The Problem With ObamaCare: The Republican Stuff

Alex Pareene:

[T[his is a dumb way to give people health insurance. This is a program that, by design, is going to annoy literally millions of Americans immediately. It will improve most of those people’s lives, but it will do so in a way that feels as coercive as possible. It didn’t have to be that way! No one is ever annoyed that they qualify for Medicare or Medicaid. People may hate paying the taxes that fund those programs, but people always appreciate direct benefits.

The way the ACA deals with people [...] illustrates nearly every problem with attempting to design conservative, “market-based” ways to do things best done by straightforward government programs. It exposes the flaws in both the technocratic wing of the Democratic Party — a too-clever solution to a very simple problem — and the centrist third-way wing — making legislation intentionally worse to shield Democrats from increasingly ineffective accusations of liberalism, or to pick up Republican support that, in this environment, is never coming. So we end up with a program that hides many of its best and most important features, and loudly advertises its most coercive element.

More . .

Democrats created this mess for themselves. Conservative Democrats are responsible for many of the programs flaws, and, perversely, their attempts to shield themselves from public outrage ended up creating a law that will lead to more public outrage than a more government-oriented program would’ve. But the program was designed by moderate and even liberal Democrats. They were working to appease the conservatives, yes, but we should have long since learned that a conservative Congressional Democrat will only ever agree to something if you promise to make it a little bit, or a lot worse. In other words, the ask should’ve been bigger.

. . .So what is to be done? Democrats who aren’t Obama should already be working on easy-to-grasp proposals to “reform” the ACA — to make it more public and less private. The immediate priority — and progressives running for office in 2014 and 2016 should practice saying this out loud — is fixing Obamacare. Not just the website, but the coverage gaps, the ways insurance companies will continue to exploit people and rip them off, and the potential for the cost burden on middle class people to grow.

What he said. And yes we all here at Talk Left said it throughout 2009 and 2010. Unlike the wonky Beltway bloggers who got this completely wrong.

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    Sigh (5.00 / 1) (#2)
    by Slado on Thu Oct 31, 2013 at 01:29:56 PM EST
    It must be hard to see Obamacare going down so fast.  It might survive but it won't in it's current form.   Too many little goodies are coming to light.   In 2015 the employee mandate shoe drops and more people will lose coverage.

    But don't worry.  As Jay and the president like to say they didn't know that that coverage was bad for them.

    For those keeping track here's Obama Lie #2

    You can keep your doctor.  Period.

    Not so much.

    We only have coverage (5.00 / 1) (#45)
    by MKS on Thu Oct 31, 2013 at 06:12:27 PM EST
    because of Obamacare.

    Pre-existing conditions and being self-employed.

    There will be many, many more like me.  


    I am genuinely glad (5.00 / 1) (#52)
    by sj on Thu Oct 31, 2013 at 06:37:37 PM EST
    that you have coverage. Or rather, will have coverage come the first of the year.

    That isn't a reason to shut down robust discussion of the cons as well as the pros.


    Have coverage now (none / 0) (#57)
    by MKS on Thu Oct 31, 2013 at 07:24:55 PM EST
    through PCIP which will end Dec 31, and then go on the exchange at approximately the same price, which is pretty good.

    Ah, I see (none / 0) (#60)
    by sj on Thu Oct 31, 2013 at 07:29:48 PM EST
    Well, like I said, I'm glad you have it.

    Don't forget the $2,500 (none / 0) (#153)
    by Abdul Abulbul Amir on Fri Nov 01, 2013 at 10:21:29 AM EST

    Don't forget the $2,500 that the family of four was going to save.

    If you like your health plan you can keep it. Period.
    If you like your doctor you can keep your doctor. Period.

    Well in fairness, those bald faced lies helped get Obama past the 2012 election, so they were not useless.


    Your (5.00 / 2) (#167)
    by Ga6thDem on Fri Nov 01, 2013 at 10:50:01 AM EST
    post shows precisely why the GOP keeps losing elections. The truth of the matter is SOME people are going to get to keep their insurance. SOME people are going to save money. SOME people are going to be able to keep their doctor but the hysterical junk from the GOP implies that EVERYBODY is going to pay more, EVERYBODY is going to lose their doctor and EVERYBODY is losing their health plan.

    You know you can't complain about Obama lying when almost everything you say is a lie.


    The truth of the matter (none / 0) (#200)
    by ExcitableBoy on Fri Nov 01, 2013 at 12:20:44 PM EST
    is that AAA is right: the President and others said you would keep your plan, keep your doctor. Period. No some. No most. These were obvious lies then, and now it's known that they knew it when they said it. But with both parties, truth and elections don't mix, and the lies served their purpose. Now, this is a complete different matter from whether the plan is ultimately better, the plans will be beneficial, etc. I'm just sick of politicians looking me in the eye and lying about such important matters. Treat me like an adult: tell me the truth and let me make up my mind.

    One more thing (5.00 / 2) (#39)
    by TeresaInSnow2 on Thu Oct 31, 2013 at 04:46:25 PM EST
    No one is ever annoyed that they qualify for Medicare or Medicaid. People may hate paying the taxes that fund those programs, but people always appreciate direct benefits.

    They are only annoyed when they try and use them.  The Medicaid doctor network is horrifying, the Medicare one merely horrendous.  The programs are not well-funded.

    And the gerrymandered doctor networks of the Exchange plans will be even worse because when Exchange plans are used, out of network doctors and hospitals can balance bill.  

    I am sorry if have had bad experiences (5.00 / 3) (#75)
    by MO Blue on Thu Oct 31, 2013 at 09:50:14 PM EST
    but the experiences you are describing are not anywhere close to the norm here in my area. I am not on Medicaid so I can not speak specifically about all aspects of that program. I do know that when I was being treated for cancer at the #1 ranked Cancer Institute in Missouri quite a lot of the patients were on Medicaid and they had no problem receiving the same treatment from the best doctors at the institute as anyone else.

    I am on Medicare and the doctor network I can access is first rate. There is nothing horrendous about it. I am treated by the same doctors now as I was when I had employee health insurance. The only difference is that I am paying a whole lot less than I did when I was on the employee retirement plan which wound up to be a rip off.


    You've hit on one of the problems with (none / 0) (#105)
    by Anne on Fri Nov 01, 2013 at 08:29:34 AM EST
    our current system, and that is that where you live very often determines what choices are available to you; those in rural areas often have fewer choices because providers can't make enough money on the eligible population.

    And that kind of decision-making process is bleeding deeper into the system, with insurance companies making decisions not to include in networks in these exhange-based/subsidy-eligible plans providers that serve areas that are poorer and more medically-complex.

    It's all about the money, and less and less about, you know, health.

    People who need an annual physical and routine screenings who don't currently have insurance may be thrilled that for very little premium outlay, they will get essential care they didn't have before.  But those with more complex situations - people who need surgeries or treatment for cancer, have chronic conditions like kidney failure or diabetes, or have a high-risk pregnancy or deliver a severely premature baby, may find their road to recovery loaded with land mines of limited providers, the surprise of being billed in full by a provider that wasn't known to be out-of-network, and an insidious thing known as "balance-billing."

    Not that the shock of a bill from an out-of-network anesthesiologist assisting a network surgeon in a network facility hasn't happened under the existing structure, but that kind of thing is going to be more common because insurance companies are not going to let the mandates and regulations of the law prevent them from finding ways to keep more of our money.

    Kind of like how the financial industry didn't let Dodd Frank keep them from (1) working overtime to gut the regulations and (2) working to find ways around the regulations they haven't been able to get rid of.


    This part is wrong and is what is so misleading (none / 0) (#114)
    by vicndabx on Fri Nov 01, 2013 at 08:45:03 AM EST
    with insurance companies making decisions not to include in networks

    I never understand why no one ever mentions the provider of care in these equations.  As though they are innocent babes-in-the-woods who are not protecting their own financial interests.  These provider choose not to accept to lower reimbursement rates.  Hmmm, I wonder what program works like that......

    Your entire post describes a failure at the provider of care and yet, somehow it's all the insurers fault.  Why do you not expect more of the hospital in your example?  Why are you as a consumer not asking these questions before the surgery?

    Your same scenario can happen in a world w/no insurers if the anesthesiologist doesn't accept the gov't's insurance.

    Going back thru my old posts, I came across this from 2009 that I think is still applicable today:

    In the survey of 1,000 consumers conducted Oct. 21-26, only six in ten consumers (61%) understand their rights to appeal a denied health insurance claim and fewer than one in three consumers strongly understands the cost factors that determine their health insurance premiums. Additionally, a strong minority of consumers (19%) also acknowledge they may go to an out-of-network doctor for health care insurance coverage.  These consumer attitudes toward understanding health insurance trigger clear financial implications


    People please be better consumers of healthcare.  It is just like any other service you purchase.

    and yes, my bias is showing.


    Uh, I think you might want to check (5.00 / 2) (#121)
    by Anne on Fri Nov 01, 2013 at 09:06:54 AM EST
    your facts.

    Example One:

    Seattle Children's Hospital is seeking a court order that would remove two health plans from the new state insurance exchange because the plans don't include the area's only children's hospital in their provider network. The suit could foreshadow similar legal moves by other providers excluded from exchange plans.

    In a petition for judicial review filed Friday (PDF), the 250-bed Seattle Children's is asking a judge in King County Superior Court to invalidate the approvals granted by the state insurance commissioner's office to health plans offered by Molina Healthcare of Washington and by the Coordinated Care Corp.


    Across the country, children's hospitals are expressing similar concerns, though Seattle appears to be the only market where the controversy has boiled over into litigation. The conflict pits the need for affordable pricing on the public exchanges against the federal requirement that the plans include sufficiently large networks. One common way insurers are making their exchange plans less expensive is to offer narrow networks.


    The Seattle Times and Kaiser Health News reported that of the seven insurers offering plans in King County, only two--Group Health Cooperative and Community Health Plan of Washington--are offering plans on the state exchange that include Seattle Children's in their network.

    Example Two:

    The president of Anthem Blue Cross Blue Shield in New Hampshire faced an unhappy audience of state senators yesterday as she defended the insurer's plan to exclude 10 of New Hampshire's hospitals from the limited network of health care providers available for people who purchase insurance through the new exchange.


    Anthem is the only insurance company planning to sell coverage through New Hampshire's exchange in 2014, though Harvard Pilgrim Health Care has said it will join the marketplace in 2015.

    Guertin said Anthem sought to reduce the cost of its plans by reducing the number of participating providers. Participating hospitals, she said, accepted lower reimbursement rates because they'll gain patient volume in a narrow network.

    I'm sure there are other examples, but this comment is already too long.  The point is that this is not simply a case of providers choosing not to participate - although I have no doubt that has been happening all along, and no doubt does have to do with reimbursement rates - but of insurance companies actively excluding providers so as to narrow the networks and drive subscribers to lower-cost providers.


    This actually (5.00 / 1) (#130)
    by Ga6thDem on Fri Nov 01, 2013 at 09:34:44 AM EST
    sounds more like collusion between the insurance companies and the hospitals they are putting in their network more than anything else. The thing is though if it actually is "quasi-medicaid" it would make no sense that people were suing to be included in the exchanges. Your NH model shows that people are taking it to the insurance companies which is a good thing.

    The word exclude in both your and MOBlue's (none / 0) (#142)
    by vicndabx on Fri Nov 01, 2013 at 09:55:37 AM EST
    examples is equivalent to saying my son is excluded from going to a certain private school because I've chosen not to pay the enrollment fees.  What's amazing is you and I linked to the same story.

    If you believe that the insurer did not "want" the provider to be in the network, that's a failure of your understanding of how the business model actually works.  Beyond the negative press, it's just bad business to not be able to market coverage of services at a facility or medical group as a benefit of purchasing coverage.  

    What's ironic about both of your comments is these attempts at cost controls are exactly what CMS does by keeping reimbursement rates low. The only difference - the gov't can largely force a provider to accept lower rates because of the volume of patients. Point is, there is no other way to help keep costs down - other than reducing member's utilization of services. What you are arguing for is the ability to go to whatever provider of care you want, regardless of their effectiveness (in terms of outcome vs. cost) and have it be covered.

    Your comments are the equivalent of having your cake and eating it too.

    As evidence of my point on the culprit for cost increases, see the reporting here:

    Prices rose for all major categories of health care--hospital stays, outpatient care, procedures and prescriptions--outpacing an uptick in the use of many of these services. Prices rose fastest for outpatient care.

    "Prices continue be the main culprit for rising health care costs," said HCCI Executive Director David Newman. "If we are really going to get health care spending under control, we have to better understand why those prices are rising and the implications those increases have for the U.S. health care budget."

    With regard to insurers denying claims:

    Cost sharing between patients and payers remains stable: Spending on health care was split between consumers and insurance companies in much the same way as previous years, with insurers paying for 83.8 percent of total expenditures and insured enrollees contributing 16.2 percent. Payers contributed $3,812 per person in 2011.

    I'll say it again - the problem is not the insurer.  You would understand this if you looked at this from the macro-level and let go of your biases.  We are all consumers of healthcare, so I can certainly understand the impact of not having a doctor in a network.  I've experienced it myself.  That does not mean I should simply throw up my hands and look to cast blame indiscriminately.  Not only will this not solve my problem, I won't be able to know where to advocate for change if I remain uninformed.


    You make a salient point (5.00 / 1) (#145)
    by Big Tent Democrat on Fri Nov 01, 2013 at 10:03:30 AM EST
    imo, that "lesser" care is part of cost control.

    But insurance companies, while not the only culprit, ARE a culprit.

    A culprit in the sense that like any other business, they want to make as much as they can.

    Can we afford them anymore for things like ACA? Imo, no.

    MKS, here is my proposal, scrap the exchanges and enroll folks in Medicare, using the same funding that would apply to purchase of private insurance.


    You will always have a middle man (none / 0) (#177)
    by vicndabx on Fri Nov 01, 2013 at 11:08:18 AM EST
    that you will have to pay.  Someone has to receive the claim data, determine its validity, send out requests for more information, coordinate benefits across different coverage, send out checks and Explanations of Benefits, etc.

    Whether that's an insurer or contractor that is an insurer (as it is today) is a matter of semantics.

    The other thing is this - we live in a Ponzi-scheme type economy.  People need to recognize that because that is the true problem here.  Witness the tech collapse & outsourcing of the 90's - everybody wanted to do it cheaper. The way the economy is structured, how we all make a living and get what we need to eat and have a roof over our heads is what needs to change. Otherwise, you start pulling out blocks from the pyramid everyone gets hurt in the collapse.  Typically people in the middle and the bottom the most as those on the top just land on everyone else.


    That's a good point Vic... (none / 0) (#185)
    by kdog on Fri Nov 01, 2013 at 11:42:47 AM EST
    the ponzi scheme economy, where 1% owns 33% and 20% owns 50% of the wealth...a lot of our problems boil down to that.

    Health Insurance Co CEO's and Hospital CEO's and Medical Schools and Banskters are sucking obscene amounts of money out of the health care system.  When Apple's CEO does it, it's not that big a deal...nobody needs an iphone.  Where as everybody needs medical care at some point.

    If we could somehow return to the golden age of the middle class, where the bossman only made 10-15 times more than the workers, most everybody could afford decent health insurance except the very poor, who would still have Medicaid.


    While you may choose not to pay to send (5.00 / 1) (#152)
    by MO Blue on Fri Nov 01, 2013 at 10:18:54 AM EST
    your son to a certain private school, one of the key words is choose. Accepting lower priced mandated private insurance coverage that does not met health care needs is not a matter of choice for a large segment of our population. Paying the higher premiums for exchange plans with bigger networks will not be a matter of choice for many because they don't have the money even with subsidies.

    BTW, I understand private insurance very well since I once worked in the insurance section of a major corporation. So please drop the BS about people not understanding the poor, poor insurance industry. The documented cases of the industry establishing procedures to deny legitimate claims and rip off their clients are legionary.


    You're right - as these providers choose (none / 0) (#180)
    by vicndabx on Fri Nov 01, 2013 at 11:15:45 AM EST
    not to accept the lower rates and thus are excluded.

    MOBlue, I know you know your stuff, you and I have discussed this many many times.  

    I think the issue here is not specific to any payer - these same problems could potentially exist if Medicare were expanded.


    Hmm funny how the actual insurers (none / 0) (#127)
    by MO Blue on Fri Nov 01, 2013 at 09:20:44 AM EST
    are the ones saying that they are narrowing the networks to keep down their costs.

    Insurers including Aetna and Health Net say narrower networks, made up of hospitals and physicians selected using cost and patient-outcomes criteria, are necessary to keep their exchange plan premiums affordable while still meeting the requirements of the Patient Protection and Affordable Care Act. They increasingly have offered such plans to employer groups over the past few years, touting annual cost savings of 10% to 25%. In the large-employer market, Aetna's narrow panels are 15% to 35% smaller than its standard preferred provider panels. Blue Cross and Blue Shield of Illinois says its exchange plans using narrow networks will cost 20% to 30% less than its exchange plans with bigger networks.

    Haven't seen any articles over the last couple of years on how employee group premiums have gone down substantially (10% - 25%) due to narrower networks. In fact, from everything I have read even people in employee plans are paying more in premiums for less coverage - higher co-pays, - higher deductible etc.

    Quite frankly we need doctors and hospitals. We just don't really need private for profit health insurance companies.


    I actually (none / 0) (#134)
    by Ga6thDem on Fri Nov 01, 2013 at 09:41:12 AM EST
    have experienced the "newer" insurance policies with my husband's former employer. What they essentially do is turn prescription drug coverage into a discount plan where instead of paying $275 for a drug you get to pay $214. Thankfully he wasn't there long enough after they had that plan for me to actually find out about what they did or did not pay in medical coverage.

    But we now have "good" coverage but I have to fight the insurance companies to pay what they are supposed to pay. The fight never ends. Even if you get a plan with a lot of providers etc. they still may not pay. So while people complain about some of these exchange plans having thin networks it's actually better to have thin networks IF that is what they are actually going to pay instead of having wide networks and thinking that you are covered when you aren't.


    I also would add (none / 0) (#117)
    by vicndabx on Fri Nov 01, 2013 at 09:01:41 AM EST
    it's not in an insurers best interests to exclude providers from a network. Why would we not want as many providers as possible available to current and future members? It's counterintuitive to the business model.  

    Further these networks generally have to be approved by State DOI's and meet certain criteria set under the ACA.


    Anne, to be fair (none / 0) (#124)
    by CoralGables on Fri Nov 01, 2013 at 09:10:44 AM EST
    where you live very often determines what choices are available to you;

    That covers everything in life from weather to grocery stores. Always has and always will.


    The ACA was developed (5.00 / 2) (#40)
    by KeysDan on Thu Oct 31, 2013 at 05:00:25 PM EST
    on the parent-like maxim  of never give children choices: We are having hot dogs, you can chose mustard or catsup, but we are having hot dogs.   The several possible approaches  were narrowed, to the exclusion of more viable options including adaption and/or adoption of successful government programs, to a complicated mixture of movable and immovable parts.

    The ACA takes on a tall order: changes to the non-group market, mandates to carry insurance, expansion of public insurance, subsidies for private insurance coverage, increases in revenues from a variety of new taxes, most middle class workers will not pay (an often overlooked reason for ACA hostility) , and reductions and "savings" in Medicare.

    A seeming selling point was that everyone should like it, the Democrats will be good soldiers and the Republicans will get a product hatched by their favorite think-tank and an idea put forth by one, and soon to be, two, failed Republican presidential candidates.  

    Moreover, some of the foundations for ACA could be considered experimental and the justification for the "savings"  in Medicare were based, in part,  on the faulty use of work such as the Dartmouth Atlas and  other health care economists.  What's not to like? What could go wrong?  Any other way would be controversial, a non-starter, so off the table and onto the floor.

    In particular light of the continuing Republican attacks on ACA, to the point of closing down the government and threatening its full faith and credit, it is difficult to understand why a "surge" in technological effort did not occur before, rather than after the grand opening.  

    Or why, some staggered system was not in place for initial use that deployed alternate days or birth years.   A smooth roll-out would have helped substantially and avoided the inevitable piling-on.

     We now have been given a hot dog with mayo--not generally,  a popular choice. But one, I think, we need to, at least, try.  Because the alternatives are bleak, with no effective replacement, in my view,  likely to be in sight for the next 50 years.  But, with the need steadily increasing.

    The Republicans will be happy to keep the status quo for the uninsured, allow premiums to skyrocket  for those who have insurance, and replace Medicare with a substitute coupon-clipping program. We see already what some Republicans think of Medicaid, even with full federal support.

    ACA needs to be made to work, to be reformed in a manner that leads to single payer starting with early buy-ins to Medicare.   Initial Democratic reforms should be based on evaluations of actual experiences and user feedback.  Subsidies should be increased and the eligibility income range expanded. And, a national PPO type network assured.  


    Your post (none / 0) (#64)
    by Ga6thDem on Thu Oct 31, 2013 at 07:57:13 PM EST
    brings up the absolute irony that the Ryan plan was basically Obamacare for the elderly.

    CBS is reporting numbers (5.00 / 1) (#85)
    by ragebot on Fri Nov 01, 2013 at 12:09:38 AM EST
    CBS is claiming six people signed up the first day and by the third day it was up to 248.  Of course this report is from the network that made up stuff about Bush that was later proved to be fake so take this with a grain of salt.


    Oh dear (5.00 / 1) (#87)
    by sj on Fri Nov 01, 2013 at 12:29:26 AM EST
    Well, I guess that's between zero and 350,000. But I think mayhap a certain woodchuck will be disappointed.

    I intend to review the attached document when my eyes aren't so bleary. This is the kind of stuff that piques my professional interest.


    The Hill (none / 0) (#92)
    by jbindc on Fri Nov 01, 2013 at 06:29:30 AM EST
    is also reporting it and it was on all the local networks here this morning as well.These are not final numbers, however, and I expect them to change drastically by the time the adminstration finally gets around to releasing this data mid-November.  But I highly doubt it will be 350,000 or more.

    House Oversight Committee Chairman Darrell Issa (R-Calif.) released documents on Thursday that show only a trickle of successful enrollments in the federal healthcare exchanges in the days after the ObamaCare website went live on Oct. 1.

    The documents show six enrollments on the morning of Oct. 2, 100 by that afternoon, and 248 on the morning of Oct. 3.

    The statistics are taken from the minutes of "War Room" meetings between Obama administration officials, ObamaCare contractors, and the Center for Medicare and Medicaid Services (CMS), the agency tasked with implementing the Affordable Care Act.

    Department of Health and Human Services (HHS) spokeswoman Joanne Peters sought to downplay the veracity of the data.

    "These appear to be notes, they do not include official enrollment statistics," she said in an email to The Hill. "We will release enrollment statistics on a monthly basis after coordinating information from different sources such as paper, on-line, and call centers, verifying with insurers, and collecting data from states."



    Oh good grief (5.00 / 1) (#94)
    by Ga6thDem on Fri Nov 01, 2013 at 06:42:28 AM EST
    Why the heck anybody listens to anything that comes from Daryl Issa's mouth is beyond me. He's a carnival barker in the circus.

    True enough and meaningless anyway (5.00 / 1) (#100)
    by CoralGables on Fri Nov 01, 2013 at 07:21:19 AM EST
    The vast majority of people that currently carry no insurance will wait until March to buy. No different than the people that owe taxes wait until April 15 to file.

    Until then any numbers are nothing more than headline fodder and blog bickery.


    It's not just (5.00 / 1) (#103)
    by jbindc on Fri Nov 01, 2013 at 08:13:44 AM EST
    "people who carry no insurance".

    Well, (none / 0) (#95)
    by jbindc on Fri Nov 01, 2013 at 06:49:54 AM EST
    It's not really "his mouth" - it's in documents produced by the administration.

    You don't (none / 0) (#96)
    by Ga6thDem on Fri Nov 01, 2013 at 06:58:29 AM EST
    think that Issa would selectively leak documents this time like he has in the past? I do.

    I think it doesn't matter (none / 0) (#98)
    by jbindc on Fri Nov 01, 2013 at 07:09:04 AM EST
    The administration says it will have numbers min-November.  By the same token, I don't expect to fully believe their numbers either - they are in the middle of a $h!t storm right now and they will do anything they can to downplay bad news and will skew stats just to inflate good news.

    But I just posted a graph that gives more information about who is actually enrolled against the White House goals for 10/31.  It still doesn't look good.

    I believe Darrell Issa as much as I believe Jay Carney, Kathleen Sebelius, or Barack Obama on this matter.


    Well (none / 0) (#116)
    by Ga6thDem on Fri Nov 01, 2013 at 08:57:59 AM EST
    then why are you putting up something from Issa as if it's worthy of discussion? I mean if you yourself is saying you don't believe it.

    Issa is my guy (none / 0) (#141)
    by MKS on Fri Nov 01, 2013 at 09:53:15 AM EST
    and I even got a nice letter from him for calling his office....

    But, really, he is just melon-shooter Dan Burton's cousin....


    Actually (none / 0) (#182)
    by jbindc on Fri Nov 01, 2013 at 11:28:19 AM EST
    What I'm saying that Issa is putting out the administration's own words - one that I actually believe are true in this instance because they really wouldn't it out.

    I don't run screaming with my hair on fire just because of who "says" something - I like to look a little deeper - for example, at the source of the information.


    More (none / 0) (#97)
    by jbindc on Fri Nov 01, 2013 at 06:59:23 AM EST
    Level of resolution (none / 0) (#143)
    by ragebot on Fri Nov 01, 2013 at 09:59:07 AM EST
    is not sufficient to determine anything because it lumps private plans and Medicaid together.  The only way Obamacare will survive if enough folks enroll in private plans to support subsidies for those who qualify for them.  If folks qualify for Medicaid this will require higher taxes for that system to survive.

    It is necessary to know the mix of folks who are getting subsidies and those who are not to determine anything.


    CBS News video this morning Nov. 1 (5.00 / 1) (#136)
    by Edger on Fri Nov 01, 2013 at 09:45:59 AM EST
    Obamacare: 6 people successfully signed up on day one of rollout
    According to government documents turned over to Congress, there were only six health insurance enrollments on the first day of Obamacare. "CBS This Morning" national correspondent Jan Crawford met with one man who was able to enroll, and takes a look back at the first month of HealthCare.gov.

    You do realize that will change? (5.00 / 1) (#139)
    by MKS on Fri Nov 01, 2013 at 09:51:32 AM EST
    The Republicans know that the website will be up and running at some point.

    But they do get some anti-government jollies over the website issues....But that is temporary.

    The Republicans have moved on to different criticisms because they know putting all their eggs in the website basket is a sure loser.

    Jan Crawford is a Republican shill.

    As to those of you who advocate single payer, how is focusing on website issues going to matter?


    That will change? (5.00 / 1) (#148)
    by Edger on Fri Nov 01, 2013 at 10:06:56 AM EST
    You mean next week obama will announce with a big grin that 6 million people signed up on day one of the rollout because the plan is so awesome, and obots will spread the glowing report all over the web?

    You may be right.

    That wouldn't surprise me.


    You sound like Fox news (none / 0) (#149)
    by MKS on Fri Nov 01, 2013 at 10:09:17 AM EST
    My Mom always said the far right and the far left are so far around the bend they actually meet.

    This (5.00 / 1) (#165)
    by lentinel on Fri Nov 01, 2013 at 10:47:48 AM EST
    is not a case of right or left.

    It is a question of whether this tangled mess can provide universal health care. It is also a question of whether it will hit middle income Americans disproportionately, imo.

    There is no doubt in my mind that Obama abandoned more equitable and workable solutions that involve the taint of socialism - in order to genuflect in the direction of his corporate sponsors.

    And we are the ones who suffer.

    It is a scandal the way we are forced to give elected officials all the care in world, and we get the dregs.

    The message, that at least we got something and that we should try to improve it rather than toss it, is alluring...but it is similar to saying we should vote for candidate A over candidate B because one is only mildly evil while the other is a raving lunatic.

    We deserve better - but as long as gigantic corporations are allowed to control media and both political parties, we will continue to get stuck in swamps like this.


    I am curious though (none / 0) (#163)
    by Edger on Fri Nov 01, 2013 at 10:45:23 AM EST
    how you saying "Jan Crawford is a Republican shill" changes the number 6.

    Could you explain how that works? Is it obamalogic or something? Eleven dimensional?


    I (5.00 / 1) (#166)
    by lentinel on Fri Nov 01, 2013 at 10:48:50 AM EST
    prefer Joan Crawford to Jan.

    The number 6 is irrelevant (none / 0) (#169)
    by MKS on Fri Nov 01, 2013 at 10:51:49 AM EST
    Under any view.  It is dated information.

    And, it does not tell the whole story.


    So you saying that (5.00 / 1) (#179)
    by Edger on Fri Nov 01, 2013 at 11:10:36 AM EST
    doesn't change the number?

    You just felt the need to change the subject quickly? Well, that I certainly understand. If I were you I would too.


    No, I responded directly (none / 0) (#190)
    by MKS on Fri Nov 01, 2013 at 11:49:05 AM EST
    to your point.  I never said 6 was an incorrect number for what it purported to represent.

    It is irrelevant because it does not measure anything meaningful.

    Cherry picking outdated but truthful facts can be misleading.  That is what happened here.


    I would simply suggest.... (5.00 / 2) (#150)
    by Dadler on Fri Nov 01, 2013 at 10:14:13 AM EST
    ...that sans sabotage, the incompetence that went into allowing this site to operate when it had so many problems is more evidence that, sigh, regular working people aren't worth the effort. Why couldn't this administration simply say the system has too many glitches, we need to work them out, the deadline is extended, and if you have a medical emergency in the meantime, we will pick up the tab."
    Hey, Republicans may have a big political boner on that one, scream and rant about socialism, but then you simply hit them with the, "So you are arguing that money matters more than people, why do you think that's a good thing? And where do you think money comes from, some currency fairy, it comes from the federal government, constitutionally so. Now, offer your rebuttal about how people should suffer because of an inanimate object that we control entirely. Tell me again why money matters more than people. Why humans should be enslaved by their own creation."

    My bugaboo again, an utter lack of imagination. But am I surprised? No. There isn't a lick of political imagination left in this country, we're back to a new gilded age, and Big Money is our government, they control it all.

    Sad state of affairs, but that said, I hope I am wrong and that the ACA is a wild success. Count me simply as dubious since it upholds, and provides tens of millions of new customers for, the FOR PROFIT insurance industry which, by its very nature, needs to focus on profit first, care second. And also count me as dubious that a government that doesn't give a sh*t about ordinary people, did next to nothing for them in the Great Real Estate and Financial Scam, and, to beat a dead rhetorical horse, will have to commit MASSIVE resources to ensure that insurance companies aren't screwing people. I just can't see it. And this is the result of Obama having no balls, having no desire to fight for or sell a public option. And he was a moron to do so.

    But this law is here, we are now ALL beholden to insurance company profits, and that is just the reality. IMO, the less fortunate, the working class, the working poor, will get what poor people always do when the government won't really fight for them -- sh*t.

    And it is precisely this kind of debate, this kind of dissatisfaction, this kind of noise from the phucked over public, and only this, that could possibly allow the ACA to evolve into single-payer. Bur when this administration can't be bothered to be competent in rolling out this program, come on, it's just inexcusable. And disrespectful, and a political mess of still unknown effect.

    I'm sure you disagree. Such is a free country. Peace.


    We humans (5.00 / 1) (#157)
    by MKS on Fri Nov 01, 2013 at 10:31:32 AM EST
    live in a binary world.  A fact of evolutionary biology, I suppose.  All computer code as I understand it is a series of binary decisions:  0 or 1.

    I am all for nuance and imagination. Politics is not about imagination.  Politics is about the crude use of hammers.

    The dreamers can motivate....and set out long term agendas.....but brass tacks time...it generally comes down to a binary choice.

    Right now, the ACA is the government's foray into health care.  If that completely fails, then any shot at further government involvement or control over health care will be set back generations.

    Delaying things, just assures failure of the ACA.  We are halfway across the river.  Turn back now, and there is no getting across for a long, long time. Conservatives know this.  This is why they favor a delay.

    The stakes now are huge.  If the ACA succeeds even in part, the conservatives will be shattered.  There are a lot of progressive opportunities that can come from that.  Including a public option in 2017. If the ACA is withdrawn or postponed, then the Republicans and President Christie will solve the problem by getting rid of insurance regulations.....

    The current fight is the whole she-bang...Winner take all.



    The ACA is really the government's (5.00 / 2) (#188)
    by Anne on Fri Nov 01, 2013 at 11:46:52 AM EST
    foray into health insurance, not health care, which is part of the problem.

    We took a dysfunctional, broken system that was serving as a barrier to care for millions of people, and decided that what would fix it, make it function better, is if more people could buy health insurance.

    And while everyone agreed that the situation with getting access to affordable care was at the crisis stage, we decided we should put almost four years in between passage of the law and full implementation - perhaps I have a different take on the meaning of "crisis," but waiting four years, giving the industry that much lead time to pick the law apart to find as many holes it could exploit so they could maintain the model that has enriched it beyond comprehension didn't seem to me to be the best way to go about dealing with it.

    If what you are really concerned about is the health of the populace, that is.

    We mandated certain basic coverages that had to be included in policies obtained after March, 2010; these kinds of coverages would be a big help to those living in states still stuck in the 19th century or operating under the belief that health care is driven by religion and still not requiring insurance companies doing business in these states to include these coverages in policies written there.

    And therein lies part of the problem: a truly universal, single-payer system guarantees that if you find yourself living in a religious backwater controlled by fundamentalists, or live in a state controlled by people who think its residents are there to serve the corporations doing business there, and you want birth control or an abortion, or you think it's unsafe to boot new mothers out of the hospital less than 24 hours after delivering, or you need mental health care (and you would if you lived in one of these states), you can.

    [I can't wait to see the stats on which states have the highest numbers of policies being discontinued because they don't meet ACA standards.]

    If the ACA succeeds, one of its consequences will be to serve as a model for how these same conservatives can restructure the social safety net:

    Konczal's second point is even more important -- the worst features of Obamacare are the very features that conservatives want to impose on all federal social policy: means-testing, a major role for the states, and subsidies to private providers instead of direct public provision of health or retirement benefits.   This is not surprising, because Obamacare's models are right-wing models -- the Heritage Foundation's healthcare plan in the 1990s and Mitt Romney's "Romneycare" in Massachusetts.

    This point is worth dwelling on. Conservatives want all social insurance to look like Obamacare.  The radical right would like to replace Social Security with an Obamacare-like system, in which mandates or incentives pressure Americans to steer money into tax-favored savings accounts like 401(k)s and to purchase annuities at retirement, with means-tested subsidies to help the poor make their private purchases.  And most conservative and libertarian plans for healthcare for the elderly involve replacing Medicare with a totally new system designed along the lines of Obamacare, with similar mandates or incentives to compel the elderly to buy private health insurance from for-profit corporations.

    Can't speak for you, but that gives me the willies.

    Public option?  If one is proposed, expect the insurance companies to insist that the mandate of guaranteed issue be eliminated; they would be happy to continue to exist with only the healthiest people in their pool, and everyone else shunted off to the public option.  If you want to deepen the divide between the healthy/wealthy and everyone else, tacking a "public option" onto this still-dysfunctional system is just the ticket.

    I'll leave you with this:
    Amy Goodman writes:

    The fundamental issue, at the core of the health-care dispute, is typically ignored and goes unreported: The for-profit health-insurance industry in the United States is profoundly inefficient and costly, and a sane and sustainable alternative exists--single-payer, otherwise known as expanded and improved Medicare for all. Just change the age of eligibility from 65 to zero.

    "When Medicare was rolled out in 1966, it was rolled out in six months using index cards," Dr. Steffie Woolhandler told me Monday. "So if you have a simple system, you do not have to have all this expense and all this complexity and work." Woolhandler is professor of public health at CUNY-Hunter College and a primary-care physician. She is a visiting professor at Harvard Medical School and the co-founder of Physicians for a National Health Program, or PNHP. PNHP is an organization with 17,000 physicians as members, advocating for a single-payer health-care system in the U.S.

    Oh, and we could move to Vermont, which plans to have a single-payer system in place by 2017.


    Yes, I understand (none / 0) (#192)
    by MKS on Fri Nov 01, 2013 at 11:53:47 AM EST
    that you prefer single payer.  Got it. Got it a long time ago.

    What is your solution?

    The only solution I have heard you say is move to Vermont....So, no real solution.

    Just complaints....more complaints.....Just throwing stones....No solutions....No fixes....

    Must be nice in a way to just criticize.....


    Oy (5.00 / 3) (#211)
    by sj on Fri Nov 01, 2013 at 01:00:19 PM EST
    Yes, I understand (none / 0) (#192)
    by MKS on Fri Nov 01, 2013 at 10:53:47 AM MDT

    that you prefer single payer.  Got it. Got it a long time ago.

    What is your solution?

     The only solution I have heard you say is move to Vermont....So, no real solution.

     Just complaints....more complaints.....Just throwing stones....No solutions....No fixes....

     Must be nice in a way to just criticize.....

    Can anyone say "lacks self-awareness"?

    Oh, and this orphaned comment belongs around here somewhere.


    In late breaking news (none / 0) (#161)
    by ragebot on Fri Nov 01, 2013 at 10:38:17 AM EST
    Mugabe has been nominated for the Nobel prize in economics.

    More food for my doubts (none / 0) (#186)
    by Dadler on Fri Nov 01, 2013 at 11:43:21 AM EST
    Harsh Food Stamp cuts hit 1 in 7 Americans today, as the government, once again, proves clearly that they essentially don't give a sh*t if they cull a decent number of "bottom dwellers." Wretched. With a Repub party crazy as a bag of jumping beans, and the Dems equally corrupt financially and, thus, incapable of using whatever imagination they have, with both of these parties atrophied and all but useless, it seems a big fat bowl of rebellion, in whatever form that takes, is going to have to happen before average people are treated with humanity and respect. Unless, of course, we are content comparing ourselves to Russian, Iran, China, Nigeria, all those bastions of freedom.

    Oops, forgot the link (none / 0) (#187)
    by Dadler on Fri Nov 01, 2013 at 11:44:58 AM EST
    Was wondering if it was only me that thought this (none / 0) (#170)
    by vicndabx on Fri Nov 01, 2013 at 10:51:56 AM EST
    Jan Crawford is a Republican shill.

    I always thought CBS was the last reputable network news organization.  Not anymore.


    She was a big Romney (none / 0) (#173)
    by MKS on Fri Nov 01, 2013 at 10:57:33 AM EST

    I know (5.00 / 2) (#159)
    by lentinel on Fri Nov 01, 2013 at 10:36:30 AM EST
    several people living in France.

    Everyone has basic coverage.
    It is a right.

    There is a scale of payment based on income.
    But no one is denied coverage regardless of income or lack of it. Many pay absolutely nothing for their coverage.

    People can supplement their coverage from "Mutuels".
    But even those companies do not gouge the way American companies do, and it is not necessary to purchase additional insurance if you do not wish to.

    In addition, medicines are extremely cheap. Generics are reimbursed 100%. Often, they don't pay anything to the pharmacy. They just have to show their medical card.

    Why Obama and Co. chose to go an unproven and fkdup route instead of following the lead of other "developed" countries is a sad commentary on the grip that medical care for profit has upon us.

    It's also a sad commentary (5.00 / 3) (#213)
    by sj on Fri Nov 01, 2013 at 03:09:41 PM EST
    on how "Socialism!" has been demonized and "Capitalism!" has been deified. I personally wish we could do away with the "-isms" and resolve each issue in that way that makes the most sense for that particular issue.

    But if we didn't have "-isms" however could we feel better than someone else?


    In other Obamacare news (5.00 / 1) (#191)
    by jbindc on Fri Nov 01, 2013 at 11:51:34 AM EST
    Horrid and wrong (3.00 / 2) (#195)
    by MKS on Fri Nov 01, 2013 at 12:01:43 PM EST

    I assume you are cheering it.

    It is authored by one of the most extreme ideologues around.

    If you engage in commerce, you are not exercising religious freedom.  


    I hope you aren't a betting man (5.00 / 1) (#199)
    by jbindc on Fri Nov 01, 2013 at 12:19:48 PM EST
    I assume you are cheering it.

    You know what they say about assuming.  Except, in this case, it really only makes an a$$ out of one of us.

    And it isn't me.


    LOL... (5.00 / 1) (#202)
    by masslib on Fri Nov 01, 2013 at 12:21:30 PM EST
    I don't know why Democrats thought passing the Republican alternative to Clinton Care was a winning idea.  So out of touch.  Now maybe, but probably not, some clever Democrat will propose a public plan.  Sigh.

    Welcome back masslib! (none / 0) (#204)
    by jbindc on Fri Nov 01, 2013 at 12:23:27 PM EST
    You are as incapable as jim (5.00 / 1) (#210)
    by sj on Fri Nov 01, 2013 at 12:45:14 PM EST
    at integrating any new thoughts or ideas that may conflict even slightly with your pre-existing opinions. All you ever have to offer is the same thing that you started out with. While you twist yourself into a pretzel patting yourself on your own back because of your "substantive" one-liners.

    It would be funny if the subject wasn't so serious.

    Of course, the real problem is ... (4.75 / 4) (#6)
    by Robot Porter on Thu Oct 31, 2013 at 01:57:40 PM EST
    that Dems now work for the banks and insurance companies.

    And they did good for their bosses.

    For this reason, of course, they also wouldn't even entertain Medicare for All.  Despite the fact that in poll after poll, over the 15 years preceding the ACA debate, it had around 70% support.

    But who needs 70% of the public when you got the banks and insurance companies behind you?  Dems chose to trade in "the rabble" for "the smartest guys in the room".  

    Happy Days are Here Again!


    The real problem is (none / 0) (#18)
    by ragebot on Thu Oct 31, 2013 at 03:36:47 PM EST
    The bill passed by congress was over 1,500 pages long.  Wait a second peeps can not even agree on how long it is.  I have seen claims that it is only 947 pages long, like that really makes things better.  To make matters worse almost no one has completely read the bill less yet understands what is in it.

    I am not sure who is most opposed to a single payer system.  Certainly the unions deserve consideration since they were one of the first groups to be exempt from Obamcare.  But with well over 1,000 exemptions so far the unions are certainly not alone in opposing single payer.  But I have to give congress the title for being most opposed to single payer since they will obviously not be covered by single payer.

    There is also the issue of real problems with how the bill is written.  If you are not up to speed on King v Sebelius of Halbig v Sebelius you need to be.

    How many of you could write a 1,500 page post with no mistakes?


    This surprised me (5.00 / 3) (#32)
    by sj on Thu Oct 31, 2013 at 04:12:24 PM EST
    I am not sure who is most opposed to a single payer system.  Certainly the unions deserve consideration since they were one of the first groups to be exempt from Obamcare.  But with well over 1,000 exemptions so far the unions are certainly not alone in opposing single. payer
    I think you have drastically misunderstood.

    Unions, by and large, are not opposed to single payer.

    Unions, by and large, are opposed to the ACA.

    As to your question

    How many of you could write a 1,500 page post with no mistakes?
    I would like to point out how easy it is to make mistakes with less than 1500 characters. (And, yes, I, too, have made some bloopers in my time).

    Obama, (none / 0) (#66)
    by lentinel on Thu Oct 31, 2013 at 08:01:04 PM EST
    in the campaign of 2000, definitively proclaimed that he "never" said that we should "go ahead" and get single payer.

    So, yeah.

    Bravo Barry.


    What?!? (none / 0) (#69)
    by Yman on Thu Oct 31, 2013 at 08:39:16 PM EST
    I am not sure who is most opposed to a single payer system.  Certainly the unions deserve consideration since they were one of the first groups to be exempt from Obamcare.  But with well over 1,000 exemptions so far the unions are certainly not alone in opposing single payer.  But I have to give congress the title for being most opposed to single payer since they will obviously not be covered by single payer.

    1.  Obamacare/ACA is not single-payer.
    2.  The unions are not exempt from Obamacare.  If they applied for a temporary waiver, they likely received a temporary waiver until the end of 2013.  Of course 2/3 of the waivers were granted to non-union applicants, mostly companies that employed low-wage workers with crappy mini-med plans.
    3.  Congress will not be covered by single-payer - neither will anyone else (unless they're on Medicare).  If you meant to claim that Congress was exempt from ACA/Obamacare, you would also be wrong.

    Well, I don't have to read thousands of (none / 0) (#73)
    by Anne on Thu Oct 31, 2013 at 09:21:31 PM EST
    pages to know something you apparently don't - that the ACA is NOT single-payer.

    Medicare is single-payer.  The VA Health System is single-payer.

    The ACA is built on the private insurance system.  The exchanges are for the purpose of vetting people for subsidies, and with the exception of those who will qualify for Medicaid - also a single-payer entity - everyone else obtaining insurance through a federal or state exchange is buying private insurance.


    You should read (none / 0) (#137)
    by ragebot on Fri Nov 01, 2013 at 09:49:46 AM EST
    the parent comment I was responding to which was about Medicare/Medicaid for all which is a single payer system.

    Here's at least one of the problems: (4.75 / 4) (#8)
    by Anne on Thu Oct 31, 2013 at 02:36:56 PM EST
    I don't think conservative Democrats see any problems, beyond the initial technological problems, and if they do, it is likely these aren't the same problems the rest of us see.  The problems they'd fix are the ones where they were forced to include regulations or provisions they didn't really want to include.

    If given the change to "fix"the ACA, they'd likely do what they did to Dodd-Frank: gut it, hollow it out, but still claim we "reformed" a broken system.

    Here's another problem: it is wrong to assume that the only kinds of insurance policies purchased on the individual market are junk; there are plenty of people with good policies, good coverage, with manageable premiums.  I am one of them, and so is my son-in-law, but I get to keep mine because it pre-dates the March 2010 grandfather cut-off, and he doesn't because he's only had it for about six months.  

    An associated problem is that it is kind of offensive for people like Pareene to cast individual plan subscribers as too dumb to know their existing policies are junk.  Unless all these individual plan-owners have never used their insurance, and are just complaining because, well, OBAMA! chances are most of them have actually used their coverage and know they are being forced to give up something they do like, with providers they like, for policies that may not allow them to see those same providers because the networks are so narrow.

    Finally - at least for the moment - it isn't just conservative Democrats that created this problem; the people who elected these conservative Democrats are part of this, too.  I'm not sure there will ever come a day when true liberal/progressive Dems outnumber the conservative ones, but that doesn't mean serious efforts should not be made to increase their numbers as much as possible.  I think there's a real possibility that on the issues of health care and privacy, Dems - the liberal kind (or at least the kind who are definitely left of center) - have a real opportunity to wedge conservative Dems out of the equation.

    Agreed (5.00 / 2) (#26)
    by TeresaInSnow2 on Thu Oct 31, 2013 at 03:57:47 PM EST

    The reason many of the plans were cancelled is because some of the "essential requirements" are onerous for people in the individual market. Thus, until required, they made no sense to have.

    People on the individual health market have to carve out affordability niches, the same way that people who own homes have to carve insurance niches.  I always use the analogy that these onerous Obamacare plans are the equivalent of making every person in the country carry homeowners insurance for every possible catastrophe that anybody in the whole country would encounter.  But why not have "essential benefits" for homeowners if we have them for health insurance.  Because people would be outraged if they had to carry such coverage.  It would be UNFAIR, they would probably say.  The coverage would be too expensive, and if it wasn't too expensive, it would do a lousy job of covering everything.

    And that is what has happened with Obamacare.  It is either too expensive or it covers things poorly.

    Take my husband's plan.  The premiums are $1200/yr more expensive starting in 2014.  The deductible will double from $2500 to $5000.  And the 4 up-front visits at $35 copay and lab care he had were taken away.  And I won't talk about my coverage because the changes are more complicated but it's similar.

    But husband's plan now covers maternity -- at these costly levels, of course.  He is a 50 year old man who has never had kids.  It covers chemical dependency.  He doesn't drink.  It covers pediatric dental.  He has no kids.

    Unlike all the years prior to now, husband will see absolutely not a dime of money from this plan he pays into and nor will most anyone else on this plan unless they have to do a hospital stay, or get pregnant.

    His plan has become junk insurance -- because of the "essential benefits".  

    Covering everything while keeping premiums affordable means poor coverage -- of everything.

    And don't get me started on the Exchange plans.  They provide a quasi-Medicaid level of access, a hobbled doctor network.  Doctors can't even give you the straight scoop on whether they accept the plans or not.  (I'd hate to live in California where the gerrymandering of doctor networks is obscene.)  And if a patient stumbles into an out of network hospital while sick, their costs are unlimited.  Unlimited!!.  That whole out of pocket cap idea doesn't apply to doctors and hospitals that are out of network, meaning they don't have a contract with the insurer.  This is because of the concept of balance billing which applies to emergency and non-emergency care.  

    And when the networks are thin, the opportunity to encounter out of network docs and balance billing is huge.  Almost all Exchange plans nationwide have thin networks.  For some, the doctor coverage is only about 35%. For others, people have to drive 25 miles to go to a hospital.  

    And it would be so nice if our good politicians on either the left or right side of the aisle would warn us about the huge financial hazards of narrow networks.  They choose not to, because their politics is more important to them than HUMAN BEINGS ARE.

    The only kind of health care system that our nation has any business mandating is a national health care system, where we all share the burden and the wealth.  It is HIDEOUS to take away people's ability to literally SURVIVE in this market by carving an affordable niche in their health care.  But the Democrat did it. They own it.  For however long it survives.  And I hope it destroys them.


    I don't have high blood pressure. (5.00 / 2) (#41)
    by MO Blue on Thu Oct 31, 2013 at 05:03:56 PM EST
    Should health insurance policies be exempt from covering that medical condition? I don't have diabetes. Should health insurance policies be exempt from covering that medical condition? I probably won't have prostrate cancer. Maybe policies should not be required to cover that illness. Men rarely get breast cancer. Should health insurance policies be exempt from covering that medical condition?

    I am against a private insurance based system but if we are stuck with a private insurance system I don't think a basic policy should be structured to only cover those illnesses that every individual will encounter during their lifetime.

    I think you have a very valid point when it comes to provider networks but I don't agree that we should eliminate the need for policies to provide coverage for medical treatment or we will soon find that the insurance industry will find more and more reasons not to pay for actual care.


    Bravo (none / 0) (#30)
    by Slado on Thu Oct 31, 2013 at 04:06:09 PM EST
    Before ACA people could buy what they needed and take the risk that they saw fit.   They could choose to pay all out of pocket expenses.   They could choose to pay a higher deductible.

    Simply put, they could think for themselves and choose.  Did some people screw this up?  Of course.   But most didn't.

    To make insurance affordable for all (on paper anyway, it's not going to work so why bother discussing it) the president and the authors of this bill had to bring people like Anne's husband into the fold.  These cowboys living in the "Wild West" after all.

    Rather then simply taxing them they decided to force them into the system by taking away their ability to choose for themselves.

    Now they try and dismiss these people's plans as "junk" as if we're too stupid to notice.

    Problem is we're talking about millions of people who we all know.    All walks of life, all forms of politics.  It's not hard to realize very quickly that calling these plans "junk" is a lie and a very stupid one.

    They told this lie because if they hadn't the plan wouldn't have passed.  It was the world worst kept secret because many warned about this but they were shouted down by the repeated lie told by Obama and all the laws supporters.


    About 3% of the people (none / 0) (#46)
    by MKS on Thu Oct 31, 2013 at 06:22:31 PM EST
    About 5% (none / 0) (#91)
    by jbindc on Fri Nov 01, 2013 at 06:18:30 AM EST
    or 14 million people or so.

    For comparison, Obama's margin of victory over Romney was just over 4% and 5 million people.

    Guess the Obama team thought that small margin was pretty important then, but now that's just a number of people that's easy to dismiss.


    That 3% (none / 0) (#106)
    by MKS on Fri Nov 01, 2013 at 08:31:01 AM EST
    at the end of the day will still have coverage.

    Those who are uninsured go from no coverage to coverage.  

    So, the downside for the 3% is paying more in some instances, as compared to the downside for about 14% is no coverage at all....

    If you are looking at the greater good....


    At the end of the day, (none / 0) (#120)
    by MO Blue on Fri Nov 01, 2013 at 09:06:39 AM EST
    the CBO estimates that after full implementation 31 million will go from no coverage to no coverage.

    A widely circulated CBO report from last summer said the "ACA, in comparison with prior law before the enactment of the ACA, will reduce the number of nonelderly people without health insurance coverage by 14 million in 2014 and by 29 million or 30 million in the latter part of the coming decade, leaving 30 million nonelderly residents uninsured by the end of the period."

    The number was revised upward to 31 million in May 2013.

    In our current projections for 2023, the ACA reduces the number of people without health insurance by 25 million, leaving 31 million uninsured (compared with 30 million in our February estimate)."

    So while "some" will benefit from coverage and others who get insurance will pay more for less or not be able to afford care even with insurance there will still be millions more without coverage at all.

    Bottom line ACA can best be described as a somewhat better than nothing attempt to address the health care needs of this nation. Unfortunately people in the U.S. have been programmed to not only accept but be grateful for "better than nothing."

    The meme now by many seems to be hush now do not advocate for anything better because better than nothing is after all better than nothing and if we ask for something as good as the rest of the civilized world we might lose even the little that some people have gained.  



    This (5.00 / 1) (#183)
    by sj on Fri Nov 01, 2013 at 11:31:38 AM EST
    The meme now by many seems to be hush now do not advocate for anything better because better than nothing is after all better than nothing and if we ask for something as good as the rest of the civilized world we might lose even the little that some people have gained.
    is just talking about a hypothetical.

    And don't aspire for anything better because "Shut up!"

    Or was it "That's not the topic!"?

    It's something like that.


    Confused by your comment to me (none / 0) (#189)
    by MO Blue on Fri Nov 01, 2013 at 11:47:13 AM EST
    MKS and others have implied numerous times that criticizing ACA and advocating for something better should be discouraged because speaking about the faults of the program will result in losing the ACA system. To criticize ACA (or any other Obama conservative policy) not only makes you a conservative but liken to Cruz.

    Evidently I do not agree with the "Shut up and cheer!" proponents any more than I agree with the better than nothing system that is Obamacare.


    Sorry (none / 0) (#207)
    by sj on Fri Nov 01, 2013 at 12:31:51 PM EST
    I didn't mean to confuse you. The comment had a level of indirection that wasn't clear.

    I was frustrated by exactly the same things you are and I should have added a snark tag.


    When single payer (none / 0) (#126)
    by MKS on Fri Nov 01, 2013 at 09:15:41 AM EST
    is up for a vote, let me know.

    When something better is up for a vote, let me know.


    How can it? (5.00 / 1) (#206)
    by sj on Fri Nov 01, 2013 at 12:29:11 PM EST
    When single payer (none / 0) (#126)
    by MKS on Fri Nov 01, 2013 at 08:15:41 AM MDT

    is up for a vote, let me know.

    When something better is up for a vote, let me know.

    How will it ever come up for a vote when people like you are shouting down anyone who advocates for or even mentions it. What hypocrisy there is in this comment.

    Or, more specifically (none / 0) (#128)
    by MKS on Fri Nov 01, 2013 at 09:20:47 AM EST
    where can I enroll in single payer in December 2013?

    Show me a better plan I can enroll in next month.

    One unfortunate characteristic of conservatives is the willingness to sacrifice real people on the alter of abstract principles.


    So you admit to being conservative (5.00 / 1) (#138)
    by MO Blue on Fri Nov 01, 2013 at 09:51:19 AM EST
    since you are evidently willing to sacrifice 31+  million real people as long as you are able to maintain a better than nothing conservative health insurance system now and in the future.

    You, as a conservative, are willing for each and every citizen (not among the uninsured - 31 million real people) to pay more for insurance each and every year than the rest of the civilized world pays for actual health care. You, as a conservative, are willing for your fellow citizens with high priced insurance to pay 35% - 50% more for prescription drugs than people without insurance in other countries pay for the same drugs. You are willing to maintain this overpriced dysfunctional private insurance system now and in the future so that we can continue to fill the coffers the health insurance industry at the expense of people who need actual health care. That sounds like the whole basis for a conservative ideology to me.

    The whole point of the article that BTD posted was that it is time NOW for people to advocate for a good system rather than be grateful for this less than adequate system that will get much, much worse unless people are willing to start working for something better now. From the quotes in the post:

    Democrats who aren't Obama should already be working on easy-to-grasp proposals to "reform" the ACA -- to make it more public and less private. The immediate priority -- and progressives running for office in 2014 and 2016 should practice saying this out loud -- is fixing Obamacare. Not just the website, but the coverage gaps, the ways insurance companies will continue to exploit people and rip them off, and the potential for the cost burden on middle class people to grow.

    Many strawmen (none / 0) (#147)
    by MKS on Fri Nov 01, 2013 at 10:06:42 AM EST
    make one big pile of....er, hay....

    Of course, I said nothing of the kind.

    For the 31 million who in ten years will be uninsured, are they ineligible for coverage under the ACA?  Or, just un-enrolled?  I understand everyone to be eligible.

    Perhaps better enrollment efforts is a good idea.  

    And, I would support an effort to graft on a public option.  The best shot at doing so is to have Hillary working with a Dem Congress do that in 2017.  

    And maybe over time, the public option would crowd out the private insurers....I am all for that....I do not brook any brief for insurance carriers....They are vultures and I have spent a portion of my professional life suing them and opposing their cut-rate counsel.....

    But running down the ACA will not get you anything positive right now.  


    Well you set up the so called (5.00 / 1) (#155)
    by MO Blue on Fri Nov 01, 2013 at 10:22:40 AM EST
    conservative straw man and now are complaining when it is point out that by your own criteria you fit that mold better those you accused of being conservative.

    I have no idea what (none / 0) (#162)
    by MKS on Fri Nov 01, 2013 at 10:38:57 AM EST
    you are talking about.

    MKS (none / 0) (#154)
    by CoralGables on Fri Nov 01, 2013 at 10:22:11 AM EST
    there are people that would qualify for Medicaid but won't have coverage because some States opted out after the Supreme Court gave them the option to expand.

    That will account for a chunk. On the upside that's more federal dollars going to states that look after their residents. The downside of course, a batch of states with Republican Governors that will have less well off residents.


    Even before the Supreme Court rulling (none / 0) (#158)
    by MO Blue on Fri Nov 01, 2013 at 10:34:06 AM EST
    when the government expected full Medicaid implementation the program was only budgeted to cover around 30 million people. I believed the number was reduced downward a little even before the Medicaid ruling. It never provided universal coverage.

    Show me (none / 0) (#168)
    by MKS on Fri Nov 01, 2013 at 10:50:20 AM EST
    one reform, just one, that is being advocated here.

    No fixes, just complaints.....

    The paragraph about reforms of ACA is just window dressing.  No one here takes that seriously.

    Show me the proposed fixes.


    No, according to these own numbers (none / 0) (#129)
    by MKS on Fri Nov 01, 2013 at 09:25:47 AM EST
    the number of the uninsured will be cut in half:  31 million will be uninsured and 31 million gain coverage insured--ten years out.

    It is not just shuffling 31 million people around, or adding 31 million and dropping another 31 million.

    The uninsured  will be in half by the numbers you cite.  


    Once again you are resorting to (5.00 / 1) (#146)
    by MO Blue on Fri Nov 01, 2013 at 10:05:04 AM EST
    being grateful for anything that is better than nothing. Rah, Rah, Rah

    There is no fcking reason for the U.S. not to have universal, affordable health CARE other than the fact that our government (Republican and Democratic Parties alike) are in the pocket of the health care industry, especially insurance industry and pharma. We wouldn't have to have a system that ignores the health care needs of 31+ million people.

    In case you missed it the provisions in ACA were written by and for these industries. Back room deals were made all along the way with Baucus actually sending his final draft proposal over to K street for approval.

    I guess you would rather pay for record profits and multi-million dollar salaries for this private system then have universal health care coverage.


    Strawman (none / 0) (#151)
    by MKS on Fri Nov 01, 2013 at 10:18:27 AM EST
    I favor single payer. Given my druthers I might even opt for true UK socialized medicine.  But that is not the real world.  

    You can disparage my efforts to obtain coverage under the current system and the real world.  

    The true facts are that no major Democratic Presidential candidate has ever advocated single payer for all.  Not one.  Not even Hillary.

    And, the only realistic path to single payer is an incremental approach that adds a public option.  An unsuccessful ACA will not lead to single payer.  The lesson that would be learned in that event is that "government" or "top down" approaches do not work.

    Advocates for single payer should hope that this current version of health coverage works at least in part.  The alternative is nothing.....  


    It is your straw man (5.00 / 1) (#156)
    by MO Blue on Fri Nov 01, 2013 at 10:26:59 AM EST
    You chose to build it. So own it.

    What was being disparaged was your willingness to gratefully accept a dysfunctional system and your willingness hush others who advocate for something that would actually provide universal affordable health care.


    Disparage my willingness (none / 0) (#160)
    by MKS on Fri Nov 01, 2013 at 10:38:05 AM EST
    to gratefully accept??....

    So, yes, you do disparage my efforts to obtain coverage....

    Your approach is the liberal version of Ted Cruz.  Lots of noise, accomplish nothing, and set back the effort.....


    No that is your straw man (5.00 / 1) (#171)
    by MO Blue on Fri Nov 01, 2013 at 10:52:03 AM EST
    I do not disparage your efforts to obtain coverage. I disparage your willingness to accept that so many others will not receive health care they need now that you got yours.

    Your version is more conservative than Ronmey and more in line with Paul Ryan. A lot more propping up dysfunctional private industries with government funds at the expense of the people who need services. You have accomplished a great deal with championing ACA. You have established that the conservative way to run any government service is though private industry. You have established that people need to pay more and more out of pocket so that they have skin in the game and won't get the health care they need. You have accepted that people should be penalized for have good health care coverage. You have set up scenarios where the insurance industry will have incentives to charge more and more in premiums for less and less actual care and the majority of people will have no recourse but to pay them what they demand.  


    I do not accept that others (none / 0) (#172)
    by MKS on Fri Nov 01, 2013 at 10:54:58 AM EST
    will not have coverage.

    I actually see a real way to improve on that.

    Your purity gets you nothing.


    Your anything is better than nothing (none / 0) (#181)
    by MO Blue on Fri Nov 01, 2013 at 11:19:00 AM EST
    gets a conservative, private insurance system that will provide less and less actual health care.

    Please link to one way that ACA has expanded on the number of people it will cover or the services it will provide since the law was passed. IOW how has the law been been improved. All changes to the program to date have made it less progressive.

    As like Dodd-Frank, more and more of those aspects that actually benefit people will continue to be chipped away until that better than nothing becomes so close to nothing that you will hardly tell the difference. The chipping away of the good progressive initiatives has already begun and rather than being a vehicle to expand Medicare to younger people it is being used to rationalize raising the age of Medicare and move older people into ACA.

    What you will get with your willing acceptance of this dysfunctional conservative system is not what you are envisioning. Accept right wing policies and agendas and all you get is more and more right wing policies and agendas.


    What is your solution? (none / 0) (#198)
    by MKS on Fri Nov 01, 2013 at 12:13:09 PM EST
    You can work to accomplish something positive. Or you can sit around and whine and complain.

    What is your solution?  Right now.  Not pie in the sky stuff. But real, now, concrete.

    All I see you do is work to defeat what is currently on the table.  


    I won't say they are dumb (none / 0) (#15)
    by ruffian on Thu Oct 31, 2013 at 03:25:16 PM EST
    but many of these people (fortunately for them) have not had to explore the boundaries of their current coverage. Even though they have used it and are happy with it so far, they don't realize they will be bankrupt with one major illness, or they can't imagine it ever happening to them. I think a good portion of them - at least the ones on my sister's FB page - are mostly the "complaining because, well, OBAMA! " variety.

    A huge boundary (5.00 / 1) (#35)
    by TeresaInSnow2 on Thu Oct 31, 2013 at 04:26:28 PM EST
    created by Exchange plans is that they have horrendous doctor networks.  People in Concord, NH will have to drive 25 miles to see an in-network hospital.  And the gerrymandering of networks in California is terrifying.  I'm so glad I don't live there.

    So if you want to talk about "boundaries" do some research on the subject of balance billing for out of network providers.  Put it in the context of networks that only cover about 35-50% of the doctors in an area, wherein the doctor networks are gerrymandered, and then we can have a conversation.

    Excruciating Boundaries = The life's blood of Exchange plans


    And also (4.00 / 2) (#24)
    by jbindc on Thu Oct 31, 2013 at 03:54:24 PM EST
    Not all these policies are "junk".  They are actually very good plans that may be missing one component.  Mine for example - has no maternity care, but it's a very comprehensive plan otherwise.

    And I am ticked that I will have to actually buy a lesser plan (with a smaller network and higher co-pays) if I want to keep approximately the same price (well, actually, a bit more expensive than I am paying now).


    Yeah but it's a "junk" policy (none / 0) (#27)
    by Slado on Thu Oct 31, 2013 at 03:58:19 PM EST
    Seems kind of silly to say that when faced with facts.

    True (none / 0) (#63)
    by Ga6thDem on Thu Oct 31, 2013 at 07:52:44 PM EST
    not all these policies are junk but realistically those of us who live in red states pretty much were forced to buy junk insurance on the individual market because honestly the cost for insurance is the same here in GA as it is in a lot of states with higher incomes than we have here in GA. I was paying $550 a month for a policy with no mental health, no maternity and a 10K deductible 8 years ago. I finally just let it go because what's the point of paying an insurance company 7K a year to basically negotiate a lower rate for you?

    You can do better negotiating for yourself (none / 0) (#70)
    by scribe on Thu Oct 31, 2013 at 08:51:45 PM EST
    and if that means paying cash and getting a better price for doing so, then that's the way to go.

    Unless and until someone can show me why paying the penalty is more expensive than buying insurance, I'm paying the penalty.


    show me how you "negotiate" the cost of (5.00 / 0) (#90)
    by cpinva on Fri Nov 01, 2013 at 06:07:28 AM EST
    medical care for a heart attack, a stroke or a broken arm/leg, and i'll be there with you.

    "Unless and until someone can show me why paying the penalty is more expensive than buying insurance, I'm paying the penalty."

    would you prefer being bankrupt, to actually having insurance? that would be the risk you run of paying the penalty. but hey, carry on. how many car engines have you destroyed, because not having the oil changed was "cheaper" than having it changed?


    But you pay the penalty (none / 0) (#72)
    by MKS on Thu Oct 31, 2013 at 09:12:44 PM EST
    plus you do not have insurance.

    It is not just comparing the amount of the penalty to the amount of the premium.


    This is (none / 0) (#93)
    by Ga6thDem on Fri Nov 01, 2013 at 06:35:25 AM EST
    true in some cases. I have found hospitals not very willing to negotiate though.

    Paying the fine is always going to be cheaper than buying insurance and I'm sure that's what a lot of people are going to do.


    Here's a problem (none / 0) (#19)
    by Slado on Thu Oct 31, 2013 at 03:38:47 PM EST
    All policy's have boundaries.

    Boundaries set by the insurer, the doctor you choose and the disease or sickness that you get.

    It's a question of do you trust an individual or the government to decide what's best for you.   If you favor progressive policies you might give the president a pass for his bold face lie because this new regulation will prevent "some" people from buying bad policies.

    Problem is it will also...as in Anne's example...prevent people from buying smart polices.

    To just dismiss this in the abstract reeks of heavy handed big government and quite frankly is the reason Obama is losing this battle politically.    

    Real people, with good policies, that they chose are being told they will lose them.

    This is just the tip of the iceberg.   Soon the stories will turn to the doctors and hospitals that will no longer take patients because they lost the policy they used to have.

    It's coming.  Just wait.


    About 3% (none / 0) (#42)
    by MKS on Thu Oct 31, 2013 at 06:04:51 PM EST
    will need to get new coverage.  How many of them will pay or get less coverage?

    Here is the (none / 0) (#43)
    by MKS on Thu Oct 31, 2013 at 06:08:28 PM EST
    3%?????????? (none / 0) (#77)
    by jimakaPPJ on Thu Oct 31, 2013 at 09:57:44 PM EST
    Try about 50%.

    Look, I'm glad you are being helped. But many others are being hurt.


    Wrong again, Jim. If you're covered under ... (5.00 / 1) (#81)
    by Donald from Hawaii on Thu Oct 31, 2013 at 10:41:56 PM EST
    ... your employer's present health care plans, as about 150 million Americans already are, your plan remains unaffected, and you are ineligible to receive coverage under the health care exchanges.

    The ACA affects people who either don't have employer-provided health insurance or are presently uninsured. That's NOT 50% of the population. Estimates right now place the number whose present policies may be affected at about 10 million Americans.

    If you don't know, then don't make things up.


    Donald, an administration (1.00 / 1) (#108)
    by jimakaPPJ on Fri Nov 01, 2013 at 08:37:30 AM EST
    study now shows that about 51% of people covered by large corps and 53% of small corps will lose their employer provided covered.

    Donald, quit being a good soldier for Obama and admit that a disaster is going on and that Obama is a serial liar.

    You will be a better person for it.


    Link? (none / 0) (#133)
    by MKS on Fri Nov 01, 2013 at 09:40:30 AM EST
    Can't trust your view if you don't show your work.....

    This is the Libertarian (none / 0) (#44)
    by MKS on Thu Oct 31, 2013 at 06:10:42 PM EST
    argument against helmet laws.

    Other people have to pick up the slack from the junk policies.


    Name one insurance plan where (none / 0) (#56)
    by ruffian on Thu Oct 31, 2013 at 07:19:06 PM EST
    'An  individual' sets the boundary. Whether in government or private insurance companies, such decisions are not made by one person. What makes you think the team at your insurance company is necessarily more favorable to you than a government team?

    I hope you realize (none / 0) (#33)
    by TeresaInSnow2 on Thu Oct 31, 2013 at 04:13:17 PM EST
    that if the plans are missing even ONE piece, they have to be cancelled.

    If a plan is missing pediatric dental it has to be re-issued.  That means just about all plans (unless grandfathered) have to be re-issued, because most medical plans have separate rather than integrated dental.

    It is a Democratic myth used to sell this law that the plans that were cancelled are junk.  Please don't buy it

    Robert Laszewski (the health insurance expert, not some rube falling for junk insurance) has some great articles on the subject:

    He had to drop his own Cadillac plan and is now shopping for a junk Exchange plan

    Many states already had mandates to create quality coverage.


    Yep.. (4.50 / 2) (#1)
    by Dadler on Thu Oct 31, 2013 at 01:22:09 PM EST
    Yep and yep and yep.

    Phuck the roof and raise the floor! This ain't rocket science. And it works in almost any area where fiat currency is king and social needs are many.

    Simply stated, make the baseline of your economic system a humane and overly generous floor, an act of national import, then go from there. We operate from the paradigm that money matters more than people, hence these ridiculous hoops to get health insurance that, in reality, are just shoving money into the pockets of private insurers, while (because no non-profit public option is offered) offering Americans no actual freedom in the classical sense.


    Seriously, are we so bought and paid for that we can't even offer up the metaphorical '69 Mets of American politics?

    I guess so.

    Sigh again...

    Go Niners!  And Chargers!  And my aching soul!!!

    Woulda Coulda Shoulda (none / 0) (#3)
    by Slado on Thu Oct 31, 2013 at 01:31:14 PM EST
    I agree with you Dadler.   With all the money we're sinking into this fiasco the government could have opened health clinics nation wide to help the poor.

    For whatever reason DEMOCRATS decided not too.

    And here we are.


    omg . . . (5.00 / 1) (#4)
    by nycstray on Thu Oct 31, 2013 at 01:38:58 PM EST
    yeah, opening health clinics nationwide for the poor would have gone over big time with the right . . . lol!~

    They could have done it (none / 0) (#7)
    by Slado on Thu Oct 31, 2013 at 02:26:01 PM EST
    the same way they did Obamacare.

    With only democratic votes.

    Don't forget they controlled all branches of government.


    I'll give credit where it's due. (none / 0) (#54)
    by Donald from Hawaii on Thu Oct 31, 2013 at 06:57:34 PM EST
    President George W. Bush more than doubled the funding for federally qualified health centers (aka FHQCs and community health centers), which greatly increased access to basic primary health and dental care for the economically challenged and indigent. This, in my estimation, was a good thing and sorely needed.

    The problem here is that while Republicans in Congress went along with Bush's initiative at the time, since he left office in January 2009 they've been hell-bent on restricting or denying funding for these very necessary facilities.

    What seems inexplicable to me from a political perspective is that so many of these FHQCs were opened  over the last decade throughout our country's rural communities, where poverty is often much more intractable than in urban areas, because nearby resources are simply not at hand. By and large, these communities are mostly represented by Tea Party Republicans in the U.S. House.

    This is what happens when you elect people whose stated mission is not to govern, but to simply break things while collecting a personal paycheck for the privilege.



    Thanks Donald (none / 0) (#76)
    by jimakaPPJ on Thu Oct 31, 2013 at 09:53:25 PM EST
    Do you also know that the Demos opposed Part D???

    Yes, as a matter of fact, I do. (5.00 / 1) (#80)
    by Donald from Hawaii on Thu Oct 31, 2013 at 10:31:39 PM EST
    That said, do YOU remember that Medicare Part D was an unfunded $1 trillion mandate at the time it was enacted, because the Republicans never bothered to include any fiscal provisions in the legislation to pay for it?

    And did you know that Medicare Part D is projected to add about $15 trillion to the federal debt over the next ten years?

    Of course you don't, Jim, on both counts. Because Partisan hypocrites with highly selective memories like yours never do.



    Doesn't make any difference (1.00 / 1) (#109)
    by jimakaPPJ on Fri Nov 01, 2013 at 08:39:05 AM EST
    The facts are that Ted "Swimmer" Kennedy voted against it.

    Oh my, back to that old (5.00 / 1) (#131)
    by MKS on Fri Nov 01, 2013 at 09:35:21 AM EST

    It was an accident....and you have got to get new material.


    Swimmer.. (5.00 / 1) (#174)
    by jondee on Fri Nov 01, 2013 at 11:02:59 AM EST
    he's dusting off the oldies but goodies. He hasn't used that one since back when he was linking to Powerline and Newsmax every five minutes.

    Next comes Death Panels and Al Gore said he invented the internet.


    Why did they oppose it, Jim? (5.00 / 1) (#101)
    by Yman on Fri Nov 01, 2013 at 07:27:46 AM EST
    Because it didn't go far enough and was a huge giveaway to big Pharma.  Remember Billy Tauzin and his deal with Pharma preventing the government from direct price negotiations and drug re-importation?

    Yman, sometimes (1.00 / 1) (#111)
    by jimakaPPJ on Fri Nov 01, 2013 at 08:40:38 AM EST
    you astound me.

    You worry about big Pharma while applauding people loosing their health care insurance.



    Huh? (5.00 / 1) (#125)
    by MKS on Fri Nov 01, 2013 at 09:13:18 AM EST
    How is pointing out the sweetheart deal, anti-free market, monopolistic protection given Big Pharma "applauding people losing their health care insurance?"

    Yman, sometimes (1.00 / 1) (#112)
    by jimakaPPJ on Fri Nov 01, 2013 at 08:40:50 AM EST
    you astound me.

    You worry about big Pharma while applauding people loosing their health care insurance.



    If you should (5.00 / 2) (#175)
    by Ga6thDem on Fri Nov 01, 2013 at 11:05:28 AM EST
    be upset about people losing their health insurance shouldn't you also be excited about people actually being able to get health insurance too?

    The fact that so many poor people (5.00 / 3) (#12)
    by MO Blue on Thu Oct 31, 2013 at 02:58:24 PM EST
    were without good care was not the only problem with the health care system in the U.S. Had that been the case in all likelihood nothing would have been done.

    Our private insurance system was falling apart from its own weight due to the fact that it was pricing itself out of the market for too many people and not delivering the benefits that people expected upon paying large premiums. It was becoming too expensive for both the middle class and employers alike.

    If you go back and look at statistics as well as polls when health care reform was discussed, you would see that more and more people were deciding not to purchase the product and more companies were stating that they were going to cut health care benefits drastically in the future or get out of the business of providing them at all.

    It is my opinion that the only way that the private health insurance business could have survived in the U.S. is with a large infusion of government money. The Dems started the health insurance profit and rehabilitation process and the all of Republicans alternative plans (i.e vouchers etc.) will not only continue to increase the industries profits but reduce the services to the point that only the very rich and the politicians will actually receive health care for their money.


    the "whatever reason" is that many (5.00 / 2) (#13)
    by ruffian on Thu Oct 31, 2013 at 03:20:21 PM EST
    Democrats are conservative. Can we for once stop pretending all dems are alike?

    And some (5.00 / 3) (#36)
    by TeresaInSnow2 on Thu Oct 31, 2013 at 04:28:36 PM EST
    are such team players that live in a bubble of denial.  They refuse to accept reality if it hurts the impression they have of their team.

    I don't even know what the point (5.00 / 1) (#48)
    by ruffian on Thu Oct 31, 2013 at 06:25:21 PM EST
    of the 'Dems controlled the government, they could have done any liberal thing you all here want' type comment is here. Just to rub it in that not all Dems as are liberal as most of us?

    Medicade. (1.00 / 1) (#215)
    by redwolf on Fri Nov 01, 2013 at 05:18:48 PM EST
    Here's an idea: Scrap Obamacare and just drop the income requirement from Medicaid.  Borrow the federal reserve to pay for it.  Maybe we'll even get some inflation to help pull us out this shitty economy while we're at it.

    That way you can leave people who like their insurances alone and cover everyone else.  In time most people will switch to medicaid.

    You could have left out the "care" ... (none / 0) (#5)
    by Robot Porter on Thu Oct 31, 2013 at 01:44:46 PM EST
    and the headline would be also be accurate.  In fact, more accurate.

    If anyone cares to bother (none / 0) (#9)
    by Slado on Thu Oct 31, 2013 at 02:38:11 PM EST
    Here is a lengthy history of the "Individual Mandate" and conservatives from Milton to Romney and back again.

    It's fair to say that Republicans have supported a mandate but it's also fair to say Democrats have.

    What is most fair to say is only Democrats in congress and the White House put it into practice nation wide.

    That one is on them.

    Conservatives and the Individual Mandate

    Republicans have had the luxury of not (5.00 / 6) (#11)
    by Anne on Thu Oct 31, 2013 at 02:47:21 PM EST
    having to vote for policies they actually do support because Democrats, in the interest of trying to find bipartisan common ground, moved so far to the right that Republicans could reject the Dems' legislation and still get most of what they wanted.

    This has happened over and over and over again.


    Fair enough (none / 0) (#21)
    by Slado on Thu Oct 31, 2013 at 03:45:06 PM EST
    but as the link points out this time Republicans of all stripes stood in direct opposition to this form of a mandate.

    Did they toy with the idea, did they suggest it?  Yes.  But by the time democrats got around to legislating it the party had moved to being unaminously against it.

    Right, wrong or indifferent democrats, starting with Hillary in 2008 took the mandate to heart and now they own it.

    Look we've battled on this so let me be blunt.   Both parties used this as a way to change healthcare.   Both parties proposed it and Romney even implemented it (even though he didn't favor the employee mandate).

    But this law, with these rules and all the ins and outs of 2,000 pages lays squarely at the feet of democrats.

    Progressive and Conservative.


    They went to being unanimously against (5.00 / 2) (#23)
    by Anne on Thu Oct 31, 2013 at 03:53:56 PM EST
    it because they could see that they were going to get, in essence, Romneycare without having to vote for it.

    I don't know how they were planning to take any credit if it turned out to be a raging success, but I know they would be able to claim no role in it if it failed.

    And just a little nit pick - this was about insurance much, much more than it was ever about care.

    Do you imagine that if this had been a GOP-sponsored plan it would be 20 pages long, with no ins-and-outs?  Come on - carping about the number of pages being somehow a Democratic thing is just ridiculous.


    It might have been 500 (5.00 / 1) (#31)
    by Slado on Thu Oct 31, 2013 at 04:08:35 PM EST

    But you're right, it's irrelevant to the bigger point.

    We seem to agree more then we disagree.  

    Point taken.


    "Unanimously against it" (none / 0) (#99)
    by jondee on Fri Nov 01, 2013 at 07:09:48 AM EST
    Unanimously posturing and grandstanding for their base about a
    program they had little if any problem with when it was proposed by conservatives.

    They're presenting a united front. They may not know why they're doing it or what it's about, but they're presenting a united front.


    You bring up a good point, Anne. (none / 0) (#55)
    by Donald from Hawaii on Thu Oct 31, 2013 at 07:15:35 PM EST
    It's always so easy to say "No!", when you feel no burden to offer a rational alternative to what's been placed upon the table for public discussion.

    But to be honest, I don't think this crop of GOPers actually support any of these policies at all -- at least, not any more.

    After all, such policies are products of a bygone political era when we actually had rational debate in Washington, and both sides felt some sense of obligation to offer counterproposals as a basis for continuing discussion. The present-day GOP crowd is on a mission from God, and as such, they believe that God will thus provide while they take a sledgehammer to the joint.

    How wonderful life would be if we could all live and work like today's congressional Republicans, and collect a nice paycheck for simply blocking the doorway, scowling at passersby with our arms folded across our chests with hammers at the ready.



    Well (none / 0) (#65)
    by Ga6thDem on Thu Oct 31, 2013 at 07:59:28 PM EST
    this is why so many of us were against the current plan. It's a win/win for the GOP. The GOP gets their own policy that they couldn't pass themselves and gets to blame democrats for the problems.

    That's just a ludicrous statement (none / 0) (#119)
    by Slado on Fri Nov 01, 2013 at 09:05:27 AM EST
    Progressive are projecting their idea of conservative motives and desires onto them so they can feel comfortable being against obamacare.

    They simply can't bring themselves to oppose a 100% democratic initiative, even though that's what it is.

    To use a phrase of the day..."Whatever".

    If that's what it takes for you to join us opposing Obamacare that will have to do.

    I just wonder if you'd give Republicans the same credit if things were going better.

    ???  For some reason I don't think so.


    Look (5.00 / 1) (#140)
    by Ga6thDem on Fri Nov 01, 2013 at 09:52:50 AM EST
    the facts are the facts and this plan came out of a conservative think tank. You want to blame Obama for passing conservative policy? Fine go ahead. Obama could have offered up the Ryan plan and they wouldn't have voted for it. It's the conservative way to be against something instead of for something. Even Bill Buckley said conservatives get their strength from being against something. It's just how they operate. It's not about the policy or anything else. The nature of conservatism is to be against any change whether it's good, bad or indifferent.

    I was against Obamacare from the beginning because the crux of the problem is the insurance company's business model. The problem with Obamacare outside of the website rollout problems is that it is heavily reliant on the failing business model. No one is discussing this problem in Washington. So all we hear is the GOP screaming "disaster".

    If you were honest you would admit that overall it is a wash. Some people who previously could not get insurance are going to now be able to. Some people are going to be better off and some are going to pay more. The thing that really riles me is the outright dishonesty in the MAJORITY of what the GOP is saying. There's certainly plenty to criticize but the GOP has just been throwing mud at the wall to see what sticks. Remember "government takeover of healthcare" talking point that was bogus. The fact of the matter is they can't find a way to criticize the policy because the only way to actually criticize it is from the left.


    Enough already (none / 0) (#184)
    by sj on Fri Nov 01, 2013 at 11:42:12 AM EST
    You think this is a progressive plan. We look back to the Heritage Foundation and say "conservative". Because some of us have a memory and are able to synthesize information.

    But what does that matter in the end? The plan we have is the plan we have. And if you don't like the actual plan then talk about that. Point out the flaws. Point out fixes.

    But, jeebus, enough already about what the right label is. Who the fck cares? And  What. Difference. Does. It. Make?


    These articles always fascinate me (none / 0) (#10)
    by vicndabx on Thu Oct 31, 2013 at 02:45:55 PM EST
    because the obvious is always buried deep after stirring up the outrage (oh the horror!)

    There's probably not an alternate scenario in which single-payer would've been achievable in 2009-2010. It may even be true -- though I don't think it is -- that this is the best possible deal liberals could've gotten in this political system and in that environment. And obviously the law is a net good. Any pragmatic left-liberal should prefer to live in an America with the ACA than one without the ACA. Millions of Americans are going to be helped. Lives will be saved and improved. It's just that it's going to help millions of Americans in a way that will make it even more difficult to create and sell future programs and reforms that will help millions of Americans.

    I disagree this will make it harder in the future.  If/when the program works as it's intended and people have better cheaper coverage, and there is no significant hit to the economy in terms of jobs lost and standard of living depreciatation, people will see, that just like Medicare Part D, this was and is a good thing and works just as well as anything else that could've been implemented.

    USA Today via Crooks & Liars:

    Nearly seven years later, 9 in 10 Medicare beneficiaries have prescription drug coverage," says the poll. "Satisfaction among those with Medicare Part D has grown 12 points from 78% to 90%. Most are very satisfied with their coverage and say their plan offers excellent value, reasonable costs, and convenience."

    Gov't is a good thing, but progressives need to remember, business, can be a good thing also.  Our country was founded in part on the principles of balance and fairness.  Too often it seems people forget that these principles apply to the means by which an objective can be met.

    Business can be a good thing. (5.00 / 5) (#14)
    by vml68 on Thu Oct 31, 2013 at 03:23:35 PM EST
    But, healthcare should be a non-profit business.

    ^^This^^ (5.00 / 2) (#16)
    by Zorba on Thu Oct 31, 2013 at 03:33:25 PM EST
    Exactly this, vml68.  Exactly this.

    Thank you vml68 (5.00 / 1) (#25)
    by sj on Thu Oct 31, 2013 at 03:56:28 PM EST
    ... for cutting through the crap to get to the core.

    Talk to the doctors and hospitals and (none / 0) (#29)
    by vicndabx on Thu Oct 31, 2013 at 04:03:03 PM EST
    medical suppliers then.

    Or do you only believe some people should be paid for their services?

    Claims and issues around them don't solve themselves.


    I have no problems with doctors making a (5.00 / 3) (#34)
    by vml68 on Thu Oct 31, 2013 at 04:20:58 PM EST
    very good salary or medical supply businesses making a good profit of their products. What I object to is health insurance companies making record profits year after year scr*wing both patients and medical professionals.

    HUGE Red herring (3.00 / 2) (#38)
    by sj on Thu Oct 31, 2013 at 04:44:26 PM EST
    Talk to the doctors and hospitals and (none / 0) (#29)
    by vicndabx on Thu Oct 31, 2013 at 03:03:03 PM MDT

    medical suppliers then.

    That used to work. It used to be an effective way to steer the conversation away from the bloodsucking middle men that are the health insurance companies, but it doesn't really work any more. That's one very good thing that the ACA did -- limn the parasitical nature of the insurance companies.  I don't think that's what Wellpoint had in mind when they dispatched Elizabeth Fowler to write law, but the law is full of "unintended" consequences, isn't it?

    And BTD, just a heads up, vicndabx is part of the health insurance provider world.


    Sorry it is not (none / 0) (#53)
    by vicndabx on Thu Oct 31, 2013 at 06:47:57 PM EST
    insurance companies don't set what hospitals and doctors charge for their services.  Yes, we negotiate rates, that is all.  If it's all us, why hasn't the gov't just cut the rates to providers it pays under Medicare Part A or B or D?  In fact, you would find Congress has either raised rates or kept them steady for years.

    Further, why would an insurer want to pay more for services if it's all about the profits as you and others claim?  Oh yes of course, we're all in cahoots.

    I've never hid the fact that I work for an insurance company.  I've worked both on the private insurance and Medicare contractor side for many years. I've posted this many times.  Please stop trying to insinuate something that is not there.  Or rather, have at it.  I really don't care.  However, if you're going to talk about who I am, at least be wise enough to ask what I do.  I'm not in sales, not in underwriting, I work on technical aspects of data submission.  For almost 20 years I've worked the very issues caused by providers of care and other entities that you lament are problems caused by insurers.  I also generally back up my claims w/links to reliable sources.  I do not claim insurers are perfect, but certainly they are not the schemers so many want to believe they are.

    We pay millions of claims every single day w/o issue, no hold up whatsoever.  You don't hear about any of that though.

    Might be better to try to learn something about how insurers actually work as opposed to relying on anecdotes that give you an incomplete picture.

    Or don't.   No need to respond.  I won't post another reply to any of yours. Thanks.


    Not surprised LOL (3.00 / 2) (#59)
    by sj on Thu Oct 31, 2013 at 07:27:24 PM EST
    I won't post another reply to any of yours. Thanks.
    Since I won't let you pretend you are not personally vested in the world of health insurance. Just as I won't stop rolling my eyes at cr@p like this:
    If it's all us, why hasn't the gov't just cut the rates to providers it pays under Medicare Part A or B or D?
    As if there were no such thing as lobbyists or closed door discussions that leave out constituents while welcoming the money guys.

    You did not hide that you work at an insurance company -- which is how I know that, right? But you somehow never seem to mention that when that is the actual topic under discussion.

    If you feel this is important:

    Might be better to try to learn something about how insurers actually work as opposed to relying on anecdotes that give you an incomplete picture.
    You are in the catbird seat to provide this information. So how about you tell exactly how claims come to be denied? The whole story. And how the ACA was written. The whole story. And how rates are set? The whole story. Then your advocacy for the other side of the coin can be taken seriously, as you want it to be.

    Your whining about providing links to "reliable sources" is meaningless to someone like me who synthesizes information. I read all your links. I am one who "needs input".

    But in the end, when I point out your bias it is as another very relevant datum.

    Just as you are perfectly free Out my own union/safety net/equal rights for all/environment/education loving biases.

    To this bunch of hooey

    We pay millions of claims every single day w/o issue, no hold up whatsoever.  You don't hear about any of that though.
    I say bullsh!t. How many people have been here talking about wanting to keep the insurance they have? They have been among the most vocal.

    If you want to be taken seriously, put a disclaimer about your employer into your comment. Then I won't feel the need to follow up with this small but very, very relevant datum when you either feign or desperately hold on to ignorance.


    And by the bye (3.00 / 2) (#61)
    by sj on Thu Oct 31, 2013 at 07:36:32 PM EST
    It doesn't matter what your personal role is in your industry.
    "It is difficult to get a man to understand something, when his salary depends on his not understanding it."
    I say that completely without malice. If you like your job and are in alignment with the goals of your company I would expect you to advocate for them. But you don't disclose that information unless prodded.

    Why shouldn't vicndabx be able (1.00 / 2) (#67)
    by Politalkix on Thu Oct 31, 2013 at 08:29:44 PM EST
    to respond on issues relating to healthcare and health insurance if
    (1) someone (eg: the person who is casting the stone)whose employment is dependent on federal contracts can have an opinion regarding government shutdowns
    (2) teachers who belong to public sector unions can have an opinion regarding education policies that curtail union power at the expense of education
    (3) lawyers (divorce lawyers, defense lawyers, etc) can have opinions on issues that affect their income or employment.

    People living in glass houses should be more careful about throwing stones...


    As I said, (3.50 / 2) (#82)
    by sj on Thu Oct 31, 2013 at 10:47:11 PM EST
    for those who are able to you know, read, he's entitled to advocate for whatever he wants. His bias, however, is a relevant factor in what he has to say.

    When issues that affect my biases are under discussion, I try to disclose them. It's relevant to what I have to say. That's why, for example, when the subject of "immigration reform" was brought up I came right out and said I am brown. It informs my opinion and anyone who may be interested in, or take exception to, what I have to say might think that is relevant.

    Similarly, I disclosed the personal impact of the government shutdown.

    I welcome a teacher's perspective to education. They have information that I do not. Similarly, vicndabx has information that I do not and so I read everything that he posts. I just wish he would disclose his biases. As the teachers here do. As the lawyers among us do. He has mentioned it, as far as I can recall, exactly once, and I'm pretty sure he wishes now that he never had.

    My glass house is in fine shape, thank you very much for your concern.

    And by the way, I even read everything you post and do my best to make sense of it.


    Imagine how satisfied they'd be if (5.00 / 3) (#17)
    by Anne on Thu Oct 31, 2013 at 03:34:06 PM EST
    Medicare could bargain for the best prices for prescriptions... but then, it would be so much harder to sell insurance, wouldn't it, if people could afford medication without Part D?

    And we all know what that means - less money in the pockets of insurance and drug companies, and more in ours.

    There's something deeply ironic about praising a plan for working well that might not be needed at all if the government was allowed to negotiate drug prices.


    I find it fascinating (5.00 / 1) (#20)
    by Big Tent Democrat on Thu Oct 31, 2013 at 03:40:58 PM EST
    that you think Part D is comparable to this.

    It really isn't.


    Why isn't it? (none / 0) (#28)
    by vicndabx on Thu Oct 31, 2013 at 04:01:34 PM EST
    Please enlighten me.  Seriously, no snark.

    As of 2011, almost 49 million people were enrolled in Part D.  The population impacted by this law is somewhat smaller.  Folks wanted to expand Medicare instead of providing coverage via private insurance.  

    The website and enrollment process had issues initially - people hated both.  I remember because I was working for a CMS contractor at the time.


    You don't see (5.00 / 2) (#37)
    by Big Tent Democrat on Thu Oct 31, 2013 at 04:41:49 PM EST
    the difference between adding prescription drug coverage to a group of already identified people through an existing structure with a program that creates a new structure that covers all insurance coverage to a group that has to be identified through a Rube Goldberg contraption that then interfaces through private insurance?

    Ok, don't see it then.


    Yes, I see your point (3.50 / 2) (#49)
    by MKS on Thu Oct 31, 2013 at 06:28:27 PM EST
    But the overall point of this diary escapes me.

    We are past the stage of deciding whether single payer would have been better.  Who is now realistically advocating that?

    The more successful you are in bashing Obamacare, the less likely we will have coverage.  Gee, thanks.  


    Why (5.00 / 1) (#50)
    by sj on Thu Oct 31, 2013 at 06:34:01 PM EST
    The more successful you are in bashing Obamacare, the less likely we will have coverage.  Gee, thanks.
    That makes no sense at all. It's a fear-based reason to put the kibosh on valid criticism and make cheerleading the only valid commentary.

    The ACA, like most things in this world, isn't pure in its "goodness" or its "evilness". There is plenty to talk about for both aspects without trying to suppress the opposite side of the coin.


    Problems in the current plan (5.00 / 1) (#58)
    by MKS on Thu Oct 31, 2013 at 07:26:30 PM EST
    is one thing....

    Comparing the current plan to a hypothetical plan that does not exist is another.


    Then how... (5.00 / 1) (#62)
    by sj on Thu Oct 31, 2013 at 07:44:33 PM EST
    ...does one ever aspire to something better?
    Problems in the current plan (none / 0) (#58)
    by MKS on Thu Oct 31, 2013 at 06:26:30 PM MDT

    is one thing....

    Comparing the current plan to a hypothetical plan that does not exist is another.

    By this measure we would all still be serfs because a better system was hypothetical and did not exist.

    I don't understand that at all MKS. I think we should always aspire to better and better. Otherwise the crumbs that we are given get smaller and smaller.

    Now mind you, it doesn't mean that we shouldn't give thanks for those crumbs. We should. We just shouldn't be satisfied with them.



    "Crumbs" means (3.67 / 3) (#74)
    by MKS on Thu Oct 31, 2013 at 09:34:29 PM EST
    coverage for us and significant benefits to Military Tracy....

    A lot of people will be hurt if Obamacare fails.


    And, as usual, (5.00 / 1) (#79)
    by sj on Thu Oct 31, 2013 at 10:29:06 PM EST
    you pick a word to get bellicose about so you can ignore the point.

    And yes, a lot of people could get hurt if it doesn't work. Is that any reason why it shouldn't be better?

    And I think MilitaryTracy has Tricare which, as near as I can tell, hasn't been touched. Granted, I could be wrong about that.


    Better? (none / 0) (#83)
    by MKS on Thu Oct 31, 2013 at 11:40:27 PM EST
    How are you doing that?  What do you propose that would make it better?

    This diary is not about making it better.  


    So that's what you've decided? (5.00 / 1) (#86)
    by sj on Fri Nov 01, 2013 at 12:21:55 AM EST

    It is an I-told-you-so (none / 0) (#88)
    by MKS on Fri Nov 01, 2013 at 12:34:26 AM EST
    diary....It suggests no improvements....

    Nor do you.


    I think you need a hug (1.00 / 0) (#89)
    by sj on Fri Nov 01, 2013 at 01:34:45 AM EST
    That's probably what causes your constant state of whining.

    You have no idea (5.00 / 1) (#205)
    by sj on Fri Nov 01, 2013 at 12:25:31 PM EST
    Better? (none / 0) (#83)
    by MKS on Thu Oct 31, 2013 at 10:40:27 PM MDT

    How are you doing that?  What do you propose that would make it better?

    This diary is not about making it better.  

    What a load of crap this comment is when by your own words
    admissionYes, I see your point (3.50 / 2) (#49)
    by MKS on Thu Oct 31, 2013 at 05:28:27 PM MDT

    But the overall point of this diary escapes me.

    You don't see the point except that you want to shut down discussion because (I conclude based on all your comments here) you are frightened that you might lose the coverage you got through PCIP.

    I don't want you to lose access to health care that you didn't have before, and, because we have the ACA that means insurance. But I do want more people to have access to actual health care without having to choose between that and food.

    You have offered nothing here. Nor have you analyzed anything that anyone else has offered here. All you have is "shut up!"

    Well, you have yours, I guess. Apparently that's enough for you.


    I remember (5.00 / 2) (#178)
    by TeresaInSnow2 on Fri Nov 01, 2013 at 11:08:19 AM EST
    you saying you're out of California.  If they ever get the doctor networks listed on your Exchange, you might want to go out and see if ANY of the California plans cover her in network.

    Some of the Exchange insurance plans in Cali have only 35% of providers in network.  Others create their doctor networks by county so that if you're out of county, you're out of network.

    These plans that you sing praises of are HMO plans.  In the 90's the Democrats attempted to enact a patient's bill of right because of the Exchange-type HMO plans that you so resoundingly praise.

    Come back and report on what you find.  You may find you aren't so happy about  your sub-par doctor selection.


    Watch out BTD (3.00 / 2) (#51)
    by sj on Thu Oct 31, 2013 at 06:35:41 PM EST
    If you're not careful, your decision to not voice full-throated, uncritical approval of the ACA is going to put you into the Obama-haters bucket.

    BTD (none / 0) (#71)
    by vicndabx on Thu Oct 31, 2013 at 09:10:17 PM EST
    there's very little difference between how Medicare Part D works and was/is implemented and the ACA.  Only difference is the population:

    Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan when you're first eligible, and you don't have other creditable prescription drug coverage, or you don't get Extra Help, you'll likely pay a late enrollment penalty.

    To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

    Yearly, you can go to the website, enter info re: your medication needs and other demographic info and you get a list of plans to review.

    Granted, the checks for eligibility aren't as rigorous and don't hit as many databases I'm sure, but the process and concept is largely the same.


    Big If (none / 0) (#22)
    by Slado on Thu Oct 31, 2013 at 03:48:23 PM EST
    "...people have better cheaper coverage, and there is no significant hit to the economy in terms of jobs let...

    We shall see shan't we.   So fare Obama is 0 for everything in terms of promises.

    I wouldn't be betting that any of those promises come true either.

    I'd be willing to bet that 2014 will be an endless year of stories about people losing coverage, coverage being more expensive and the real fun begins around mid terms when companies start dumping employees getting ready for 2015.

    There's a reason they put it off.   It's not going to be good.


    There will be stories (none / 0) (#47)
    by MKS on Thu Oct 31, 2013 at 06:24:29 PM EST
    of people who gain coverage....

    More will gain coverage than will have to trade up for coverage they do not want.


    It is not a matter of wanting (none / 0) (#78)
    by jimakaPPJ on Thu Oct 31, 2013 at 10:07:42 PM EST
    It is of a matter of not being able to pay.

    You also need to take into (none / 0) (#84)
    by MKS on Thu Oct 31, 2013 at 11:42:45 PM EST
    account the subsidies--something that many of the so-called horror stories do not.

    You assume (none / 0) (#102)
    by jbindc on Fri Nov 01, 2013 at 08:12:17 AM EST
    (worngly, I think) that most of the people whose insurance gets cancelled will be eligible for subsidies.

    No, I do not (none / 0) (#104)
    by MKS on Fri Nov 01, 2013 at 08:22:55 AM EST
    But those whose policies get cancelled will be able to get other, and generally, better coverage.

    The subsidies, however,  are available to a lot of middle class families.


    No, MKS (none / 0) (#107)
    by jimakaPPJ on Fri Nov 01, 2013 at 08:33:39 AM EST
    The subsidies are not available to middle class families. For example, if a family of 4 makes around $65K they can't get a subsidy and a $400 a month increase just has to come out of their pockets.

    And guess what. That money isn't spent in the general economy. That means vacations get cancelled, cars aren't purchased, dining out doesn't happen, new clothes aren't purchased, groceries are down scaled,etc., etc.

    This plan is a total disaster. Period.


    What the (5.00 / 1) (#118)
    by Ga6thDem on Fri Nov 01, 2013 at 09:04:29 AM EST
    heck are you talking about? Subsidies to up to 80K for a family of four last time I looked.

    You really have to quit letting the talk radio crowd get away with lying to you. I'm by no means a fan of Obamacare but I actually checked the policies out online. The same Kaiser policy I had in the individual market 5 years ago went from 800 a month of 544. The copays went up from 24 to 60 but I would have to go to the doctor seven times a month to make up the difference. Once more and more people start actually checking things out the GOP is going to go even lower than their record low of 22% approval right now. You guys keep thinking if you scream disaster enough that people will believe you but of course you've been able to repeat a lie over and over time and again and get away with it. So I guess you figure to continue doing what worked.


    So you say (none / 0) (#110)
    by MKS on Fri Nov 01, 2013 at 08:40:28 AM EST
    A lot of people will get insurance because of it....

    And many, many people will qualify for subsidies....


    And, sorry, Jim (none / 0) (#113)
    by MKS on Fri Nov 01, 2013 at 08:41:44 AM EST
    I can't give any weight to your predictions in light of the fact we do not have President Romney in office right now.

    If you do not show your work, can't trust it.


    Not true (none / 0) (#115)
    by jbindc on Fri Nov 01, 2013 at 08:52:42 AM EST
    Some will, but many won't get "better" coverage and many won't get subsidies.

    But keep channeling the talking points.


    Very real issues (none / 0) (#122)
    by MKS on Fri Nov 01, 2013 at 09:09:42 AM EST
    Most will get better coverage according to this report.

    The newer policies will not have annual caps....That is a big difference for those who have significant health issues.  


    You seem to be channeling (none / 0) (#123)
    by MKS on Fri Nov 01, 2013 at 09:10:26 AM EST
    your own talking points.  

    So many things wrong with this (none / 0) (#132)
    by jbindc on Fri Nov 01, 2013 at 09:39:09 AM EST
    First - you keep citing TPM, which we all know is an administration mouthpiece, and can't really be counted on as "objective" and "factual" journalism.

    About 80 percent of people, those who receive insurance through their employer or are already enrolled in a government program, won't experience any change at all, Gruber said. (The Kaiser Family Foundation puts the number at 79 percent).

    Ok.  Of course, that assumes that employers won't drop their coverage and force their employees on the exchanges or dropping employees' hours below 30.  You can say it won't happen, but you (and this author) really have no clue.  It won't happen in all cases, but it will happen.

    So then you have 6 percent who might receive a cancellation letter (Kaiser says the individual market is 5 percent). Of those, Gruber argued, about half aren't really going to see a change: They'll technically enroll in a new plan, but it'll be very similar to what they already had.

    No proof of this yet.  Can't compare what happened in Massachusetts with what happens across the whole country.

    That leaves 3 percent who will have to buy significantly different plans, some of whom might have to pay more for them (at least before the law's tax credits and other financial assistance kick in).

    Again, no proof that a majority will qualify for subsidies.  Just talking points and wishful thinking.

    But those numbers require some historical context. According to the federal rule that birthed this controversy, research suggested that 40 to 67 percent of plans purchased on the individual market were in effect for one year or less. That's a lot of turnover that already existed before the ACA.

    More and more people are keeping individual policies for longer than a year (if they can afford it).  The quoted statement is a misleading statistic in the fact that it does not address how many people may get individual plans for a year and then drop it because they go back to work for an employer who provides it vs. people who drop it all together because it is too expensive.

    Alright, so those 3 percent of people who are going to have to purchase significantly different coverage: What are they going to get?

    Nobody's disputing that they're going to get better coverage. The reason that plans are being cancelled in the first place is that they don't comply with Obamacare's requirement that they cover 10 categories of care known as essential health benefits.

    Um, I dispute that. I may get a couple extra things in my plan, but that doesn't make it "better".  "Better" is a subjective term.  What would be better for me, for example, would be no maternity coverage, and instead put that "cost" on giving me lower co-pays.

    People making less than 400 percent of the federal poverty level qualify for either tax credits or expanded Medicaid (which, to be clear, has to cover the same set of 10 benefits that private plans have to cover). According to Kaiser, about 60 percent people in the individual insurance market (more than 10 million) have an income within that range, which leaves the other 40 percent (about 4.4 million) who don't and won't qualify for help.

    This is talking about the very and moderately poor - most of whom can sign up for Medicaid and pay nothing, so to include them in any discussion of what is going to happen to people who have to buy policies is a complete red herring.  More and more people are working like me - professionals in temporary positions, or working in jobs that are paying a lot less than they used to (but will still put people above the threshhold )- people who "make too much money" to qualify for subsidies, but will still be buying more expensive plans.

    Talk to me when you aren't quoting and administration water carrier as your source.


    TPM is citing (none / 0) (#135)
    by MKS on Fri Nov 01, 2013 at 09:43:41 AM EST
    some very good sources....

    And you cite what?

    You say:

    Can't compare what happened in Massachusetts with what happens across the whole country

    That sounds like Romney.....Is that your source?


    Ah.. (5.00 / 1) (#176)
    by jbindc on Fri Nov 01, 2013 at 11:05:39 AM EST
    Bringing out the "you must be a Republican" comments.

    Evidence that you know you have lost this argument.


    Were is your citation (none / 0) (#196)
    by MKS on Fri Nov 01, 2013 at 12:04:44 PM EST
    to evidence supporting your position?

    I cited evidence.  You did not.....


    Since I have cited much evidence (1.00 / 0) (#201)
    by jbindc on Fri Nov 01, 2013 at 12:21:18 PM EST
    for days now, instead of just repeating one post at TPM, I think I will let you go look for it.

    The Fifth Circuit (none / 0) (#68)
    by MKS on Thu Oct 31, 2013 at 08:29:45 PM EST
    just reinstated Texas's abortion restrictions that were struck down by the District Court Judge, a Bush appointee, on Monday.

    The New Third Rail of Politics... (none / 0) (#164)
    by Mr Natural on Fri Nov 01, 2013 at 10:47:32 AM EST

    We own a small business and provide health (none / 0) (#193)
    by Angel on Fri Nov 01, 2013 at 11:56:57 AM EST
    insurance to our employees.  Because we were not providing maternity coverage (employees are all men, or women of non-childbearing age) we now have to use the state's exchange (we're in Texas).  We've started looking at our options and have found that our premiums are going to go up about 40%. We haven't yet selected a plan but that's the ballpark increase among the ones we're looking at.  Coverage will be more comprehensive in some areas but there's coverage included that the employees just don't need.  Any comparison of rates for pre-exchange and exchange will be an apples to oranges comparison, but it sure seems to us that the rates are much higher than they should be based on what we've paid for the past almost 20 years.  

    Curious (none / 0) (#194)
    by vicndabx on Fri Nov 01, 2013 at 11:58:27 AM EST
    can you purchase coverage outside of the exchange that's tailored to your employee's needs?

    Well, that's what we currently have, a policy (none / 0) (#197)
    by Angel on Fri Nov 01, 2013 at 12:10:29 PM EST
    that meets our employees' needs.  But we've been told we have to provide the maternity coverage regardless.  Still investigating our options.  

    Oh, but isn't it delicious... (none / 0) (#203)
    by masslib on Fri Nov 01, 2013 at 12:23:22 PM EST
    to hear Republicans complain that only a handful of people have even been able to sign up.  Shouldn't they be thrilled with that?

    Which plans cover abortion? (none / 0) (#208)
    by jbindc on Fri Nov 01, 2013 at 12:33:04 PM EST
    Not really clear on the exchanges....

    It should be noted that in 23 states there is little question. Those states have passed laws that ban all plans in their health exchange from offering coverage for elective abortion. Eight of those states have also banned private insurers outside the exchange from offering coverage for abortion as well. Most, but not all, include exceptions for life endangerment, rape or incest. Some of those states allow abortion coverage to be sold as a separate policy, called a rider, but so far there's no evidence that any plan is offering that.

    Judy Waxman of the National Women's Law Center says this is a major change from what has traditionally been the status quo for abortion coverage in private health plans.

    "Abortion has generally been covered because it is treated like any other medical service and is just part of outpatient care or doctor care, and really has not been singled out very much in private insurance," she says.

    But the fight over the Affordable Care Act changed that. In order to ensure that no taxpayer money went to pay for elective abortions, it created a very complex system by which insurance companies would have to separate out a portion of each premium if they wanted to continue to offer abortion as a covered benefit.

    Waxman says, as a result, there is at least anecdotal evidence that some insurers are dropping coverage, at least for this first year, just because of the added hassle.

    "We had heard that some plans are saying that they are not going to offer it now because they have so much to figure out, and this little extra administrative activity they have to be involved in is something they want to figure out when things calm down a little," she says.

    Don't worry your pretty little heads about it - all will be revealed in good time....

    It surprised me that so many people (none / 0) (#209)
    by oculus on Fri Nov 01, 2013 at 12:37:46 PM EST
    are receiving letters from their current insurers informing people their current policies do not comply w/current law and are being cancelled. Was this effect of the ACA anticipated?

    Answer to oculus (none / 0) (#212)
    by jbindc on Fri Nov 01, 2013 at 01:25:43 PM EST

    Four sources deeply involved in the Affordable Care Act tell NBC News that 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive a "cancellation" letter or the equivalent over the next year because their existing policies don't meet the standards mandated by the new health care law. One expert predicts that number could reach as high as 80 percent. And all say that many of those forced to buy pricier new policies will experience "sticker shock."


    None of this should come as a shock to the Obama administration. The law states that policies in effect as of March 23, 2010 will be "grandfathered," meaning consumers can keep those policies even though they don't meet requirements of the new health care law. But the Department of Health and Human Services then wrote regulations that narrowed that provision, by saying that if any part of a policy was significantly changed since that date -- the deductible, co-pay, or benefits, for example -- the policy would not be grandfathered.

    Buried in Obamacare regulations from July 2010 is an estimate that because of normal turnover in the individual insurance market, "40 to 67 percent" of customers will not be able to keep their policy. And because many policies will have been changed since the key date, "the percentage of individual market policies losing grandfather status in a given year exceeds the 40 to 67 percent range."  

    That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them.

    In that same Federal Register, the employer coverage and "grandfathered" status was also discussed:

    Estimates are provided above for the percentage of employers that will retain grandfather status in 2011. These estimates are extended through 2013 by assuming that the identical percentage of plan sponsors will relinquish grandfathering in each year. Again, to
    the extent that the 2008-2009 data reflect plans that are more likely to make frequent changes in cost sharing, this assumption will overestimate the number of plans relinquishing grandfather status in 2012 and 2013.

    Under this assumption, the Departments' mid-range estimate is that 66 percent of small employer plans and 45 percent of large employer plans will relinquish their grandfather status by the end of 2013. The low-end estimates are for 49 percent and 34 percent of small and large employer plans, respectively, to have relinquished grandfather status, and the high-end estimates are 80 percent and 64 percent, respectively.

    So yes, they had some idea this was going to happen.

    NYT re three people's whose coverage was cancelled (none / 0) (#214)
    by oculus on Fri Nov 01, 2013 at 04:43:55 PM EST