HereРІР‚в„ўs where the health care exchanges created by the ACA come in. And corporate benefit offices grew expert at negotiating with insurance companies, doctors and hospitals to keep costs down. Over the next sixty years, workers grew accustomed to generous company-sponsored health plans that seemed to cost them little, even though cash wages clearly were reduced somewhat as a result. It was then that Congress, reluctant to permit manufacturing companies to raise wages carefully regulated under wartime controls, instead doled out tax breaks to firms that offered workers health insurance. The measure was eventually structured without a РІР‚Сљpublic optionРІР‚Сњ that would have allowed purchasers to simply buy into Medicare РІР‚вЂњ a sop to the large and powerful private insurance companies that have grown up since World War II.

Citizens would have to show that they were insured, by their employer or by the government, or go to the exchanges to insure themselves. Two years later, in 2010, the Democratic majorities in Congress passed the ACA. Then he hired her advisers and took over her position. Barack Obama who resisted the idea РІР‚вЂњ until he won the nomination. Hillary Clinton who proposed enacting an individual mandate, and Sen. Mitt RomneyРІР‚в„ўs successful health care reform in Massachusetts, three years earlier. The individual mandate was, youРІР‚в„ўll remember, a major issue in the Democratic primaries in 2008. There is a big difference between giving citizens health care as a right and requiring them to buy it as a responsibility РІР‚вЂњ and then subsidizing those who cannot afford the most basic plans. More interesting to me is the camelРІР‚в„ўs nose that is the individual mandate. A lot of things could go wrong along the way, Krugman said. Instead, he noted, the ACA requires individuals and companies to go online or make a phone call and then make a complicated choice among options that depend on the presence or absence of subsidies. And indeed, many early supporters of the Obama administrationРІР‚в„ўs health care restructuring initiative were hoping for just that.Р”Р‡or instance, New York Times columnist Paul Krugman wrote last week that the ACA is РІР‚Сљa Rube Goldberg device, a complicated way to do something inherently simple.РІР‚Сњ To extend Medicare-style insurance to the uninsured, he said, РІР‚Сљthe government could have simply sent a letter saying РІР‚ВCongratulations, youРІР‚в„ўre covered.РІР‚в„ўРІР‚Сњ So why the ruckus? Republicans have feared from the beginning that the measure is a Trojan Horse, concealing plans for a single-payer system run by the Federal government. In other words, the ACA controversy is about bringing the poor and the relatively powerless into the health care system, partly out of considerations of fairness, partly in hopes of reducing the overall cost. Another 49 million persons are enrolled in Medicare, because they are 65 and older. In contrast, more than 150 million Americans are covered by insurance purchased by employers. (Why are governments, at least in the US, so generally bad at buying information technology?)Р”В®ven at its flood, expectations are that as few as 25 million previously uninsured persons will take advantage of the act. Never mind the more interesting question of why the implementation of the program was so badly botched. Never mind the political bickering about the composition of the group РІР‚вЂњ it is inside-baseball stuff, at least until plans begin setting their 2015 rates, early next year. The first annual period of open enrollment ended last week, 7.1 million persons have signed up. For all the political controversy surrounding the rollout of the Affordable Care Act, the remarkable thing is how few persons are affected by it.

Pingzapper bronze silver gold platinum