In 50 years time the ACA will be be remembered as 'Obamacare'.

[denem]

Barack and Michelle will be digital video, but this presidency, this memory will live on. The arc of history bends towards justice.

[DetlefK]

1. I predicted it a while ago:

About 5 years from now, Fox News will start to claim that Obama dubbed it Obamacare out of vanity.

[BlueStreak]

2. It won't be remembered as anything

It is about 80% a package of subsidies to buy the same insurance that has been out there for decades, and 20% various regulations that improve the business practices at the margins. It isn't a "thing" in the sense that Social Security and Medicare are real things.

Do you realize how easy it will be for opponents to cut the subsidies? Just as easy as it is to cut foods stamps and Meals on Wheels. This "program" is just a number, and you can very easily make the number smaller. That is how the Republicans will kill it.

If, on the other hand, this had been done as an expansion of Medicare, or even included a real public option as an alternative to private predatory insurance policies, that would be a real "thing" that would be much harder to cut.

The next 4 years will determine whether or not this turns into a "thing" or just remains as a number that can be whacked every year. What we have now is the government handing hundreds of billions of dollars over to the same predatory insurance companies that created this mess of a HC system in the first place. And they are responding with huge increases in premiums. The next step is to introduce real competition. In markets where the insurance companies are acting like a cartel (which seems to be almost every market) we need to introduce either for-profit co-ops or a real public option into the policies available in the exchanges.

Right now we guarantee these companies 20% profit (or close to it.) That is obscene. In most other large, mature industries, 6-8% profit is considered very good. The next President needs to bolster the ACA by mandating that Medicare will offer a public option in any market where the insurance companies are setting their prices more than 8% higher than it would cost Medicare to provide the same coverage.

For better or worse, Obama put us on the path of exchanges. Now we have to make the exchanges work for the people. If that doesn't happen, then ACA will slowly fade into the sunset, being nothing more than a couple of paragraphs in some political science textbooks 50 years from now.

Did I say "textbook"? I meant no more than a few droplets of "liquid knowledge" that is taken intravenously by students 50 years from now.

[denem]

3. A child's first steps are remembered if someone has camera.

Baby steps are just that: No more and no less.

[BlueStreak]

5. If the child dies at age 5, his first steps aren't the lasting story

My point is that this program is built on a foundation of quicksand. It is not a "program" per se. It is mostly just a huge government subsidy. And that boils down to being a line item in next year's budget. And Republicans whack line items. Maybe only 5% or 10% at a time, if that is all they can get away with, but whack it they will.

Don't make the mistake of comparing this with Medicare, or even the EPA. Those are real programs with real infrastructures beneath them. They provide real services. The ACA doesn't provide any real service on its own. It just subsidizes private insurance. The insurance companies will fight to keep that, just as Archer Daniels Midland fights to keep farm subsidies going.

Republicans wanted to stop it before it got out of the starting gate. And they assumed they could do this because Obama has capitulated every time before. They haven't talked about plan-B because none of them ever thought that would be needed.

But plan-B is simply to whack away at the subsidies. Very easy to do. It just may take them 5-10 budget cycles to practically kill it. And 15 years from now, there might be a tiny stream of subsidies for the lowest income uninsured, but not much more than that.

The only way for ACA to survive is for it to become a REAL program, consisting of something other than just government handouts.

[denem]

6. If a child dies

it is all over bar the shouting. So what?

[BlueStreak]

7. The "so what" is that the ACA, as currently constituted

won't be a significant program 10 years from now, let alone 50 years from now.

It is just a bunch of subsidies to private insurance companies plus a collection of regulations. Starting tomorrow, the new game plan for the GOP will be to nip away at the subsidies and the regulations until there is nothing significant left.

For example, how long do you think it will be bore somebody sneaks an amendment into some post office naming bill that effectively gives United Health Care some new options to cancel policies when people get sick, or restores the lifetime cap concept?

[Loudly]

4. Solid perspective and excellent summation.

Medicare availability for all is the real deal.

[intaglio]

8. In 50 years the ACA will be remembered as the first step

... towards single payer.

at least I hope so