Comment Re:Obama is not (Score 1) 356
You will see that it is going to turn into single-payer without a single vote being cast in favor of a single payer system. This transition will occur overnight (practically) and it is something that was forseen from the first conception of the plan. It is very simple:
In 2014 group health insurance premiums are going to skyrocket mostly because we are moving from a state-by-state "must cover" set of rules to one national set. So if today only plans in California are required to cover acupuncture (or is it acupressure?), in 2014 there is a choice - either it isn't covered anywhere or it is covered everywhere. One national plan requirements set. My guess is that everything covered anywhere will be part of the national plan requirements. That is going to have an effect on premiums.- Similarly, in 2014 if your employer's coverage sucks you can (with the government's blessing) get your own plan from the "exchanges". Your employer is then fined around 150% of your policy's cost - if you took it from your employer. This introduces a huge incentive for employers to drop coverage and eliminate the linkage between having a job and having insurance. Employees then go to the exchanges and get a government-subsidized plan which may cost less than their contribution to the employer plan was costing them - so the employee doesn't lose anything. Huge incentive for companies to get out of the insurance game altogether.
- So now the government is paying these subsidies (which are very large) for nearly 100% of all Americans. The cost of O-Care just jumped from the OMB estimate of around 900 billion to the more pessimistic figures of 2-3 trillion. Maybe more. There simply isn't that much cash lying around for this, even if we eliminate all military forces. So the government is going to be looking for a way to save some serious cash.
- One way is to start rationing care big-time, probably by reversing the difference between US health care and the way it works in the rest of the world. Most US health care spending is better called dying care as it is spent in the last year of life. But getting people to accept that Granny just has to skip that operation and die a little quicker is going to be tough.
So, the next best choice for cost control is to get rid of the insurance companies and pay the bills (at a greatly reduced reimbursement rate) directly - just like Medicare. Problem with that is how many hospitals can afford to take a 50% cut in revenue across the board when today it is made up for by private (cash) patients and private insurance? None, that's how many. So we may see a lot of health care providers simply closing up shop under this plan. But the government will be able to dictate how much the government is spending on healthcare... which by the way is how single-payer works.
So, overnight we have single-payer whether we want it or not. It is built into the system and it will show up by 2016. If things happen really fast, we might see it by the end of 2014.