More Trouble For "Market Reforms" In ACA

Last month, I wrote a post titled The Problem With Obamacare: The Republican Stuff. Ironically, to make the Republican stuff work, folks had to be forced into the private insurance market. Ezra Klein indvertently explains:

The bill [Louisiana Senator Mary] Landrieu is offering [it would let folks 'who like their insurance, keep it'] could really harm the law. It would mean millions of people who would've left the individual insurance market and gone to the exchanges will stay right where they are. Assuming those people skew younger, healthier, and richer -- and they do -- Obamacare's premiums will rise. [...] "I think it would be a real substantive mistake to do the Landrieu bill," says MIT health economist Jon Gruber, a supporter of the Affordable Care Act.

(Emphasis supplied.) Of course this has been the fundamental problem with Obamacare - its Republican ideas need the government to force people to participate in the private insurance market, and not just any insurance market, but the ObamaCare exchanges. I t did not have to be this way. More on the flip.

The wonks who championed this Rube Goldberg contraption (the exchanges I mean, not the Medicaid expansion) of course have hit the panic button as their contraption has fallen apart.

But the problem is not with the "fixes," it is with the contraption itself. What should have been done in a Democratic plan was rely on the policy we actually believe in - public insurance.

The solution was an autoenroll into public insurance for anyone who does not choose or have private insurance.

Why did the wonks fight against that approach? Why did they fight for the Rube Goldberg contraption? Who is surprised by the chaos and the policy failure here? Not me for one. I hope they turn it around but I doubt it.

Finally, it's fine to be a wonk now apparently and ignore political realities. But it is ironic to hear them be "purists" on the exchange and insist on ignoring the political realities they helped cause - the realities that are leading to the demise of their cherished Rube Goldberg contraption - the Exchanges. Why the told us we had to accept this "imperfect reform" because of political constraints but now refuse to accept the political constraints caused by the failure of their championed policies only they can say.

Now that the political constraints have come home to roost - and the chicken in the oven is their cherished exchanges, they are not so philosophical about it.

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    Very much this (5.00 / 5) (#1)
    by TeresaInSnow2 on Wed Nov 13, 2013 at 03:29:06 PM EST
    The solution was an autoenroll into public insurance for anyone who does not choose or have private insurance.

    Very, very, very much this.

    Medicare for all would have been way better, but (5.00 / 1) (#26)
    by Coral on Wed Nov 13, 2013 at 05:31:36 PM EST
    I do think the Medicaid expansion is a significant improvement. It will really help people who have no access now, and the fewest options. Also the elimination of discrimination vs. those with pre-existing conditions.

    I was a big skeptic on MA Romney plan when it was introduced, but I think much more highly of it now. It's better that people are covered, lower income people have a dignified path to access to affordable health care. It's still hard on people in the individual markets who are older and just over the income cut-off for subsidies.


    Could not agree more (5.00 / 3) (#2)
    by Dadler on Wed Nov 13, 2013 at 03:31:57 PM EST
    Read a good piece about this at CNN yesterday, of all places. (LINK)

    I just don't get it. Insurance companies only want the wealthy and largely healthy. Let them have the phuckers who want and can afford that. For the rest your supposedly free Americans...let the be FREE! Stop getting on your knees and start getting on your ladder.

    Excellent link (5.00 / 4) (#4)
    by Big Tent Democrat on Wed Nov 13, 2013 at 03:39:40 PM EST
    Highly recommended.

    From your link (5.00 / 4) (#11)
    by MO Blue on Wed Nov 13, 2013 at 04:26:34 PM EST
    While it is true that the perfect should not be the enemy of the good in American politics, it is also true that sometimes a fight for the perfect is one worth having and could produce results that only strengthen the case for more.

    This, too (5.00 / 4) (#22)
    by sj on Wed Nov 13, 2013 at 05:02:07 PM EST
    But the policy problems should also be a wake up call for liberals that it might be worth fighting for something bigger next time around. It was not inevitable that Obama chose the path that he did.

    Sure seemed "inevitable" at the time. (5.00 / 2) (#39)
    by oculus on Thu Nov 14, 2013 at 03:18:54 AM EST
    Single payer was "not on the table."  Insurance industry moguls at the White House.

    I guess it depends on how you read the sentence (5.00 / 1) (#95)
    by sj on Thu Nov 14, 2013 at 11:21:23 AM EST
    Read one way, the way the administration clamped down and shut out even the mention of single-payer, I would have to agree with you. That was extremely disciplined in the boarding-school/Charles-Dickens sense.

    But reading "inevitable" as treading through the only path available, I agree with the quote.


    I never thought it was literally (none / 0) (#120)
    by oculus on Fri Nov 15, 2013 at 05:26:21 AM EST
    inevitable the Obama admin. would sacrifice its signature.accomplishment to appeasing the very industry which has  created the status quo.

    I was going to link that too (none / 0) (#13)
    by TeresaInSnow2 on Wed Nov 13, 2013 at 04:32:41 PM EST
    I hate the title tho.  It's not liberalism, but much of the narrative was spot on.

    lol; we don't even agree on the definition (none / 0) (#107)
    by Mr Natural on Thu Nov 14, 2013 at 01:27:59 PM EST
    of "liberalism."

    Once in a while somebody attempts to lecture us, but they're usually rebuffed.

    We're all over the map on issues, our host, BTD, everybody here.


    Don't entirely agree (none / 0) (#33)
    by ragebot on Wed Nov 13, 2013 at 09:33:11 PM EST
    Social Security was never sold as wealth redistribution.  Even today there is widespread perception that Social Security is not wealth redistribution.  To a large extent this also goes for Medicare.

    Folks who work for a paycheck see deductions every week/month for Social Security and those who qualify see monthly payments for Medicare.  Both Social Security and Medicare could be self supporting if costs and benefits were balanced.

    On the other hand Medicaid is a wealth redistribution program.  The only source of funding it has is tax dollars that mostly come from tax payers who do not receive Medicaid.

    While some folks, including the writer of the CNN article, take it for granted that wealth distribution is accepted as a social good not everyone does.

    I am well aware that projections are that Social Security and Medicare (especially with Part D) are bleak lots of folks are not aware of how bleak it is.  But almost everyone understands that Medicaid will go broke without a constant infusion of tax dollars.

    Sure there are real issues with the federal exchange.  But the bigger problem is trying to convince a majority of folks that wealth redistribution is a good idea, instead of taking it for a given.


    Unless the people in the U.S. are willing (5.00 / 2) (#35)
    by MO Blue on Wed Nov 13, 2013 at 10:03:30 PM EST
    to stand by and let people die rather than access some form of medical care, some form of wealth distribution will occur to treat sick poor people whether there is Medicaid or not.

    The Republican solution is for the people who do not have insurance to get treatment at the ER. The ER is by far one of the highest cost forms of treatment around. Are people really so dumb that think the hospitals and doctors do this for free if people can't pay. People who pay taxes or get health insurance or care pay for this higher cost of treatment for the poor with a combination of tax dollars and padded hospital bills.



    Those who do not believe most stridently (none / 0) (#34)
    by Politalkix on Wed Nov 13, 2013 at 09:45:09 PM EST
    that wealth redistribution is a good idea also believe that 47% of people in America do not get social security and medicare withheld from their paychecks.

    The Pete Petersons of the world also believe that people are living too long and are taking way more out from SS and Medicare than they put in.


    The French that earn more than (none / 0) (#134)
    by fishcamp on Sat Nov 16, 2013 at 08:07:45 AM EST
    $1.4M per year pay 75% taxes and I'm sure they don't like that either.

    I think it's funny (5.00 / 4) (#3)
    by jbindc on Wed Nov 13, 2013 at 03:32:46 PM EST
    that Jon Gruber keeps getting quoted (by Ezra Klein et al) as "a supporter of the Affordable Health Care Act".  No, he's much, much more than that. He was one of Obama's closest health advisors, and was one of the principal architects of the law, so he has much more of a vested interest in keeping the plan as is, than to tweak it or change it altogether. (He was also instrumental in getting Romneycare passed in Massachussetts).

    To quote him now, as young Mr. Klein does, as a supportive, but disinterested party is deceitful.

    Yes, a "supporter," (5.00 / 2) (#14)
    by KeysDan on Wed Nov 13, 2013 at 04:33:33 PM EST
    but Jonathan Gruber was much more, including a paid contractor with HHS.   Although, Dr. Gruber claims that his role was not one of public relations, but as an evaluator.  In any event, he was a champion who did not always provide disclosure, as he did, at least, on his N.E J. M. cheerleading.

    Obamacare and HAMP (5.00 / 3) (#71)
    by Anne on Thu Nov 14, 2013 at 09:11:31 AM EST
    Disturbing similarities?

    Do you all remember HAMP, the program that was supposed to help homeowners avoid foreclosure?  Do you remember the kinds of problems people had just getting through, how many times they were told their information hadn't been received, the many times people had to submit the same documentation?

    Do you remember how people were told that while the modification process was underway, they should stop making their mortgage payments, only to find out months later that their banks had started foreclosure proceedings, or they were told they first had to pay all the back payments, with tons of servicing charges?

    Now, think about the anecdotal reports of people having to create multiple profiles on healthcare.gov, because the system didn't recognize the profile they had already entered.  And think about the people who did get in, finally, who put a plan into their "cart" but hadn't officially decided or enrolled or submitted the application.

    Maybe you'd better sit down...

    From Lambert at Corrente, via a WaPo article:

        In Pennsylvania, Charles Roes­sler, 64*, tried to apply three ways: online, through a call center and on paper. The retired computer salesman has decided on a health plan but hasn't been able to sign up via any of the methods because no one has been able to verify his subsidy.

        During his most recent attempt, on Monday, he asked a call center representative to delete duplicate applications but was told that the center lacked the authority. "We're being told that you can go online or enroll through the call center," he said. "Well, no, not really. . . . I'm just inches away from the finish line."

    And worse (via a comment from a naked capitalism post):

       So... I was one of the lucky (?) few who actually managed to establish a "profile" early after the roll-out of healthcare.gov. But like others, once I got into the site, it was rather useless. I found a lot of plans but few of them had the specific benefits detailed fully. So I was clicking on a lot of different plans to do some comparison shopping, knowing full well that even if I ultimately was gonna go with an exchange plan, I certainly was not ready (or informed enough) to choose which plan would be best. I logged on after that, once or twice, and couldn't get past the blank page that told me I was logged in but offered me nowhere to go.

        Yesterday I logged in, maybe 3 weeks since my last attempt, to discover that I have an "application" on file. Somehow the system has determined that I chose one of the plans I was looking at and locked me into it. Mind you, the site tells me I haven't yet completed the application, but nonetheless this incomplete application has me locked into a plan I did not choose. On the live chat, I told "Michael" of the problem and told him he needed to clear that plan from my profile so that I could look at others. He said he could not. He told me I have to "pay to start the plan" then call ARC (I assume that's the insurer offering the plan I didn't choose) personally to cancel it.

        I told him that was ridiculous, that I would not "pay to start" a plan I don't want not "call to cancel it." I suggested that someone needed to fix this BS and said goodbye, logging off without waiting for another worthless reply.

    And consider this gem, that probably very few people are aware of::

    Although there are ten categories of essential health benefits that must be included in the coverage, the insurers are allowed to vary the benefits within each of the ten categories as long as they remain actuarially equivalent. Imagine the calculating tool that would be required to compare plan coverage. It would challenge the Obamacare exchange computer systems in complexity.

    The bottom line? Because of private health plan chicanery, it is impossible to know what expenses you may face in the next year. But if you develop a major disorder, there is a great risk that you will have to pay more than the out-of-pocket limit that is posted on the exchange plan descriptions.

    Add to this that a number of the companies offering plans on the exchange haven't supplied the required comparisons between plans for coverage of specific conditions.

    When will people know these things?  When it's too late to do anything about it.

    Obama to make an announcement (5.00 / 1) (#72)
    by Anne on Thu Nov 14, 2013 at 09:23:40 AM EST
    at 11:35 am EST regarding a fix for dropped coverage...

    Here's the idea of his announcement (none / 0) (#88)
    by jbindc on Thu Nov 14, 2013 at 10:34:20 AM EST

    President Obama is preparing to announce Thursday a change in one of the bedrock ideas in the Affordable Care Act, by allowing people with individual insurance policies to keep them for another year, even if they do not comply with the law's rules for minimum benefits.

    The White House, responding to intensifying pressure from disgruntled consumers and Congress, has decided to make the change as a strategy to try to ward off more far-reaching changes that are being advocated on Capitol Hill.

    Under the White House's approach, the Department of Health and Human Services will notify the nation's state insurance commissioners that they have federal permission to let consumers who already have such insurance policies keep them through 2014. It will be up to each state whether to go along.

    He's killing his own program, and (5.00 / 3) (#90)
    by Anne on Thu Nov 14, 2013 at 10:56:12 AM EST
    demonstrating how little he knows about what elements are critical to it functioning successfully.

    Makes me wonder about the people advising him, too - isn't that why you have experts?  Shouldn't they know the dangers in taking this approach?

    So, what will he do when, in a year, people start screaming about the higher costs?  Agree to keep them at the 2014 level?

    See, this is what happens when you tinker with a Rube Goldberg-designed structure - it either fails, or it functions in a way you don't want it to.


    True... (5.00 / 2) (#101)
    by ScottW714 on Thu Nov 14, 2013 at 12:21:22 PM EST
    ....but those people losing what they have vote, and there a re a lot of them.  At this rate I think he's more worried about them losing the Senate because of ACA's p1ss poor implementation.  He has to know if R's hold both houses, it's gone.  Might take a lot of crazy wrangling, but the R's will figure out how to essentially repeal it without a veto.

    And if there is one thing we know about Obama, his legacy trumps all, the problem of course is that would be admitting that he not only lied, but that he and his party is incapable of implementing their own legislation. Not exactly the stuff of legacies.


    Oh, it will be a legacy, all right (5.00 / 1) (#102)
    by jbindc on Thu Nov 14, 2013 at 12:28:35 PM EST
    LEGENDARY comes to mind, as well.

    This is what they should have started with (5.00 / 1) (#103)
    by jbindc on Thu Nov 14, 2013 at 12:31:00 PM EST
    Heck, even in Massachussetts it took a YEAR to roll out and get everybody on board.  They didn't try to change everything with one fell swoop in a 3 month period.

    Hard to say how many people (none / 0) (#91)
    by Abdul Abulbul Amir on Thu Nov 14, 2013 at 10:58:56 AM EST

    Hard to say how many people this will help.  It is likely that no ensurer has submitted any pre-Obamacare plan to a state regulator for 2014 approval.  To get approval, a provider network and customers signed up in quantity and coverage provided by the January 1 expiration date of most policies could best be described as God's Holy Miracle.



    Of course, the Medicare for All solution ... (5.00 / 1) (#124)
    by Robot Porter on Fri Nov 15, 2013 at 11:35:21 AM EST
    was shouted down by most of the blogosphere, including BTD.

    Despite the fact that it had been shown to have overwhelming popularity with the public (around 70%)in poll after poll for at least 15 years.

    ACA has never had support anywhere near that.  Despite the fact that we were told over and over again by blog-pundits that this is what Americans wanted.

    What I really get a kick out of (4.43 / 7) (#30)
    by scribe on Wed Nov 13, 2013 at 08:10:28 PM EST
    are the people who shriek that even the poor can get insurance because of the subsidies in the law.  You know - that will help them pay the exorbitant premiums.

    How long do you - anyone in the room, please - think the subsidies will continue for those feckless, worthless poors?  Hmmm?

    How about asking the people formerly receiving food stamps (you know, "subsidies" so they can eat) before Republicans and Democrats alike voted to, you know, cut them off.  People will buy health insurance while hunger stalks the land?

    Face it, all you O-bots out there:  your idol will go down in history as the greatest insurance salesman in history, nothing more, someone who sold a lot of insurance for a year or two until he collected the sales bonus, and then skipped town.

    The funny part is (5.00 / 3) (#40)
    by jbindc on Thu Nov 14, 2013 at 06:33:42 AM EST
    When the administration talks about "all those people getting subsidies".  What they don't say is how many people will be getting subsidies that are around $100 or less for the year.  While any money back in people's pockets is a good thing, how is $100 going to make a dent for people who are now paying hundreds, if not thousands of dollars more a year?

    True (none / 0) (#43)
    by CoralGables on Thu Nov 14, 2013 at 07:11:45 AM EST
    but they also don't mention the up to 7 million individuals that are eligible for free policies with their subsidies.

    Well, yes they do (5.00 / 1) (#44)
    by jbindc on Thu Nov 14, 2013 at 07:23:05 AM EST
    That's exactly who they're talking about in the first place - the people who get enough subsidies that all or most of their premiums will be covered.

    And of coruse, (5.00 / 2) (#46)
    by jbindc on Thu Nov 14, 2013 at 07:25:44 AM EST
    Those same "free" policies will have the highest out-of-pocket expenses, so depending on how much those people have to use them, it really won't be "free".

    Three independent estimates by Wall Street analysts and a consulting firm say up to seven million people could qualify for the plans, but federal officials and insurers are reluctant to push them too hard because they are concerned about encouraging people to sign up for something that might ultimately not fit their needs.

    The bulk of these plans are so-called bronze policies, the least expensive available. They require people to pay the most in out-of-pocket costs, for doctor visits and other benefits like hospital stays.

    And 6 million of those (none / 0) (#49)
    by CoralGables on Thu Nov 14, 2013 at 07:40:43 AM EST
    currently have no insurance at all. So a cap on annual expenses that they will receive for no cost at all is a great present under the Christmas tree.

    Except that present under the tree (5.00 / 2) (#56)
    by MO Blue on Thu Nov 14, 2013 at 08:05:55 AM EST
    will be delayed for some until 2015 (or later) because the poor insurance companies couldn't fix their programs in time.

    A Limit on Consumer Costs Is Delayed in Health Care Law ...

    The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.

    Of course (none / 0) (#53)
    by jbindc on Thu Nov 14, 2013 at 07:54:41 AM EST
    You actually have to believe the numbers, and assume that most of those people won't just say, "Screw it.  I'll pay the penalty and not go through the hassle."

    Ironically (5.00 / 1) (#99)
    by sj on Thu Nov 14, 2013 at 11:41:54 AM EST
    You actually have to believe the numbers, and assume that most of those people won't just say, "Screw it.  I'll pay the penalty and not go through the hassle."
    CG informed us that, until recently, she was one of those who was seriously considering doing just that.

    You've read poorly (none / 0) (#105)
    by CoralGables on Thu Nov 14, 2013 at 01:11:53 PM EST
    I don't see it as a hassle. I don't have to pay a fine whether I purchase or not. I may and probably will purchase on the exchange as the price is extremely nice and there are over 30 options available in my county.

    If I do it won't be until after filing taxes so check back in March and I'll let you know.


    Why wouldn't you have to pay the fine? (none / 0) (#106)
    by shoephone on Thu Nov 14, 2013 at 01:25:10 PM EST
    I have nearly no income this year (none / 0) (#108)
    by CoralGables on Thu Nov 14, 2013 at 01:42:58 PM EST
    I'm eligible for a waiver.

    That may be (none / 0) (#110)
    by sj on Thu Nov 14, 2013 at 01:51:04 PM EST
    but that isn't what you said. hmm... I think. I'll have to go back and check to make sure that I haven't misunderstood/misremembered.

    Point taken (none / 0) (#109)
    by sj on Thu Nov 14, 2013 at 01:50:03 PM EST
    You did say you were seriously considering paying the penalty. I'll take your word for it that it wasn't to avoid the hassle.

    I don't believe you'll ever find where I said (5.00 / 1) (#111)
    by CoralGables on Thu Nov 14, 2013 at 01:58:00 PM EST
    I'd pay the penalty. I did say I may or may not purchase, which under the circumstances could understandably be misconstrued into thinking I'd be paying a fine.

    It's my understanding that residents coming in under the medicaid income threshold in the 25 states that didn't expand and don't qualify under the medicaid rules of their respective state can get a waiver.

    At least that's how I translated the letter I received from my ACA marketplace application giving me my options. I can purchase or waive.


    I see where my memory took a (none / 0) (#112)
    by sj on Thu Nov 14, 2013 at 03:08:35 PM EST
    turn for the worse. I was mistaken. You said from the beginning that you currently have no insurance and preferred to keep it that way, but, while you may purchase through the marketplace, you had the ability to get a waiver and avoid the fine.

    Which probably wouldn't be a problem for you because you said you also support euthanasia.

    I forgot about that little bit. Thanks for the correction.


    Don't you wonder how many people (5.00 / 1) (#100)
    by Anne on Thu Nov 14, 2013 at 11:57:38 AM EST
    will get tagged by the IRS for failure to comply who actually did sign up for a plan?

    I do a lot of tax work in my job, and have had some experience dealing with that bureaucracy.  Between keeping track of the subsidies, track of those who don't have insurance who will then have to prove they are exempt, getting subsidy credits to the right insurance company for the right subscriber, dealing with people who don't believe their subsidies are correct, dealing with people who had subsidies and then lost them for one reason or another, collecting fines and dealing with people who refuse to pay them, how in the name of all that is good and holy is this even remotely close to being "reform?"

    At least with Rube Goldberg, his contraptions actually worked; this whatever-you-want-to-call-this thing probably wouldn't even come close to getting the Goldberg Seal of Approval.


    And those would never be cut, of course. (5.00 / 3) (#45)
    by Edger on Thu Nov 14, 2013 at 07:24:58 AM EST
    since the whole point of the ACA is concern for their health, of course.

    They aren't food stamps, after all...


    Go back to your bookshelf, (3.67 / 3) (#31)
    by scribe on Wed Nov 13, 2013 at 08:21:36 PM EST
    pull down your copy of Dickens' Martin Chuzzlewit and read the story of The Anglo-Bengalee Disinterested Loan and Life Assurance Company.  Consider whether Obama could play Tigg....

    Why the need to thow Republicans in? (none / 0) (#5)
    by Slado on Wed Nov 13, 2013 at 03:39:53 PM EST
    Just to make yourself feel better?

    This is Obama's baby.   Leave republicans out of it.

    It is GOP policy on the "reform" side (5.00 / 4) (#6)
    by Big Tent Democrat on Wed Nov 13, 2013 at 03:49:05 PM EST
    If you want to argue GOP would have executed it beter, sure, but  .  .  . Iraq.

    There are some hints of republican (none / 0) (#16)
    by Slado on Wed Nov 13, 2013 at 04:39:22 PM EST
    or conservative ideas but one big thing that is different is conservatives never supported the employee mandate but instead only the individual mandate.   Romney even vetoed the employee mandate but was overulled by the Senate.

    Also it was democrats that put it into practice and the real problem with this bill and what is a democratic only idea was the need to make insurance so all encompassing.   The regulations for what kind of insurance had to be bought is not a republican idea.

    That one is democratic.

    Either way it's silly to quibble over whose idea it is.   As long as we all agree that it's not working and needs to be fix.

    How to fix it?   Well that's another argument all together.


    Oh (5.00 / 2) (#19)
    by TeresaInSnow2 on Wed Nov 13, 2013 at 04:44:25 PM EST
    ...only the the individual mandate.  Republicans reserved the indentured servitude to insurance companies for small business owners, underemployed, unemployed, spouses of employed but without medical insurance.

    Ayep, that is SOOOOO much better.


    It is if you trust the market (none / 0) (#21)
    by Slado on Wed Nov 13, 2013 at 04:52:01 PM EST
    to make better decisions then government.  I would support the government then providing another system to pick up those that can't get care.   A two tier system.

    Not asking you to agree just pointing out the difference.


    I wasn't aware... (5.00 / 2) (#24)
    by sj on Wed Nov 13, 2013 at 05:11:37 PM EST
    It is if you trust the market (none / 0) (#21)
    by Slado on Wed Nov 13, 2013 at 03:52:01 PM MDT

    to make better decisions then government

    That "the market" had a mind of its own.

    Now if you're talking about an entity serving shareholders vs serving the common good, that's another matter.

    I would much rather trust an entity which would at least purport to serve the common good, without a very, very obvious conflict in that interest. Prior to the the NSA's TIA-by-another-name that would have been the government, unreservedly.

    It's still the government but not so enthusiasticly.


    We on the individual market (5.00 / 2) (#25)
    by TeresaInSnow2 on Wed Nov 13, 2013 at 05:19:48 PM EST
    have been dealing with "market based solutions" all along.  They have not served us.  But Obamacare is WORSE for us. And to pre-empt some folks, the Quasi-Medicaid Exchange plans are not the solution.  

    And the problems that we on the individual market are facing now are the exact problems we would face if the administration only regulated the individual market, as you suggest.  

    We need the government to take on the high risk pool, rather than us doing it.  And that is pretty much what BTD suggested.


    That is (5.00 / 2) (#28)
    by Ga6thDem on Wed Nov 13, 2013 at 07:23:45 PM EST
    the crux of the problem: letting for profit insurance companies determine the "market". Republicans say if we get the government out of it altogether things would be so much better. In reality, they don't understand how insurance works any better than Obama does.

    The truth of the matter is if the market was going to determine who had insurance then the majority of Americans would not have it. The business model of the insurance companies is destined to fail because the people that they want to have insurance are the ones least likely to buy their product. What other business has succeeded with that model? None that I can think of.


    I know (5.00 / 1) (#36)
    by NYShooter on Wed Nov 13, 2013 at 10:51:40 PM EST
    what you were trying to say, Ga,
    but your wording is a little confusing (for a dense mutt like me, anyway :)

    You stated, "In reality, they don't understand how insurance works any better than Obama does."

    But, "They" absolutely do know how it works. And, by making quality health care unattainable they achieve the market efficiency people like Slado so desperately desire.

    I think the confusion comes from the difference between how a free market is supposed to work and how it actually works. So, I think now is a good time for me to confess to a tightly held secret, to "come out of the closet," so to speak.

    Years ago, when I was just starting out in the business world, and formulating the ideas that would guide me through "the jungle," Conservatism seemed quite appealing to me. While I was always a staunch Liberal I believe a case can be made that the two disciplines are not necessarily, mutually exclusive. The problem, of course, is that the term, "Conservative," has been hijacked by political opportunists (mostly Republican) and prostituted beyond recognition.

    Today's "conservatives" have achieved Conservatism about as well as Neville Chamberlain achieved "Peace in our time."

    In any case, and, because I've ranted on more than I wanted to when I started this response, let me apologize for hijacking your post. What I wanted to bring out is that Monopolies have no place in a "free market." Unfortunately, all we have in our markets these days are Monopolies.
    And, that one, irrefutable fact is the reason that today's Conservatism, Libertarianism, and/or Slado-ism is a sham, fraud, and, to use his favorite word, "Scam."


    I believe in the free market (5.00 / 3) (#41)
    by jbindc on Thu Nov 14, 2013 at 06:42:03 AM EST
    However, the problem is, conservatives like to think the free market means "no rules".  A completely free market works well - in theory and in the aggregate.  But like water running to the sea, individuals (and companies) within the free market will always find a shortcut to get where they want to go, even at the expense of the masses. We build dams in this country to guide and direct water where we want it go, all the while letting it flow freely within the boundaries we set.  Why shouldn't the market work the same way?

    A lot of truth in there, shooter (none / 0) (#57)
    by jimakaPPJ on Thu Nov 14, 2013 at 08:13:57 AM EST
    And we do not have a "health care insurance market."

    We have 50 individual health care insurance marketS.

    And within each of those 50 individual markets we have additional individual markets. (See Medicare Guide to get a good picture.)

    And while not all Conservatives are conservative, not all Liberals are liberal.

    MY truth says that you cannot have any plan that is fair unless you have 100% acceptance and 100% availability of the same treatments for everyone.

    The problem is that if I have worked hard and succeeded then I believe I should be rewarded. I get the better car, the nicer home the better health care provided via better insurance paying better doctors.

    Oh. You? Well, sorry about that.

    The only thing that comes even close to fair is the Medicare model for EVERYONE paid for by a federal sales tax. And that last phrase, I suspect, ends any agreement we might have.


    Well, I don't trust the market to make (5.00 / 1) (#42)
    by Anne on Thu Nov 14, 2013 at 06:47:01 AM EST
    better decisions than the government.  If you free-marketers had your way, there'd be no standards for safety for anything, nothing to get in the way of complete destruction of the environment, no way to prevent the kind of financial industry behavior that almost blew up the economy.  You want chemical plants built near schools?  You want a pipeline running through your neighborhood?  Want to buy a car that hasn't been safety-inspected because a market free of government interference allowed the manufacturer to skip those in favor of a fatter bottom line?  Want to trust that the prescription the pharmacist fills for you came from a manufacturing plant that self-inspected and not one that skipped that part because there was no law or regulation that mandated it?  Would you want to know that the steak you buy didn't come from a facility that processed meat from diseased cattle?  How are you going to do that?

    Are you out of your mind?

    You want a two-tier system, do you?  Something that settles once and for all who the haves and have-nots are?  

    Sounds more like what you'd end up with is a recipe for revolution.  A present day production, only with real people and real lives, of Les Miserables.

    Ooh, that sounds like so much fun...


    Anne, you're describing (none / 0) (#114)
    by NYShooter on Thu Nov 14, 2013 at 06:42:35 PM EST
    conservatism the way it is, the way it's been prostituted. In my post I was referring to the way it's supposed to be, the way it could be.
    Honest Conservatives would say that real competition in a free, open marketplace is the way an economy should run, and, a way to assure that the public receives maximum value for their consumption dollars.

    Of course, just like in sports, the competition must be fair. Nobody questions that we need referees, judges, and umpires in sporting events to make sure the rules are followed. Yet, when it comes to guaranteeing the marketplace is run in a fair manner, today's "conservatives" scream, "regulations are destroying the economy!"

    Nobody questions that a referee who uses his authority to favor one team over another should be punished, even jailed. Yet, when JP Morgan/Chase spends millions of dollars to make regulators "look the other way," we give them a slap on the wrist and watch their stock price shoot up.


    "Trusting the market" is why I can't (none / 0) (#126)
    by jondee on Fri Nov 15, 2013 at 11:55:38 AM EST
    eat the fish in Lake Ontario..

    Whence comes this primitive tribal superstition about the beneficence and wisdom of the market?

    We're talking about a fallible, artificial, deity every bit as irrational and ultimately destructive as Leninism or Maoism..

    But believing in it curries favor with the powerful so it must be true.


    The 1992 Heritage Consumer Choice Health Plan (5.00 / 4) (#23)
    by MO Blue on Wed Nov 13, 2013 at 05:05:30 PM EST
    established a "Minimum standard coverage required for all Americans." The basic plan would have been required by law. The regulations for what kind of insurance had to be bought is very definitely a republican idea and has been since at least 1992.

    The basic plan would have required prenatal coverage and well baby and child coverage among other things.

    This should not be new information to you since I provided to you on another occasion.


    So if the Republicans... (none / 0) (#38)
    by unitron on Thu Nov 14, 2013 at 12:16:54 AM EST
    ...had recused themselves completely and said "go ahead and pass whatever you want and make it law and we won't interfere", do you really think we'd have wound up with the exact same ACA?

    Problems (none / 0) (#7)
    by vicndabx on Wed Nov 13, 2013 at 03:59:58 PM EST
    who are the providers where do they come from?

    The solution was an autoenroll into public insurance for anyone who does not choose or have private insurance.

    Surely you don't just assume providers that currently accept Medicare or Medicaid patients would be OK w/a potential large influx of varied age patients into their practice along w/the unpredictability (making appts, canceling appts, volume)?  That's why the issue of narrow-networks talked about here exists.

    Further, what would CMS have paid these providers?  The same or new (higher/lower) rates?  How would that have worked out in Congress when for as long one can remember rates have either stayed the same or gone up only slightly?  What if I'm a doc that only handles Medicare patients and I see a doc willing to take on the burden of these auto-enrollees getting more than I do?  Does everyone get a raise now?

    Where was congressional support to pay for all these tax-payer costs going to come from?

    No sir, the rube Goldberg contraption was needed because of the vagaries of the health care economy in the US.

    Hold on a second (5.00 / 1) (#8)
    by Big Tent Democrat on Wed Nov 13, 2013 at 04:05:05 PM EST
    Is it your view that providers who currently accept Medicare and/or Medicaid would have balked at accepting the OCare exchange pool?


    Tell me another one.


    Laugh it up fuzzball (1.67 / 3) (#10)
    by vicndabx on Wed Nov 13, 2013 at 04:26:25 PM EST
    (and no that's not a diss, it's a reference to Star Wars) for those that seem to interpret every comment in the worst possible way

    NYT Link

    If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems

    Do you have any proof they would?

    Have you not read any of the articles about how small the provider networks supposedly are?  I've said this is not due to the insurer, rather, providers don't want to receive either the patients or the lower $ amounts.  Seriously, a little common sense is in order here - what other reason is there?

    There are real concerns in the provider industry as well as with insurers. However, these are not new problems.  These problems can only be fixed with either:

    -healthier people
    -more money

    Get the people on board w/a tax increase - then.....


    Yes you have said that the small provider (5.00 / 2) (#17)
    by MO Blue on Wed Nov 13, 2013 at 04:39:36 PM EST
    networks are not due to the insurers. Yet, the insurers themselves have clearly stated that they were responsible for limiting the networks. It was their decision.

    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.

    Many doctors and hospitals are protesting this decision by the insurance companies.

    But some physician groups, hospitals and patient advocates say they are concerned that many of the insurers' networks have not yet been publicly announced less than two months before open enrollment begins Oct. 1. They fear that patients, particularly those who need specialized providers, may not have adequate access to care. Last year, the Obama administration issued a rule that insurers "must maintain a network of a sufficient number and type of providers ... to assure that all services will be available without unreasonable delay." It also required that "essential community providers" be included in all plans.

    Get people on board with eliminating the unnecessary insurance industry and focus on providing health care.


    You seem to clump (5.00 / 3) (#20)
    by NYShooter on Wed Nov 13, 2013 at 04:47:15 PM EST
    Medicare and Medicaid together, as if they're one and the same.

    Nothing could be further from the truth.

    "Medicaid" is insurance for the truly destitute, the bottom of the bottom. Obviously, by necessity, reimbursement rates for Medicaid would be low.

    "Medicare" covers a much larger swath of people, more in line with a majority. And, that's why, in spite of some fear mongers here, the large majority of doctors accept it.  


    That makes no sense (5.00 / 1) (#27)
    by Big Tent Democrat on Wed Nov 13, 2013 at 07:01:30 PM EST
    This is a pool of people who will have the smae reimbursement rates.

    If they take that bow, why would they refuse this new group?


    Physician practices (none / 0) (#32)
    by TeresaInSnow2 on Wed Nov 13, 2013 at 09:20:03 PM EST
    that accept Medicaid and Medicare patients do it out of the kindness of their hearts.  They use their insurance customers as their bread and butter/bill payers.  The Medicaid/Medicare patients are for the thumb twiddling fill in times.  Had to pay people for doing nothing otherwise, so the few Medicaid bucks are kind of nice.

    Medicaid especially is practically pro-bono work.  Medicare is less so, but still is. I know a dentist who would rather just work 3.5 days a week than take any Medicaid patients.  She literally can't pay her staff their hourly rate for the time spent on a Medicaid patient, let alone herself.

    Many of the providers who theoretically accept Medicaid aren't taking new patients.

    Practices CANNOT survive with all Medicaid patients.

    I've heard that many of the Exchange plans pay barely above Medicaid rates, so expect the same kind of doctor access for those.


    Lately I've noticed two of my doctors (5.00 / 1) (#55)
    by fishcamp on Thu Nov 14, 2013 at 08:00:44 AM EST
    regularly claim "long visit" on my Medicare paperwork thereby collecting $360 instead of the normal office visit cost of $180.  The visits didn't seem longer to me nor more special.  It may be a quiet method of collecting enough $$ to cover their Medicaid costs.  

    Or help make their boat payment :) (5.00 / 1) (#67)
    by CoralGables on Thu Nov 14, 2013 at 08:53:13 AM EST
    Bingo!... (5.00 / 1) (#104)
    by kdog on Thu Nov 14, 2013 at 12:41:01 PM EST
    Give that man a cigar.

    Or in the case of younger doctors still strangled by student loan debt, their next monster student loan payment and a resonable quality of life.  


    Well, you can't just say, (none / 0) (#37)
    by NYShooter on Wed Nov 13, 2013 at 11:08:04 PM EST
    "......many of the Exchange plans pay barely above Medicaid rates," out of context and suggest that's all that is available. At the lower end of choices, yes, there may be plans that pay barely above Medicaid rates. But, that's the reason for having a range of choices, isn't it? Compared to No insurance, a bare-bone, barely above Medicaid plans, sounds pretty good.

    And, your statement, "Practices CANNOT survive with all Medicaid patients," is simply redundant as no one I know has suggested that they can.


    Pro Bono Example (none / 0) (#50)
    by vicndabx on Thu Nov 14, 2013 at 07:45:14 AM EST
    If you already have a number of reduced rate or free clients, how many more would you be able to accept before it became an issue for you financially or time-wise?  How many would it take for your efficacy as a lawyer to suffer?

    These same issues exist for providers.


    "Reduced rate" is (5.00 / 1) (#51)
    by Big Tent Democrat on Thu Nov 14, 2013 at 07:50:21 AM EST
    really a misnomer.

    It is the rate.

    Now it may be that the government needs to program for more medical professionals and open up the cartel.

    And yes, tiered medical care would be exacerbated but in my view, this is the better path for health insurance and health care reform.


    Simple solutions to the problem (5.00 / 2) (#54)
    by MO Blue on Thu Nov 14, 2013 at 07:58:30 AM EST
    Get rid of the overhead cost of the insurance companies and use some of the cost saves to raise the provider rates where needed. Another alternative:

    People who want to maintain a insurance based system often refer to Switzerland as an insurance based system that works. O.K. lets go to the highly regulated insurance based system of Switzerland where insurance companies must provide the basic minimum standard coverage on a non profit basis.


    Same old same old (2.00 / 1) (#61)
    by vicndabx on Thu Nov 14, 2013 at 08:38:10 AM EST
    Profits are not the reason costs go up. The share of costs for profits/administration is small. The reason costs go up is because utilization is up, charges are up.

    Why not just shoot all the truly sick people and thereby eliminate those costs altogether? I'd probably be killed because I have type 1 diabetes.  (I have to add this lest those who don't notice obvious snark think I'm saying we should kill people and thus the discussion become about me)

    I snark, but like this, yours is another impractical solution not based in reality.

    There will ALWAYS be a need for someone to take in your claim data, adjudicate it and pay $$ back to providers.  What is fair compensation for these people?  Do you know how much these people even get paid or are you only talking about CEO's again?  Do you honestly believe CEO salaries alone will solve the problem?

    Please do not quote admin cost of insurers vs. that for Medicare unless you also have an idea of who processes Medicare claims.


    Insurance companies (5.00 / 2) (#65)
    by MKS on Thu Nov 14, 2013 at 08:42:00 AM EST
    make money off the float....

    Insurance companies are not just clerks processing claims.

    Medical insurance companies should be put out of business.


    I don't know about that for all companies (none / 0) (#70)
    by vicndabx on Thu Nov 14, 2013 at 09:11:13 AM EST
    make money off the float

    but if true, why is that a problem as long as money is available for your claim?

    I would submit that is a better way to derive profit and investment capital (i.e. via investment return) as opposed to medical loss ratio - which I'm sure you know is also present in the law.

    Is your issue with capitalism?  If yes, isn't that a different discussion?


    I have several problems (5.00 / 3) (#115)
    by NYShooter on Thu Nov 14, 2013 at 07:21:49 PM EST
    with your post, vicndabx.

    First, regarding,"..mak[ing] money off the float."
    You ask, "why is that a problem as long as money is available for your claim?"

    My answer is, because its unnecessary. And, its a "problem" because the money skimmed off for its investors should be going for its clients. Its a useless appendage that business has usurped for the sole purpose of enriching its self appointed "gate keepers." A referee in a football game serves both teams equally. An insurance company serves only itself, and its shareholders. Its business plan is transparent: the less health care it provides, the more profit it makes. Its obligation is to its shareholders, not to its clients.

    And, second:  "Is your issue with capitalism?

    Of course not. Real "Capitalism" stimulates an economy by encouraging numerous providers to compete with each other in order to gain as much market share as possible. The businesses win by being compelled to become more efficient and provide higher quality products than their competitors. As a result the consumers also win for those very same reasons.

    In other words, in "real" capitalism, both sides win. With the current system one side wins only by assuring the other side loses. That's not "capitalism," that's "corruption."


    I do not think that health (5.00 / 3) (#116)
    by MKS on Thu Nov 14, 2013 at 09:02:24 PM EST
    care should be subject to the vagaries of what you call capitalism.

    Computers, cars stoves, widgets--fine.  Health care, not.


    Same old same old (5.00 / 2) (#68)
    by MO Blue on Thu Nov 14, 2013 at 09:03:02 AM EST
    nonsense regurgitated by a member of the insurance industry.

    The insurance industry tried to kill off a lot of sick people by denying their claims. There was even a term for it. Death by spreadsheet.

    Guess what there is not an epidemic in France, Canada, Japan, the UK etc. of people dying from type 1 diabetes. People with type 1 diabetes get good quality care in other countries that do not gouge their citizens with overpriced insurance premiums. In fact, more people with type 1 diabetes get good quality care since their systems provide universal health care.

    Maybe if I type real slow you will understand that you do not need an insurance industry employee to process health insurance claims. That is a processing function that any processing department could handle. In fact, a processing department could process the claims more efficiently and at a lower cost if we eliminated the insurance industry and standardized all claim forms. Eliminating the various health insurance companies and standardizing the claim forms would also save doctors, hospitals and other health industries a ton of money in processing costs.


    You've been out the game too long (1.00 / 1) (#76)
    by vicndabx on Thu Nov 14, 2013 at 09:28:30 AM EST
    bolded has already happened

    fact, a processing department could process the claims more efficiently and at a lower cost if we eliminated the insurance industry and standardized all claim forms.

    HIPAA covered entities don't use claim forms anymore.

    How do you pay the "processing department"?  Who makes up the processing department?  You figure we can just pay those folks less eh?  Just like we can just pay the doctor and hospital less?  Everybody's just gonna roll w/that?  You really have no idea about the complexity of the data that comes in and the support needed to resolve issues w/the data so claims can be adjudicated effectively.  

    In fact, the gov't has moved away from the decentralized type of processing you seem to be referring to because it was not cost-effective.

    You're talking millions of people w/hundreds of millions if not billions of claims and you're talking about processing departments.  OK.

    Last I heard, there wasn't an epidemic of people dying from Type 1 Diabetes here either.  

    There was however an epidemic of people dying from preventable illnesses such as heart disease and obesity.


    Who said anything about paying (5.00 / 1) (#81)
    by MO Blue on Thu Nov 14, 2013 at 10:09:08 AM EST
    the claims people less. Not me. The insurance industry is known for how little they pay their processors. So that is just some BS that you made up just like all the other crap you make up. Like you would be dead if it the U.S. did not have a private insurance based system.

    Of course I'm talking about processing departments. Every insurance company has processing departments to process claims. Or has the insurance industry come up with some fancy name for a processing department. I never said the processing had to be located in a central location so that is just something you made up so that you could have a different argument. Processing can be done locally or regionally. Any processing company could process the claims with trained staff and the proper equipment. The same millions of people w/hundreds of millions if not billions of claims would still happen if the insurance industry did not sell health insurance. Health care claims get processed and paid all across the world without having a private insurance based system.

    Banks probably process Macy's payments but they don't sell clothes, shoes etc. They just process the payments. H&ll for that matter the insurance companies could be contracted to process the claims without selling the product. Also the complexity of processing claims would be reduced a great deal by eliminating the insurance departments (legal and processing) that spend a great deal of time trying to find the smallest loophole to deny legitimate claims.

    Whether a claim is submitted electronically or with a paper form is irrelevant if the data or requirements are not standardized.


    And how much additional overhead (5.00 / 2) (#89)
    by Anne on Thu Nov 14, 2013 at 10:47:05 AM EST
    do providers incur in order to facilitate the processing of claims for the care they provide?  I go to the doctor and give them my information, which they then have to submit to my insurance company, which then notifies me and the provider what is and isn't covered, and I may or may not get a bill from the doctor that reflects a balance due.

    If I am one of 20 patients my doctor sees that day, there's a chance the other 19 patients don't have insurance from the same company I do, and if they do, it's not going to be the same plan.  So, the back office is dealing with a multitude of forms, claims, and insurance companies every single day.

    That cost adds to overall costs, does it not? I mean, how could it not?

    Does the doctor keep cutting his or her profit?  Does the insurance company pay its shareholders a smaller dividend?  Does the CEO take a pay cut?

    No.  Not in this lifetime.  Please don't make me laugh.


    For those that are concerned (none / 0) (#92)
    by vicndabx on Thu Nov 14, 2013 at 11:11:19 AM EST
    and would like to be better informed, why not ask you doctor what he/she does?

    Here's what I know: a great many doctors have Practice Management Software that generates an 837 electronic claim file (in the same format to every payer in the country) either directly to the payer or to a clearinghouse.  If using a clearinghouse, the clearinghouse receives claims from other providers and batches them in large files containing everyone's 837 claims to the individual payer.  I would note the addt'l thing you hear in all that - jobs.

    It's efficient and has been going on for decades. Under HIPAA law, providers and payers MUST use standardized X12 transactions to exchange data about you.  No one but the smallest doctor's office is exempt and therefore allowed to use claim forms. You should note however that even paper claim forms are standardized - 1 for professional/doctor claims (HCFA 1500), 1 for institutional/facility claims (UB04).  Again - have been for years.

    The doctor may be dealing w/different companies on the phone (they don't have to, there are X12 transactions available for all but the most critical needs) but as far as submitting claims, that is an easy process.

    What you will find is a great many practices are not using all the transactions they can to streamline their processes.  Payers have to support everything (eligibility, claims, claim status, claim payment, enrollment, others) providers do not.  


    A company does not need to sell a product (5.00 / 1) (#113)
    by MO Blue on Thu Nov 14, 2013 at 04:00:34 PM EST
    in order to process a claim. If you eliminated private health insurance, claims would still be paid. Jobs would not be lost in the claims processing area. The clearing houses would still exist.

    The only jobs that would be lost would be for the high cost lawyers, lobbyists and CEOs that make more money by denying people actual health care and buy off government officials to reduce or eliminate regulations and allow exorbitant rate increases.



    Yes, I have a very good idea how much (5.00 / 2) (#73)
    by MO Blue on Thu Nov 14, 2013 at 09:24:49 AM EST
    the average claims processor makes. The insurance industry is notorious for underpaying their claim processors.

    Here is some 11/13 salary data:

    Average Medical Claims Processor Salaries

    The average salary for medical claims processor jobs is $29,000. Average medical claims processor salaries can vary greatly due to company, location, industry, experience and benefits.

    Here is a great opportunity for someone with at least 3 - 5 years Medical Claims experience.

    Salary range: $11 - $13 an hour

    Wow using the $13 an hour figure that would equate to the huge annual salary of $27,000 for a 40 hr week.


    Well (5.00 / 3) (#75)
    by jbindc on Thu Nov 14, 2013 at 09:28:04 AM EST
    They would qualify for subsidies on their purcahse on the exchange.  IF they could ever get into the system, that is....

    So then your proposition (1.00 / 2) (#78)
    by vicndabx on Thu Nov 14, 2013 at 09:32:49 AM EST
    is to pay these folks even less?

    (note, I don't believe those numbers are accurate, nor do they reflect the other jobs that are needed)


    You know that you are making (5.00 / 1) (#82)
    by MO Blue on Thu Nov 14, 2013 at 10:14:21 AM EST
    that up. Do you go to seminars on how to use distortion techniques so that you can convince yourself that you are winning an argument?

    OK Mo (none / 0) (#84)
    by vicndabx on Thu Nov 14, 2013 at 10:21:27 AM EST
    I would suggest you go back and re-read the thread.  You will see that it is not I that has gone off track.

    Agreed (none / 0) (#98)
    by sj on Thu Nov 14, 2013 at 11:36:45 AM EST
    I would suggest you go back and re-read the thread.  You will see that it is not I that has gone off track.
    You have not gone off-track at all. You have been very consistent in your distortions and ludicrous claims.

    I don't blame you, I guess. You're just trying for some job security. Welcome to my world. There is no such thing as job security. Thankfully, propagandizing isn't required in my field.


    They need a raise! (none / 0) (#85)
    by kdog on Thu Nov 14, 2013 at 10:21:36 AM EST
    The two ton elephant in the room is how we get CEO's to take less...median Health Care CEO pay in 2012 was 11.1 (cue Dr. Evil voice) million dollars.

    As the say on NFL Primetime...C'mon man!


    The narrow networks are there (5.00 / 4) (#9)
    by MO Blue on Wed Nov 13, 2013 at 04:16:50 PM EST
    so that the insurance companies can limit care  while still appearing to adhere to the requirement of not denying coverage for preexisting conditions.

    The rube Goldberg contraption was devised solely for the purpose of propping up a health insurance system that was pricing its self out of the market and not providing value for the money received.


    So you believe (none / 0) (#12)
    by vicndabx on Wed Nov 13, 2013 at 04:31:05 PM EST
    please point to evidence where a provider says "we wanted to join at the rates they were going to pay but the insurer told us no".

    You ask (5.00 / 5) (#15)
    by TeresaInSnow2 on Wed Nov 13, 2013 at 04:38:10 PM EST
    And you shall receive:

    According to the announcement, "From day one, the management of Frisbie Memorial Hospital has asked for the same offer other New Hampshire hospitals in the Affordable Care Act network received from Anthem Insurance. Frisbie leaders have asked for a new dialogue with Anthem to gain access to NH's ACA system to no avail. Now, the Rochester hospital is taking legal action to appeal the decision that prevents its team of providers from caring for its patients.
    "The door to Obamacare was slammed shut and we are blocked from participating," said Al Felgar, CEO of Frisbie Memorial Hospital.



    You see (5.00 / 2) (#18)
    by TeresaInSnow2 on Wed Nov 13, 2013 at 04:41:34 PM EST
    ...the whole idea is to limit the access people have generally to providers.  That's why the networks are narrow.  It's about cost per visit, yes, but it's also about limiting the access.  If people get sick and tired of waiting to see someone, maybe they just won't go.

    The same issue holds true elsewhere.  Google, google, google!


    You really believe that? (none / 0) (#47)
    by vicndabx on Thu Nov 14, 2013 at 07:30:28 AM EST
    "people get sick and tired....maybe they won't go"

    As someone who works for an insurer, I find this appalling. That is certainly not what happens at the companies I've worked for.

    It's not about limiting access at all. It is about getting people to go where for the vast majority of care needed, they will get the most bang for their buck and the largest segment of the population can be served. People can still go to these hospitals for urgent care (i.e. ambulance & closest hospital).


    I have (5.00 / 6) (#29)
    by Ga6thDem on Wed Nov 13, 2013 at 07:31:32 PM EST
    a solution for the provider problem and have actually worked with people who have been working on a solution. One of the solutions is to expand the ability of nurse practitioners and PAs to write prescriptions and offer care to patients. One of the great flaws of our system is that there are too many chiefs and not enough Indians in the heath care provider networks.

    Here in GA there was a movement to allow nurse practitioners to go to rural areas and serve as doctors. The medical lobby fought tooth and nail against it. They did not want the competition but doctors also did not want to go to these rural areas and practice because there was not enough money. So in essence the medical lobby is only looking out for doctors not patients


    100% correct (5.00 / 2) (#69)
    by MO Blue on Thu Nov 14, 2013 at 09:04:44 AM EST
    The broader utilization (5.00 / 1) (#74)
    by KeysDan on Thu Nov 14, 2013 at 09:26:14 AM EST
    of health care professionals is, in my view, a bright spot in health care delivery that is occurring and contemplated.  The established medical profession does not seem to object so long as health care professionals, such as nurse practitioners, serve as their "hand-maidens," but do so if they are to be independent practitioners.

    However, the needs, especially with emphasis on preventative care, will slough off  these entrenched and old-fashioned ideas. Indeed, younger members of the medical profession have a new attitude having trained with a range of health professionals whose contributions are respected and depended upon.


    Not sure of nurse practitioners (none / 0) (#80)
    by CoralGables on Thu Nov 14, 2013 at 09:44:19 AM EST
    but the rules on PA's vary from state to state. Some can practice on their own under the supervision of a doctor who need not be on premises, but have a practice within a set number of miles way.

    Yes, I believe this is the case for (none / 0) (#83)
    by KeysDan on Thu Nov 14, 2013 at 10:17:14 AM EST
    nurse practitioners, as well---depends on the state licensing laws.  In many ways, P.A's and nurse-practioners' responsibilities are similar.  

    I Disagree... (none / 0) (#86)
    by ScottW714 on Thu Nov 14, 2013 at 10:22:50 AM EST
    One of the great flaws of our system is that there are too many indians who think they are chiefs because their are not enough chiefs to service the public.

    I bet insurance companies would love this model, they get to collect the same premiums and pass their clients off to people who work for considerably less.

    Me personally, when I go to the doctor, I want the doctor's opinion and expertise, not anyone else's.  It's what I am paying for.

    That being said, many times I am forced to make an appointment with a doctor when all I really need is an assistant.  Like when I am sick or need a prescription refill.  It's a waste of resources, plus I am positive that when I call in for a refill, the doctor's input is nothing more than a rubber stamp.

    But I suspect the prescription writing ability would never float over at the DEA who already has their nose way too far up the medical industry's collective arse.


    Agree that (none / 0) (#93)
    by KeysDan on Thu Nov 14, 2013 at 11:16:52 AM EST
    the insurance model is to pay less and give less, including to health care professionals.   But, the needs are such that P.A.s and nurse practitioners, for example, will increasingly be deployed for primary care.  And, the days of, essentially, any physician with a medical license winding up in the highest income levels is changing.  Indeed, the earnings of  nurse practitioner and primary care medical doctor are not dissimilar.   Of course, that is one reason that many medical graduates do not chose primary care.

    The VA Medical System makes (5.00 / 1) (#96)
    by Anne on Thu Nov 14, 2013 at 11:34:13 AM EST
    extensive use of physicians' assistants and nurse practitioners; the appointments my husband has at the Baltimore facility are almost exclusively with a nurse practitioner.

    There is extensive off-site communication with them, too.  My husband's been having some problems stabilizing his blood sugar levels, and has been having weekly phone consults to discuss his readings, go over his medication levels and diet.  She is also available by e-mail, and is very responsive.

    It's worked very well for him.


    i have no problem (5.00 / 1) (#97)
    by jbindc on Thu Nov 14, 2013 at 11:36:30 AM EST
    Seeing the nurse practitioner for things like sinus infections.  It's very convenient, since I can go to CVS across the street from my apartment and go to the Minute Clinic, instead of trying to get into see some doctor - when I KNOW I have a sinus infection and need an antibiotic.

    I can (none / 0) (#125)
    by Ga6thDem on Fri Nov 15, 2013 at 11:53:17 AM EST
    appreciate what you are thinking but right now the insurers are saying that they have to charge more for insurance in rural areas because of the provider problem. So right now the rural areas have the worst combination: highest insurance rates coupled with few providers and I suspect an extraordinarily high use of emergency rooms for care.

    Now can we have a public option? (none / 0) (#48)
    by Militarytracy on Thu Nov 14, 2013 at 07:34:43 AM EST

    Curious (none / 0) (#52)
    by CoralGables on Thu Nov 14, 2013 at 07:50:42 AM EST
    why do people like to say "Medicare for all", but rarely does anyone say "Medicaid for all"?

    Because Medicare has age as its (5.00 / 2) (#59)
    by Anne on Thu Nov 14, 2013 at 08:21:47 AM EST
    only requirement for eligibility, whereas Medicaid eligibility is based on financial need.

    There's no shame in saying you have Medicare, unless you hate admitting to being at least 65; tell people you have Medicaid coverage, and the first word that pops into their heads is "poor."  

    Try it sometime...tell someone you have Medicaid coverage and see what happens.  Do they look at you differently?  Are they now judging you because you're wearing expensive running shoes and wondering why the government is helping you with low/no-cost health coverage if you can afford those shoes?

    I can't believe you couldn't figure this out.


    Agreed. (5.00 / 1) (#79)
    by KeysDan on Thu Nov 14, 2013 at 09:40:34 AM EST
    It is also well not to overlook the interrelationship that exist between Medicaid and Medicare--for those who qualify for Medicaid, automatically qualify for extra help paying for Medicare costs and services not covered by Medicare (Medicare is primary, Medicaid is secondary).  Also, Medicaid may help with the payment of Medicare premiums.

    Oh I know the reason Anne (none / 0) (#60)
    by CoralGables on Thu Nov 14, 2013 at 08:35:34 AM EST
    It was rather rhetorical to make people think. Kind of sad at a liberal site that stereotype might still be in play. (not saying it is with you, just noticeable that I have never seen it commented here as "Medicaid for all")

    Medicaid for all was recommended (none / 0) (#63)
    by MO Blue on Thu Nov 14, 2013 at 08:41:23 AM EST
    by one of the Republicans on the site. Can't remember which one.

    And what was the response? (none / 0) (#77)
    by CoralGables on Thu Nov 14, 2013 at 09:29:22 AM EST
    IIRC some people asked why Medicaid (5.00 / 2) (#119)
    by MO Blue on Thu Nov 14, 2013 at 10:40:46 PM EST
    instead of Medicare? No explanation was given.

    I also think that I made a comment questioning how this could be done based on the Supreme Court ruling and the structure of Medicaid itself.

    I don't see the components of Medicaid compatible with universal health care.

    If you maintain the Medicaid cost sharing between State and Federal funding, it runs flat up against the SCOTUS ruling that prohibits forcing the states to accept a Medicaid expansion to a universal system for all.

    If you maintain the means testing that exists in Medicaid, it would also prevent it from becoming an universal health care plan.

    Change those components and you have a system that is basically more like Medicare for all.

    Hey, I'm open to hearing the details on how Medicaid could be changed to become an universal health care system. I just don't see it.



    Thank you (none / 0) (#121)
    by CoralGables on Fri Nov 15, 2013 at 06:37:45 AM EST
    Then as others have stated (none / 0) (#123)
    by MO Blue on Fri Nov 15, 2013 at 11:29:03 AM EST
    in other ways there is such a thing called "good will" involved in the sale of a company or product.

    The brand name and how favorable people react to that name is very important in marketing a product. I will refer you to the polls that were conducted during the run up to passing the current insurance legislation. Any poll that included a phrase similar to "a public option based on Medicare or Medicare Buy In" got higher approval ratings. IIRC at one time a poll came in somewhere in the neighborhood of 70% (from memory - not verified). Without that element, the program did not get even majority approval.

    Medicare has wide acceptance across all political lines. People like it - Medicaid not so much. Now that might be unfortunate, but it is the current reality and that view would need to be changed if you somehow wanted to base your entire system on Medicaid.

    I admit I might not be seeing the forest for the trees but no one has given any reason(s) why pursuing universal Medicaid would be preferable to pursuing universal Medicare.



    I opine (none / 0) (#58)
    by jimakaPPJ on Thu Nov 14, 2013 at 08:20:14 AM EST
    that more people are familiar with Medicare and how it works.

    True truth jim... (none / 0) (#64)
    by fishcamp on Thu Nov 14, 2013 at 08:41:26 AM EST
    One must be basically destitute for 60 months to qualify for Medicaid...no assets, no bank account and really bad health.  Even then many of the locations that accept Medicaid are located in dangerous neighborhoods, at least in Miami.  Of course most neighborhoods in Miami are dangerous.

    I didn't make any comment re (none / 0) (#117)
    by jimakaPPJ on Thu Nov 14, 2013 at 09:44:17 PM EST
    any of that.

    Just why people do what they do.


    Sorry, I wasn't very clear. (none / 0) (#122)
    by fishcamp on Fri Nov 15, 2013 at 07:23:23 AM EST
    I agree more people are familiar with Medicare.  I then went on to some of the difficulties connected with Medicaid qualification.  People with continuing medical problems must get creative to continue treatments.  My friend with bi-lateral below the knee amputation just received a grant from the electric co-op for a hand controlled driving apparatus.  Medicaid pays but reluctantly.

    I wouldn't expect Medicare to (none / 0) (#129)
    by jimakaPPJ on Fri Nov 15, 2013 at 05:13:58 PM EST
    do anything but pay reluctantly.

    But reluctantly is better than not at all.

    The issue remains.

    How do we pay for it??

    The Left will want additional FIT.

    The Right will say no, as will the general public.

    A national sales tax is the only way.


    Really? (5.00 / 2) (#130)
    by Yman on Fri Nov 15, 2013 at 06:44:23 PM EST
    You speak for the "general public", now - and the "general public" agrees with the Right?

    That's pretty funny.

    BTW - Why do you think that the most regressive form of taxation is the only "fair" and (according to you) accepted method of funding it?


    This bit of non-thinking... (5.00 / 2) (#133)
    by sj on Sat Nov 16, 2013 at 02:58:24 AM EST
    How do we pay for it??
    ...annoys the cr@p out of me. We're already paying for it. Except that right now those dollars are going into profits and expenses for insurance companies and dividends to shareholders first and access to care second. I would be thrilled if the thousands of dollars that I am paying annually right now were going into taxes for Medicare for all instead of to the insurance companies.

    Dadler was right. There is a distinct lack of imagination all around here. That lack of imagination and lack of  creative, critical thought leads to pronouncements that [insert puerile solutions here] is "the only way".


    The lack of what??? (1.00 / 1) (#135)
    by jimakaPPJ on Sun Nov 17, 2013 at 01:06:16 PM EST
    The question is simple. How shall we pay the doctors, nurses, etc.??????

    So please, don't avoid the issue.

    Shall we increase our FIT??

    Shall we collect a national sales tax???

    Inquiring minds want to know.

    Except I know what you want. You want someone else to pay for via an increase in FIT.


    What is this "someone else" ... (5.00 / 1) (#136)
    by Yman on Sun Nov 17, 2013 at 04:03:05 PM EST
    ... cr@p?

    Are you under the impression that sj doesn't pay FIT?  Maybe we should apply the same reasoning to your SS payments and Medicare ... cut them off as soon as you've hit the point where you and Mrs. PPJ have taken out precisely what you've put in to the system.


    I don't understand why you can't read (none / 0) (#137)
    by sj on Mon Nov 18, 2013 at 01:54:48 AM EST
    what is written. You can type. You can kind of write. But somehow you never actually read. So I won't bother saying it again.

    It's too bad your mind is too busy inquiring to actually think.

    But I submit that if you gave a dollar for every extraneous question mark you added at the end of your questions, and another dollar for every question you repeat after it has already been addressed, you could probably pay for some d@mn fine health care.


    Nasty nasty, eh?? (none / 0) (#139)
    by jimakaPPJ on Mon Nov 18, 2013 at 01:49:09 PM EST
    My point was that you paying your taxes won't solve anything.

    I even gave a solution.

    Sorry if that was too complicated.


    Oy (none / 0) (#140)
    by sj on Mon Nov 18, 2013 at 02:05:52 PM EST
    Do you read yourself?

    You expose the true reason (none / 0) (#62)
    by vicndabx on Thu Nov 14, 2013 at 08:40:59 AM EST
    we as a nation can't get our costs under control.

    No one wants to get $hitty service.


    Funny how other countries can provide (5.00 / 4) (#66)
    by MO Blue on Thu Nov 14, 2013 at 08:45:33 AM EST
    good quality universal health care at a fraction of the cost that we pay. Instead of good quality affordable health care, we get $hitty insurance.

    Republican stuff, that's rich (none / 0) (#87)
    by Abdul Abulbul Amir on Thu Nov 14, 2013 at 10:27:00 AM EST

    Washington (CNN) - Senate Democrats voted unanimously three years ago to support the Obamacare rule that is largely responsible for some of the health insurance cancellation letters that are going out.

    In September 2010, Senate Republicans brought a resolution to the floor to block implementation of the grandfather rule, warning that it would result in canceled policies and violate President Barack Obama's promise that people could keep their insurance if they liked it.

    The Dems own this Charlie Foxtrot Tango lock, stock, and barrel.  Obamacare passed the senate with every Repub voting against the disaster, and passed the house against bipartisan opposition with only Dems voting in favor.

    If you like your health plan, you can keep your health plan.  Period.

    A big fat lie.

    If you like your doctor, you can keep your doctor.  Period.

    A big fat lie.

    $2,500 premium savings for a family of four.

    Hardy har har.


    AAA, I believe Slado has already informed (none / 0) (#94)
    by vml68 on Thu Nov 14, 2013 at 11:19:27 AM EST
    all of us of the "big fat lies", ad nauseum.

    Perhaps he has (none / 0) (#118)
    by jimakaPPJ on Thu Nov 14, 2013 at 09:46:54 PM EST
    but then again we wouldn't want to forget.

    Elections have consequences.


    No (5.00 / 1) (#127)
    by Ga6thDem on Fri Nov 15, 2013 at 12:00:00 PM EST
    elections only have consequences for Democrats is what you say. It has ZERO consequences for Republicans and even losing the popular vote has ZERO consequences when it comes to governing is what Republicans think.

    Well, no Repubs voted for Obamacare (none / 0) (#128)
    by jimakaPPJ on Fri Nov 15, 2013 at 05:10:37 PM EST
    If the shoe fits, wear it.

    No (5.00 / 1) (#132)
    by Yman on Fri Nov 15, 2013 at 06:47:41 PM EST
    Baa waa waa (none / 0) (#138)
    by Ga6thDem on Mon Nov 18, 2013 at 06:24:59 AM EST
    and the GOP voters voted FOR it back in 1996. I guess Obama should have gotten the message back then when it was Bob Dole's proposal for health insurance that the voters really did not want it. LOL.

    Really? (5.00 / 1) (#131)
    by Yman on Fri Nov 15, 2013 at 06:45:49 PM EST
    So you voted against GW for all of his lies?