a public option knowing full well it was likely he would be blocked in congress. I suspect he hoped that this would make him appear some kind of white knight figure struggling against evil republicans when really he is probably glad he doesn't have to provide a public healthcare fund as such. And I am certain that the only reason Obama pitched his healthcare solution in the first place was to win votes, and the only reason this perverse mandate bill exists is because he had to deliver some sort of policy after all his promises, if he wanted a second term.

I think we have to understand modern politics as being all about power. Politicians want power. In order to get it, they occasionally have to deliver things to us the people. The best one can hope for is to support the candidate who will give you the best deal in their personal quest for advancement.

[copper]

Originally Posted by scarpia

I bet private healthcare is super expensive. I still remember an old Benny Hill sketch where he showed two guys getting healthcare - one private insured and one public insured. The guy with private insurance got great care and the guy with public insurance got terrible care. Then at the end the guy with the public insurance drives away in a limo while the guy with private insurance drives off in a ratty old bicycle. lol.

I get medical, script, optical, and vision at work. It cost the agency I work for $474 per month. But this is cheaper then just getting a policy on my own due to it is a group policy which they give a discount. Starting in October I will have to pay 20% of the premium thanks to Governor Snyder thinking that human services workers are part of the 1%.