― C.S. Lewis
Yes, classic American culture tends to take rights violations very seriously, to the point that it may baffle those used to living under tyranny. Yes, many of us have a problem with the government commandeering the healthcare of 100% of the population just to "help" 3% of the population. Would have been cheaper, and far less disruptive, to just buy that 3% health insurance outright.
Obamacare has problems, but being targeted to just 3% of the population is not none of them. Are you completely free from anything that an insurance company might call a pre-existing condition? Do you plan to never be unemployed? Of so then congratulations, you might not personally benefit from healthcare reform of this type. Most Americans are not in that boat. Certainly more than 3%.
If you're an open-source participant, you may have experienced the power of what I've heard called adhocracy or do-ocracy. In it, we're all equal individuals; power is used situationally, in a bottom-up fashion, by those who are currently accomplishing something for the common good. In those contexts, top-down exercise of power feels very interfering.
The US's history includes a strong dose of that, plus a strong sense of individual liberty. Our country was born in rebellion to some far-away people who wanted to boss us around. Almost everybody here is descended from somebody who said, "Fuck this country; I'm outta here," and moved to America. One of our central civic documents, the Bill of Rights, basically lists all the things the federal government can't do. A giant chunk of our national mythos is bound up in westward expansion, where in a thinly populated frontier, the cowboy-hero did what he wanted and bowed to no man. Never mind that the era was short and the story more complicated; it's the idea that lives on.
Most of us who live in cities have long ago accepted the need for modest civic organization and collective action. We live too close to one another to be able to pretend that every man is an island. But even here, we tend to jealously guard our independence. Much more so in the suburbs and in rural America, where interdependence is harder to see.
Given all that, a demand that you buy health insurance can easily seem like (or be made to seem like) a crazy imposition from a far-off bureaucracy. Most other tax in the US is based on income, assets, or expenditures; if you aren't making/owning/spending anything, you don't have to pay. To some this feels like being dragged into participation in a society that they never particularly wanted to be part of.
All of that is intensified by several factors. A big one is the Republican party's strong shift rightward [1]. There is also a large segment on the right that has decided that the black guy with the funny name is not an American [2], making anything he does seem more like an imposition. Plus, there's a long tradition [3] of painting this as "us" (that is, white people) paying for "them" (black and brown people), even though the federal government actually shifts a lot of money from liberal states to conservative ones [4]. There are also strong streaks of anti-intellectualism and fundamentalist religion that play into this.
All that said, I agree it's kinda crazy when you take the bigger picture into account. America's health care system is a mess, costing way more than anybody else's, and leaving millions with little or no service. Something has to be done. This solution was actually a conservative one [5], and it's not like the American right has proposed anything better. It's not the solution I would have picked on my own, but given current American politics, I think it was the most achievable option.
Ok. That's more than you every wanted to know about America. Thanks for making it this far.
[1] http://voteview.com/images/polar_house_means.png [2] e.g., http://www.ocregister.com/totalbuzz/obama-469434-http-href.h... [3] http://en.wikipedia.org/wiki/Southern_strategy [4] http://www.economist.com/blogs/dailychart/2011/08/americas-f... [5] http://en.wikipedia.org/wiki/Patient_Protection_and_Affordab...
Thing is, the law has its issues, but the other side never gets near them, they just make shit up "death panels" and government interference and stuff. I, as an American, am super embarrassed by all this. It doesn't help that the health care companies wrote the fucking law, anyway... now they're fighting against it!
The sad truth is, unless we have a single-payer, socialized medical system, none of these changes will help much. Really, the biggest change the new law enacts is that it forces health care companies to cover people with pre-existing conditions like Diabetes and heart disease. Right now, they can tell you to go away, they won't cover that stuff. IN 2014, I hear they'll be forced to at least offer you a psychotically expensive plan if you have diabetes.... Ah, this country sucks ass.
"" Q: Will there be a limit as to how high a premium insurance companies can charge if you have a pre-existing condition?
A: Yes. As of 2014, insurers cannot charge consumers different rates for health insurance because of health status or gender.
You can be charged more for your age, however, with older people paying a higher premium than young people. But that increased charge is capped at no more than three times the standard rate"[1]
Edit: Actually "The law allows for differences of premiums based only on four criteria: age, location, family size, and smoking."[2], which seems like a good way to do racial profiling and increasing premiums on poor people(since they're probably less healthy), as expected in the u.s, but at least pre existing conditions couldn't be a basis for a rate difference.
I wonder thought how legal would be doing data mining with this information (an other free datatbases) , and how much deanonimization could be practically achieved ?
[1]http://www.webmd.com/health-insurance/health-reform-insuranc...
[2]http://ahip.org/Issues/January-1-2014-Provisions.aspx [1]http://www.webmd.com/health-insurance/health-reform-insuranc...
I believe we could fix health care costs by removing just one law.
Stop making health insurance a tax deductible employee benefit.
Think critically about the effect that small change would have and you'll see why our system is broken.
The ACA does remove that tax exemption, albeit partially. Every dollar above $10k or so ends up being taxed now. And not a small amount, either: the tax is to the tune of 40%. And since the cost of healthcare will continue to rise faster than inflation for the foreseeable future, more and more employer health plans are going to be hitting that number.
I'd certainly prefer the tax exclusion to disappear entirely, but the ACA is nothing if not an attempt to offer coverage to the poor and people with pre-existing conditions while doing the minimum possible to disrupt the healthcare market. That's why it's a bit of a Frankenstein: no one in their ideal world would have chosen the ACA as their ideal policy. But given the set of institutional actors and the setup of our government, it may well be the best that was possible. That's how the Obama administration thought of it, at least.
IIRC that tax was actually a pretty nasty fight between the Obama administration and labor unions, who get their members relatively good benefits and will be hit disproportionately by it. And you know what? The tax-free cap may well have been significantly lower with Republican input. But they chose to put 100% of their efforts into making a mediocre law fail than trying to turn it into a good or great one.
Apologies for the angry rant.
Employer premium contributions for employees and their opposite-sex spouses and tax dependents are 100% deductible as business expenses under federal and state tax law. This is true regardless of business type-sole proprietorship, partnership, LLC, corporation, etc. These rules also apply to owners of C corporations and LLCs classified as corporations for tax purposes. These business owners are considered to be employees of the business for purposes of the tax treatment of premium contributions.
http://healthcoverageguide.org/reference-guide/laws-and-righ...
http://www.healthaffairs.org/healthpolicybriefs/brief.php?br...
A 40 percent excise tax will be assessed, beginning in 2018, on the cost of coverage for health plans that exceed a certain annual limit ($10,200 for individual coverage and $27,500 for self and spouse or family coverage). Health insurance issuers and sponsors of self-funded group health plans must pay the tax of 40 percent of any dollar amount beyond the caps that is considered "excess" health spending.
So, you cherry picked a bunch of stuff here.
1) Neglected to state it starts 4 years from now...a lot can happen in that time.
2) Neglected to state 10K limit is for individuals, 27K for families.
3) Confused excise tax and tax exemption.
I don't think anything here refutes my point or makes what I said incorrect.
I point out that the ACA did do that. Not enough to yours or my liking, but it did nonetheless.
Your response is to complain that it didn't go far enough. Sure. But the least you can do is recognize that the ACA certainly does do something in the spirit of what you were claiming no one had attempted. That doesn't mean you have to like the law as a whole.
If your employer pays for your car insurance as a benefit, they pay for it with post tax dollars, so they don't do that.
So, employers pay the premium on your health care for the tax advantage. Now consider the how psychology behind not being the one who pays for the premium.
Do you care how much your services cost? No.
Do you care if the premium goes up? No.
Do you shop around for better insurance? No.
Do you care if you loose your job if you're sick? Hell yes.
In effect all normal market pressures are gone. No one who consumes resources cares about their costs because they're are completely disconnected from paying them or some derivative of them.
This is why doctors don't post prices.
While the net effect for people with employer provided health insurance is ever increasing rates, the effect on those people without health insurance is brutal. They are trying to enter a market that has no price pressure.
Then you poke fun at "American idiots", and then admit in your last sentence that you don't really even know how the law works yourself.
Bonus points for picking the two conditions, heart disease and diabetes, that mostly result from poor choices instead of random innocent victims.
Your whole post is like a parody of pseudo-intellectual liberalism.
In the meanwhile, I am perfectly healthy and will look both ways before crossing streets.
[citation needed]
They should have just gone with full-on socialized health care like the rest of the civilized world... Would have been better for every party involved (except perhaps the insurance companies).
Yes, we're not "like the rest of the civilized world": this country was founded on valuing individual rights above the whims of the majority.
This is why we fail so badly as a country.
Your right to previously underpay for health insurance had ended. Externalized costs are now being internalized. That's how insurance works; to spread risk across everyone. Now, if you're unhappy with that, I suggest either leaving the country or simply not paying for insurance and paying the IRS-imposed fine. You can then self-insure and absorb any of your healthcare costs yourself.
ETA: just because I'm opposed to one program doesn't mean I favor others. I'm just as opposed to "NSA, TSA, wars on terrorism and drugs and a thousand other programs" as I am to Obamacare. I'm not sure how you conclude that by opposing wasteful oppression in one area somehow means I'd be more tolerant of wasteful oppression in other areas.
If you're opposed to wasteful spending by NSA, TSA, wars on terrorism and drugs and a thousand other programs and Obamacare, where do you propose spending all those trillions?
I feel obliged to point out that America is already severely behind the rest of the developed world in those things.
I've always thought of ObamaCare as the first step in the right direction. Hopefully many more steps follow shortly.
That part is still very much open for debate.
America you so crazy.