The Fate of Obamacare: 2020 Edition

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God, I haven’t done one of these posts in a while.

I really don’t want to do one of these posts. After the exhausing spectacle of 2016 when Republicans, having just seized control of the House of Representatives, the Senate, and the Presidency, tried again and again to make good on their promise to repeal and replace Obamacare, only to be thwarted by the slimmest of margins. Despite having a majority in the Senate, 3 Republicans, Lisa Murkowski, Susan Collins, and John McCain, surprised everyone by breaking party ranks to vote against the repeal measure.

And in 2018 when the Democrats successfully retook the House, we all thought the fight to kill Obamacare was over.

Well, turns out, it isn’t.

Ah, 2020. If a year could have a slogan, I’d give it “Oh, great. What’s gone wrong NOW?” As if this year hadn’t thrown us enough curve balls already, the recent death of Supreme Court Justice Ruth Bader Ginsburg has given Republicans a last-minute chance to screw with everyone’s health care right before the election.

If you aren’t caught up in the news, Ruth Bader Ginsburg was a liberal icon, and the de-facto head of the liberal wing of the US Supreme Court. Her death opens up a seat, a seat that Republicans are eager to fill. The reason why they’re so excited is that prior to her death, the Supreme Court had a 5-4 split in conservative’s favour. By filling the seat with a socially conservative nominee, the Supreme Court will tilt heavily conservative by a margin of 6-3.

Why this is important for health care is that Republicans currently have a lawsuit sitting on the Supreme Court’s docket related to Obamacare. While I won’t get into the legal nitty-gritties of the suit, basically Republicans, after proving unable to abolish Obamacare legislatively, used a rider on an unrelated tax bill to effectively eliminate the individual mandate that would have charged people a penalty if they didn’t sign up for health care. Now, Republicans are arguing that Obamacare compelling people to buy insurance without the individual mandate penalty (which, again, they were responsible for eliminating) is unconstitutional, and therefore the entire law should be struck down.

The judicial nominee has, in the past, made her stance on being against Obamacare known, so if she’s successfully confirmed before the election, Obamacare is toast.

What’s The Worst That Could Happen?

I’ve written about this in the past, specifically with regards to this issue’s impact on the FIRE community, and through it all my personal stance on Obamacare is that it’s overall good for the FIRE communtity because it gives people who retire early the ability to get (relatively) affordable health care coverage without being tied to their jobs. And back in 2016, while the Republican effort to repeal and replace Obamacare was infuriating to watch, the fact they were replacing it with something gave me hope that even if they were successful, at least some of the most popular provisions of the Affordable Care Act like coverage for pre-existing conditions and income-based government subsidies would survive.

This, however, is the worst possible outcome when it comes to overturning Obamacare.

If the Supreme Court sides with the Republicans and strikes the law down, nothing will be there to replace it. The Republicans have no plan ready to go, and even if they did they don’t have enough time (or the votes in the House) to pass it before the election.

So if Obamacare gets struck down, this will not only hurt the people who were relying on its system of subsidies and grants to afford health care coverage, it will hurt literally everyone in the US because it will eliminate protection for people with pre-existing conditions.

Remember, before Obamacare it was relatively common for health insurance companies to take your money, wait until you were sick with something really serious, then deny you coverage for some pre-existing condition in your past like a yeast infection or being overweight. Even if that pre-existing condition was completely unrelated to your current condition, the bet was that by denying you coverage, you would die from lack of treatment before you could take them to court to force them to pay.

A health care system that doesn’t take care of you if you get seriously ill is not a functional health care system. That was what America had before Obamacare, and that’s what would come back.

And oh yeah, exposure to COVID would almost definitely count as a pre-existing condition, so anyone who’s taken a COVID test could have the results be used against them in the future to deny them coverage.

That doesn’t just hurt the FIRE community, that hurts everyone.

Can Democrats Block The Nominaton?

On the surface, it looks like no, they can’t. Republicans currently have a 53-47 majority in the Senate, so you’d figure that they’d just be able to rubber stamp this thing through in 10 minutes, right?

But dig a little deeper and we realize there’s some wiggle room.

Two Republican senators, Lisa Murkowski and Susan Collins, have already signalled that they wouldn’t vote for a Supreme Court nominee so close to the election. These are also the same two senators that, along with John McCain, torpedoed Trump’s earlier efforts to kill Obamacare. So the Republican’s effective majority is 51-49.

But so what, you might think. A majority’s a majority. Well, yes and no. Because of Senate rules, the Senate can’t do anything unless they have what’s called a quorum, which means at least 50 senators are physically in the chamber. So that means if just two Republican senators can’t go to the Senate because, say, they’ve tested positive for COVID and are forced to quarantine, then the Democrats can simply boycott the Senate chambers and block the nomination that way.

As of the time of this writing, three Republican Senators have tested positive for COVID.

Things are changing day by day, of course, but all I can say is if a global pandemic somehow ends up saving Obamacare, I’m going to need to lie down from my head spinning.

You can’t make this shit up! If I were a writer on West Wing and I proposed that as a storyline, Aaron Sorkin would shoot it down for being too unbelievable.

What If Biden Wins in November?

But lets say that COVID doesn’t end up saving the day (yeesh, there’s a phrase I never thought I’d have to write). That makes the upcoming election hugely consequential, especially for health care.

Joe Biden was one of the chief architects of Obamacare, and has pledged to not only defend it but expand it as well, adding back the state-run public option that didn’t make it in the first go around. So if he gets elected as president, Democrats would be able to dust off the old Obamacare bill, make a few tweaks to fix whatever the Supreme Court finds unconstitutional, and re-pass it as, I guess, Bidencare. Or Joecare? Nah, Bidencare sounds better.

Anyway, polls are placing Joe Biden as favoured to win in November, and now that Trump’s hospitalized with COVID and unable to campaign, momentum will favour Democrats, but remember, polls also heavily predicted Hillary Clinton’s win back in 2016, so who the Hell knows what’s going to happen in a month? Remember the slogan of 2020: “Oh Great. What’s gone wrong NOW?”

What If Trump Wins in November?

While a come-from-behind Trump win sounds like it would be terrible for health care, there would still be room for some optimism here. Don’t get me wrong, it’s still definitely negative, but at the very least this would give Republicans the opportunity to fulfill the “replace” part of their “repeal and replace” slogan.

Republicans did have some replacement bills back in 2016, and they did retain some of the more popular provisions of Obamacare like protection for people with pre-existing conditions. So if Republicans win, health care would likely be rolled back, but not all the way to the pre-ACA system.

Or Trump could just spend his entire second term trying to repeal term limits and having himself installed as President for life. Who knows.

What If the election produces a Split Government?

But as bad as a second Trump term might sound, this secenario is actually more likely and much more harmful. If Joe Biden wins the presidency, he would definitely take the House of Representatives since every seat is up for grabs. But because not every Senate seat will be voted on in November, it’s possible that Democrats get the presidency and House, but Republicans maintain a majority in the Senate by the tips of their fingers.

This would be the worst case scenario for health care. Because without the Senate and zero appetite for bipartisanship in America, Joe Biden would be a lame duck as soon as he enters office. Obamacare would get struck down in the Supreme Court, but Republicans would be able to block Democrats from passing a replacement. Both sides would then spend the next two to four years finger pointing and blaming each other while millions will lose their health care coverage. The pandemic would then spin even more out of control, since people will avoid getting tested out of fear of getting a pre-existing condition, making the spread even worse since health officials won’t know where the outbreaks are.

So this is by far the least appealing outcome of the election in November. In order to have a functional health care system, not only does one side need to win, they need to win resoundingly enough to seize control of both chambers of Congress.

Which will it be? I honestly don’t know. But we’ll found out in…*checks calendar*…29 days.

Yikes. Buckle up, people. 2020’s not done with us just yet.

 


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73 thoughts on “The Fate of Obamacare: 2020 Edition”

  1. This is great news! It would be wonderful to get rid of Obamacare.

    It would be nice to remove a lot of legislation around the medical care system in the US so we can have a more free market system in the health care industry. The two need to be done in tandem since a heavily regulated medical care system cause the desire for government health care. The the solution for better care and inexpensive care is a free market system which will lead to helping the disadvantaged more so than any government and heavily regulated care ever would.

    1. Can you actually point to any ‘free market’ healthcare system on the globe that works ? For humans I mean – it works in the veterinarian world, but that is because animals are property and you can assign a value to them. There is no ‘free market’ healthcare system, if you get seriously sick, you don’t have the time to compare and be a fully informed market participant, you might not even have the mental capacity to be one….healthcare is an insurance system and an insurance system only works if the pool of the insured is as large as possible and the insurer has the largest leverage towards the service provider (if you want to separate those two) – see Medicare, see Veterans Health – in particular Medicare works just fine, why not expand it ?

        1. Hey Matt, I think your example is a little skewed: in Thailand or Mexico, YOU, a foreigner earning a Western income, could get anything done for an affordable price.

          Most Thais or Mexicans earning a local wage can’t afford the private “free market” because it is prohibitively expensive for them. And most receive cheap or even free healthcare through the public system… Private healthcare in those countries is only for the rich.

          1. If you want a different example, look at the Czech Republic. Great care and a developed country. Also in areas of the US healthcare market where the Government and insurers are not involved like lasik and elective surgeries the price goes down not up.The free market does work if allowed to. I do acknowledge below a certain income threshold any price many be unaffordable. The States have the option of taxing and providing these services and could do it much more effectively locally than at The Federal Level.

        2. Agree. I visited a specialist (as suggested by my US doctor) in Melbourne and the cost was less than my copay in the US.

    2. What an astoundingly idiotic post. Americans suffered under the “free market healthcare” system for decades and that was an epic fail on every level.

      1. Hi Sue,

        There has been no free market healthcare in generations. We have an oligopoly of private health insurers incentivized to extract profits. Further these companies spend billions lobbying to keep regulations high to create barriers to entry for smaller competitors.

        I am a proponent of free market healthcare, but we have not had that here in the US in my lifetime, with the exception of lasik and plastic surgery.

        I think a great place to start is to allow for price transparency. Pharma and healthcare companies do not even publish pricing here. You don’t find out what your medical cost is until you are done. Can you imagine a service you don’t know the cost of until you have consumed that service?

        Having spent time in Canada I can say there is a much greater trust in the Government amongst Canadians, and in general the Canadian Government is much more trustworthy.

        In the US we are dealing with nearly a total lack of trust of our elected officials because we watch them accept campaign contributions and then create laws that protect incumbent medical providers.

        Right now Congress has an approval rating of just 17% among Americans
        https://news.gallup.com/poll/1600/congress-public.aspx

        The root of the problem is trust. We simply don’t trust the politicians to do the right things on either side of the aisle. Also we can’t seem to change the laws that prevent crony capitalism. While this dynamic exists, I think you will continue to see many Americans push for a more free market, because we don’t trust the politicians to create a fair medical market.

        1. Free market healthcare doesn’t work, unless it’s optional services. When you arrive at a hospital bleeding, you don’t have the ability to say “Nah, that price is too high, I think I’ll just bleed to death.”

          Why free market works for optional services like Lasik and plastic surgery is that they’re optional. If plastic surgery cost $1M, you’d tell them to fuck off until they priced it more reasonably. That’s free market, but it doesn’t work with critical care.

      1. @Wanderer, What do you define as free market health care? The US has not had a free market health care system for a very long time. I said that in many comments already. We have elements of a free market health care system.

        A capitalist system means:

        > A socio-economic system based on private property rights, including the private ownership of resources or capital, with economic decisions made largely through the operation of a market unregulated by the state.

        The US health care system is one of the most regulated industries in the United States, therefore it is not a free market system.

        All I’m advocating is that we don’t go in the direction of a more socialist and/or mercantilist system.

        It is a historical fact that as a people get closer to a free market system the people prosper and have more access to things which they desire, including the poor. It is a known historical fact as a people get closer to socialists systems the people don’t prosper and the poor suffer more than the wealthy.

        That is why I argue so strongly for the US to move to more of a free market system. I also argue against mercantilism because it makes people, overall, less well off.

        1. I’m curious to know what part of this so-called “free market” healthcare system would ensure that unprofitable individuals (those with low incomes, with pre-existing conditions, probably many in the FIRE community, etc.) have access to health care? Do you genuinely believe that a socially just system can exist without government involvement? Would “Healthcare by Amazon” really be preferable to “Medicare for All?”

          1. I recall saying that people with low incomes, etc would be guaranteed health care. It sounds callous. But we know free market systems produce more at lower costs than a socialist system (or socialist attempt like in the US).

            But I wouldn’t be surprised if you removed much of the regulations and licensing laws that would wouldn’t see prices be at 1/10th to 1/3rd of the current price (we know this because we have seen other drops in other industries after they have been freed for high regulations), maybe even more. When you go to the hospital and they charge you $60 for a $1 pill that you can get over the counter you know something is wrong and that is definitely not the free market.

            So, that would be part of it. We also, know that we would have a lot more access to medical devices/medicine if it wasn’t for all the current laws. If you read Mary Ruwart’s great book “Healing Our World: The Compassion of Libertarianism” she goes over how she was trying to create a new device but the cost of regulations was just too high and the market for the device wasn’t great enough. So, with more of a free market we would even have more medicine/devices to choose from and not just for the mainstream diseases!

            So, we lowered the price significantly. What about the people that still can’t afford care? Well, it appears you care about the poor. So, with all this extra money you will be saving in taxes and health care you will join all the many others to donate to organizations which help get care to the poor.

            Will it be some utopia? No. Will some people still not get care? Probably. But I would be highly surprised if it wouldn’t be better than what we have now.

            And remember, if you look at the places that have 100% healthcare covered by the government you’ll find that it isn’t true that they get all their health care needs taken care of. And it actually takes decades (typically) before the affects of socializing the care before you start seeing the negative affects of socialism. And by then the poor care seems normal.

  2. So you don’t believe in democracy? Regardless of the issue, shouldn’t an elected majority decide? I’m interested in your thoughts on this.

    1. What if one day, the ‘majority’ decide to vote for communism? What if we hold a referendum which asks – “Should the wealth of the top 25% be seized and distributed to the bottom 75%?”

      I think such a referendum would pass with 75% of the vote. Now tell me if you believe in a democracy.

      1. Democracies may not produce the “right” result all the time, but they are the most stable form of government because the people have a way of changing the regime without bloodshed.

    2. The US doesn’t allow the democratic process to impinge on The Bill of Rights. The US is a Republic, not a Democracy, for this very reason.

  3. Obamacare is done for, IMO.
    Maybe things will have to get really bad first before the people force the government to make a better deal. It might take a while, though. If it gets that bad, I’ll leave the US. Why stick around when there are so many better options around the world? For people who are FI, that is.

  4. Learn to follow you first “gut reaction” (“I really don’t want to do one of these posts.”). If you really felt that then maybe you should not. You will loose at half of your followers.

    The US has some issues with high cost of medical insurance and delivery systems. Obamacare was not a good answer. In a republic there should have been a discussion and agreement. There was not. (“You can keep your medical insurance and your doctor”).

    1. Obamacare was a key campaign issue and Americans voted in a Dem President, Congress and Senate based on that campaign issue.

      It was again an issue in 2012 and Americans voted Obama back to office.

      It was again an issue in 2016. A Republican President, Congress and Senate had the chance to overturn it, but they couldnt because the constituents of at least 3 Republican senators didnot want it to go away.

      The law was challenged in the Supreme Court, where conservatives were in a majority and still the law the was not deemed unconstitutional.

      What more ‘discussion and agreement’ do you want?

    2. what an insanely idiotic comment. No discussion? LOL It passed the house, senate, and was signed into law by the POTUS. That is exactly how bills work dipshit.

      You fucking libertarian morons really came out of the woodwork for this one huh?

  5. Don’t know why everyone calls it Obamacare. Isn’t it actually the Affordable Care Act?

    Apparently, morons abound everywhere. Sad that healthcare is so politicized. I guess life and wellbeing has so little value in the great U.S. of A that the almighty corporate dollar trumps it (pun intended). “It is what it is.” – quote from the worst president ever. The U.S. is a putrid place.

    I’m happy to be Canadian. Go to walk-in clinic, hospital, etc. Swipe healthcard. Receive healthcare. Walk out. No change to what’s in my wallet.

    1. lol, it’s politicized because something should be done voluntarily between people isn’t. The government with the threat of violence or actual use of violence forces people to participate in a system that they don’t want to.

      > Walk out. No change to what’s in my wallet.

      Canadians pay over $13,000 per household for this service. What are you talking about no change in your wallet? Not only that but health care is a scarce resource. You can’t just give it away. It has to be payed for somehow. In Canada this scarce resource is limited by waiting lines for medical care. Sure, for simple things it is in and out. But just wait until you have something more serious – especially as you get older. And then if the government system doesn’t take care of you and you want to just pay out of pocket the court system there has ruled, in certain circumstances, that you aren’t even allowed to get care. So, you have to flee to another country just to get that care in a timely manner.

      There is a cost to everything. The only system that I know of that takes care of the poor than any other system is a free market system. Unfortunately the US does not have a free market system. Health care in the US is one of the most regulated industries. I would expect if many of those regulations were taken away we would see a significant reduction in price and an increase in quality. Because of the FDA many drugs and other medical technologies aren’t even created because of an over abundance of caution. Yes, there should be caution but not to the exclusion of drugs/technology being completely unattainable because of the artificial cost getting past all the regulations.

      1. > Canadians pay over $13,000 per household for this service

        Nope. As someone who is an American-Canadian dual citizen and moved to Canada over 4 years ago, I can tell you that my total tax paid has gone down in Canada, even as my income has gone up. My wife, a Canadian Citizen, has diabetes and epilepsy, and gets thousands of dollars worth of coverage free of charge. The fact of the matter is, the Canadian health care system is as good if not better care than the US, and costs about half per person than the US. I can say this as someone who has experienced both.

        Some Americans have put American Health Care up on pedestal and think it’s the most amazing thing in the world, and anything challenging their worldview most be wrong, because ‘Murica. As a fellow American, please stop. It’s ignorant and just wrong.

      2. I’m well aware that I’m paying for healthcare however it’s already part of my taxes and the payment is spread throughout the country’s population. From that, we all benefit.

        As a side note, I had surgery in Germany when I was on vacation there a few years back. I had travel insurance however the hospital refused to even look at it. You know why? Because healthcare is free. Even for tourists. Think about that one.

        Enjoy your free market system, sucker. Let me know when it eats you alive and then spits you out.

        1. Dear Dave,

          I agree with you that the German Healthcare System does (compared to other systems globally) a great job at making sure that almost no one gets left behind and that almost everyone, irrespective of financial status, gets really good healthcare.

          However, it is normally not free. I am not an health insurance expert, so please take this with a grain of salt. But I would roughly describe it as follows: There is one major public system, where most employees are insured. In that system the premium is roughly 15 % of your monthly paycheck to be paid half by you and half by your employer. So if you earn 5000 Euro a month (currently a bit under 6000 USD) as your gross salary before taxes and social security deductions, you would roughly pay 360-370 Euro for health insurance and your employer would double that for you. Of course, if you earn half that amount per month, you also pay half for health insurance. And there is also a cap and I admit that in our example here we are probably already close to it.

          The other big system is the private system, available to people who earn a higher salary (I think our example above is already very close to the threshold) and some other groups like entrepreneurs. There you pay an individual premium. I am not that familiar with it but I would expect to pay very very very roughly 300-500 Euro as a younger person joining the system for good coverage but once you grow old that might much more (maybe double?).

          Best wishes,

          Steffen

  6. Wanderer, boy did you just step into a loaded topic. Healthcare and guns are the 2 issues in the US that imho, Americans are most ignorant and brainwashed about by the GOP. I grew up in France, which combines both a single-player and private insurance systems to cover everyone from birth to death at low cost and with great outcomes overall, as any basic google search For “best healthcare system” shows. And yet, because most Americans hardly travel, let alone live abroad for any extended period of time, they believe the GOP when it tells them that the US has the best system, even though it costs a fortune, leaves millions uncovered (even with the ACA), and delivers poor outcomes compared to much less wealthy countries. American exceptionalism alright, exceptional in its abysmal performance and the number of dead and maimed left behind – all the more so in these covid times. It’s truly a Greek tragedy. Most Americans work so hard for so little, and have no idea how much better it could be. Your first commenter is exhibit A in brainwashing. And please don’t give a pass to Murkowski or Collins – they’re both evil and only vote to save their seats. The only reason the ACA has survived even this far is John McCain, the last GOP senator who actually tried to serve the little people.

    1. @Fille Frugale, I for one recognize that the US has significant issues with its medical system. My gripe is the direction we are going to fix those issues. This takes a lot of research and listening to all sides of the debate to understand the pros and cons of different systems. Which means reading books and listening to differing ideas.

      1. Thanks @Jon. I’m certainly all for reading and studying the issue (I’m an academic). But we’ve been discussing this since 2008, and meanwhile all our peer countries, say those in the G8, all have systems that deliver better health outcomes for cheaper to their entire populations. Let’s not re-invent the wheel, let’s copy one of them and be done. And more specifically to your earlier comment, the idea that the free market will solve everything is really common in the US and so so wrong. When (God forbid) you’re about to collapse from a heart attack or plow into a car accident, you’re not going to start studying which hospital delivers the cheapest care and/or has the best staff, closest to you. You’ll hope that your government has regulated that stuff for you and all your countrymen. That’s not something the free market can do. That’s why everyone of those G8 countries uses its government to regulate its health care. None of them leaves it to the free market.

        1. @Fille Frugale, I’m not asking to “reinvent the wheel”. The closer a country gets to a free market system the better off the wealthier and poorer are in society. This isn’t rocket science.

          So, if your main gripe is that for emergencies a free market system doesn’t work, then maybe emergency care can be given some other form than a free market (which I doubt would be better than a free market). But don’t throw the whole system in the toilet.

          We know that the more regulations there are the less innovation there will be. A great book on the topic is Matt Ridley’s new book *How Innovation Works*. We need that freedom but in the US we get less and less of that freedom every year because of a build up of laws and bureaucracy over time.

          And we know in countries which have government health care that their health care isn’t all that great like a lot of people say it is. We know that health care is a finite resource so it has to be limited in some way. You can’t just wave a magic wand and all of a sudden everyone has all the health care they need. It cost real money. There are also queues or lines in these countries that limit the health care system. Want to see a specialist? You’ll have to wait some time to see one and it will take quite a while to happen. You pissed off your doctor? You might not even find a replacement. You’re an immigrant – depending on the country you might not even be able to get regular care. You’re older with more serious illness? Good luck with that you might have to wait awhile to get service.

          Sure, it might work for the young and those that don’t have weird illnesses but it might not work for you if you don’t.

          It seems pretty disingenuous that those that say their government health care is perfect on these blogs/comments but then don’t recognize all the problems associated with them. Like the court ruling in Canada recently that said you can’t go to a private doctor if the government refuses to treat you. WTF is what I have to say about that. If I can pay for a private doctor the government has no business telling me otherwise.

          1. Give it a rest. Use all that wasted energy on something useful, not badgering others because they don’t want to join you in a groupthink.

            A variety of opinions is healthy. Trying to bend everyone to your will is not. And will not happen.

    2. I’m the most comfortable wading into into loaded topics. After this, I’m going to write an article on gun ownership and religion. That should give the hit counters a workout.

    1. +2, Fille frugale… I’m a fellow French who has lived and worked in half a dozen countries (now in Canada), and so far, the only place I have actively avoided is the USA, because of this issue.

      It’s really sad, but Americans just don’t realize how brainwashed they are. For a European, it is truly shocking to see the number of people abandoned, facing financial ruin or even left to die because they are not covered by a universal healthcare system.

      1. Merci beaucoup Val! ☺️ “Shocking” is almost too weak imho. 8 months into this pandemic, with on average 2 9/11’s worth of covid dead each week, not a single GOP politician has publicly expressed sorrow for them or their loved ones.

        1. Not True
          GOP politicians publicly express sorrow for Covid victims and their families all the time including President Trump.

          1. Words are cheap. As cheap as those GOP politicians and sleezeball T-rump consider the health and lives of their fellow citizens.

  7. I’m surprised you left out the most likely scenario….

    …Yes, Biden will win and democrats will hold the house with republicans holding the senate. Also, ACB will be confirmed, rendering what seems to be a solid conservative leaning for the court. But, what will actually happen is any SCOTUS ruling on Obamacare will likely be so incredibly convoluted and confusing that it will effectively leave Obamacare in place as it is.

    ..No need to lose any sleep. Obamacare ain’t going anywhere, regardless of how the election turns out.

  8. Thanks so much for publishing this article! Well researched and analyzed. ACA has HUGE impact to FIRE community. It’s a shame to see US citizens resorting to medical tourism to other countries. It’s also sad to see people who defend for a system that screw them over. Without ACA, you are the corporation slaves. No freelancing, no FIRE, no sabbatical, no personal freedom and choices…

  9. Great post, Bryce! Ignore the negative comments above. For being a Canadian, you are well versed on our healthcare mess. I for one, wish I was a Canadian right now.

    1. Brycia! We miss you so much!

      And for the record, I know about American politics because it’s so much more interesting than ours. You know what’s happening in Canadian politics right now? Our Conservatives and Liberals are cooperating and doing their best to fight the virus. Booooorrrrrriiiing!

  10. Need some help here. My wife and I pay $2000 a month for ACA coverage. Just lost our business to Covid-19 related problems. I guess now I can get subsidized by others that are paying $2000 a month for insurance. Any idea what my subsidy will be? Probably can’t do my Roth IRA conversion ladder any more because that will mean I make too much to be subsidized. Don’t suppose there is just an option to get catastrophic insurance coverage and pay for my doctor visits out of pocket. Appreciate any insight.

  11. This is going further than just Obamacare.

    A law passed by the Congress which is elected by the people can still be repelled by the Supreme Court by saying it violates the Constitution? Are we still better than the ones whom we have been barking at?

  12. I think it’s mostly only possible to think we in the US have a good healthcare system while you are young and healthy. It seems to me that once you start interacting with the “system” you realize that there isn’t one, and you, the sick person, will be expected to do heavy lifting while… well, sick. More transparency (aka more like a free market) would help — but just don’t kid yourself that a Republican gov’t would actually set that up. Working class and poor republicans don’t get love from their elected R reps; the insurance companies have already bought and paid for them. Not that the Dems are fabulous, mind you, but they are trying to market themselves as the party for the people who are not necessarily rich. The Repubs aren’t even really trying to fake that any more… they’re just the party for the rich. Full disclosure: I’m (effectively) rich but I realize that I’m vastly outnumbered by folks who are not. Eventually all the struggling people will bring out the pitchforks when they realize what a ridiculously raw deal they have.

  13. A quick set of comments here. I have lived in Taipei, Taiwan for a long time now and I’m covered by the National Health Insurance system. I’m a permanent resident with an APRC (Alien Permanent Resident Certificate, like a Green Card for immigrants back in the USA). On the upside, costs tend to be low & the doctors and hospitals do pretty good work, in my experience. On the downside, there are some more recent medical techniques and equipment that either don’t exist here (yet?) or aren’t covered by NHI, so I’d have to pay out of pocket and that can cost a lot of $. Also, I read a study somewhere by a Government demographer (statistician? actuary?) that the system won’t be as sustainable in X# of years due to our low birth rate (which also makes it harder for those of us who are educators to fill seats in universities and find jobs, as an aside).

    Back in the US, when I was employed or a full-time student, my student insurance or my work-related insurance took pretty good care of me. I have no idea from personal experience what things are like now & I have very limited experience at navigating the US system while being uninsured or underinsured.

    Dan V
    Taipei, Taiwan

  14. Republicans are just repugnant. Imagine being fine with people not being able to afford healthcare. I hope Biden wins and expands ACA to be Medicare for all, like in civilized countries.

    1. American Republicans are…special. Let’s just say that.

      Personally, I’m a conservative voter. I believe in lower taxes, fiscal restraint, and individual freedom. But I would never support Republicans. I don’t know WHAT they believe in anymore, honestly.

      1. Hi,
        Thanks for your insightful article. While on the topic of touchy subjects, why is it that those who lean towards the party of ‘individual freedom’ also want to legislate the hell out of someone’s uterus? Not asking you specifically but conservative/GOP/Republican voters are the ones all ready to tell some one what they can and shouldn’t do with their uterus but don’t give one rats ass about ensuring their fellow neighbor can get affordable healthcare? It drives me absolutely nuts.

  15. As an American I for one cannot wait for ObamaCare to be repealed. They wanted to charge me $750 a month for insurance. Probably this year hospitals will be required to be transparent in their charges so at least the patient will know hopefully what they’re going to be charged for their stay.

    Polls are part of the propaganda Outlets so beware. Polls predicted Hillary would win in 2016. Good article thank you

  16. As someone who had to use both, Obamacare was the worst garbage I ever had to deal with. It’s not care. It’s mismanaged drug pushing instead of care. Just like here in Canada. The QALY’s bs took my mom from me, if I was only able to get her to the usa in time I would have her still.

    The best care I have ever received regardless of country was pre Obama private medical insurance. If anything i would support a 2 system similar to Australias but with severe oversight and accountability.

    1. You know that “pre Obama private medical insurance” still exists, and is just called “private medical insurance” right? Like, you don’t have to get your insurance from the exchange (which is really just a government run marketplace, like a bazaar, for…wait for it…private medical insurance).

      You sound really ignorant on this topic. You wouldn’t be the first (or even the worst) offender in this thread, but really there is such a thing as not commenting if you don’t know what the fuck you are talking about.

  17. Contentious topic here.

    Bottom line is Obamacare helps more than it hurts. A country where those who get sick or injured and don’t become indebted to private companies or risk death/bankruptcy, is a better country.

    Health care should be as much a right as access to “free”primary education, or so you would hope it would be in one of the most prosperous countries of our age in history.

  18. Somehow winding up with nothing certainly does seem like a worst-case scenario, thanks for helping paint that as a real possibility! 😉 Ha.

    Whether ACA stays, gets replaced with something better, or is expanded–the option of just cutting loose everyone, suddenly, due to a SCOTUS decision before 2021 seems horrendous for all involved. I can’t imagine SCOTUS would even be willing to do so for the sheer destruction of their own reputation if that happened.

  19. “Insightful comments, as always. I subscribe to the FIRE lifestyle for a long time now, by accident originally (like most of us, I think….). The one part that I continue to struggle with is meeting a partner that doesn’t destroy all my progress toward FI(RE). So recently I created a site to connect FIRE and fiscally-responsible individuals together, fireandmatch.com. I thought it was worth sharing and getting out there, because the current member base is small but strong, and hoping that it can actually mean something to the community. Anyway, hoping you might help spread the word! http://fireandmatch.com!

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