Mounting Evidence of Obamacare's Unintended Consequences

This episode of The Motley Fool's Market Checkup drills down on the hottest headlines and biggest market movers in the health-care sector.

In this video, health-care analysts David Williamson and Max Macaluso discuss one of the potential unintended consequences of Obamacare: the changing dynamics behind employer-sponsored health-care coverage.

Trader Joe's, the popular privately held supermarket, previously applauded for offering coverage to their part-time employees, is reversing course and, instead of coverage, employees will receive a $500 check. Trader Joe's argues that the employees will likely be able to find a similar plan at a similar cost on the Affordable Care Act's freshly minted state-based insurance exchanges. 
 
Of course, the cost is similar if you add in the government subsidies that those low-income employees are likely eligible to receive. As Trader Joe's was followed by Home Depot, this could be the start of a potentially unintended consequence of Obamacare: shifting the cost of providing health care from employers, to the government.
 
However, there is a broader trend at work, and that is a chance for businesses to shift from a defined benefit to a defined-contribution model for health care. Walgreen's is one of several companies, including Time Warner, that are either putting current employees, or retirees, on private exchanges. They will continue to subsidize coverage, but the private exchanges provide a way to control health-care costs.

Investors should watch any retailers or companies with large retiree benefits that can be changed. Health-cost inflation has been a big headwind, not just to government spending, but also to business spending. If management can unload at least part of that expense without too much pushback, it will.

Obamacare and you
Still in the dark about how Obamacare might affect you and your portfolio? Don't worry -- you're not alone. To help prepare investors for the massive changes coming to the American health care system, The Motley Fool created a special free report that makes this complex topic easily understandable. Download "Everything You Need to Know About Obamacare," and discover how the law may impact your taxes, health insurance, and investments. Click here for your free copy today.

Follow David on Twitter: @MotleyDavid.



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  • Report this Comment On September 28, 2013, at 9:25 AM, Spanview wrote:

    Obama said years ago when campaigning, to a union group, that he believed we should have universal health care..but that we would have to start small.

    We, on the right, said from the beginning that this was the camel's nose under the tent, and would lead to universal health care. The entire intent of this leftist dream is to destroy private insurance and private health care,..in other words, destroy our health care.

    It has begun. Suckers who voted for it are shocked at what is happening to their choices, the rest of us who are being brought down by the voters' stupidity are just mad.

    I work in geriatrics, which has been cut and cut and cut through Medicare, and have many patients who are really angry "But President Obama promised it would be better!!" as they learn of their doctor leaving their care or their equipment no longer being cared for, or can't find a therapist willing to take them any more because of the severe cuts in reimbursements. They are confused, and angry, ..but of course voted for this.

  • Report this Comment On September 28, 2013, at 9:26 AM, Spanview wrote:

    Not "Unintended" at all.

  • Report this Comment On September 28, 2013, at 9:59 AM, slb0 wrote:

    The problem is, these consequences weren't unintended. Obamacare was designed to do exactly what it is doing, causing companies to move people from them to the government. Obamacare is a business and businesses need customers. When you're the government, you make the rules, you drive out competition and you get more people coming to you. The problem with this is, the government doesn't pay for it. We all do.

  • Report this Comment On September 28, 2013, at 10:00 AM, jimmymae wrote:

    "Obamacare's Unintended Consequences," from unconsciuos leadership.

  • Report this Comment On September 28, 2013, at 10:04 AM, deralynch wrote:

    People should read the writing on the wall. Big business wants out of the healthcare business. Since prices have been rising dramatically in the past decade, they want to get rid of it, but didn't have an out until now. We need that single payer system. These companies were paying for freeloaders who didn't or couldn't pay for insurance. Even with insurance, you could easily find yourself destitute if you had a major illness. I knew exactly what I was voting for and I'd do it again in a heartbeat. I don't want my job and my insurance linked together.

  • Report this Comment On September 28, 2013, at 10:05 AM, drixnot wrote:

    Shifting the costs of insurance from the employer to the government ISN'T a bad thing. People change jobs all the time... and who likes the idea of changing your doctor when it happens. Then there are the cases where an older person would like to retire... but they can't because they need to keep the insurance for their younger spouse. Even in cases where that older person SHOULD retire for their own health.

    And lets face it... many times the older person is pushed out of their jobs ... and then what? COBRA? Yeah that's a joke.

  • Report this Comment On September 28, 2013, at 10:08 AM, been40 wrote:

    Motley Fool is a fool on this on if they think these consequences are unintended. The whole purpose of universal health care is to take it out of the hands of the public and place it in the hands of the government and is just another means of control.

    Those of us who claimed this in the beginning were ridiculed and called sensationalists. I would like to say we have the last laugh, but it is no laughing matter when your liberties are constantly being infringed by socialists and their ignorant drones.

    They have already taken over the schools. Eliminating gun ownership is next.

  • Report this Comment On September 28, 2013, at 10:12 AM, NoMoeMoney wrote:

    Yes, this is just what the Obamadoctor ordered? Healthcare will drastically change in America and some might find a benefit but I suspect the majority are going to lose, either through large premiums and co-pays or a lack of quality and available service. The dream of a single payer system is Obamas goal but the destruction of healthcare is a high price to pay to get there and the government will be broke long before that happens. We are on a road to ruin.

  • Report this Comment On September 28, 2013, at 10:12 AM, Rusty56 wrote:

    No it is unintended, however, this is and will be effecting tens of thousands of Americans adversely. As most of us know by now, since the mandate requires employers to offer coverage to employees working at least 30 hrs. per week, many employers are reducing the number of hours so they don't have to provide this benefit. You CAN'T blame employers for doing this as many were not providing to less than 40 hr. employees previously so why pick up all this added cost. So people are taking pay cuts who are already having a tough time. In addition, you will see many employers NOT provide spouses the opportunity to be on the employees plan as spouses are optional next year. This will force many more spouses who are not working or working for employers who don't offer coverage or who might be self employed to go to the exchanges and buy their coverage with AFTER tax dollars as you can;t run the premiums thru a section 125 plan. People are still blind to the fall out here but it is not good. The exchanges may look appealing price wise in many states but the coverage will NOT be as good as what they might have previously had and guess what the carriers who participate, many of them are providing much smaller networks of providers thru their exchange products so that will limit many in choosing docs and hospitals they might have previously utilized. The main reason for this law, just so you all know, is to reduce the unfunded liability of Medicare from roughly 90 trillion to 50 trillion. It also caps future Medicare liabilities. Access to healthcare was a distant second reason for this bill and ultimately you guess it, to get to a single payor system. Obama flat out lied to us about the overall intention and NO YOU can't necessary keep your own plan as this moron first told everyone. You who believed him are simply either very gullible or very STUPID?? By the way, the rates on the exchange products will go up dramatically in a couple of years, mark my words.

    Insurance / Medical Delivery Expert!

  • Report this Comment On September 28, 2013, at 10:12 AM, bc3b wrote:

    What can you expect when Congress passes a 2,400 page bill that no one has read and a moronic woman says, "We have to pass the bill to see what's in it." Imagine how the media would have crucified Sarah Palin had she said something half that stupid.

  • Report this Comment On September 28, 2013, at 10:22 AM, cityperson wrote:

    But, like Obama and Nancy and many others stated, "we will sign to see what is in it", words to that effect. So, the Obamacare tax it is unintended consequences? How fooled the uninformnd voters were at the time of thier re-elction of these clowns and now all will suffer in the US for the few.

  • Report this Comment On September 28, 2013, at 10:25 AM, sabebrush6 wrote:

    Lenin said the quickest way to control people is by controlling their medical. Obama is following Lenin teachings right to a tee.

  • Report this Comment On September 28, 2013, at 10:28 AM, CaribouPaku wrote:

    ACA may not be a perfect coverage but as we have see private insurance has not been either. Cost sprialling out of control. not covering pre-existing conditions, Children dropped after reaching certain ages and on and on. Universal care is the answer for many who would otherwise have not been able to afford it. If you are wealthy, I am sure, you can still have you cadillac health plan. So, with change comes some complications but it will be better than it has been for millions of people. It seems to work in the other countries so why cannot it work here?

  • Report this Comment On September 28, 2013, at 10:31 AM, crossle27 wrote:

    This is what happens when one party has the power to pass a 100% partisan bill, that NONE of them understood or cared to. THEY have better insurance and will not be effected by this tax fiasco at all, so the absolute absurdity of this unmanageable mess is not an issue for them.

    This is part of the master plan to move this nation as rapidly as possible into the Marxist utopia that these radical un-American idiots are working so hard to achieve. Total control by the government, with no guns or dissent allowed.

    A few more years of these liberal twits playing their games will end this Republic for good, and obamee and his muslim masters will have accomplished their goal, without firing a shot.

  • Report this Comment On September 28, 2013, at 10:35 AM, Goldenboys wrote:

    Everywhere you look there are far reaching an potentially grave consequences of the ACA. From young people's arms being twisted to buy high deductible health plans where they'll have to spend thousands of dollars before they get a penny's worth of coverage, to to employers dumping family coverage to the shift to DC health plans. As Congressional staff get special subsidies to cover their spiraling insurance costs, the Middle Class will not. And sadly, at the end of the day the CBO says there will still be 30 Million uninsured Americans when Obamacare is fully implemented. You couldn't make this up in your wildest dreams.

  • Report this Comment On September 28, 2013, at 10:36 AM, tighar42784 wrote:

    Obamacare is a train wreck waiting to happen. You cannot force anyone to purchase health insurance if they do not want to. The President thinks they can raise the debt ceiling, exclude congress from Obamacare, pay for all the thing the President wants, A government takeover of our healthcare system is a disaster. It is for big business by big business. If it applies to the American people, it should apply to Obama himself and all members of the Senate and house as well.

  • Report this Comment On September 28, 2013, at 10:36 AM, ykaplinsky wrote:

    Trader Joes and others with similar plans are in for a nasty surprise. It is ILLEGAL to give employees money to buy on the exchanges in lieu of providing them company insurance.

  • Report this Comment On September 28, 2013, at 10:40 AM, QuantumLeap10 wrote:

    Obama has and has had ONE objective: to crumble the United States into little pieces, and too many people are blind to his goal. He divides the people, by race, by religion, by class, and then he shreds the Constitution and Freedom of Speech, Right to Bear Arms, then he tells them what they can eat. This man has an agenda that comes straight from the Devil. This so-called health care is for his black community and Hispanics who are absolutely enthralled with his blackness and totally unaware of his diabolical ambitions. He is a dictator, a socialist, a radical Muslim and --- he needs to be stopped ---its time to wake up, America, before Obama and his radical progressives destroy us all.

  • Report this Comment On September 28, 2013, at 10:47 AM, rotorheadv8 wrote:

    In a couple of years when Obamacare has totally destroyed the private health insurance industry, when the number of doctors is a third less than today, when the cost is 5x what was promised: Nancy Pelosi will say "What difference does it make now? This is the law, Deal with it."

  • Report this Comment On September 28, 2013, at 10:50 AM, one618tone wrote:

    Has anyone actually read the HomeDepot and Trader Joe article?

    Has anyone actually gone to the website and checked it out? Used the calculator? Review the

    PLANS?

    Most family's of 4 with income of $100,000. or less will qualify for a tax credit.

    As an individual Health plan you can cover a sick child or spouse with a comprehensive plan and cover the other family members under a basic plan. You can't separate plans under your employer coverage. This is Group Health Insurance at it's best!

    Pre-existing conditions will be covered. The is also a PLAN for people who never get sick and don't want health care insurance or are unable to afford the insurance.

    The law requires all healthcare companies to offer

    10 mandatory benefits including mental health coverage (God knows we need that with all of the mental health SHOOTERS on the rise) as well as

    physical therapy and newborn baby coverage at BIRTH.

    I am a licensed Insurance Producer with 25 years of experience. I am a Baby Boomer Tweenie (over 50 and under 65) and I was laid off in 2011. Cobra premiums are outrageous!!!

    On market coverage for me without a subsidy is $7,041. a year. With cost sharing benefits and tax credit (applied at the time of purchase) my annual premium is $1,021.00 a year with a maximum out of pocket payment (deductibles) of $2,250.00.

    This is a premium and plan that I can live with on a PT income of $20,000.00. (I haven't been able to secure a permanent full-time job. yes I have a degree).

    May I suggest that you checkout the program for yourself before you make an uninformed decision. Most State Governments have changed the name of the Federal program.... In Kentucky they have been using ObamaCare for 2 years under a different name and they love it!!! Ask the Paul Clan!

  • Report this Comment On September 28, 2013, at 10:56 AM, mso88 wrote:

    This is no time I-told-you-so gloating because the catastrophic consequences demand every American's focused attention on overturning Obamacare.

  • Report this Comment On September 28, 2013, at 11:00 AM, gsman36 wrote:

    I see that most of the problems with health care is the continued rising cost of charges medical institutions and Drugs. If the doctors and pill manufactures would not rack us on charges then everyone would be able to afford them. It does not matte what plan you have costs go up higher than our pay and most can not afford to purchase it. Government needs to regulate the price of meds and then set a price on what doctors can charge for visits. lets get real no one is worth $175 per visit which lasts about 10-15 mins... have then charge like everything else set prices and then people can afford it.

  • Report this Comment On September 28, 2013, at 11:00 AM, faber100 wrote:

    Quantumleap10 appears to have chosen an approprite name. To quote Bill Murray in the movie Stripes "Relax Francis".

  • Report this Comment On September 28, 2013, at 11:01 AM, philthymcnasty wrote:

    this actually makes cobra pointless. We can now abolish cobra, and save millions.

  • Report this Comment On September 28, 2013, at 11:05 AM, WayneCarlos wrote:

    "this could be the start of a potentially unintended consequence of Obamacare: shifting the cost of providing health care from employers, to the government."

    There was nothing unintended about this.

    And to whoever said that Kentucky had Obamacare under a different name for years and they love it. You're uninformed at best. There nothing like Obamacare here.

  • Report this Comment On September 28, 2013, at 11:06 AM, cjseejay wrote:

    Reading this aricle one would be scared that the whole world is goin to change. It is abunch o lies. First of all, the law is not called Obama Care. The author referred to it as Obama Care because he knows that there is rift between some people and Obama. The Law is the Health Affordable Care Act... I don't see the name Obama written in the law. The author also mentioned that this will affect our pension plan in that employers will move from Defined Benefit Plan to Defined Contribution Plan as a result of the Law when in fact companies have been doing away with DBC for years and that hardley any company offered DBC plan anymore. Even if employers were following a DCP model for healthcare I don't see what is wrong with that concept since most people will have a chance to choose themselves. The ACA is good for a lot of people with no insurance today the more insured we have in this country the less exposed I think most of us will be to any outbreaks.

  • Report this Comment On September 28, 2013, at 11:09 AM, MsAbby wrote:

    Here's an intended consequence. I'm shutting my doors end of this year. Too many new regulations in the last 8 years, too many new taxes and too much government interference in my business.

    122 jobs lots. Meanwhile I will be living part time in another country until you people get your heads back on straight and stop this dictatorship and the march toward Communism.

  • Report this Comment On September 28, 2013, at 11:13 AM, TMFHurricane wrote:

    Nice explanation guys!

  • Report this Comment On September 28, 2013, at 11:13 AM, MsAbby wrote:

    Cjseejay - Why in h e l l did I go to school, work menial jobs to pay for college and then work more menial jobs to save money to start my business? So I can pay for a 'LOT OF PEOPLE WITH NO INSURANCE"?

    So that all the blood suckers in this country that had the same advantages that I did could live off me like leaches? No. I worked to have a secure and productive live for myself and my family.

    I work charities. Habitat is one and it helps people help themselves and get a leg up, unlike all the government programs that have ruined the family unit, caused people to drop out of school and the mentality that because they were born I somehow owe them.

    I DON'T and I'm shutting the doors to my business end of this year, 122 jobs lost. Have a nice day.

    BTW, I'm a Sioux and that's a hard road to climb from the reservation but I did it and so can all the other lazy people that believe we owe them.

  • Report this Comment On September 28, 2013, at 11:15 AM, devoish wrote:

    Obamacare only exists because what came before it was overpriced and underperforming.

    Best wishes,

    Steven

  • Report this Comment On September 28, 2013, at 11:15 AM, starfish36 wrote:

    Extremist chatter doesn't mean much, especially when the USA has the most expensive health system in the world and is still ranked only 38th in the world for quality health care delivery by the WHO. The system is fine for the wealthy but lousy for the poor and middle class -- and very expensive for all. Every country in Europe, Scandanavia, the U.K., Canada, and Japan have excellent social medicine systems that are better than ours according to the WHO and many people who have resided there. That's one reason that countries that have adopted universal health care do not abandon it. Yet instead of discussing these points, your readers want to tell us about what Lenin said, how Obama is a leftist and the unintended consequences of Obamacare. Why didn't you lead your article with the observation that, with likely government subsidies the employees at Trader Joe's would come out with out the same costs that they now have, and they would avoid previous existing condition exclusions, last minute cancellations, discrimination against women, expanded preventive health care and diagnostic procedures, moments, improvements? .

  • Report this Comment On September 28, 2013, at 11:16 AM, soundersfan wrote:

    It's been said accurately enough in the other comments that, no, this wasn't unintended. People have to stop believing that all politicians are so stupid/naïve, whatever that they didn't see these consequences because, yep, they did. This is quite definitely following the path to a universal health care. Let's talk about that for a quick second. One poster was gushing about universal health care - as though it was some 'perfect' solution. It most certainly is NOT. Oh sure, under that system, people will have access to healthcare and on the surface, that sounds great. However, ask yourself how much money that is going to cost? Take a look at the tax levels that people, for example, in Canada and England have to pay - specifically for universal healthcare. Did you people who tout it as the best way of life think it would be free? No one seems to think about that. Your taxes will go up, up up in order for the govt to pay for covering everyone. In addition, and no, it is not just a fabrication, your benefits will be drastically different than what we are used to. Take for example, the case of preventative care. That's great on the surface but....how look at what Medicare considers 'preventative care'. A simple 'wellness' checkup - NOT what most doctors would call a yearly checkup. This is the way that our medical care will go - to the stripped down basics and I mean STRIPPED down. A simple blood pressure check and a 'chat' with your doctor is not what is considered 'preventative care'. There will still be insurance companies and employers who want to retain employees will continue to offer supplementary plans. This will allow certain groups (this practice is already in existence in Canada) to have 'more' care and the complaining will start that 'I'm only getting substandard care on my universal healthcare', blah, blah, blah. I'm sorry if you don't have healthcare insurance because you choose not to work, or you have minimal skills that aren't what employers want (the kind of employers who offer insurance). Then DO something about it and better yourself. Get some training, get an education do whatever to find a better job but don't complain to the rest of us who DO work and make a good living that we should be forced to pay for not only ourselves but for you as well. I have absolutely NO objection to the idea of some sort of a marketplace whereby small businesses can utilize 'buying power' to obtain insurance. That used to be done on a smaller scale years back with the Better Business Bureau. Their members who were small businesses could buy insurance for their employees through a deal that the BB had. It worked wonderfully!

    If those who think that universal healthcare will be the 'best' thing - think again. There will ALWAYS continue to be a group of people who will have supplemental coverage - whether it be dental, prescription or another medical - and there will always be those who whine and complain that their lot in life isn't fair, blah, blah, blah.

  • Report this Comment On September 28, 2013, at 11:20 AM, karl614 wrote:

    I see a lot of comments both pro and con. What I don't see are suggestions for making the ACA better. I understand this has been a long burning issue but I don't understand why there needs to be this time line in the sand.

  • Report this Comment On September 28, 2013, at 11:23 AM, Barmil wrote:

    I liked the camels nose inside the tent that was original!

    Now to blast this system: As it was pointed out that this is a government run business that is exactly right. And it wreaks of a monopoly waiting to happen.

    This country did at one time break up the monopolies but now I see that they are being embraced by the government. It won't be long that they will have a surplus of funds to play with and come up with some other program to abuse.

    In the mean time we will be swallowing the rest of the bad medicine that is in this healthcare plan. We haven't seen of or heard of what all is attached to this law. We can't get past the insurance with out a fierce debate, wait until the law affects you on a more personal level when you health is dictated to you.

    I want this law exposed in it's entirety and fully explained before we go one step further, then put it up for a national referendum item vote on a ballot. This vote does not go to my representatives it involves me.

    Before that I want to clean up the voting laws by eliminating all the the deceased voters and the multiple district voting that goes on. That means one person one vote.

    I am skeptical of this plan, if you look back at other programs that the gov't ran like the CIA's Tuskegee experiment or the LSD experiment on the public what makes you think I am going to trust my health to a government board with no say in my care.

    I should be free to make my own choices in personal matters. Not trapped in a gov't run system where my choices are being threatened.

  • Report this Comment On September 28, 2013, at 11:27 AM, jjn1976 wrote:

    Unexpected…how would anyone have expected anything they didn’t read the bill before they signed it but in fact every major insurance company said this was a bad idea, most financial analysts, and of course most GOP representatives. Now part timers are losing benefits, hours are shrinking, and full time is going away. Yeah this is good for the country. Moving the middle class, what’s left of us, to poor. Anyone who wants to argue can but the facts are the facts.

  • Report this Comment On September 28, 2013, at 11:28 AM, NoMoeMoney wrote:

    @MsAbby - If your Sioux then your exempt from getting the Insurance, native Americans are exempt.

    @mso88 - Yes we can, told-you-so gloating because voters were SO STUPID in electing Obama for a second term and now they must pay the price. People were shouting loud warnings about ACA for a long time to deaf ears. Those who voted against this are paying the price and thoses who voted for it DESERVE what they get period !!!!

  • Report this Comment On September 28, 2013, at 11:29 AM, sagehopper wrote:

    What could possibly go wrong with a 20,000 page set of rules, written by the very people that stand to make a huge fortune off of it?

  • Report this Comment On September 28, 2013, at 11:33 AM, TorinoJim wrote:

    ACA is so good that the King says you should have it but not him. The Democrats say it is so good but they don't want it applied to Congress!

    What more do you need to know!

    Ask an American Indian if it is good to have the government in charge of your life!

  • Report this Comment On September 28, 2013, at 11:33 AM, DunkVT wrote:

    One would think that greater profitability for the business community would be applauded by Republicans. Instead it seems to be an ignored aspect of what can happen when our business sector gets out from under the crushing weight of escalating healthcare coverage for their employees. We read often about the disadvantage in taxation for American corporations. What we hardly ever hear is the cost of healthcare to the bottom line of American companies and how competitors around the world do NOT face these costs. Of course the Heritage Foundation (a Republican think-tank) and Romney (where he was governor) understood this. But the Koch Brother's anger machine has simply lied to the American people...and unfortunately, people simply believe it.

    Will changes be needed in the Affordable Care Act? Certainly. But if Republicans would manage their hostility toward Obama and work constructively, we just might have a healthcare system that is able to slow escalating costs, cover most Americans at affordable rates, and increase corporate global competitiveness. Think about it.

  • Report this Comment On September 28, 2013, at 11:35 AM, jmsla wrote:

    I call bs on those who say that our healthcare system is only 38th in the world. Nowhere else can you get the advanced technology and the kind of doctors that we have. Just because the WHO says it doesn't make it true, and anyone who believes that is a fool. Our country is probably the most unhealthy . You can't always have the best outcomes when you are treating those who don't and never have taken care of themselves.The consequences of Obamacare are exactly what the Marxist-in-Chief wanted....to destroy the insurance industry. Finally, I for one am SICK of paying for everyone else's crap!!! Food, housing, obamaphones, and now INSURANCE!! I shouldn't be forced to pay for someone's INSURANCE!!!!!!!!!

  • Report this Comment On September 28, 2013, at 11:41 AM, DenverGuy111 wrote:

    I hate Obama, I hate Obamacare, and I believe that Obama's supporters are idiots.

    But don't forget, the real father of Obamacare is Mitt Romney. He did it to Massachusetts.

  • Report this Comment On September 28, 2013, at 11:43 AM, cnwtrainman wrote:

    Socialized medicine is an idea who's time has come. Why do we expect business to shoulder the cost of employee healthcare? And unless we cover everybody those who pay will always cover those who don't as I highly doubt we are willing to deny healthcare to the uninsured.

    We live in a global economy and most of the countries we compete with have socialized medicine. We can't ask companies to pay for healthcare and compete with foreign companies that don't. The conversation should be how do we pay for this and how do we de-couple healthcare from employment? We'd be better off with workers unshackled from employment conditioned healthcare and with companies that no longer had the burden of de-cyphering the ups and downs of the healthcare market.

  • Report this Comment On September 28, 2013, at 11:43 AM, lm1b2 wrote:

    The sad part is no one,and least of all the people who voted for it know what is going to happen when this plan is implemented,because as usual no one bother to read it before they voted on it !We need a system like they have in Western Europe,and Canada,but of course this will not happen because of the Republicans who represent Corporate America,and could care less about the poor,and the middle class.The only way we will ever have a true Democracy is to have Term Limits,and open Primaries !

  • Report this Comment On September 28, 2013, at 11:46 AM, tiredAmerican wrote:

    I agree with others here that Obama is doing this know full well it will entrench farther in debt and people still won't have medical care.

    It is no different than running the coal industry out of business and Obama has ADMITTED it will do NOTHING to stop global warming.

    How many examples do we need slammed in our faces before Obama's supporters reaalize he DESTROYING our Country?

  • Report this Comment On September 28, 2013, at 11:49 AM, Tsnva wrote:

    They need to stop all employer's subsidizing health care bundled in as a job perk. Everyone needs to be on the same footing. I once, not by choice, working for a state government, had a large share of health care cost taken over vs an outright raise in take home pay. Having lost a take home raise I pearly into a career for the heath care was over all a bad move and showed up at retirement if you run the numbers, but as I say, no choice.

    What hurts like hell, no pun intended, is working for 35 years neatly forgetting that employer's share.

    When I retired there was a collective gasp of disbelief when told at the retirement debriefing meeting I went to. Try $850 per month for two without the employer's share. You better factor that into your retimement pay. Understand, you may have worked for 35 years with zero medical problems, I did, took only 3 weeks in sick leave in 35 years. Things will change trust me, factor in prescription cost, Dr visits as you now have hit an age where this stuff kicks in. Better suck it up, you will not qualify for food stamps. It is called the middle class starving on a middle class retirement. you may not have a house payment, you have something worst on your back.

    Health care milks you for money when you are young, big profits, they make you pay the dues again at retirement age. Jobs would have to be offered, should be offered with Heathcare money bundled into your take home pay. I am convinced health care cost are artificially inflated because they know most salaried employees have their health care cost subdized by their work, this is where the money is, hit 50 -ish, getting near retirement they would prefer to dump you.

    I know a couple of college professors who now work part time at a community college in their upper 70s, the reason? To pay for health care, one told me he can never retire. 35-50 years from now, those 20 year olds now bitching, living in the moment are in for a very rude awakening. You will have two choices, die young before mid age, or work until the grave. Amazing how many people neatly forget to get to 60 you had to be twenty, 30, 40, 50 and retirement is just a vague distant thing. Good luck with that.

  • Report this Comment On September 28, 2013, at 11:50 AM, Itsjustmeagain wrote:

    Simply Corp. greed.

    Employees are chattel, any opportunity to reduce costs at the expense of families is good.

    Subway owner with 21+ franchises put all employees on PT to include a 10 year FT employee. Reason given: It would cost him a car payment.

    Home Depot is providing some compensation for those who were kicked off the Corp plan. How long is anyone's guess.

  • Report this Comment On September 28, 2013, at 11:54 AM, jessejr wrote:

    People on both sides have to realize that all endeavors have unintended consequences as proven by the fact that there is no perfect law. There are however situations where we have to accept tolerable limits and preferable consequences. The private healthcare system is a capitalist system where talent and innovations are highly rewarded, thus money commands immediate and best form of service. However, costs limit its availability to all and the govt must re-allocate tax money away from other public services to help those unable to pay them until that govt runs out of money since the need is endless, the abuse tempting and the greed is a black hole. A single payer system will limit doctors' pay, costs of medicines,medical devices,procedures & tests, hospital fees, and will rationalize healthcare to maximize benefits and limit expenses in order to distribute its available funds. To rationalize is to give emphasis on productive people and deny or limit expenses for non-productive people. It makes sense,no mammogram to females above 70 y/o, or no resuscitation for 90 y/o & above. We should now prepare for a crowded healthcare delivery system and standard mode of care, and let the few very rich avail of the best and whimsical medical care that money can buy.

  • Report this Comment On September 28, 2013, at 11:55 AM, Baxter1939 wrote:

    I am not a supporter of Obamacare, I have read ever page from the first bill presented in Congress to final signed law. There is a lot of BAD and UGLY and very little good. Some of the BAD and UGLY is the simarlarty to our IRS system for calculations. Obamacare has been real clear about how to calculate the minimum premium that you will have to pay from the very start. All you need is to know your family size, what your family income is per year and have the Family Poverty Level table (FPL). Calculations are based on a stair step approach. 2% of family income from) up to 133% of poverty level; plus 3% on additional income from 133% to 150%, plus 4% on additional income from 150% to 200%, plus 6.3% on additional income from 200% to 250%, plus 8.05% on additional income from 250% to 300%, plus 9.5% on additional income from 300% to 400%.

    I have provided calculations for two specific family below, but you should be able to do your own, by following the below approach.

    Family has 4 members and total income of $65,000 per year; calculations would be;

    up to 133% $ 23,550 to $31,322 at 2% = $ 626.44

    133% up to 150% $31,322 to $35,325 at 3% = $ 120.09

    150% up to 200% $35,325 to $47,100 at 4% = $ 471.00

    200% up to 250% $47,100 to $58,875 at 6.3% = $741.83

    250% up to 300% $58,875 to $65,000 at 8.05% =$493.06

    Total minimum premium = $2,452.42 per year for the baseline Silver Plan with a yearly deducible of $2,000 and 30% co-pays. If you want a better plan then the Baseline Silver you also have to pay the full difference between the Silver and the higher cost plan.

    Family has 4 members and total income of $94,200 per year; calculations would be;

    Up to 133% $ 23,550 to $31,322 at 2% = $ 626.44

    133% up to 150% $31,322 to $35,325 at 3% = $ 120.09

    150% up to 200% $35,325 to $47,100 at 4% = $ 471.00

    200% up to 250% $47,100 to $58,875 at 6.3% = $741.83

    250% up to 300% $58,875 to $70,650 at 8.05% =$947.89

    300% up to 400% $70,650 to $94,200 at 9.5% = 2,237.25

    Total minimum premium = $5,144.50 per year for the baseline Silver Plan with a yearly deducible of $2,650 and 30% co-pays. If you want a better plan then the Baseline Silver you also have to pay the full difference between the Silver and the higher cost plan.

    For all states except Alaska and Hawaii the 2013 Poverty Guideline is $11,490 for a single person and $4,020 for each additional family member.

    1 person family $11,490

    2 person family $15,510

    3 person family $19,530

    4 person family $23,550

    5 person family $27,570

    6 person family $31,590

    7 person family $35,610

    8 person family $39,630 if your family is larger just add $4,020 for each person

    Alaska it’s $14,350 for a single person and $5,030 for each additional. Hawaii it’s $13,230 and $4,620.

    Page 62 PPACE (Consolidated)

    (2) ANNUAL LIMITATION ON DEDUCTIBLES FOR EMPLOYERSPONSORED

    PLANS.—

    (A) IN GENERAL.—In the case of a health plan offered

    in the small group market, the deductible under the plan

    shall not exceed—

    (i) $2,000 in the case of a plan covering a single

    individual; and

    (ii) $4,000 in the case of any other plan.

    Page 119 PPACE (Consolidated)

    (c) DETERMINATION OF REDUCTION IN COST-SHARING.—

    (1) REDUCTION IN OUT-OF-POCKET LIMIT.—

    (A) IN GENERAL.—The reduction in cost-sharing under

    this subsection shall first be achieved by reducing the applicable

    out-of pocket limit under section 1302(c)(1) in the

    case of—

    (i) an eligible insured whose household income is

    more than 100 percent but not more than 200 percent

    of the poverty line for a family of the size involved, by

    two-thirds;

    (ii) an eligible insured whose household income is

    more than 200 percent but not more than 300 percent

    of the poverty line for a family of the size involved, by

    one-half; and

    (iii) an eligible insured whose household income is

    more than 300 percent but not more than 400 percent

    of the poverty line for a family of the size involved, by

    one-third.

  • Report this Comment On September 28, 2013, at 11:57 AM, Beachvenom wrote:

    My opinion of the Motley Fool has dramatically changed due to the crap they have been printing about Obamacare - I will never read or believe anything they say again.

  • Report this Comment On September 28, 2013, at 11:57 AM, DunkVT wrote:

    The US is 38th in the world based on uniform health indicators. This does NOT mean that some of the best hospital facilities in the world are not here...they are. It means that we spend 50 percent more than most other nations, and across all our citizens, we do not rank well when it comes to health outcomes from childhood health all the way through till seniors. We need to reduce the cost as it will cause us to go broke. The US is heading toward 20 percent of GDP on healthcare costs...totally unsustainable. A large part of government costs is related to escalating healthcare.

  • Report this Comment On September 28, 2013, at 12:00 PM, LogicalMaybe wrote:

    The Patient Protection and Affordable Health Care Act is better known as Obamacare since he was the president who signed them into law. Just like the tax cuts brought to us in 2001 and 2003 are better known as the Bush tax cuts.

    For those who like and believe Socialist medical plans work in other countries, I request an example of ANY government run/sponsored program that operates efficiently and effectively. I hesitate to think about what they could do to healthcare.

    Plus, medicine is a PRACTICING SCIENCE. This means it is always changing, so the best idea for today may not be the best for tomorrow. Government does not have the ability to quickly adapt for new situations. Will they write another 2K + document to deal with it? And need another year to decipher?

    However, if you still think England, Japan, France, etc have better health care, then please feel free to move there and take advantage of it instead of forcing your belief in their system on me.

    For those who want a better idea... Have health insurance work like car insurance. That way I can set up a plan that covers chiropractors and holistic providers; or you can set up full hospital with mental health; and still others can set up a catastrophic plan; or perhaps a combination of all.

    Without the government or business to interfere, you could set up the coverage and deductible you decide are best for your particular situation. You even get price breaks for "good behavior".

  • Report this Comment On September 28, 2013, at 12:05 PM, DunkVT wrote:

    Part-time workers at Trader Joe's will actually make out better under this new health care plan. Trader Joe's being a responsible company, provides a check to employees which can then be used to purchase healthcare in the exchange. Trader Joe's now has a defined cost per year for healthcare (the amount they provide to each employee); and the employee has choice in which plan they purchase. When all is said and done, part-time workers spend less.

  • Report this Comment On September 28, 2013, at 12:08 PM, JBignutt wrote:

    Some of the more popular comments crack me up. The main central comment seems to be: "Why do employers have to pay for employee health care costs?" Answer: Because wages have been kept so low to appease share holders and to give a return on stock. If the minimum wage had kept up with the same return as GDP over the years, minimum wage would be $22 an hour. That is MINIMUM wage! People that actually work for a living cannot afford health insurance because of income inequality. To deny these people basic health insurance and a way to pay for health care is immoral.

  • Report this Comment On September 28, 2013, at 12:11 PM, calamay wrote:

    As much as I oppose socialized medicine or parts of the health care reform, I dislike even more when a company dumps its employees on the tax payer when that company can clearly afford to provide health care coverage.

  • Report this Comment On September 28, 2013, at 12:13 PM, DunkVT wrote:

    To those who think Obamcare is socialized medicine, you really need to stop listening to Fox and listening to Talk Radio.

    Canada - not socialized but centralized single manager of healthcare. Doctors are not government employees.

    Greta Britain - closest think one can get to socialized medicine.

    Switzerland - private insurers and health providers but government helps to fund (through taxes).

    I could go on here....most Western democracies have government play a larger or lesser role in controlling costs...which is why they pay less for medical procedures, drugs, medical devices, etc. than we do.

    Obamacare is closest to the Switzerland model where the private sector plays a central role, with government financial support. Kinda like Medicare. Do seniors call Medicare "socialized medicine"?

    No. In fact Tea Party members famously screamed about government largess all the while asserting that people should keep their hands off their Medicare.

    If this was't so sad, I would be laughing.

  • Report this Comment On September 28, 2013, at 12:16 PM, TogAK wrote:

    The only thing different form what we have now and ACA is Uncle Sam will pay the insurance bill. The ACA law was written by the Insurance Industry and Drug Companies. The insurance industry has already priced 50 million people out of their product and the people that have insurance are retiring by the thousands daily and going onto Medicare. What do you do? You pass a law that mandates that everyone must buy you product. The drug companies love the limits on out of pocket expenses.

    When the average American is told that their drug treatment will be $100 to $125 thousand per year most will walk away. But now Uncle Sam will pay the bill. MAN what deal!! And, we all know how well the government manages our money. The sky the limit!

    The insurance industry is low balling their premiums to get people enrolled and then will raise them year after year. Which has been their policy for decades.

    There is reason that these companies spend $100's of millions on lobbing, because they get it back in the billions, on the back of tax payers

  • Report this Comment On September 28, 2013, at 12:19 PM, DunkVT wrote:

    Trader Joe's is NOT dumping their part-time workers onto government healthcare. They are PAYING for a large share of the cost of healthcare on the exchange. Home Depot, now this is another story. They are pulling a "Walmart" and simply shedding responsibility. Might want to stop spending your money at such irresponsible companies.

    Please people...get the facts before spouting off.

    As Thomas Friedman is fond of saying: "Dumb as we want to be!"

  • Report this Comment On September 28, 2013, at 12:20 PM, thsolo wrote:

    Unintended consequences?! I don't think so. The end game is a single payer system and Obama(doesn't)care is designed to mess things up so much people while cry for a solution and who better to step in? The very people who cause the mess of course, the federal government. I prefer to maximize freedom/liberty. Full tax credits for medical expenses include health insurance premiums or health insurance premium vouchers from the feds. Put the power in the hands of the people as much as possible rather than this gang of power/control mad thugs and thieves.

  • Report this Comment On September 28, 2013, at 12:21 PM, TechNicole wrote:

    wow, where did you go to college? Russia, Iran?

    Big business has been wanting to get out of providing healthcare to it employees for decades. Ever year, Big Business makes their employees pay a little bit more for their own healthcare. Why you may want to ask, because even though I assume you already know this, but were purposely not reporting it because you want to try to help make ObamaCare look real bad, to compete against companies from around the world that already have healthcare paid for in full by their governments. Take note that Obamacare, as much as you and your folks want to paint is as SocialCare, it is NOT. A payment is still being made separate from the taxes we all pay. The big company i used to work for went from 10% copay to 15% copay, and I am sure, in a few years they will move it to 20% copay.

    Big Business want ObamaCare to work, it is the Insurance companies and the Koch brothers that dont want it to work.

  • Report this Comment On September 28, 2013, at 12:23 PM, DunkVT wrote:

    We are the wealthy nation in the world and we can't provide basic healthcare for our citizens?? What sense does this make? This is not hypothetical, nations around the world have found solutions and at much lower cost and with better health outcomes. Hmmm, might we learn something here?

    Conservative governments in Great Britain, Canada, Germany...you name it, never want to repeal their healthcare systems which seem to work well and at reasonable cost.

    Might there be a lesson here for us?

  • Report this Comment On September 28, 2013, at 12:23 PM, Twiddlefin wrote:

    This is good for business. It will save business a lot of money in reduced expenses.

  • Report this Comment On September 28, 2013, at 12:28 PM, DunkVT wrote:

    LogicalMaybe...this was a Republican idea developed at the Heritage Foundation and enacted by a Republican governor in Massachusetts. You might want to learn how it's working in Massachusetts. Far as I have heard, nobody is dying, the Commie's have not arrived...and in fact, most people seem to like it.

  • Report this Comment On September 28, 2013, at 12:29 PM, serioso777 wrote:

    Just know this, Unemployment will rise, retail sales will fall, and the destruction of America will continue...the ball of shet is still rolling down hill...

  • Report this Comment On September 28, 2013, at 12:32 PM, entitled wrote:

    So let me see if I have this straight. I pay around $150/month for a policy with a $5k deductible and get reimbursed for 60% of my medical cost? Yep, that's "Affordable" alright.......Me thinks that that "affordable" Bronze plan really costs (roughly) $550/month (factoring in the deductible), which is what I pay now as an employee co-pay, but I get far more benefits...

  • Report this Comment On September 28, 2013, at 12:36 PM, josekarlos29 wrote:

    This was always the intention of obamacare. But it doesn't just shift it from business to government, but rather from business to the individual and individual insurance companies. That is a great thing. I don't need a job to worry about health insurance. That is one less level of control my employer has over my life that he doesn't need. And if he isn't paying for my health insurance, the business is making more money. It's a win win for both parties.

  • Report this Comment On September 28, 2013, at 12:42 PM, clutch1958 wrote:

    @Starfish-ours is the most expensive because we are the innovators-that costs big money. I'll say it again-if we're so bad, explain all the Ontario license plates on the cars in the Buffalo, NY health care centers' parking lots (and I have family in the Buffalo area, and I grew up there, so don't try telling me otherwise).

    faber100-actually, it was SGT. Hulka, and he said "Lighten up, Francis."

  • Report this Comment On September 28, 2013, at 12:44 PM, clutch1958 wrote:

    @Dunk-Great Britain and Canada are trying to get rid of their single-payer plans. If you're rich in those countries, you have supplemental insurance, so you can go to the front of the line, or even come to the US to be taken care of.

  • Report this Comment On September 28, 2013, at 12:52 PM, Stevegarry22 wrote:

    The bottom line is, working Americans are getting screwed so freeloaders and illegals get free health care! Thank odumbo and the morons that voted for this P. O. S. !!!!!

  • Report this Comment On September 28, 2013, at 1:00 PM, Orlandca wrote:

    Am I the only lawyer to read this at it's entirety ?

  • Report this Comment On September 28, 2013, at 1:04 PM, cedriclynn wrote:

    I don't get all of the crying and negativity. There's been an average 7-10% increase yearly in costs since the 90s with health composing a 25% plus in GDP which is unsustainable. It could be 40% plus in 20 years if left as is. That's with a very large number of people uninsured or underinsured now it only gets worse in 20 years. I don't get any alternatives to Obamacare only" we just don't want Obamacare" the Republican outcry since 2008... It may be the greatest thing ever done if it works I don't know but what I do know is doing nothing is what was being done and the problem was only getting worse. A solution I don't know it's a start....

  • Report this Comment On September 28, 2013, at 1:09 PM, efan46 wrote:

    The whole truth of the matter is..the govt doesn't give a rats azz about the older americans..they want to make it tough on them so they die before their time. If the medicaid funding is being cut and more and more docs are not getting reimbersed than what are the people who really need that extra help to do.? There are handicapped people and older americans not able to work and have money to pay for their insurance or deductible out of pocket. What about the people who go without food just so they can have money to pay for their meds? It's crazy.

  • Report this Comment On September 28, 2013, at 1:09 PM, BERTHACRACKER wrote:

    If the people in government really wanted to improved the healthcare to a universal system for everyone there is already a framework in place for this to happen. We are not shackled into this problem. It can be fixed and use what we already have in the place as well the current tax system.

    The corporate healthcare for profit executives do not want it fixed. But the people do and you can read more at this link: http://www.pnhp.org/publications/a_national_health_program_f...

    Reprinted from the New England Journal of Medicine 320:102-108 (January 12), 1989

    Abstract:

    Our health care system is failing. Tens of millions of people are uninsured, costs are skyrocketing, and the bureaucracy is expanding. Patchwork reforms succeed only in exchanging old problems for new ones. It is time for basic change in American medicine. We propose a national health program that would (1) fully cover everyone under a single, comprehensive public insurance program; (2) pay hospitals and nursing homes a total (global) annual amount to cover all operating expenses; (3) fund capital costs through separate appropriations; (4) pay for physiciansÕ services and ambulatory services in any of three ways: through fee-for-service payments with a simplified fee schedule and mandatory acceptance of the national health program payment as the total payment for a service or procedure (assignment), through global budgets for hospitals and clinics employing salaried physicians, or on a per capital basis (capitation); (5) be funded, at least initially, from the same sources as at present, but with payments disbursed from a single pool; and (6) contain costs through savings on billing and bureaucracy, improved health planning, and the ability of the national health program, as the single payer for services to establish overall spending limits. Through this proposal, we hope to provide a pragmatic framework for public debate of fundamental health-policy reform. (N Engl J Med 1989; 320: 102-8.)

  • Report this Comment On September 28, 2013, at 1:10 PM, tsquares wrote:

    What I cannot understand is why the RepubliCANTS are not on board with this health care law. If indeed employers are paying people to get on the exchanges, this is increasing the employer's bottom line. RepubliCANTS should be all aflutter. Insurance companies are gaining billions in premiums, RepubliCANTS should be getting wet! This law should take our country's medical ranking from 38th in the world to the mid 20's. If this was the RepubliCANTS idea, they would be dancing in the aisles. The insurance companies must use 80% to 85% of their received premiums directly for healthcare....this should increase the amount of medical attention we receive. If you have ever had a relative die because the insurance company said they used up all of their benefits for the year, you should be happy about this law. Hospitals will no longer be spending billions in non recompensed services to the uninsured. So, why DOES this law piss you all off so much? Other than it came from a black democratic president?

  • Report this Comment On September 28, 2013, at 1:12 PM, rw93003 wrote:

    It's amazing that anything about it works. Obamacare's creators didn't know what they were doing. It was like having a bunch of monkeys fix your car.

  • Report this Comment On September 28, 2013, at 1:14 PM, tsquares wrote:

    Oh, I get it! You morons believe that because you are "hard working" YOU deserve healthcare, and SCREW everyone else. I'm sure your old Sunday School teachers would be so proud of you now!

    Well, the number one reason your premiums ARE so freaking high is that hospitals have to give away free healthcare. THIS WAS NOT AN OBAMA RULING, IT HAS BEEN GOING ON SINCE FOREVER. Obama is trying to STOP this crap, and you idiots can't see past Faux News. Get thinking for yourselves before the Koch brothers make it illegal.

  • Report this Comment On September 28, 2013, at 1:28 PM, Loxly wrote:

    The die is cast! This just goes into the same MO that the Feds always use. Implement something without a one year pilot. Perhaps if this was done they'd have the time to figure out "how it works" along with what it might take to make it work. What major business would take the chance of ruining themselves without first doing a pilot.

  • Report this Comment On September 28, 2013, at 1:34 PM, Dadw5boys wrote:

    Americans pay 35 % more for Medical Care and get the same or worse results for all those Billions.

    Solution ? Well stop the bleeding first !

    Stop those who provide NO MEDICAL CARE from taking the Lions Share !

    Then make sure the Medical Providers are paid better, have the best information on what works and what does not work only wastes time and money.

    The get the Patients to learn to take care of themselves.

    Or we could keep on being the LAUGHING STOCK OF THE WORLD because we are foolish enough to pay more and get less and less and less !!11

  • Report this Comment On September 28, 2013, at 1:36 PM, Dadw5boys wrote:

    All those poor Lobbyist the Insurance Companys paid Billions will have to go on Food Stamps.

  • Report this Comment On September 28, 2013, at 1:51 PM, Swoop1918 wrote:

    Wow, this sure brought out the America-is-doomed fringe, didn't it?

    JoseKarlos has it exactly right... this is about giving millions of Americans choices they never had before, and taking control of our health care out of the hands of corporations who don't give a damn about us.

    On behalf of those of us who have had our health insurance canceled with no notice, no cause and no other reason than the insurance company didn't want to pay for our care (in my case back surgery that I had to pay for out of pocket), I'd like to thank President Obama for ensuring it will never happen to any American ever again.

  • Report this Comment On September 28, 2013, at 1:54 PM, charlie41us wrote:

    And we are shocked why??? This administration has not had any surprises to anyone with half a brain that doesn't vote by what rhetoric the candidate is using..

  • Report this Comment On September 28, 2013, at 2:00 PM, Swoop1918 wrote:

    I've seen some old conservative newspaper editorials from 1965. They use the same hysterical, anti-government, anti-Socialist rhetoric to describe the impending destruction of America due to the proposed program known as Medicare.

    Wonder how many of the angriest posters here are (or have family members who are) getting their medical care through Medicare or that other socialized obscenity, the VA.

  • Report this Comment On September 28, 2013, at 2:03 PM, Paulson545 wrote:

    Obamacare is going to happen ; so in a few years obama will be out of office and won't care about the lost jobs and higher taxes. Republicans should just wait it out and in a few years when obamacare causes another recession let the democrats try to explain it away.

  • Report this Comment On September 28, 2013, at 2:11 PM, Gowithit wrote:

    Great, hey, this is still an investment site and not Drudge, right? So as an investor, wouldn't we be more interested in things that will help the bottom line? And to the person who said the US isn't 38, look it up. Great, we have a ton of innovation no one can afford, clap clap clap. Go get a colonoscopy and look at the bill. Before this act passed, my deductible portion for a routine procedure like that totalled 3k. That's with insurance. Great system, lmao. I'm hoping this is a move to universal care, want to make the US more competitive, companies pay more in health care costs in the US than SSI taxes, scary, huh. And this is the only country they need to do that in. Employer based health care is a joke to begin with, but people, especially pea brains, are always afraid of change.

  • Report this Comment On September 28, 2013, at 2:17 PM, mainstreeter wrote:

    More disinformation hypothetical chit-chat that will be laughed at this time next year. However, I will say that the first correction to the ACA will be adding the Public Option which will start the process of shifting health care from an employer based system to a government based system. The fact that some businesses want to shift the healthcare burden from employers to the government indicates that there is hidden but strong support among businesses for a public option feature, if not full single payer. Now for the insurance companies getting out of the picture, well, that is another story and a long way off.

  • Report this Comment On September 28, 2013, at 2:25 PM, Higherroad wrote:

    3 yrs ago I was married and had a great health insurance plan. I am now divorced, lost my home, on EBT, jobless and almost 60 yrs old. I have many medical issues including 2 artifical joints which will not last forever.

    A lot of you sound like you listen to FOX news. What is wrong with you. It doesn't make you an informed viewer, it makes you an idiot! They act like that on the show because it sells ratings.

    I am an Independant who has mostly voted Republican. What I see happening is that the extreme Right has traded it's Bible for Dr. Seuss.

    It would be laughable if not for the fact that my taxes pay for that jokers right to act that way.

    I am not overly "religious" but I think that if "all" people are created equal, then all deserve to have healthcare, rich or poor.

    In my opinion, the insurance industry is and has been a fraud for as long as their existance They have no tangible product and government has given them license to do as they please. (I was a licensed agent for a short time.) If they were ever audited, they would probably be outlawed.

    Money has replaced love, compassion and respect. The world will have to change or reap the consequences. If you lost everything today, would you then be nothing?

  • Report this Comment On September 28, 2013, at 2:26 PM, LL0109 wrote:

    This was absolutely intended. For those of you that keep bringing up how much more we spend on healthcare; that is because we are subsidizing those without insurance, AND because of medical malpractice insurance. We needed 2 laws, one that made it illegal to deny insurance based on a pre-existing condition; and another that offered ongoing healthcare to the uninsured with a chronic condition. Those 2 laws would have resolved 85% of the healthcare problems. Instead what Obama did was downgrade middleclass healthcare and charge us more to provide more downgraded healthcare to the poor. The healthcare of the wealthy will not be affected; they will just buy good healthcare. Once again, the middle class will get hit.

  • Report this Comment On September 28, 2013, at 2:39 PM, kake154 wrote:

    Responding to one618tone, I don't know where you got your information, but I am employed by the Commonwealth of Kentucky and what you posted is so untrue. We have not had any form of Obamacare, we have Humana. Our open enrollment for 2014 insurance starts October 1. We got our package options this week and no one is happy. Everything is going up!

    Also according to the Henry J Kaiser Institute Subsidy Calculator

    http://kff.org/interactive/subsidy-calculator/

    A family of 4 in Kentucky, with a $100,000 income (with both adults being 40 years old) would cost $9,700 per year with no government subsidy.

    The above calculation is for Kentucky, but if you go to the calculator you will see that the premiums increase with age and the subsidy decreases with income. But then again, the subsidy is just another way of saying "our tax dollars"

    According to the calculator, a couple of 61 year olds in Kentucky, making $65,000 per year would have to pay a premium of $17,467 per year out of pocket with no "taxpayer" subsidy. How many 61 year old couples do you know that can afford $1455 insurance payment each month?

    I suggest everyone check out this calculator. You can punch in your state, your family size, your income, etc, and get an idea of how much is out of pocket and how much all the taxpayers have to cover.

    Let's face it, the people who don't pay anything now will still be covered. This is not going to hurt the wealthy, but this will absolutely destroy the working middle class.

  • Report this Comment On September 28, 2013, at 2:41 PM, Makikijoe wrote:

    Some benefits from the Affordable Care Act have already taken effect;

    Insurance companies can no longer deny coverage to children with pre-existing conditions — from asthma to allergies to old injuries — with the exception of “grandfathered” plans in the individual market.

    Young adults may stay on the their parents insurance up to age 26.

    Insurance companies may no longer limit the amount of coverage available to those who face expensive medical conditions. This will help Americans who develop chronic illnesses.

    Many plans, with the exception of those “grandfathered” plans in the individual market, must phase out annual limits over the next three years.

    Insurance companies must pay for preventative care, such as mammograms and immunizations.

    Insurance companies must improve the appeals process for insurance claims.

    Insurance companies must provide more direct access to OB-GYN care, instead of requiring women to have referrals from a primary care physician.

    Senior caught in the Medicare “Donut Hole” — where “Part D” beneficiaries pay all of their own prescription costs — will receive a one-time rebate check from Medicare this year.

    Tax credits will help small businesses cover employees.

    Medicare will now cover the full costs of annual wellness visits and personalized prevention plan services.

    A Medicaid program will allow states to offer home and community-based care for disabled Americans who would otherwise receive institutional care.

  • Report this Comment On September 28, 2013, at 2:46 PM, julio2 wrote:

    Business should not have been in the healthcare anyway but Obamacare now has an even bigger problem. It encourages business to send employees to the exchanges with a raise and at the same time has no way of getting young healthy people to sign up. The young and healthy and the pay check to pay check poor who don't have health insurance now are most likely not going to sign up because it is cheaper to pay the penalty instead. That will leave Obamacare grossly underfunded with no way to get raising the funds through congress. Do you think the republicans will approve raising the individual mandate penalty? Not a chance. This should be fun to watch.

  • Report this Comment On September 28, 2013, at 2:51 PM, Makikijoe wrote:

    In the near future, Americans will benefit even further from the new health care law.

    As of 2014, health insurance companies will no longer be able to deny coverage to adults with pre-existing conditions.

    Health insurance exchanges will open for small businesses and individuals.

    Individuals with income up to 133% of the poverty level will qualify for Medicaid coverage, as long asthe state has agreed to particpate in the Medicaid expansion. Curiously, some of the state's with the HIGHEST number of residents without health care, mostly GOP controlled states like Texas, have chosen to not participate.

    For people with incomes up to 400% of the poverty level, health care tax credits will become available to help them purchase coverage on the exchange.

    By 2019, health care reform may extend coverage to 32 million Americans who would not otherwise be insured.

    Yet, the advantages of this health care reform law is only beginning to be felt. It must be defended against obstruction and relentless attack by conservatives, in order for Americans to be allowed to experience all of its benefits. Like other programs that the overwhelming majority of Americans now support — such as Social Security and Medicare — the support for these health care reforms will continue to grow as more Americans feel its positive impact in their lives and as they see the number of Americans without insurance go down..

  • Report this Comment On September 28, 2013, at 2:58 PM, freedomnuts wrote:

    I fell down the other day caus I was thinkin about freedom and tripped, thanks Obama!

  • Report this Comment On September 28, 2013, at 3:06 PM, doco177 wrote:

    Google "Obamacare Flowchart" at Intellectual Takeout to see a visual representation of the convoluted, corrupt mess this really is

    Congress,Muslims, Amish, Native Americans are exempt from mandate and penalties under Obamacare that the rest of us have to pay.

    1. Millions are losing the insurance Obama promised they could keep. Because ObamaCare forces employers to offer expensive Cadillac plans but also offers the option of paying a fine for not providing health insurance that can be cheaper than providing it, between seven and twenty million Americans are likely to lose their health insurance coverage according to the Congressional Budget Office. The original estimate was closer to four million.

    2. The cost of healthcare premiums have exploded. In the near future, we could see costs double or worse. Naturally, these costs will hit an already burdened middle class hardest.

    3. Lost jobs. Lost jobs.

    The Federal Reserve's March beige book on economic activity noted that businesses "cited the unknown effects of the Affordable Care Act as reasons for planned layoffs and reluctance to hire more staff."

    Consulting firm Adecco found that half of the small businesses it surveyed in January either plan to cut their workforce, not hire new workers, or shift to part-time or temporary help because of ObamaCare.

    4. Doctor shortages that will mean rationing: The healthcare industry is already a bureaucratic quagmire. ObamaCare is about to add steroids. As the profession becomes tyrannized by government, the talented people currently practicing medicine plan to get out sooner than expected. Who knows how many will choose not to get in. Doctor shortages are what lead to the nightmare known as rationed care.

    5. Somewhere around $900 Billion in tax increases will hit America's middle class. This added burden will not only further oppress a middle class already reeling from a drop in wages over the last few years, but could damage the overall economy.

    6. Inflation, the cruelest tax on the poor. When businesses get socked with added costs brought about by higher taxes and burdensome government mandates, they pass those cost along to the consumer in the form of higher prices.

    7. Added bureaucracy. Even those Obama lapdogs over at the Washington Post's Wonk Blog are admitting that applying for health care is about to get more burdensome than the byzantine paperwork involved in buying a home.

    8. To cut costs or to avoid having to provide insurance, workers on the economic margins are already losing hours, which means a lower paycheck.

    9. ObamaCare is projected to add $6.2 TRILLION to a deficit the GAO has already declared "unsustainable." That's "trillion" with a "t".

    10. More taxes than currently estimated are likely to hit because of situations like this one.

    Three years ago, Obama, Democrats, and his media lied to us about cutting the cost of health care, being able to keep our insurance, and not taxing the middle class. Today, those lies and what ObamaCare is and will do to the working and middle class are the biggest untold story in America.

    The govt becoming more involved in health care is the reason the costs have increased. So Govt creates a crisis, then provides a solution that comes at the expense of liberty and freedom, costs trillions, and by most accounts won't solve the problem but in fact make it far worse.Corruption, incompetence, disregard of the Constitution, and lying are integral to the way that this country is being run.

    REFUSE and Repeal Obamacare...If only a mere 20% of the over 300 million population of the USA boycott Obamacare the government would be overwhelmed to even think they could penalize or mandate every citizen that refused to participate in the most corrupt and unlawful ways which it was passed that circumvented the constitution of the United States

  • Report this Comment On September 28, 2013, at 3:07 PM, freedomnuts wrote:

    We all know that Stalin didn't like coal and wanted "renewable energy". Who els does this sound like? That's rite you gussed it buddy!

  • Report this Comment On September 28, 2013, at 3:10 PM, freedomnuts wrote:

    Hey doco177, I alredy saw this chain emial in the last Obumer article. I like it and of cors it's all tru, but do you have any new ones?

  • Report this Comment On September 28, 2013, at 3:11 PM, 1234whatever wrote:

    I just asked my father who has had cancer for last 8 years if his medical has been effected by this crap. He said oh yea. Before it was covered and free to see a doctor now I have to pay$35 each visit and my copay for meds went up. He said in one week 8 doctors, $280 he takes 26 pills a day. x7days?! Month? this is highway robbery.

    He will average now over a $1000 combined for pay outs WITH INSURANCE !!! What does that cost, basically who in the hell will be able to afford $1500 a month FOR ONE PERSON!!!!! NOONE. We should be storming the white house and hang them all on the front lawn for their treason !!!

  • Report this Comment On September 28, 2013, at 3:16 PM, freedomnuts wrote:

    Im tryin to find that one bout the layer in Texas who red the Obama act and figured it all out. Its a socializm act. I think it went to spam. Ill find it and post it.

  • Report this Comment On September 28, 2013, at 3:17 PM, ddoyle95 wrote:

    Home depot earnings up for Q3 and trader joes is expanding their operations. BS on blaming this on ACA. These companies have an excuse to not take care of their employees. Whats amazing to me that no one points that out.

  • Report this Comment On September 28, 2013, at 3:22 PM, Freddyfreebe1 wrote:

    If it doesn't work they will make it work. There is no option, people need healthcare. What this country don't need is insurance which should never have ever been a part of healthcare. Feeding the insurance companies is a handout to dirty politics but you have to start somewhere.

  • Report this Comment On September 28, 2013, at 3:27 PM, hagar2935 wrote:

    If you are on Medicare or about to be, you have already seen that MOST Doctors & Clinics are refusing Medicare/Medicaid Patients, largely because of the "unintended" consequences of Obamascare.

    Seniors will soon find that they will be placed on long-term waiting lists for care that will result in them dying before receiving needed care.

    May Doctors are considering changing to a CASH ONLY practice, to avoid the onerous rules and regulations of Obamascare.... so like in all Socialist societies, ONLY THE VERY RICH and the VIP/Government Bigwigs will receive prompt and QUALITY care. The rest of us will be forced to lose our preferred Doctors and go on long waiting lists for care that we may never receive.

  • Report this Comment On September 28, 2013, at 3:28 PM, Costanzawallet wrote:

    It would be interesting to know how many people making comments here have actually experienced and lived in a country with a universal single payer system. Not the majority I think. I have. Apparently the government can run the best military in the world, but not anything else according to many here. Right now private insurers decide your health care, They are raising their premiums right now because they will do anything they can to preserve their profits. Monopoly? I would like to subpoena all the email communications internal and between insurers and I would be willing to bet there is price collusion and fixing. A for-profit model is incongruous with health care, period. Tying health care to being employed is also ridiculous. A universal single payer affordable health system will reduce the incredible stress on people who are afraid to see a doctor for fear of being diagnosed with something that will make them ineligible for coverage (no longer the case with Obamacare), and lift the stress of getting a hospital bill that will require you to empty your 401k, or mortgage your house. Young freeloaders who think they are invincible, then get sick and now ride for free, will have to chip in to carry their weight, which if they don't use the system when they are young, will certainly use it when they get older and need it. Perhaps then, rather than focusing on how to pay for health care, and stressing in fear about getting sick and losing their savings, people can actually think about their careers, family and jobs without the fear of losing everything unless they are wealthy. Single payer of die, literally!

  • Report this Comment On September 28, 2013, at 3:37 PM, 1Mic1 wrote:

    By giving each employees a check for say $ 2,000 or more and sending them into the state exchanges a company can very easier improve their bottom line as they have just eliminated the need for HR personnel to manage the healthcare needs of their firms employees. Also each state will offer pans that provide more options than most employers...sounds like a win-win to me.

  • Report this Comment On September 28, 2013, at 4:18 PM, TSP1973 wrote:

    So how much more proof do the Obama Zombies need before they see this Obamacare is a disaster waiting to happen?

  • Report this Comment On September 28, 2013, at 4:20 PM, CheshireKatt wrote:

    We can't keep letting the insurance companies dictate what kind of coverage we get. Yes we ALL have to pay into this change. People need to quit thinking of themselves, I try to look at it as if some family and their children have coverage because I paid in then I sleep better knowing I helped someone out. Someone with cancer will get better options than they would have with their insurance plan most likely and I can feel good that my money helped that person get it. It's called doing your part and not needing a pat on the back for it. We can't keep chugging along like we are, there is a big need to do something different. In the end this will pay off. Not everyone will like this and no matter what happens you can't please everyone. You vote, that's your say just like me and everyone else. Maybe next election you'll get your way.

  • Report this Comment On September 28, 2013, at 4:37 PM, LaryB wrote:

    I don't think that now there is any doubt Democrats knew exactly what they were doing to the American people. They obviously wanted the confusion that now exists. They also obviously knew that this law would never be completely understood. I believe, with many others, that Democrats wanted this confusion in order for the government to rescue Obamacare and develop a universal model for health care. Democrats passed this bill without asking for Republican input and now we all are reaping what they passed. The only group responsible are Democrats. They are the ones that need to pay the American people for their corruption.

  • Report this Comment On September 28, 2013, at 5:28 PM, greyhound44 wrote:

    I retired on 31 Aug 2003 at age 58.75.

    Sure hope you idiots who voted for Insane Hussein and her entire ship of Fools NEVER find a good Physician.

    ret expat MD: NBME; ABIM; ABNM; ABR w/spec comp NR

  • Report this Comment On September 28, 2013, at 5:31 PM, TogAK wrote:

    Universal Health Care or Single payer is not Universal Health Insurance. When you walk into a hospital in Canada, Germany , UK and many other countries that have true Universal Health Care. They don't ask for if you have the gold plan or the bronze plan. If you smoke or don't smoke. They don't care what age you are. ObamaCare is not universal health care. It is a federally mandate insurance premium that everyone must buy. This law will hit the middle case so hard it is hard to comprehend. This an investment blog we have been told.

    Here's one, invest in companies that are in the Temp Business like RHI. Because this law is turning millions of full time jobs into part-time. Then invest in Insurance companies because when you and I are paying the bills at any price, it almost impossible to lose money. This law will do nothing to lower health care costs

  • Report this Comment On September 28, 2013, at 5:55 PM, Swoop1918 wrote:

    “I cannot help fearing that men may reach a point where they look on every new theory as a danger, every innovation as a toilsome trouble, every social advance as a first step toward revolution, and that they may absolutely refuse to move at all.” ― Alexis de Tocqueville , French historian and author of Democracy in America.

  • Report this Comment On September 28, 2013, at 6:23 PM, rsniper19988 wrote:

    I make 13k a year because I'm a full-time student. I cannot afford insurance. With obamacare, I will have to pay 45$ a month for 94% coverage and no deductible, OBAMACARE HELPS ME. Now, if I was making 100k a year, I'd have to pay 13,000$ in premiums, which obviously covers my own, and the people who make 13k a YEAR. If you don't like it, I'll GLADLY TRADE PLACES and I'll pay for ur subsidy while I make 100k, and you make 13k and get a discounted premium.

  • Report this Comment On September 28, 2013, at 6:30 PM, sfh2615 wrote:

    Obamacare has OVER 1k waivers--businesses, unions, churches etc which ARE NOT required to participate in it. Evil Waiver #1--U.S. Congress, family and staff!!

    I WILL *NOT* SUPPORT OBAMACARE UNTIL AND UNLESS THE U.S. CONGRESS IS REQUIRED TO PARTICIPATE IN IT!!!!!!

  • Report this Comment On September 28, 2013, at 7:18 PM, timfromvt wrote:

    There is nothing unintended about this at all. he anticipated the shift....in fact, desired it. It was obvious to all...even Pelosi.

    Cradle to grave...no new (obvious) taxes until the money runs out....then go to Congress and coerce more and more.

    The store is open !!!! And all the clerks and police have gone home.

  • Report this Comment On September 28, 2013, at 7:30 PM, emal2me wrote:

    My insurance through my employer will not change. However, I cannot keep my children on my policy until age 26 as I believed.

    My company informed me that my kids can stay on my policy if they really are dependents as shown on my last years federal tax return.

  • Report this Comment On September 28, 2013, at 8:05 PM, ceh4702 wrote:

    I might not like obamacare, but I cant accept it as long as so many people and businesses and unions and other groups like federal employees get all kind of exemptions and special privliges. This is illegal under the constitution. It is unequal application of law. This is also what is wrong with the tax system. This is why people dont trust the government. It is like exempting your friends from prosecution as a judge.

    Just the facts.

  • Report this Comment On September 28, 2013, at 8:22 PM, Albert0Knox wrote:

    The US is the only country where employers are responsible for the health care costs of workers. This places us at a disadvantage. Other countries tax workers for the health care they receive. Our model is ridiculous and Obama care is only slightly better (in that it does insure more people).

  • Report this Comment On September 28, 2013, at 8:23 PM, misterfrost wrote:

    They paid corporate "think-tanks" gobs of cash..I'm sure this was all intended and the media failed to inform once again. Anyone with a little foresight could see this coming.

    Healthcare is needed not insurance..it's another scheme to separate the people from their money.

  • Report this Comment On September 28, 2013, at 10:15 PM, beachwalker65 wrote:

    This is giving me a headache. We have gone to the same doctor for 30 years. He is now going concierge because of the ACA. $2000.00 a year. Each. While we don't have to continue to see this doctor, the thought of having to pick another doctor also gives me a headache.

  • Report this Comment On September 29, 2013, at 8:37 AM, DunkVT wrote:

    Greyhound, why don't you go find a perfect country to live in...good luck with that. Such disrespect for democracy and for our elected (twice) President is mind numbing. This "Taliban-like" mentality that is infecting our nation is deeply troubling.

  • Report this Comment On September 29, 2013, at 8:44 AM, DunkVT wrote:

    Expenditure on healthcare % of GDP

    US 16%

    France 11%

    UK 8.4%

    Life Expectancy

    US 78

    France 81 yrs

    UK 79

    Expenditure on health, per capita US$

    US $7290

    France $3601UK $2992

    Infant mortality per 1,000 live births

    US 6.7

    UK 4.8

    France 3.8

    Without health insurance

    15.3% of population – 45.7 million

    Medicaid and Medicare insure 13% of population

    UK – Universal, tax-funded system

    11% of population also have private health insurance

    Great Britain represents all that is good and bad with centralized, single-payer health care systems. Health care spending is fairly low (7.5% of GDP) and very equitable. Long wait lists for treatment, however are endemic and rationing pervades the system. Patients have little choice of provider and little access to specialists.

    Percent Insured. ~100%

    Funding. Great Britain has a single payer system funded by general revenues. With any centralized system, avoiding deficits is difficult. In 2006, Great Britain had a £700 million deficit despite the fact that health care spending increased by £43 billion over five years.

    Private Insurance. 10% of Britons have private health insurance. Private health insurance replicates the coverage provided by the NHS, but gives patients access to higher quality care, and reduced waiting times.

    Physician Compensation. Unlike in the case of other single payer systems such as Norway, most physicians and nurses are mostly government employees. In 2004, the NHS negotiated lower salaries for doctors in exchange for reduced work hours. Few physicians are available at night or on weekends. Because of low compensation, there is a significant shortage of specialists.

    Physician Choice. Patients have very little physician choice. However, under the experimental London Patient Choice Project, patients waiting more than six months for treatment will be offered a choice of four different treatment providers.

    Copayment/Deductibles. There are no deductibles and almost no copayments except for small copayments for prescription drugs, as well as for optical and dental care.

    Waiting Times. Waiting lists are a huge problem in Great Britain. Some examples: 750,000 are on waiting lists for hospital admission; 40% of cancer patients are never able to see an oncologist; there is explicit rationing for services such as kidney dialysis, open heart surgery and care for the terminally ill. Further, minimum waiting times have been instituted to reduce costs. “A top-flight hospital like Suffolk Est PCT was ordered to impose a minimum waiting time of at least 122 days before patients could be treated or the hospital would lose a portion of its funding.”

    Benefits Covered. The NHS system offers comprehensive coverage. Because of rationing, care might not be as easy to get as advertised. Terminally ill patients may be denied treatment. David Cameron has proposed that the NHS refuse treatment to smokers or the obese

    GERMANY

    The most significant difference between Germany’s health care system and that of other countries is its use of sickness funds. All Germans with incomes under €46,300 are required to enroll in one of the sickness funds. Those with higher incomes can either join a sickness fund themselves or opt out and instead buy private insurance.

    The federal government decides the global budget and which procedures to include in the benefit package.The state government regulates physicians and sets physician reimbursement rates.

    In 2006, Angela Merkel proposed reforming the health care system by creating a centralized health fund, shifting funding from payroll taxes to general revenues, trimming benefits, and increasing cost sharing. This plan was abandoned due to a lack of public support and political opposition.

    Percent Insured. 99.6% (There are about 300,00 uninsured individuals)

    Funding. Sickness funds are financed through a payroll tax which averages 15% (but varies depending on the fund chosen). The tax is split between the employer and employee. In 2006, Germany ran a €7 billion deficit and the government has proposed a 1% increase in the payroll tax.

    Private Ins. Approximated 9% of Germans have supplemental insurance. The private, supplemental insurance covers items not paid for in the sickness fund benefit package. As mentioned above, only middle- and upper-class individuals can opt-out of the sickness funds. Of those eligible to opt out, only about 1/4 of individuals do decide to opt out.

    Physician Compensation.

    Physician reimbursement is set through negotiation with the sickness funds. Most of the negotiating power, however, lies with the sickness funds. Thus, the purchasing power of German physician’s wages is about 20% of that of physicians in the U.S. In 2005, there were physician strikes over low wage compensation. Further, physicians have to deal with significant reimbursement caps and budget restrictions. According to Tanner, physicians only attempt to provide the minimum care necessary.

    Copayment/Deductibles. Until recently, there have been almost no copays or deductibles. Recently, Germans have begun paying €10 copays for prescription drugs, doctors visits, and hospital stays.

    Technology.

    The U.S. has four times as many MRI units per capita and twice as many CT scanners per capita. Tanner claims that the existence of a small private insurance market helps to supplement technology spending. For instance, CT scanners at one point were almost non-existent in the public sector, but competition with private insurance companies meant that the public system had to add more CT scanners.

    Waiting Times. It is a matter of some debate whether or not there are long waits for medical care in Germany. A WHO report says that “Waiting lists and explicit rationing decisions are virtually unknown.” On the other hand, another study finds that care is frequently rationed. For instance, the elderly and those with terminal illnesses are often denied care. Since hospitals are run through a global budget, this can reduce their incentive to treat those with serious, expensive-to-treat medical conditions.

    Benefits covered. There is an extensive benefit package which even includes sick pay (70% to 90% of pay) for up to 78 weeks.

    FRANCE

    France is often seen by liberals as the ideal system. It has universal health care, with few waiting lists. France has the highest level of satisfaction with their health care among all European countries. How can this be? What is their secret?

    France provides a basic, universal health insurances through large occupation-based funds. The General National Health Inusrance Scheme covers 83% of French workers, while other occupational specific (e.g.: for agricultural workers, for the self employed, for miners, etc.) cover the remainder. About 99% of individuals are covered by this universal health insurance system.

    However, France utilizes more market-based ideas than most people realized. Copayment rates for most services are 10%-40%. About 92% of French residents have complementary private health insurance.

    In essence, the French system avoids widespread rationing because, unlike true single-payer systems, it employs market forces. Even the OECD says that the “proportion of the population with private health insurance” and the degree of cost sharing are key determinants of how severe waiting lists will be.

    Insured. About 99% of French residents are covered by the national health insurance scheme.

    Cost. France is the third most expensive health care system (~11% of GDP). While the system has generally been well funded, in 2005 the health care system ran a €11.6 billion deficit and in 2006 the health care system had a €10.3 billion deficit. No centrally planned health insurance system will be immune from occasional (or even frequent) deficits.

    Funding. Most of the funding is from a 13.55% payroll tax (employers pay 12.8%, individuals pay 0.75%). There is a 5.25% general social contribution tax on income as well. Thus, there is an approximately a 18.8% on employees for health insurance. There are also dedicated taxes which are assessed on tobacco, alcohol, and pharmaceutical company revenues.

    Private Insurance. “More than 92% of French residents have complementary private insurance.” This insurance pays for additional fees in order to access higher quality providers. Private health insurances makes up 12.7% of French health care spending. These complementary private insurance funds are very loosely regulated (less than in the U.S.) and the only stringent requirement is guaranteed renewability. Private insurance benefits are not equally distributed so there is, in essence, a two-tier system.

    Physician Compensation. French doctors are paid by the national health insurance system based on a centrally planned fee schedule, but doctors can charge whatever price they want. The fees are based on an up front treatment lump sum, which is similar to DRGs in the U.S. The patient–or their private insurance–must make up the difference between the fee charged by the doctor and the amount paid for by the universal health care system. The average French doctor earns only €40,000, although medical school is free for them and the French legal system is fairly tort-averse.

    Physician Choice. The French have a fair amount of choice in which doctors they choose. However, recently the French have moved towards a more “managed care” practice style where patients have a “preferred doctors” who acts as a gatekeeper for specialists.

    Copayment/Deductibles. 10% to 40% co-payments.

    Technology. The government does not reimburse new technologies very generously and because of global budgets and fee restrictions, there is little incentive to make capital investments in medical technology.

    Waiting Times. France has generally avoided waiting lists, likely due to the fairly high coinsurance charges. Recent trends towards Increased restrictions, reduced reimbursement rates, and rationing has increased wait times however.

    Tanner’s summary. “To sum up: the French health care system clearly works better than most national health care systems. Despite some problems, France has generally avoided the rationing inherent in other systems. However, the program is threatened by increasing costs and may be forced to resort to rationing in the future.”

    CANADA

    Canada has a single payer system but the provinces have the bulk of the responsibility of running the health care system for their own residents. In order to qualify for federal funding, each province must meet the following criteria.

    1. Universality. Available to all provincial residents on uniform terms and conditions;

    2. Comprehensiveness. Covering all medically necessary hospital and physician services;

    3. Portability. Allowing residents to remain covered when moving from province to province;

    4. Accessibility. Having no financial barriers to access such as deductibles or copayments; and

    Public administration. Administered by a nonprofit authority accountable to the provincial government.

    Percent Insured. ~100%

    Funding. Funding is provided jointly by the federal and state governments. The federal government uses funds from general revenue to provide a block grant to each of the provinces. The block grant finances only about 16% of each province’s health care expenditures. The remainder is funded by provincial taxes: mostly personal and corporate income tax. Health care spending makes up between one-third to one-half of provincial social welfare spending. For the nation as a whole, health care costs only 9% of GDP.

    Private Ins. “At one time, all provinces prohibited private insurance from covering any service or procedure provided under the government program. But in 2005, the Canadian Supreme Court struck down Quebec’s prohibition on private insurance contracting.” Private clinics are barred from offering medical services which are covered by the Canada Health Act, but many begun to offer services in the black market.

    Physician Compensation. Physicians work in private practice and are paid on a fee-for-service basis. Since these fees are set by a centralized agency, wages are fairly low which has lead to a physician shortage. There are only 2.1 physicians per 1,000 people. This is far less than the OECD average of 3.0 physicians per 1,000. Hospitals are funded on a global budget basis. Capital expenditures are reviewed and approved on a case-by-case basis.

    Physician Choice. Referrals are required for all specialist services except the ED.

    Copayment/Deductibles. There are generally no copayments or deductibles for services. However, British Columbia, Alberta and Ontario charge insurance premiums (although health services cannot be denied because of inability to pay).

    Technology. The U.S. has five times as many MRI machines per capita as Canada and three times as many CT scanners. However, because of Canada’s proximity to the U.S., many Canadians do have the option of coming to the U.S. for treatment.

    SWITZERLAND

    Of all the countries with universal health care, Switzerland’s is the most market-oriented and merits discussion. Switzerland’s health care spending as a percentage of GDP is second only behind the U.S. (11.6% of GDP for Switzerland, 15.3% for the U.S. according to Frontline), yet the government pays for very little of this funding. The Swiss system is similar to the “managed competition” health care plan proposed by the Clintons in the early 1990s.

    Percent Insured. 99.5%. Does this mean a mandated system system would lead to universal coverage in the U.S? This is unlikely. In Switzerland, a mandate for auto insurance has nearly 100% compliance, but in the U.S. the auto insurance mandate’s compliance rate is only around 83%.

    Funding. Insurance is purchased by individuals. Individuals generally must pay the full cost of premiums, but the government helps to finance insurance purchases for the poor. “These subsidies are designed to prevent any individual from having to pay more than 10 percent of income on insurance,” and one third of Swiss citizens receive this type of subsidy. Thus, the Swiss government only pays for 24.9% of health care costs (compared with 44.7% in the U.S.).

    Private Insurance. All insurance is private insurance. However, insurance companies are mandated to offer the same “basic benefits package.” Some physicians operate outside the negotiated schedules and individuals are beginning to purchase supplemental insurance to cover the cost of these higher cost physicians. Some estimates claim that 40% of Swiss citizens have purchased supplemental insurance.

    Physician Compensation. Physician compensation is negotiated between the insurance companies and doctors on a canton by canton basis. Balance-billing is not allowed. Switzerland has strong regulation with respect to nonphysician health care professionals (e.g., nurses, PAs, NPs,) and thus patients are often compelled to use expensive physicians even when this may not be medically necessary.

    Physician Choice. According to a WHO study, Switzerland ranks second only to the U.S. in terms of the ability of patients to choose their provider.

    Copayment/Deductibles. Premiums are community rated and only adjusted for sex and age. Employers do not pay for workers insurance and thus many Swiss have opted for less expensive plans with higher deductibles. This has lead to the Swiss paying for 31.5% through out of pocket expenses.

    Waiting Times. According to a WHO study, Switzerland ranks second only to the U.S. in terms of timely care.

    Benefits Covered. All insurers cover the “basic benefits package” so most competition between insurers is based on price and service.

  • Report this Comment On September 29, 2013, at 8:56 AM, DunkVT wrote:

    Bertha's post underscores how America's healthcare system was imploding BEFORE the Affordable Care Act. Obama simply tried to address many related issues: 45 million uninsured, rapidly rising healthcare costs, the impact of this rapid rise on the federal budget, moving toward 20 percent of GDP on healthcare, etc.

    As one can see from looking at other countries and their healthcare systems, many other countries have worked out details of these systems that address both quality and expense. The U.S. has waited too long to address this problem.

    Although the Affordable Care Act will need to be adjusted over time as we learn how implementation works in our country, this is what politicians are supposed to do...work together for the public good. Our problems today is that some radicals in the Republican Party simply refuse to work with Democrats.

  • Report this Comment On September 29, 2013, at 2:39 PM, vet212 wrote:

    None of the consequinces are unexpected , unplanned perhaps but not unintended, the Democrats are attempting to follow the 60's radical mantra of tear down destroy anything worth while and the people have given them the power to do it STOOOOOOOOOOOOPID

  • Report this Comment On September 30, 2013, at 6:38 AM, JackTroy wrote:

    How do you know the consequences were unintended or intended? Nobody in Congress had time to read the damn law before they voted for it?

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