Health Care Reform - almost a done deal? DONE

[mheslep]

...If I were American, I'd be pressing for a system like they have in France. Hospitals and doctors are not owned/employed directly by the state there. Instead, they have a system of universal national insurance, and they pay fixed amounts for particular treatments. You can then choose to go to a hospital that charges this standard rate or use the contribution as part-payment at a more expensive place, but the hospitals themselves are not run directly by the state.

I'm aware of the French approach and I'll pass. People keep forgetting the US has effectively had the government paid by and controlled by (if not employed by) system for years for the poor and the elderly via Medicaid and Medicare; the results are that either the care is poor or the costs explode or both. The http://healthcare-economist.com/2007/09/07/wsj-on-the-dutch-health-care-system/" interests me though.

French healthcare is generally very good, ...

No doubt they're good, but my reading shows actual medical outcomes are generally better in the US. The real problem here is cost and access, not quality.

 

[mheslep]

...He also takes examples of things that happened several years ago, problems that have since been solved.

Solved? Perhaps better funded for the moment. I understand that NHS quality has improved quite a bit in recent years, coincident with a http://www.channel4.com/news/articles/society/health/factcheck+is+the+nhs+in+the+worst+financial+health+ever/306547" of the NHS budget from £33bn in 1996-97 to £75bn ten years later. My observation is that government agencies run ok for awhile after being fed by simply growing larger but never really gaining in efficiency, and then they either collapse quality again or explode costs again or both, ending with a problem much more intractable in the end. That's certainly the trend with agencies like the the US postal service.

 

[mheslep]

Yes, Daniel Hannan's appearances on US TV were well covered here. He is considered an extremist right-winger even in his own right-wing political party, the Conservatives – whose leader, David Cameron, disowned him because of his comments.

Hmm, in the Cameron interview I heard, Cameron opposed Hannan's NHS views, but didn't disown him.

 

[Sea Cow]

Solved? Perhaps better funded for the moment. I understand that NHS quality has improved quite a bit in recent years, coincident with a http://www.channel4.com/news/articles/society/health/factcheck+is+the+nhs+in+the+worst+financial+health+ever/306547" of the NHS budget from £33bn in 1996-97 to £75bn ten years later. My observation is that government agencies run ok for awhile after being fed by simply growing larger but never really gaining in efficiency, and then they either collapse quality again or explode costs again or both, ending with a problem much more intractable in the end. That's certainly the trend with agencies like the the US postal service.

Hmmm. Unlike the bloated, extraordinarily bureaucratic, expensive and wasteful US health insurance system, you mean?

It appears that you have fallen for the rather crude propaganda of Fox News when they drag out people like Hannan to tell blatant lies. Look at health care spending in the US. The UK's NHS budget is not that much more than the US's Medicaid programme – about £200billion in 2008 compared to £75billion (US population about 5 times greater than the UK's, so Medicaid is in fact a little cheaper than the NHS, but not much). Yet the UK's NHS provides comprehensive coverage for every single person and Medicaid covers just basic treatment for the poor. You think you're getting a good deal there?

 

[WhoWee]

Hmmm. Unlike the bloated, extraordinarily bureaucratic, expensive and wasteful US health insurance system, you mean?

It appears that you have fallen for the rather crude propaganda of Fox News when they drag out people like Hannan to tell blatant lies. Look at health care spending in the US. The UK's NHS budget is not that much more than the US's Medicaid programme – about £200billion in 2008 compared to £75billion (US population about 5 times greater than the UK's, so Medicaid is in fact a little cheaper than the NHS, but not much). Yet the UK's NHS provides comprehensive coverage for every single person and Medicaid covers just basic treatment for the poor. You think you're getting a good deal there?

It is time to request support for your comments. First, your description of "the bloated, extraordinarily bureaucratic, expensive and wasteful US health insurance system" is misleading. The insurance companies are highly regulated and must maintain a compliance office with each individual state (because their products can't be sold across state lines). Next, the Medicare products differ not only by state, but by COUNTY. Insurance companies - unlike Government - operate with as few departments and employees as possible. The goal of private industry is to control costs - not become a bloated bureaucracy.

As for Medicaid, how much of the budget total is allocated to services such as transportation costs, health club memberships, eyewear, hearing aids, and meals per year (again Medicare related)?

If you want to engage in rhetoric, start first with an analysis of the Center for Medicare and Medicaid (CMS) - not the insurance industry that it oversees and burdens with mandates.

 

[mheslep]

...It appears that you have fallen for the rather crude propaganda of Fox News when they drag out people like Hannan to tell blatant lies.

Look at my last couple posts. Which lie do you contend I'm repeating? Cost?

Look at health care spending in the US. The UK's NHS budget is not that much more than the US's Medicaid programme – about £200billion in 2008 compared to £75billion (US population about 5 times greater than the UK's, so Medicaid is in fact a little cheaper than the NHS, but not much). Yet the UK's NHS provides comprehensive coverage for every single person and Medicaid covers just basic treatment for the poor. You think you're getting a good deal there?

I already stated in https://www.physicsforums.com/showpost.php?p=2659094&postcount=316" that I'm critical of the US Medicaid program.

And I don't agree that government run systems provide 'comprehensive coverage' for every single person, rather they provide the service the government decides you'll receive, good, bad, or indifferent, for every single person.

 

[Sea Cow]

http://ucatlas.ucsc.edu/spend.php"

This link provides some sobering stats regarding value for money in the US system.

Ironic that their relative life expectancies should place the US and Cuba side-by-side in the second graph down.

I find the casual disregard for inequality that some on here show quite mystifying really. I don't judge US health care by the best care available. I judge it by the worst care given to the poorest. By that judgement, it is very poor indeed. That some appear not to feel any responsibility towards the health needs of their neighbours is simply shameful.

 

[mheslep]

http://ucatlas.ucsc.edu/spend.php"

This link provides some sobering stats regarding value for money in the US system.

Ironic that their relative life expectancies should place the US and Cuba side-by-side in the second graph down.

You are simply looking around for what you want to see. Those comparisons have little to do with medical care.

 

[Ivan Seeking]

You are simply looking around for what you want to see. Those comparisons have little to do with medical care.

How are the cost of health care and life expectancy not related to health care?

 

[drankin]

How are the cost of health care and life expectancy not related to health care?

If your lifestyle is not "healthy" then it doesn't matter what your health care is. I do not believe life expectancy is related as much as culture and lifestyle.

 

[turbo]

If you lifestyle is not "healthy" then it doesn't matter what your health care is. I do not believe life expectancy is related as much as culture and lifestyle.

Lifestyle may have a role in depressing the life expectancy of Americans WRT the very high costs we pay, but there's another factor that needs to be taken into account. Many people (especially in poor rural areas and in blighted cities) have no access to regular preventive care, and conditions that might have been detected earlier go untreated until they become serious enough to require emergency care, which is VERY expensive. There may be a rigorous analysis out there somewhere that addresses this situation, but I have yet to find it.

Here is a nation-to-nation comparison of "amenable mortality" - rates of deaths due to untreated or undertreated preventable conditions. I don't have access to the journal Heath Affairs, so I don't know how rigorous the study was, but this summary is a bit discouraging.

http://blogs.consumerreports.org/health/2009/08/amenable-mortality-us-health-care-system-versus-other-countries-.html

 

[Ivan Seeking]

If your lifestyle is not "healthy" then it doesn't matter what your health care is.

Really? I'd like to see you backup that one. My dad just had quintuple bypass surgery and a pacemaker implanted, that saved his life. He was in a perpetual state of heart failure. How is the surgery irrelevant? What IS irrelevant at this point is how he got so bad that he needed the bypass.

I do not believe life expectancy is related as much as culture and lifestyle.

Beliefs are a dime a dozen.

 

[drankin]

Really? I'd like to see you backup that one. My dad just had quintuple bypass surgery and a pacemaker implanted, that saved his life. He was in a perpetual state of heart failure. How is the surgery irrelevant? What IS irrelevant at this point is how he got so bad that he needed the bypass.



Beliefs are a dime a dozen.

Figured you would call me on this. So let's do a little logic exercise:

Group A and Group B have the same excellent health care available. Group A does not have a healthy diet. Group B has a healthy diet and works 20% less than Group A. Which group has a longer life expectancy?

 

[Ivan Seeking]

Figured you would call me on this. So let's do a little logic exercise:

Group A and Group B have the same excellent health care available. Group A does not have a healthy diet. Group B has a healthy diet and works 20% less than Group A. Which group has a longer life expectancy?

But not all groups have the same excellent health care, so your point is moot. Try this one. One critical heart patient has socialized medical care through the Veteran's administration [dad], and another has no insurance or VA benefits, and lives in Watts, California. Who is more likely to survive?

Query: Why are only vets entitled to socialized medicine?

 

[Ivan Seeking]

Actually, since it came up, wrt to the VA, let me put it this way: If government run health care is so terrrible, then why do we impose this on our Vets? Don't they deserve the same care as everyone else? We don't have government run health care under the Obama reforms, but the position of the right is very perplexing in this respect.

Has one opponent of universal health care ever called for the VA medical system to be deconstructed? It almost begs the question: What does the right have against our vets? Or is the problem that their position is completely inconsistent?

 

[WhoWee]

Actually, since it came up, wrt to the VA, let me put it this way: If government run health care is so terrrible, then why do we impose this on our Vets? Don't they deserve the same care as everyone else? We don't have government run health care under the Obama reforms, but the position of the right is very perplexing in this respect.

Has one opponent of universal health care ever called for the VA medical system to be deconstructed? It almost begs the question: What does the right have against our vets? Or is the problem that their position is completely inconsistent?

I like your logic - let's impose VA on ALL Government workers and retirees (including politicians) and abolish TRICARE as well - who needs it when they can have VA.

By the way, how many VA eligible people are on Medicare? I'll look for a link.

 

[turbo]

My father is a WWII vet and gets VA care, as well as Medicare to help with medications, etc. Getting decent care was tough, as the nearest VA hospital is quite distant. Within the last year or so, though, the VA has been offering care in small field offices in rural towns on a rotating basis. That way, he gets to see the same nurses and doctors routinely, when he needs care. Lots of our veterans are getting quite old, and it is a burden on them to have to drive 2-3 hours or more to get the health care they were promised, so this is a welcome change.

Transfer all government officials, elected or appointed, over to VA care, and watch how fast that system would improve. It would get LOTS better very quickly once our cherished bureaucrats had to rely on it for their primary health care.

 

[mheslep]

How are the cost of health care and life expectancy not related to health care?

Of course they're related. The complication is that longevity is related to many things. Thus, a comparison based on a couple years of difference in unqualified life expectancy as a metric for the medical system is invalid. Many things having zero to do with the medical system impact life expectancy, including homicides, car wrecks, gene pools. If one corrects for those factors, the US comes out at or near the top of a longevity ranking.

 

[mheslep]

Actually, since it came up, wrt to the VA, let me put it this way: If government run health care is so terrrible, then why do we impose this on our Vets?

Probably we should not:

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/17/AR2007021701172.html"

Currently they're given no (economic) choice. In the US, the government has set up the system so that one can only get medical benefits economically through an employer. For VA patients, their employer is the US military, and it says you will use the VA.

 

[mheslep]

Massachusetts Care (now Patrick Care) is often compared to Obama care. In response to state price controls, in the last few days health insurance companies decided to stop selling any more new heath policies. In my view this was all too predictable.

Earlier this week, the state’s six largest health insurers sued Massachusetts after nearly all of their requests to raise rates were denied. For several days they stopped offering policies to individuals and small businesses as the dispute intensified.

http://blogs.marketwatch.com/election/2010/04/08/massachusetts-a-harbinger-of-health-law-problems/

The state's insurance commissioner blocked 235 of 274 increases ranging from 8 to 32 percent on policies for small businesses and individuals. Those hikes would have taken effect April.

The insurers say increased costs of care are the problem and lay the blame for the hikes on higher charges by hospitals and doctors. They want a state judge to quash the insurance commissioner's actions.

In reaction to the commissioner's decisions, most of them said earlier this week they would stop offering new policies at the old rates, as the Boston Globe reported.

http://www.npr.org/blogs/health/2010/04/by_scott_hensley_massachusetts.html

 

[Choronzon]

Query: Why are only vets entitled to socialized medicine?

Are you kidding?

Let me give you a very simple answer to your query— because they earned it. You would like to just give away for free what your father earned. What your father and myself and people like us earned by risking our lives.

But of course we were stupid to do so, because we should have just stood in line with all of the useless people who are so vehemently opposed to making their own way through the world. Are you going to ask now why only vets are entitled to the G.I. Bill?

 

[turbo]

Are you kidding?

Let me give you a very simple answer to your query— because they earned it. You would like to just give away for free what your father earned. What your father and myself and people like us earned by risking our lives.

But of course we were stupid to do so, because we should have just stood in line with all of the useless people who are so vehemently opposed to making their own way through the world. Are you going to ask now why only vets are entitled to the G.I. Bill?

My father is a WWII vet who quit HS, lied about his age and joined Airborne. His compatriots are dying daily. He deserves VA care and he deserves Medicare assistance to help pay for prescription drugs. He left his family to live with a store-owner and his family when he was in his early teens, so he could work every night, have regular meals, a roof over his head, and money to send to his mother every week. When he joined the Airborne, he designated that all his checks be sent to his mother. Until very recently, VA care in this state was horribly deficient, and elderly veterans had to drive hours one-way to get to a VA center to get any treatment. Why should any veteran be subjected to that?

Why should any citizen be subjected to that? If you have a good answer to that, you can get the 2012 presidential nomination because that will be the GOP's hot-button.

 

[Choronzon]

My father is a WWII vet who quit HS, lied about his age and joined Airborne. His compatriots are dying daily. He deserves VA care and he deserves Medicare assistance to help pay for prescription drugs. He left his family to live with a store-owner and his family when he was in his early teens, so he could work every night, have regular meals, a roof over his head, and money to send to his mother every week. When he joined the Airborne, he designated that all his checks be sent to his mother. Until very recently, VA care in this state was horribly deficient, and elderly veterans had to drive hours one-way to get to a VA center to get any treatment. Why should any veteran be subjected to that?

Why should any citizen be subjected to that? If you have a good answer to that, you can get the 2012 presidential nomination because that will be the GOP's hot-button.

Hey, you won't find me defending the quality of VA health care. It should definitely be improved—but it should in no way be used as some model to describe what every person is entitled to. Vet's earned the money society spends on them, which is not something that can be said about everybody else clamoring for hand-outs.

 

[turbo]

Vet's earned the money society spends on them, which is not something that can be said about everybody else clamoring for hand-outs.

People in the US are not exactly clamoring for hand-outs. They would like for their coverage not to be canceled if they get sick. They would like for their children's coverage not to be dropped because the insurance company deems the kids' sickness a "pre-existing condition" and other types of abuse. Insurance is supposed to be a shared-risk/shared-cost pool, but it has been perverted into a situation in which the insurance companies can drop people on any pretense, and no individual has the financial means to prevail against them in court. How would you feel if you bought fire insurance, and your insurance company dropped your insurance as soon as they got word that your house was on fire? Health insurance companies do this every day, all day long. I spent years in the health-care industry as an IT specialist, and I have never seen a more predatory bunch than health insurance companies.

 

[Choronzon]

People in the US are not exactly clamoring for hand-outs. They would like for their coverage not to be canceled if they get sick. They would like for their children's coverage not to be dropped because the insurance company deems the kids' sickness a "pre-existing condition" and other types of abuse. Insurance is supposed to be a shared-risk/shared-cost pool, but it has been perverted into a situation in which the insurance companies can drop people on any pretense, and no individual has the financial means to prevail against them in court. How would you feel if you bought fire insurance, and your insurance company dropped your insurance as soon as they got word that your house was on fire? Health insurance companies do this every day, all day long. I spent years in the health-care industry as an IT specialist, and I have never seen a more predatory bunch than health insurance companies.

That's not what I've seen throughout this health care debate. Those are just the talking points that the left has used to get reasonable people to support the bill, and in the end they're going to get none of those. They're going to get a massive bill to provide welfare in the form of health care subsidies. Insurance company abuses can be handled with nothing more than strong consumer protection laws. This massive farce of a bill is basically legerdemain designed to create more subsidies for useless people who then become voters desperate to keep democrats in office so that their monthly portion of their neighbors labor arrives via the USPS.

 

[Ivan Seeking]

This massive farce of a bill is basically legerdemain designed to create more subsidies for useless people who then become voters desperate to keep democrats in office so that their monthly portion of their neighbors labor arrives via the USPS.

What people in particular are you referring to, and what subsidies? People on the bottom end wouldn't be affected by this. People on Medicare would actually lose some benefits, such as hearing and vision benefits, IIRC.

Moving up one notch on the economic ladder: The last time I checked, one the biggest complaints is that this penalizes people who don't have insurance and who refuse to purchase insurance through the low-cost insurance pool. How does this support your premise?

 

[Galteeth]

My father is a WWII vet who quit HS, lied about his age and joined Airborne. His compatriots are dying daily. He deserves VA care and he deserves Medicare assistance to help pay for prescription drugs. He left his family to live with a store-owner and his family when he was in his early teens, so he could work every night, have regular meals, a roof over his head, and money to send to his mother every week. When he joined the Airborne, he designated that all his checks be sent to his mother. Until very recently, VA care in this state was horribly deficient, and elderly veterans had to drive hours one-way to get to a VA center to get any treatment. Why should any veteran be subjected to that?

Why should any citizen be subjected to that? If you have a good answer to that, you can get the 2012 presidential nomination because that will be the GOP's hot-button.

You realize this is an argument AGAINST socialized medicine, right?

 

[Sea Cow]

Many things having zero to do with the medical system impact life expectancy, including homicides, car wrecks, gene pools. If one corrects for those factors, the US comes out at or near the top of a longevity ranking.

Rubbish.

Diet, exercise, primary health care provision – these are the single most important factors, in fact, to raise life expectancy. The levels of obesity in the US certainly show that the first two of these factors are at a bad level for many people there, and primary health care is precisely the area that the poor and uninsured do not receive. These are linked, of course – improve primary care and diet and levels of fitness will also improve.

The factors you mention are ridiculous. Homicides will have a fairly negligible bearing. 17,000 murders in the US in 2006 – about 3–5 times the rate of most industrialised countries. So, let us call that 12,000 extra deaths due to murder. Compare that to http://prescriptions.blogs.nytimes.com/2009/09/17/harvard-medical-study-links-lack-of-insurance-to-45000-us-deaths-a-year/", which estimates that 45,000 deaths per year can be directly attributed to lack of health insurance.

As for car crashes, you haven't been to Cuba, have you? I have been to both the US and Cuba, and I can assure you that US roads are much safer. Cuba's life expectancy would probably jump ahead of the US 'correcting' for this factor. Road deaths in the US are high – 40,000 per year, a rate that's three times higher than the UK (which has a very good record), and about twice as high as Japan (which has one of the highest life expectancies, and is about average for road deaths). So, again, even comparing the US with countries with good records, you're talking about an extra 20,000 deaths. This also begs the question: How many of these deaths could have been prevented if the victims had all had good health insurance?! Is the UK's low death rate on the roads in part attributable to the fact that we all have equal access to all A&E departments? I would suspect that it is – you are taken to the nearest hospital, not the nearest hospital that your insurance will cover.

And your final factor, gene pools... I'd like to see some evidence, please. The US is largely a country of descendants of recent immigrants – there's a pretty wide gene pool in the US population. At the very least, you would need to provide some evidence for this assertion. I suspect that it is, to put it in the British vernacular, utter bollocks. In fact, it would be pretty easy to show that this is bollocks. Life expectancy among black Americans is significantly lower than the overall average. Is this because of their genes? No. How do we know that? Because we can compare the life expectancy of poor black Americans and rich/middle class black Americans and see that the difference can be fully explained by their relative positions in society.

ETA: Just to put these figures into perspective – 12,000 extra deaths due to murder, 20,000 due to car crashes – 2.5 million people die in the US each year. Even if you could show that none of these extra deaths could have been prevented with a more equitable health care system (there are strong reasons to doubt this), these are not the reasons for the US's relatively poor performance wrt life expectancy.

Please don't make stupid, unjustified assertions like "If one corrects for those factors, the US comes out at or near the top of a longevity ranking." It simply isn't true and it debases the discussion.

 

[hypatia]

How many of these deaths could have been prevented if the victims had all had good health insurance?! Is the UK's low death rate on the roads in part attributable to the fact that we all have equal access to all A&E departments? I would suspect that it is – you are taken to the nearest hospital, not the nearest hospital that your insurance will cover.

All general hospitals in the USA must take emergency cases, you can not be turned away. Once the person has become stable{non critical}, they can then be transferred to another hospital for recovery.

 

[Sea Cow]

All general hospitals in the USA must take emergency cases, you can not be turned away. Once the person has become stable{non critical}, they can then be transferred to another hospital for recovery.

Glad to hear it. My argument doesn't stand on this point, however. The reason for the US's relatively low life expectancy (for a rich country) is its health care system. Why flounder around searching for alternative explanations when the truth is so obvious, and easily demonstrable. If you're rich in the US, you have a very good life expectancy. If you're poor, you have the life expectancy of a poor country, not a rich one. This is due mostly to your relative access to health care, in particular primary health care. Nobody who has seriously studied the matter disagrees with this. If you do, you're probably one of those with access to the good care, and are simply in denial about the situation of others.

It's a common psychological defence strategy for the relatively rich to blame the poor for their poverty. It makes them feel less guilty about the fact that they have drawn the lucky cards in the lottery of life.

 

[Sea Cow]

More stats, this time http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate" .

Try explaining the ranking of the US (33rd or 46th, depending on which table you use) without reference to the health care system.

 

[Zefram]

Massachusetts Care (now Patrick Care) is often compared to Obama care. In response to state price controls, in the last few days health insurance companies decided to stop selling any more new heath policies. In my view this was all too predictable.

This isn't a feature unique to the Massachusetts system. Roughly 30 states require premium increases to be approved by state insurance regulators. Recent (i.e. in the last few years) raises have been rejected or challenged in a number of states--Maine, Connecticut, and Washington come to mind immediately and I'm sure some of you have heard about the recent challenge (and subsequent delay) to premium increases in the individual market in California.

 

[Choronzon]

What people in particular are you referring to, and what subsidies? People on the bottom end wouldn't be affected by this. People on Medicare would actually lose some benefits, such as hearing and vision benefits, IIRC.

Here's from Whitehouse.gov Link:http://www.whitehouse.gov/health-care-meeting/proposal/whatsnew/affordability"

Health reform also improves the cost sharing assistance for individuals and families relative to the Senate bill. Families with income below $55,000 will get extra assistance; the additional funding to insurers will cover between 73 and 94% of their health care costs. It provides the same cost-sharing assistance as the Senate bill for higher-income families and the same assistance as the House bill for families with income from $77,000 to $88,000.

That sounds an awful lot to me like the government has been feeling like it doesn't send our enough checks in the mail to voters. I'm so glad that people with income under $55,000 feel that 73-94% of their health care is other people's problem.

Moving up one notch on the economic ladder: The last time I checked, one the biggest complaints is that this penalizes people who don't have insurance and who refuse to purchase insurance through the low-cost insurance pool. How does this support your premise?

That complaint, at least in my own opinion, falls squarely on constitutional grounds. The government is telling me that I have to give another private entity some of my labor, whether I desire their product or not—that's basically the definition of enslavement. It's part of the legerdemain I was talking about earlier—mere slight of hand to take money from people who want nothing to do with this stupidity and give it to potential voters for the Democrats.

What people like you fail to grasp is you have effectively delivered the provision of health care into the hands of the government. You think that's okay now, because all the talk about Quality Life Years and all that jazz doesn't bother you, but you have a big surprise coming. Wait until religious conservatives are back in power, and all of a sudden there is a clamor to save money by denying care to homosexuals and infected with AIDS, or perhaps people who have harmed themselves through the use of recreational drugs. You'll see the monstrosity of this bill quite clearly then, and you'll finally reap what you've sown.

 

[Galteeth]

Why flounder around searching for alternative explanations when the truth is so obvious, and easily demonstrable.

By this logic, comparative placebo studies are just a big waste of time.

 

[Ivan Seeking]

Here's from Whitehouse.gov Link:http://www.whitehouse.gov/health-care-meeting/proposal/whatsnew/affordability"



That sounds an awful lot to me like the government has been feeling like it doesn't send our enough checks in the mail to voters. I'm so glad that people with income under $55,000 feel that 73-94% of their health care is other people's problem.

I believe the purpose of that is to ensure that the cost of health care premiums do not exceed the insured's ability to pay; which was one of the main goals of reform. What you would need to demonstrate is that this exceeds what would be considered reasonable. It is a limit based on a percentage of one's income, which is how one would deteremine the limit on costs that can be managed. What is not clear at all is how many people would be entitled to assistance under this section.

That the CBO projects deficit reductions means that cost alone is not a sufficient objection. There is give and take throughout the system. Obama argued that the strings must all be pulled at once in order to make this work. Note also that the assistance is for the premiums. The cost of health care itself is still paid by insurance companies.

That complaint, at least in my own opinion, falls squarely on constitutional grounds.

This thread addresses your concern.
https://www.physicsforums.com/showthread.php?t=389899

What people like you fail to grasp is you have effectively delivered the provision of health care into the hands of the government. You think that's okay now, because all the talk about Quality Life Years and all that jazz doesn't bother you, but you have a big surprise coming. Wait until religious conservatives are back in power, and all of a sudden there is a clamor to save money by denying care to homosexuals and infected with AIDS, or perhaps people who have harmed themselves through the use of recreational drugs. You'll see the monstrosity of this bill quite clearly then, and you'll finally reap what you've sown.

Imo, that is just silly Fox-like fearmongering. Also, first and foremost, it was the current cost of health care that drove this issue. To assume that doing nothing was an option, is fallcious. The cost of health care was going to bankrupt the country if not addressed soon, and aggressively. That you failed to recognize this shows that you lack even a basic understanding of the need for reform.