Excellent column as always - I have a small quibble with the way you answered this question:
Was Obamacare helpful or hurtful?
Short answer: Both.
As you go on to explain, the ACA improved things but did not fix the underlying system. (People can argue why that was, to me, it was because that was the most they could get passed.)
I don't think it's fair to say that there are elements of the ACA that were hurtful; there are still elements of the system that cause harm, but I don't think the ACA is to blame.
I agree. My plan is not an ACA plan, but I benefit from provisions in the ACA nonetheless. We must never go back to the days of pre-existing conditions. The medical loss ratio rebate is very good as well. Insurance companies still hold all the cards, and in my view that is a big part of the problem.
That America's dysfunctional health system delivers poor value for money is bad enough, but the real harm it does is to make it necessary for everybody to focus on piling up enough money to meet any medical emergency in the family without becoming bankrupt - exactly as if there was no fire insurance so everybody had to accumulate enough money to pay off the mortgage and buy another house after a fire. This distorts every citizen's life, while losing the health lottery distorts "only" the lives of those unfortunate enough to get sick. A single-payer national health system should be as obvious a solution to both problems as insuring against fire, theft or accident.
(1) As designed it was to become a national health insurance plan for all poor Americans through Medicaid expansion. The US Supreme Court found the conditions unconstitutional. This was a great loss and a tragic frustrated opportunity.
(2) It permanently eliminated "Medical Rating" for everyone. Previously you could be denied health insurance (or given a huge premium increase) if you any (even insignificant or resolved) prior medical condition. If insured and you got ill, health insurance companies would often comb your application for omitted illnesses, and, if found, they would revoke your contract of insurance all together. This was a great improvement in nudging the health system from profit toward care. This is now so long ago that most people are unaware of the bad old days.
(3) Primarily due to vociferous Republican opposition and medical industry lobbying, it was never allowed to include any real medical cost control measures, thus leaving the system unstable.
(4) It is hard to recall at this time the vociferous, aggressive, inflammatory, even violent mobilization against the now routine and accepted ACA program by the Tea Party Republicans, presaging current federal policy turmoil and behavior. (Cries of "Communist Death Panels were heard across the land.) I went to a local Democratic town hall where the police had to be called to protect our Congresswoman.
Thank you for bringing out these points about the struggle to implement the ACA as originally proposed. I find it maddening that so many discussions of its shortcomings fail to mention the changes conservatives insisted on before it could be passed into law. The ACA allowed me to finally quit a job that was necessary in order to afford health insurance premiums but was ultimately destroying my health. The Republican party's original cuts to it and attempts to kill it over the years have proven how beholden they are to lobbyists with big money.
Your description of Obamacare's shortcomings was right. But the labeling of it as 'hurtful' misses the mark. It did not accomplish all that it set out to do. So it was quite 'imperfect.' And if by 'imperfect' you understand it to be hurtful by establishing an unsatisfactory status quo, then ok. But please be careful about using descriptive labels that can be used by those against what was a real effort - and accomplishment - on healthcare reform.
Thank you for all your work! Your newsletters make me feel like I’m not crazy. I am a clinician and work in urgent cares in Texas. I have seen an anecdotal increase in viral URIs that are presenting like COVID/Flu with severe symptoms but the POC tests are negative. Many of these patients are having 3+ weeks of bronchitis/pneumonitis-like symptoms but it doesn’t progress to PNA. It reminds me of early COVID when people would have lingering coughs x weeks. I think I had ~10 flu B’s in adolescents yesterday.
It feels like it’s ramping up to be a tough year. 😷
"As always, we’ll end with some good news." This is a LOVELY habit! I've been trying to persuade PBS News Hour to do the same, so far with mixed success. If you want to badger them, try viewermail@newshour.org.
Re… ACA or ObamaCare… Yes this was a monumental piece of legislation that until the 2025 Trump cuts and in 2021 Biden's failure to make subsidies permanent had helped many millions of citizens. I would argue the only failing at all is the fact that the ACA preserved the insurance industry as the gatekeeper of health.
I would defend Pres. Obama over this. He looked around and saw that fighting the insurance industrial complex would be an uphill battle. Perhaps as perilous to his health overhaul as salmon face when going up against bears in Alaska. Obama the salmon and UHC and the rest being the bears.
Can and should the ACA have some repairs made? Absolutely. We'll have to wait for a more favorable congress and maybe more aggressive inputs from healthcare voices such as KJ and her colleagues.
You mention that the CDC updates their data on influenza-like illnesses every Friday. My question: how much, and what kind, of government public-health data can we trust these days?
* At the beginning of the present administration, YLE made much of politically-motivated meddling with public-health data sets, especially those having to do with gender-related care.
* YLE has also expressed concern about the Morbidity and Mortality Weekly Report.
* In addition YLE has mentioned various academic and public-health entities downloading pre-Trump CDC content, lest the administration withhold or change that information.
In light of YLE’s concern about the integrity of CDC content, can you suggest what CDC content is likely to be trustworthy?
Your reports have become the only thing I trust today in this unimaginable national situation. Thank you for providing the people a place to hear what is happening.
I agree with Mitchell's "it was because that was the most they could get passed."
I let AI help me summarize: "Republicans undermined Obamacare during its implementation by reducing funding for outreach and enrollment efforts, cutting subsidies to insurance companies, and promoting state-level waivers that weakened the law's provisions. These actions contributed to increased premiums and limited access to coverage for many."
In other words, any "harms" of the ACA are because of how it was shredded prior to implementation, and still continues to be decimated incrementally by its GOP critics. I do not call it Obamacare because it was so diminished prior to implementation, not the robust measure that Obama wanted to pass.
Very helpful information on the adapting flu virus. For yes or no on helpful for Obama. A key ingredient to this is understanding the limits of the what the environment would permit. Politics is the art of the possible. One huge positive was focusing health care insitutions on avoiding readmittance which drove better discharge processes.
I was born in the old days and I have no memory of having measles. I do remember having German measles, mumps, chickenpox. I probably had the first available measles vaccine which was not completely effective long term. I did an MMR titer and I had low immunity to measles so I had the MMR vaccine last June. So if anyone here is in the same boat, get an MMR shot. I had no side effects except a mildly sore shoulder. I’m updated on Covid and flu.
I'm a pediatric primary care provider. I love your newsletter and reference it frequently. I want to address the comment regarding RSV immunizations. While technically there is not a national shortage in supply, there was absolutely a delay in distribution from the VFC and there continue to be disruptions in processing. Our practice ordered a large supply the day we were authorized to do so and have received a fraction of what we ordered. We have no issues ordering or receiving Beyfortus outside of VFC, so it's not a supply issue, but it's not as simple a pediatric practices under-ordering or underestimating demand.
I just got both my flu & Covid shot last week. Minimally sore Covid deltoid injection site for less than 48 hours.
Infantile botulism strikes fear in my heart!
One of the last cases I had as a pediatric hospitalist was a case of infantile botulism. Had never seen one before: sloooooow onset of progressive muscle paralysis with no other symptoms such as fever, etc.
The family was visiting from another state and the 2 month old was exclusively breastfed. Made the diagnosis with via a stool sample sent to the state's public health reference lab. The child needed intensive care support, but came through it unscathed.
Infantile botulism is a whole different animal than the other form of botulism toxin disease.
In infantile botulism, the baby ingests the spores and those spores are not destroyed in the GI tract, as would be the case of an older child or adult. The spores take up residence in the gut and slowly release picograms of the potent botulism toxin. The toxin slowly but progressively irreversibly binds to neuromuscular junctions (except cardiac muscle, Thank The Lord!) and paralysis sets in. In this case, paralysis developed over several days.
The other presentation of botulism toxin poisoning is when some food stuff has been growing botulism organisms and those growing forms release the toxin into the food. Toxin levels can be very high. The patient consumes the tainted foodstuff and severe symptoms often have a rapid onset.
Interesting about how much flu virus has shifted/mutated. Question: why does U.S. use a different formula for the flu vaccine than the UK?
Also, re: the 14-year old whose family lost their SNAP benefits during the shutdown. That must have been disappointing to the 14-year old to gain weight back, due to lack of healthy food choice, but I'm wondering why the adults in her family accepted the pastries from the food bank in the first place. And it's disappointing to hear that food pantries are handing out candy. Food banks in our area were still distributing fresh produce during the shut down, because they were still getting it from local grocers and farmers. Maybe being in CA makes this easier.
Thanks, as always, for your clarity and big picture. Regarding the bird flu and backyard flocks, I understand that backyard poultry increases one's risk, but a backyard bird feeder for wild birds -- as long as it is disinfected weekly and you wash your hands after handling -- is a low risk pleasure. Assuming this is correct (a topic I wold love to see explained in YLE) I wish this distinction was emphasized in more places.
Excellent column as always - I have a small quibble with the way you answered this question:
Was Obamacare helpful or hurtful?
Short answer: Both.
As you go on to explain, the ACA improved things but did not fix the underlying system. (People can argue why that was, to me, it was because that was the most they could get passed.)
I don't think it's fair to say that there are elements of the ACA that were hurtful; there are still elements of the system that cause harm, but I don't think the ACA is to blame.
That's a fair quibble! I think you're right
I agree. My plan is not an ACA plan, but I benefit from provisions in the ACA nonetheless. We must never go back to the days of pre-existing conditions. The medical loss ratio rebate is very good as well. Insurance companies still hold all the cards, and in my view that is a big part of the problem.
That America's dysfunctional health system delivers poor value for money is bad enough, but the real harm it does is to make it necessary for everybody to focus on piling up enough money to meet any medical emergency in the family without becoming bankrupt - exactly as if there was no fire insurance so everybody had to accumulate enough money to pay off the mortgage and buy another house after a fire. This distorts every citizen's life, while losing the health lottery distorts "only" the lives of those unfortunate enough to get sick. A single-payer national health system should be as obvious a solution to both problems as insuring against fire, theft or accident.
Exactly what I came here to say. It was an imperfect fix due to applied limitations from outside the effort; that's not the same as causing harm.
More about Obamacare:
(1) As designed it was to become a national health insurance plan for all poor Americans through Medicaid expansion. The US Supreme Court found the conditions unconstitutional. This was a great loss and a tragic frustrated opportunity.
(2) It permanently eliminated "Medical Rating" for everyone. Previously you could be denied health insurance (or given a huge premium increase) if you any (even insignificant or resolved) prior medical condition. If insured and you got ill, health insurance companies would often comb your application for omitted illnesses, and, if found, they would revoke your contract of insurance all together. This was a great improvement in nudging the health system from profit toward care. This is now so long ago that most people are unaware of the bad old days.
(3) Primarily due to vociferous Republican opposition and medical industry lobbying, it was never allowed to include any real medical cost control measures, thus leaving the system unstable.
(4) It is hard to recall at this time the vociferous, aggressive, inflammatory, even violent mobilization against the now routine and accepted ACA program by the Tea Party Republicans, presaging current federal policy turmoil and behavior. (Cries of "Communist Death Panels were heard across the land.) I went to a local Democratic town hall where the police had to be called to protect our Congresswoman.
Thank you for bringing out these points about the struggle to implement the ACA as originally proposed. I find it maddening that so many discussions of its shortcomings fail to mention the changes conservatives insisted on before it could be passed into law. The ACA allowed me to finally quit a job that was necessary in order to afford health insurance premiums but was ultimately destroying my health. The Republican party's original cuts to it and attempts to kill it over the years have proven how beholden they are to lobbyists with big money.
Your description of Obamacare's shortcomings was right. But the labeling of it as 'hurtful' misses the mark. It did not accomplish all that it set out to do. So it was quite 'imperfect.' And if by 'imperfect' you understand it to be hurtful by establishing an unsatisfactory status quo, then ok. But please be careful about using descriptive labels that can be used by those against what was a real effort - and accomplishment - on healthcare reform.
Thank you for all your work! Your newsletters make me feel like I’m not crazy. I am a clinician and work in urgent cares in Texas. I have seen an anecdotal increase in viral URIs that are presenting like COVID/Flu with severe symptoms but the POC tests are negative. Many of these patients are having 3+ weeks of bronchitis/pneumonitis-like symptoms but it doesn’t progress to PNA. It reminds me of early COVID when people would have lingering coughs x weeks. I think I had ~10 flu B’s in adolescents yesterday.
It feels like it’s ramping up to be a tough year. 😷
"As always, we’ll end with some good news." This is a LOVELY habit! I've been trying to persuade PBS News Hour to do the same, so far with mixed success. If you want to badger them, try viewermail@newshour.org.
Re… ACA or ObamaCare… Yes this was a monumental piece of legislation that until the 2025 Trump cuts and in 2021 Biden's failure to make subsidies permanent had helped many millions of citizens. I would argue the only failing at all is the fact that the ACA preserved the insurance industry as the gatekeeper of health.
I would defend Pres. Obama over this. He looked around and saw that fighting the insurance industrial complex would be an uphill battle. Perhaps as perilous to his health overhaul as salmon face when going up against bears in Alaska. Obama the salmon and UHC and the rest being the bears.
Can and should the ACA have some repairs made? Absolutely. We'll have to wait for a more favorable congress and maybe more aggressive inputs from healthcare voices such as KJ and her colleagues.
You mention that the CDC updates their data on influenza-like illnesses every Friday. My question: how much, and what kind, of government public-health data can we trust these days?
* At the beginning of the present administration, YLE made much of politically-motivated meddling with public-health data sets, especially those having to do with gender-related care.
* YLE has also expressed concern about the Morbidity and Mortality Weekly Report.
* In addition YLE has mentioned various academic and public-health entities downloading pre-Trump CDC content, lest the administration withhold or change that information.
In light of YLE’s concern about the integrity of CDC content, can you suggest what CDC content is likely to be trustworthy?
Your reports have become the only thing I trust today in this unimaginable national situation. Thank you for providing the people a place to hear what is happening.
I agree with Mitchell's "it was because that was the most they could get passed."
I let AI help me summarize: "Republicans undermined Obamacare during its implementation by reducing funding for outreach and enrollment efforts, cutting subsidies to insurance companies, and promoting state-level waivers that weakened the law's provisions. These actions contributed to increased premiums and limited access to coverage for many."
In other words, any "harms" of the ACA are because of how it was shredded prior to implementation, and still continues to be decimated incrementally by its GOP critics. I do not call it Obamacare because it was so diminished prior to implementation, not the robust measure that Obama wanted to pass.
Very helpful information on the adapting flu virus. For yes or no on helpful for Obama. A key ingredient to this is understanding the limits of the what the environment would permit. Politics is the art of the possible. One huge positive was focusing health care insitutions on avoiding readmittance which drove better discharge processes.
I was born in the old days and I have no memory of having measles. I do remember having German measles, mumps, chickenpox. I probably had the first available measles vaccine which was not completely effective long term. I did an MMR titer and I had low immunity to measles so I had the MMR vaccine last June. So if anyone here is in the same boat, get an MMR shot. I had no side effects except a mildly sore shoulder. I’m updated on Covid and flu.
Thanks for all the info and all your hard work. So appreciated.
I'm a pediatric primary care provider. I love your newsletter and reference it frequently. I want to address the comment regarding RSV immunizations. While technically there is not a national shortage in supply, there was absolutely a delay in distribution from the VFC and there continue to be disruptions in processing. Our practice ordered a large supply the day we were authorized to do so and have received a fraction of what we ordered. We have no issues ordering or receiving Beyfortus outside of VFC, so it's not a supply issue, but it's not as simple a pediatric practices under-ordering or underestimating demand.
Can I both brag and ask for forgiveness?
I just got both my flu & Covid shot last week. Minimally sore Covid deltoid injection site for less than 48 hours.
Infantile botulism strikes fear in my heart!
One of the last cases I had as a pediatric hospitalist was a case of infantile botulism. Had never seen one before: sloooooow onset of progressive muscle paralysis with no other symptoms such as fever, etc.
The family was visiting from another state and the 2 month old was exclusively breastfed. Made the diagnosis with via a stool sample sent to the state's public health reference lab. The child needed intensive care support, but came through it unscathed.
Infantile botulism is a whole different animal than the other form of botulism toxin disease.
In infantile botulism, the baby ingests the spores and those spores are not destroyed in the GI tract, as would be the case of an older child or adult. The spores take up residence in the gut and slowly release picograms of the potent botulism toxin. The toxin slowly but progressively irreversibly binds to neuromuscular junctions (except cardiac muscle, Thank The Lord!) and paralysis sets in. In this case, paralysis developed over several days.
The other presentation of botulism toxin poisoning is when some food stuff has been growing botulism organisms and those growing forms release the toxin into the food. Toxin levels can be very high. The patient consumes the tainted foodstuff and severe symptoms often have a rapid onset.
Interesting about how much flu virus has shifted/mutated. Question: why does U.S. use a different formula for the flu vaccine than the UK?
Also, re: the 14-year old whose family lost their SNAP benefits during the shutdown. That must have been disappointing to the 14-year old to gain weight back, due to lack of healthy food choice, but I'm wondering why the adults in her family accepted the pastries from the food bank in the first place. And it's disappointing to hear that food pantries are handing out candy. Food banks in our area were still distributing fresh produce during the shut down, because they were still getting it from local grocers and farmers. Maybe being in CA makes this easier.
Thanks, as always, for your clarity and big picture. Regarding the bird flu and backyard flocks, I understand that backyard poultry increases one's risk, but a backyard bird feeder for wild birds -- as long as it is disinfected weekly and you wash your hands after handling -- is a low risk pleasure. Assuming this is correct (a topic I wold love to see explained in YLE) I wish this distinction was emphasized in more places.