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The original intention was for all the states to build their own exchanges. The more liberal democrats wanted a single federal exchange, but compromised to stat

by jaibot 13y ago

The original intention was for all the states to build their own exchanges. The more liberal democrats wanted a single federal exchange, but compromised to state-level exchanges to get enough votes for passage. Then the conservative states declined to make their own exchanges so the federal government had to do it anyway, because the American political system makes no sense.

hga 13y ago
Minor correction that proves the rule: "Then all conservative states except Idaho declined to make their own exchanges...." I'd correct your latter statement to "most recently, the American political system makes no sense". Prior to Obamacare, every major entitlement program, from FDR's Social Security to G. W. Bush's Medicare Part D prescription program was passed with large bipartisan majorities, strongly suggesting they had wide majority support. Obamacare famously did not, heck, it only passed within the Democrats by a whisker, and a lot of them found themselves spending more time with their families after their next election. So any sane plan by Team Obama to implement it should have factored in very strong resistance in a lot of places. Heck, I along with 71% of the people in my Purple, very much not Red, home state of Missouri voted in 2010 to outlaw mandates (http://ballotpedia.org/wiki/index.php/Missouri_Health_Care_Freedom,_Proposition_C_(August_2010) http://ballotpedia.org/wiki/index.php/Missouri_Health_Care_F... ) and then in 2012 62% voted to outlaw the creation of a state exchange unless authorized by the people or the legislature (http://ballotpedia.org/wiki/index.php/Missouri_Health_Care_Exchange_Question,_Proposition_E_(2012) http://ballotpedia.org/wiki/index.php/Missouri_Health_Care_E... ).
- tunesmith 13y ago
  Curious why you voted against the mandate. System-wise, a vote against a mandate is basically a vote for allowing rejection of pre-existing conditions.
  - hga 13y ago
    Note, you're having labeled me as dishonest, that ... frees me a bit from my usual constraints (not that that's costing you upvotes from me for posts like this one: https://news.ycombinator.com/item?id=6623010 https://news.ycombinator.com/item?id=6623010): How about, "Because I have a fucking clue and could see that the ACA would make things at net a lot worse, and very possibly result in my premature death?" Did you even note the vote was almost certainly symbolic? Not that making the most firmest statement (almost 2/3rds of Missouri voters) was pointless. Anyway, you're focusing way too much on the micro-details of political promises. I prefer macro reality. ADDED: ah hah, I now see the ACA is in theory going to save you 20% over your previous costs. No wonder you're defending it. I just hope for your sake you don't e.g. experience a shift from access to healthcare to access to a waiting line, or as Obama himself said, Liverpool Care Pathway style, you don't get a pain pill instead of treatment that will save your life.
    - tunesmith 13y ago
      You're asserting that my defense of the ACA is because my premium went down. That's a pretty uncharitable interpretation of my views. In that same comment I wrote that the chief goal of the ACA was not to lower our premiums. To make it explicit, I would also support the ACA if my premiums had gone up. It sounds like the rest of your views are based off of your beliefs of how things will play out, which is of course difficult to argue about.
      - hga 13y ago
        In the context of your labeling me as dishonest, I think it's a fair counter jab. More seriously, not that you can be bought for so few pieces of silver, but let's suppose your costs tripled as have so many others? These particular long term views are relevant in the context of my likely (at the time) symbolic Proposition C vote; it's indeed difficult to impossible to argue about them, but I hope I've at least demonstrated a basis for my "Obamacare belongs in the ash heap of history" mid-2010 opinion.
protomyth 13y ago
The American political system makes quite a lot of sense. It isn't supposed to be top-down. The writers of the law wanted a top-down centralized approach and that isn't how the US Constitution or US States are structured. You can get away with it for a lot of things, but anything this intrusive just doesn't work. Its not the first or, sadly, the last that the federal government will try this sort of thing.

by jaibot 13y ago

hga 13y ago

Minor correction that proves the rule: "Then all conservative states except Idaho declined to make their own exchanges...." I'd correct your latter statement to "most recently, the American political system makes no sense". Prior to Obamacare, every major entitlement program, from FDR's Social Security to G. W. Bush's Medicare Part D prescription program was passed with large bipartisan majorities, strongly suggesting they had wide majority support. Obamacare famously did not, heck, it only passed within the Democrats by a whisker, and a lot of them found themselves spending more time with their families after their next election. So any sane plan by Team Obama to implement it should have factored in very strong resistance in a lot of places. Heck, I along with 71% of the people in my Purple, very much not Red, home state of Missouri voted in 2010 to outlaw mandates (http://ballotpedia.org/wiki/index.php/Missouri_Health_Care_Freedom,_Proposition_C_(August_2010) http://ballotpedia.org/wiki/index.php/Missouri_Health_Care_F... ) and then in 2012 62% voted to outlaw the creation of a state exchange unless authorized by the people or the legislature (http://ballotpedia.org/wiki/index.php/Missouri_Health_Care_Exchange_Question,_Proposition_E_(2012) http://ballotpedia.org/wiki/index.php/Missouri_Health_Care_E... ).

tunesmith 13y ago
Curious why you voted against the mandate. System-wise, a vote against a mandate is basically a vote for allowing rejection of pre-existing conditions.
- hga 13y ago
  Note, you're having labeled me as dishonest, that ... frees me a bit from my usual constraints (not that that's costing you upvotes from me for posts like this one: https://news.ycombinator.com/item?id=6623010 https://news.ycombinator.com/item?id=6623010): How about, "Because I have a fucking clue and could see that the ACA would make things at net a lot worse, and very possibly result in my premature death?" Did you even note the vote was almost certainly symbolic? Not that making the most firmest statement (almost 2/3rds of Missouri voters) was pointless. Anyway, you're focusing way too much on the micro-details of political promises. I prefer macro reality. ADDED: ah hah, I now see the ACA is in theory going to save you 20% over your previous costs. No wonder you're defending it. I just hope for your sake you don't e.g. experience a shift from access to healthcare to access to a waiting line, or as Obama himself said, Liverpool Care Pathway style, you don't get a pain pill instead of treatment that will save your life.
  - tunesmith 13y ago
    You're asserting that my defense of the ACA is because my premium went down. That's a pretty uncharitable interpretation of my views. In that same comment I wrote that the chief goal of the ACA was not to lower our premiums. To make it explicit, I would also support the ACA if my premiums had gone up. It sounds like the rest of your views are based off of your beliefs of how things will play out, which is of course difficult to argue about.
    - hga 13y ago
      In the context of your labeling me as dishonest, I think it's a fair counter jab. More seriously, not that you can be bought for so few pieces of silver, but let's suppose your costs tripled as have so many others? These particular long term views are relevant in the context of my likely (at the time) symbolic Proposition C vote; it's indeed difficult to impossible to argue about them, but I hope I've at least demonstrated a basis for my "Obamacare belongs in the ash heap of history" mid-2010 opinion.

protomyth 13y ago

The American political system makes quite a lot of sense. It isn't supposed to be top-down. The writers of the law wanted a top-down centralized approach and that isn't how the US Constitution or US States are structured. You can get away with it for a lot of things, but anything this intrusive just doesn't work. Its not the first or, sadly, the last that the federal government will try this sort of thing.