Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

http://www.nejm.org/doi/full/10.1056/NEJMp1616577

by cagrimmett • 9 years ago

51 85 9 years ago

jbigelow763• 9 years ago

I doubt anyone in Congress or the White House working to repeal the ACA reads the New England Journal of Medicine.

grzm6• 9 years ago

It's a pretty prestigious journal. It's likely that aides to senators and representatives in key positions, as well as it being forwarded from interested constituents will make sure that the article makes the rounds. And it's generally good political practice to keep informed on the moves made by major players. Likely people in the White House know about it as well.

dghughes2• 9 years ago

It's a pretty prestigious journal...

It is but these days it can hard to know going by past reputation alone.

There seems to be a push by some sleazy publishers to buy prestigious medical journals and then take money to publish questionable studies.

Even the watchdogs who have tried to warn everyone have given up (or were forced to shut up).

http://www.ctvnews.ca/health/website-tracking-so-called-pred...

jbigelow763• 9 years ago

When I say "read" I mean take the time to understand it and put thoughtful consideration into it. Repealing Obamacare is an idealogical imperative to most Republican legislators, it's intrinsic to their identity now. Awareness of what they probably consider propaganda is not the same as "reading" it.

projektfu• 9 years ago

They might not, but they are probably lobbied by doctors, hospital administrators, and insurance executives, all of whom are likely to at least skim the top medical journals.

maxxxxx4• 9 years ago

I don't think any of these groups care much about affordable Care.

jbigelow763• 9 years ago

A good chunk of the rich that foot the bill for a lot of the ACA subsidies[2], the same ones that pump money into PACs and would see money coming back into their pockets if the ACA was repealed [1], also have a vested interest in saying "meh, those journals are full of crap".

1. http://www.slate.com/blogs/moneybox/2017/01/12/obamacare_rep...

Edit: 2. If this is bullshit I sincerely want to know so I can understand all sides.

pcunite• 9 years ago

will likely be true with President-elect Donald Trump

Is it still proper to refer to him that way?

tinalumfoil• 9 years ago

Only if it was initially published before the inauguration, which it appears to be.

grzm6• 9 years ago

Looks like the article was first published prior to the inauguration:

This article was published on January 6, 2017, at NEJM.org.

Admittedly it's a bit confusing, given the online article is dated January 26, and includes "SOURCE INFORMATION: Mr. Obama is the former President of the United States." Likely inconsistency when repurposing content.

spoiledtechie2• 9 years ago

It's a wonderful idea. Free healthcare for all. Sadly, it simply isn't sustainable financially. I think in the next 10 years alone it was supposed to cost tax payers 10 trillion and that money can't literally be printed fast enough and the debt our country holds, extremely unsustainable. If they did it cheaper or more cost effective, I would say yes, but financially, you can't.

aplummer• 9 years ago

It's sustainable in all the other first world countries. I don't understand what is different about the United States.

hsitz• 9 years ago

I'm not sure what you're talking about, but it's definitely not the ACA/Obamacare. The ACA has has nothing to do with "free healthcare for all", and is only tangentially related to free healthcare for anybody (by its relations to Medicaid and Medicare).

If you're talking about virtually every major country besides the U.S., though, they do have something close to free healthcare for all, and it does work, and it's actually a lot cheaper for their societies than the system we have in U.S.

pessimizer• 9 years ago

Entirely silly. Free healthcare is cheaper than what we have. If we could reduce the portion of GDP spent on healthcare to the level of what all other rich western countries have spent on their unsustainable universal healthcare for decades for better outcomes than what we have, we would be running surpluses.

Our crap healthcare is one of the biggest drains on the economy. What the US government spends on healthcare disregarding spending by individuals is still more per capita than any other universal health service.

sjg007• 9 years ago

You have no idea what you are talking about. Multiple countries have single payer and good health outcomes. And it doesn't cost 10 trillion.

WaylonKenning• 9 years ago

It's not free healthcare for all. It's healthcare paid for the taxpayers, by the taxpayers.

And if the costs go up - it's because perhaps healthcare is better as a not-for-profit system rather than a for-profit system. Pretty hard to negotiate which hospital gives you the better deal when you're having a heart attack.

And I say this from a position of love in New Zealand - I wish you had normal government healthcare, like most other countries in the world. America spends 3x the amount on healthcare per capita compared to NZ (https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...).

lend0007• 9 years ago

An ACA thread always seems like a good time to throw in a plug for socialized medicine, but I do want to remind everyone:

Many people think that without ACA, the US healthcare market is free, which is why it has so many problems. This could not be further from reality. We have more government distortions in our healthcare market than countries with completely socialized healthcare. For example:

Medicare: socialized medicare for the elderly, which alone creates more distortion than a universal program would cause by inflating demand/prices for non-qualifying citizens.

Medicaid: socialized healthcare for specially qualifying poor people, which creates the same distortion as Medicare.

An oppressive FDA: which, coupled with overly-powered IP laws, grants de-facto monopolies in the medical product industry. We have an incredibly expensive and subjective medical equipment pre-approval process (as compared to a less-terrible FDA that would just be in charge of labeling, preventing fraud, and maintaining accountability in the event of incidents). Then there's the length and flexibility of patent protections in our current system (maybe we could cut those protection times in half, and patent trolling would not be a lucrative industry).

Oppressive occupational licensing: It's way too hard to become a doctor of any kind, even the kinds that don't manually put things into your heart. This will be a major battle as AI comes to the point where it can better diagnose conditions and largely replace generic/non-specialized pediatrics. Of course, the government will not make this easy.

Plus a slew of more minor things like malpractice regulation, and now the ACA (which is not so minor, and which will apparently be replaced with something similar).

If we cleaned up/removed all of the problems in the above and replaced it with single payer, it would be OK and we would have something similar to New Zealand/other countries with long wait times, not as much access to specialists, slow innovation, and a system where the government gets to decide who gets the last liver transplant and who dies. That would be a less distorted market than we have today, but ONLY if accompanied by fixing the aforementioned problems.

Or we could try going the free-ish market approach and try to find a much freer balance with the FDA/USDA/occupational-licensing/scrap Medicare/Medicaid,etc., which we do not currently have AT ALL. And maybe even declare health insurance fraudulent and pay everything out of pocket (accident insurance makes more sense as a hedge against risk, which is what insurance is supposed to be, whereas all people are expected to develop health problems at some point, with a probability approaching one).

kchoudhu• 9 years ago

Please point me to the non-partisan, non-hack, non-goldbug study that tells you that the US cannot support its current debt load. The feeding frenzy at every new treasury auction tells me that there's plenty of space yet for us to issue debt.

Serious claims require serious proof.

AnthonyMouse• 9 years ago

It isn't that no one will buy the debt, it's that the interest on the debt hurts the country. Every dollar in interest the government pays is a dollar it has to take from taxpayers and then not spend to the taxpayers' benefit.

anigbrowl2• 9 years ago

Other countries manage it fine, and the costs here are overblown. Aetna claimed last year that it was pulling out of the ACA over costs, but it has emerged that this was a purely strategic decision after the FTC or the SEC declined to support a merger the firm wanted to enter into.

http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-...

I reject the claim that 'we just can't afford it', and claim instead that the economic loss of not doing it is far greater, just not properly accounted for.

spoiledtechie2• 9 years ago

They are not. With 50-70% income tax on It's citizens, they are not just fine. Do your research. Long waits, little access to specialised docs. People are dying waiting in line.

toodlebunions2• 9 years ago

Do you mean the $10 trillion cost from repealing?

Here is republican senator Rand Paul on the huge budgetary expense of ACA repeal

https://m.youtube.com/watch?v=6AuIwR00T5g

lend0007• 9 years ago

Still in disbelief that Rand Paul did not win the Republican primary.

melling• 9 years ago

At 1:20 he says he's in favor of repealing ACA He doesn't like how it's being done.

ikeboy• 9 years ago

No peer review?

grzm6• 9 years ago

It's a Perspective piece, similar to an editorial. It's not a paper.

thomasthomas4• 9 years ago

Thanks to the ACA, a larger share of Americans have health insurance than ever before

because its compulsory. this shouldn't an argument for the ACAs effectiveness. I have to buy car insurance if i choose to drive a car on public roads. i have to pay income tax if i have income. now, by birth, i automatically owe the state. i'd like my freedom and right to choose back please.

the fact this isn't the main argument from GOP shows their incompetence.

dlp2115• 9 years ago

You pay for private insurance or you pay for public insurance via taxes. Any other solution is unworkable and you are a free rider.

67726e• 9 years ago

Or you pay a hefty tax penalty. Hardly "free"

thomasthomas4• 9 years ago

i'd like the choice to not have any insurance

DougN7• 9 years ago

The fact that we have to buy such expensive insurance is what burns me. Before ACA my family had good options for an individual plan (I'm self employed). Now we must pay $20K/year, and don't even get much benefit until we've spent another $5K out of pocket. The scope is what I don't like.

burkaman• 9 years ago

You actually don't owe the state anything if you can't afford health insurance. So similar to income tax, you can choose not to work and you won't have to pay the penalty.

And of course, it's not by birth, you owe nothing if you're dependent on someone else.

nyxtom3• 9 years ago

Choosing to not be insured is unsustainable for our economy the moment you have an issue and need a doctor.

thomasthomas4• 9 years ago

so i shouldnt have the right to choose?

felipellrocha• 9 years ago

If, you chose to gamble with your life, and end up not being able to afford medical treatment in the future one of two things ends up happening. You actually notify your doctors before hand that you don't have money, and will elect to not receive any treatment and follow through with your gamble, or someone else will pay for your treatment for you. Most likely every other person who can afford to pay for their treatment via raised prices (which will, in turn, remove more people from the market, more people will gamble, raising prices further in a spiral).

Which option do you think is more likely to happen?

rrock3• 9 years ago

Which is, of course, exactly what happens: those with insurance subsidize those without. Why do you think a simple bandage or ibuprofen costs so much on insurance? To cover those that walk into hospital ERs, uninsured. It's a hidden tax, highly inefficient, but quite real.

runamok• 9 years ago

They definitely did push back against the mandate and that was one of the arguments that went to the supreme court. http://www.nytimes.com/2012/06/29/us/supreme-court-lets-heal...

Furthermore all of us are consumers of health care at one time or another. I admit I am resentful against the many people that take terrible care of themselves but the fact is 40% of americans will get cancer. http://www.upi.com/Health_News/2010/05/06/41-percent-of-Amer...

Due to laws like this: https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an... and of course for ethical reasons hospitals can't turn you away when you can't pay.

I do feel it all needs urgent reform but I do feel the ACA was an attempt to expand competition and fairness while not leaving it completely unfunded like so many government plans seem to.

uberuberuber• 9 years ago

For 8 years, this man had the option to walk humanity back from the threat of hair-trigger, launch-on-warning nuclear armageddon. An armageddon that would either destroy humanity in a single day...or perhaps merely starve a few billion in the resulting nuclear winter. From these facts alone, I know everything I need to know about his, and all US presidents, commitment to the health of their citizens, and humanity at large.

flukus• 9 years ago

Or Armageddon simply isn't profitable.

JohnJamesRambo• 9 years ago

I miss having a President that can write in complete sentences.

maxerickson2• 9 years ago

Related discussion, JAMA paper published last summer:

https://news.ycombinator.com/item?id=12081314

Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

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