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View Diary: It's Republican versus Republican in Obamacare fight in the states (91 comments)

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  •  don't think so (12+ / 0-)

    I think this is a clash between 2 perspectives in the R party:

    The Grownup: I don't like the law, but we will have to have an exchange according to the law.  We have a choice on whether we want to build our exchange and do it on our terms with our oversight and our rules or leave it up to the feds so its better to do it and maintain control.

    The 2 Year Old:  You can't make me, nyah nyah nyah.  I dare you to create a federal exchange.

    Unfortunately there are way too many 2 year olds.

    •  There are those states that say the federal rules (1+ / 0-)
      Recommended by:
      madhaus

      for exchanges are too onerous and nit-picky.

      Which to me says the fed rules are meant to help as many people as possible. This idea, of course, is anathema to Rs.

      "I believe more women should carry guns. I believe armed women will make the world a better place. Women need to come to think of themselves not as victims but as dangerous." Anna Pigeon

      by glorificus on Fri Nov 30, 2012 at 09:13:33 PM PST

      [ Parent ]

    •  or fortunately (2+ / 0-)
      Recommended by:
      blue denim, Sherri in TX

      Because a federal exchange is what progressives generally wanted, precisely to keep Republican states from screwing them up.

      •  If you want to see health care without an exchange (0+ / 0-)

        take a look at the Medicare Advantage and Part D (drug benefit) open season right now.

        Part D is operated entirely by private companies (all insurance companies) in separate regions. They are required to have at least two companies in each region, and some states are have enough population to be a region by themselves. But you either have to pay for the Part D insurance or give up standard Medicare and go to an insurance company for a Medicare Advantage Plan. (These are subsidized at about 10 to 13% higher than regular Medicare costs)

        Each plan negotiates with the pharmaceutical companies on its own and decides how much of the savings to share with the suckers beneficiaries. Each plan also has its own private formulary that determines which medications it will provide.

        This was all set up in the Part D bill Bush and the Republican Congress passed in 2003. It was supposed to prove that competition could provide better health care at lower cost. It has instead proven to provide worse health coverage and require a federal subsidy to even continue to exist. (That's the largest part of the money Obama promises to remove from Medicare costs - the subsidies for inadequate health coverage are a total waste of money both for beneficiaries and for tax payers.)

        If you take a set of specific medications you know nothing about coverage beyond the sales brochures you get in the mail during the open season. This is also true for the physicians! They don't know the insurance coverages either.

        Selecting the coverage that covers your specific set of prescriptions is almost impossible if you take more than 3 or 4 - as most of us seniors do. so how do you choose a plan? You guess!

        Oh, and you are stuck with that plan for the next year. But the plans can change the medication formulary they cover overnight just by notifying you.

        The so-called Free Market does not provide adequate health coverage! All it does is deliver up a set of patients who need coverage to financial predators who make their money by promising health care, charging too much for it, and then by cutting it off if you really need it. All the rules favor the private insurers and they cannot compete on either cost or adequate coverage even then.

        A standardized nation-wide health care market run by the federal government is the only solution! It won't solve all the problems overnight, but it will provide the information everyone in the system - patients, health care providers, administrators, etc. - really need to have to identify and solve the problems.

        The US Supreme Court has by its actions and rhetoric has ceased to be legitimate. Whiskey Tango Foxtrot - over

        by Rick B on Sun Dec 02, 2012 at 08:22:42 AM PST

        [ Parent ]

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