ACA Realities – by Harper

Obamacare was written by and for the insurance companies. United Healthcare dispatched lobbyists and lawyers onto the Senate staff of Max Baucus to write the bill that had the backing of the Obama White House. The bill diverts hundreds of billions of dollars that previously went as payments to doctors and hospitals directly into the pockets of the big private insurance companies.

Whatsmore, under Sections 1341 and 1342 of the Affordable Care Act, the insurance companies are guaranteed their projected profits. If there are shortfalls in their profits due to changes or failures in the Obamacare bill, taxpayers have guaranteed 80 percent payouts to the insurance companies. Now that there has been a delay in deadlines for small businesses to comply with ACA, now that people with previous individual insurance policies have been allowed to keep those policies ("if you like your previous policy you can keep it") and now that young healthy people are going to be able to buy cheap catastrophic care insurance at a fraction of the costs of ACA-compliance policies, the insurance companies are going to see their projected profits shrink.

Look what happens when the public learns that they are committed to another bailout! Furthermore, even the New York Times has documented that more than 9 million Americans will be stuck in the "gap" between Medicaid and affordable policies. If they can't pay the premiums, they can't get the policies offered on the exchanges, even if they are slated to have the government subsidize their policies. Of the first 1.6 million people who successfully navigated the website, 1.4 million were automatically signed up for Medicaid due to low incomes. But many people are finding that doctors are not taking Medicaid patients anymore because the cuts in payouts for Medicaid are so severe that they can't afford it. This is a disaster that will be playing out more and more in the coming months. Coming out of World War II and the experience of the military, Congress passed the Hill Burton Act, which was on the books until the mid-1970s when the for-profit HMOs were legalized. Under Hill Burton, there were regular surveys of America's medical needs and there were mandatory amounts of doctors, specialists, hospital beds, etc. per geographic area. A recent report indicated that if we had a Medicare for all single-payer program, $400 billion in overhead costs would be saved in year one. But the Obama White House told Congress that single-payer was off the table and that the system would center on for-profit insurance companies. This is yet one more example of the Obama Administration's slavish loyalty to the big Wall Street banks and insurance companies that paid for his two election campaigns.

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158 Responses to ACA Realities – by Harper

  1. tv says:

    “A recent report indicated that if we had a Medicare for all single-payer program, $400 billion in overhead costs would be saved in year one”
    From efficient government management?
    That same government that’s done such a good job so far?
    Using the Canadian/UK model of rationing?
    Reducing medical costs by limiting services and putting specialists on quotas.
    Not good for people’s health, but cheaper.
    But then, this whole mess has never been about health care.
    It’s about creating a new class of entitled voters – and the political power excepted to come with it.

  2. Lesly says:

    “But the Obama White House told Congress that single-payer was off the table”
    I attended a local Democratic rally when the HCR debate-that-wasn’t got underway. Brown was in and out. Kilroy refused to say whether Democrats would commit to single payer. Her aide scowled at me. The protesters/hecklers outside were as approachable.
    Friends, enemies and frenemies didn’t believe me when I said insurance companies would end up being the beneficiaries. It was the beginning of the cannibalization of Democratic sympathizers (I washed my hands of the party when the 110th reauthorized the Patriot Act) in the service of Obama’s legacy.
    I’m for single-payer. Get it right, or leave it alone.

  3. steve says:

    There are so many false political narratives out there, and two of them that thus far have tended to define the Obamacare debate are 1. it’s a policy to make insurance affordable for the majority who no longer can easily afford it, and 2. it’s socialized medicine. The false debate seems to revolve around those.
    Of course, as you demonstrate, it’s neither. Imho, it’s a program to keep the increasingly dysfunctional for-profit heath insurance model creaking along for a few more years.
    The debate is similar in its falseness to Obama’s role in Iraq. Certain Obama cheerleaders hailed the US withdrawal from Iraq as evidence of Obama’s peace-making sensibilities, suitable for the peace laureate. Of course, Obama worked for months to extend the military presence, and it was Iraq that said no, and pulled the plug, not Obama.
    And of course those dem partisans all conveniently forgot that it was Bush who negotiated the withdrawal date, not Obama.
    Now, with Al Qaeda taking Fallujah, the repub partisans and rightwing media, buying into the false dem narrative that Obama willingly ended the war, are accusing Obama of having “lost” Fallujah.
    Of course, all these false narratives serve to deflect from the real issues, and just stir up political posturing, enabling Pepsi and Coke to market themselves as having meaningful differences.

  4. Tyler says:

    It was written for insurance companies AND the Democratic base of poor minorities via wealth transfer from the middle class.
    Let’s give the blame where blame is due.

  5. JerseyJeffersonian says:

    All this is true. I knew in 2008 that Obama was a lying, self-loving weasel who had his eye on the big payout that he could expect after his time in office from serving the interests of his Big Money playmates. I detested McCain and Wasilla Barbie, but I owed a duty to myself to not vote for the purported “lesser evil”, and so I voted third party that year, and yet again in 2012.
    But let’s not be too quick to let the Congress off of the hook here. They had agency, too, agency that they could have used to guarantee that single payer got a fair hearing, but decided not to exercise it. And why not? Because they were largely in the pockets of the very same Big Money playmates as Obama. So the best interests of the citizenry be damned, they chose corruption over their clear duty.
    The sheep looked up, and were not fed, in this instance as in so many, many others over these last decades. Untouchable banksters, captive regulatory agencies, Federalist Society activists squatted down on the judicial benches vaulting corporate interests over those of the citizens, a “Justice” Department that can’t remember in what Justice might consist… The litany of shame goes on and on.
    The stench of corruption emanating from our so-called leaders rankles my nostrils. I fear for the future of my stepson and his wife, and understand the qualms that they have about bringing children into the world, something that is particularly disheartening when I reflect upon what good parents they would be, and how their children would be a credit to their family, and an asset to their community. But seeing what I have seen, I can’t argue with them if they feel that the deck is increasingly stacked against them, regardless of their good characters and their work ethic. Perhaps these “quaint” values no longer count for much, given how Our Betters have opted for debt slaves toiling on their latter day latifundia as their preferred social construct.

  6. robt willmann says:

    The Obamacare Patient Protection (?) and Affordable (?) Care Act (ACA) has the two sections mentioned by Harper, 1341 and 1342, in Part 5 of Title 1, Subtitle D, which is called “Reinsurance and Risk Adjustment”.
    That part contains only three sections, each with its own title. Section 1341 is “transitional reinsurance program for individual and small group markets in each state”; section 1342 is “establishment of risk corridors for plans in individual and small group markets”; and section 1343 is “risk adjustment”. They take up about four and a fourth single-spaced pages.
    Section 1341 requires a reinsurance program that the States must set up starting in January 2014. Reinsurance is insurance bought by insurance companies to cover certain problems (risks) that might happen to them. Health insurance issuers and third party administrators on behalf of group health plans are required to make payments to a reinsurance entity which will then in turn make payments to health insurance issuers that cover “high risk individuals” in the individual market. This program is to last three years starting now. The health plan companies will be shuffling money between themselves through at least one reinsurance company in each State.
    Section 1342 gives us some real comedy by making up a new name, “risk corridors”, for what are really subsidies from taxpayers and a taxpayer bailout to the health plan companies. I kid you not: “The Secretary shall establish and administer a program of risk corridors for calendar years 2014, 2015, and 2016 under which a qualified health plan offered in the individual or small group market shall participate in a payment adjustment system based on the ratio of the allowable costs of the plan to the plan’s aggregate premiums”. If the “allowable costs” of providing benefits under a plan are more than a certain amount above the “target amount”, the Secretary pays money (originally from the taxpayers) to the health plan company; if the allowable costs are a certain amount below the target amount, the company pays money to the Secretary (the government, but not back to the taxpayers).
    Section 1343, “risk adjustment”, is not limited to three years. It says that each State shall assess a charge on health plans and health insurance issuers if the “actuarial risk” of the enrollees of such plans or coverage for a year is less than the average actuarial risk of all enrollees in all plans or coverage in the State for such year; and that the State shall provide a payment to health plans and health insurance issuers if the actuarial risk for a year is greater than the average actuarial risk.
    In other words, section 1343 can give taxpayer money from a State to health plan companies based on a high “actuarial risk”, and not on documented high costs.
    The ACA is Public Law 111-148. At least some (or all) of it is in Titles 42 and 26 of the U.S. Code. You can find it at what used to be the Library of Congress web site–
    and which now switches to–

  7. Edward Amame says:

    Oh please. The ACA sucks but it’s better than what we had.
    Single payer, which I favor, never had a chance because Socialism yada yada and because the insurance industry wouldn’t allow it.

  8. Fred says:

    If you weren’t sick before just read the details of the ACA and you will be.

  9. Charles I says:

    Following on Shrub’s drug plan profits guarantee, lets follow cui bono, as I said before. Its corporations that KEEP the dough they already rake in, not the Dems and the poor. There is NO TRANSFER of wealth from corps to any citizens.

  10. Charles I says:

    Huh. Fancy that. Must have been written by the free trade drafters, who always insert a provision to compensate a corporation for “taking” its putative future profits – when no business has been conducted – should domestic law and regulation preclude a more straightforward manner of looting the commons by usual business operations.

  11. NancyK says:

    I agree with you completely, single payer is the answer and there is no way the Republicans in Congress would ever let it happen. They have their great medical insurance and that is all they care about. Now we hear them whining how ACA will punish the middle class, when exactly have they cared about the middle class.

  12. NancyK says:

    There are a lot of poor white people too. Have you ever been to West Virginia, Kentucky, Tennessee? I agree that insurances companies will be the big winners, but they have always been the big winners, nothing much has changed. As a nurse I worked for a year as the liaison between the insurance companies and the hospital and the insurance companies were brutal,they tried to deny everything they could whether or not the patient needed it. On the other hand the hospital wanted to discharge the patient as soon as the insurance ran out or was denied.

  13. Tyler says:

    I’ve relatives in all three, and my point still stands that this is wealth transfer.
    Please include stories of Medicaid short changing your poor people in the next sob story and the hospital expecting them to foot the bill TIA.

  14. Tyler says:

    No the Dems get the votes for the gimmedats and the poor continue to get free stuff from Uncle Sugar. Cui bono indeed.

  15. Tyler says:

    I too thought our system of specialty hospitals and plans based on your needs was nonsense. The days of volunteer firefighters and New York musicians having their own plans are OVER! One size fits all insurance with narrow provider markets and ridiculous deductibles is much better.
    However Comrade, some may ask HOW we pay for single payer. Well we will fall back on that old standby of “taxing the rich*”.
    Viva la revolucion!
    * rich being an arbitrary number as defined by a Chicago “community organizer” who never turned a hand’s span of private labor in his life

  16. Tyler says:

    I personally like the part about how they knew hundreds of millions were going to lose their insurance but said EFF IT UTOPIA DEAD AHEAD!
    Also the fact that they combined a student loan bill with the ACA so that they could claim the loan repayments as revenue under ACA and show how they were saving money.

  17. Mark Kolmar says:

    We need an engine that delivers a range of standard care, and another engine that delivers R&D. The German model is a start. I’m not one of those people who thinks process efficiency is the same thing as social or moral efficiency. So maybe a place will continue for a private insurance industry legislated into 20% profit. Will they deliver the R&D, or can they rest on earlier accomplishments and increase profits at the same time?
    I see a few technical fixes that are indicated, but how likely is that?

  18. different clue says:

    The Democratic base of poor minorities is just a conduit through which middle class wealth can be transferred to the insurance companies. The poor minorities are just used as cover to obscure the intended beneficiaries of the transfers . . . the insurance companies. Or so it looks to me.

  19. different clue says:

    I have long wondered how many accusations against Obama of socialism have been reverse-psychology operations against DemParty members to convince them that Obama is not really Wall Street’s pro-OverClass Warrior. I wonder how many DemParty members say to themselves: ” if the
    RepParty is calling Obama socialist, maybe he really is a liberal.”

  20. jon says:

    Politics is the art of the possible. Health care reform had to be a bill that could make it through Congress. If doctors, hospitals, insurers, pharmaceutical companies and related industries had opposed the ACA it would have been defeated. I’m disappointed that Obama refused to put single payer on the table, but I imagine that his advisors told him that it was a hopeless play and might wreck getting to any deal.
    The simple fact is that US health care couldn’t continue the way it was. Costs were rising 15% a year, insurance policies were crippling and insurers wouldn’t cover you when you needed care. The US pays more per person for health care than other developed countries. Our system is overly complicated. And our health, longevity and quality of life lags other nations.
    No one really likes the ACA, but at least it’s a start at making changes to the healthcare system and fixing some of the problems. I’m sure it will change. I’d start by cutting out the private insurers; they are bloated and profit seeking, complicate care delivery, and are poor at cost containment. But to do that, they have to be isolated politically, and that will take time and effort.

  21. different clue says:

    Is it? Is it? Naked Capitalism blog offers many detailed articles describing how it will be worse for many people than what they had before. Saying that is an acceptable price to make healthcare better for some people than what they had before is justification of human sacrifice.
    Senator Baucus and Obama (and others) conspired to pre-emptively rule out any open hearings / discussion of Single Payer because they knew how much of a chance it had . . . so much of a chance that the insurance industry needed the collaborative conspiracy of a pro-OverClass Congress and President to make sure it wouldn’t be allowed.

  22. Matthew says:

    Tyler: Both the corporations and the poor are getting a wealth transfer.

  23. Dr. K says:

    I voted for Pres. Obama when I was paying $1200/yr for health insurance. Now I pay $600 for health insurance. Same health care. Same doctor. Just less money. Win/win for me.

  24. Dr. K says:

    Yeah to people like you. Sucking up the free govmint insurance ya’ll.

  25. Fred says:

    If memory serves his wife was an executive at a ‘non profit’ hospital in Chicago. Of course it’s hard to live on 1/4 million a year in Chicago. Which part is profit and which is non I’ll leave to others to explain.

  26. walrus says:

    You can borrow our system. It has worked well for Thirty years.

  27. Fred says:

    “We need an engine that delivers a range of standard care, and another engine that delivers R&D”
    Why does this need to be a function of the federal government?

  28. Dr. K says:

    No you idiot. Instead of paying 1000/mo to zombie do nothing insurance insurance executives. You cut out the middle man and pay on a sliding scale according to income. We all pay. And let the insurance executives look for jobs.

  29. Matthew says:

    Two points: (1) Market forces are a good mechanism if the commodity is not a necessity or if the market tends toward monopoly (ex: utilities); (2) market forces are a terrible mechanism if you cannot brake what Ricardo called the “Iron Law of Wages.” See
    Market-based solutions can yield truly obscene results. One federal judge has advoated many market solutions to problems, even using auctions for adoptions. See I doubt you would be comfortable with that.
    Is health care a right? Is a public school education a right? I think so. So is police protection. Are poor people who don’t pay taxes mooching when they dial “911”?

  30. Norbert M Salamon says:

    more money for health care is possible by cutting defence, NSA, homeland thugs, etc.
    Of course, the cuts also have to be in overuse of MRI and other expensive technologies [mostly created by defensive medical practice re malpractice] and probably some limitations on end of life [last six months of terminally ill] medical costs by use of palliative care.

  31. turcopolier says:

    Dr K
    You are not allowed to insult people here or call them names. Only I can do that and I try not to. Don’t do it again. I doubt that Tyler gets free government health insurance. I will be interested to know. BTW, lay off the phony, mocking Southern business. How is it that your health insurance is so much cheaper now? Subsidy? pl

  32. CK says:

    It would be a challenge to find any “free markets” in the USA. What necessity has the market failed to price and distribute correctly?
    Ricardo had a theory that has never had any real world examples.
    I fail to see the “obscenity” in allowing those who can afford a child to bid against each other for one of the many excess children at auction.
    I suspect the progressive’s “obscenity” would be the differential values assigned by the bidders to the various qualities of the children up for bid. It seems no more obscene than having a government employee determine your worth by the quality of your begging.
    The supreme court has already spoken on the right to police protection … i.e. you have none.
    Nor do you have any right to other people paying for your health or your education. Except that in a democracy the gang with the most guns gets the most rights.

  33. Tyler says:


  34. Tyler says:

    This sounds like more “evil k-k-k-korporations” talk that ignores the bouquet of gimmedats for those who decide they ain’t working anymore.

  35. Tyler says:

    Comrade, relax!
    Your idea of sliding scales is a good one, but let us hope that the ones who end up paying for the expensive medical care do not ask questions about your sliding scale and the poor! Otherwise they may ask how someone in poverty covers tens of thousands of dollars worth of treatment, and realize that they will be on the hook for it!
    Instead we’ll have to call it..fighting inequality! And we can blame the evil “CEOs” for it, as you’ve said. Glorious.
    Su hermano in la revolucion,
    Comrade Tyler

  36. Tyler says:

    Health care is currently a 6th of the economy alone, to say nothing of all the other gimmedats in play right now.
    But yeah I’d be down for cutting all that other stuff too. Don’t bother me none.

  37. Will Reks says:

    Mostly because the private healthcare system has shown itself to be too expensive effectively pricing out millions of people. People can complain about Medicare or Medicaid but there’s no denying that there is less administrative overhead. Transfer those programs to the private sector and costs go up a faster rate.
    You won’t find another such system in the Western world. There are hybrid private healthcare systems in places like Singapore and Switzerland but these all rely on significant government regulation that standardize care and regulate costs.
    Now I don’t think that the federal government needs to assume total control over healthcare. States can take charge and run their own system. Vermont is expected to start their own single-payer program for its residents in 2017. I’m all for states experimenting with their own solutions.

  38. Tyler says:

    Health care as a right? Education as a right?
    Please point to me where this is covered in the Constitution that its a right and not made up left wing fantasy talk, thanks in advance.

  39. D says:

    For another take, see this from Jared Bernstein’s blog:
    An excerpt:
    “Political scientists will write tomes on this, I’m sure, but as someone who was there at the time, the relevant question was: do we, a new administration that successfully ran a campaign with a large plank to make major changes to the health care delivery system, try to go around the existing insurance industry or through it? While Moore and many progressives may believe that either path was viable, many others were justifiably convinced that there was no political path around the insurance industry that Congress would support.”
    Who Bernstein is:
    Larry Kart

  40. Tyler says:

    I pay for BCBS that runs me about $400 a month or so but its a pretty good plan and I’m happy with it.

  41. Tyler says:

    Yeah she got paid hundreds of thousands of dollars to be a diversity coordinator, a position that was so integral to their operations that they never filled it after she left.

  42. Edward Amame says:

    It is for millions of Americans who could not afford health insurance on the individual market and for people with preexisting conditions.
    It would be nice to give the ACA a shot before declaring it DOA, “worse” or whatever five days into its birth.
    Your second paragraph leaves me totally perplexed. I have no idea where your take came from. As much as I favor single payer, it didn’t have a chance in hell of passage. Dems of all stripes understood that, and so we all swallowed hard and were willing to support the possible. I am also convinced that Obama and Dem leadership were convinced that they’d get *some* bipartisan support from the side that actually birthed the ACA idea. Something they were 100% certain they would not have gotten pushing single payer.

  43. jonst says:

    We pay for it Tyler by some (hopefully, semi fair and reasonable) rationing of access to treatment, and that is the grown up unpleasant but probably unavoidable truth

  44. jonst says:

    Whatever else one can say Dr K, you can’t cut the “middle man” and give medicare to everyone. It is the middle man that is doing the admin work for Medicare/aid….sure, for their own greedy profit or whatever, but they are the ones doing the admin work. Get rid of them and watch the costs of Medicare admin skyrocket. Now maybe that is a better way…or maybe that is the only way, but somebody has got to do the admin work. And for better or worse, right now, that is the insur company.

  45. Dr. K says:

    Subsidy. So what? Your angle?

  46. Dr. K says:

    Also my wife has a pre-existing condition. No penalty for that anymore.

  47. tv says:

    And concede all medical decision-making to a government drone.
    Health care from the DMV.
    “We all pay”
    You need better dope.
    47% don’t pay now.

  48. tv says:

    Define “overuse”
    Insurance companies are already reducing testing.
    Of course, I can change insurance company and/or sue them.
    Kind of hard to change, must less sue, a faceless brain dead bureaucracy.

  49. Norbert M Salamon says:

    Only the Central government can assure that the minimum standard care [whatever that might be by law]is available to all citizens. This is true for Canada [with numerous provinces/territories all semi independent per Constitution], Germany [with various States with different views] France with her Departments, etc.
    For in the USA “we the people….

  50. different clue says:

    Win/win for you? Will that prove correct over time? What are your co-pays now? What is your deductible now? Is your network smaller now? If you need specialized care will the doctors who can provide the best version of it be inside or outside of your network now?
    And if it turns out you really have won/won, who lost/lost so you could win/win? Net/net, how many people have lost/lost so other people could win/win?
    I voted for Obama in 2008 as well to prevent Senator McCain from becoming President and to prevent Governor Palin from becoming President after him. By 2012 Obama was revealed as just too awful to vote for again. I almost voted for Romney to vote most effectively against Obama, but fear of a war with Iran made me vote for a minor candidate

  51. steve says:

    I’m not sure how middle class is defined nowadays, but median household income in the US is $51,000.
    According to the Kaiser calculator, a family of four earning a statistically middle class household income of $51,000 would be entitled to subsidies of $4,781 per year and themselves pay $3,509 per year out of pocket for the premium.
    An identical family earning $75,000 would receive $1,165 per year and pay out of pocket $7,125 per year for the premium.
    The subsidies end for that family at about $85,000 which is just about at the 75th percentile level for household income in the US.
    My point is that 75% of US households may qualify for subsidies, a substantial number of which would qualify as middle class by any standard.
    So unless the middle class is considered to come mostly from the top 25% of income households, there is in fact a financial benefit to the “bottom” 75%.
    And on another note, as mentioned below, minorities are not the sole beneficiaries of medicaid by any means. Kentucky is a red state and overwhelmingly white and is touted as an Obamacare success story in terms of medicaid enrollment.
    I live in lily-white Iowa and know many people on medicaid.
    At least there is on paper, since the above figures are for a silver plan, which very few of those insured will be able to actually use in practice given the c. $15,000 they will have to expend in copays, deductibles, etc.

  52. steve says:

    Yet for all those gargantuan transfers of wealth from Uncle Sam and the upper income earners to the lower classes, income inequality has soared under Obama, and those upper earners take a greater and greater percentage of national income.

  53. steve says:

    Yep, that about covers it.
    And at least in two states, Iowa and Arkansas, medicaid itself has been privatized. More skim for the insurance industry.
    I suspect the wet dream for the dem and repub duopoly/oligarchy is the ultimate privatization of medicare and social security.

  54. Laura Wilson says:

    Once again I am impressed and encouraged by the dialogue and intelligence and knowledge shared by folks who follow tucopolier…you all give me hope that conversation and dialogue will trump Tea Party rantings and we will be able get through all of this as “E pluribus unum”! `Cause there is no way we are all going to agree all the time!

  55. steve says:

    The insurance companies paid big money for Obamacare, and by golly Obama better find a way to make the dang thing work, or no private jets or big foundations for him post-2016, unike Bubba.
    Hey, just had a thought is Carter still doing habitat for humanity? Sort of a quaint thought.

  56. steve says:

    Singe payer never had a chance because Obama never pushed it nor wanted it.
    It was off the table from day one. More specifically it was never on the table.
    It would have passed the House and could have passed the Senate through reconciliation. In January, 2009, the dems controlled all 3 branches of government, and Obama had a very real mandate for change.
    Obama’s legacy? “I coulda’ been a contender, instead of a bum, which is what I am.”

  57. turcopolier says:

    Dr K
    No point, just trying to understand. pl

  58. Tyler says:

    Yeah no kidding. Its the middle class that’s getting squeezed which is my point. The problem is that way too many of you guys are unable to see the forest for the trees because you’re too wrapped up in team red vs team blue horseshit.

  59. steve says:

    Pay for it through a supplemental payroll tax like medicare, or an increase in income taxes, or some combination.
    As the article we are discussing says, medicare for all would have resulted in net savings of $400 billion a year. Costs of medical care are already being paid by the private sector through employer contributions or wages paid as insurance premiums. Reduce those costs proportionally vis a vis the $400 billion in savings, and you still come out ahead even with a new payroll tax.
    Ask any employer or employee if they would prefer to pay a new 4% payroll tax to fund medicare for all, or pay insurance premiums to private healthcare companies.

  60. Tyler says:

    Steve, that’s a lot of smoke and mirrors to distract from the fact that “if you like your healthcare, you can keep it” morphed into “Nanny Government knows best”.
    Who do you think is paying for all those tax “rebates”, anyway?
    So if I fit your narrowly defined corridors I get to lose my plan, and get a worst plan with giant deductibles, huge copays, and a ridiculously narrow provider network? Oh wow sign me up.

  61. Tyler says:

    Of course. For the glorious utopia that’s just around the corner, some will indeed have to depart due to their “Rationed” care! We will just have to make sure that the mandarins in charge of rationing are fellow brothers and sisters in la revolucion so that only the correct kind of rationing occurs.
    We will do this under the mantle of “Fairness” and “Equality”, of course. We must remind the populace that while we’re ALL equal, some are more equal than others.
    En la nombre de la revolucion,
    Comrade Tyler

  62. Will Reks says:

    Don’t most of us (especially the older we get) benefit from a subsidy of sorts through the cost sharing of being in a health insurance pool? We don’t nearly pay anywhere near the true cost of our healthcare.

  63. Stephanie says:

    I remember that. Mrs. Obama also received a nice raise when her husband was elected to the US Senate. I believe her position, such as it was, was eliminated in a round of cost-cutting. So when Michelle talks about waste in the health care system, she knows whereof she speaks….

  64. Stephanie says:

    Max Baucus, nobody’s bleeding heart, admitted that taking single-payer off the table from the get-go weakened the Administration’s bargaining position and left the public option as the socialist bogeyman, thus virtually guaranteeing it would get traded away.
    I would also prefer single-payer but there are countries like Germany where public and private systems co-exist successfully.

  65. Norbert M Salamon says:

    In France approx. $260per use in USA approx. $1200 per Ezra Klein

  66. Edward Amame says:

    Sorry Steve, but that is a fantasy re-write of history. I was paying VERY CLOSE attention all through the Dem primaries to the various health care proposals from Edwards, Clinton, and then Obama because my wife and I were on the individual market and I was paying north of $1600/month for an Oxford Freedom that didn’t include a prescription plan. NOT A SINGLE ONE OF THOSE CANDIDATES was pushing single payer because they knew exactly what would have happened to that plan.
    Nobody, and I mean nobody, active on the Democratic side was pushing any of the candidates towards single payer either because (a) there would be no hope of bipartisan support for single payer (it’s doubtful the Dems could have mounted the necessary 100% support for it, either). And you apparently have zero knowledge of how Washington works if you blithely ignore the power of the insurance industry. Maybe I should remind you of what a very frustrated Dick Durbin let slip in the wake of the economic collapse brought on by the banks in 2008 after the Senate couldn’t muster 60 votes to overcome a banking reform bill filibuster: “And the banks — hard to believe in a time when we’re facing a banking crisis that many of the banks created — are still the most powerful lobby on Capitol Hill. And they frankly own the place.” It’s not just banks. Add insurance, energy, guns, and more to that list.

  67. Matthew says:

    Tyler: Glad to see you back here.

  68. Matthew says:

    Tyler: you are correct that these rights are not clearly enumerated in the Constitution. And so they are not “rights” in that sense. I was making a political statement.

  69. Tyler says:

    Steve I’m already losing roughly a third of my income in payroll taxes, from SS to Medicare and every other new scheme they can dream up. So it should come as no surprise I’m not eager to fund yet ANOTHER left wing utopian scheme. Remember how much money Obamacare was going to save? But I’m sure THIS time it’ll be different.
    You guys on the left sound like neocons on the Middle East: “No really, THIS time its different!”
    Much of Medicaid’s “savings” is smoke and mirrors that vanishes when you look at the numbers, and is generated either from the government deciding what its going to pay (“cost controls”) and lack of advertising. This is hardly a glowing endorsement of the efficiency of Medicaid.
    We’re also finding out that Medicaid patients use the ER 40% more, and there’s no difference in the rates of them being treated by a primary care physician. However they DO get taxpayer funded taxi rides from their house to the hospital and back.

  70. Fred says:

    “Outreach” executive with all the right contacts in the Daly machine and the fundraising circuits. There are plenty of ‘outreach coordinator’ types (I know a few) who struggle along on $32,500. After a few years, if they don’t marry well, they give up professional social work and try and make a living.

  71. Fred says:

    “expensive medical care ”
    I see nobody has mentioned (since ’08 anyway) end of life care – which racks up the medical bills. Nor do we ever mention some quite simple regulatory changes that would go a long way towards curbing obesity – namely banning high fructose corn syrup from being used as a food additive. It doesn’t trigger the insulin response in the body and thus you can drink 32 oz of Coke and still be thirsty. Those empty calories, however, continue to add up.

  72. Tyler says:

    Thanks Matthew, though its always curious to see how that sentiment lasts, hah.

  73. Will Reks says:

    “And concede all medical decision-making to a government drone”
    Assuming this was at all true then it appears you are fine with conceding all “medical decision-making” to a bureaucrat at BCBS, Humana, Kaiser or whichever HMO offers your insurance plan.

  74. Will Reks says:

    You were making good points but then you went too far with the hyperbole. Hundreds of millions, eh?
    Utopia? Nice talking point that you use every other post. We’re talking about health insurance, man. Don’t pretend like we’re already not paying an arm and a leg more than we should be in premiums just to cover all the unhealthy fatbodies and free-riders that seem to multiply in this country.
    Maybe Obamacare won’t solve the problem but we’re stuck with it for now and maybe 10 years from now we’ll be in a better position overall. Maybe not and we can get a little closer to that revolution you want.

  75. different clue says:

    If Senator Baucus was so confident Single Payer would never have a chance, why did he make so sure to have members of Physicians for Single Payer arrested and ejected from his hearing when they dared to physically show up?
    And I haven’t declared Ocare “dead on arrival”.
    It lives and it will do exactly what Baucus/Obama/insurance industry lobbyists and law-writers designed it to do. It will make the insurance industry permanently wedged in between people and healthcare, taking a percentage of the premium money now force-of-law forcibly paid to them. It will be the first step towards a purer Heritage Foundation plan. When the Republicans take both Houses and the Presidency, they will not “repeal” Ocare. They will merely re-engineer it closer to the insurance industry’s desired end-state. They will definitely maintain the mandate for the same reason that Roberts worked to uphold the mandate. Ocare was the opening wedge for Heritage care, and my suspicion is that Obama/Baucus/the insurance industry designed it with that final goal in mind.

  76. different clue says:

    Which I suspect is why he did it, probably in quiet collaboration with Obama right from the start.

  77. steve says:

    I am not wrapped up in any repub v. dem BS whatsoever.
    If you have read any of my posts in this thread, you would see that I am critical of both repub and dem narratives.
    In this particular instance, I am critical of the false narrative that the poor have made out like bandits under Obama when the facts and stats demonstrate that they have fared worse under neoliberal Obama than under the neoliberal repubs: the lower quintile (the poor) have virtually disappeared as an economic factor.

  78. steve says:

    Smoke and mirrors distraction from Obama’s lie? Obama’s self-evident lie was not the topic, and I didn’t address it.
    The topic I was discussing was the gop false narrative that Obamacare only benefits the poor at the expense of the middle-class in terms of subsidies.
    That’s a false gop narrative.
    This is my critique of the dem narrative:
    I step outside both the dem and repub narrative–regardless of the subsidies which up to 75% of US families may be entitled to, the fact is that a very substantial number of insureds will never, ever be able to use the junk insurance considering the copays and deductibles–up to and in some cases exceeding $15,000 before the insurance even kicks in.
    For many, many middle-class families, the government could pay 100% of the premiums, and the insurance would still be junk and unuseable.
    I think that fact will become the most damning part of Obamacare this year.
    The whole scam is not much more than a sop to the insurance industry–the doors to the treasury are open.

  79. Tyler says:

    At least there’s accountability there of some sort, poor as it is.
    Meanwhile at HHS..

  80. steve says:

    If you are paying one-third of your income in payroll taxes, your employer is committing payroll fraud. I am assuming here that you know what a payroll tax actually is:
    The SS tax is 6.2% of your income capped at c. $110,000 in income. The Medicare tax is 1.45% on all income.
    Those are your payroll taxes.

  81. Tyler says:

    170 million, to be precise, according to the government’s own numbers.
    I don’t know dude, but all I know is that I’m not the one who wants to flood the US with the 3rd World with amnesty and then promise single payer to everyone. If that ain’t utopian thinking, I don’t know what is. Seems we always need just MORE taxes and another grand program and all of our problems will vanish, but the problems only get worst. Yeah, I’d say utopianism is a good fit there.
    O-care is a damn mess and if the Democrats were facing any other group other than Boner and the other Big Statists in the House they’d be done for a generation. As it is the Republicans might pull defeat from the jaws of victory and actually accede to an amnesty.
    Do I want a revolution? Hell no. I just want to be left alone. Unfortunately I don’t get that because it seems every week there’s another unelected judge inventing rights out of whole cloth.
    Count on any civil conflict to look more like Bosnia and less like Shiloh.

  82. Tyler says:

    You should probably mention the demographics of those two countries, and hell, might as well look at Vermont’s as well.
    I’m sure that has more than a little to do with it.

  83. steve says:

    Uh, that’s just what I said. It was never on the table.
    If Obama in 2009 had gone to the mat for it, Congress would have passed it.
    But the important takeback from that year is that he didn’t want it. Before the public debate began, he told the industry in 2009 that any form of public option was off the table, all the while lying to the public and insisting it was still an option.
    Obama instead went for the Bob Dole HeritageCare package.
    You get what you pay for, sayeth Blue Cross.

  84. steve says:

    What’s the anecdote?
    Obamacare is a 2000 page bill and took 3 yrs. to implement.
    Medicare was an 8 page bill and took 1 yr. to implement.

  85. steve says:

    1. What demographics would those be? and
    2. How do they “have more than a little to do with” healthcare?

  86. steve says:

    I think that’s generally true in an employer based system. My wife and I are in our 60s and get BlueCross through her employer and I don’t believe pay more than younger employees.
    Then again, several years ago, there was a 30-something couple whose child got a liver transplant.
    Under Obamacare though, you are rated by 1. age, and 2. tobacco use.

  87. optimax says:

    Because I left the railroad on an occupational disability before my retirement age, am not decrepit enough for MEDICARE and my preexisting condition made what insurance I could get unaffordable after a few years; I haven’t had insurance for a few years. I am now able to buy a Kaiser plan with a subsidy of 225 a-month for two years, when I will then be old enough for MEDICARE. I’ve gotten by paying out-of-pocket for a couple of doctor’s visits a year and medications.
    The plans I surveyed all had a maximum yearly out-of-pocket and no lifetime ceiling on benefits. Those were the most noticeable change from the old plans I recognized.

  88. CK says:

    About those pre-existing conditions and folks being kicked out of their insurance. PL 104-191, The HIPAA law from 1997, Sec 2742 is your dearest friend. ( Approx. 19 million US citizens have been or will be needing to read that section and then contact their insurer. )
    If you would wish to be better informed is a good start.
    This might not be a panacea for all but it will be majorly beneficial to many.

  89. Edward Amame says:

    Why wasn’t it on the table? Because the insurance industry had/has a stranglehold over congress and all of the Dem candidates pushing universal access to healthcare knew that. And you know what? They were 100% correct. Because we now know that on the day he was inaugurated, the GOP leadership came up with the strategy that they were convinced would make Obama a one term president: say no to every major piece of legislation he put forward. So there would have had to be enough Dems in the Senate willing to break a filibuster and say yes to single payer in the face of what would surely be a furious insurance industry attack on all fronts. Not to mention the House. As it was, the Dems barely mustered the votes on theirs side to get the ACA passed, even without the public option. So I don’t know where you dreamed up, “If Obama in 2009 had gone to the mat for it, Congress would have passed it.” There is absolutely no evidence for it.

  90. kao_hsien_chih says:

    And not getting single payer didn’t exactly save the Dems in Congress either in 2010. Cowards get what cowards deserve.

  91. Edward Amame says:

    Conspiracy theories.
    The simple fact is that Obama had a reputation for trading away the left-er positions which always put him in the position of bargaining from the center while the GOP bargained from the hard right. It’s while a lot of his base thinks that his presidency has been much more Nixon than Johnson.

  92. Edward Amame says:

    You’re a pip you are, Comrade Tyler.
    Maybe your healthcare provider didn’t ration, but Oxford has had a lot of say over what my wife and I could/couldn’t do on our $1600+/month Freedom Plan with no prescription coverage on the individual market. Then there’s all the uninsured who got theirs in an emergency room.
    We’ve got a broker looking for a new plan for us. He thinks we should wait a bit. The plans out there right now are still works in progress. More should be introduced soon, including next year, small business plans. No matter what, we hear that our monthly payout should be cut in half. Viva la Revolución!

  93. Edward Amame says:

    *Millions* “lose their coverage?” Those aren’t the figure I’ve heard. And apparently what was being lost were plans that didn’t meet new federal standards.

  94. Edward Amame says:

    I’m curious about that too.

  95. Tyler says:

    You can be as critical of it as you want, but the tax subsidies for the poor are coming for increased taxes from the middle class.
    EBT, unemployment insurance, food stamps, obamaphones..Yeah the poor are doing alright.

  96. Tyler says:

    Well at least we agree on something.

  97. Tyler says:

    Excuse me, I’m paying a third of my paycheck in taxes and benefits. I misspoke.
    Until this year, as a single man renting, I was getting absolutely HAMMERED with income taxes.
    I’m not really looking for more of my money to vanish off into the aether of the government, all the same.

  98. Tyler says:

    1) White/Asian & Educated
    2) For the same reason most sane people would rather live in Gstaad than Harare or Jo’burg.

  99. Tyler says:

    I personally thought HSAs with catastrophic insurance would be a much better plan myself as far as simplicity and ease of use goes, versus the horse abortion we have going on now that’s neither fish nor fowl.

  100. Edward Amame says:

    About half the costs of the ACA subsidies are offset by projected savings in Medicare payments to insurers and hospitals. Another quarter comes from added taxes on medical device makers and drug companies. The final quarter comes from tax increase on incomes over $200,000 for single and head of household and $250,000 for married filing jointly taxpayers. They’ll pay 0.9% more in Medicare payroll taxes.

  101. Edward Amame says:

    So here you acknowledge the importance of education while above you sneeringly refer to the right to an education as “leftwing fantasy talk.” I don’t follow.

  102. Fred says:

    “projected savings in Medicare payments to insurers and hospitals.”
    The government cust to reimbursement rate to the hospital. The insurance companies follow suit and cut thier reimbursement rates. That does not change the actual doctor or hospital cost structure. It shifts the payment of the difference right back to the patient.

  103. Fred says:

    Singapore is a citystate with 3.4 million people.
    Switzerland has a population of 8 million. Neither are comparable to the USA in population or culture. How is that difficult to understand?

  104. different clue says:

    Weren’t those new federal standards cynically designed to cancel many millions of plans people had in order to force them onto the Ocare exchanges? How many of those people will discover their forced Ocare plans to be rendered unusable junk by high co-pays, high deductibles, networks restricted narrowly keeping the best specialists or best entire disease-specialty facilities entirely out of their networks? That blog called Naked Capitalism goes into these problems in painfully granular detail.
    If Ocare works out better for its forcibly drafted captive consumer base than is expected, then let the Democratic Party prosper along with the grateful Ocare premium payers. If Ocare ends up causing all the foretold problems for millions of people, then let the Democratic Party die along
    with the hopes of millions of forced Ocare payers.

  105. Tyler says:

    Well you live in an alternate reality, EA, so I’m not surprised you haven’t heard those figures.
    And if you google “millions losing coverage feds knew” you’re going to get a bunch of stories.
    I know you’re happy with a federal mandarin telling you what’s good for you, but not all of us are. A lot of people just wanted catastrophic insurance and didn’t want to pay for contraceptives or sex changes, which I think is a lot more reasonable than “I KNOW WHAT IS GOOD FOR YOU, CITIZEN” coming from above.

  106. Tyler says:

    Like most leftists you have a problem parsing equality of opportunity and equality of outcomes.
    And yes, the idea that anyone has a “right” to an education that’s up there with any of the enshrined Bill of Rights is ridiculous left wing fantasy talk that shows a fundamental misunderstanding of the purpose behind the “Rights” so described. Just like no one has a “right” to marriage, or a “right” to abortion.

  107. Tyler says:

    “Projected” savings, much like Obama’s “projected” budget surplus.
    I’m all ears, but Fred already laid out how Medicare’s “savings” are smoke and mirrors.

  108. Tyler says:

    Or get sucked into government busy work.

  109. Tyler says:

    You must understand, once we bring in more illegal al-…undocumented alie…MIGRANT BORDER CROSSERS we will have more problems with overuse of the ER, yes we will have some small problems. However once the ACA comes we will be doubleplus sure that everyone will have the same experience. And that experience will ALWAYS be a great one in the Glorious Future that is to come.
    The lack of doctors and narrow networks may hamper you when you do get your plan, but remember that it is for la Revolucion and things will be better manana.
    En el nombre de la revolucion!
    Comrade Tyler

  110. Alba Etie says:

    I been meaning to compliment you as you grow in your ability to be respectful and ironic all in the same post . Its always better to disagree without being disagreeable , – (that’s a good working theory anyway 🙂 … )

  111. Alba Etie says:

    Should we then be on the look out for ethnic cleansing by all sides ?

  112. Edward Amame says:

    The insurance companies haven’t set their ACA reimbursement rates because they don’t know how many people they will have to cover on the exchanges yet. Rates will likely be set this month.
    My understanding is that reimbursement rates for hospitals are currently based on volume, but under the ACA they will be based on performance on outcomes. The ACA will increase payments to primary care docs. Medicaid reimbursement rates will be equal to Medicare rates for 2 years (although I’m not sure how that plays out in states that chose not to expand their Medicaid coverage).
    The bottom line is that the ACA is trying to push for more coordinated care between health care providers: between doctors and specialists, between surgeons and hospitals, etc. The ACA provides potential $$$ windfalls to doctors and hospitals who are able to keep costs down/meet quality standards and to financially punish those who don’t.

  113. Edward Amame says:

    That wasn’t exactly the answer Tyler gave. It had more to do with race and education.

  114. Tyler says:

    Oh goodness yes it was. You’re trying to tell me that what works in Switzerland or even Vermont is going to fly in Mississippi or California?

  115. Tyler says:

    I’m too busy and too tired nowadays to stand athwart a pile of arguments, covered in fiery blood and screaming at the sky why so and so is an idiot for believing such and such.

  116. Tyler says:

    Mmm. I think it’ll be a bit more complicated. as one black commenter put it, race arguments in America are simply two groups of white people using minorities as clubs. I think its going to come down to a battle of values.
    Roundheads v Cavaliers, more so. The English Civil War with assault weapons.

  117. Edward Amame says:

    And I responded to Fred’s comment. If I was too general and you want to see in more detail how the ACA intends to achieve those savings, it’s all here:

  118. Edward Amame says:

    I get it. You like to read Naked Capitalism. I do too. But without citing specific posts, it doesn’t help you or me at all.
    The Senate Finance Committee is largely responsible for drafting the ACA: Ds Max Baucus, Jeff Bingaman, Kent Conrad, and Rs Mike Enzi, Chuck Grassley, Olympia Snowe.
    Obama pushed it and the Dems passed it without the votes of the pr*cks on the R side who helped develop it. But yes, the Dems will sink or swim with it as they well should. You apparently give the other side a free pass for their cynical role in it.

  119. Edward Amame says:

    There are 2 sides to every story:
    Small percentage losing health coverage due to ACA
    How Does the Affordable Care Act Affect People Who Buy Health Insurance in the Individual Market?

  120. Fred says:

    I will be quite happy if ACA does anything near what it is intended to do, however I stand by my statement that Uncle Sam has been punishing doctors and hospitals already by cutting medicare/cade reimbursement rates before ACA was passed. That did little to actual change the cost structures of hospitals or doctors offices.

  121. different clue says:

    I also suspect this. It is part of the reason
    I almost voted for Romney. The Dem Senators would have opposed a Romney effort to degrade or attrit Social Security to weaken it enough for eventual privatization. The very same Dem Senators would have supported Obama’s effort to do the very same. It is said that only a Democratic President can “go to China” against Social Security and Medicare. And the Democrats want to reserve that trip for a Democratic President.
    It was the threat of Romney going to war with Iran that scared me into voting for a minor candidate.

  122. Tyler says:

    Gonna keep on projecting just like Iraq was projected to be a functioning democracy.

  123. Tyler says:

    LOL no there’s not there’s the truth and then there’s spin.
    More people have lost their insurance than have gotten it.
    WalMart coverage better than Obamacare:
    This is what I mean by utopianism. Things will always be better tomorrow. Just ignore how much everything sucks today.
    Obamacare is so great he’s only had to constantly make sweeping adjustments to the law and try to fix things on the fly. Going just as planned I guess.

  124. different clue says:

    Yes, I do give the other side a free pass. Their opposition was known and expected from the start. Its their job, their mission, their reason for being. What I did not expect was the depth of the treachery under cover of “weakness” and “bipartisanshipfulness” on the self-styled “Democratic” side. I did not expect them to pre-exclude Single Payer from the media-covered discussion in order to deprive those Democrats who might want to use it as a leverage tool to have negotiated for free-choice personal Medicare buy-in as the Public Option on the Ochanges.
    Naked Capitalism divides its posts into topic areas just as this blog does. Here is a link to the topic area called Health Care. It has every Ocare-related post that NaCap has run, plus some others bearing on the general topic.
    I don’t know how many Demcratic base-members are becoming semi-exDemocrats over this and
    other things like it. Perhaps just a bitter very few. If people who generally don’t read blogs much start describing the Democratic Party with phrases like “roach motel” and “policy laundry”, you will know the disaffection is starting to spread.

  125. Richard says:

    Yes they are? See
    Medicaid increases emergency room use….. 40%

  126. Richard says:

    This gift cuts across party lines. A meanful number of Democrats are going to to be in for a rude and unpleasant surprise.

  127. Edward Amame says:

    Hospitals didn’t see it that way, Fred. They agreed to slight cuts over time because of all the new paying patients they’ll be seeing due to ACA insurance expansion.
    There are cuts to Medicare Advantage too, the private commercial substitute for Medicare that pays more per enrolee than original Medicare.

  128. Tyler says:

    Some already got their “surprise”. A lot of NY’s art and law community who voted for Obama discovered that they can’t use their plans anymore and have to buy ridiculous ones now.

  129. Edward Amame says:

    Nevermind that the ACA was birthed by the Heritage Foundation and that the individual mandate had a strong history of support from Mitt Romney and Chuck Grassley.
    Nevermind that there were six bipartisan health care reform working groups that met more than 70 times in 2009. That there were 15 bipartisan hearings on health care reform in 2009. That there were at least 13 amendments sponsored by one or more Republican senators in the Senate Finance Committee’s 2009 bill. That the final bill contained 161 GOP amendments, from guys like Mike Enzi, Tom Coburn, and Pat Roberts.
    So I dunno, based on all of that, was the final vote really “known and expected from the start?” Should Obama and the Dems have known in advance that Grassley wouldn’t vote for his own bill?
    Is it possible that GOP Senators weren’t negotiating in good faith?
    The ACA is what it is. It reeks of politics all around. IMO Obama ran with the ACA vs single payer because he know that as politics is all about the art of the possible. Jim DeMint and co saw it as the art of the possible too. A way to possibly break him, to possibly make him a one term president.
    But you’ve made your call, go ahead and stick to it.

  130. Edward Amame says:

    I was taking you seriously until your reply to me with a link to Breitbart. So much for your above the blue/red fray pose.

  131. Fred says:

    So hospitals are continuing with ineffient practices because they will see more patients and thus total revenue recieved will be essentially the same? That does nothing to change ineffient practices. That also does nothing for the patients who are expected to pay the difference between the now lower rates or reimbursement and the amounts changed.

  132. Fred says:

    Let me know how many imigrants illiterate in the native language(s) of Singapore and Switzerland those two societies have and how that compares to the US.

  133. different clue says:

    The Democratic officeholders could very well have held out for a bill based around single payer, or even just a bill containing free-choice personal medicare buy-in as the public option on the Ochanges if they had wanted to. When they lost they could have campaigned against Republican officeholders/seekers by pointing out that the Democratic Party is/was committed to either single payer or at least Medicare choice on the Ochanges. If people who would have voted Republican otherwise valued single payer or Medicare choice enough to vote based on getting them, they would have had a party sincerely and visibly committed to these things to vote for instead.
    But the Democrats were not devoted to either of these things. They were devoted to the cult of Obama the First Black President and giving him cardboard replica achievements so he would be a two term President. He wanted the insurance companies further protected and entrenched and enriched, so that is what the Democrats gave him. He wanted Single Payer prevented for decades to come and he wanted the whole issue rendered so toxic that it will not even be discussed for years to come. I don’t know how many of the Democrats wanted the same thing right from the start but it is clear that some did. Baucus certainly did.
    So yes. The Democrats have made my mind up for me by their performance on this matter. And Obama will collect hundreds of millions of dollars from the insurance industry and the FIRE sector players in general for a job well done after he leaves office.

  134. Edward Amame says:

    No Fred they are not “continuing with ineffecient practices.” Reimbusrsement rates will no longer be based on volume as they were. Instead, as I wrote on this thread at 08 January 2014 at 03:58 PM, reimbursement rates are now based on performance.

  135. different clue says:

    I already knew that Ocare was Heritage-derived and
    Romney-Grassley supported. That’s exactly why Obama
    pursued it. Because Obama opposed single payer and even free-choice Medicare right from the start, and was devoted to entrenching and fortifying the insurance industry in place right from the start, just like the Heritage Foundation and Romney and etc. And why should I care if Obama became a one term President? I would rather have had no bill now and a good bill later than to have a second Obama term at the price of a bad bill designed on purpose to prevent a better solution from ever emerging.

  136. Edward Amame says:

    I live in NY as you know and have been paying over $1600/month for the Oxford plan (with no prescription plan) for my wife and I. According to our insurance broker, our payout will be cut in half via the ACA. At least.
    Further, my wife wase stuck on that plan after she developed a chronic condition a few years back.
    At this point, I’m gonna ignore you. You REALLY don’t know what you’re talking about. You’re just trolling.

  137. Edward Amame says:

    You have a tendency to frame everything in the extreme Tyler.
    It would be great to ensure every kid an *equal* educational opportunity and then a level playing field as adults. But that’s not possible. And who’d want to live anywhere that’s so regulated that everybody brings home the same paycheck? The idea is to strike some kind of balance. Maybe where the lowest on the economic rung have enough to live humanely and hopefully. And where the top of the economic ladder can’t buy the gov’t/rig the game.

  138. Tyler says:

    Attacking the messenger is a pretty pathetic fallacy, EA.

  139. Edward Amame says:

    Jared Bernstein begs to differ with you:
    “…Political scientists will write tomes on this, I’m sure, but as someone who was there at the time, the relevant question was: do we, a new administration that successfully ran a campaign with a large plank to make major changes to the health care delivery system, try to go around the existing insurance industry or through it? While Moore and many progressives may believe that either path was viable, many others were justifiably convinced that there was no political path around the insurance industry that Congress would support.
    That’s Congress. What about the general public? As Ezra Klein points out, if a small minority—about 5% of the population–was deeply upset about not being able to keep their existing plan, why would it have been OK if pretty much everyone now in the private market faced that same transition?..”
    More here:
    Bernstein was Biden’s Chief Economist and Economic Adviser in the Obama Admin and Paul Krugman’s choice in 2008 for Obama’s Economic Recovery Advisory Board, so as to “give progressive economists a voice.”

  140. Fred says:

    I am well aware of what changes to reimbursement rates mean. You apparentl do not understand my position that the management processes in place that may not be optimal are not being changed because of this legislation.

  141. Tyler says:

    my_personal_anecdote.txt isn’t an argument.
    This is though:
    Ms. Meinwald, 61, has been paying $10,000 a year for her insurance through the New York City Bar. A broker told her that a new temporary plan with fewer doctors would cost $5,000 more, after factoring in the cost of her medications.
    Ms. Meinwald also looked on the state’s health insurance exchange. But she said she found that those plans did not have a good choice of doctors, and that it was hard to even find out who the doctors were, and which hospitals were covered. “It’s like you’re blindfolded and you’re told that you have to buy something,” she said. …
    Again: “Democracy is the idea that the voters know what they want – and deserve to get it good and hard.”

  142. Edward Amame says:

    Nice attempt at spin, Fred.
    The discussion was about different healthcare systems around the world, how they deliver standardized care and Will Reks brought up why it’s necessary have gov’t regulate healthcare in places like Singapore and Switzerland that have public/private systems. Your friend Tyler mentioned nothing about the size of the two populations. He chose to chime it with a weird nonsequitur about the race and education levels of the population.

  143. Edward Amame says:

    I don’t see the problem, Tyler. Different states have their own exchanges. We’re not allowed to buy into a public option on a federal exchange because socialism, remember?

  144. Edward Amame says:

    You’re calling for, what exactly here Fred? Gov’t telling managers how to micromanage their hospitals? That’s a bridge to far for me. I’m fine with the ACA laying out general cost cutting goals and letting hospitals themselves decide how best to achieve those numbers.

  145. I would guess fewer than 100 people, mostly lawyers and lobbyists understand ObamaCare! But HHS just sole sourced to a new company the website interfacing with the PUBLIC!
    My guess will be staffed by the current employees of the current contractor!
    Did you know that First Ladies [First spouses] are not covered by Federal ethics laws? Bill Clinton we await you?

  146. Edward Amame says:

    Again, you don’t know what you’re talking about.
    Over the summer, Cuomo approved plans for the exchanges this year that were at least 50% lower *on average* than the rates on the individual market in 2013. So there may be some people whose rates may increase and who make too much money to qualify for a subsidy, but I don’t know that for sure. I am sure however, that right wing media outlets are scouring the country to find them. But like I said before, I’m not following any links to that POS site.
    All that’s available right now on our exchanges are a limited number of individual plans. More are being developed and will be coming online and small biz plans are coming in next year.

  147. Alba Etie says:

    Time better spent with Dexter

  148. Alba Etie says:

    Guess I ‘ll start reading up on Cromwell ..

  149. Tyler says:

    LOL @ “I’m not following any links to something I might disagree with!”
    Sorry broseph, but these plans you keep talking about that will soon exist DON’T exist, so we’ve gotta go with what we’ve got, which is that O-care is a mess and no amount of double specialty approved plans is going to fix that, because the core crux behind it all is someone has to pay for it.
    Audacity of hope indeed.

  150. Tyler says:

    That’s a lot of what we call “muh feels” talk in the other parts of the internet where I hang out. Basically “muh feels” override all other rational thought because you feel something should be that way.
    Who the hell justifies what is “humanely and hopefully”, or what a “level playing field” is? You can’t, and its not the government’s job to do so, at least as enshrined in the Constitution. This executive branch though just does what it wants.

  151. Tyler says:

    Will Reks was talking about single payer originally and why couldn’t what works for Vermont work for the nation.

  152. Tyler says:

    “Demographics” typically includes population as well. This was implied.

  153. Fred says:

    NO. THat is however exactly what you are trying to say the ACA is doing by cutting reimbursement rates. Hospitals etc will ‘figure it out’ and by no means will patients be charged the difference between the total bill and the insurance payment. If patients are – well that’s not in the ACA legislation. Thanks for the tutorial.

  154. different clue says:

    Edward Amame,
    I read the Jared Bernstein blogpost you suggested. It seems like self-justification for the preemptive plot to prevent any public discussion in hearings of single payer or free-choice medicare than anything else. No way through but through the insurance companies? Fine. Fight for the ways around the insurance companies and let the public behold the insurance companies defeat those attempts in open view. Recruit more candidates for next election cycle pledging to work around the insurance companies. Of course that would have deprived Obama and the DParty their chance to prance around upon the stage of Obama’s “delivered campaign promise”.
    I found an article predicting predictable damage to particular groups of people over the next two years due to particular features of Ocare awaiting rollout. We will see if it plays out this way.

  155. Fred says:

    Surely you remember the host’s advice to vet the source and the and the information separately? Sometimes the information reported is valid

  156. Fred says:

    Somehow I am not surprised.

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