Obamacare Is Now Beyond Rescue

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Illustration by Thomas James

Wednesday, January 15, 2014

With the disastrous launch of the HealthCare.gov website, critics of the Affordable Care Act, or “Obamacare,” were given more fuel for the fire. Is this political hot potato's inevitability once again at stake? And is the medical community really on board with the law, or resisting (rewriting?) it from the sidelines?

  • Scott-Gottlieb-90px

    For

    Dr. Scott Gottlieb

    Practicing Physician & Former Deputy Commissioner, FDA

  • McArdle90x90px

    For

    Megan McArdle

    Writer and Columnist, Bloomberg View

  • JonathanChait90px

    Against

    Jonathan Chait

    Political Commentator and Columnist, New York Magazine

  • Kamerow90px

    Against

    Dr. Douglas Kamerow

    Family Physician & Former Assistant Surgeon General


    • Moderator Image

      MODERATOR

      John Donvan

      Author & Correspondent for ABC News

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For The Motion

Dr. Scott Gottlieb

Practicing Physician & Former Deputy Commissioner, FDA

Scott Gottlieb, M.D., is a practicing physician and a resident fellow at the American Enterprise Institute. From 2005 to 2007, he served as the FDA deputy commissioner for medical and scientific affairs and before that, from 2003 to 2004, as the FDA’s director of medical policy development. He left the FDA to work on the implementation of the new medicare drug benefit as a senior adviser to the administrator of Medicare and Medicaid Services. Gottlieb is an editorial board member of the journal Value Based Cancer Care and the Food and Drug Law Institute’s Policy Forum, and he writes a regular column for the Wall Street Journal. He is also a clinical assistant professor at the New York University School of Medicine.

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McArdle90x90px

For The Motion

Megan McArdle

Writer & Columnist, Bloomberg View

Megan McArdle is a Washington, D.C.-based blogger and journalist who writes about economics, business, and public policy. Currently a columnist for Bloomberg View, she was previously a special correspondent for Newsweek/The Daily Beast, the business and economics editor at The Atlantic, and a writer for The Economist. She also founded the blog Asymmetrical Information. Her book, The Up Side of Down, will be published by Viking in February 2014.

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Against The Motion

Jonathan Chait

Political Commentator & Columnist, New York Magazine

Jonathan Chait is a daily columnist at New York magazine, where he contributes lead pieces of political commentary to nymag.com, along with short and longer form pieces for the print magazine. His influential writings are regularly among the most highly trafficked stories on the site. Previously, he was a staff writer at The New Republic for fifteen years, writing their signature TRB column and then running his own eponymous blog on their site. An influential voice on politics and policy, he was the winner of The Week’s “opinion award” for columnist of the year in 2010 and a 2009 National Magazine Award finalist for columns and commentary. Chait is the author of The Big Con: Crackpot Economics and the Fleecing of America (2007), and has been a guest on MSNBC, CNN, NPR, and WNYC, among other outlets.

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Against The Motion

Dr. Douglas Kamerow

Family Physician & Former Assistant Surgeon General

Doug Kamerow, M.D., is a family doctor and specialist in preventive medicine; a chief scientist in health services and policy research at RTI International, a large, non-partisan research institute; and a professor of clinical family medicine at Georgetown University, where he teaches medical students and family medicine residents. He is also an associate editor of the global medical journal BMJ, for which he writes a regular column on health policy, and he recently published a book of essays titled Dissecting American Health Care (2011). Previously, Kamerow spent 20 years in the U.S. Public Health Service, leading a range of clinical, health policy, and research activities, and retiring as an assistant surgeon general in 2001.

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Declared Winner: For The Motion

Online Voting

Voting Breakdown:
 

57% voted the same way in BOTH pre- and post-debate votes (13% voted FOR twice, 40% voted AGAINST twice, 4% voted UNDECIDED twice). 43% changed their minds (2% voted FOR then changed to AGAINST, 1% voted FOR then changed to UNDECIDED, 9% voted AGAINST then changed to FOR, 4% voted AGAINST then changed to UNDECIDED, 11% voted UNDECIDED then changed to FOR, 16% voted UNDECIDED then changed to AGAINST). Breakdown Graphic

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    38 comments

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    • Comment Link Aquifer Wednesday, 15 January 2014 20:31 posted by Aquifer

      I tried posting this before the debate, but now that it is over maybe the site will allow this post ...
      Another good debate:
      http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=10805

    • Comment Link Aquifer Wednesday, 15 January 2014 19:30 posted by Aquifer

      Evan Madianos

      "The pursuit of his own productive career is- and, morally, should be- the primary goal of a doctor's work, "

      Apparently you took a different Hippocratic Oath than I did ....

      A physician, IMO, has a right to make a decent living from practicing his/her craft, but not to maximize profits from his patients ills ....

    • Comment Link Singlepayer Central Wednesday, 15 January 2014 16:09 posted by Singlepayer Central

      Huh? We're already seeing success from the ACA. While a single payer system would go a lot farther in truly bringing health care costs down as well as increasing the quality of healthcare, the ACA is better than what we had AND there is a path within the law that allows for innovation by states such that states can take the funding and use it to create a state single payer system. I don't understand the question given the web site is now working as well or better than other comparable sites even and we already have people who previously had only access to an ER for medical care now beginning to get the preventative care that will eliminate those ER visits thus bringing down health care costs. Lastly, we are ALREADY seeing health care costs beginning to slow so how was it determined that "Obamacare" NEEDS rescuing at all? Huh?

    • Comment Link James Wednesday, 15 January 2014 15:21 posted by James

      Dr David Wong is pretty accurate in his assessment of the act. Congress did not even attempt to solve the problem they defined with this bill, they just chose to throw money at it in an attempt to disguise the fact they have no clue how to solve problems.

      The next step, and here is a big failure on their part, is to identify the causes of the problem- in other words, what goes into the cost of healthcare that makes it cast so much ? They stopped after making HUGE assumptions - that all doctors, hospitals, drug manufacturers, and healthcare insurance companies are greedy. That is as far as they went.

      They did not look at all the costs a doctor has in his/her practice to evaluate ways to lessen those costs. Same goes for every other factor that enters into the high cost of healthcare. The biggest one they left out - TORT REFORM. Why ? Self-interest of the attorneys serving in Congress. If they are voted out, they do not want to dry up their well of funds to support their lifestyle There are so many other factors that enter into the cost of healthcare that it would take a lot longer to craft the bill than the Democrats did in their OH SH*T moment when they feared the Republicans were going to take over both houses of Congress.

    • Comment Link Evan Madianos, MD Wednesday, 15 January 2014 06:44 posted by Evan Madianos, MD

      Aquifer:

      The specious arguments you offer regarding rights and property in the Constitution and Declaration are mistaken and merely the transparent rationalizations of any petty thief.

      Our founding documents were, in fact, intended to protect them. Individual rights and liberties do not exist without private property rights, since a right to property is the practical implementation of individual rights. Property is merely the material consequence of an individual's time, physical and intellectual work. The man who works to produce while others deprive him of the product of his work is a slave.

      You are also sadly mistaken regarding the Hippocratic Oath, which offers guiding principles to a physician plying his craft. His obligation is that _if and when_ he freely chooses to enter into a doctor-patient relationship for the purpose of practicing medicine, that he apply his skills and knowledge responsibly to attempt to heal the patient's malady and make every effort to “do no harm”.

      The Hippocratic Oath surely is not a prescription for indentured servitude for physicians- and certainly not in a free country. This country keeps moving closer to a system of government controlled, single payer socialized medicine, under which health care providers essentially become indentured servants. This would make for another excellent debate topic. One does not forfeit their individual rights by getting an MD degree. The ability to provide a "service" does not turn one into a "servant". Ayn Rand makes the important distinction here:

      "...Doctors are not the “servants” of their patients. No free man is a "servant" of those he deals with. Doctors are traders, like everyone else in a free society- and they should bear that title proudly, considering the crucial importance of the services they offer.

      The pursuit of his own productive career is- and, morally, should be- the primary goal of a doctor's work, as it is the primary goal of any self-respecting, productive man. But there is no clash of interests among rational men in a free society, and there is no clash of interests between doctors and patients.

      In pursuing his own career, a doctor does have to do his best for the welfare of his patients. This relationship, however, cannot be reversed: one cannot sacrifice the doctor's interests, desires, and freedom to whatever the patients (or their politicians) might deem to be their own "welfare."
      America does not need more government intrusion in the doctor patient relationship. America needs a system of real reformed based on respect for individual rights and free market principles:

      http://docs4patientcare.org/prescription

    • Comment Link Mark Mack Wednesday, 15 January 2014 06:26 posted by Mark Mack

      Honestly Obamacare flubbed up those needing to survive on minimum wage (like myself, whom is going into college but has to work minimum wage jobs because I don't have a degree yet).

      Before this year you could get about 39 hours a week as a part timer. But after the new 39 is 28. I've not run into a single job that will let you go past 28 because (drumroll) OBAMACARE aka ACA!

      I have to work two jobs and balance them precariously (thankfully one is scheduled every four months, hate to see how it works for those working two jobs scheduled weekly) just to make 40 hours.

      The act went too far in forcing businesses over 50 employees to give healthcare for workers working 32 hours a week. Before it would have been no sweat to get 39 hours at one job. Now you have to earn the slim chance to become a full time worker.

      And I know that there is the thought that "minimum wage isn't meant to support a person". It should exactly do that, at least the bare minimums.

    • Comment Link Erin Tuesday, 14 January 2014 22:14 posted by Erin

      I think the wording in this question is confusing for some people. People are probably voting against Obamacare not knowing that against means supporting it. I do not support it and do not want the government to have anything to do with my healthcare. Also, there is no reason that I should have to pay for some fat slobs triple bypass while I keep myself healthy. This is a tax on healthy people who aren't needing surgery for a disease caused by obesity. It's ridiculous how much my premiums, deductible, and out of pocket went up when I haven't deserved it. Obamacare needs to be stopped.

    • Comment Link David Wong, MD Tuesday, 14 January 2014 19:34 posted by David Wong, MD

      The reality is that our resources as a country are NOT limitless. Everyone can not have everything. The goal of fixing the system needs to be to make healthcare affordable and to make it less expensive. The Affordable Care Act simply does NOT do this. It does not make care more affordable. If anything, it drives the cost of care up. All of the incentives are misaligned. I had a conversation with a patient who had back pain for years and was really happy to get a bronze plan on the exchange. I asked him if he knew what his deductible and co-insurance was. I explained to him that the first couple thousand dollars would be out of his pocket and then insurance would pay for 60% after that until his out-of-pocket max. His response "I can't afford that!"

      Universal coverage is NOT working in other countries -- and Americans culturally simply would not work well under it -- it would mean that care would need to be rationed (and that >would

    • Comment Link Aaron Barr Monday, 13 January 2014 23:13 posted by Aaron Barr

      I think the fact that there are so many votes "Against the motion" goes to show just how out of touch Academia is with mainstream America. Color me disgusted.

      So far, many more people have lost coverage due to the ACA than have gotten it.

    • Comment Link George Blanchard Monday, 13 January 2014 19:46 posted by George Blanchard

      This is the time where we really take the big step forward. Our old system was terrible, leaving several people injured and broke being uninsured. The Affordable Care Act is so blocky and convoluted, leaving some paying outrageous rates because of policy. It is not time to pull out Obamacare, it's time to push forward.

      What we need is a government system of entirely free health care. France has it, Britain has it, and we should too. It wouldn't cost much and it would save lives. Not only would people get the care they need but they wouldn't get f*cked in the ass by insurance companies to do it.

      You know why we won't? Corporate greed. The insurance companies like getting fat, taking people's money then denying the people every operation possible. And their lobbyists bribe the politicians to not do a thing about it.

      Today is the day that we must decide in free universal healthcare. If you've watched the movie "Sicko" you can see that it's not hard, that it's not impossible, and it's not some evil communist plot!

    • Comment Link Aquifer Sunday, 12 January 2014 18:09 posted by Aquifer

      Evan Madianos:

      The fact that the author of the article in your first citation is the founder of the Ayn Rand Institute says it all ...

      PS the Dec. of Ind. does not mention a "right" to property, as i recall. and the Cons says a person may not be deprived of his/her property without due process of law ...

      I gather from the fact that you have an MD after your name, you have committed yourself to providing it to those who need it? Or only those who can pay for it ....

    • Comment Link Jay Thursday, 09 January 2014 16:07 posted by Jay

      Once the 80% of Americans that already had insurance heard the President say you can keep your policy and doctor if you want to, they promptly tuned out thinking Obamacare only affected the uninsured. It has been a terrible shock for everyone to learn otherwise. This program was never explained, poorly drafted, and poorly executed. There are so many things that need amendments and the Democrats sit there and say everything is fine. The Republicans want to throw the whole thing out. Probably, what will happen is that the government will have to bail out the insurance companies to make it work. I don't think the American People will stand for it. It would be nice to see both parties working together to fix this mess but lets face it, the Democrats that didn't read the bill should be screaming for amendments. They will suffer because the American people don't like being lied to--

    • Comment Link Lucas Phlipsak Wednesday, 08 January 2014 23:19 posted by Lucas Phlipsak

      Whether you are for it or against it, "fixing it" with congressional reform is an invalid course of action to suggest... barring another super majority, which even if there was, would probably be republican anyways. Why is the congressional path of action worth discussion? Did 47 repeal votes not "shut the door" on this one?

    • Comment Link Martin Wednesday, 08 January 2014 21:01 posted by Martin

      I tend to vote republican, but I believe it is too late to turn back this clock. Stopping the politics and doing something that works is in the best interest of the country. That's the way American style compromise is supposed to work. The founders warned us of what would happen if political opportunity was allowed to override the interests of the people.

      After the eighth try at doing what only tainted the party and did nothing to repeal Obamacare, it's time to counter balance the leftist principles that created the act in order to make it something sustainable and truly affordable. I would ask politicians to stop scaring people with talk of a take over when these same politicians can't even run a package delivery service effectively, let alone threaten competition.

    • Comment Link Evan Madianos, MD Monday, 06 January 2014 13:50 posted by Evan Madianos, MD

      Americans need to see beyond the power-seeking charlatans and dishonest zealots fraudulently promising them a free lunch of unlimited medical technology through phony government largesse, at no cost, or paid for by someone else for their own cynical, self serving political ends.

      America needs and deserves real, lasting health care and health insurance reform based on economically and financially sound principles and consonant with the founding principles of this country: namely, the respect for individual rights.

      http://westandfirm.org/Peikoff-01.html

      http://westandfirm.org/index.html

    • Comment Link Nym Sunday, 05 January 2014 22:50 posted by Nym

      Is it possible that any legislation which had to "be passed before we know what is in it", could be good law? Certainly, the road to Washington is paved with good intentions. Well intentions aside, do you really believe that the Affordable Care Act has made health care more affordable for anyone except new enrollees to Medicaid?

      When the President arbitrarily grants waivers to organizations who would challenge the constitutionality of the law or to those whom he is beholden, and selectively enforces the law as written without first signing legislation that changes the law itself, then we clearly have a law that is beyond repair and an imperialist executive branch.

    • Comment Link Ritannette Friday, 03 January 2014 13:00 posted by Ritannette

      I am PRo-ACA--universal coverage

      "Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane." MLK 1966.

      I cannot accept that REP,et al Champions, brag, and glory the death of US citizens annually that can be stopped by affordable healthcare healthcare must include healthy access to food. REP is against the Constitution, Bill of Rights and fundamental care of people.

      The ACA isn't universal coverage--just first steps

    • Comment Link Sedra Shapiro Tuesday, 17 December 2013 15:18 posted by Sedra Shapiro

      How exactly could someone be against Affordable Health Care or the Affordable Health Care Act?. If you are smart you know a bad website is not what you gamble your future on with quick impressions - Sure be against the HealthCare.gov website, but are you not able to distinguish between the website and the healthcare law that helps millions of people - not just millions it helps you!

      So don't be so easily fooled by a bad website.

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