I've heard that complaint over and over, yet I've never in my life actually heard someone called a racist for opposing the Patient Protection and Affordable Care Act (PPACA), nor have I ever seen such an accusation in print. Let's see if you can come up with even one actual quotation, kempo, one single citation as evidence of someone being called a racist just because he doesn't like this law. Really, the endless self-pity of you people over imaginary slights astonishes me.kempo wrote:This is how the left portrays the average American, "RACISTS". If you don't like Obama Care you are a racist. Just saying the phrase "Obama Care" you are considered a racist by some.
You make two substantive observations. The first is that the PPACA is "taking" $500 billion out of Medicare and giving it to Medicaid. That has been a frequent talking point in the recent Republican presidential debates, but of course it isn't true. The PPACA does try to control the increase in Medicare spending over the next ten years. The $500 billion figure comes from the reduction in the amount planned over ten years compared to what would happen if we did nothing. I don't know anyone, anywhere who is against trying to control rising Medicare costs. The normal complaint is that the PPACA doesn't do enough. "Stealing from Medicare" is just something opponents trot out misleadingly when they want to demonize the act. Under the PPACA, the cost of Medicare will "only" go from $499 billion per year in 2009 to $929 billion per year in 2020. If the act can save an average of $50 billion a year, that would be great. There is an excellent, dispassionate explanation of how the PPACA aims to accomplish this at http://www.kaiseredu.org/Tutorials-and- ... icare.aspx. A large part is controlling the increase in the rate of provider payments. Part of the savings is from curtailing what are called disproportionate share hospital (DSH) payments, some of which come out of the Medicare budget. These go to hospitals that treat a disproportionate number of uninsured patients. Those payments will be greatly reduced starting in 2014, which makes sense, since the number of uninsured patients should decline. Finally, much of the savings comes from reducing the subsidy to Medicare Advantage members. This is a program that replaces traditional Medicare by instead paying an insurance premium to a private carrier. That's all well and good, except we are now paying much more for the Medicare Advantage members than for other beneficiaries. If private insurance is more efficient, good, but why should we pay extra. The PPACA cuts back on the subsidy. The main point, though, is that the PPACA isn't taking money out of one program and putting it in another. It is simply trying to control the rate of increase in Medicare costs, which everyone agrees is necessary.
Your second point is that all our health insurance problems would be solved if only Congress would pass legislation to force the states to allow consumers to purchase insurance across state lines. I don't know where to begin. The states regulate health insurance, as they should, but that doesn't mean big companies don't offer health insurance in every state of the United States. The industry is dominated by a few large, publicly traded corporations like Unitedhealth Group, Wellpoint, Kaiser, and Aetna. The fact that they follow state standards and often operate through state subsidiaries doesn't mean we don't have a national market for health insurance. Those companies are everywhere. In addition, large employers avoid state regulation altogether by self-insuring part of their cost and buying stop-loss insurance on the national market. There is a thriving association market as well. This only works for large organizations, however. Small businesses and individuals can't use a far-away health insurer the way they can a life insurer, for example, because with health insurance you are buying much more than a fixed payment in case of a loss. Among the biggest benefits of health insurance is what I think of as the Sam's Club effect. Health insurance is almost all based now on negotiating a discount with providers in exchange for volume, and only a company with many local insureds is in a position to negotiate a decent discount. For example, I'm looking at my most recent hospital bill right now. The face amount is $21,13.65, but the discount is $13,650.41, so the insurance company and I only have to pay about one third of the official rate. I get that benefit because the Blue Cross company here in Illinois has market power because of its huge customer base. If I wanted to buy from Joe's Insurance Company of Tacoma, Washington, it couldn't get the good deal and couldn't offer me a decent premium. The idea that interstate purchase would cure the market's ills is an illusion. In any location, there will never be more than a limited number of carriers with enough members to squeeze the healthcare providers effectively.
