Misconception #247: It's actually called Bidencare.

July 2, 2012 8:09 AM

What's Obamacare? A studious Reddit user has read the mammoth 955-page Patient Protection and Affordable Care Act, and outlined the important points of what the new law actually does, with specific citations. While the recently-upheld law itself remains unpopular, most individual components of the bill enjoy widespread popularity among republican politicians and the public, despite the fact that both groups remain largely unaware of the bill's actual provisions.

Another interpretation of the PPACA, straight from the horse's mouth.

posted by schmod (77 comments total)

(Oh, and I might not have made it clear enough in the FPP, but the Reddit link is the thing that you should read here. After you do that, you can take turns throwing pies at the news media for profoundly and collectively failing to report on this very basic piece of journalism)
posted by schmod at 8:13 AM on July 2, 2012 [4 favorites]

I spent a while reading through this when it was new, and I was shaking my head the whole time that it wasn't under the masthead of Time magazine or USA Today or NYT some other journalistic organ that claims to cover important events in depth.
posted by wenestvedt at 8:17 AM on July 2, 2012 [5 favorites]

...among republican politicians and the public, despite the fact that both groups remain largely unaware of the bill's actual provisions

This is how to turn the PR tide, Democrats. EDUCATE the public. Honestly, I wish I knew how to accomplish this, given nobody seems to want to listen, but get people to understand the bill and you win.

Love that bullet point breakdown of the bill. Very well done, Reddit user.
posted by mcstayinskool at 8:21 AM on July 2, 2012 [15 favorites]

Holy shitballs, there is a lot of awesome stuff in there that I didn't realize was in there, and I consider myself pretty well informed. For example: it looks to my reading like biologic therapy for rheumatoid arthritis, which is currently illegal to produce in any way other than the incredibly expensive name brand, will now be able to be sought for generic approval.
posted by KathrynT at 8:21 AM on July 2, 2012 [5 favorites]

Honestly, I wish I knew how to accomplish this, given nobody seems to want to listen, but get people to understand the bill and you win.

Start by sending this out on Facebook and Twitter?
posted by vacapinta at 8:22 AM on July 2, 2012 [5 favorites]

Diane Rehm had her first hour this morning dedicated to ACA. She had a caller who identified themselves as, I believe, a nurse at a large hospital. She said the hospital management told them after the SCOTUS decision that ACA was going to be responsible for many of them losing their jobs at the hospital.

One can only imagine how much ACA is going to be used as a handy scapegoat for all manner of negative corporate decisions in the coming months.
posted by Thorzdad at 8:23 AM on July 2, 2012 [15 favorites]

Right after I posted this, this Kaiser Foundation quiz on the bill's provisions popped up in my Facebook feed. Massive selection-bias disclaimers apply, but it's still pretty interesting to look at. It's worth mentioning that Kaiser Foundation appears to be the one of the only major players competently covering and explaining the reform as it progresses. If you have even a passing interest in this stuff, their site offers some fascinating reads.
posted by schmod at 8:26 AM on July 2, 2012 [5 favorites]

you can take turns throwing pies at the news media for profoundly and collectively failing to report on this very basic piece of journalism

I was shaking my head the whole time that it wasn't under the masthead of Time magazine or USA Today or NYT some other journalistic organ that claims to cover important events in depth.

Where is this coming from? I'm pretty sure every major media outlet has done something like this. Here's one from the New York Times from 2010:

http://www.nytimes.com/2010/03/22/your-money/health-insurance/22consumer.html

Also, the Reddit writeup is editorialized ("If you make over $200,000 a year, your taxes go up a tiny bit"), and it doesn't include "everything" in the bill, as it says it does.

You can't blame news outlets for people not paying attention.
posted by ultraviolet catastrophe at 8:29 AM on July 2, 2012 [3 favorites]

I have spread links to that Reddit page for the last week or so. It really is the best synopsis that I've found so far.

Oh, and if I hear one more fat-ass ignorant Republican douchebag (think Mitch McConnell) say things like insuring 30 million more people is "not the issue", or "Americans don't want this", or "we have the best healthcare system in the world", I may actually explode.
posted by Benny Andajetz at 8:30 AM on July 2, 2012 [5 favorites]

The battle has moved to the implementation phase. The Confederate Party will fight this as hard as they fought school segregation for 50 years. King Rick I of Florida just decreed that Florida residents won't see any of the benefits. Sorry Florida, you're getting what you elected. People of South Carolina, Texas, Virginia, Michigan and Wisconsin should take a long hard look before November.
posted by T.D. Strange at 8:30 AM on July 2, 2012 [3 favorites]

You can blame news outlets for focusing on the silliest shit they can find though.
posted by Artw at 8:30 AM on July 2, 2012

*de-segregation
posted by T.D. Strange at 8:31 AM on July 2, 2012

Just posted it to FB for the benefit of my US friends. Hope it has an impact. Thanks for posting schmod.
posted by arcticseal at 8:44 AM on July 2, 2012

The Reddit writeup is also -- coincidentally -- a lot like this summary on Wikipedia.
posted by ultraviolet catastrophe at 8:44 AM on July 2, 2012

This morning, I will be doing my part and forwarding this list to every. single. person. that I know of voting age.

And this is an aside, but I'll probably vote this upcoming election for Obama and every other democrat in my districts who supported it (I am a registered Socialist, and vote that way) but this is a step in the right direction, and should be rewarded. It's not perfect. Not everyone is going to be happy with it, but it's actual, tangible progress.
posted by furnace.heart at 8:48 AM on July 2, 2012 [4 favorites]

Excellent article, gonna pass this around.
posted by kafziel at 8:49 AM on July 2, 2012

This is how to turn the PR tide, Democrats. EDUCATE the public.

We can't. Journalism has been gutted - accurate information is not presented fairly if one "side" makes outrageous lies to counter it... instead it's presented as the lies told by the other side. All journalism does these days when covering public policy is to present information on the opposing opinions. Mainstream news outlets will not referee anymore... it's not profitable, and makes enemies in the business and regulatory spheres.
posted by Slap*Happy at 8:58 AM on July 2, 2012 [7 favorites]

This is a great condensation of a very complex statute. Thanks for posting.
posted by caddis at 9:02 AM on July 2, 2012

Print this out and start handing it to people
posted by Mick at 9:10 AM on July 2, 2012 [1 favorite]

When he talks about the changes that go into effect on Jan. 1, 2013 and says that people who earn more than $200,000 a year will get a tax increase of 0.9 percentage points, he mysteriously leaves out a new 3.8 percent tax on investment income for the same tax bracket that goes into effect at the same time.

If we're really talking about educating the public, there are better summaries out there, such as the one on Wikipedia.
posted by ultraviolet catastrophe at 9:10 AM on July 2, 2012

Meanwhile, down in the comments is a link to a simple explanation of the heart of the legislation:

Bob: Hi, insurance company. I'd like to buy some health insurance.
Insurance company: No. You had cancer when you were 3 years old, and the cancer could come back. We're not selling health insurance to you.
Bob: It's not my fault I got cancer when I was three! Besides, that was years ago!
Insurance company: If we sell insurance to you, we'll probably lose money, and we're not doing it.
Bob: But I need insurance more than anyone! My cancer might come back!
Insurance company: We don't care. We're not selling you insurance.
Obama: Hey, that's totally not fair. Bob is right, he does need insurance! Sell Bob some insurance.
Insurance company: If we have to, I guess.
Mary: This is cool. Obama said the insurance company has to sell insurance to anyone who needs it.
Sam: Hey, I have an idea. I'm going to stop paying for health insurance. If I get sick, I can always go buy some insurance then. The insurance company won't be able to say no, because Obama's told them they have to sell it to anyone who needs it!
Dave: that's a great idea! I'm not paying for health insurance either, at least not until I get sick.
Insurance company: Hey! If everyone stops paying for insurance, we'll go bankrupt!
Obama: Oh come on Sam and Dave, that's not fair either.
Dave: I don't care. It saves me money.
Obama: Oh for god's sake. Sam, Dave, you have to keep paying for health insurance, and not wait until you're sick. You too, Mary and Bob.
Mary: But I'm broke! I can't buy insurance! I just don't have any money.
Obama: Mary, show me your piggy bank. Oh, wow, you really are broke. Ok, tell you what. You still have to buy insurance, but I'll help you pay 95% of the cost.
Mary: thank you.
Obama: I need an aspirin.
Insurance company: We're not paying for that aspirin.
posted by EmilyClimbs at 9:11 AM on July 2, 2012 [133 favorites]

When he talks about the changes that go into effect on Jan. 1, 2013 and says that people who earn more than $200,000 a year will get a tax increase of 0.9 percentage points, he mysteriously leaves out a new 3.8 percent tax on investment income for the same tax bracket that goes into effect at the same time.

I'll submit that the people who are affected by this:

A. Probably already know about this
B. Are in a group that, to a much greater degree than the general public, will be opposed to this law regardless
C. Are way down the list of people who need to learn what's actually in the law
posted by Benny Andajetz at 9:28 AM on July 2, 2012 [7 favorites]

Awesome link - thanks for posting.
posted by wolfdreams01 at 9:28 AM on July 2, 2012

People have mentioned this on here before but I think it bears reiterating. When polls say that the bill is unpopular, it can provide the misleading impression that the majority of people are against any kind of universal healthcare. When I think it's probably more accurate to say that a significant proportion of the people polled don't like the bill because it doesn't go far enough in providing healthcare for all in an equitable manner.

I kind of wish they would poll more accurately on this issue because I think the numbers would be very different and then people who are against universal healthcare could quit using this as a talking point.
posted by triggerfinger at 9:30 AM on July 2, 2012 [4 favorites]

It's not unrelated. From Wikipedia:

In addition, an additional Medicare tax of 3.8% will apply to unearned income, specifically the lesser of net investment income or the amount by which adjusted gross income exceeds $200,000 ($250,000 for a married couple filing jointly; $125,000 for a married person filing separately.

I would instead point out that if it had been included in the reddit link's list of bullet points, it would have been the least important point on the list. I'm interested in what the act will do for fixing the most broken healthcare system in the developed world, and largely could care less about higher taxes for people earning more than $200K.
posted by mcstayinskool at 9:32 AM on July 2, 2012 [2 favorites]

...but I do have to agree that it probably should have been included for completeness
posted by mcstayinskool at 9:32 AM on July 2, 2012

Isn't that part of unrelated legislation? Why would you include other tax increases in a discussion about ACA?

Nope, it's in the ACA. I'm not saying I'm not in favor of the tax increases, but I am in favor of getting all the facts.
posted by ultraviolet catastrophe at 9:32 AM on July 2, 2012 [1 favorite]

I kind of wish they would poll more accurately on this issue because I think the numbers would be very different and then people who are against universal healthcare could quit using this as a talking point.

To be fair, a lot of polls actually do go into the nitty-gritty, including breakdowns of specific provisions and too far/just right/not far enough. It's just that few media outlets (including some of those that also conduct those polls) actually report it as such, or bury it in a sentence or two towards the end of the article. For instance, almost every provision of the ACA apart from the mandate was and is polling as popular (sometimes overwhelmingly so), and I've since started seeing bloggers, if not journalists, pointing out which side people who don't like it fall on.
posted by zombieflanders at 9:36 AM on July 2, 2012

triggerfinger: "When I think it's probably more accurate to say that a significant proportion of the people polled don't like the bill because it doesn't go far enough in providing healthcare for all in an equitable manner."

Generally speaking, the polls are worded to rule that possibility out.

That said, polling on the healthcare bill varies wildly depending upon how the poll is worded, which suggests that the information gap might be playing an even bigger role than what we're currently acknowledging.

No matter how you spin it, the bill just isn't very popular right now, even though the things that it does are.
posted by schmod at 9:37 AM on July 2, 2012 [1 favorite]

I would instead point out that if it had been included in the reddit link's list of bullet points, it would have been the least important point on the list. I'm interested in what the act will do for fixing the most broken healthcare system in the developed world, and largely could care less about higher taxes for people earning more than $200K.

You may not care, but without that 3.8 percent tax we wouldn't have the healthcare bill. It raises $210 billion in revenue over 10 years. That's almost half of the $440 billion in new revenue that the bill raises overall. Without that revenue, Republicans never would have agreed to pass the bill.

Tax provisions are absolutely essential to any new piece of legislation because there's a law that says that Congress has to pay for any new spending unless they specifically exempt the bill from that requirement, and they have to pay for it by either raising taxes or cutting other spending.
posted by ultraviolet catastrophe at 9:42 AM on July 2, 2012 [1 favorite]

without that 3.8 percent tax we wouldn't have the healthcare bill

Right, and I concede this point entirely.

I'm willing to guess that the Reddit link misses a bunch of other stuff about how we're going to pay for it, but I think the spirit of this bullet list is about what the act going to do, not how it's going to be paid for.

Maybe they should have left out the tax bullet point entirely? I'm mainly coming at this from the perspective that the most concise description of what the act will do is needed for the majority of Americans who can't pay attention enough to understand it.

How it's going to be paid for is important, but (perhaps) could have been handled in a separate list.
posted by mcstayinskool at 9:55 AM on July 2, 2012

Without that revenue, Republicans never would have agreed to pass the bill.

How many Republicans agreed to the bill? My recollection of the legislation process doesn't involve a lot of what I would call support from that party.
posted by weston at 9:55 AM on July 2, 2012 [2 favorites]

How many Republicans agreed to the bill? My recollection of the legislation process doesn't involve a lot of what I would call support from that party.

You're right, and the way I worded that made it sound like Republicans supported the tax increase, which of course they don't. But not paying for a significant part of the bill would have opened it up to accusations that it was another unfunded Democratic spending program. It was essential for Obama and Democrats to say that the bill was paid for.
posted by ultraviolet catastrophe at 10:02 AM on July 2, 2012 [1 favorite]

Zero Republicans agreed to pass the bill.

Any bullet list should really have this as every other line.
posted by Benny Andajetz at 10:13 AM on July 2, 2012 [12 favorites]

Zero Republicans agreed to pass the bill.

Right. I didn't word it very well. Not paying for the bill would have made it vulnerable to a so-called pay-go point of order by Republicans.

More about pay-go here.
posted by ultraviolet catastrophe at 10:19 AM on July 2, 2012

If you want to know about taxes included in the PPACA go to a conservative think tank hit piece. The claim is 500 billion over 10 years or about 50 billion a year for "universal" healthcare. Compare that to the cost of DoD operations budget for the Afghan war @ 115 billion for 2012. This war has never been pay as you go.

Obamacare is the problem?
posted by pdxpogo at 10:31 AM on July 2, 2012 [4 favorites]

Over the weekend, barely more than half of Americans knew that the ACA was upheld last week, and 18% were certain that the verdict hadn't been announced.
posted by schmod at 10:45 AM on July 2, 2012 [5 favorites]

If you want to know about taxes included in the PPACA go to a conservative think tank hit piece.

If you want the nonpartisan rundown, look to the Joint Committee on Taxation, which does the official tallies of how much revenue the tax provisions in a piece of legislation will raise or lose. Here (PDF) is the revenue estimate for ACA and here (PDF) is the JCT's explanation of how the tax provisions work.
posted by ultraviolet catastrophe at 11:08 AM on July 2, 2012 [2 favorites]

Over the weekend, barely more than half of Americans knew that the ACA was upheld last week

That's actually quite high for a recently-announced, somewhat arcane Supreme Court decision.
posted by downing street memo at 11:22 AM on July 2, 2012

Most people are unaware of any provisions beyond the individual mandate. Those who supprt the bill need a simple "no free riders" campaign. There is nothing Americans hate more than some jerk who is getting a free ride. I propose the following ad:
Jermaine is a drug dealer living in Detriot. He has a dozen gold chains but no health insurance. When one of his six illegitimate kids by 6 different women gets sick, you pay. When gets shot in a deal gone bad, you pay. When he OD's you pay. Republicans think this shouldn't be a crime, in fact they call it freedom. I call it the freeloading, the only freedom is that Jermaine is free to screw you over. Thanks to Obamacare, we can punish these freeloaders They want to repeal Obamacare and stick and go back to the old days when you got stick with the bill. Call Congress today and say keep Obamacare and stop freeloading drug dealers like Jermain.
posted by humanfont at 11:41 AM on July 2, 2012 [15 favorites]

I'm pretty sure every major media outlet has done something like this.

Well, none that I read.

My state's main newspaper, the sorry ass Providence Journal, hasn't done a chart like this. And I don't watch much TV (my kids are usually watching Ruff Ruffman or something), and while I listen to NPR I just don't recall a wall of sound like this -- though, to be fair, if they ever read off this list of bullet points I would have dozed off and driven into a ditch.
posted by wenestvedt at 11:41 AM on July 2, 2012

http://www.reddit.com/tb/vbkfm

>This is how to turn the PR tide, Democrats. EDUCATE the public.
Slap*Happy: We can't. Journalism has been gutted

Well, obviously, it is possible. This guy just did it.

This is slightly off-topic but I find it fascinating. Obviously, someone has read the bill before, the people who wrote it. And some of the people who voted on it read it, or at least someone on their staff did. And when bills are passed, there are people whose jobs it is to implement them who will read it.

Bills are a lot like DNA in that they contain the instructions necessary to write elements of some language upon the world. But the mechanism by which those instructions are read and implemented is weird and interesting, and to some extent, I would think, you can't understand the instructions without understanding that translation. How does that happen, and is this process vulnerable to abuse?
posted by JHarris at 11:43 AM on July 2, 2012 [1 favorite]

Obama: Mary, show me your piggy bank. Oh, wow, you really are broke. Ok, tell you what. You still have to buy insurance, but I'll help you pay 95% of the cost.


I'd love to post that dialogue to Facebook as a great explanation of why it's only fair to require everyone to have health insurance. But this part is the real sticking point. It's not Obama who's paying 95% of the cost, but taxpayers. And there's a lot more people who think they're too broke to afford it than the law will cover.

I support progressive taxation to provide health care for those who can't afford it (although I'd much prefer a single-payer solution and truly universal health care), but that's not as popular and obviously fair as the other parts of the plan, and yet it's an essential component that we can't pretend isn't there.
posted by straight at 11:46 AM on July 2, 2012 [1 favorite]

No, ‘Obamacare’ isn’t ‘the largest tax increase in the history of the world’ (in one chart)
posted by homunculus at 12:43 PM on July 2, 2012 [4 favorites]

the Reddit writeup is editorialized ("If you make over $200,000 a year, your taxes go up a tiny bit")

How is this editorializing? Under what definition of "tiny" does a nine-tenths of a percent increase in taxes fail to qualify as tiny? The impossibility of satisfying everybody is precisely the reason you don't such a clear straightforward statement of facts from the mainstream media.
posted by jonp72 at 1:00 PM on July 2, 2012 [7 favorites]

stop freeloading drug dealers like Jermain.

Something tells me Jermain's supplier isn't filing W2's and that Jermain isn't completing his 10-40 EZ yearly as he should be, and therefore this bill won't really help prevent "freeloaders" of this fashion in any appreciable way.

./nitpick

on topic - awesome work, reddit poster. I'll forward this on...
posted by Nauip at 1:21 PM on July 2, 2012

She said the hospital management told them after the SCOTUS decision that ACA was going to be responsible for many of them losing their jobs at the hospital.

Many corporations will indeed do this, but then again, what can you expect? Shitty companies will use any means to be shitty.

The company I work for, a Catholic healthcare ministry, actually sent out an email after the ruling to come out in favor of the ACA, which I was impressed with, because of all the death panels and forced contraception in the bill.
posted by dave78981 at 1:29 PM on July 2, 2012 [1 favorite]

ultraviolet catastrophe: "When he talks about the changes that go into effect on Jan. 1, 2013 and says that people who earn more than $200,000 a year will get a tax increase of 0.9 percentage points, he mysteriously leaves out a new 3.8 percent tax on investment income for the same tax bracket that goes into effect at the same time. "

If this was a comment about the tanning bed tax, it would be so goddamned eponysterical, I'd have to suture my gut from laughing so hard. *sigh*
posted by symbioid at 2:02 PM on July 2, 2012

I'd love to post that dialogue to Facebook as a great explanation of why it's only fair to require everyone to have health insurance. But this part is the real sticking point. It's not Obama who's paying 95% of the cost, but taxpayers.

But taxpayers are already paying for ED care, which is by far the most expensive way to treat people. That's at the heart of all of this - that early non-ED care saves loads of money.
posted by Sebmojo at 2:03 PM on July 2, 2012 [1 favorite]

What about the person who has a family of 5 and makes $100,000/year. Today, that person probably pays maybe $8-10K/year for insurance for the entire family. Under the ACA, in 2016, if they choose not to have health insurance, they'll have to pay $2.5K as a penalty. Besides being foolish and risking their family's health, what is the downside to paying the fine every year, paying medical bills out of pocket, and then when something seriously goes wrong, getting insurance? Are premiums higher for the first year back or something? Is this a problem in Mass?
posted by (Arsenio) Hall and (Warren) Oates at 2:04 PM on July 2, 2012

the Reddit writeup is editorialized ("If you make over $200,000 a year, your taxes go up a tiny bit")

How is this editorializing?

Because a "clear straightforward statement of facts" would just say how much the tax increase is (0.9 percentage points) without characterizing it as large or small. There's no such thing as a "tiny" tax increase or a "massive" tax increase. They're only tiny or massive in relation to something else.

Under what definition of "tiny" does a nine-tenths of a percent increase in taxes fail to qualify as tiny?

Well, what if I told you it was a 62 percent increase in the hospital insurance tax rate levied on upper-income earners? Which it is, because the rate is increasing from 1.45 percent to 2.35 percent. That doesn't sound tiny when you put it that way.

I'm not saying it should be characterized as a large or small tax increase, I'm saying it depends on how you look at it. If you are characterizing it one way or the other you're already looking at it from a certain perspective, and thus it's editorialized.
posted by ultraviolet catastrophe at 2:21 PM on July 2, 2012

It's not Obama who's paying 95% of the cost, but taxpayers. And there's a lot more people who think they're too broke to afford it than the law will cover.

Well, obviously "Obama" is a simplification of "the government" in the whole dialogue. And while I support single-payer too and I don't think the subsidies go high enough either, they're not just for a small sliver of lower-income folks-- they go up to 400% of the federal poverty level, around $45,000 a year for a single person or $90,000 for a family of four. (Of course there's a phase-out, and folks at the top won't be getting 95% of the cost subsidized. But they will be guaranteed to pay no more than 9.5% of their income on health insurance.)
posted by EmilyClimbs at 3:10 PM on July 2, 2012

straight: "And there's a lot more people who think they're too broke to afford it than the law will cover. "

There's a lot of people who are misinformed then, given that the subsidies aren't completely phased out until 400%(!) of the poverty line. That is to say, if you are a single taxpayer and make less than $44,680 (barring deflation in the interim) you will be eligible for some subsidy. Obviously, if you're very close to that income, it will be much smaller than if you only make $22,340.

For a family of four, that's over $92,000 a year you can make and still get help paying for insurance.

Overall, I think it's a dumb way to go about this because it fails to eliminate one of the most useless parts of our health care system, dealing with the insurance companies, but it's specifically designed to avoid creating hardship for those who can't afford insurance coverage on their own and who will be required to obtain it under the law.
posted by wierdo at 3:11 PM on July 2, 2012

Big journalism today is all about the fucking horserace to power. Who's up. Who's down. No one cares if the horse is dying or on steroids or a hollowed-up shell filled with re-constituted bile of a thousand rabid weasels. Just whose nose is an inch closer to the finish line. Glorified gossip columnists.
posted by RandlePatrickMcMurphy at 3:29 PM on July 2, 2012 [3 favorites]

From the article by Nate Silver: "Meanwhile, the level of public knowledge about the bill is relatively low. Many Americans do not know what exactly the bill does, or they have mistaken impressions about it."

And the dumbening of America continues.
posted by reenum at 3:49 PM on July 2, 2012 [1 favorite]

Something tells me Jermain's supplier isn't filing W2's and that Jermain isn't completing his 10-40 EZ yearly as he should be

There was no welfare queen in Chicago driving a Caddy, but it still got Reagan 2 terms and ended welfare as we knew it. Distilling your argument to a myth that plays to truthyness and exploits jealousy is an effective tactic.

Besides being foolish and risking their family's health, what is the downside to paying the fine every year, paying medical bills out of pocket, and then when something seriously goes wrong, getting insurance?

An injury in a household accident or accute illness isn't covered unless you have insurance, it isn't a pre-existing condition. So most things that would wipe you put financially you'd be on the hook for. A broken arm is $20k or so.
posted by humanfont at 4:08 PM on July 2, 2012 [3 favorites]

Just to echo that, when I broke an arm and a leg, my hospital bill was over $100k. Perversely, because I didn't have insurance, the taxpayers got stuck with that bill.

(I'll add that I am also a tax payer, I just didn't have $100k sitting around.)
posted by klangklangston at 4:13 PM on July 2, 2012 [2 favorites]

Those are good points, Sebmojo, Wierdo, and EmilyClimbs. Thanks.
posted by straight at 4:22 PM on July 2, 2012

Overall, I think it's a dumb way to go about this because it fails to eliminate one of the most useless parts of our health care system, dealing with the insurance companies

It's definitely inefficient, but it also represents a lot of pretty-good-quality jobs in the insurance industry. If we got rid of it all, eliminating all those jobs, what are the chances we'd spend the savings on anything of equal value to the economy? We'd probably just buy more crap from China at Wal-Mart.
posted by straight at 4:27 PM on July 2, 2012 [1 favorite]

Isn't that part of unrelated legislation? Why would you include other tax increases in a discussion about ACA?

ultraviolet catastrophe: Nope, it's in the ACA. I'm not saying I'm not in favor of the tax increases, but I am in favor of getting all the facts.

The 3.8% medicare tax on unearned income is not in the ACA. It is part of the Health Care and Education Reconciliation Act. The ACA was signed on March 23, 2010. The HCERA was signed on March 30, 2010.

You could say that the tax provision is part of the "Obamacare" package, but it is not the ACA. The Reddit account is correct, but could be helpfully amended to include the HCERA.

The HCERA includes some important revenue provisions such as the 3.8% medicare tax, delays the excise tax on "cadillac" health plans to 2018, charges employers a penalty if they do not provide employees a health plan, provides better subsidies for low income people, closes the prescription drug donut hole and includes the struck down state Medicaid provisions.
posted by JackFlash at 5:08 PM on July 2, 2012

GOP Governors May Turn Down $258 Billion In Obamacare Funds, Leave 9.2 Million Americans Uninsured
posted by homunculus at 5:24 PM on July 2, 2012 [3 favorites]

Thanks for this! The bill covers dental insurers as well, right? My teeth and I are pretty excited about the end of yearly caps, if so.
posted by rifflesby at 6:36 PM on July 2, 2012

It's also worth reading the only journalist cited as a source in the Supreme Ct decision: Suzy Khimm -- Will states really turn down federal money? They’ve done it before. It's taken what? about 100yrs to get legislation of this magnitude on healthcare through, yeah? I can easily understand how it may take some years for the ripples of opposition and undermining to subside.

Hell, with McConnell's gaffe about insuring the uninsured 30 million not being "the issue" and his basic admission that repeal is much less likely now to Mr etch-a-sketch advisor to Romney saying the mandate is definitely not a tax and a majority in a poll thinking that this healthcare thing should be laid to rest (kinda sorta words to that effect), I'd say repubs are going to lose healthcare as a major issue over the coming months. The overall legislation - and not just the parts - might even reach 50% approval by November. BFD
posted by peacay at 8:08 PM on July 2, 2012

Thanks for this! The bill covers dental insurers as well, right? My teeth and I are pretty excited about the end of yearly caps, if so.

It does? If so, my teeth and caps are happy about the caps on teeth.
posted by krinklyfig at 10:29 PM on July 2, 2012

Excellent post, thank you.
posted by Vindaloo at 12:59 AM on July 3, 2012

Just to echo that, when I broke an arm and a leg, my hospital bill was over $100k.

Oh my GOD. How the hell does something like that happen, a tenth of a million because you broke two limbs?!
posted by JHarris at 2:05 AM on July 3, 2012

Quite easily JHarris. He was in a bicycle accident and I assume they did a lot of diagnostic tests (X-rays, CT scans, MRIs) to look for other injuries. Those cost a ton of money. Plus he needed surgery and I think he stayed in the hospital for a while. In addition there are lab fees (they often take your blood at least daily), doctor fees, surgeon fees, anesthesia fees, etc. all of which may be billed separately from the main hospital charges. And I don't know if he needed physical therapy.

Klang's my birthday twin. Hope you're well, Klang, I thought of you Sunday.
posted by IndigoRain at 2:22 AM on July 3, 2012 [1 favorite]

The 3.8% medicare tax on unearned income is not in the ACA. It is part of the Health Care and Education Reconciliation Act.

"ACA" is used as shorthand for both acts since it would be onerous to mention them both in t he same breath all the time. The Reddit account includes provisions from both. For example, it includes the closing of the Medicare donut hole by 2020.
posted by ultraviolet catastrophe at 5:10 AM on July 3, 2012

Thank you for this. This is the first time I've felt like I could sensibly argue with my Republican FB friends about Obamacare and know what I'm talking about. I'm surprised at how in favor of it I am. It's not as revolutionary as I'd like, but not nearly as ineffectual as I'd suspected.

Weee!
posted by Peevish at 7:21 AM on July 3, 2012

Quite easily JHarris. He was in a bicycle accident and I assume they did a lot of diagnostic tests (X-rays, CT scans, MRIs) to look for other injuries.

I was expressing rhetorical disbelief, not asking to have it explained to me. But even explained, that honestly seems like price gouging, or at least running up charges. I'm sure if examined closely it could be made to seem reasonable, but I can't help but think that it's really just the hospital negotiating from a position of power.
posted by JHarris at 8:38 AM on July 3, 2012

"Klang's my birthday twin. Hope you're well, Klang, I thought of you Sunday."

Aww, thanks Indigo. Hope your birthday was awesome too.

"But even explained, that honestly seems like price gouging, or at least running up charges. I'm sure if examined closely it could be made to seem reasonable, but I can't help but think that it's really just the hospital negotiating from a position of power."

I spent five days in the hospital, and the room was charged at over $10k per day. That made up the bulk of the fees, if I recall correctly. At least it included meals!
posted by klangklangston at 11:23 AM on July 3, 2012 [1 favorite]

But even explained, that honestly seems like price gouging, or at least running up charges.

A friend of mine was in a hit-and-run on her bicycle. A neighbor called 911 when they found her unconscious in the street. Nobody knows what happened, but her helmet was split fore and aft. She spent nine days in the neuro ICU at our local trauma center, most of them in a sedation coma while they waited for the swelling in her brain to go down. When she came to, she was able to get on the wireless (she was a grad student at the university complex that is affiliated with the hospital) and reach out to folks online.

"I'm worried about how much this is going to cost," she messaged me. "I mean, this hospital room has got to be at least $800 a day just for the room, right?"

I wrote back and said "Oh, honey. I'm so sorry, but in the spirit of honesty I need to tell you that you need to add at least another zero to that total. The recovery room when I was in the maternity ward was $1200 a day and that was basically just a room with oxygen in the walls, not an ICU unit."

Through a combination of luck and will, she needed a much shorter hospital stay than the doctors expected, and almost no physical therapy. She was 9 days in the neuro ICU and I think three or four in the stepdown unit. Her total bill before insurance got a hold of it was pushing half a mil, and after her insurance was done, her responsibility was something like $30K. Thirty thousand dollars for an accident she doesn't even remember.

Just a couple of days ago, I had to take my 18 month old son to the ER for breathing problems (croup), and he seemed to maybe be improving on the drive. We've done this before, but for all our previous visits, he had a Cadillac insurance plan that covered everything. Now we have individual insurance that is OK but frankly not great. I sat out in the parking lot with him for about fifteen minutes, knowing that if I walked in through the door it was going to cost a minimum of a thousand dollars. But then he started to go into distress, and I thought "Well, OK, here we go" and took him in. They haven't submitted to my insurance company yet so I have no idea how much it's going to cost, but I'm pretty sure it's going to be at least a couple of grand, and we needed only medical intervention (drugs, and cheap ones) and monitoring, no diagnostics or bloodwork or X-rays. And we were there for less than 24 hours.

Hell, I had to take my daughter to the urgent care for IV rehydration due to gastroenteritis, and that was $700 after insurance. It might be price gouging, but that's what these things cost.
posted by KathrynT at 12:00 PM on July 3, 2012 [2 favorites]

In other news, GlaxoSmithKline pays record-setting $3,000,000,000.00 fine for fraud and misrepresentation.
posted by warbaby at 12:10 PM on July 3, 2012 [1 favorite]

Mitt Romney's two-minute PowerPoint explanation of the individual mandate personal responsibility principal and why it's totally great, as explained to the Heritage Foundation all the way back in the ancient mists of 2006.
posted by Rhaomi at 2:24 PM on July 3, 2012 [3 favorites]

King Rick I of Florida just decreed that Florida residents won't see any of the benefits. Sorry Florida, you're getting what you elected.

They may also be getting tuberculosis: Rick Scott Shuts Down TB Hospital Amid "Worst Outbreak in 20 Years" - Despite a warning from the Center for Disease Control, it's the latest move by the Florida governor to gut public services.
posted by homunculus at 12:59 PM on July 9, 2012 [3 favorites]

Texas Refusal To Comply With ACA Will Hurt Sexual Health Outcomes
posted by homunculus at 4:06 PM on July 9, 2012

How I lost my fear of Universal Health Care, one American in Canada's experience.

Followup : Why I used to be afraid of Universal Health Care
posted by the man of twists and turns at 6:03 PM on July 29, 2012 [1 favorite]