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Readers sharply divided on Affordable Care Act

Last month marked the second anniversary of the signing of the Patient Protection and Affordable Care Act, commonly called the Affordable Care Act or Obamacare. And time has not done much to change readers’ opinions.

Fifty-four percent of respondents to this week’s RBJ Daily Report Snap Poll disapprove of the health care reform legislation, compared with 59 percent who opposed the legislation two years ago when President Barack Obama signed it. Forty-six percent now say they strongly disapprove of the law versus 53 percent in March 2010.

The law is designed to guarantee coverage to some 32 million uninsured Americans. To do so, starting in 2014 it requires nearly all individuals not covered by employer- or government-sponsored insurance plans to maintain basic essential health insurance coverage or pay a penalty—a provision referred to as the individual mandate. It provides subsidies for low- and middle-income people. Companies with more than 50 employees will have to offer affordable insurance to their workers or pay a penalty.

Among other provisions, the law also requires insurance companies to cover individuals with pre-existing medical conditions and allows children to stay on their parents’ health insurance plans until age 26.

In a recent New York Times/CBS News poll, national views were in sync with Snap Poll respondents’. Among Times/CBS poll respondents who stated an opinion, 57 percent disapproved of the health care law.

The U.S. Supreme Court last week heard oral arguments on actions challenging the law’s constitutionality. Readers are divided on how they would like justices to act, with a narrow plurality favoring the court striking down the entire law.

If the justices strike down the entire law, nearly half—49 percent—of readers favor a single-payer “Medicare for all” national health care system.

Roughly 975 readers participated in this week’s poll, which was conducted April 2 and 3.

Do you approve or disapprove of the Affordable Care Act?
Approve strongly: 32%
Approve somewhat: 15%
Disapprove somewhat: 8%
Disapprove strongly: 46%

In the Supreme Court case, how would you like the justices to act?
Strike down the entire law: 45%
Strike down the individual mandate: 12%
Uphold the entire law: 43%

If the justices strike down the entire law, would you support a single-payer “Medicare for all” national health care system?
No: 51%
Yes: 49%


Isn’t “Affordable Health Care” an oxymoron? Our health insurance went up 85 percent this year. I think controlling health cost is the better issue. How can 20 minutes in an MRI cost more than $1,500?
—Jerry Valentine

It failed to address its intended purpose, but it certainly provoked debate (even if you had to pass it before you could read it). Hopefully, it will get taken out in whole and rethought. The three real issues were quality, access and cost. As written, costs will soar, quality will deteriorate and access would inevitably suffer. If they had only taken the approach of how do we improve access, promote improved quality and keep costs in line, it would have been a great achievement. I feel it is still achievable, just not when it is jammed down our throats.
—Bill Lanigan

The law is imperfect but necessary. Forget about arguments based on rights or politics. Health care costs need to be brought under control; otherwise our economy will suffer like Greece. This law fundamentally changes the dynamic about how health care is paid for and is far more economically sound than the current system.
—Brian A. Kane

Affordable Care Act is helping lots of people get the medical care they need. Politics need to be taken out of health care.
—Arthur Johnson

The government—federal, state or local—should not have the authority to tell me what I have to buy. As for regulation, most states have the authority to write their insurance laws and every state may have different priorities. Using the Commerce Clause is a bogus argument.
—J. Camar

The health care system can’t continue in its current state. Unless it is mandated, people will continue to opt out of medical care, which contributes to the problem and costs extra. Until someone proposes something better, I believe this is a good start.
—Nancy May

To be affordable and sustainable, large pools of participants are necessary—including those who are young and healthy. Challenges to the individual mandate are thinly veiled attempts to sabotage the Affordable Care Act.
—Cindy DeFalco

If we all paid 3 percent toward medical coverage, that would solve a lot. I do not want the government to run the program; I would prefer if current insurance companies got paid for the coverage. There is too much hidden in this current law that I disagree with, one being the requirement to upload all medical data of patients to a central database. That is just wrong.
—Mike Knox

The health of the nation should not be a business.
—Ed Leary

I think the stickler here is that it’s forced on you. If you want to take part in something like this, then you should sign up for it and take the small hit for it, too.
—D. Zarpentine

Medicare for all? We have that now. The safety net is there for those who have to use it. Force the nonpayers to pay their bills. Send them to collections; I have to force my deadbeats to pay. Increase the payments and force the doctors and hospitals to accept Medicare and Auto MVA payments. Now in Rochester, the doctors and hospital play the game of your malady wasn’t cause by a motor vehicle accident, it was caused by an injury at home or you have fibromyalgia. This way they can charge your health care provider and get the payment they want and not have to settle for what the government allows to be paid. Allow insurance companies to sell their products in other states, and the market would take care of itself. It’s time the Excellus, it’s HMOs, and these other insurers played by the same rules that everyone else in business has to deal with. Competition is a GOOD THING.
—Jim Duke, Victor

Canada, France, Germany, England, India and just recently South Korea enacted nationalized health care plans, plans that take the problem of health care out of the hands of insurance companies, employers and anyone with a vested interest in gouging the process for big profits. Doctors in those countries enjoy a very high standard of living and in return provide top care to individuals, who don’t have to worry that a broken leg or cancer or whatever disease befalls them will financially ruin them. In birth rates, death rates, obesity and many other medical comparisons we are far behind these and many other countries that have health systems designed to serve the patient and not enrich insurance companies. HMOs and the insurance companies exist to make a large profit off of people’s misfortunes to get sick. These other countries provide better care and do it at two-thirds the cost! How is that possible? Because they don’t allow insurance cost and other middlemen to steal money that could go for care. Expand Medicare to improve the risk pool; do it every year for the next ten years, including more and more individuals of lower age groups and continue to have checks and balances to regulate care and keep cost and fraud down. We already have death panels; it is the insurance companies denying services to clients and watching them die as they profit. End this antiquated unjust system, and let’s get health care for every person in the U.S.A., take the burden off of business and start working for the patients.
—Joe Wierzbowski, Plymouth Photo Studio

The theory of health care for all Americans is sound, however, the means to achieve this needs work. Forcing everyone to have health care through insurance companies is part of the problem of rendering health care. Insurance company employees (profit/loss specialists) not doctors (trained to diagnose and treat disease) often make and/or usurp a provider’s treatment recommendation. Hospitals must implement policies about who, what, where and how to treat disease and conditions which would begin to curtail or triage inappropriate use of health care use i.e. ER admits for nonemergency conditions, unnecessary ambulance transport, etc. The DRG and CPT code system needs to be overhauled because certain procedures and specialties have higher financial incentives than others. The state taxes health care costs, so the higher a hospitalized patient’s health care bill the greater the tax revenue toward the state. This is the tip of the health care iceberg and is a system fraught with financial conflicts of interest. Thankfully providers of health care take an oath to do no harm but they are working in a system that rewards based on profit and loss first and increasingly the human element second.
—Leslie Apetz

The current health-care financing system in this country significantly lags those of other developed countries. It hurts our global competitiveness. It costs employers more than it should, causes those covered to play convoluted games to have or keep coverage, and siphons money from the delivery of care. Health care demand will always exceed health care supply. Everybody needs and uses health care. We need a single-payer system, and the Affordable Care Act is an appropriate step in that direction.
—Bob Volpe, Highland Development Services

There are problems with health care, but fixing it at the expense of our individual liberty is not the answer. As evidenced by the Postal Service, Amtrak and government support of alternative energy (e.g. Solyndra), more government control and involvement will not cure health care’s ills.
—Peter Short, J.J. Short Associates

I am not an expert on the subject, but intuitively I believe there needs to be universal coverage somehow. My problem with Obamacare is that it has the management of the program top to bottom; start to finish by a government bureaucracy. It needs to be managed in the private sector.
—Mike Kaser, Penfield

The Affordable Care Act is essentially the Republican health care plan. The fact they are against it is nothing more than politics and hypocrisy. No one should go bankrupt or lose everything they own because they get sick. No one should be unable to get insurance because of a pre-existing condition. How can anyone be against these ideas? The individual mandate is a mechanism to get everyone to participate—because EVERYONE uses health care. The other choice is to levy a tax instead of an insurance premium to an insurance company to cover these costs. Hmmm, sounds like a single-payer system. Or we could just go with the alternative and let our citizens not be able to access care and die. What other alternatives have been offered by Republicans? They just say no to everything. Any why should they care, they have health care fully paid for by the tax payers.
—Judy Palmieri, Rochester

The president is marching ahead to turn our country into the United Socialist States of America. His socialist agenda is approaching the practices of some of our European cousins. Furthermore, he dismisses a U.S. citizen’s right to choose on the option of health care. The president entirely dismisses one’s religious faith, remember the First Amendment, as a basis for a conscience based decision with regard to the HHHS mandate. Mr. Obama has also turned his back completely on the “human unborn.” This IS the biggest civil rights issue of our generation.
—J. Brunette, Webster

Obamacare was never intended to be the last evolutionary step toward government control of one-sixth of the American economy, only an intermediary phase to single-payer coverage that would render physicians mere functionaries working under bureaucratic control from Washington. It will require a Herculean effort, but health care needs to be returned to a private relationship between patient and physician without the prying (and controlling) involvement of government workers.
—Bob Sarbane

I agree with the Republican governor of Louisiana who is on record saying that he trusts government to handle health care more than for-profit insurance companies.
—Dave Atias, Center for Disability Rights

"Obamacare" does not go far enough. In the UK, the biggest proponents of the NHS are the conservatives. Why can’t “our” conservatives step up in this country and do what is right?
— Steven Smith

How about an affordable food act or an affordable utility act or an affordable automobile act? This act is nothing more than an Obama, Pelosi, Democratic left wing establishment attempt to destroy the constitution and depress economic freedom. Neither health care, food, utilities nor automobiles are not a right but are necessities to many people. As free and RESPONSIBLE people we are entitled to earn them if we wish, not have them doled out as welfare by a totalitarian government.
—Jim Weisbeck, Bloomfield

I don’t want government-run health care! They can’t do anything right, and health care is just way too important!
—George Thomas, Ogden

The Affordable Health Care act has done nothing to reduce the cost of health care for Americans. Costs continue to increase, both for health care procedures and for insurance. Meaningful cost reductions can only come with a significant structural change in how we provide health care in the marketplace. Patients need to know how much their services cost, in advance of treatment. We need to be able to choose providers and services ourselves, so to meet our budgets and to obtain a baseline of care that we can each afford. Litigation reform is needed so that physicians are not compelled to provide every very expensive test and treatment, or face potential law suits. I’d like to see the insurance providers take a back seat on my health care. Today, they negotiate costs, payments, types of care, frequency of care. The third-party payers are viewed as the "customers" —not the patients. Return health care to the real customers by making the patients the ones who get bills, submit them to insurance companies, know pricing of services, and can choose what they need. The federal government as the "big brother" health care provider is definitely going in the wrong direction!
—Laura Weller-Brophy

The problem with the act is that it was a compromise that satisfies neither party. The fact that insurance companies support it proves it’s a bad deal for consumers. The only solution to our health care issue long-term is a single-payer system, with private insurance providing additional coverage for those who wish to purchase it. Employers should not be responsible for health care for their employees—in the long run the best way to both control costs and spread risks is a single pool of all eligible candidates—young and old, sick and healthy.
—Lee Drake, OS-Cubed Inc.

All this law does is create many additional problems in an already broken system!
—F. Muto, president, FJM Inc.

Compared to its 30 industrialized nation peers, the U.S. spends 45 percent more than the second most expensive country (Switzerland) and more than double the average. However, we rank 27th in life expectancy and rank well below the average in almost every healthcare outcomes statistic. The fact that we may have to wait longer for certain procedures than in many of these other countries, pales in comparison to the important statistics of life expectancy and other relevant health outcomes.
—Alan Ziegler, RABEF

This country desperately needs major health care change. Now this Act may or may not be the end result or best approach, but it is a starting point. You’ve always got to start somewhere and whatever they might say, the GOP have failed to address the subject despite decades of power. To put it simply: without the PCIP component of this act, I might as well be a dead man walking—and give up the ghost on my small business to boot. Ten major health care providers turned me down last year for a pre-existing condition (a.k.a., discrimination). Shortly after that, I had 36 hours with emergency surgery in hospital and now face bills of around 65,000 to 75,000. The Act has allowed me to finally get medical coverage again. To all those people trying to tear down this Act, I say, "Let’s all start with no health care and then we’ll build from there." You know full well those pampered people against the Act would soon have a different outlook on life—as conversely I do now because of it. Bravo, Mr. Obama, for having the courage to enact change.
—Richard Stevenson, co-founder and CEO, CobbleSoft International

The health care act is a first step in determining what kind of health care we need and can afford. We need some method to guarantee health care for all, at a reasonable price, and not have those who pay for health care subsidize those that do not have it. Several core things need to be accomplished. They are: 1. Quality medical care for everyone regardless of income or pre-existing conditions. 2. Affordable health care for everyone. Take the profits from the insurance companies to help reduce premiums. 3. Reasonable cost of health care for required medical procedures to sustain or protect life. Sorry, face lifts and buttock blow ups should not be covered. 4. Programs that emphasize improvement in quality of care and the efficiency of care. 5. Methods to fund care or reimburse for care for those who can absolutely not afford care. I’m not looking for a hand out program but I believe the uninsured emergency room visits add a lot to the costs. I don’t care what party comes up with the idea or wants to work to evolve it. It will not happen overnight. I would like the two parties to seriously work together to make it happen. There are a lot of other countries where this is happening and yes at some cost. Why can’t we figure it out? Stop all the political wars and get the job done. It’s not just the responsibility of the president to make it happen. We have a lot of other elected government representatives that are not doing their job to move the country ahead and thus we are falling behind. Get over the fact that you have a progressive black president. Don’t be a conservative racist. Work for the people and not yourself or your party. That’s only my hope.
—Bob Stein 

Imagine—you or your representative calling up some government agency to negotiate reimbursement with some staff person on a procedure or prescription that your own doctor decides is best for your care or for a loved one’s care. If that doesn’t scare you, it had better.
—Jay Birnbaum

The idea that our current Universal Health Care law will actually lower costs is nice, but totally unrealistic. A September 2011 Beacon Hill Institute study shows that four years after implementation of Mass Health Care Reform there was nearly universal coverage but the costs of health care in MA trended higher than the rest of the country. Costs are out of control and hitting MA hard. Our country can ill-afford that now. We need to make changes as our costs are out of hand and getting worse, but the law before the courts now is not the answer.
—Nat Garfield, APFS Rochester

Our health care system as it currently operates is unsustainable except for the wealthy. At the same time, our system is one of the most expensive and our outcomes trail most other industrialized countries. I am also sick and tired of the "I’ve got mine so to hell with the rest" mentality that is the frequent undertone of those who resist reform. Although Obamacare has some deep faults, at least it is a step forward. Legislation to continually correct inefficiencies after the law is fully implemented will obviously be called for.
—Greg Reynolds, East Rochester

If you want universal health care, go to Mexico. President Calderon was bragging about it yesterday. Hasta la vista baby!
—Devon Michaels, Chili

My opinion on this topic is simple. I believe that the government needs to adhere to its Constitutional responsibilities and absolutely nothing else. That renders this topic as insignificant with regard to any government edict whatsoever. IRS enforcement, abortion, illegal alien coverage, tax on home sales, really? Have to pass it to see what’s in it? Who is the author of this debacle? Could you name him or her? Was it your elected official? Time to wake up the sleeping giant—that would be the taxpayer. Wake up!
—Lou Romano 

The manner in which the Congress passed the bill and the secretive content that could only be examined after passage suggests Congress did not even know what was passed. We are still discovering the content and complications to implement this monstrosity. Further, the "waivers" authorized to favored entities suggests political capital was expended by the party in power (Democrats) to pass this bill, including favored status for Nebraska and Florida, to name a few, supports the prevailing opinion that the Affordable Care Act does more than what the public expected (to cover the 13 million uninsured). It is time to start over and focus on health care as an administered state responsibility to regulate abuses, and let the open competition of private insurance companies to remedy. And it is unconstitutional. The Supreme Court ruling will go far to establish the legislative agenda for this and the next Congress.
—Dennis Kiriazides, retired

Everyone knows the current system is broken. From those opposed to the entire law and/or mandate I have yet to hear how we fund those who have no insurance but have no problem misusing our emergency rooms for his/her care while we who have health insurance and pay taxes wind up paying for their care. Medicaid is meant for those who can’t pay for health care not for those who can. Of course we can always use Rep. Ron Paul’s answer to the dilemma, i.e. “let them die," unless of course the person is related or a close friend.
—Pete Bonenfant

The Obamacare bill is an abomination. When Nancy Pelosi admitted Congress didn’t read or understand the entire bill, it’s irresponsible that it was passed anyway. The Supreme Court should strike down the entire bill because the basis of Obamacare is not credible and there is no severability clause. Unless this bill is struck down, this bill will take away $500 billion from our seniors and distribute it to non seniors some of whom are illegal aliens. It’s a wealth transfer and government control device. Obamacare has already driven up the cost of health care with new taxes on various components in the healthcare system and many more taxes in the future. The bill will also reduce the number of private insurance companies by imposing expensive new mandates. Obamacare will kill the use of health savings accounts (HSA) which was working for many small businesses. Thus, government will control more of the health care market by default. The loss of private competition will result in much higher long run costs and lower availability of medical services. Also, there is only 2 percent of the population who have totally fallen through the cracks of the health care system. A much smaller, less expensive and simpler solution could have been found for this 2% through charity, Medicaid, Medicare, etc. Wouldn’t it be great if the Supreme Court pitched a shutout and voted to declare Obamacare unconstitutional by a margin of 9-0?
—John Rynne, president, Rynne, Murphy & Associates Inc.

People without health insurance are a burden to the rest of society because they get ill and injured like everyone else. When they can’t pay for their medical care, people with medical insurance pay for them. If we let people who needed medical care and couldn’t afford it go without it, then the government would not have to force everyone to get it.
—Donald A. Dinero, TWI Learning Partnership

Health care should be the responsibility of the individual, not the government. Our nation’s Constitution does not allow for the government to mandate or provide any health care though some want to think it is an individual right. Nowhere in the Constitution or its amendments, which include the “Bill of Rights,” does it so much as suggest that healthcare is right. If an individual desires healthcare they and they alone should be able to shop around for an affordable plan. If an employer provides healthcare that is good if he does not it should remain the employer’s prerogative. In any case purchasing a healthcare plan should be as easy as purchasing auto insurance. The “Patient Protection and Affordable Care Act,” (a.k.a.; Obamacare) relies upon the IRS for administration and enforcement. I trust everyone reading this admires the IRS and how it enforces tax law. (Even the mob treats you with more respect and offers better interest rates.) Have you ever had the “opportunity” to visit the local IRS office to resolve a tax problem? Consider that it takes hours to get a simple answer and even after waiting hours for that answer you may still have to wait longer for them to act on it. There was no good reason to destroy our current healthcare system as Nancy Pelosi, Louise Slaughter and others felt necessary. They and their cronies fail or refuse to acknowledge that healthcare costs will increase enormously as costs have in all government run programs. It is a truism, when the costs of government increase so will taxes because somebody must pay and the government has no problem getting the IRS to take more money from your paycheck. One thing is certain healthcare will not improve or become more affordable. As with all government run or mandated programs, quality will decline; in healthcare when quality declines patients die.
—Michael F. Kloppel, chairman, Ontario County Conservative Party, Canandaigua

We need to get the government to realize that they have never been a good solution when it comes to providing services. What "top notch" service is provided by any governmental agency? There is just no motivation to do it well or inexpensively.
—John Costello

There must be a better way to provide healthcare to all citizens of the United States. When the politicos call it socialized medicine or Obamacare, there seems to be an automatic response that this is a bad thing. Let’s look at some facts first. The U.S. spends $7,538 per capita on health care of which $3,507 is public money. The next closest is Norway at $5,003 per capita of which $4,213 is public money. Norway is the only country in the industrialized world that spends more public money per capita on health care than the U.S. EU countries such as Austria spend $3,353 per capita of which $2,263 is public money. For this expenditure, the average life span in the US is 78.49 years while Austria is 79.91 years. Norway is 80.32 years, while the whole European Union is 79.76 years. The summary is the U.S. already spends more public money per capita than any EU country and enjoys a lesser average life span. These medical costs per capita came from "The US Health System in Perspective: A Comparison of Twelve Industrialized Countries" done by the Organization for Economic Cooperation and Development (the US is a member) and the life span information came from a report compiled by the Central Intelligence Agency. Instead of political bickering, send someone to one of the EU countries that has longer average life spans and lower per capita health costs and copy their system.
—Ed Jackson, retired

This has been a crazy debate. As to those who don’t want the increased cost of caring for the uninsured—who they think is paying for it now? There is no free lunch! As someone who spent 30 years in health care finance, believe me, the hospitals and other providers aren’t magically providing the care (mostly in terribly expensive hospitals) for nothing. WE are paying for it via higher insurance premiums, higher Medicare premiums and higher Medicaid costs! Any health care bill paid by anyone is inflated to cover the cost of "free" care for the uninsured! And to my dear fellow senior citizens who "don’t want the government involved in my health care,” what the hell do you think Medicare and Medicaid are! The irony is, that if Health Care Reform is knocked down, it will speed up the day when we have a universal single-payer health care system—the ultimate and best reform (unless you own stock in a health insurance company!).
—Paul E. Haney

Single-payer should have been enacted the first time around. Too bad that the insurance lobby is so strong.
—Charles Kaplan

PPACA was an elaborate Band-Aid approach to a healthcare insurance system that had evolved in the wrong direction. If we were to invent the system from scratch, single-payer is the way to go. But at this point, who really wants to dismantle an entire industry, even if it does not add value to U.S. healthcare delivery? (Just ask your friends at Excellus, MVP and Aetna.) The only ways to make the healthcare insurance system work better are to either add more regulation, a la PPACA, or strip away regulation and let the free market reign, as risky as that is. Right now, we are in healthcare purgatory.
—John Gebhardt, Axle Consulting

So called "Obamacare" is the reason that my 25-year-old sons, both of whom have service industry jobs without benefits, have affordable health insurance. Thank you, Democrats and President Obama.
—John Osowski

4/5/12 (c) 2012 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email rbj@rbj.net.



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