But don't worry.  As Jay and the president like to say they didn't know that that coverage was bad for them.

For those keeping track here's Obama Lie #2

You can keep your doctor.  Period.

No one is ever annoyed that they qualify for Medicare or Medicaid. People may hate paying the taxes that fund those programs, but people always appreciate direct benefits.

They are only annoyed when they try and use them.  The Medicaid doctor network is horrifying, the Medicare one merely horrendous.  The programs are not well-funded.

The ACA takes on a tall order: changes to the non-group market, mandates to carry insurance, expansion of public insurance, subsidies for private insurance coverage, increases in revenues from a variety of new taxes, most middle class workers will not pay (an often overlooked reason for ACA hostility) , and reductions and "savings" in Medicare.

A seeming selling point was that everyone should like it, the Democrats will be good soldiers and the Republicans will get a product hatched by their favorite think-tank and an idea put forth by one, and soon to be, two, failed Republican presidential candidates.  

Moreover, some of the foundations for ACA could be considered experimental and the justification for the "savings"  in Medicare were based, in part,  on the faulty use of work such as the Dartmouth Atlas and  other health care economists.  What's not to like? What could go wrong?  Any other way would be controversial, a non-starter, so off the table and onto the floor.

In particular light of the continuing Republican attacks on ACA, to the point of closing down the government and threatening its full faith and credit, it is difficult to understand why a "surge" in technological effort did not occur before, rather than after the grand opening.  

Or why, some staggered system was not in place for initial use that deployed alternate days or birth years.   A smooth roll-out would have helped substantially and avoided the inevitable piling-on.

 We now have been given a hot dog with mayo--not generally,  a popular choice. But one, I think, we need to, at least, try.  Because the alternatives are bleak, with no effective replacement, in my view,  likely to be in sight for the next 50 years.  But, with the need steadily increasing.

The Republicans will be happy to keep the status quo for the uninsured, allow premiums to skyrocket  for those who have insurance, and replace Medicare with a substitute coupon-clipping program. We see already what some Republicans think of Medicaid, even with full federal support.

ACA needs to be made to work, to be reformed in a manner that leads to single payer starting with early buy-ins to Medicare.   Initial Democratic reforms should be based on evaluations of actual experiences and user feedback.  Subsidies should be increased and the eligibility income range expanded. And, a national PPO type network assured.  

According to government documents turned over to Congress, there were only six health insurance enrollments on the first day of Obamacare. "CBS This Morning" national correspondent Jan Crawford met with one man who was able to enroll, and takes a look back at the first month of HealthCare.gov.

Everyone has basic coverage.
It is a right.

There is a scale of payment based on income.
But no one is denied coverage regardless of income or lack of it. Many pay absolutely nothing for their coverage.

People can supplement their coverage from "Mutuels".
But even those companies do not gouge the way American companies do, and it is not necessary to purchase additional insurance if you do not wish to.

In addition, medicines are extremely cheap. Generics are reimbursed 100%. Often, they don't pay anything to the pharmacy. They just have to show their medical card.

And they did good for their bosses.

For this reason, of course, they also wouldn't even entertain Medicare for All.  Despite the fact that in poll after poll, over the 15 years preceding the ACA debate, it had around 70% support.

But who needs 70% of the public when you got the banks and insurance companies behind you?  Dems chose to trade in "the rabble" for "the smartest guys in the room".  

Happy Days are Here Again!

If given the change to "fix"the ACA, they'd likely do what they did to Dodd-Frank: gut it, hollow it out, but still claim we "reformed" a broken system.

Here's another problem: it is wrong to assume that the only kinds of insurance policies purchased on the individual market are junk; there are plenty of people with good policies, good coverage, with manageable premiums.  I am one of them, and so is my son-in-law, but I get to keep mine because it pre-dates the March 2010 grandfather cut-off, and he doesn't because he's only had it for about six months.  

An associated problem is that it is kind of offensive for people like Pareene to cast individual plan subscribers as too dumb to know their existing policies are junk.  Unless all these individual plan-owners have never used their insurance, and are just complaining because, well, OBAMA! chances are most of them have actually used their coverage and know they are being forced to give up something they do like, with providers they like, for policies that may not allow them to see those same providers because the networks are so narrow.

Phuck the roof and raise the floor! This ain't rocket science. And it works in almost any area where fiat currency is king and social needs are many.

Simply stated, make the baseline of your economic system a humane and overly generous floor, an act of national import, then go from there. We operate from the paradigm that money matters more than people, hence these ridiculous hoops to get health insurance that, in reality, are just shoving money into the pockets of private insurers, while (because no non-profit public option is offered) offering Americans no actual freedom in the classical sense.

Sigh...

Seriously, are we so bought and paid for that we can't even offer up the metaphorical '69 Mets of American politics?

I guess so.

Sigh again...

It's fair to say that Republicans have supported a mandate but it's also fair to say Democrats have.

What is most fair to say is only Democrats in congress and the White House put it into practice nation wide.

That one is on them.

There's probably not an alternate scenario in which single-payer would've been achievable in 2009-2010. It may even be true -- though I don't think it is -- that this is the best possible deal liberals could've gotten in this political system and in that environment. And obviously the law is a net good. Any pragmatic left-liberal should prefer to live in an America with the ACA than one without the ACA. Millions of Americans are going to be helped. Lives will be saved and improved. It's just that it's going to help millions of Americans in a way that will make it even more difficult to create and sell future programs and reforms that will help millions of Americans.

I disagree this will make it harder in the future.  If/when the program works as it's intended and people have better cheaper coverage, and there is no significant hit to the economy in terms of jobs lost and standard of living depreciatation, people will see, that just like Medicare Part D, this was and is a good thing and works just as well as anything else that could've been implemented.

USA Today via Crooks & Liars:

Nearly seven years later, 9 in 10 Medicare beneficiaries have prescription drug coverage," says the poll. "Satisfaction among those with Medicare Part D has grown 12 points from 78% to 90%. Most are very satisfied with their coverage and say their plan offers excellent value, reasonable costs, and convenience."

It should be noted that in 23 states there is little question. Those states have passed laws that ban all plans in their health exchange from offering coverage for elective abortion. Eight of those states have also banned private insurers outside the exchange from offering coverage for abortion as well. Most, but not all, include exceptions for life endangerment, rape or incest. Some of those states allow abortion coverage to be sold as a separate policy, called a rider, but so far there's no evidence that any plan is offering that.

Judy Waxman of the National Women's Law Center says this is a major change from what has traditionally been the status quo for abortion coverage in private health plans.

"Abortion has generally been covered because it is treated like any other medical service and is just part of outpatient care or doctor care, and really has not been singled out very much in private insurance," she says.

But the fight over the Affordable Care Act changed that. In order to ensure that no taxpayer money went to pay for elective abortions, it created a very complex system by which insurance companies would have to separate out a portion of each premium if they wanted to continue to offer abortion as a covered benefit.

Waxman says, as a result, there is at least anecdotal evidence that some insurers are dropping coverage, at least for this first year, just because of the added hassle.

"We had heard that some plans are saying that they are not going to offer it now because they have so much to figure out, and this little extra administrative activity they have to be involved in is something they want to figure out when things calm down a little," she says.

Four sources deeply involved in the Affordable Care Act tell NBC News that 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive a "cancellation" letter or the equivalent over the next year because their existing policies don't meet the standards mandated by the new health care law. One expert predicts that number could reach as high as 80 percent. And all say that many of those forced to buy pricier new policies will experience "sticker shock."

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None of this should come as a shock to the Obama administration. The law states that policies in effect as of March 23, 2010 will be "grandfathered," meaning consumers can keep those policies even though they don't meet requirements of the new health care law. But the Department of Health and Human Services then wrote regulations that narrowed that provision, by saying that if any part of a policy was significantly changed since that date -- the deductible, co-pay, or benefits, for example -- the policy would not be grandfathered.

Buried in Obamacare regulations from July 2010 is an estimate that because of normal turnover in the individual insurance market, "40 to 67 percent" of customers will not be able to keep their policy. And because many policies will have been changed since the key date, "the percentage of individual market policies losing grandfather status in a given year exceeds the 40 to 67 percent range."  

That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them.

In that same Federal Register, the employer coverage and "grandfathered" status was also discussed:

Estimates are provided above for the percentage of employers that will retain grandfather status in 2011. These estimates are extended through 2013 by assuming that the identical percentage of plan sponsors will relinquish grandfathering in each year. Again, to
the extent that the 2008-2009 data reflect plans that are more likely to make frequent changes in cost sharing, this assumption will overestimate the number of plans relinquishing grandfather status in 2012 and 2013.

Under this assumption, the Departments' mid-range estimate is that 66 percent of small employer plans and 45 percent of large employer plans will relinquish their grandfather status by the end of 2013. The low-end estimates are for 49 percent and 34 percent of small and large employer plans, respectively, to have relinquished grandfather status, and the high-end estimates are 80 percent and 64 percent, respectively.