Tuesday, September 17, 2013

We passed it. Guess what's in it.

I'm not in human resources; most of my time is spent doing engineering, sales, marketing, and accounting --  functions necessary to keep my small manufacturing concern going.  But yesterday, I spent half the day at a seminar on this:
This flow chart appeared in the speaker's presentation on the "Affordable" "Care" "Act", otherwise known as Obamacare.  Now, I'm sure I know what you're thinking:  This chart is the work of some Tea Party crank who tried to make this seem much more complicated than it actually is -- it's a piece of propaganda.

That chart was published by the Department of Health and Human Services, as an honest attempt to simplify the law and its interdepartmental relationships.  This was produced by the act's proponents.  (That's them, the big red dot in the center of the universe.)



Elements of the law have started to come into effect.  Earlier last week, our business, and every employer in the US, was instructed to send out notices to all of our employees by October 1, informing them of the existence of exchanges.  We received these instructions from our insurance broker; had we not, we might have found ourselves noncompliant and subject to fines.  And rest assured, when you're talking about a law that looks like this:
...you will eventually, inevitably, find yourself in noncompliance.  The speaker at this symposium, Peter Marathas, has worked in Massachusetts during the Romneycare era, and told us this story:  One morning his client found that one of their bank accounts was $400,000 smaller than it had been the day before, because the state came in and took the money.  They did this because the business had failed to respond to requests for an audit of their health insurance policies, and they'd failed to reply because they had never received them -- the state agency had mailed them to the wrong address, in the wrong state.  The agency had actually received them back marked "return to sender."

When confronted with this fact, the state's representative said:  "It is always the employer's responsibility to respond to our notices, even when they don't receive our notices."

We have no in-house attorneys; we don't even have a formal human resources expert.  I've already attended three symposia on this monstrosity, making me our company's ACA "pointman" -- and I have no idea whether we'll know, or how we'll find out, what we're supposed to do next to remain in compliance.

But I'm sure all of these hidden costs of compliance, business-destroying and soul-sucking red tape, and enormous fees and taxes (HIT, Temporary Reinsurance Fee, etc.) will be worth it, because of the wonderful insurance that will be made available to everyone through the exchange.  If you haven't checked these plans out, I'd encourage you to use this calculator.  Plans range in level from Platinum (aka "shitty and over-priced") down to Bronze (aka "why would anyone pay this much for insurance with an actuarial value of 60%.")

For a family of 4 making $60,000 per year, a Silver plan that pays roughly 70% of expenses for covered benefits would cost them about $5,000 per year, taxed income, and they'd still be liable for up to $12,700 per year in out-of-pocket costs, not including that $5,000 premium.  And that's with $5,000 in subsidies, that we would all pay on that family's behalf.  At that rate, I'm sure literally dozens of people will be clamoring to purchase this insurance.

And if that same family makes $80,000 per year, their premium will be $7,600 per year.  That's an additional $2,600 premium, simply because that family has a $20,000 higher gross income (which would be just $15,000 net).  So that's essentially a new income tax, on top of that family's current tax -- the marginal rate at that level basically goes from 25% to 38%.

But that family of four making a whopping $80,000 per year, they're fat-cat one-percenters.  They can afford it.  Once you have so much money, you don't need any more, a great man once said.

We passed it, and what's in it?  Wealth redistribution, confiscatory fees and taxes (including "cascading taxes" where taxes will increase fees and those increased fees will increase taxes), some truly shitty insurance that no one will want, and a mine field of hidden and unknowable disasters-waiting-to-happen for employers.

161 comments:

Eric the Fruit Bat said...

Nothing ventured, nothing gained.

chickelit said...

The London Tube Map was considered a classic diagram when it first appeared.

This map needs a ligation.

Joe Biden, America's Putin said...

Centralized government control. If they turn us into beggars, we will be easier to please.

Joe Biden, America's Putin said...

Republican obstructionism!

Death Panels!

The Dude said...

"Arbeit macht frei".

Shouting Thomas said...

Might put me back to work. Many, many, multimedia presentations, complete with snazzy video and background music, will have to be created to explain how this all works.

Don't knock featherbedding bureaucracy.

Beats doing real work.

Got a call today for a work-at-home job, which is just what I'm looking for. That way I can still babysit. And play music when I get bored.

Palladian said...

This world is such a wide world! Why then do you answer to a temple bell and don ceremonial robes?

— attributed to the Zen master Yunmen Wenyan.

test said...

But that family of four making a whopping $80,000 per year, they're fat-cat one-percenters. They can afford it. Once you have so much money, you don't need any more, a great man once said.

I don't think Obama has a problem with one-percenters. The Clintons have made 100 million since Bill became President and his only beef with them is jealousy.

Obama's priority is taking money from those who make it in free exchange and shoveling it to those who work for government. That's it, that's his governing vision. Everything else is a reaction to circumstance.

bagoh20 said...

When you run a business with lots of people's livelihoods at stake including your own, you have some sleepless nights, and some nagging anxieties that never quite leave you alone.

Ever since our company took a huge beat down in 2008 - 2009 and we reconfigured we have been growing steadily, hiring, training people, and increased our payroll by 300%, and thankfully the anxiety and sleepless nights faded. In 30 years of doing this, I've been through a pack of recessions and scary times, all of which came out fine eventually.

This law has me more worried about the future of my company and my people than anything I can remember. Everyone at my company who wanted it already had cadillac health insurance at very reasonable cost, and it saved my life as well as others.

But now I have lost all confidence that real quality and affordable health care will be accessible, and even whether the jobs we have will continue. I'm worried for my company, my people, and even my life. It's unprecedented uncertainty, or maybe the real concern is the certainty of it. The sureness that the people behind this both have no idea what they are doing, and also have no willingness to admit it.

Pelosi's admission about passing it to find out what's in it was just one of many brainless unsupportable proclamations from proponents that really amount to nothing more than when someone chugs a beer and says "watch this." Usually you can walk away from that guy, but he's driving the bus, and we're on it.

XRay said...

"It is always the employer's responsibility to respond to our notices, even when they don't receive our notices."

It's hopeless.

Methadras said...

I'd like to see the left and specifically PHX's take on how this maze of bureaucratic nightmares can be resolved as being affordable and actually gives care when you actually see the convoluted mess via this flowchart that this law creates. I'd also like to see how CJ John Roberts can still call this a tax based on this viewpoint? Oh wait, he didn't have it either. So pretty.

Methadras said...

This law will effectively outlaw, in roughly 5 years, private health insurance an go totally single payer. Watch what happens then.

Lem the artificially intelligent said...

The Fox and the Grapes.

When the fox fails to reach the grapes, he decides he does not want them after all.

When Obamacare fails, it wont be because it was an impossible burden on business, which it obviously is, it will be because Republicans were intransigent (sower, unhelpful), they kept it from working the same way they keep the economy from working.

The same way they are responsible for the Naval Yard shooting, and everything else that is wrong with the world.

The frustrating part is that a lot people have bought into that.

Eric the Fruit Bat said...

It's been a while since I've heard those horror stories about how our best and brightest no longer want to be doctors.

But then again I haven't been paying much attention.

bagoh20 said...

The truth is that people were better off without insurance under the old system. It was cheaper for them (free), and it was even cheaper for the rest of us paying for it. If the uninsured got sick they still got treated for free. They got billed, and they either settled or just never paid. The rest of us had to cover that, but we had good access and it was affordable. That will all go away. Everyone will pay more and get less real value, and it will be extracted from tax returns and paychecks before you ever see it. It will seem to be free while robbing you of your standard of living. They will be sure to avoid people getting billed directly, cause that will just not fly. You have to hide the cost.

My biggest problem with health insurance before the ACA was getting people to take it. Many of my people just prefered to wing it rather than pay the $150 a month. The advantage of that system is that nobody uses the system unless they really need it, which is how insurance should work. They would pay out of pocket for regular health maintenance, and there was a market out there of clinics and doctors that served that. Personally I think the insurance was a better deal, but they had a choice.

I'm Full of Soup said...

Pasta- where did I get the idea you were a chef and owned a restaurant in Charlottesville?

Also, I am going to print out multiple copies of this flow chart and jam it down the throat of libs if they claim the ACA will work.

I'm Full of Soup said...
This comment has been removed by the author.
I'm Full of Soup said...

Lastly, neither Obama nor Pelosi could balance their books if they were serving a paper route with only fifty customers. Yet they have the balls to come up with this monstosity!

The Dude said...

This was never about health care, it's about controlling the money in the health business and getting access to everyone's medical records.

Of course people will get worse treatment - that's part of the deal.

Will doctors be treated like second rate mechanics? I sure hope so - most of the ones I know are raving liberals. I hope they cannot earn enough to pay off their college loans.

Hope and change, baby, you got it!

Birches said...

Yes. I want to hear from supporters. Why is this law such a good thing?

Birches said...

Oh btw. It appears two Republicans made the flowchart.

But if HHS is using it, its got to be pretty accurate.

http://news.investors.com/ibd-editorials/080310-542520-obamacare-a-tangled-knot-around-americas-throat.htm

Amartel said...

"Yes. I want to hear from supporters. Why is this law such a good thing?"

Because ... Obama.
what God wants, God gets.

Revenant said...

That chart was published by the Department of Health and Human Services, as an honest attempt to simplify the law and its interdepartmental relationships.

Do you have a link to the original?

deborah said...

Is it illegal for to see the doc on your own dime and get directly billed by him?

Mitch H. said...

As far as I can tell, that chart was created by Congressional Republican staffers. You can't see it in that version - the PDF original is only really readable at 400% magnification - but the key makes reference to "potential for rationing", *not* the sort of thing HHS would say about its own baby.

A very clever chart, but it only works as a full-blown standup, even at poster size it's too fiddly to read or follow.

Mitch H. said...

The original.

Aridog said...

Purportedly that is a flow chart, but really, it is an organization of power chart.

I've seen worse in both the military and the civil fed...but it is still a classic complex tautology....and those can not be defeated in politics. Propositional logic always wins in politics. It is a perfect system where total bullshit is considered valid.

If you ever reach that point where that chart makes sense to you, from a process flow standpoint, watch out...little men in whites coats will be coming to take you away. Ha Ha.

Methadras said...

AJ Lynch said...

Lastly, neither Obama nor Pelosi could balance their books if they were serving a paper route with only fifty customers. Yet they have the balls to come up with this monstosity!


No they didn't. They didn't even know what's in it or what was going to go in it or how it was going to be administered. They voted on tabula rasa without any knowledge or idea of how it would come together or implemented. But they knew they had the momentum to make it happen and that's what they fought and voted for and we got stuck with it.

Methadras said...

deborah said...

Is it illegal for to see the doc on your own dime and get directly billed by him?


Not now, but it might be in the future as new regulations are added to this open ended act, law, tax.

Methadras said...

Look at the chart and see where doctors and patients are. That should tell you something immediately on how bad this crap really is. It's a giant shit sandwich.

Dust Bunny Queen said...

People still don't understand or are unable to make the distinction between health insurance and health care. And unfortunately we have some of the biggest ignoramuses in Congress making laws about these things.

Insurance as a concept is that you purchase a policy to cover you for risks that you can't handle on your own or that if occur you would be unable to pay for.

Risk: the chance of something happening. Each person has a different level of risk or risk tolerance.

For example car insurance. I don't drive very much anymore and the vehicle that I drive is older so:

1. my chances of being involved in a car wreck are less and
2. the amount of money I would be compensated by the insurance company if my car were totaled is not very much.

Therefore...I would be a fool to buy comprehensive coverage or more coverage than I actually need. I am better off to pocket the difference and put it into a savings account towards a future new car.

Medical Insurance: I don't take any medications and at every annual check up I am told how healthy I am. I can afford to pay for my medical check up, mammogram and any small doctors office visits. My biggest risk would be an unexpected injury or sudden surprising onset of a catastrophic disease or a lingering illness.

I would be a fool to buy

1. High premium insurance that has a low deductible,
2. Covers things that I have no possibility of ever needing like Maternity Care, drug or alcohol treatment, or prescription coverage that I can pay for.
3. Covers things I don't want like accupuncture

Yet. Under Obamacare I am forced to buy these things.

Insurance is not meant to cover routine maintenance

For example your auto insurance doesn't pay for your tire rotation, oil changes, detailing the inside of your car or annual tune up. Why should health insurance pay for routine maintenance on your body. Annual Dr. visit/wellness check up and other minimal and routine events?

If your auto insurance DID pay for those things the cost of premiums would skyrocket and THIS is why health insurance is so expensive now and even more expensive than ever.

The disconnect between what is insurance, what is risk, what is routine maintenance and the unreal notion that everyone needs the same levels of insurance or maintenance is the biggest problem.

One size does not fit all.

The Dude said...

It does now.

It is a Procrustean solution to a non-existent problem.

ricpic said...

What's a bureaucrat to do? Anything to destroy doctor-patient trust.

I'm Full of Soup said...

DBQ:

If only Obama and his supporters thought like you and many of us do. But they want first dollar coverage for every little sniffle and scratch plus they'd rather sit for hours in a doctor's waiting room than go to work.

Joe Biden, America's Putin said...

Forgive me if you've heard this one before.

One of my liberal neighbors traveled with to France with her family. They had a nice time, but she was mystified and shocked at the price of basic ordinary household and personal items like sunscreen and toothpaste.
20 dollars for a tube of toothpaste in France? Yep.

I politely reminded her--
That is why France has "free" health care.
There is no "free". Everyone pays for it though higher prices and taxes everywhere else.

She did not comprehend.

Obamacare - the deal is bad and more expensive. The additional insult being that actual health care will deteriorate, and so will access. Competition gone.
Even though Obama lied about it in his speech yesterday, health insurance premiums are already skyrocketing.

But hey - Obama can sound like some 2 year old on the Daily Show and whine about death panels.

Joe Biden, America's Putin said...

Now even Warren Buffet - the dick head who endorsed Obama - is insisting the thing be scrapped.

Sadly, the ego of our democrat betters won't let that happen. The democrats would rather see the nation sink than admit they made a mistake.

KCFleming said...

This chart is why they have to confiscate our guns.

Joe Biden, America's Putin said...

I insist, through higher taxes on the evil rich and the evil productive,
that the government provide me with free oil changes.

It's a human right!

/
Where does this shit end?

Birches said...


If the mandatory insurance requirement was for a high deductible catastrophic plan, I doubt many people would have a problem with it. Heck, you could eliminate the penalty, and give people a tax credit for purchasing an "in case I get hit by a car" insurance policy.

The problem is so many in the political class think we the unwashed masses are incapable of making rational choices without someone holding our hand or forcing us to.

bagoh20 said...

I'm not all that evil, but I will change your oil.

Pastafarian said...

Birches and Mitch H: I stand corrected. The speaker at the symposium told us that it was created by HHS.

Michael Haz said...

Pastafarian - did they tell you about the IRA having real-time access to Americans' banking accounts?

If you complain that your premium it too much for you to pay, the person you are dealing with can access your checking account and remind you that you have two car payments, and tell you to sell one of your cars. Or buy a home with a smaller mortgage. Or cancel cable. Or stop going out to dine so often, etc. And by "remind". I mean "order".

ACA is not about insurance. It is about a fascist federal government extracting form its citizens a far higher insurance premium that private insurance companies ever did, provide a lousy insurance plan, and pocket the difference.

It gives the FedGov absolute dictatorial power to collect data about your sex live, present and past; about what food you eat. The ability to dictate what you should weigh.

But...the elected officials and their supporters are exempt. You and I are not.

Utter totalitarianism.

Michael Haz said...

IRS, not IRA

Methadras said...

AprilApple said...

Now even Warren Buffet - the dick head who endorsed Obama - is insisting the thing be scrapped.

Sadly, the ego of our democrat betters won't let that happen. The democrats would rather see the nation sink than admit they made a mistake.


When you have ego and narcissistic driven legislation as a function of edifying those who make that and approve that legislation, this is what you get. I think at this point the system of a body making laws and then passing or rejecting those laws is long past gone. It's like making your own final test and having the answers. Yes, there are discussions and arguments, but I think these are mere formalities for the unwashed masses.

I'm beginning to see a premise by which transcending the radical Marxist/leftist vs. conservative paradigm needs to come to the fore. There is going to either be a better way or a devolution of sorts. We cannot go on like this much longer. The destruction of this country and it's citizens via incrementally devastating changes to our foundations and traditions are evident. Urkel and his cadre just so happen to see that momentum was on their side and decided that taking bigger bites out of all us can be done with little to no opposition. Especially in the face of speeches like he gave today. Republicans have zero response to him whenever he attacks them like he did today. Boehner is just sitting in his office weeping at what a fuck up he has become. There is no fight anymore in the GOP of any merit or note.

edutcher said...

Where's the Silver Haired Angel of Death, sitting on her throne at the center?

I think the flow chart for the Normandy landings was simpler.

Methadras said...

bagoh20 said...

I'm not all that evil, but I will change your oil.


April RUN!!! He's gonna come check your dip stick!!!

edutcher said...

PS The Republicans aren't in DC, for the most part.

The Whigs are.

Understand that and you understand why things can't go on the way they are.

Icepick said...

The sureness that the people behind this both have no idea what they are doing, and also have no willingness to admit it.

The concerning thing is that the Administration has had three and a half years and still hasn't been able to implement basic parts of the law, thus the delays. This is a basic failure of competence.

Icepick said...

Of course people will get worse treatment - that's part of the deal.

MOST people will get worse care. The select will continue to get the best of everything.

Bleach Drinkers Curing Coronavirus Together said...

What's the point of the illustration? To show that health care's complicated? Those of us familiar with it already knew that. Better to leave that complexity to the bureaucrats and administrators than the doctors and patients.

Icepick said...


It is a Procrustean solution to a non-existent problem.


In the future, all hospital beds will be manufactured by Procrustes Restorative Devices, Gbh.

Icepick said...

Procrustes Restorative Devices, Gbh motto: One size fits all!

Bleach Drinkers Curing Coronavirus Together said...

Insurance is not meant to cover routine maintenance.

Dude. Dude, dude, dude. Dear DBQ. Your car is not the same and was not subjected to "managed care" to cover the whole shebang. You can leave preventive care ("routine maintenance") out of the managed care norm, but that only drives up costs and disincentivizes against paying for the care that then becomes inevitable. The HMOs know this, but they're not paid to care at that point, unless you make them. Auto maintenance doesn't go by a "managed care" plan, but if they did, it would work the same way.

Icepick said...

Ritmo, the problem is that now small companies are going to have to navigate that maze in order to stay in business, whereas before they could take the option to either farm some of that complexity out to an insurance company, or not carry insurance at all.

In addition, individuals are going to have to do the same, or suffer the consequences. And given that the Obama Administration itself can't even implement the thing with three and a half years warning is telling. It's too complex for this Administration to implement, so what's the likelihood that smaller companies are going to be able to handle the additional regulatory burden placed upon them?

They came up with damned near the worst possible solution to the problem, and they're going to keep working on it until it gets even worse.

chickelit said...

R&B wrote: You can leave preventive care ("routine maintenance") out of the managed care norm, but that only drives up costs and disincentivizes against paying for the care that then becomes inevitable.

I recall going over this fallacy with you and Inga earlier. It's erroneous to think that preventative care will less costs later on unless you assume that people will all keel over quietly at a ripe old age. People will always be dying of something; new diseases come along. Just because you get fewer people dying of lung cancer and HIV does not translate to lower end-of-live cost.

chickelit said...
This comment has been removed by the author.
chickelit said...

The truth is that this was all foisted on us because one stupid woman went to live abroad and failed to get adequate health care/insurance.

Bleach Drinkers Curing Coronavirus Together said...

You're a sincere guy, Ice, and the concern sounds like a legitimate one, but the proof will have to be in the results. If the ranks of the uninsured and the costs of their premiums rise, it will be a failure. If the opposite happens, a success.

As far as complexity goes, I can only make it out at the bureaucratic level of the chart, and not in the plans themselves. The administration's tiering of coverage should reduce complexity for the consumers and payers. As far as scale goes, the exchanges should help go a long way in letting little states and little companies get some better leverage.

We pay more than double per capita for health care than the next country, with much worse results in nearly every metric. Something had to give and hopefully this way will preserve innovation while simply putting into place better incentives for coverage and quality than existed before.

Methadras said...

Rhythm and Balls said...

Insurance is not meant to cover routine maintenance.

Dude. Dude, dude, dude. Dear DBQ. Your car is not the same and was not subjected to "managed care" to cover the whole shebang. You can leave preventive care ("routine maintenance") out of the managed care norm, but that only drives up costs and disincentivizes against paying for the care that then becomes inevitable. The HMOs know this, but they're not paid to care at that point, unless you make them. Auto maintenance doesn't go by a "managed care" plan, but if they did, it would work the same way.


For some automakers, they include scheduled maintenance on their vehicle. Clearly they wrap the cost of this maintenance in the total cost of the car, but they already have accomplished two things with this. The first is, that you bought the car and most likely at that price, so whether you get he maintenance or not becomes irrelevant at that point. The second is, you get the maintenance done and your care is taken 'care' of. Manufacturers now are getting on the mandatory maintenance or you void your warranty kick. The unintended consequences of that are going to become evident.

Now can that be analagous to AHA mandates? We don't know because those provisions haven't been hammered out yet. Go in for your yearly check up or face a bigger fine? or denied access? or delayed access? or? and since this law is open ended, then they can put anything in it anytime they want. Even many unions are complaining and looking for waiver to get out of the coverage because they can see its bad for business.

Bleach Drinkers Curing Coronavirus Together said...

People will always be dying of something; new diseases come along.

This is a generalization big enough to fly a 747 through. You are not providing any argument against the cost of prevention outweighing the cost of cure. It never does. Find me a single physician or health care administrator who disagrees. What craziness that you will actually take a stance of being "pro-disease" and "pro-complication" simply because you refuse to accept the obvious truism that prevention's better, and without any evidence for that.

Just because you get fewer people dying of lung cancer and HIV does not translate to lower end-of-live cost.

Yes it does. You do not know how to quantify those treatments accompanying the end-of-life costs one iota. You are throwing in oranges in your apple cart. End-of-life care might generally be expensive. End-of-life care during and after treating the terminal illnesses you describe is still more expensive. What is wrong with you that you could decide it's better financially, let alone ethically, to die of AIDS or cancer than of old age? Are you going to lecture me about the costs of treating those who die peacefully in their bed at a ripe old age while sleeping? Where do you get this stuff?

Methadras said...

El Pollo Raylan said...

The truth is that this was all foisted on us because one stupid woman went to live abroad and failed to get adequate health care/insurance.


Who is she, I'd like to hunt her down.

Methadras said...

Ritmo, would it be in the best interests of the AHA to keep people alive for as long as possible to necessite those that pay into the system to keep doing it? As long as birth rates decline, you can see the costs go up as the next generation is less then the previous one. And when the boomers die off in about another 20 - 30 years, their ideas and policies will go with them as gen x'ers en masse decide that the scam can't go on forever. It's a waiting game.

Bleach Drinkers Curing Coronavirus Together said...

Ritmo, would it be in the best interests of the AHA to keep people alive for as long as possible to necessite those that pay into the system to keep doing it?

It seems oddly morbid that any provider wouldn't want to keep someone alive for as long as ethically possible, but if you're skeptical, no one seems to think that Medicare is in the "rush to die" business, despite insuring the highest-risk demographic, and they are the model of efficiency as far as the managed care market is concerned. Seniors, no matter how market-oriented they are, can't seem to stop signing up for it.

Joe Biden, America's Putin said...

I'm not all that evil, but I will change your oil.


Just a wee bit evil?
You give dogs a second chance and you provide good jobs. You're near perfect. But I'll still take you up on the oil change.
:)

Icepick said...

As far as complexity goes, I can only make it out at the bureaucratic level of the chart, and not in the plans themselves.

How about in how it is impacting companies RIGHT NOW? Ask Bagoh and Pastafarian how it is working out for them right now.

Plus, the President said that people would keep their doctors and costs would come down radically BECAUSE of this plan. That's two promises already broken.

Finally, I guess you wouldn't swerve when driving towards a cliff. After all, until you go over the cliff and die in a flaming heap of wreckage, you can't know how it is going to work out.

Bleach Drinkers Curing Coronavirus Together said...

How about in how it is impacting companies RIGHT NOW? Ask Bagoh and Pastafarian how it is working out for them right now.

Physicians and scientists would refer to their reports as "anecdotal" and "biased". The overall prices and numbers across an entire population are what matter, and if their experiences bear out more generally, then they can be studied and addressed. But in the meantime, the decreased premiums in two large states is good news, and less subjective.

Plus, the President said that people would keep their doctors and costs would come down radically BECAUSE of this plan. That's two promises already broken.

Not from what I heard - on the costs, at least.

Finally, I guess you wouldn't swerve when driving towards a cliff. After all, until you go over the cliff and die in a flaming heap of wreckage, you can't know how it is going to work out.

Let's be empiric about this, shall we? If it's health care, citing studies works for doctors and medicine - it should work for this. And if you see a problem here or there - does it mean the whole thing's a failure and can't be tweaked? And should I trust the answer on that from someone unless they agree beforehand that 100+% higher per capita costs with less coverage in the population or quality was/is the problem that the president declared it was?

chickelit said...

R&B: You seem to think that my logic flies in the face of the adage "an ounce of prevention is worth a pound of cure." What I'm really saying is that disease and treatment always morphs into something else. As I understand it, the Hippocratic Oath will motivate doctors and healthcare providers to do something about any illness people encounter in the future. Costs are not being realistically addressed.

Icepick said...

I used to work on the financial side of the health-insurance business. Having had experience with the business, I do know one thing about the ObamaCare sales pitch: The President and his minions either didn't know how the business actually worked, or they were lying through the teeth about it in order to sell the idea. I wrote about some of that back at the time. But the whole thing was sold on false premises.

At the time of passage I was convinced that the whole thing had been designed to intentionally wreck the system, as it doubles down on some of the worst aspects of the then current mess. (E.g., governmental interference in the system in a grossly incompetent bureaucratic fashion, health insurance provided through employers*, a convoluted mix of federal and state systems, etc.)

But these days I'm inclined to believe that the people that put it together are just that damned incompetent.

* Most people don't even know that Hitler, yes, that Hitler, should be held partly accountable for the structure of the current US healthcare system. I strongly suspect that in not knowing how we got here, there's no possibility of getting any place else that isn't worse.

chickelit said...

Finally, I guess you wouldn't swerve when driving towards a cliff. After all, until you go over the cliff and die in a flaming heap of wreckage, you can't know how it is going to work out.

It's back to Keynesian model of who cares about sustainability. Live well for the moment.

Icepick said...

We pay more than double per capita for health care than the next country, with much worse results in nearly every metric. Something had to give and hopefully this way will preserve innovation while simply putting into place better incentives for coverage and quality than existed before.

This bill did nothing towards reducing costs in any real fashion. SO citing that we spend more than anyone else on a per cap basis doesn't carry any weight when addressing the merits, or lack thereof, of THIS legislation. The only measures taken in that direction by this legislation concern mandatory reductions in Medicare expenses (and given how well the 'doctor fix' has worked over the last 15 or so years, that's completely laughable), and the so-called death panel, or IPAB.

There is no reason to think that these cost reductions plans are going to work, and the reasons for that are because they're basically repeats of earlier ideas that have failed politically.

Pastafarian said...

Ritzy, our premiums went up by double digits this past renewal.

And our insurance broker promises much, much higher increases, as elements of the ACA take effect.

And then we get to pay all the new taxes: There's that "cascading" tax on health insurers, that they'll pass on with higher premiums -- and those higher premiums will increase the tax, which will increase premiums still more. That alone will be at least a $60 billion confiscation.

The effect of this law will be the ruination of small businesses like mine; and the abandonment of our employees to truly shitty plans available on the exchange.

Bleach Drinkers Curing Coronavirus Together said...

I'm having trouble seeing where adage meets observed reality, Chick, but hopefully this will make more sense to me than your deleted post.

In any event, the Hippocratic Oath says "first, do no harm", so non-intervention's a professionally responsible consideration. Usually tests aren't all that harmful, but they do drive up costs quite a bit. So do safer procedures with questionable outcomes.

A lot of times, a new procedure looks flashy and fun, and showcases the physician's marketing skill, and then ten years later we find out it does nothing. We should still allow for experimenting with new ideas, but only continue to fund when it shows they make a difference.

The law does just that - it reimburses based on how the privately practicing, autonomously credentialing, hugely and rightly influential physician organizations have ranked the outcomes of every approach in every disease or situation through as many, quality-controlled studies as they can find.

"Evidence-based medicine" (EBM) is actually a relatively recent paradigm in practice, and the new law incorporates this welcome innovation even better than the HMOs, without discriminating on the basis of price alone, but on efficacy results.

If nothing else, that's a very damn good thing.

Bleach Drinkers Curing Coronavirus Together said...

How big a state do you live in, Pasta, and did your governor sign on for the funds and the exchanges or did he/she take a political stand against them? When will the exchanges be implemented where you live?

chickelit said...

i'm having trouble seeing where adage meets observed reality, Chick, but hopefully this will make more sense to me than your deleted post.

My deleted post? I corrected a typo and reposted. Don't insinuate that I "deleted" a thought.

Bleach Drinkers Curing Coronavirus Together said...

You deleted a post, and that's what I said. I didn't say you deleted a "thought". Sorry if that sounded antagonistic.

But why get so touchy? My 8:44 replies pretty thoroughly to your last concern, as did my 8:17 to the previous one.

Thanks.

Pastafarian said...

Ohio, Ritzy. Anthem BC/BS increased premiums by an average of 12% here last year statewide.

That's not anecdotal. That's an entire fucking state, and a pretty big one.

And when that $60 billion tax kicks in, I'm pretty sure premiums will increase by at least...$60 billion. Unless there's some magic money tree involved in all this that they're keeping secret to surprise us all with later.

edutcher said...

Funny how Ritmo never shows up unless it' s to defend another Obama policy disaster.

Last I looked, this one only had about 30% support.

Bleach Drinkers Curing Coronavirus Together said...

So you're telling me, Pasta, that you're living in a "pretty big" state that's neither New York or California, then.

What are they doing wrong that your state is doing right?

Pastafarian said...

What are you talking about, Ritzy? I'm in Ohio. Explain to me, as you would to a small child: Why did premiums increase here by 12% this year?

And why do people in the insurance industry promise even larger increases in the future?

If Ohio's rates increased more than another state's, I'd suggest that this is because Ohio had lower rates than they did in NY or CA, and now we're all going to be in the same shitty boat together. If this is wrong, explain why, without the riddles.

Revenant said...

So you're telling me, Pasta, that you're living in a "pretty big" state that's neither New York or California, then.

He's obviously not living in California. Anthem BC's premiums are going up 12% in his state. They're going up 14% in California. :)

Pastafarian said...

Well, I just found something in the NY Times indicating that Anthem Blue Cross in California bumped up premiums by...wait for it...

26%.

Jesus Christ, I guess we got off pretty good here in Ohio.

Now, bear in mind, I'm talking about actual increases that we've actually seen. Not the heart-warming projections and make-believe fairy tales that Kathleen Sebelius has been reading to you at beddy by time.

Bleach Drinkers Curing Coronavirus Together said...

Funny you should ask that!

I actually just googled "premium change" and found, at the first return, one likely answer to your question: Certain states were used to getting away with approving completely horrible coverage.

This isn't funny. I do want to know what's working and what's not. I take that very seriously. But in the meantime, assuming CNN's got any insight, why should NY and CA have suffered for actually looking out for the health of their residents to a degree that Ohio, for whatever reason, just didn't ever think was that important?

Pastafarian said...

Oh, wait, they just proposed 26%. So they only got 14%.

They probably made up the difference in some other state that would have went up less. Like Ohio.

Revenant said...

The government forces people to buy something, and its price goes up. If only there was some sort of economic law that explained this phenomenon.

Bleach Drinkers Curing Coronavirus Together said...

Dates of publication on cites and losing the presumption that a single insurer speaks for an entire state would be helpful.

Bleach Drinkers Curing Coronavirus Together said...

The government forces people to buy something, and its price goes up. If only there was some sort of economic law that explained this phenomenon.

I know! I know! Would it be the economic law that says if they come into your E.R. you must treat them?

Oh well. We all know what Ron Paul's fans thought the answer to that was! (Let him die!)

Revenant said...

NY and CA have suffered for actually looking out for the health of their residents to a degree that Ohio

You probably should have read the bit about California's rates going up more, before you posted that.

Although there is some humor value in you equating "buy this or I'll take your money" with "looking out for me".

Pastafarian said...

Yeah, that's not it, Ritzy. Again, our rates went up by over 10%, and we offer a plan that almost qualifies as "Cadillac" (plans so good, they should be illegal, according to this law).

Think about that -- they're going to punish employers for providing benefits that are too good.

And now you're criticizing Ohio employers for not offering plans that are good enough. Who died and made you Goldilocks, Ritzy?

Methadras said...

Icepick said...

This bill did nothing towards reducing costs in any real fashion.


It can't and never could even if it tried because it has been deemed a tax.

Revenant said...

I know! I know! Would it be the economic law that says if they come into your E.R. you must treat them?

That's not an economic law, that's a federal law.

It takes a special kind of person to demand that hospitals provide free service and then whine that people are using hospital services for free.

Bleach Drinkers Curing Coronavirus Together said...

Think about that -- they're going to punish employers for providing benefits that are too good.

And now you're criticizing Ohio employers for not offering plans that are good enough. Who died and made you Goldilocks, Ritzy?


I don't know... the same person doing it in the preceding paragraphs.

Just because a plan offers a lot of "something" doesn't mean it's a good plan. You have to have a basis for saying what's a good medical benefit, and not just flashy coverage. The new names might indicate otherwise, but good coverage is not just about "bling".

Methadras said...

Rhythm and Balls said...

Ritmo, would it be in the best interests of the AHA to keep people alive for as long as possible to necessite those that pay into the system to keep doing it?

It seems oddly morbid that any provider wouldn't want to keep someone alive for as long as ethically possible, but if you're skeptical, no one seems to think that Medicare is in the "rush to die" business, despite insuring the highest-risk demographic, and they are the model of efficiency as far as the managed care market is concerned. Seniors, no matter how market-oriented they are, can't seem to stop signing up for it.


Then why have the AHA to begin with when one of the primary arguments for the AHA was to facilitate the 30 million or so uninsured? There could have been a sandboxed provision under Medicare to allow those 30 million uninsured to join or at least create a new sandbox just for those 30 million under a new provision. As to pre-existing conditions, under Medicare Advantage you can sign up already unless you have end-stage renal disease which appears to be their only exception to pre-existing conditions. So you can sign people there without creating a whole new law or if you are one of the 30 million uninsured, could be extended in the sandbox. No need for this gargantuan law at all.

Pastafarian said...

I know it's just an anecdote, but we have employees whose children have chronic, life-threatening conditions. And we've been able to offer them affordable insurance for decades.

And now we won't be able to. And the policies available on the exchange are laughable. And because we (for the moment) offer, by definition, "affordable" insurance, our employees won't be eligible for the wealth-redistributing subsidies that chronically unemployed lay-abouts will receive.

Anonymous said...

Sweet Obamacare deals for young

Bleach Drinkers Curing Coronavirus Together said...

It takes a special kind of person to demand that hospitals provide free service and then whine that people are using hospital services for free.

And an even more special person to say, "Fuck the fact that this will never happen! Let's pretend we can agitate to drop the emergency care provision anyway! Fuck democracy and fuck ethics!"

chickelit said...

Oh well. We all know what Ron Paul's fans thought the answer to that was! (Let him die!)

We went over that one too in the past, R&B. The video evidence shows a measured applause at that point so there absolutely no reason to tar Paul with your brush unless you're a Palin-loathing Sullivanist. :p

chickelit said...

R&B: While you're at it, why don't you trot out the nonsense about the Ron Paul staffer dying alone in a hospital and being denied care because he lacked insurance because of HIV.

chickelit said...

And if you ask why I'm sounding upset--it's because I'm fucking sick of the emotional manipulation from your side.

Pastafarian said...

They're such sweet deals, Inga, that they have to be forced to take them, or pay a penalty. Such sweet deals that the difference between their premiums and the payouts on their medical costs are being counted on to finance the system.

And yet again, the younger generation that voted for this shit in droves gets brutally hosed.

Methadras said...

Revenant said...

So you're telling me, Pasta, that you're living in a "pretty big" state that's neither New York or California, then.

He's obviously not living in California. Anthem BC's premiums are going up 12% in his state. They're going up 14% in California. :)


And if health insurers were allowed to operate across state lines and compete, those prices would drop and I bet even with ACA implementation. Without ACA, probably even more, so much so that states could afford to buy bulk coverage for the uninsured and still save money.

Revenant said...

If the real concern was that people might rack up huge ER bills and stick someone else with them, there was a much simpler solution than ObamaCare.

Step 1: Require purchase of a high-deductable health insurance plan. No coverage of pre-existing conditions, of course (that's why it is called "insurance", not "free money").

Step 2: Repeal the law requiring free emergency room care for the uninsured.

Mind you, that law wouldn't be any more constitutionally acceptable than Obamacare is. But it would address the "problem" of uninsured free riders quite handily. It is, in fact, the exact approach states take with regard to liability insurance for cars.

They don't mandate you purchase car insurance that provides free monthly car detailing, checkups, maintenance, and tree-shaped air fresheners. They just mandate that you have enough insurance to cover a disaster.

Bleach Drinkers Curing Coronavirus Together said...

I know it's just an anecdote, but we have employees whose children have chronic, life-threatening conditions. And we've been able to offer them affordable insurance for decades.

And now we won't be able to.


No, in that case, it's not just an anecdote, in my book. If that's the sort of thing that actually ends up happening, then I want to know - as I will rise up to oppose the ACA (or any such provision in it) the very next day.

I'm not being an ideologue or hack, here. I really want to know.

chickelit said...

Inga's here...can fionamcgee be far behind?

Anonymous said...

"It's a win win most of the time"

Fortune 500 companies are on board.

Bleach Drinkers Curing Coronavirus Together said...

R&B: While you're at it, why don't you trot out the nonsense about the Ron Paul staffer dying alone in a hospital and being denied care because he lacked insurance because of HIV.

Oh, I already did. It wasn't nonsense and it wasn't a staffer. It was someone in the audience.

And if you ask why I'm sounding upset--it's because I'm fucking sick of the emotional manipulation from your side.

Well, you can see where "cruel neutrality" gets you. ;-)

I'm not being manipulative. Lives and good care is important and if you fear allowing your emotions to validate that fact, then the discussion's not worthwhile to have. If Pasta points out a problem with the care that would cause me to reconsider, that's important to me. It's possible to try for objectivity without fearing your own emotions or pretending that closing them off from what's important is achievable or desirable. Don't pretend that the cries of "Stalinism" weren't manipulative, either.

Revenant said...

On a related note, isn't it interesting that even though insurance is not mandated by the government, the law requiring hospitals to treat people for free remains wasn't actually repealed?

I wonder why that is... :)

Methadras said...

Rhythm and Balls said...

I know! I know! Would it be the economic law that says if they come into your E.R. you must treat them?

Oh well. We all know what Ron Paul's fans thought the answer to that was! (Let him die!)


If insurers were allows to operate across state lines, remove as much federal intervention into health care and allow states to actually buy bulk insurance for catastrophic emergency care via that competitive advantage, then that kind of coverage would be acceptable with regular health care visits being bought at a much lower rate that the states can sell or let insurers directly sell to consumers and drive costs down.

Revenant said...

Bah, that should have been "insurance is NOW mandated by the government". Not "not".

Wishful thinking on the part of my subconscious, no doubt.

Bleach Drinkers Curing Coronavirus Together said...

They don't mandate you purchase car insurance that provides free monthly car detailing, checkups, maintenance, and tree-shaped air fresheners. They just mandate that you have enough insurance to cover a disaster.

Oh, Crikees! And what would the cost of mandated HDHPs have been? If they'd have been actually cheaper on a population-wide basis, (and I know they are generally), then this is exactly the sort of alternative that the Republicans you ride had been asked to provide before empty-handedly telling Obama that they had nothing to offer but opposition.

Pastafarian said...

I'll keep you updated, Ritzy.

One kid has a congenital heart defect, and the other has Crohns Disease. (I'm not allowed to know these things, because of HIPAA, so don't turn me in).

The one with the heart thing has to get surgery once every few years. The one with Crohns might get into the bone marrow study in Seattle. Interestingly, they wouldn't even consider him for this, had he not been insured. He's already had an iliostomy and he's in pretty bad shape, and that bone marrow thing might be his last shot.

So it's a really bad time for this upsetting of the apple cart with the ACA. I don't mean to be testy with you on this stuff...it gets me a little worked up.

It's remarkable, actually, that you're here commenting on this, taking barbs from every side. Good job, Ritzy.

Methadras said...

Rhythm and Balls said...

It takes a special kind of person to demand that hospitals provide free service and then whine that people are using hospital services for free.

And an even more special person to say, "Fuck the fact that this will never happen! Let's pretend we can agitate to drop the emergency care provision anyway! Fuck democracy and fuck ethics!"


Actually you could remove the emergency care provision if people in that state new that catastrophic emergency room visits were covered by being a resident of that state. That wouldn't be unethical, but prudent. Also, the ethics of a state that covers that kind of insurance for their residents (legal residents) is ethical and would work because it would be cheap since insurers can compete to give the state the best prices or work directly with emergency care facilities to negotiate the best prices on the states behalf.

Bleach Drinkers Curing Coronavirus Together said...

Sorry, I meant to say "nation-wide", not "population-wide".

Anonymous said...

"It's remarkable, actually, that you're here commenting on this, taking barbs from every side. Good job, Ritzy."

September 17, 2013 at 9:35 PM

Pasta, so who on the left side are throwing barbs at Ritmo?

President-Mom-Jeans said...

Ah, the boozed up old cunt rears her ugly head.

May the death panels (or whatever euphemism the leftards are using these days) deny you some medical procedure in the near future.

Forward!

Bleach Drinkers Curing Coronavirus Together said...

I won't turn you in. I think this is the sort of thing that's actually important to know, and admire that you do take the care of your employees and their dependents as personally as you do. Anyone willing to defend the ACA, if they're honest, needs to be honest in confronting any shortcomings that would result. I'm not of a fixed belief on what is best, appreciate where a number of the opposing arguments came from, and wouldn't be unwilling to do a 360 if the evidence shows that alternatives they'd come up with would have done better overall, or left us with better trade-offs. I want the best care possible, with as much access to as much innovation as possible, as affordably as possible and as available as possible. Some might say those are impossible to achieve all in one, but I can tell where a trade-off might be unacceptable within the context of what I'd previously believed.

Anonymous said...

Ah, Sixty Grit gets into President Mom's jeans.

Shouting Thomas said...

I'm willing to wait and see how this turns out.

The medical care system as it existed prior to ACA was anything but a free market, and it was a mess.

For instance, my doctor just wrote a prescription for a brand name drug in the hope that my insurance would cover it. When I presented the prescription, the cost was $1,200 a month!

He also gave me a backup prescription for the generic, which I cashed in. $15 co-pay.

So, as you can see, the existing medical system is screwy, and based on playing games with the insurance system.

You righties out there might be interested to know that Fred Reed, one of the toughest of the old time traditionalists, favors universal medical insurance along the lines currently used for military personnel.

As I said, I'll wait it out and see how it turns out.

Revenant said...

Oh, Crikees! And what would the cost of mandated HDHPs have been?

Higher than non-mandated HDHPs I have were, of course, since "government mandates X" = "price of X goes up". One of many reasons Obamacare increases insurance costs; we're required by law to buy it. :)

But the cost would obviously have been less than the mandated extensive-coverage insurance of Obamacare.


If they'd have been actually cheaper on a population-wide basis, (and I know they are generally), then this is exactly the sort of alternative that the Republicans you ride had been asked to provide before empty-handedly telling Obama that they had nothing to offer but opposition.


Look, I'm open to the possibility that every single Democrat in Congress is too brain-dead to come up with the plan I outlined above. Perhaps they are; perhaps the only hope for a non-retarded solution to the free hospital care "crisis" lay with the Republicans.

But color me skeptical. I've known Democrats who understood basic economics. Surely someone in Congress did, too.

Anonymous said...

Ok, ST now you've convinced me to read your buddy, Fred Reed.

Revenant said...

And an even more special person to say, "Fuck the fact that this will never happen! Let's pretend we can agitate to drop the emergency care provision anyway! Fuck democracy and fuck ethics!"

The existence of Obamacare is, in itself, proof that Congress is willing to say "fuck democracy and fuck ethics". :)

After all, it was passed despite most of the public being against it, and relies on the redistribution of money from the poor-but-healthy young to the richer-but-unhealthy elderly.

Shouting Thomas said...

I worked as a contractor for pharma for the last 5 years of my career, so I know the people, and I don't think of them as evil.

But, the obvious reason why my doctor wrote that brand name prescription was that he hoped the insurance company would cover it, and he would get a kickback.

The currently existing medical delivery model is anything but a free market.

Shouting Thomas said...

Inga, Fred is all over the place.

He's a bitter critic of U.S. foreign military intervention. He believes that the U.S. military is a bloated, corrupt mess that can't even deliver on its stated function, which is to win wars.

And, at one time Fred was a reporter for the weapons trade industry.

Bleach Drinkers Curing Coronavirus Together said...

After all, it was passed despite most of the public being against it, and relies on the redistribution of money from the poor-but-healthy young to the richer-but-unhealthy elderly.

That's how all insurance works to spread costs onto everyone despite the needs of a few. And the job of a leader isn't always just to follow an inchoate public opinion, if he can shift it in a more productive direction. The opposition isn't "most" anymore, and half the rest do want to see how it will play out instead of going along with the Republicans to undemocratically decide that defunding it is the hostage they want to take in exchange for preventing the government from defaulting.

Anonymous said...

Interesting ST, I'll check him out.

Bleach Drinkers Curing Coronavirus Together said...

Look, I'm open to the possibility that every single Democrat in Congress is too brain-dead to come up with the plan I outlined above.

You have to be open to the possibility that understanding medical practice is at least as essential to solving this problem as is a knowledge of economics and policy.

Trooper York said...

The thing I have noticed is that more and more doctors are opting out of treating patients. Two of them in my neighborhood alone have become concierge doctors who will only treat people who will pay a yearly fee.

The one GP is so busy that he is moving to swanky digs because he is making so much money picking up the slack.

I would be interested in hearing what a real doctor like Pogo has to say about this.

William said...

For many men Obamacare would stand as the signal, defining failure of their career. Not so with Obama. He'll top this. Immigration reform. Mid East policy statements. Race relations. These initiatives have not yet reached their full flower of futility.....,If people are still literate in a hundred years and history books are written about these times, I'm sure Obamacare will merit just a footnote, as just a prologue to the coming horrors.

Revenant said...

You have to be open to the possibility that understanding medical practice is at least as essential to solving this problem as is a knowledge of economics and policy.

My solution works perfectly with existing medical practices.

HDHC plans handle emergency-room visits just fine. That's why I pay for one -- because of that remote chance of expensive disasters. They handle your semi-mythical "guy refuses to buy insurance and runs up a huge bill he sticks the hospital with" scenario.

They don't cover routine care, but access to routine care isn't a problem whether you've got insurance or not. Minor medical facilities take cash; that's what I used to do back when I was younger and poorer.

Shouting Thomas said...

My sister and brother-in-law live in Hawaii, and they both made their living in healthcare before they retired. She was an RN, he was an OB/GYN.

Hawaii has had what amounts to single payer universal healthcare for a long time.

My sister and brother-in-law were happy to work under this system, and they made one hell of a lot of money.

Not advocating anything. I'm not even attempting to delve into the intricacies of pharma and healthcare because the current system is a labyrinth, and the new one probably will be, too.

Anonymous said...

Health Law's ailments could be cured by single-payer system

From the doc's mouth to our ears.

edutcher said...
This comment has been removed by the author.
edutcher said...
This comment has been removed by the author.
edutcher said...

What was intended all along, according to Dingy Harry.

And the She Devil of the SS can't wait for American hospitals to start looking like British ones.

As someone said earlier, Arbeit Macht Frei.

Icepick said...

It seems oddly morbid that any provider wouldn't want to keep someone alive for as long as ethically possible, but if you're skeptical, no one seems to think that Medicare is in the "rush to die" business

LOL, then you clearly haven't dealt with the goddamned system then! This comment alone means that your opinion on these matters is completely worthless.

Icepick said...


Fortune 500 companies are on board.


No shit, dingbat. This is going to crush smaller firms that might otherwise compete with them. It will operate as both a barrier to entry and as a complicating factor to companies that do enter the market. GE already has the massive HR, legal and tax departments to deal with this kind of bullshit. It's why their tax forms are so long, and why they're completely happy with the current tax system.

Icepick said...

Well, I just found something in the NY Times indicating that Anthem Blue Cross in California bumped up premiums by...wait for it...

26%.


They got Californicated. Sounds like more fun than it it.

Revenant said...

Health Law's ailments could be cured by single-payer system

Single-payer polls even worse than Obamacare does.

"You can fix the things you don't like by doing something you like even less" is, for some strange reason, a tough plan to sell.

Icepick said...

One kid has a congenital heart defect, and the other has Crohns Disease. (I'm not allowed to know these things, because of HIPAA, so don't turn me in).

If the employees involved tell you, you should be fine on the HIPAA front. SHOULD be. Take nothing for granted with the government.

Revenant said...

"Fortune 500 companies are on board."

No shit, dingbat. This is going to crush smaller firms that might otherwise compete with them.

If I had a dollar for every time a big government type tried the "EVEN major corporations support increased regulations" line, I'd almost have enough to cover the price hike in my insurance. :)

It ranks somewhere between "even black people voted for Obama" and "even Republicans oppose abortion".

Trooper York said...

This is just another debacle that this idiot has gotten us into and we will have to wait until he leaves office to fix it. The key is to oppose it in every way we can before we can abort it.

That should even make the libs happy. Another abortion. They love abortions.

Icepick said...

Some articles giving some perspective on Obama's economic policies, a few years in. I suppose this data will be considered anecdotal too.

Census: Typical Family Makes Less Today Than in 1989

15% of Americans living in poverty

Census on Obama’s 1st Term: Real Median Income Down $2,627; People in Poverty Up 6,667,000; Record 46,496,000 Now Poor

A lot of the same ground gets covered, but each story has its own useful subset of data, or nice little graph.

No doubt the jury is still out on Obama's economic policies, which have resulted in a decreased median income DURING the recovery.

Icepick said...

It ranks somewhere between "even black people voted for Obama" and "even Republicans oppose abortion"

What's funny is that the line is used mostly by leftists, who happen to think that the Fortune 500 companies own the government and manipulate it for their own purposes anyway.

Bleach Drinkers Curing Coronavirus Together said...

LOL, then you clearly haven't dealt with the goddamned system then! This comment alone means that your opinion on these matters is completely worthless.

You go ahead and try arguing to get anyone >65 on private insurance and we'll see whose hold on reality is worthless.

As far as opinions go, I hope that's all you have. You should try a fact or two before weighing different arguments.

Bleach Drinkers Curing Coronavirus Together said...

Single-payer polls even worse than Obamacare does.

Ladies and Gentlemen, a libertarian populist!

You should make up your mind and get your story straight for when to go for popularity versus when to go on principle. Maybe if your ideology got votes...

Bleach Drinkers Curing Coronavirus Together said...

Dog the Bounty Hunter on Hawaii's "broken" system.

Anonymous said...

Ritmo, bwhahahaha! That clip is priceless.

Sydney said...

There's an inaccuracy in that chart. The patient and doctor circles are too close together. They should be separated by the furthest distance.

Dante said...

OK, let's pop up a level.

There is essentially a fixed amount of health care in the US. It doesn't matter if you magically added $100Trillion real dollars into the system, doctors can only work so much, and treat so many, and it takes a long time to make new ones.

Yet, bagoh20 says Obamacare is going to ruin things, despite that he notes people get health-care in this country.

So I'm wondering how it is going to ruin it. It primarily seems to change the seating arrangements, punishes young people to pay for the old, etc.

While its true Big Phara gets more money, and they aren't making many new good drugs, I don't see that detracting form the overall value of doctor health care in the country.

What I want to understand is how Obamacare makes the system fundamentally less efficient. Note, I'm opposed to the seating re-arrangement, think Steve Jobs should have gotten his liver, etc., but I don't see the waste. Where is it?

Revenant said...

Ladies and Gentlemen, a libertarian populist! You should make up your mind and get your story straight for when to go for popularity versus when to go on principle.

Happily, single-payer hits the sweet spot: ideologically unacceptable to supporters of individual freedom AND hated by the public at large. :)

Revenant said...

What I want to understand is how Obamacare makes the system fundamentally less efficient.

Health care will be distributed the same under Obamacare that it is under any other system: doctors will treat people they are paid to treat, with priority given to people who pay more.

Obamacare substitutes a thick layer of government bureaucracy on top of the already thick layer of corporate bureaucracy that allocates those health-care dollars. Therein lies (much of the) inefficiency.

That inefficiency is only part of the problem, of course. The major problem is that it increases demand at the same time that its price controls remove the incentive for adding new supply. Thus the existing shortages of health care will get worse. It is hard to get much more inefficient than "you're forced to buy insurance but can't find a doctor who'll accept it".

The well-off have a workaround, of course. They pay out of pocket. Doctors might not take new Medicare patients, but they'll always take cash.

Joe Biden, America's Putin said...

Democrats have successfully destroyed our health care system for decades. The 100% tax payer funded government controlled system - (single payer) is what they want.

It will suck, unless you are healthy - then it will be wonderful.

Joe Biden, America's Putin said...

Fortune 500 companies are thrilled to get tax payer dollars.

Crony capitalism.

ndspinelli said...

If you take the following terms away from the liberal sycophant vocabulary they would be unable to speak:

Single Payer[Don't call it socialism]

Racism[Even though they treat blacks like children and they're enabling parents]

Red State[Failing to understand most states are red]

Fairness[Fuck the law, we need fairness]

Open Dialogue on Race[Led by Sharpton, Jackson, etc.]

Choice[except for schools for poor kids].

Vegan[So I'm better than you]

Hypocrisy[except when they are hypocritical].

There are many more nut that will keep them tongue tied on most topics.

bagoh20 said...

"So I'm wondering how it is going to ruin it."

Look at what has happened to higher education just because the government subsidizes loans and tuition. It gets overused, the quality drops, and the cost explodes. Some people play that system to great reward, but most are getting ripped off, and those least capable get ruined.

Great fortunes will be made and nice careers created for a few due to the ACA, but the general public will get hosed.

The law is complex, and has a lot of terrible effects which you can read about in the news all day long if you look, but even if you don't know anything about the law, you can still gleam it's value from seeing how those who do and have some power are reacting to it, even if they supported until they saw it actually coming at them.

Congress, it's staff, unions, large corporations, and nearly all us small ones who have been educated are now scrambling to get away like rats on a sinking ship.

Do you think that all these people are reacting this way because they learned is that it's gonna be great or even better than what they had?

Methadras said...

This is why I love Heinlein:

“There is no worse tyranny than to force a man to pay for what he does not want merely because you think it would be good for him.”

And that is in effect what government is doing with the ACA and can now do, as a matter of precedent, with any other law if they see fit. You can now be forced into buying something you don't want by law. Tyranny as a function of the perception of the greater good. Which won't and doesn't to turn out to be that great, nor that good.

Dante said...

Look at what has happened to higher education just because the government subsidizes loans and tuition. It gets overused, the quality drops, and the cost explodes.

For sure it's going to cost more. But the core stuff can't change. A heart surgeon isn't going to start prescribing SSRIs, and as you pointed out, people who need heart surgery are going to get it, insurance or no.

What I'm wondering is how the efficiency of the system is changed. I'm supposing you think required care will be pushed out for elective/abusive reasons. There will be some of that, no doubt, but who wants to see a doctor?

I do think people who are currently paying for their health care will be impacted, because more people will now be hitting up primary care physicians. But that's what I meant by rearranging the seating. In aggregate, I don't see the amount of health care produced decreasing, only who gets care will change.

Revenant said...

A heart surgeon isn't going to start prescribing SSRIs, and as you pointed out, people who need heart surgery are going to get it, insurance or no.

Not necessarily, no.

Demand for health care was increasing faster than supply *before* Obamacare happened. The population is aging and (until recently) getting richer, which means more demand for doctors' services.

It is certainly true that emergency rooms covered people who needed immediate treatment before. That's not changing, except inasmuch as some percentage of doctors will retired rather than deal with this crap.

But the real problem is all the OTHER stuff -- the vast majority of medical care that you can't walk into an ICU and demand to be given for free. For example, all of the heart-disease treatment that falls short of responding to a heart attack. Now there's more demand for that, but reduced supply. So if you're a middle-class American, your odds of being able to make an appointment to discuss your blood pressure problems are likely to go down.

Aridog said...

Dante asks ...

What I'm wondering is how the efficiency of the system is changed.

It is changed by adding in accountants and statisticians to the medical care process. This adds cost, and decreases efficiency by default...e.g., they do not know anything but number counting, not medicine.

I cited a specific example regarding physical therapy that came in to effect in 2013...you apparently missed the comment, or ignored it.

A clerical administrator in the PT department over-rides a Orthopedic Surgeon's prescription and for why? Because Medicare NOW has numeric limits on therapy and the policy is now to cut off therapy at the two thirds of the limit mark, as determined by half assed metrics of progress, mnot progress per se...to be on the safe side. Further, I am not allowed to pay for any therapy on my own, they could not/would not even quote me the cost of same.

This is at least a double layer of staffing (accountants and statisticians) between me and my physician....who happens to be on the same sports medicine team that handles the local professional sports teams. But, what do they know, eh...bean counter at Medicare/CMS (contractor) knows best, screw the doctors.

I'm guessing, but I suspect you've not passed 65 years of age yet, or if you have, you've not needed any repetitive treatment.

Aridog said...

Dante says ...

... people who need heart surgery are going to get it, insurance or no ...

Where do you get this idea.

Name me a hospital with serious surgical facilities that doesn't have a **qualification board** for major surgeries?

I have had to have oncology related surgical treatments reviewed by such boards, in 2012. I was accepted...in 2013, I'd bet at 70+ years of age I would not have met the bean counter's standards of probability (just like the physical therapy shit I cited earlier).

Turns out that I am essentially cancer free as of today, thanks to no meddling by fucking bean counters and "non-medical experts."

You presumption that anyone who needs surgery will get is preposterous...even before Obamacare, and doubly so after the implementation of start up protocols in 2013.

Dante said...

First, lest their be any misunderstanding, I am not an Obamacare fan. I hate it. I think it is what's wrong with America. I don't like low income housing. I want people to earn what they get, and the America of today is falling short of that. And worse, there are a lot of ownership class types robbing the middle class along the way.

Regarding Obamacare, I'm wondering where inefficiencies will creep in on account of it.

Aridog points out accounting, and the rectal exam by the government will make it less efficient, and that's possible, though in the age of computers I would think not too bad, and possibly there are good outcomes, ends justify the means which I don't agree with, kinds of outcomes. More violations of the individual.

Bagoh20 points out that people will abuse the system, but people are already abusing the system, and end-of-life care is the big cost anyway.

All it seems to me to do is change who is going to get care and who is not, and it also has the property of putting more burden on the young.

Yes, it will be more expensive, and yes, there will be more of the kinds of things Aridog is concerned about (getting the care when you need it based on your private decisions), but I don't see a efficiency change.

One of the qualities at least here in CA, is that Nurse Practitioners will be able to do more things, I read somewhere. I think that's fine, and can add capacity and some competition.

But overall, bang for the buck, if as much health care delivered, regardless of whether you earned it or not, I don't see that changing.

And finally, I'm glad Bagoh20 got his liver, and I'm glad Steve Jobs got his liver though in a "Fair" system he would not have. So don't get me wrong, Obamacare is exactly the wrong thing because it provides the wrong incentives.

P.S. Aridog, "I cited a specific example regarding physical therapy that came in to effect in 2013...you apparently missed the comment, or ignored it." didn't see it in this thread.

I don't read Lem as much as I used to read Althouse (not ever anymore), so I don't know what you are talking about.

Aridog said...

DAnte said ...

Aridog points out accounting, and the rectal exam by the government will make it less efficient, and that's possible, though in the age of computers I would think not too bad, and possibly there are good outcomes,...

Seriously? You believe what you just said? I worked as military and a fed for years and I find your idea here beyond laughable, just sadly uninformed.

If your ambivalence makes you feel better, then I understand it as a method of coping with the absurd. So be it.