American People: Fix ACA

CBS Poll:

Just seven percent of Americans think the Affordable Care Act is working well and should be kept in place as it is. Far more, 48 percent, think there are some good things in the law, but changes are needed to make it work better, and another 43 percent think the law needs to be repealed entirely.

(Emphasis supplied.) Mend it, don't end it.

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    California, Kentucky, and Connecticut (5.00 / 1) (#1)
    by CoralGables on Wed Nov 20, 2013 at 08:33:56 AM EST
    all say enrollment is now exceeding expectations. All three obviously maintain their own well run websites.

    California with "Covered California", Kentucky's is "Kynect", and Connecticut has "Access Health CT"

    And other states (none / 0) (#13)
    by jbindc on Wed Nov 20, 2013 at 09:46:41 AM EST
    Maryland, for one, are having huge problems.

    And it's now being used as a wedge (5.00 / 2) (#21)
    by Anne on Wed Nov 20, 2013 at 10:17:56 AM EST
    in the governor's race, since Anthony Brown, the current Lt. Governor and a Democratic primary candidate, was responsible for the MD rollout.

    I'll keep an eye on how that goes.


    And could hamper (5.00 / 1) (#24)
    by jbindc on Wed Nov 20, 2013 at 10:36:41 AM EST
    Any higher political aspirations Martin O'Malley has.

    We can only hope that, come January 1, (5.00 / 5) (#8)
    by Anne on Wed Nov 20, 2013 at 09:29:19 AM EST
    those people who've signed up for brand new insurance coverage on the exchange, or through state exchanges, will find that it lives up to their expectations, and we don't begin another whole round of "problems."  Not that we haven't already had years and years of problems between subscribers and insurance companies/providers, but the people who are just getting into insurance now are new to that game.  I don't know what their expectations are - will they think it's going to be easy-peasy, and be disappointed to find out what those of us who've had insurance all along have been dealing with?  I hope not, but my trust level for the insurance companies isn't all that high.

    But here's another thing: I don't really understand how anyone can say the ACA is or isn't working well, since no one who has new coverage under an exchange plan is able to use it yet.  And I don't think the quality of the coverage can be measured by the quality of a website.  Especially since the website is just the gateway - once you've signed on, you're not dealing with healthcare.gov, you're dealing with Aetna or CareFirst or United Health, etc.  That's where the premium notices will come from, where the explanations of benefits will come from.  When you have a question about your coverage, healthcare.gov isn't going to be able to answer it.  So, while the federal website will continue to exist to facilitate the enrollment of people as they enter the insurance market, or who are already on the exchange and want to change plans, how the website functions isn't going to have anything to do with how the coverage - and the insurance company providing it - perform.

    The states that established their own exchanges, and where the enrollment process is working well, prove that it is possible to design a user-friendly website, but I think it remains to be seen whether that translates to people having a positive experience with the coverage itself.

    So, I'd think that polls asking people to rate how the ACA is working might have more credibility if they weren't taken until maybe a year from now, when there is a body of actual experience with ACA-compliant and -exchange-based plans.

    It makes me question the ulterior motives of whoever's commissioning these polls - I doubt this is about "information" as much as it is about "influence" - i.e., if 93% hate it, it must not be any good.  It's why I really kind of hate polls, in general.

    You've hit on something (5.00 / 2) (#14)
    by Slado on Wed Nov 20, 2013 at 09:48:03 AM EST
    Proponents just keep assuming this thing will turn around.

    What evidence other then unjustified hope leads us to that conclusion?

    The employer mandate shoe hasn't dropped yet.   FYI, millions more are going to loose their insurance next year when that happens.

    Nothing has worked as advertised.   It's more expensive then promised, doesn't deliver as promised and isn't being rolled out as promised.

    I for one am skeptical and think the best option is to gut it and find some money to pay for what we can't do which is take away the insurance of the millions on medicaid and the millions who already lost it because of this terrible law.


    Just go to single (5.00 / 4) (#17)
    by Ga6thDem on Wed Nov 20, 2013 at 10:01:46 AM EST
    payer. As long as the for profit private insurance model is the basis of anything it is bound to fail. It was already failing. The jig is up for the insurance companies current model. They can either turn themselves into nonprofits to survive or stick to selling property and casualty.

    You know, if we went to (5.00 / 2) (#54)
    by Zorba on Wed Nov 20, 2013 at 01:06:31 PM EST
    Medicare For All, there would still be a role for the insurance companies, selling supplemental insurance for things not covered by Medicare.  They just wouldn't be making the piles of dough they make now.  (Which, of course, is the main problem.  For them, and the politicians.)
    The politicos could have advocated for single payer originally, just by calling it "Medicare For All."  The ads promoting this would have written themselves.  "Does your granny like her Medicare?  Wouldn't you like to have that, too?  Medicare For All."

    Don't accept that (none / 0) (#107)
    by jimakaPPJ on Thu Nov 21, 2013 at 06:07:51 AM EST
    "selling supplemental insurance for things not covered by Medicare."

    Our supplemental just tripled.

    100% coverage of everything.


    That's (5.00 / 1) (#118)
    by Ga6thDem on Thu Nov 21, 2013 at 07:50:37 AM EST
    because you live in Tennessee. States in the south that have really no consumer protections against the insurance companies are the ones taking the big hit on everything.

    As long as we in the south allow this to happen it is going to continue to happen. The little guys are supposed to pay for everything in the south while the corporations don't pay taxes or pay very little taxes.


    Don't believe that (none / 0) (#111)
    by Yman on Thu Nov 21, 2013 at 06:25:16 AM EST
    The average Medicare Advantage plan premium actually decreased 16% between 2010 and 2012.  The average increase for 2013 was projected to increase only $1.47/month, to $32.60.  Even if your claim of a 300% increase is true, your experience - as usual - isn't representative of people as a whole..

    Thanks for calling me a liar, (none / 0) (#117)
    by jimakaPPJ on Thu Nov 21, 2013 at 07:44:06 AM EST
    you dofus.

    But then that is what you do.

    Oh well, it's time to put My Shadow back on the ignore list.


    I didn't SAY you ... (none / 0) (#162)
    by Yman on Thu Nov 21, 2013 at 06:56:29 PM EST
    ... were a liar, Jim.  Maybe, while everyone else's Medicare supp premiums have decreased or increased slightly, yours magically tripled.

    Or ...


    They Will Be Fine... (none / 0) (#37)
    by ScottW714 on Wed Nov 20, 2013 at 11:32:22 AM EST
    ...just double my homeowners insurance, again, never lower my car insurance, even though in 20+ years of driving I have never filed a claim or had an accident.  And I am positive my life insurance is way too low for the number of drinks I consume in any given month.

    And you base that statement on ... (5.00 / 1) (#68)
    by Donald from Hawaii on Wed Nov 20, 2013 at 02:51:43 PM EST
    Slado: "FYI, millions more are going to loose their insurance next year when that happens."

    ... what, exactly -- the talking points you found in your in-box this morning?

    Did islanders lose their coverage when the Hawaii state legislature enacted the HI Pre-Paid Health Care Act of 1975? Did Massachusetts residents lose theirs when the MA Affordable Care Act, aka "Romneycare," took effect in 2006? I ask that, because both Hawaii and Massachusetts are the two practical working experiences which the federal ACA seeks to replicate on a nationwide level.

    And the answer is no, they did not, on either count. In fact, some 36 months after the respective effective dates of the enabling legislation, both states were able to truthfully claim that over nine in ten of their residents now had health care coverage.

    Today, both those unrepentant bastions of American liberalism enjoy robust economies with corresponding low unemployment rates, and both have further fared much better than many so-called "right to work" states during the recent economic downturn, thanks in significant part to their healthy and stable workforces.

    Your hyperbolic contention is completely groundless.


    You (none / 0) (#73)
    by lentinel on Wed Nov 20, 2013 at 03:45:57 PM EST
    are the king of talking points.

    You shouldn't be throwing stones....


    Speaking for myself only, I happen to have considerable experience in the area of public policy development on the state level, including public health. Can you say the same?

    You know something else, dude? I'm proud of the various direct and tangential roles I played over the years in seeking progress and betterment, even if we're sometimes moving forward by only a few yards. I'll make no apologies to you or anyone else for my work and activism, or for sharing my personal knowledge and experiences in the hope that it might inspire others to undertake similar initiatives in their own respective locales, so that they might perhaps make a significant difference on behalf of the greater good.

    Again, can you offer anything comparable? Personally, while I'd be very pleasantly surprised to learn otherwise, I very seriously doubt it. And that's simply because I've met far too many political bleacher bums over the years to either need worry about you as a potential adversary, or count on your help and support during critical periods of intense activity.

    And you know why I think that? Because when I worked in the public sector, you're exactly the type of person who wouldn't hesitate to call me up at my office, and then proceed to tell me both how to do my job and what I'm doing wrong. You're the guy at the meeting who just loves to criticize my perceived mistakes, and who gets off on pointing out my shortcomings to everyone, regardless of whether it's done in public or in private.

    And then, often in the very next breath, you'd be that guy who offered all sorts of personal excuses in order to avoid making any commitments on behalf of the very causes you ostensibly espouse -- only to show up just in time for the photo op and celebration, as we proclaimed a victory or success.

    That way, you never have to risk a public defeat or failure, and endure any attendant personal embarrassment or even humiliation. You won't be seen as having lowered yourself to the base level of those whom you perceive as your moral inferiors and intellectual subordinates. And you can continue to pretend -- even if only to yourself -- that you're somehow so far above it all, as to be excused from ever having to get your hands dirty.

    In the meantime, just pardon me all to H*ll for getting off my a$$ and trying to walk the walk and fight the good fight on a near-daily basis, both in my professional life and in my political activism, sometimes successfully and other times, probably not so much.

    I've always freely admitted that I'm far from perfect. I make mistakes. I sometimes show questionable judgment and impatience. When I get tired, I tend to not suffer fools lightly and can be very curt and short with others. I'll laugh inappropriately once in a while at a crude or offensive remark, when I should really know better. I'll shoot the occasional brick from the free throw line, or get caught looking on a strike three call with the bases loaded and two outs.

    But just who do you think you are, my friend? Well, from my standpoint and strictly my opinion, you are likely what the kids here in the islands call "all show, but no go." You are the stereotypical salon liberal who loves to wear your causes so prominently on your sleeve, yet I suspect that there's actually very little if any room in your own heart for the type of faith and passion which can otherwise compel one to action or decision.

    Because were there otherwise, you'd be out there working the corridors at city hall, testifying at the state capitol and meeting with your public officials. You'd be organizing like-minded citizens and residents within your community, or manning public information booths at local fairs to get the word out. You'd be stuffing envelopes, making phone calls and holding campaign signs. Further, you'd be sharing those experiences with all of us here and showing me your game, rather than merely babbling on about the issues ad infinitum.

    And that's what renders guys like you a dime a dozen and a nickel a bushel. For at the end of the day when all is finally said and done, it's really all about you and only you, and just as it's probably been all along, you are one with your own agenda.

    And quite honestly, that makes you no different from all those self-absorbed political hucksters in D.C. and elsewhere, of whom you purport to so thoroughly despise.

    As for myself, I tend to not care about others' opinions of me when I have every confidence that what I'm saying or doing is right and correct. Painfully flawed creature that I am, at least I'm still out there scrapping, and putting one foot in front of the other. I know where I'm going because I know where I've been, and while the dogs may bark, the caravan will pass.

    Aloha. Have a nice life.


    Oh, good...it's been a while since we've (5.00 / 3) (#99)
    by Anne on Wed Nov 20, 2013 at 10:01:00 PM EST
    been treated to one of your haughty and insufferable skewerings.

    Not that I haven't ripped someone from time to time, but you do something I don't think I've ever done, and that's question someone's value as a citizen because you think your own experience and contribution are worth soooo much more.  And you do it with no knowledge of what lentinel is or isn't doing, or what contribution he makes off-blog.

    You must have gotten a new and larger tote for your massive ego, one with enough room for the large mirror in which you can gaze adoringly at your wonderful self.

    [excuse me, I'm feeling the urge to vomit]


    Anne, I actually quite (2.00 / 2) (#103)
    by MKS on Wed Nov 20, 2013 at 11:08:06 PM EST
    enjoyed the post....

    Donald and Christine have actually accomplished stuff....And you guys rip them.....Wonderful.


    You have no idea what anyone has accomplished (5.00 / 4) (#105)
    by shoephone on Thu Nov 21, 2013 at 01:09:38 AM EST
    unless he/she chooses to crow about it, incessantly, and for the express purpose of silencing others. Consider how many people post comments here in just one week, whether regular or infrequent commenters. Now tell me that you are able to discern exactly how many of those have "accomplished" something?

    This little game has become insufferable bullsh*t of the first order.

    I was brought up to believe that the people who brag the most are usually the ones who have accomplished the least.


    shoephone, I have (1.00 / 1) (#122)
    by MKS on Thu Nov 21, 2013 at 09:33:29 AM EST
    to admit your biting comment is quite effective:  It will deter people from talking about themselves for fear of being labeled a braggart.

    I for one am far more interested in people's actual experiences than regurgitated, half baked analysis....

    And, indeed, I would actually be far more interested in your actual experiences than your attempted shout down of those who share what they have done.   Your post is one that attempts to censor.  That is going in the wrong direction.

    What is different about this site and DKos is that you get to read what real people are doing and interact with them on that basis.  That is the magic of these sites.  And you just dumped all over that.   I can read endless criticism of Obama or his administration or Pelosi any number of places.  And others do it better than is done here.  I can tune in Fox or read the National Review or the Wall Street Journal.

    If you p*ss on people when they share personal experiences, they're less likely to share again.


    MKS, you are nothing but a whiner (4.25 / 8) (#152)
    by shoephone on Thu Nov 21, 2013 at 02:52:50 PM EST
    All you want to do is get into p*ssing matches with people about who's higher up on the food chain of age, experience, and career. Your recent attempts to play gotcha with Yman over what kind of law he practices (not as impressive as what you do!!) and how old he is (not as old as you!!) to prove you're on some higher plane of intelligence and experience (he's not worthy!!) was so f*cking immature--and insecure--I could hardly believe we all had to be subjected to it. For what it's worth, he isn't the age you you assumed. And I find his ability to back his arguments up with links and facts to be very convincing. Whah whah. Go blow your nose.

    Unlike you, I'm not impressed by anyone's credentials, and what they claim they've accomplished--before an audience of people on a blog, for chrissakes--and I AM more interested in people's opinions and analysis, because I'm interested in ideas. I'm not interested in braggarts.

    I've known lots of politicians in my life, I know quite a few now, and despite what you and Donald and Christine would have us believe, they ain't all that. It generally takes a lot of money and alot of who-you-know to get elected. Most of the politicos have egos as big as the planet, and big mouths to match. I think most of them are useless, and fill up space. That's been my experience.

    My private life is none of your g*dd*amn business. My past history in political activism is none of your g*dd*mn business. If I choose to share some of it here, that's my prerogative, not something you're entitled to.

    Lentinel doesn't owe you any explanations at all. His life is none of your g*dd*amn business either. But now that he's ponied up a hint about his past affiliations with a known quantity of the Democratic party (ooh, ooh, he said Jerry Nadler!!), you and Christine are suddenly impressed and intrigued. How transparent and pathetic is that?

    I repeat: You have no idea what anyone here has accomplished, unless they want to crow about it to make a point.

    There are dozens of really smart and interesting people commenting here, people who get me thinking and inspire me to research things and learn more. And, lo and behold, they aren't the people who spend all their time crowing about themselves and how much better they are than the rest of us! I don't know what their credentials are, and I don't care. I see how their minds work. That's really all that matters to me.


    I never asked about (5.00 / 1) (#156)
    by MKS on Thu Nov 21, 2013 at 05:37:13 PM EST
    your background and experience.  Frankly, given your viciousness, it would not be of interest.

    As to others, I am glad when they share.


    Too funny (5.00 / 1) (#165)
    by sj on Thu Nov 21, 2013 at 08:05:17 PM EST
    Frankly, given your viciousness, it would not be of interest.

    So much hostility (3.00 / 2) (#155)
    by MKS on Thu Nov 21, 2013 at 05:29:24 PM EST
    And you want discussion.  Not really.

    You want only your kind of discussion.  


    How's your conversion rate? (3.00 / 2) (#157)
    by Edger on Thu Nov 21, 2013 at 05:37:47 PM EST
    Find a buyer yet?

    And you? (1.33 / 3) (#158)
    by MKS on Thu Nov 21, 2013 at 05:40:44 PM EST
    Planning another rocking throwing protest about globalization.....Just like Seattle? That is you right?

    Every time you reference Seattle "riots" (5.00 / 3) (#168)
    by shoephone on Thu Nov 21, 2013 at 10:14:25 PM EST
    you sound like a stupid old jack a$$. Try talking about things you actually know about, Mr. Genius With The Oh-So-Impressive CV.

    Throwing rocks doesn't make you (5.00 / 1) (#170)
    by jondee on Sat Nov 23, 2013 at 03:33:25 PM EST

    The Tony Blair's of the world when talking about Seattle remind me of Orson Welles on the ferris wheel in The Third Man: "Look at those insects down there..they'll never understand.."


    It was a simple yes or no question (none / 0) (#159)
    by Edger on Thu Nov 21, 2013 at 05:42:10 PM EST
    Too complicated?

    And yet...you share nothing. (3.00 / 2) (#124)
    by Anne on Thu Nov 21, 2013 at 09:56:54 AM EST
    which puts you in the category of those providing
    "regurgitated, half baked analysis," doesn't it?

    You should look up the meaning of "hoist by your own petard."


    Is that a request, Anne? (none / 0) (#129)
    by MKS on Thu Nov 21, 2013 at 10:24:18 AM EST
    You had asked for my c.v. awhile ago.....

    I would be happy to discuss.  What would you like to know?


    Nah (5.00 / 1) (#143)
    by sj on Thu Nov 21, 2013 at 11:59:25 AM EST
    No reason to suffer through your form of "discussion".
    You had asked for my c.v. awhile ago.....

    I would be happy to discuss.

    A posted link would be fine.

    No, it's not a request. I'm not one of (5.00 / 1) (#153)
    by Anne on Thu Nov 21, 2013 at 03:22:35 PM EST
    those people who has to know what someone does or where they live or where they went to school or how many degrees they have in order to form an opinion about whatever it is they're saying here.

    I admit (none / 0) (#151)
    by sj on Thu Nov 21, 2013 at 02:31:05 PM EST
    I hadn't seen that as your goal.
    If you p*ss on people when they share personal experiences, they're less likely to share again.
    I mean, I should have, but I thought you were just being you when you were doing the p*ssing.

    It also explains why you don't share personal experiences.


    Well, you got me on this one (none / 0) (#160)
    by MKS on Thu Nov 21, 2013 at 06:32:25 PM EST
    Anne says she doesn't care; you apparently fault me for not sharing...

    What's a person to do?

    Christine's point does make sense,though.


    ::shrug:: (none / 0) (#164)
    by sj on Thu Nov 21, 2013 at 08:03:34 PM EST
    Who said I faulted you? I just said that explained a lot. Everybody has reasons for what they do, even if it seems inexplicable to those around them. And it's sometimes inexplicable even to themselves, for that matter. I don't see human nature changing any time soon.

    Yes, Donald and christine never fail (5.00 / 4) (#113)
    by Anne on Thu Nov 21, 2013 at 06:43:33 AM EST
    to remind us of their vast and valuable contributions, but Donald usually whips his out for the express purpose of believing he can shame and intimidate others into shutting up.

    This is a blog, a place where people come of their own volition and own interest to express their opinions and engage others on subjects that matter to them.  For the most part, the people who comment here are well-informed on the issues, they vote, they do what they can when they can to hold their representatives accountable.  They bring information, perspective, passion and compassion, and mostly manage to do so in a civil, respectful way.

    We may disagree with each other, and those disagreements may get heated.  Because we care.  Which is more than we can say for a lot of people these days, and yet Donald takes it upon himself to judge and deride and belittle those whom he thinks devote less of themselves to the cause out in the real world than he does.  

    That we all aren't tooting our own horns all the time doesn't mean we don't all make valuable contributions.  It's all well and good to provide context for our opinions, to share our experiences, but it's possible to do that without a tone and a message that implies we think we're so much better than everyone else because of them.

    And let's face it, MKS, your support for Donald and christine is as much because when they fire the experience cannon, it's usually aimed at someone you don't like and whom you regularly downrate as it is because you admire and respect what they've said they've accomplished.  Try to imagine Donald's abusive and belittling invective questioning your value as a citizen and your right to "complain" and maybe you wouldn't find his shtick quite as admirable.  I'm pretty sure that if I were the one using the christine tactic of shining the bright light of interrogation on you as I insist  you admit your true agenda, and suddenly, maybe you don't have as much respect for that tactic, either.

    No one's telling Donald or christine - or you or Politalkix - that you can't express your opinions unless and until you somehow prove your worth as a citizen, so I have no idea why you find so much to admire in that approach as you apparently do, except that it's aimed at people with whom you do not agree politically or ideologically.

    Question people's opinions, their sources for information, the conclusions they reach - but questioning their value to society and their commitment as a citizen verges, in my opinion, on the kind of thing we saw in the McCarthy era.  

    It's disappointing that you apparently support that.


    I actually value (3.50 / 2) (#121)
    by MKS on Thu Nov 21, 2013 at 09:21:57 AM EST
    what others have accomplished and would like to hear more.  It sure beats the rat-a-tat-tat of talking points criticism that can be found from any number of different sources.

    If Donald were to question my value, as you posit, I would say I want to have value, and ask him how I can get an invite to the next big soiree.

    If Christine were to question my liberal bonafides, as you posit, I would be flattered that it is acceptable to talk about myself, and would go on for as long as someone seemed interested.

    What you do not acknowledge is that many comments here are laden with invective by you and others like you even if such invective is cloaked in an avalanche of words.  Take for example your post immediately above to which I am responding. Do you think it a reasoned attempt at discussion?  Of course not. You basically accuse me of McCarthyism.  The worst insult a liberal can dish out...Nice...

    Anne, no one has silenced you, or even been able to reduce your posts by even one paragraph.  There is no effort to silence you.  Your assertion of McCarthyism is baloney, a reach for a stock insult.

    What you are doing is dissuading people from sharing their personal experiences by accusing them of McCarthyism if they do so.  Who is the censor here?


    Anne: Am I supposed to return the favor (2.00 / 1) (#123)
    by christinep on Thu Nov 21, 2013 at 09:56:35 AM EST
    now and personally call you something, some not so nice adjectival something.  That is rhetorical, and not a question.  I'll choose another path ... do not have the taste for character psychoanalysis these days.

    'Did want to note, however, your remark in this thread in which you acknowledged an occasional "rip" of other commenters here ... while you appear to castigate Donald for his "rip."  Are some rips good and some bad; is the measurement in the eye of the beholder?  

    BTW, while we all get up on that infamous high horse periodically, I value Donald's experience.  He speaks from a perspective that can be quite helpful to those who want to work on the community and regional political level.  For one thing, his commentary about the state-of-politics in Hawaii is an eye-opener.


    I'd be happy for you to return the favor (5.00 / 1) (#125)
    by Anne on Thu Nov 21, 2013 at 10:03:42 AM EST
    if I had actually called you anything, christine, but I didn't.  I described one of your tactics, but I didn't call you anything.  This is a concept you seem to have some trouble with.

    And if you had bothered to take in the totality of my comment, you'd note that I made a distinction between the ripping we all do from time to time, and the kind Donald employed, wherein he demeaned and belittled lentinel's value as a citizen.  That's something I have never done.  I can disagree with someone 24/7, but I am not going to take the position that I am a better person or a better citizen because I think my experiences are inherently more valuable than someone else's.


    Beg to differ, Anne (none / 0) (#128)
    by christinep on Thu Nov 21, 2013 at 10:15:06 AM EST
    The technique that you ascribe to me is a method for ascribing a characteristic ... and, btw, your conclusion that I use a particular technique relating to experience is faulty.  We disagree as well on how we characterize what is acceptable.  IMO, you like your style and I like mine.  Frankly, that is really what it comes down to ... no matter the words we use to deny it to each other.

    Curious... (5.00 / 3) (#134)
    by lentinel on Thu Nov 21, 2013 at 10:53:00 AM EST
    I tend to not care about others' opinions of me when I have every confidence that what I'm saying or doing is right and correct. Painfully flawed creature that I am...

    Interesting how you could contritely acknowledge that, like many, you are a painfully flawed creature - and yet have "every confidence" that what you do and say is right and correct.

    One is left to suppose you consider that your painful flaws in no way impact upon your actions or utterances.

    You must have an interesting filter.

    Serious, Don.
    Can't you just offer an opposing opinion without assaulting someone - and offering yourself as someone speaking from Mount Olympus or Mount Sinai?


    I was with you, Donald, (2.00 / 2) (#101)
    by MKS on Wed Nov 20, 2013 at 11:02:35 PM EST
    until you admitted to taking a third strike with runners in scoring position....Can't do that.

    But you hit the nail on the head:  The complaining here is probably inversely proportionate to actual efforts to secure votes and effect change.


    MKS (5.00 / 2) (#106)
    by lentinel on Thu Nov 21, 2013 at 05:43:05 AM EST
    You really have no idea about the efforts on the part of people writing here on TalkLeft. (Jerry Nadler asked me and got me on the Democratic ticket some years ago in NYC at a time when I was interested in Democratic party politics.)

    What I object to with Donald is that instead of dealing with the content of what a person has written with which he disagrees, he resorts to nasty, kindergardeny ad hominum attacks.

    If one criticizes Obama, he calls you a hater.
    (He likes to write it, Huffpo or Kos style as, "h8ter"...)

    Or above, he marginalizes Slado as someone using "talking points" - as if his own comments are immune from such a designation.

    That is why one cannot converse with Don.
    He assaults the person (the person he imagines) instead of dealing exclusively with content.

    If he is someone who believes that the average Joe or Jane cannot criticize or be contemptuous of a public official unless meet his selective criteria, I can't imagine why he is interested in this website which describes itself as "Left".

    Personally, I respect the opinion of anyone out there. Everyone has a personal experience. Everyone is affected by government policy.

    I will go so far as to say that what he is expressing is inherently dangerous. It is a small step from having activity in partisan politics as a requirement for expressing an opinion - to having some specific social requirements to allow people to vote.


    I'd like to hear about the background (3.50 / 2) (#127)
    by christinep on Thu Nov 21, 2013 at 10:09:21 AM EST
    Sharing the Nadler story and what you learned there can be helpful.

    Really, lentinel.  Speaking only for myself, I find it much more valuable to hear about political experiences that led you to where you are ... what worked, what didn't, were there any examples of local political types that taught you something important (good & bad.)  Admittedly, screeds and general statements of belief and political venting have tremendous value ... but, when people like myself employ the same political arguments with the same people here again and again doesn't the value diminish?  Doesn't the value diminish, then, throughout the blog in terms of advancing genuine respect, knowledge, and appreciation of the whole experience?  Maybe I'm on an idealistic tear this morning, but it would be nice for us to move beyond our almost assigned roles...don't you think?


    During (5.00 / 3) (#132)
    by lentinel on Thu Nov 21, 2013 at 10:44:57 AM EST
    my brief foray into democratic party politics - attending local meetings, etc. - what I discovered soon enough was that while people could express their feelings - as on this site - the people in control were only interested in electing democrats - as if that would in and of itself change anything.

    So, I stopped attending.

    To get anything changed, one has to buck a seriously entrenched system that is interested primarily in self-preservation. And if one gets really active - and is perceived by higher-ups to threaten the status quo - there is an uneasy feeling that ones kneecaps are in danger.

    I experienced the same thing when I was active in the Union movement. You could express your thoughts, ideas and ideals... but if you appeared to be a threat to the people in leadership positions, there was a sense of menace.

    People like Donald think - at least it appears to me - that if they support a party position, they are on the side of right - or at least less wrong. He is all puffed up because of his work for the party.

    I didn't find it so.
    And, frankly, people who really really want to assume leadership positions must have the resources ($$$$$) and time to do it.
    I have neither.
    The other thing that can change things are truly inspirational people who are on the grassroots level. People like King and Malcolm. But, once again, when things appear to severely threaten the entrenched powers, it can become quite dangerous - and even bloody.

    All I can do is express my opinions and go about my work and my life in a way that best expresses those beliefs.

    I don't pretend to have answers.
    Like anyone, I only know what I feel.


    FWIW, what you describe (5.00 / 1) (#148)
    by christinep on Thu Nov 21, 2013 at 01:58:24 PM EST
    about organizations and meetings--in this case, local Democratic Party meetings and some Union gatherings--is something I experienced years ago as well.  Example: When raising questions or issues as a student precinct committeewoman at county meetings I was typically ignored because the "can't hear you, could you speak up" excuse was employed (my take: keep the young woman in her place)etc.  At a point, I worked at getting in the inner workings and played the protégé role ... but, resented it. Eventually, they began to hear me.

    I think what you describe happens more than we might want to admit.  Not just in Democratic Party politics, not just in other large organizations like Unions ... but, naturally, in corporations and in the big bureaucracies of any government and even religious organizations.  I never have liked that pattern; but, it does seem that the inner core and the long-timers in many organizations (even the best of movements) tend to drift toward groupthink by regarding the knowns as more knowledgeable/innovative/creative than the newbies.  

    Paths diverge often depending upon trade-offs, upon our own personalities.  Sometimes fortune intervenes.  The trade-off for me has been decisions to stay with certain organizations (work, politics, certain relationships) after determining that I could make a difference by staying. OTOH, that decision meant curbing some of my outspoken tendencies from time to time (tho, happily, nowhere near always.)  When I've been asked about future employment suggestions by younger relatives et al, that dilemma --about what degree of individual say-so and expression--is near the top of the list.

    Maybe it isn't always different beliefs that define us ... but rather our own personalities and, if we are true to our person, how we mesh those political beliefs with where we are and where we fit in a movement. (An old Saul Alinsky bit of organizational advice on movements and compatibility therein.) You seem to have followed your heart as well as mind.

    Thank you, lentinel, for recounting your experience.


    Thank you (none / 0) (#149)
    by lentinel on Thu Nov 21, 2013 at 02:15:22 PM EST

    Why are political experiences more (5.00 / 3) (#135)
    by Anne on Thu Nov 21, 2013 at 10:56:06 AM EST
    valuable in the formation of one's opinions than life experience?

    Are you suggesting that by virtue of sharing your political experience that your comments do not ever sink to the level of "screeds" and "venting?"

    I mean, the "political experience" of the vast majority of people is probably limited to voting, but their voting is often determined by what matters to them in the lives they're leading.  And if you are going to take the position that their opinions are less valuable because they don't come from the same kind of place yours do, you're forgetting that all of our votes are equal - your vote doesn't count as a half-vote more because you have actual political experience, and someone else's is not discounted for lack of same.  

    At some point, there begins to be a sense of people feeling they have to prove to your or Donald's satisfaction that their opinions have more credibility - and while you can choose to discount or ignore or disagree with anyone's opinion, you should also be aware that just because you have some experience doesn't set it off to the side, never to be questioned or challenged.  And yet, both you and Donald fairly bristle whenever anyone does.

    This is a blog, christine, not a 12-step program, or group therapy.  While it's certainly "interesting" when people share more personal information, not everyone is comfortable sharing enough detail of their experiences that their identities could be sussed out.  

    And as I suggested to one of the interchangeables, I don't see you wanting more experience stories from those with whom you agree, so in some respects, I see this whole thing as more than a little disingenuous.


    A couple of things, Anne (none / 0) (#147)
    by christinep on Thu Nov 21, 2013 at 01:11:29 PM EST
    First: As for experience stories, everyone here has a valuable experience.  That is not mush.  Those experiences fill us out, help us to become who we are.  Because the occasional sharing of an experience has a way of humanizing us on a screen, that blog experience can impart surprising and not-so-surprising gems ... the kinds of gems that lead to an "Aha, I understand" "I get it now."

    Two:  There are a number of specialties and broad interest areas to be found on this blog.  Some share fishing stories, food stories, sports stories, newspaper flashes and their meanings, stories about their families' happy and less-than-happy moments and ... yes .. politics.  In keeping with the political motif of TL, political discussions are a natural, expected biggie. We all have different areas of expertise.  We have different interests.  We have different approaches to things political too ... and, in those discussions, it should be okay to acknowledge those differences.  

    To acknowledge those political differences, there is certain amount of sense in wanting to understand what drives a person in order to have an open, honest discussion.  The political drives ... e.g., is a person a Democrat, Republican, Third Party, no party, apolitical, etc.  It isn't a judgment or even evaluation of the person; but, rather, the understanding that a person is a staunch Democrat (e.g., moi) or an individual whose experience with party politics has left rather negative feelings about the process (see lentinel's sharing statement) or a uniquely NY sorta Libertarian (a compilation of kdog's comments or ?????   Understanding "where one is coming from" takes the discussion from either the theoretical interchange and/or from the trading of barbs, escalating disagreements--I believe--to a growing acceptance of the diversity of opinions here among considerate people.  

    An experience of mine that has always remained with me actually occurred over an almost two-year period in the late '90s.  It involved a project that I reluctantly walked into ... the members were 2 EPAers, 2 or 3 State regulators, 3 industry reps, and an SBA ombudsman.  What started as an interchange of ideas (driven, in part, by earlier EPA regs and State requirements and a previously resolved--but not forgotten--enforcement action) evolved to full-fledged engagement at multiple level.  We drafted a pamphlet designed to be read by the many store operators in this industry to minimize pollution associated with the industry's many service components ... complete with graphics and one that we could all read.  But, it wasn't the pamphlet so much as the process and the relationships of human trust that grew when we got past misapprehensions, our own images, and what not.  The growth of the representative trust led to a mutual product that was recognized and used as a guide to prevent pollution.  In all my years at work and in spite of my initial misgivings, it would become one of the more effective results I had the fortune to see in those years.  That sure was a learning experience for me ... and, I employ it to remind myself that understanding others' driving forces is not only useful, but indispensable, to advancing collective goals.


    lentinel, (none / 0) (#133)
    by MKS on Thu Nov 21, 2013 at 10:52:56 AM EST
    I liked the part about Nadler.  

    The accusation of being "dangerous," not so much.  Labeling someone's comments as dangerous is what reactionaries do.  


    I didn't (5.00 / 1) (#146)
    by lentinel on Thu Nov 21, 2013 at 01:01:08 PM EST
    say that his comment was dangerous. At least I didn't mean to.

    What I was trying to express was that if we are going to set up specific criteria to allow people to express an opinion, it seems to me to suggest that we can also set up specific criteria to allow people to vote. They must have a certain education. They must have participated in some political party. They must have a certain amount of money, or they must engage in a profession with a certain amount of distinction.

    If we can't allow people to express an opinion based solely on their life experience, why should we allow just any citizen to have an equal say in who runs the government?

    We have had some pretty stinkin' governments these last decades - and they were formed by choices made by an elite and "qualified" bunch who ultimately presented us with the dreck from which we were made to choose.

    I am a democrat. Small d.


    Donald may take his (5.00 / 2) (#150)
    by fishcamp on Thu Nov 21, 2013 at 02:18:33 PM EST
    laptop up to his ivory tower just like we all do but his historical stories of many subjects are the best on this blog.  I truly love his WWll stories.  BTW since it's finally cooling down slightly (air 75, water 80)  the fish are moving in.  If anybody wants to fish or just go to lunch by boat...come on down.

    Not just fish (none / 0) (#166)
    by ragebot on Thu Nov 21, 2013 at 08:31:54 PM EST
    the lobsters are coming in to shallow water as well.  Problem it the wind is up and makes it hard to dive, or at least take pix while you are diving.

    Not to mention I am still in Tallahassee after my operation and enjoying watching the 'noles demolish every team they play.  Kinda an interesting sidelight with the Winston stuff but I should be back to the Keys by Thanksgiving for the traditional lobster salad, lobster mac and cheese, and a main dish of lobster with Key lime pie for desert.


    Rag, it's been very calm down here (none / 0) (#167)
    by fishcamp on Thu Nov 21, 2013 at 09:47:32 PM EST
    the last 3 daze...I've been out on and in the water too much for these old bones.  sorry you're stuck up in Tallahassee.  get well.

    Not really stuck (none / 0) (#169)
    by ragebot on Thu Nov 21, 2013 at 11:09:49 PM EST
    Got my ticket from FSU and still am a big fan.  But need to finish up some lose ends before heading to the Bahamas for the winter.  Also really enjoy the season FSU is having this year.  Looks like an easy path to the natty and I don't see anyone beating them.  Kinda wish I could go but I really like Nassau for Christmas, the parties there are great.  Not bad weather either.

    Nonsense (none / 0) (#82)
    by Slado on Wed Nov 20, 2013 at 04:48:14 PM EST
    I stated that millions more Americans will lose insurance because of the employer mandate.


    Do you acknowledge this reality?  

    The administration does.

    It's long so I'll quote one of the important parts...

    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

    Obmacare is different.   it is not simply a exchange system.   It is a radical transformation of the insurance industry.   Both in the way it was written and in the way the administration has interpreted the law through regulations and enforcement.    Quite simply the goal is to redistribute money to cover the uninsured.   The only way to do that is to get the rest of us (those with insurance) to pay more.    

    It's simple math.  

    In order to pay for this everyone's got to pay more.

    To do this many of us will have to not keep our plans.



    What is your alternative? (none / 0) (#94)
    by MKS on Wed Nov 20, 2013 at 07:42:28 PM EST
    Libertarians talk about tort reform and abolishing consumer protections by allowing carriers to sell insurance across state lines.

    That won't work.  


    Quite frankly I have no idea (none / 0) (#126)
    by Slado on Thu Nov 21, 2013 at 10:07:58 AM EST
    The system took 50 years to get to this point.

    It started out with charity and private hospitals then the insurance industry started to kick into gear and then government got involved with Medicaid and medicare.   Pile on all the regulations both state and Federal and you have our non governmental/capitalist mish mash medical system.

    We can't have single payer and we can't have a pure capitalist system because they're too intertwined at this point.   Both sides need to confront that reality.   Both are simply impossible politically and realistically.

    All you can do it incrementally change things for the better on the margins.  

    If I was the emperor of the USA I'd start with this...

    1. Medicaid for the poor.   Expand it and fund it.   That means cuts to Social Security and Medicare.    Grandfather in those that are already in the system and then start raising the requirements to get both.    The money has to come from somewhere.
    2. Cut defense spending by 25%.   We spend way too much and the military has become a corporate welfare program.   We don't need the soldiers and bases and equipment.    
    3. Deregulation.   Too much driving up cost.  Free the insurance industry to lower costs.   No required care etc..   People need to pay more on the front end to allow us to cover more on the back end.
    4. Tort Reform.    Sorry lawyers.   Too much defensive medicine is driving up the cost.

    That's what I'd do.

    However all those things come with huge political costs and tangles that make them impossible.

    Attack this thing one issue at a time.   The large comprehensive bill that was the ACA was simply never going to work.  

    Too much, too fast.


    What do you mean by tort reform? (5.00 / 1) (#136)
    by MKS on Thu Nov 21, 2013 at 11:01:59 AM EST
    California implemented tort reform decades ago.  At least the version I have heard conservatives talk about.  It has had no effect on costs.

    So, what exactly do you mean by tort reform?


    Tort Reform... (5.00 / 2) (#138)
    by ScottW714 on Thu Nov 21, 2013 at 11:13:27 AM EST
    ...is complete BS.  I live in Texas which a decade ago limited the exposure of doctors to $250k, still waiting for that drastic measure to equate to dollars in anyone pockets but insurance companies.

    That means if a surgeon accidentally cuts off the wrong leg, too bad.  And good luck finding an attorney to take a case where they payment isn't much larger than the cost of medical malpractice case.

    On the tenth anniversary of the enactment of "tort reform" in Texas that dramatically limited damages in medical malpractice lawsuits, Gov. Rick Perry was shocked that anyone could doubt the law's success. "I'm just continually surprised that some people still want to argue that tort reform didn't work." That's because Gov. Perry is only looking at the impact on doctors. He doesn't care about the impact on patients or the millions of other Texans

    Doctors in Texas now have lower medmal insurance premiums to pay and face sharply reduced risks of being held accountable for their negligence. The doctors are doing just fine.

    The patients? Not so good. The cap on damages and new expert-witness rules sharply reduced the ability of a law firm to handle a medmal case for years, fronting the costs of preparation and litigation, and to find an expert who would qualify as a witness in court. Lawyers are simply turning away many cases that might have been filed prior to 2003.

    Moreover, the basic promises of the proponents of the medmal limits have never been met. They promised more access to health care, more doctors, and lower health care costs. But an objective study by respected academicians show no positive impact on the number of doctors. Even a leading critic of the plaintiffs' bar declared that he would no longer claim that the Texas law increased doctor supply.

    That talking point has been proven to be a republican wet dream not based on actual evidence.  Actual real life evidence proves it doesn't accomplish what you or any other republican thinks it should.

    Same with deregulation, it puts dollars in people pockets would are already swimming in them and leaves the rest of us without any recourse to their bad behaviors.  It's a GD myth, stop spreading it as fact.

    And don't think I missed your link to the Heritage Foundation, the inventors of Obama Care, the ones who you dismissed over and over.  But even better them dismissing their own GD creation, great source on two fronts.  I guess today they are an ok source so long as they side with you.  Who cares if they created this market based BS, they got a President to slam.


    So 10% didbn't have coverage (none / 0) (#108)
    by jimakaPPJ on Thu Nov 21, 2013 at 06:09:38 AM EST
    I am just under whelmed.

    That's because you're one of the ... (5.00 / 1) (#112)
    by Yman on Thu Nov 21, 2013 at 06:27:42 AM EST
    ... "takers", living on the dole - SS, Medicare, etc.

    You got yours - the rest of the people don't matter.


    Absolutely (none / 0) (#115)
    by jimakaPPJ on Thu Nov 21, 2013 at 07:42:08 AM EST
    And all those taxes I paid and the premiums now for Medicare and the supplemental....

    Well those are just figments of my imagination.


    Sorry, Jim (none / 0) (#161)
    by Yman on Thu Nov 21, 2013 at 06:54:32 PM EST
    We'll need to compare how much you contributed versus how much you and Mrs. PPJ are taking out ... eventually, you'll be a "taker" ... probably already are.

    Absolutely (none / 0) (#116)
    by jimakaPPJ on Thu Nov 21, 2013 at 07:42:08 AM EST
    And all those taxes I paid and the premiums now for Medicare and the supplemental....

    Well those are just figments of my imagination.


    And... (none / 0) (#55)
    by lentinel on Wed Nov 20, 2013 at 01:09:56 PM EST
    what about businesses mandated to offer insurance to their employees if they have 50 or more?

    I wonder how many mid-sized businesses are going to opt to downsize to 49....


    This is affecting small businesses NOW (5.00 / 1) (#120)
    by jbindc on Thu Nov 21, 2013 at 08:14:28 AM EST
    The writer, Thomas Edsall (5.00 / 1) (#12)
    by christinep on Wed Nov 20, 2013 at 09:43:58 AM EST
    has a fairly extensive article in today's NYTimes enumerating the number of issues initially confronting and expected to confront the inherently complicated ACA.  

    The one-time WashPo political reporter and author doesn't make value judgments so much as describe the pathway.  Glancing through the Times' three-pager, the most striking description about why the high controversy was expected, politically, is the "redistributive nature" of the ACA.  Edsall notes that the legislation is the largest example of social legislation in many years ... and, he highlights the redistribution of benefits to the poor and less well off and costs to some better off contained therein as noteworthy and probably exacerbating the controversy that comes with this kind of change.

    I agree, of course, with "fix it, don't end it" -- and, even in the gale of the website roll-out and the repetition of predictable negative media that rained down on us (as well as the equally predictable House "fact-finding" hearings), Americans apparently agree too.  Now, as we take a breath and as the media starts a different narrative about the complexities of the stories, the fixes, and the comeback trail, we can also await November and December numbers.  As more and more people sign up on the exchanges (per new stories appearing in this week's press), we may find that the Earth still spins on it's axis.

    Part of the problem is (5.00 / 1) (#16)
    by jbindc on Wed Nov 20, 2013 at 09:55:08 AM EST
    40% of the site isn't even built yet.

    As quoted in the same paper as Mr. Edsall writes:

    WASHINGTON -- The chief digital architect for the federal health insurance marketplace said Tuesday that 30 percent to 40 percent of the project was still being built.

    The official, Henry Chao, made the assessment in testimony before a panel of the House Energy and Commerce Committee. Lawmakers expressed surprise that so much work remained to be done seven weeks after the federal website opened to the public.

    Mr. Chao, the deputy chief information officer at the Centers for Medicare and Medicaid Services, said the government was still working on "back office systems," including those needed to pay insurance companies that are supposed to provide coverage to millions of people under President Obama's health care law.

    "We have yet -- we still have to build the financial management aspects of the system, which includes our accounting system and payment system and reconciliation system," Mr. Chao said. These parts of the system, he said, are "still being developed and tested."

    Mr. Chao said the government had largely completed computer systems that were most important to consumers and allowed them to apply for insurance, compare health plans and enroll. However, White House officials said that even these parts of the system were still being repaired and were not performing as well as they had hoped.

    And it certainly doesn't help the story when things like this make the news.


    Yes, the payment management (none / 0) (#48)
    by christinep on Wed Nov 20, 2013 at 12:24:53 PM EST
    portion needs finalization.  Personally, I believe that has the potential for being a real hair-pulling challenge in the longer run than the relatively momentary trials to date.  I also understand that the component has been expected to be completed in 2014 per its schedule.

    Except (none / 0) (#50)
    by jbindc on Wed Nov 20, 2013 at 12:44:59 PM EST
    people will need to pay the bills BEFORE 2014 if they want them to start by Jan 1.

    So, this isn't something to be dismissed lightly.


    Sadly, they'll find out ... (5.00 / 4) (#23)
    by Robot Porter on Wed Nov 20, 2013 at 10:28:37 AM EST
    you can't fix it.  Because it isn't about the public.  It's about insurance companies.

    You can probably make it a little better.  If the insurance companies are still happy.  But basically you're stuck with this.

    Too bad more in political world and the blogosphere didn't get behind Medicare-for-All.

    It wouldn't be having any of these problems.

    Of course, wiser people than me said that was a non-starter.  Despite the fact that it was hugely popular with public.  Would actually create real cost containment.  Had a pre-existing, and efficient, organizational structure. Didn't need $600 million websites. And on and on and on. But, again, wiser heads than me said it was a non-starter.

    But I guess they're happy.  They don't care that 95% of the people are against them.  They still have many friends at the banks, insurance companies and in big pharma.  Who will continue to fund their campaigns and advertise on their websites.

    I heard one highly polished (5.00 / 3) (#26)
    by jondee on Wed Nov 20, 2013 at 10:42:04 AM EST
    professional obfuscator say the other night, with frigid, smiling equanmity, that they weren't ruthless but were "portfolio driven"..

    As if the realm of portfolios and "markets" belonged to some higher order of reality. Beyond Good and Evil, as Nietzsche said..


    That is what punitive damages (5.00 / 1) (#91)
    by MKS on Wed Nov 20, 2013 at 07:22:00 PM EST
    are for.

    I honestly don't think it will ever be (5.00 / 5) (#27)
    by Anne on Wed Nov 20, 2013 at 10:45:37 AM EST
    better than what it is.  I think it's far more likely that there will be regulatory changes over time that will weaken it, much like the changes made to Dodd-Frank have weakened that.

    That is (5.00 / 3) (#53)
    by lentinel on Wed Nov 20, 2013 at 01:05:03 PM EST
    precisely what I feel about this tangled mess.

    As long as the system is perpetuated in which people stand to make more of a profit if they offer less care, we ain't going noplace.

    Obama sold us out from day one.
    No surprise there.

    Exhortations to "fix" this rather than junk it, just doesn't lead very far, imo, sad to say.

    I think about trying to fix some defective piece of machinery - even a car --- a clunker...
    After a certain time, one comes to the conclusion that it is makes more sense to buy a new car rather than throwing more and more money down a rathole.

    But I am sympathetic to people desperate for insurance and hoping that this might help them.
    I can see why they think it is best to hold on to a glimmer of hope...

    But I just can't feel the "let's make it better" mantra. It is analogous to being exhorted to vote for the "lesser evil". We just go from rotten to mediocre at best. And we deserve better.

    Unless the profit motive is removed, there is little hope for improvement imo.

    And it is an absolute scandal to me that profit entered the picture in the first place.


    A good example (5.00 / 2) (#137)
    by TeresaInSnow2 on Thu Nov 21, 2013 at 11:05:25 AM EST
    of how broken the narrow network Exchange plans are.

    From the Washington Post:

    The Obama administration made it a priority to keep down the cost of insurance on the exchanges, the online marketplaces that are central to the Affordable Care Act. But one way that insurers have been able to offer lower rates is by creating networks that are far smaller than what most Americans are accustomed to.

    The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.

    The family described in the article are staunch proponents of the Affordable Care Act, but they are heavily considering foregoing $400/month subsidies to buy insurance outside of the Exchange.  They cannot buy an Exchange plan and still expect a safety net for their child's extreme care, because none of the *(pseudo)-PPO plans on the Exchange include Children's Hospital, the organization responsible for saving their child's life.  The HMO plans on the Exchange include Children's but would require prior authorization for the child to see specialists there.  And no doubt, the insurance companies will fight this authorization by every means.  The child already lost her eyesight because of delayed diagnosis.

    This is how gatekeeping works under the Affordable Care Act.  This gatekeeping is in no way regulated.  It is the exact same problem that existed before the ACA.  This is why I say that the Affordable Care Act allows insurers to take premium money but skirt requirements by heavily restricting access to treatment for the most serious conditions the ones that broach lifetime caps, the ones that would in the past be considered pre-existing conditions, etc.  The money is taken.  The heels are dragged in treatment.

    And what the family in this article doesn't understand is that removing lifetime caps is only going to accelerate the demise of their child's care.  As premiums increase because of this, only the sick will be able to justify insurance.  As premiums spiral out of control, this family will have no choice but to take subsidies meaning going to the Exchange and to restricted doctor networks for their child.

    Health care was in bad shape.  Breaking it further was not the answer.   We need national health insurance, or at least we need a national safety net for the sickest patients.  Asking small businesses and under-employed individuals to foot the bill will only increase the downward cascade to failure.  And maybe that failure is the only thing that would take us to a national system (something I doubt).  However regardless, people will die in the process. And rationalize-ers might say, that's what had to happen.  And that's fine, when it isn't you or your child.

    Death by spreadsheet is alive, well and thriving, maybe even better under the "A"CA.

    *My reference to (pseudo)-PPO.  Any plan that heavily restricts doctor access is effectively an HMO, whether they call themselves PPO or not.

    Smaller networks than Medicaid (5.00 / 1) (#144)
    by TeresaInSnow2 on Thu Nov 21, 2013 at 12:04:17 PM EST

    President Obama promised when the Affordable Care Act was enacted that people who liked their doctors could keep them, but the reality of the law both in New York and around the country is that the new, lower-cost policies it is creating sometimes have smaller provider networks than Medicare, Medicaid, or the plans people typically get through their employers.


    New paradigm....


    It doesn't matter, Teresa (4.20 / 5) (#139)
    by jbindc on Thu Nov 21, 2013 at 11:19:52 AM EST
    You are never going to convince the True Believers.

    I know (5.00 / 1) (#141)
    by TeresaInSnow2 on Thu Nov 21, 2013 at 11:28:36 AM EST
    But I still keep trying ;-).

    I remember when (4.00 / 4) (#142)
    by TeresaInSnow2 on Thu Nov 21, 2013 at 11:29:22 AM EST
    people made fun of the George W. Bush 30%'ers. Those were the days.

    "Just go to single payer" (2.00 / 1) (#69)
    by Donald on Wed Nov 20, 2013 at 03:07:11 PM EST
    What happened to that whole settled law thing?

    I know, I'm new, what the hell do I know.

    I'm sure the constitutional justification will be hammered on me by all the members of this big ole tent.

    Good grief (5.00 / 1) (#109)
    by jimakaPPJ on Thu Nov 21, 2013 at 06:18:08 AM EST
    Settled law???

    I could name you quite a few "settled laws" that were very very bad.

    One even started a civil war.


    One big issue is security (none / 0) (#2)
    by Slado on Wed Nov 20, 2013 at 08:36:54 AM EST
    They need to Take it down if it's so vulnerable.

    I have had this conversation on facebook too (5.00 / 0) (#5)
    by Militarytracy on Wed Nov 20, 2013 at 09:13:37 AM EST
    Obamacare is not a website.  A website has become a part of the implementation at this time but Obamacare is legislation, not a website.

    It is legislation that prevents an insurance company from killing my son for profit, which they tried to do once while the Republican led government stood there and watched.  It also prevents my son who was born a pre-existing condition from being denied coverage.....once again for nothing but profit.  It ends insurance companies dropping the insured when they get sick and finally need to use that insurance too.


    Tracy (none / 0) (#6)
    by Slado on Wed Nov 20, 2013 at 09:14:47 AM EST
    Not sure what your point is.

    If a website is so dysfunctional that it lets hackers get the personnel information of millions of US citizens then it needs to be taken down.

    That's my point.


    This sounds like (5.00 / 1) (#102)
    by MKS on Wed Nov 20, 2013 at 11:06:55 PM EST
    the conservatives railing about voter fraud.  Not that it happens but it sure sounds like a good argument.....really scares people.....  

    And it turns (none / 0) (#7)
    by TeresaInSnow2 on Wed Nov 20, 2013 at 09:27:35 AM EST
    the entire individual insurance market into an HMO system.  The narrow networks are HMO's.  Yes, they accept people.  They'll take their money.  And then they roadblock their care.  

    The old idea was managed care during the 1990s, which involved restricting the number of physicians a patient could visit in order to give insurers greater bargaining power over provider and plan rates. The plans were ultimately abandoned; patients felt they had too few options and let their insurers know about it. But the general concept has been revived.


    But now consumers won't even have the option of rejecting the HMO's with their pocket books. They are mandated now.

    And this is what the Democrats said about HMO's in the 90's.


    Your glorified Obama talking points are not the reality, Tracy.  All of the things you're talking about were already at least as accessible if not moreso via laws like HIPAA and state legislation.  And all the insurance companies had to do to get around them was to turn the whole individual market into an HMO system.


    Sorry (5.00 / 0) (#34)
    by Militarytracy on Wed Nov 20, 2013 at 11:21:08 AM EST
    Murder by Spreadsheet is what she called most of her writing on this.  Please also check activist Wendell Potter on the reality before Obamacare.

    Wendell Potter (5.00 / 1) (#43)
    by TeresaInSnow2 on Wed Nov 20, 2013 at 11:57:35 AM EST
    is a bought and paid for shill for Obamacare.  His job is to cheerlead, not to provide realistic analysis of the issues.

    Good Lord (5.00 / 0) (#56)
    by Militarytracy on Wed Nov 20, 2013 at 01:45:43 PM EST
    That is just delusional.

    It IS delusional, MT (5.00 / 1) (#71)
    by christinep on Wed Nov 20, 2013 at 03:30:26 PM EST
    A trend that seems to have escalated of late here is for some to refer to anyone with whom they disagree as "cheerleaders or cheerleading" for the dreaded other side.  It is becoming increasingly sad that the moat between people is positioned and has so many crocodiles.

    What stands out these days is how the debate is permeated with a kind of hysteria.  What has happened to watching the "facts" develop. What this shouts out to me is the power of fear ... of change.

    MT: You have definitely fought the battles under the old regime and schema.  I have some experience through my family as well.  Tell me:  Does it take horrific personal experiences like that to get others to take a deep breath, consider what is going on, and be open to the facts?


    Really rich, coming from you (3.00 / 2) (#72)
    by jbindc on Wed Nov 20, 2013 at 03:37:20 PM EST
    Does it take horrific personal experiences like that to get others to take a deep breath, consider what is going on, and be open to the facts?

    When you yourself, are blind to the many facts presented here by many people via their own experiences.

    Frankly, you wouldn't know a "fact" if it hit you in the face.  It's all about what you "feel" is right.

    Pure rubbish.


    Nasty and unwarranted personal invective (5.00 / 0) (#74)
    by christinep on Wed Nov 20, 2013 at 03:47:25 PM EST
    But, have it your way, jbindc.

    You do not know my life ... so, let us put it nicely, please don't pretend to know my life experience.  Suffice to say that--because of very close family situations--I have slept more than once on hospital floors; I've washed my sister's bloody stump after amputatation; I've talked with cardiologists in the midst of tears when told about my Dad's cardiomyopathy and the invidious suggestion that the money wasn't there to provide the best of treatment; and, among a series of other "learning experiences," my sister and her best friend and I stood/sat in the lobby of a major hospital with a sign pointing out that my sister did need medical attention for a broken shoulder, until the management was embarrassed enough to respond (at which point I had a long discussion about the process with the would-be surgeon.)

    Please cut the cutey crap!  This area is quite personal for me.  I did not come to it of late.  I'm not playing games.  And, if you want to talk with me on the phone, you may have my phone number.  But--under the very real circumstances of my own life which you tend to laugh at--I must admit to abhorrence of your game-playing.

    If you want to talk, then talk.  But, stop the personal insults and downright BS.  


    Christine, many of us (5.00 / 3) (#80)
    by Zorba on Wed Nov 20, 2013 at 04:43:36 PM EST
    have had horrific experiences, have slept in hospitals, have cared for family members in extremis.
    My parents got quite good care at the end of their lives, thanks in great part to Medicare (a single-payer system for those over 65, BTW).  I have had to sign DNR's, as well.  At the end of my mother's life, I was the only one who could be there in time to hold her hand, pray with her, and give her permission to go and be with Dad.  I was the one before that who had to pressure my siblings and my mother to sign a DNR and let my father go (after I and my sibs had spent many a night at the hospital watching over him as he declined horrifically).
    But one of my younger brothers died of HIV-AIDS some years ago (he was one of the early ones).  And his partner had very many medical bills to pay off, which we all helped him to do.
    So please do not think that you are the only one who has had awful experiences with loved ones.  I appreciate your own experiences, and I sympathize more than you know.  But there are others here who have also had personal experiences with the health care in this country.  Which, for me, has only lead me to believe that the only way to go is a Medicare For All, single-payer system, as opposed to the half -@ssed Affordable Care Act.  It is better than nothing, but it is nowhere near where we need to be.
    Namaste,  my sister.  I wish you well.

    I wish you well too, Zorba (5.00 / 1) (#85)
    by christinep on Wed Nov 20, 2013 at 05:01:02 PM EST
    And, as you know, this is not a game ... as you point out, the matter of healthcare comes down to life and death in too many instances.  

    No, I do not pretend nor contend to be the only one or even a special one because of my life experiences with or without hospitals and the previous "healthcare" system.  But ... and I mean this as much as I can mean anything ... I did nothing to deserve the initial demeaning tone, attitude, and words that jbindc has exhibited.  Nothing.  

    It really does seem to mean that we all need to rein it in a bit.  In the process of advocating for our positions, there has been a deterioration in how we treat others.  We all have our "pet peeves" or more (as I recall Scott said the other day.)  In that vein, can we cut out the cutey names ... the stereotyping run amok (e.g., those that like this person are "bots" or "adorers" or "cheerleaders.")  It gets more than tiring.  Frankly, it does remind me of about 8th grade.  Really.  Most of the people here are too articulate, smart, dedicated to rely on those chintzy short-cuts.  For me, it is like "up to here."  I'll call on you to see what you can do.


    I would ask (5.00 / 4) (#87)
    by Zorba on Wed Nov 20, 2013 at 05:33:38 PM EST
    that those on the "other side" also rein it in a bit.  Very frankly, I am referencing mainly Politalkix and MKS.  Who, I might mention, you yourself have agreed with and uprated more than one time.  As I have uprated jbindc and others in response to them, I admit.
    This is more than beginning to look like the ugliness that occurred during the whole Zimmerman- Martin threads.
    But you also have to realize that some of those who are on the opposite side of jbindc have bullied and called her names, too. This is unacceptable to me, no matter which side commenters are on.
    Let us all hope that we can reach a level of comity.

    The problem often is (5.00 / 1) (#90)
    by MKS on Wed Nov 20, 2013 at 07:20:32 PM EST
    that I know what jbindc is against but not what she is for.

    You may not know (5.00 / 1) (#95)
    by Zorba on Wed Nov 20, 2013 at 08:05:42 PM EST
    what jbindc is for, but I have been around here long enough that I pretty much do.  I don't agree with her on some things, but I do agree with her on very many others.
    Be that as it may, I do feel that I can have a rational discussion with Christine and other commenters with whom I often disagree.  I do not feel that I can have one with you.
    Nevertheless, namaste.

    Sure, you can (none / 0) (#100)
    by MKS on Wed Nov 20, 2013 at 10:50:49 PM EST
    if you direct the conversation that way....



    Gee, thanks for a great start (none / 0) (#89)
    by MKS on Wed Nov 20, 2013 at 07:09:13 PM EST
    to this thread. I didn't even comment yet.

    I wasn't aware (5.00 / 1) (#92)
    by Zorba on Wed Nov 20, 2013 at 07:29:19 PM EST
    that this was a "start" to this thread.
    Be that as it may, I am referencing your many past comments.
    Have a nice day, MKS, and namaste.

    Yes , you did (1.00 / 0) (#86)
    by jbindc on Wed Nov 20, 2013 at 05:12:54 PM EST
    I did nothing to deserve the initial demeaning tone, attitude, and words that jbindc has exhibited.

    First, I disagree with your premise that I gave the initial "demeaning tone, attitude, and words." But if that's what you'd like to believe, then have at it.

    Second, I called you out.  I didn't call you a name. But again, an ironic statement from someone who likes to tag the word "Republican" on someone as a perjorative because they don't parrot your views.  Speaking of cutey-names.....

    But I stand by my words.  You constantly diminish others' experiences and positions because you somehow feel you have a better insight into what is "for the greater good".  No, you actually don't have any better insight. You have opinions.  Sometimes those opinions are based on things not borne out by actual facts.  

    I'm sorry for all the heartache you have had in dealing with hospitals and sick loved ones.  But you do not get to tell other people that their experiences - whether it be in dealing with illness, in dealing with insurance companies or regulations, or the economy, or whatever, are sad, but "more people are benefitting" because you think we've had fine and nuanced leadership in this country and if we'd only open our eyes and see the bigger picture, we would agree with you.  No.You.Don't.

    I am done talking about this with you.  If you find my comments so abhorrent, then please feel free to  skim on over them.


    Your words were demeaning (5.00 / 0) (#88)
    by christinep on Wed Nov 20, 2013 at 05:52:16 PM EST
    That is my honest opinion.

    And yet (1.00 / 0) (#75)
    by jbindc on Wed Nov 20, 2013 at 03:52:12 PM EST
    You dismiss the very real experiences of those with whom you disagree here, because, well, of course, we just haven't seen the light. You of course, know what's better for us than we do.

    You cut the cr@p.


    Bull (2.00 / 1) (#76)
    by christinep on Wed Nov 20, 2013 at 03:56:20 PM EST
    I don't dismiss anything.  But, I steadfastly believe in the greatest good for the greatest number.  

    Kindly do not tell me what I dismiss.  You have no idea.  There is no need to play the name-calling routine, no need to personalize it.  But, if you want to go there, I will.


    Of course you dismissed something. (5.00 / 3) (#77)
    by dk on Wed Nov 20, 2013 at 04:04:14 PM EST
    You dismissed a human being above by calling her delusional.  Someone who time and time again has been discussing her personal experiences on this site.  That, in no uncertain terms, is nasty invective.  

    I agreed with MT (5.00 / 1) (#84)
    by christinep on Wed Nov 20, 2013 at 04:50:44 PM EST
    The individual to which MT referred is not delusional; but, the conclusion is way-off-the-mark and--per previous comments--demonstrates that there is no openness to discussing anything about the ACA other than the possibility of ruin.  That repeated position, if not technically "delusional," seems to abjure any present or subsequent data that would show otherwise. (As you must know, dk, the language around here has been getting heated in areas such as the ACA.  To the extent that I suffer from it, I'll heed your comment.)



    I believe in this, too (5.00 / 3) (#79)
    by sj on Wed Nov 20, 2013 at 04:22:36 PM EST
    I steadfastly believe in the greatest good for the greatest number.
    But the ACA is not that. The 30 million that will remain uninsured speak to that reality. I'm not saying that the ACA is all bad, and I am far from screaming for its repeal, but if you really believe what you say I'm surprised you aren't advocating for single payer.

    We should not be satisfied with what has been delivered to date. Now is not the time for anyone to rest on their laurels when it comes to health care for the greatest number.


    Thank you for your courteous reply, sj (5.00 / 1) (#81)
    by christinep on Wed Nov 20, 2013 at 04:44:21 PM EST
    The ACA is the first step--a big step--but the first step.  The insurance reforms aspect (the requirements respecting pre-existing conditions, cap on medical costs, prescription $$$ donut-hole fix, minimum percentage directly to healthcare per yearly audit, meaningful restrictions on cancellations without fraud, extended opportunity for young people to remain on family healthcare coverage, preventive care at no extra cost, etc.) is very significant... and its immediacy is key.  

    I opt for the expanded coverage now...and the expansion lately.  The theory or hope that we can get to Medicare-for-All or other Government Single Payer Healthcare--at this point--is a future reality.  IMO, to debate what might have been is to ... debate.  There are too many people who need help now...people who cannot afford what we have had...many of these people will be covered via ACA (and lower costs and/or subsidies) or expanded Medicare.  The numbers are already starting to show that.  Yes--like you--I want to see the guarantee of healthcare for everyone; but, given the political realities that exist (hey--so many people frightened even by these initial steps), I believe that improving what we have is the best pathway to making what we want a reality in this country.  (I came to believe that as a teenager; I've always believed that the getting-there involved taking the first steps.)


    Agreed. (5.00 / 1) (#97)
    by Donald from Hawaii on Wed Nov 20, 2013 at 09:04:09 PM EST
    sj: "We should not be satisfied with what has been delivered to date. Now is not the time for anyone to rest on their laurels when it comes to health care for the greatest number."

    You're right, we should not rest upon our laurels. But we need to also recognize the necessity of having to consolidate those gains which have been achieved in the face of considerable resistance, and not get caught up in a game of chicken with our own side and allies.

    I look upon the ACA as the first step on the road to reform, and most certainly not the last. Personally, I believe a move to a single-payer system to be inevitable. But quite honestly, I couldn't begin to offer a timeline for when that might occur. As someone who's had to count votes and gauge public support over the years as part of my job, I'd offer that we're still a good way off from achieving critical mass within the body politic. But that said, I believe that when critical mass is finally there, the change will be quick, and it will be decisive.

    It helps to have patience and an eye for the long march, but I admit that it's often still really frustrating to have to yomp in the mud, sometimes for years on end. We simply have to persevere with our eyes always on the prize, and further have the vision and wisdom to accept the half-loaf when it's offered -- with the tacit understanding that we're going to come back and grab the rest at the first available opportunity.



    I'm getting there, too (none / 0) (#98)
    by sj on Wed Nov 20, 2013 at 09:11:38 PM EST
    Personally, I believe a move to a single-payer system to be inevitable. But quite honestly, I couldn't begin to offer a timeline for when that might occur.
    I didn't feel that way even two months ago, but the more it gets mentioned the greater the possibility. Until it morphs into probability.

    Two things make me more hopeful for our society. First, the way marriage equality is domino-ing across the states. Equal rights is a Big Deal to me. The second is the medical/legal marijuana and how that how jump-started the questioning of the whole "war on drugs." One of the Bad Things that Nixon left behind.

    Those two things were unthinkable a few short years ago.

    Now if we could reclaim privacy and transparency.


    And Wendell Potter update with several links (5.00 / 0) (#35)
    by Militarytracy on Wed Nov 20, 2013 at 11:27:45 AM EST
    Oh, Teresa (5.00 / 4) (#114)
    by jbindc on Thu Nov 21, 2013 at 06:53:30 AM EST
    Why are you sounding the alarm?

    Oh wait, it's because you were right....


    No they weren't Teresa (none / 0) (#11)
    by Militarytracy on Wed Nov 20, 2013 at 09:37:39 AM EST
    Now you're just being ridiculous.  I would suggest reading activist nurse nyceve's series Death by Spreadsheet.

    Reading this site can give (5.00 / 1) (#104)
    by MKS on Wed Nov 20, 2013 at 11:13:12 PM EST
    one a skewed view of things.

    I suggest (none / 0) (#42)
    by TeresaInSnow2 on Wed Nov 20, 2013 at 11:56:53 AM EST
    you spend some time studying HMO's, Tracy.  They provided the opposite of care in the past and will continue to do so in the future.  In fact, they provided roadblocks to care.  And that's what the Exchange plans are, HMO plans.  Just because you're in denial about that reality doesn't mean it's wrong.

    You have this Pollyanna-ish notion of a system that, in reality, was built to prop up health insurance companies. No amount of calling me "silly" is going to change that fact. The sooner you understand the realities of such a system, the better for your and your son's future.  Right now, your brain is defying logic on the topic.


    Pollyanna-ish notion? (5.00 / 0) (#46)
    by Militarytracy on Wed Nov 20, 2013 at 12:00:29 PM EST
    Yeah right Teresa.  The system that tried to kill my child, yeah, I spent no time studying how that whole scenario came to pass.  And I have spent no time seeking out important activists who understand that whole system from the inside out.

    Precisely (5.00 / 1) (#19)
    by Ga6thDem on Wed Nov 20, 2013 at 10:07:37 AM EST
    why privatization doesn't work: too many cooks in the soup and too many people who can get their hands on sensitive information.

    93% sounds like (none / 0) (#3)
    by Edger on Wed Nov 20, 2013 at 08:45:57 AM EST
    an awful lot of haters.

    But on closer examination we find that at the bottom of the article CBS notes that "This poll was conducted by telephone November 15-18, 2013 among 1,010 adults nationwide", so really it only proves that there are only 939.3 people in the whole country who don't like it. Right?


    The fact (none / 0) (#4)
    by ragebot on Wed Nov 20, 2013 at 08:56:53 AM EST
    that even someone like BTD is aware that Obamacare is in need of being fixed shows just how poorly it is working, or perhaps more accurately not working.

    My undergrad degree was in the hard sciences and one thing always stressed was that something had to be falsifiable.  So my question to BTD is what set of circumstances would result in BTD taking the position that Obamacare could not be fixed.

    "even someone like BTD?" (5.00 / 1) (#10)
    by Anne on Wed Nov 20, 2013 at 09:36:33 AM EST
    What the heck does that mean?

    Again, no one's experiencing positives or negatives from policies purchased on the exchange, because the earliest any of those policies go into effect is January 1.

    "Even someone like me" is aware of that; you keep telling us how smart you are, so how come "someone like you" keeps perpetuating the nonsense that people are having a negative experience with something that hasn't gone into effect?


    What the heck it means (none / 0) (#15)
    by ragebot on Wed Nov 20, 2013 at 09:49:36 AM EST
    is that BTD started a thread about the need to fix Obamacare and I asked what conditions would be required for BTD to say it is beyond fixing?

    I also pointed out that when someone like BTD asks a question like that it is proof that there is something wrong with Obamacare.

    You can try and change the subject all you want but all you are doing is lowering the signal to noise ratio.


    Jeez, you did it again... (5.00 / 2) (#20)
    by Anne on Wed Nov 20, 2013 at 10:15:25 AM EST
    when someone like BTD asks a question like that it is proof that there is something wrong with Obamacare.

    Would you expect him to not be smart enough to make that observation, or so clueless the problems must have to be really big in order for him to notice?

    No one who has a brand-new policy knows whether it works or not because the coverage isn't effective until January 1.

    The rollout has been terrible, the website has had tons of problems, but that has nothing to do with whether the coverage people purchase will function as they need it to, does it?

    Perhaps you need to be more specific about how "Obamacare" isn't working well.  

    Let's say you wanted to buy a new car.  You have a terrible time getting to the dealership, and once you get there, no one can help you, so you have to come back another day.  And another day.  when you finally get someone to help you, they show you a bunch of cars and tell you what the features are.  But you don't get to drive any of them.  

    You go ahead and buy a car that you've never driven, but you can't take delivery of it for another three months.  You tell all your friends that you bought a new car, had a terrible experience doing it, and are very unhappy with the car, and someone's going to have to fix it.

    How can you be unhappy with a car you haven't even driven?  And what exactly are you fixing?


    Have you been (5.00 / 1) (#22)
    by sj on Wed Nov 20, 2013 at 10:23:41 AM EST
    ... reading the site?
    I also pointed out that when someone like BTD asks a question like that it is proof that there is something wrong with Obamacare.
    I don't think even its most ardent supporters have ever said that the ACA is perfect.

    What is pretty clear is that it does some good things, and some other good things could have been done a lot better using a different approach. And that some other good things can still be done building on the current approach.

    So the signal to noise ratio coming from you right now is all noise.


    Good point (none / 0) (#9)
    by Slado on Wed Nov 20, 2013 at 09:32:38 AM EST
    What if the best way to fix it is to take away 80% of it?

    Keep some of the new regs that help people out, keep the expanded Medicare and then cut out the rest.

    I would argue we might be better off to cut bait now instead of dealing with the potential that the exchanges implode and we're stuck with millions with unaffordable insurance that the government has to pick up the tab for.

    That would be worse IMHO then starting over.


    Here's (none / 0) (#18)
    by Ga6thDem on Wed Nov 20, 2013 at 10:06:32 AM EST
    what you don't understand. The most popular regulations like preexisting conditions are what is causing the insurance companies to jack up their rates. I mean stuff like pediatric dental is nothing.

    And the reason (5.00 / 2) (#40)
    by TeresaInSnow2 on Wed Nov 20, 2013 at 11:52:33 AM EST
    the rates are being jacked is because it's expensive to cover these people.

    And the people who are bearing the burden of this expensive coverage are small businesses and underemployed people.

    You have the right problem, but you are lobbying for the wrong solution.


    There are cost controls in ACA (5.00 / 1) (#41)
    by Militarytracy on Wed Nov 20, 2013 at 11:56:32 AM EST
    Also a panel to establish that will oversee more cost control that Republicans refuse to appoint anyone to at this time.  If you read Wendell Potter's site though you will discover that many individuals are going to receive better coverage for less money spent.

    The greatest good for the greatest number (5.00 / 0) (#49)
    by christinep on Wed Nov 20, 2013 at 12:30:59 PM EST
    You mean like (none / 0) (#62)
    by jbindc on Wed Nov 20, 2013 at 02:19:18 PM EST
    Affecting the 5% of the population on the individual market versus 7.5% of the population that are ultimately expected to get coverage (including under the Medicaid expansion)?

    And then add in the 12% of worker who are expected to be affected by the tax on "Cadillac" health plans, starting in 2018?

    IS it really "the greatest good for the greatest number?"


    We'll see soon enough (5.00 / 1) (#66)
    by christinep on Wed Nov 20, 2013 at 02:47:38 PM EST
    To start with, tho, there sure are a lot of individuals eligible and added to the rolls of the expanded Medicaid provision under the ACA.  

    Yes (5.00 / 1) (#110)
    by jbindc on Thu Nov 21, 2013 at 06:24:20 AM EST
    That would be in the "7.5%" total I listed.

    Ok. I'll bite. (none / 0) (#25)
    by labrat on Wed Nov 20, 2013 at 10:37:39 AM EST
    Here are a few suggestions.

    1. Get rid of the ridiculous "Essential Health Benefits" mandate. Change the mandate to a requirement to carry catastrophic plans - sort of like mandatory minimum liability insurance for cars. Add the option to piggyback that with HSA's.
    2. Get rid of the Exchange website. Scrap it. It's a money pit. Let insurance companies enroll people. If you want to continue to offer subsidies, people can apply through either through their insurance company or DHS just like they currently do for other benefits.
    3. Change the employer mandate so that full-time is defined as 36-40 hrs so people stop losing their full-time jobs.

    Carrying (5.00 / 2) (#30)
    by Ga6thDem on Wed Nov 20, 2013 at 11:00:30 AM EST
    catastrophic plans will do nothing but create a cash cow for the insurance industry. After a year or so of carrying a catastrophic plan most people will likely drop it because it's not cost effective. Healthcare bankruptcies with probably go even higher with a lot of people carrying catastrophic plans shifting the cost onto other people with insurance making lower deductible insurance even more costly.

    Comprehensive coverage (none / 0) (#32)
    by labrat on Wed Nov 20, 2013 at 11:15:01 AM EST
    is the single biggest driver of healthcare expenditure. It separates the consumer from the price. You want to "drive the cost of healthcare down"? Let people see some true price competition. If more people paid cash for services, they'd be more conservative in their use and more sensitive to the costs/quality of what they consume.


    Let insurance companies go back to being insurance companies - not third party payers of pre-paid care.


    Maybe it's things like this that drive (5.00 / 1) (#38)
    by Anne on Wed Nov 20, 2013 at 11:34:26 AM EST
    the cost of health care.

    From Medscape:

    An individual hospital might be paid by a dozen or more distinct third-party payers, each with its own distinct set of rules for and levels of payment, which are negotiated separately with each private insurer once a year. Medicare and Medicaid have their own extensive rules for paying hospitals. Relative to hospitals paid under the much simpler national health insurance schemes in other countries, the contracting and billing departments of U.S. hospitals therefore are huge enterprises, often requiring large cadres of highly skilled workers backed up by sophisticated computer systems that can simulate the revenue implications of the individual contract negotiations. Furthermore, because violations of contracts with the government programs can trigger severe civil or criminal penalties, hospital billing departments are strictly monitored and supervised by sizable internal control operations.


    Whatever an insurer's base for paying hospitals might be, the dollar level of payments is negotiated annually between each insurer and each hospital. Under a DRG system, for example, the item to be negotiated is the monetary conversion factor for the year and, possibly, some of the DRG weights. These actual dollar payments have traditionally been kept as strict, proprietary trade secrets by both the hospitals and the insurers. Recently Aetna announced that it will make public the actual payment rates it has negotiated with physicians in the Cincinnati area.[20] That this small, tentative step toward transparency made national news speaks volumes about the state of price-transparency in U.S. health care. It remains to be seen whether that first step will trigger a larger industrywide move toward removing, at long last, the veil that has been draped for so long over the actual prices paid in the U.S. health system.

    Until recently, only uninsured, self-paying U.S. patients have been billed the full charges listed in hospitals' inflated chargemasters, usually on the argument that the Medicare rules required it.[21] This is how even uninsured middle-class U.S. patients could find themselves paying off over many years a hospital bill of, say, $30,000 for a procedure that Medicaid would have reimbursed at only $6,000 and commercial insurers somewhere in between.


    The central idea of consumer-directed care is that the high degree of cost sharing will force patients to take a more active interest than they hitherto have had in the cost-effectiveness of their care. This "consumer empowerment," as it is sometimes called, can only occur, however, if prospective patients actually have easy access to user-friendly, reliable information on at least three dimensions of their care: the prices charged by competing providers of health care; the costliness of practice styles adopted by these various providers--that is, the prices times the quantities of services and supplies they package into the treatments they render; and the quality of these providers' services. If such a transparent information infrastructure now exists anywhere in the United States, it would be the rare exception.

    Comprehensive coverage is not the problem.


    H*ll (5.00 / 2) (#45)
    by Ga6thDem on Wed Nov 20, 2013 at 11:59:44 AM EST
    and the last time I was in a hospital I got I don't know how many d*mn bills. They subcontract so much junk out running up their costs too.

    This is relative minor (5.00 / 2) (#51)
    by lentinel on Wed Nov 20, 2013 at 12:51:27 PM EST
    as an observation, but I recall that when I had to have my appendix taken out at New York Hospital... I'm lying there waiting - my stomach throbbing, and the anesthetist comes in and presents me with a bill to pay - before I'm taken into the surgery.

    It was like the medical equivalent of the protection racket.

    You wanna have the operation "au naturel", or do you want to pay the bill? Up to you my man.

    What a scene.


    That's horrifying. (5.00 / 3) (#58)
    by shoephone on Wed Nov 20, 2013 at 01:48:27 PM EST
    I'm so sorry, lentinel (5.00 / 3) (#60)
    by Zorba on Wed Nov 20, 2013 at 02:04:28 PM EST
    And this is not in any way minor.  You could have died.
    Yes, you are correct.  This is the Medical Mafia version of a protection racket.
    Do doctors no longer take the Hippocratic Oath?  Or if they do, I guess it has become meaningless to many of them.  Profits before all!
    This system is just so totally f*cked up.

    I know the feeling. (5.00 / 1) (#63)
    by Ga6thDem on Wed Nov 20, 2013 at 02:24:52 PM EST
    The first surgery I had a few years ago somethign similar happened. Before I went to the hosptial they send you all this information about how you don't bring your purse, credit cards, cash or anything with you. When I was sitting in bed waiting on the wheel chari to come, someone comes up to me and announces that i need to pay my bill IN FULL before I leave. So they tell you to bring nothing and then they look at you wanting you to pay them. Anyhow i just told her that I had nothing on me.

    But also other times when I was just signed up to go to the hospital, the billing department called me wanting payment up front before i even walked in the door.


    When I went to Swedish Hospital in Seattle (5.00 / 4) (#59)
    by shoephone on Wed Nov 20, 2013 at 01:52:18 PM EST
    to get tests done for crushing abdominal pain, I received seven different bills, from five different entities. And the Seattle Swedish Physicians bills came from some outfit in Oklahoma. It's totally insane.

    Two weeks ago I had a 30-minute doctor's appointment. I've already received four separate bills.


    Have you been (5.00 / 3) (#44)
    by Ga6thDem on Wed Nov 20, 2013 at 11:58:00 AM EST
    to the doctor without insurance? I have. Have you ever had catastrophic insurance? I have.

    If you are sick and don't have $150 to pay for a doctor's visit what do you do?

    There is over use but there is also under use and then there are people who only get care when they get so sick because of your mindset. What if those people had done preventative care? The cost to everyone would be a lot less.

    The insurance companies DO NOT want you to go to the doctor no matter how sick you are. It interferes with their profits. They are the ones putting out all this information about "over use" and it's running up their costs. And then when they're not running with that story line it's the pharmaceutical companies who are costing them or the doctors OR the hospitals. They really hate the hospitals.

    If you really wanted people to realize the full cost of paying then you would not even recommend catastrophic. Catastrophic insurance is a joke.


    I Have Insurance... (5.00 / 3) (#64)
    by ScottW714 on Wed Nov 20, 2013 at 02:32:21 PM EST
    ...and I can't remember the last time I went to see a doctor without getting some BS bill because the lab wasn't in my plan or the facility I went for additional testing wasn't covered even though there was no mention of it when I gave them my insurance information.

    My company has a full time employee who's only purpose is to get the insurance company to pay all the crap they deny.  That person IMO is one of the most valued employees we have.  She has saved me many aggravations and some money, but she saved a coworker of mine a rather large amount because of sort of mix-up with a hospital leaving the network midyear, something apparently he should have known before the surgery.

    There is literally no other business in the world in which you sign a form assuming all financial responsibility without having any control over who will be involved and what the costs are.  IMO blindly signing financial liability should illegal under customer protection laws.  

    Imagine having a car repaired by BigInsurance.  You go in thinking you have a warranty, but they won't even look at without making you sign a from assuming all responsibility.  But the good news is they accept your warranty.  There is no standardized pricing or any conceivable way to find out if the repairs are covered or what they cost, but it's cool because you have a warranty.  They fix it, no mention of any costs.

    A week or two later you get the bills, turns out the warranty isn't accepted by the folks the original service station contracted the work out to, so you are on the hook for the entire amount, even though are one of the lucky ones with a warranty, which the service company stated they accepted.  Oh, and the amount is higher than they would have charged the warranty company had they the taken the warranty.  And there isn't a damn thing you can do about it because apparently consumer protection laws against that kind of BS don't apply to health care or the insurance industry.

    All of this BS could be easily avoided with industry specific national consumer protection laws.  Like no one is required to sign for financial responsibility without some sort of estimate that has to be w/i a certain percentage of the final bill.  Or that the facility is on the hook when they use outside services that aren't covered by insurance.  One bill for each visit, if they want to contract out the work fine, but the customer is only billed by the entity in which they went to.  And lastly, a real and understandable reason as to why any item is not covered, maybe even standardized codes so they just can't make up reasons.

    Anyone who sides with BigInsurance either is young and has never had to actually deal with them or works in the industry. No reasonable person could even believe the system in place is anything but a complete racket designed to rip people off.


    Purely anecdotal (none / 0) (#65)
    by jondee on Wed Nov 20, 2013 at 02:46:14 PM EST
    but I've heard some hospitals in this country give people a 2.00 bag of saline solution and then charge the insurer 700.00 for "IV therapy".

    Could that possibly be true? Shades of 400.00  Pentagon hammers..


    Yep (5.00 / 1) (#83)
    by Ga6thDem on Wed Nov 20, 2013 at 04:48:50 PM EST
    It can be true. They can sneakily code some of this stuff but it also works both ways. I went in for my annual physical one time and got a huge bill even though the insurance was supposed to cover it. Apparently they were supposed to code it with one code and not the one they used.

    I got a bill for $10.00 from a subcontracted company that did drugs for a hospital. It was for two Tylenol. I learned long ago to take medicine with me to the hospital.


    yes (3.50 / 2) (#57)
    by labrat on Wed Nov 20, 2013 at 01:47:30 PM EST
    The first half of my life - when healthcare was affordable.

    Maybe if that doctor didn't have to hire 2 people to code and process all his claims he could see you for $75? And if you can't afford $150 to go to a doctor when you are sick - how are you going to afford $300/mo for a plan with a 5K deductible? huh?

    So-called "preventative" does NOT save money. Another myth.


    A doctor's (5.00 / 1) (#61)
    by Ga6thDem on Wed Nov 20, 2013 at 02:06:38 PM EST
    office visit does not go against the deductible. If you are able to pay the 300 for the premium you are only going to have to come up with an extra 20 for the OV. People who cannot pay the 150 for the OV are likely not going to be able to afford insurance either of any kind but catastrophic insurance is actually detrimental to people in those situations because they would have to pay the premium and the FULL Price to go to the doctor.

    Say what? (5.00 / 2) (#70)
    by Donald from Hawaii on Wed Nov 20, 2013 at 03:10:11 PM EST
    labrat: "So-called "preventative" [care] does NOT save money. Another myth."

    What rubbish and nonsense! You may work in the medical profession, but clinical practice and sound public health policy are not necessarily one and the same thing, and you quite obviously haven't a clue regarding the latter.

    What are you going to tell us next -- that people shouldn't bother to be vaccinated against diseases, because the economic effects of flu, meningitis, cholera and diphtheria outbreaks are overstated, and should properly be but figments of our now-uninnoculated and subsequently fevered imaginations?

    I don't know where you live, but it sure wouldn't surprise me to learn that your local high school's alma mater is "Dueling Banjoes."



    A comment to labrat (5.00 / 1) (#52)
    by christinep on Wed Nov 20, 2013 at 12:52:58 PM EST
    How we come out on Healthcare Reform and Healthcare, in general, often has a lot to do with our societal values.  For those, like myself, who believe strongly that healthcare and the delivery thereof should be a fundamental right and not a privilege, the movement made by the ACA is the right movement, the right change to replace the everyone-for-themselves under-regulated model to date.

    Cost-benefit models always contain a degree of subjectivity.  The real issue as to healthcare and any purported economic model has to do with how we measure.  If not already clear, it should become so shortly ... that the ACA approach does shift a noticeable cost benefit to the poorer and less well-off people in our society (witness the subsidy approach on the exchanges and take note of the large numbers now being included in expanded Medicaid.)  Repeating the "Greatest Good for the Greatest Number" mantra, that design was not accidental. This is what societal change is.


    Lets see if I got this right (none / 0) (#31)
    by ragebot on Wed Nov 20, 2013 at 11:11:58 AM EST
    Employers are cutting hours to avoid reaching the minimum number of hours that triggers mandated health care insurance coverage.  So the solution is to lower that minimum number of hours.

    What happens if the employers cut hours even more.  This is what is often called unintended consequences.


    The plans (none / 0) (#39)
    by TeresaInSnow2 on Wed Nov 20, 2013 at 11:50:53 AM EST
    already are far more catastrophic than any plan I've ever had.

    My "catastrophic" plan had a $2500 deductible.

    The new "non-catastrophic" bronze plan has a $5000 deductible.

    These plans are catastrophic and equally cash cow-ish for the insurance companies.  They are just more expensive catastrophic.


    Technically even (5.00 / 2) (#47)
    by Ga6thDem on Wed Nov 20, 2013 at 12:02:33 PM EST
    5K isn't considered catastrophic and hasn't been considered catastrophic coverage for years. Catastrophic is something like 10K and up. I have had 10K deductible policies. They are not worth the price of the premium because they pay nothing. Sure if i could get it for something like $25.00 a month maybe but seven years ago that plan cost $550 a month for a family of four and had no maternity coverage, no checkup coverage nothing. Why even bother to pay for that kind of premium?

    Catastrophic coverage (none / 0) (#93)
    by TeresaInSnow2 on Wed Nov 20, 2013 at 07:38:59 PM EST
    in my state was historically anything above $1750. That's all been thrown out the window in favor of Obamacare.  $2500 deductibles are gone unless you buy completely unaffordable GOLD plans..  How a middle class INDIVIDUAL can afford to pay $5000/year in premiums and meet a $5000 deductible before they get a dime of care, I don't know, but that is what Obamacare asks.

    Double that for a family.  

    And all that so that the yummy insurance companies can restrict Obamacare plans from research and teaching hospitals.

    And I don't know about anyone else's state, insurance is far junkier in my state under Obamacare.  

    You can choose to believe whatever you want to believe.  Here in reality the facts say something else.


    Well (none / 0) (#119)
    by Ga6thDem on Thu Nov 21, 2013 at 07:58:28 AM EST
    then you had a better structure in WA than a lot of other states.

    I had to pay 10K a year for a 5K dedutible plan here in GA five years ago and that was with Kaiser and it was the best deal I could find because it included mental health which other carriers like BCBS and Aetna didn't have for the same price.


    How many (none / 0) (#130)
    by TeresaInSnow2 on Thu Nov 21, 2013 at 10:36:44 AM EST
    did you insure at that price?  Also, what were the age groups?

    Yes, Washington state had good protections for insurees, while maintaining a certain level of affordability.  I didn't like the insurance here at all, until I saw the Obamacare plans.  Compared to Obamacare and the plans offered outside of it, my insurance was Cadillac for my needs.


    Four (none / 0) (#131)
    by Ga6thDem on Thu Nov 21, 2013 at 10:41:18 AM EST
    people with two over the age of 40 at the time. That's kind of the strange thing. States like GA are going to come out better on the federal exchanges I'm guessing than people in states that actually regulated insurance like WA. That same Kaiser plan is now a bronze plan and it costs $544 a month instead of $800 but the co-pays are more but I still would come out ahead on that vs. what i was paying previously for Kaiser.

    You can look at (5.00 / 2) (#140)
    by TeresaInSnow2 on Thu Nov 21, 2013 at 11:27:00 AM EST
    WaHealthPlanFinder.org to see plans.  You do not have to sign up to see them. Double the deductibles shown for 2 people.  Strangely enough, LOL the site doesn't do that...but if you click through to plan details that's what it is.

    And note that even the non-HMO plans have very limited networks.  The only BCBS affilitate on the Exchange does not have any of the research or specialty hospitals in network.  The non-BCBS affiliate does have some additional hospitals but only covers doctors and hosptials in the county.

    Exchange: $631/mo for a two person plan 50-yr-old, $10,500 deductible before any benefits paid (other than "preventive," just hope they don't find anything because you're on the hook for 10 grand before they pay for illness).

    This year, right now (2013), with preventive services, unlimited lifetime caps, and some other "A"CA restrictions already in place, we're paying $666 for a $5,000/yr deductible and a network that covers pretty much every doctor in town and ALL specialty centers.  We also have some up front doctor's visits and lab work not subject to deductible.

    If, next year, I want a plan with the same doctor network I have now, again, it's the $10,500 deductible, but $850/mo premiums for the two of us.  And this plan takes away my up-front coverage.

    If this keeps up, I DEFINITELY won't carry insurance anymore. And I'll sit on the Capitol steps until my mandate is waived or they throw me in jail for demonstrating. I don't care.

    The Affordable Care Act is unaffordable.  It's as simple as that.


    Thanks for this (5.00 / 1) (#154)
    by leinwa on Thu Nov 21, 2013 at 05:22:37 PM EST
    you've answered a question i had on another thread whether the narrow provider networks were limited geographically ("BCBS affilitate on the Exchange does not have any of the research or specialty hospitals in network.  The non-BCBS affiliate does have some additional hospitals but only covers doctors and hosptials in the county.").
     It appears if I have an accident out of state I won't be covered. It also appears that the benefit for children staying on parents' plans has some pitfalls in that if they are in college and out of area coverage, good luck with that.

    I already (none / 0) (#145)
    by Ga6thDem on Thu Nov 21, 2013 at 12:15:11 PM EST
    looked at the plans that how I know my Kaiser plan is now 544 instead of 800 and there are 39 plans to choose from in my area. Look I'm not doubting what you're saying about WA but I'm talking about GA not WA. The problem here in GA is the rural areas. They are not going to get the choice in plans the more populated areas are and since GA did not participate in the Medicaid expansion, the majority of these people are going to be left out because BCBS is the only carrier and the hospitals have a monopoly in some of these rural areas and their insurance is going to be more expensive to boot.

    SITE VIOLATOR (none / 0) (#29)
    by jbindc on Wed Nov 20, 2013 at 11:00:29 AM EST

    Come on, it's Hy (Hyman Roth?) (none / 0) (#33)
    by Dadler on Wed Nov 20, 2013 at 11:19:14 AM EST
    He's a good cat. He just doesn't know how to break the ice.

    Hyman Roth was Meyer Lansky in (none / 0) (#36)
    by fishcamp on Wed Nov 20, 2013 at 11:31:16 AM EST
    Godfather ll.  Not sure how good a guy he was but he sure built a nice hotel in Havana.  The Hotel National.

    Meyer Lansky (1902-1983) was known as ... (5.00 / 1) (#78)
    by Donald from Hawaii on Wed Nov 20, 2013 at 04:14:50 PM EST
    ... "The Mob's Accountant," and the Jewish racketeer was a powerful figure in the American underworld during the mid-20th century. He was the contemporary and erstwhile compatriot of the notorious gangster Charles "Lucky" Luciano and that farsighted Las Vegas visionary, Benjamin "Bugsy" Siegel.

    Like the quasi-fictional Hyman Roth, Lansky tried to keep a relatively low public profile, but he was nonetheless quite ruthless in his pursuit of good business opportunities. And like Lansky allegedly did with Siegel, Roth didn't hesitate to take out a contract on the life of someone perceived as a potential problem, Michael Corleone (Al Pacino), once he had determined it to be in his best interest to do so.

    But unlike Roth, Lansky allegedly succeeded and Bugsy was unapologetically rubbed out at his Beverley Hills mansion in June 1947.

    True Addendum: The character of ambitious Las Vegas entrepreneur Moe Green in Mario Puzo's original novel "The Godfather" and the subsequent 1972 film was inspired by the visionary side of Bugsy Siegel, and his name was a clever play on the names of two well-known underworld associates of Meyer Lansky, Moe Sedway and Gus Greenbaum. Like Siegel, Green was killed in a mob hit and shot through the eye.

    But Sedway and Greenbaum actually fared much better in real life, and were the two guys who on June 20, 1947 entered the Flamingo Hotel & Casino in Las Vegas within 20 minutes of Bugsy Siegel's murder in Beverley Hills, to take formal possession of the property on behalf of Lansky and his east coast partners.

    Another True Addendum: Shortly after Francis Ford Coppola's epic sequel "The Godfather, Part II" received 11 Academy Award nominations in the spring of 1975, Meyer Lansky phoned actor Lee Strasberg to congratulate him on the Best Supporting Actor nomination he received for his performance as Hyman Roth, and added half in jest, "You could've made me more sympathetic."



    And he gave a lot more (none / 0) (#67)
    by jondee on Wed Nov 20, 2013 at 02:47:40 PM EST
    propaganda ammo to Castro.