Obamacare roll-out and impact

[Uncle Charlie]

Needless to say, the roll-out has been less than what the Dems have been expecting.  Most of the folks I know have employer healthcare, so I have only found two people I know well enough to ask about how their experience has been:

1.  Late 30's unemployed un married male with good health history.  His premiums went up about 80% and now has higher deductibles.  He's considering paying the tax.
2.  Early 70's retired male unmarked with mixed health history (multiple hip replacements but otherwise healthy).  His premiums were comparable, but only one of the docs he uses will accept the new carrier.  He still hasn't decided what do to.  He's upset about the decision to be made and is clearly conflicted (big Dem) about what he thinks of the law.

Does anyone here have any experiences or knowledge of them?

[Fredia]

no real knowledge but i am loosing my docs too

[Mr. Happy]

The website rollout has been a clusterfuck. I find out tomorrow how my employer healthcare changes. I'm dreading it because I know that the news won't be good. I think that the Democrats underestimated healthy people's willingness to pay a tax versus take a government subsidy.

[Limey]

Needless to say, the roll-out has been less than what the Dems have been expecting.  Most of the folks I know have employer healthcare, so I have only found two people I know well enough to ask about how their experience has been:

1.  Late 30's unemployed un married male with good health history.  His premiums went up about 80% and now has higher deductibles.  He's considering paying the tax.
2.  Early 70's retired male unmarked with mixed health history (multiple hip replacements but otherwise healthy).  His premiums were comparable, but only one of the docs he uses will accept the new carrier.  He still hasn't decided what do to.  He's upset about the decision to be made and is clearly conflicted (big Dem) about what he thinks of the law.

Does anyone here have any experiences or knowledge of them?

1)  Just curious:  has he been on the exchanges, or just looked at the renewal offer from his existing carrier?  People in this guy's situation are getting a shitty renewal because Obamacare forces a minimum level of coverage that was not there in many of the cheap plans available.  In many cases, people shopping the exchanges are able to beat their old carrier's offer by a considerable margin.

2)  Not sure why a 70-year old is buying health insurance when presumably he qualifies for Medicare.  Is that just his Part D coverage?   Obamacare has just closed his "donut hole", swept away any lifetime limits he may have had, and eliminated any exclusions for pre-existing conditions which, for a 70-year old, means he can shop amongst carriers like its Black Friday because he won't lose coverage by switching.

[HudsonHawk]

The website rollout has been a clusterfuck. I find out tomorrow how my employer healthcare changes. I'm dreading it because I know that the news won't be good. I think that the Democrats underestimated healthy people's willingness to pay a tax versus take a government subsidy.

I think you underestimated the people who were willing to only do the latter prior to Obamacare.

[Limey]

The website rollout has been a clusterfuck. I find out tomorrow how my employer healthcare changes. I'm dreading it because I know that the news won't be good. I think that the Democrats underestimated healthy people's willingness to pay a tax versus take a government subsidy.

Unless the cost of insurance is a significantly higher charge than the tax, it would be stupid to pay the tax.  The tax is dead money while you may end up using the insurance, even if it's just to get your cholesterol checked.

[sporadic]

even if it's just to get your cholesterol checked.

This right here is what pisses me off about insurance.  You should not fucking use insurance to go get your cholesterol checked, you should pay the fucking doctor for the service.  Insurance should be for things you cannot affford, not to receive $20.00 doctor visits.  Car insurance does not cover tires and oil changes...health insuance should be the same fucking way.  Drop a lung, we got you...get a cold, take care of it yourself.

[HudsonHawk]

This right here is what pisses me off about insurance.  You should not fucking use insurance to go get your cholesterol checked, you should pay the fucking doctor for the service.  Insurance should be for things you cannot affford, not to receive $20.00 doctor visits.  Car insurance does not cover tires and oil changes...health insuance should be the same fucking way.  Drop a lung, we got you...get a cold, take care of it yourself.

Car insurance doesn't cove blown engines, stripped transmissions, broken axles, and other things do to a lack of proper maintenance.  For your analogy to be accurate, health insurance should only kick in if you're stabbed or shot, not if you get cancer.  But it doesn't...it covers things that can be prevented with some minor preventative care, so it's in the best interest of the insurance company to pay for a $20 doctor visits every year to avoid a $2MM hospital bill.

[Limey]

This right here is what pisses me off about insurance.  You should not fucking use insurance to go get your cholesterol checked, you should pay the fucking doctor for the service.  Insurance should be for things you cannot affford, not to receive $20.00 doctor visits.  Car insurance does not cover tires and oil changes...health insuance should be the same fucking way.  Drop a lung, we got you...get a cold, take care of it yourself.

I think you're missing the point of getting free checkups.  It's the same reason Hartford Steam Boiler or Factory Mutual will come and survey your plant and machinery for free if you have a policy with them.  It's so they can take a look under the hood and let you know if they find anything wrong.  That way, you have a chance to take care of it before it blows up and causes an even bigger loss.

The main problem with the way healthcare is handled in the country is that, for many people, it has been reactive.  If you have no insurance - because you can't afford it - you never get to have your plant and machinery checked.  This leads to worse outcomes down the road as really expensive things like heart disease and cancer go unnoticed until they blow up and you end up in an emergency room - getting the most expensive form of healthcare on everyone else's dime.

I do not like Obamacare.  I think using insurance companies as overseers of healthcare provision is a really bad idea, if for no other reason than they do no better a job than, say, Medicare, but do it as 5 times the overhead.  However, I also do not like people using emergency rooms as their family practitioner, and having me (and you) pay for it.  That's just bad for all concerned: patients, hospitals and the insured public.

[sporadic]

Car insurance doesn't cove blown engines, stripped transmissions, broken axles, and other things do to a lack of proper maintenance.  For your analogy to be accurate, health insurance should only kick in if you're stabbed or shot, not if you get cancer.  But it doesn't...it covers things that can be prevented with some minor preventative care, so it's in the best interest of the insurance company to pay for a $20 doctor visits every year to avoid a $2MM hospital bill.

Bad analogy...cars generally don't cause devastating financial loss.  Big ticket health items can.  I want reasonable fees for services rendered, whether it is my or the insurance company or me paying the bill and I don't see the new system making anything more affordable for the average Joe.  I truly hope I am wrong about that...

[sporadic]

However, I also do not like people using emergency rooms as their family practitioner, and having me (and you) pay for it. 

The ER needs to charge folks prior to service for non life-threatening issues.  NP sees you...you have a cold or upset tummy.  Want to see the doc and get a scrip, that'll be $75.00...if not, go to Walgreens and buy some Ny-Quil or Pepto Bismol.

[Limey]

The ER needs to charge folks prior to service for non life-threatening issues.  NP sees you...you have a cold or upset tummy.  Want to see the doc and get a scrip, that'll be $75.00...if not, go to Walgreens and buy some Ny-Quil or Pepto Bismol.

So who pays for the services of the Nurse?  Who decides what's life-threatening, and who pays for their time and expertise?  You want to turn away sick people - untreated - so that they can go on and infect more of the rest of us?

[HudsonHawk]

Bad analogy...cars generally don't cause devastating financial loss.  Big ticket health items can.  I want reasonable fees for services rendered, whether it is my or the insurance company or me paying the bill and I don't see the new system making anything more affordable for the average Joe.  I truly hope I am wrong about that...

Of course it's a bad analogy.  That's my point.  You can't treat preventative health care the same as tires (or tyres for Limey) and oil changes.

[HudsonHawk]

The ER needs to charge folks prior to service for non life-threatening issues.  NP sees you...you have a cold or upset tummy.  Want to see the doc and get a scrip, that'll be $75.00...if not, go to Walgreens and buy some Ny-Quil or Pepto Bismol.

We don't, as a society, turn people away from healthcare.  We pay for it, then bitch about having to.  When someone tries to force them to pay for themselves, we bitch about that too.  It's what we do.

[Ty in Tampa]

We don't, as a society, turn people away from healthcare.  We pay for it, then bitch about having to.  When someone tries to force them to pay for themselves, we bitch about that too.  It's what we do.

I will be stealing this from you.

[Limey]

For anyone interested, here's a completely nerdtastic explanation of how Obamacare is cutting healthcare costs for most people, but not everyone.

[subnuclear]

Obamacare wasn't intended for the average person, but the person who has serious medical issues who can't get into a useful insurance pool. This is probably a small group people, so the fact that there is so much effort to even cover them tells you there is a lot of people involved in health care that don't have the public's best interest.

[Mr. Happy]

I think you underestimated the people who were willing to only do the latter prior to Obamacare.

Maybe. I'm betting that most healthy people opt to pay the tax, thereby undercutting the whole cost platform for those who presently have no coverage because of their claims experience. Again, it was an underestimation.

[HudsonHawk]

Obamacare wasn't intended for the average person, but the person who has serious medical issues who can't get into a useful insurance pool. This is probably a small group people, so the fact that there is so much effort to even cover them tells you there is a lot of people involved in health care that don't have the public's best interest.

Insurance companies don't have the public's interest in mind, they have their own.  They're in it to make money.  That's what private, for-profit companies do.

[Limey]

Obamacare wasn't intended for the average person, but the person who has serious medical issues who can't get into a useful insurance pool. This is probably a small group people, so the fact that there is so much effort to even cover them tells you there is a lot of people involved in health care that don't have the public's best interest.

It's about 10% of the population.

Opponents of Obamacare have fearmongered about having the Government in the doctor's office.  Of course, this conveniently ignores the previous status quo, of having insurance companies - whose worth is improved by not providing coverage - in the doctor's office instead.

[subnuclear]

Insurance companies don't have the public's interest in mind, they have their own.  They're in it to make money.  That's what private, for-profit companies do.

Also, doctors, pharma companies, medical supply companies, hospitals, educational institutions, etc.

[subnuclear]

It's about 10% of the population.

Its not anywhere near 10% of the population. I doubt its more than 1% who have serious medical issues and who don't qualify for a decent insurance pool.

[Limey]

Its not anywhere near 10% of the population. I doubt its more than 1% who have serious medical issues and who don't qualify for a decent insurance pool.

There is about 50 million uninsured in the U.S., or 16%.  Obamacare attempts to reduce this to zero with an expansion of Medicaid and the insurance mandate - providing subsidies for those who fall in the gap between not qualifying for Medicaid but too poor to buy insurance.

The article I linked to above mentioned the 10% figure as being those left out of the Medicaid expansion.

[Limey]

Also, doctors, pharma companies, medical supply companies, hospitals, educational institutions, etc.

These entities make money by providing healthcare.  Insurance companies make money by not providing healthcare.

[subnuclear]

There is about 50 million uninsured in the U.S., or 16%.  Obamacare attempts to reduce this to zero with an expansion of Medicaid and the insurance mandate - providing subsidies for those who fall in the gap between not qualifying for Medicaid but too poor to buy insurance.

The article I linked to above mentioned the 10% figure as being those left out of the Medicaid expansion.

But most of those people in both groups are healthy or have inexpensive health care needs and therefore were not in the group I was referring to.

[subnuclear]

These entities make money by providing healthcare.  Insurance companies make money by not providing healthcare.

It's a lot more complicated than that and those people have a lot of say about how health care is applied and how it is distributed.

[mrpink]

But most of those people in both groups are healthy or have inexpensive health care needs and therefore were not in the group I was referring to.

I think this is the number you were talking about (from that same wiki article):

An estimated 5 million of those without health insurance are considered "uninsurable" because of pre-existing conditions.

That's somewhere between 1 and 2 percent of the population.

[Limey]

But most of those people in both groups are healthy or have inexpensive health care needs and therefore were not in the group I was referring to.

Yep.  The healthy uninsured have been offered up as the "quo" in the deal with insurers to remove pre-existing condition exclusions and lifetime limits.  Insurers now have to cover everyone fully, but they get to cover everyone.

As anyone in the insurance biz will tell you: insurance works better the more risks are added to the pool, exponentially so when you can improve the overall risk in the pool (by adding better risks).

[HudsonHawk]

Maybe. I'm betting that most healthy people opt to pay the tax, thereby undercutting the whole cost platform for those who presently have no coverage because of their claims experience. Again, it was an underestimation.

People are right now opting to not have insurance and aren't paying a tax.  They're not paying *anything*.  That's the problem.  At least if they pay the tax, they're paying *something*.

[Mr. Happy]

Apparently, the tax isn't that great, and certainly not the cost of the insurance unless you qualify for the government subsidy, in which case it might be free.

[HudsonHawk]

Apparently, the tax isn't that great, and certainly not the cost of the insurance unless you qualify for the government subsidy, in which case it might be free.

It's free for them now.

[Limey]

Apparently, the tax isn't that great, and certainly not the cost of the insurance unless you qualify for the government subsidy, in which case it might be free.

It's definitely worth checking out what's available on the exchanges before opting to pay the tax.  The Federal exchange is working better now (not a high bar) but for those who live in States that set up their own exchanges, things are going much better.

[NeilT]

It's free for them now.

But their medical costs aren't free for me.

[Limey]

It's free for them now.

Yes and no.

They are running the risk of getting seriously hurt/ill, and having to spend a fortune on medical treatment.  It's a hidden cost, but it's a cost.

[Mr. Happy]

But their medical costs aren't free for me.

Exactly.

[HudsonHawk]

Exactly.

So why are you complaining at trying to make them pay, at least *something*?

[HudsonHawk]

Yes and no.

They are running the risk of getting seriously hurt/ill, and having to spend a fortune on medical treatment.  It's a hidden cost, but it's a cost.

They won't spend a dime.  The public will pay for it.  We don't let people die because they're stupid.

[mrpink]

So why are you complaining at trying to make them pay, at least *something*?

Not speaking for anyone else, but I complain because it's bullshit that we are forced to purchase something that we may not feel we need.

[NeilT]

Not speaking for anyone else, but I complain because it's bullshit that we are forced to purchase something that we may not feel we need.

Just curious, but are you saying you don't feel like you need insurance, or are you saying that you don't feel you need the level of insurance required?

[sporadic]

Just curious, but are you saying you don't feel like you need insurance, or are you saying that you don't feel you need the level of insurance required?

Does that really matter?  If he does not want to buy insurance he should not have to.  Does not mean he is entitled to world class treatment in the event something happens, but that is his decision to make. 

[mrpink]

Just curious, but are you saying you don't feel like you need insurance, or are you saying that you don't feel you need the level of insurance required?

I both have and need insurance, but I haven't always felt that way.  I'm in my thirties and have a family and obligations, but 10 years ago I considered not being insured because I was young and dumb.  After talking to a few people and having it pointed out to me that it wasn't worth the risk I went ahead and got it.
However, that was my choice.  One shouldn't be punished for choosing to risk his own financial future for a short term gain.

The level of insurance required is a whole other conversation, IMO.  For example, why is it that the law now requires all insurance plans to cover prenatal care for all women?  If a woman knows she won't be having children she should be able to decline that coverage and reduce her premium.  Or is that not an actual requirement?

[mrpink]

Does that really matter?  If he does not want to buy insurance he should not have to.  Does not mean he is entitled to world class treatment in the event something happens, but that is his decision to make. 

Exactly.

[Limey]

They won't spend a dime.  The public will pay for it.  We don't let people die because they're stupid.

If you can pay some or all, they'll take it first.

[Fredia]

doesnt the policies carry maternity coverage

[subnuclear]

In general, if you don't want insurance companies to turn you down for pre-existing conditions, everyone has to have insurance. Otherwise, people will get insurance right before they need treatment and then drop it when they are better.

[BudGirl]

I both have and need insurance, but I haven't always felt that way.  I'm in my thirties and have a family and obligations, but 10 years ago I considered not being insured because I was young and dumb.  After talking to a few people and having it pointed out to me that it wasn't worth the risk I went ahead and got it.
However, that was my choice.  One shouldn't be punished for choosing to risk his own financial future for a short term gain.

The level of insurance required is a whole other conversation, IMO.  For example, why is it that the law now requires all insurance plans to cover prenatal care for all women?  If a woman knows she won't be having children she should be able to decline that coverage and reduce her premium.  Or is that not an actual requirement?

Like a woman has any choice.

[Limey]

Does that really matter?  If he does not want to buy insurance he should not have to.  Does not mean he is entitled to world class treatment in the event something happens, but that is his decision to make. 

Personally, I don't want to have to walk past the sick and dying in order to go to see my doctor (that my insurance is paying for).

We make people wear seat belts and hard hats.  We regulate building construction and food content and a whole host of other things that aren't really optional in modern life.  All these things cost money directly or indirectly.  Making people buy health insurance - for the good of society as a whole - is not at all out of whack.  It's not about making people protect themselves (although that is a huge by-product), it's about making sure that the rest of us don't end up paying for someone's mistake/selfishness.

[sporadic]

Like a woman has any choice.

NO means NO!  Unless you are married.  Then no means no, maybe means no and yes means OK, but hurry the fuck up about it

[NeilT]

Does that really matter?  If he does not want to buy insurance he should not have to.  Does not mean he is entitled to world class treatment in the event something happens, but that is his decision to make. 

To me it matters.  If he doesn't have insurance and isn't rich, then I'm going to be paying part of his medical bills when doctors do what they're supposed to do and don't refuse him treatment next time he runs a red light and ends up in the county emergency room.  It's going to cost me through increased costs on my insurance and medical costs or through my tax payments to Harris County Hospital District for indigent care.  It's nonsense to think that failure to insure isn't a cost out of my wallet right now.  It's not my decision to make toi pay those costs now, and they don't benefit me and mine.

[mrpink]

Like a woman has any choice.

Good point, I forgot about Mary.

[NeilT]

If you can pay some or all, they'll take it first.

If you'll pay it.

[Limey]

The level of insurance required is a whole other conversation, IMO.  For example, why is it that the law now requires all insurance plans to cover prenatal care for all women?  If a woman knows she won't be having children she should be able to decline that coverage and reduce her premium.  Or is that not an actual requirement?

This is the "quid" part of the bargain in Obamacare.  It's akin to the mandate: everyone buys insurance, and the insurance covers everyone to a minimum standard.  Men don't even get a discount for not requiring any type of natal care - we're just chipping in a little bit of our premium towards the care of the lucky ladies we happen to impregnate.

[mrpink]

We make people wear seat belts and hard hats.  We regulate building construction and food content and a whole host of other things that aren't really optional in modern life.  All these things cost money directly or indirectly.  Making people buy health insurance - for the good of society as a whole - is not at all out of whack.  It's not about making people protect themselves (although that is a huge by-product), it's about making sure that the rest of us don't end up paying for someone's mistake/selfishness.

Don't even get me started on seat belts....

[mrpink]

To me it matters.  If he doesn't have insurance and isn't rich, then I'm going to be paying part of his medical bills when doctors do what they're supposed to do and don't refuse him treatment next time he runs a red light and ends up in the county emergency room.  It's going to cost me through increased costs on my insurance and medical costs or through my tax payments to Harris County Hospital District for indigent care.  It's nonsense to think that failure to insure isn't a cost out of my wallet right now.  It's not my decision to make toi pay those costs now, and they don't benefit me and mine.

Give me a different scenario.  I don't run red lights so if someone else runs a red light and injures me that money comes out of their auto liability insurance.  In the case where I might get injured and rack up a six-figure medical bill, I will pay that bill.  It's the assholes that don't that are increasing your costs, not me (in this hypothetical scenario where I don't have insurance).

[subnuclear]

Believe it or not, people can get sick/injured for no particularly good reason or reasons beyond their control.

[Bench]

However, that was my choice.  One shouldn't be punished for choosing to risk his own financial future for a short term gain.

The issue is that it's not just his own financial future.  Some people may want to live in a world where somebody without insurance suffers a sudden accident or illness is left to die without anybody paying a dime, but (fortunately, IMO) that's not the world we live in.  The cost gets spread around somehow no matter what.  

[HudsonHawk]

Not speaking for anyone else, but I complain because it's bullshit that we are forced to purchase something that we may not feel we need.

What's bullshit is you forcing other people to pay for it because you "don't feel like it".

[mrpink]

Believe it or not, people can get sick/injured for no particularly good reason or reasons beyond their control.

That's why I decided to stay insured.

[mrpink]

What's bullshit is you forcing other people to pay for it because you "don't feel like it".

Who exactly did I force to pay for what?

[HudsonHawk]

I both have and need insurance, but I haven't always felt that way.  I'm in my thirties and have a family and obligations, but 10 years ago I considered not being insured because I was young and dumb.  After talking to a few people and having it pointed out to me that it wasn't worth the risk I went ahead and got it.
However, that was my choice.  One shouldn't be punished for choosing to risk his own financial future for a short term gain.

So if you had say been in a car accident and routine emergency care would save your life, you would have been ok with letting you die in the street because, you know, you don't want to be punished?  You're ok with letting children suffer disease because you don't to punish their parents with that whole responsibility thing?

[HudsonHawk]

Who exactly did I force to pay for what?

When you need it, you will get it, whether you felt like paying for it or not. That doesn't mean it was free.

[HudsonHawk]

If you can pay some or all, they'll take it first.

But people don't. They don't "feel like" paying, so they don't.

[mrpink]

So if you had say been in a car accident and routine emergency care would save your life, you would have been ok with letting you die in the street because, you know, you don't want to be punished?  You're ok with letting children suffer disease because you don't to punish their parents with that whole responsibility thing?

The absence of insurance doesn't mean I would die in the street.  I would get treated in the ER and pay the bill.  It would be a huge bill, no doubt, but (assuming I survive) it would get paid.  I don't know what you're getting at with the second question.

[Limey]

Give me a different scenario.  I don't run red lights so if someone else runs a red light and injures me that money comes out of their auto liability insurance.  In the case where I might get injured and rack up a six-figure medical bill, I will pay that bill.  It's the assholes that don't that are increasing your costs, not me (in this hypothetical scenario where I don't have insurance).

A few years ago, the energy insurance community in Houston held a fund raising drive on behalf of a guy in our industry who needed to buy his son new legs.  His son had been pushing a friend's car along a quiet suburban street, on a bright and clear afternoon, when an old geezer ran into the back of him.  He lost one and a half legs.  The geezer's insurance company cut a check for the limit of his insurance - $25,000 - said "sorry" and was out of it.  The geezer's assets, what there were of them, were all protected by various State laws regarding homestead and retirement income.

The cost of legs on which the kid would be able to walk was $100,000 a pair, and they don't last forever.  This is on top of all the medical attention he needed, and will continue to need throughout his life.  And we're not counting the cost of widening doors, adding ramps and bars and various other modifications required to make his life livable.

The kid was a recent college graduate at the time, and as such, had just been kicked off his Dad's health insurance.

[mrpink]

A few years ago, the energy insurance community in Houston held a fund raising drive on behalf of a guy in our industry who needed to buy his son new legs.  His son had been pushing a friend's car along a quiet suburban street, on a bright and clear afternoon, when an old geezer ran into the back of him.  He lost one and a half legs.  The geezer's insurance company cut a check for the limit of his insurance - $25,000 - said "sorry" and was out of it.  The geezer's assets, what there were of them, were all protected by various State laws regarding homestead and retirement income.

The cost of legs on which the kid would be able to walk was $100,000 a pair, and they don't last forever.  This is on top of all the medical attention he needed, and will continue to need throughout his life.  and we're not counting the cost of widening doors, adding ramps and bars and various other modifications required to make his life livable.

The kid was a recent college graduate at the time, and as such, had just been kicked off his Dad's health insurance.

That's tragic.  I hope the fund raiser was wildly successful.  To partially remedy that situation I wouldn't be against raising the minimum required liability insurance. 

[Bench]

 It would be a huge bill, no doubt, but (assuming I survive) it would get paid.

It quite often doesn't.  Medical costs are the biggest cause of personal bankruptcies in the country. 

[HudsonHawk]

The absence of insurance doesn't mean I would die in the street.  I would get treated in the ER and pay the bill.  It would be a huge bill, no doubt, but (assuming I survive) it would get paid.  I don't know what you're getting at with the second question.

1) how do I know you'll pay the bill?  What if its more than you earn in 10 years?  From whom will you borrow the money?  What interest are you willing to pay?  Do you think that people sometimes simply *don't* pay?

2)  Not everyone doesn't have insurance by their own choice. Sometimes the people who need medical care are people incapable of being a millionaire 

[Limey]

That's tragic.  I hope the fund raiser was wildly successful.

It was.

To partially remedy that situation I wouldn't be against raising the minimum required liability insurance. 

To what?

[NeilT]

Give me a different scenario.  I don't run red lights so if someone else runs a red light and injures me that money comes out of their auto liability insurance.  In the case where I might get injured and rack up a six-figure medical bill, I will pay that bill.  It's the assholes that don't that are increasing your costs, not me (in this hypothetical scenario where I don't have insurance).

Because they're forced to have auto insurance, or at least are supposed to be.  I don't know whether you can afford a six-figure medical bill or not, or will allocate payments for payment if you can.  Most people can't.  Some people won't make the allocation, notwithstanding good intentions.

I'll give three examples of pretty common medical costs, and all run to at least five figures.  All are mildly age related, but not so age related that they're inconceivable for anybody.

Four or five years ago I had a macular hole.  A macular hole is basically a detached retina, but instead of detaching the retina wrinkles.  With a macular hole, it's hard to see.  It's not tied to genegics, or injury, or anything except that as you age they're more common.  It's cured by a vitrectomy, where a surgeon sucks all the goo out of your eye and then fills it up with gas to push the retina into place.  That's usually followed by cataract surgery because the gas scars your cornea, so by the time you're done you've been to a surgeon a couple of times. 

Second example.  While I was in the waiting room for the first surgery the nurses kept coming over to me to ask me what drugs I was taking.  They thought I needed to be taking something because everybody else in the room was there for eye surgery associated with diabetes or blood pressure.  It was a group that wasn't rich, and I suspect that because of cost or ignorance they had chosen not to treat their diabetes or blood pressure, so they developed complications.  So there you have two examples: Me perfectly healthy having out of the blue to go through a bunch of expensive eye surgery, and a lot of other expensive surgeries going on because of failure to pay for earlier less costly treatment.  I suspect I was paying costs of every surgery in that waiting room.  I guess people could have chosen to go blind, but that would have cost me too.

Third example.  Three weeks ago I fell when I tripped on a Houston sidewalk while I was jogging .  My stupidity, I was jogging on a Houston sidewalk, but who isn't stupid sometime?  By the afternoon I couldn't walk.  Wednesday I have surgery on my knee. Even if you're healthy, shit happens, and it's really expensive when it does.  I'd just as soon people pay for it by having insurance if they can afford it, because I'm a stingy bastard.  I really don't care much about their choice, because they're likely to make a choice that saves them money and costs me. 

Bottom line is that whatever example one picks, you can say it won't happen to you, but something will.  And either you cover the cost or the rest of us cover the cost, and frankly, I don't trust good intentions.


Edited to make HH happy.

[HudsonHawk]

Because they're forced to have auto insurance, or at least are supposed to be.  I don't know whether you can afford a six-figure medical bill or not, or will allocate payments for payment if you can.  Most people can't.  Some people won't make the allocation, notwithstanding good intentions.

I'll give three examples of pretty common medical costs, and all run to at least five figures.  All are mildly age related, but not so age related that they're inconceivable for anybody.

Four or five years ago I had a macular hole.  A macular hole is basically a detached retina, but instead of detaching the retina wrinkles.  With a macular hole, it's hard to see.  It's not tied to genegics, or injury, or anything except that as you age they're more common.  It's cured by a vitrectomy, where a surgeon sucks all the goo out of your eye and then fills it up with gas to push the retina into place.  That's usually followed by cataract surgery because the gas scars your cornea, so by the time you're done you've been to a surgeon a couple of times. 

While I was in the waiting room for the first surgery the nurses kept coming over to me to ask me what drugs I was taking.  They thought I needed to be taking something because everybody else in the room was there for eye surgery associated with diabetes or blood pressure.  It was a group that wasn't rich, and I suspect that because of cost or ignorance they had chosen not to treat their diabetes or blood pressure, so they developed complications.  So there you have two examples: Me perfectly healthy having out of the blue to go through a bunch of expensive eye surgery, and a lot of other expensive surgeries going on because of failure to pay for earlier less costly treatment.  I suspect I was paying costs of every surgery in that waiting room.  I guess people could have chosen to go blind, but that would have cost me too.

Second example.  Three weeks ago I fell when I tripped on a Houston sidewalk while I was jogging .  My stupidity, I was jogging on a Houston sidewalk, but who isn't stupid sometime?  By the afternoon I couldn't walk.  Wednesday I have surgery on my knee. Even if you're healthy, shit happens, and it's really expensive when it does.  I'd just as soon people pay for it by having insurance if they can afford it, because I'm a stingy bastard.  I really don't care much about their choice, because they're likely to make a choice that saves them money and costs me. 

Bottom line is that whatever example one picks, you can say it won't happen to you, but something will.  And either you cover the cost or the rest of us cover the cost, and frankly, I don't trust good intentions.

Not to pick nits, but that was only two examples.

[Craig]

Its not anywhere near 10% of the population. I doubt its more than 1% who have serious medical issues and who don't qualify for a decent insurance pool.

Maybe states with bigger populations have decent insurance pools, but most smaller states don't. When we moved to Arkansas in 2006, there was one private health insurer in the state -- BCBS. We weren't in the high-risk age groups yet -- I was in my 40s and my wife in her 30s. They rejected me for having mild asthma and high cholesterol, both of which are easily treated with generic prescriptions. They rejected my wife for a history of childhood epilepsy and, believe it or not, being "reproductive age." That's what it said on the rejection letter -- a functional uterus was considered a pre-existing condition.

Once we were rejected, our only choice for private insurance was to go into the state pool for uninsurable people. Guess who ran the pool ... BCBS, but with state subsidies. The state pool was originally made for people with cancer and heart attacks, and ended up covering asthma and high cholesterol. And it was incredibly expensive. Our regular monthly bill for premiums and prescriptions was over $1000 a month, and that was several years ago. Add in office visits or an unplanned trip to the ER, and it went much higher.

Now, with Obamacare, we can get a plan with much better coverage, and we can also include my college-age son on it. And with subsidies the premiums will cost between $100 and $200 a month. Thanks Obama.

[Limey]

Now, with Obamacare, we can get a plan with much better coverage, and we can also include my college-age son on it. And with subsidies the premiums will cost between $100 and $200 a month. Thanks Obama.

Arkansas is the only southern State to take up Medicaid expansion offered in Obamacare.  They did it in an interesting way, though: they took the federal subsidy, and used it to buy insurance on their exchange.  This not only provided insurance for those who fell into the gap between the existing Medicaid program and Obamacare, but it increased the premium volume and the pool of lives* insured in the State's exchange, making it more attractive to insurers.

* "Lives" is the industry term for a insured/insurable person.

[Craig]

Arkansas is the only southern State to take up Medicaid expansion offered in Obamacare.  They did it in an interesting way, though: they took the federal subsidy, and used it to buy insurance on their exchange.  This not only provided insurance for those who fell into the gap between the existing Medicaid program and Obamacare, but it increased the premium volume and the pool of lives* insured in the State's exchange, making it more attractive to insurers.

* "Lives" is the industry term for a insured/insurable person.

Yeah, I've been watching it closely. The political carnival here around Obamacare is interesting, because we have a well-liked Democratic governor but an insane Tea Party legislature. The governor was able to convince just enough of the legislature to pass the Medicaid expansion (because it saves the state an assload of money), but now the Republicans are dragging their feet on paying their share. Imagine that. So it's still up in the air.

Once Arkansas got approved for the weird "private Medicaid option," I think a few other states started looking at it too. It's not a perfect solution, because it's more expensive than just accepting Obamacare as written, but it seems workable. At least for states that are full of insane Tea Partiers who would never give up their Medicare, but come unhinged at the thought of someone else getting subsidized health care. Or getting any health care, for that matter.

[jbm]

Arkansas is the only southern State to take up Medicaid expansion offered in Obamacare.  

I think Kentucky did also.  (I consider Kentucky southern)

Eventually, I assume most will because it is incredibly stupid and cruel not to. 

[Craig]

I think Kentucky did also.  (I consider Kentucky southern)

Eventually, I assume most will because it is incredibly stupid and cruel not to. 

I don't know if they used the private option for Medicaid, but Kentucky has been doing great work with the Obamacare rollout. It's become one of the model states for participation.

[chuck]

Not to pick nits, but that was only two examples.

I think he's counting

1. His eye
2. Unhealthy people's eyes
3. His knee

They never did figure out what happened to my ankle, by the way. I had an x-ray ($30) and an MRI ($500) and the specialist looked at the MRI results and didn't see anything unusual ($50). The swelling eventually subsided and everything's more or less back to normal. I got a sweet pair of crutches out of the deal, though ($30). After a day or so I got pretty good at hauling ass around on them.

[NeilT]

Not to pick nits, but that was only two examples.

I decided it was three somewhere in the middle of the telling, and then didn't get it changed around.

[HudsonHawk]

I decided it was three somewhere in the middle of the telling, and then didn't get it changed around.

I just didn't want anyone to feel cheated.

[NeilT]

I just didn't want anyone to feel cheated.

Sometimes when I channel Noe I get lost in the length of the posting.

[subnuclear]

Being an eyeball surgeon sounds pretty cool.

[NeilT]

Being an eyeball surgeon sounds pretty cool.

Sucking all the goo out of peoples' eyes?  I could do that all day long.

[HudsonHawk]

Being an eyeball surgeon sounds pretty cool.

I used to drink with an eye surgeon. He said the surgery part was pretty easy. Anyone with a reasonably steady hand can do it. It was the convincing people to let you cut their eyeballs that was the hard part.

[Ron Brand]

I used drink with an eye surgeon. He said the surgery part was pretty easy. Anyone with a reasonably steady hand can do it. It was the convincing people to let you cut their eyeballs that was the hard part.

Yeah, I had a little something going on a while back and they wanted to jab a needle in my eye and inject something inside. I probably would've ended up letting them do it, but it sure as hell wasn't the first alternative I was going to entertain.

[HudsonHawk]

Yeah, I had a little something going on a while back and they wanted to jab a needle in my eye and inject something inside. I probably would've ended up letting them do it, but it sure as hell wasn't the first alternative I was going to entertain.

My mother had a blood vessel in her eye rupture, and the fluid in her eye filled with blood. The options were to let it absorb back into her eye, which would take several months, or have the fluid replaced, using large needles. She chose the former. She said she never felt a thing, but it was annoying as shit.

[Ron Brand]

That's pretty much what happened to me. It was like someone threw blood - a lot of blood - on a piece of glass that was right in front of my eye. I couldn't see much except for the outer edges. Real fucking distressing.

[Ebby Calvin]

* "Lives" is the industry term for a insured/insurable person.

Check with your doctor before taking this prescription.  Tell him if you're on any other medications, as those can often negate the effects of this prescription.  Also tell him if you reside in Arkansas, as that pretty much negates everything.

[Limey]

I think Kentucky did also.  (I consider Kentucky southern)

Eventually, I assume most will because it is incredibly stupid and cruel not to. 

Opponents of Obamacare have been breathless and apoplectic about people getting their insurance cancelled.  While this is a concern, the vast majority of those getting cancelled can get equivalent or better coverage through the exchanges, their old policies having been cancelled due to them no longer being Obamacare compliant.  Meanwhile, 26 States have declined the essentially free expansion of Medicaid, which has left 6 to 7 million eligible uninsured, still uninsured.  Where's the outrage in the media about that?

It's not like people haven't noticed.  In Louisiana's 5th district, a run-off between two Republicans was won by the candidate who said that the State should accept the Medicaid expansion.  His opponent was endorsed by the party establishment and the Tea Party, and also supported Gov. Jindal's rejection of the expansion.

[Limey]

Sucking all the goo out of peoples' eyes?  I could do that all day long.

Only if I get to choose which people's eyes.

[mrpink]

Because they're forced to have auto insurance, or at least are supposed to be.  I don't know whether you can afford a six-figure medical bill or not, or will allocate payments for payment if you can.  Most people can't.  Some people won't make the allocation, notwithstanding good intentions.

Bottom line is that whatever example one picks, you can say it won't happen to you, but something will.  And either you cover the cost or the rest of us cover the cost, and frankly, I don't trust good intentions.

People are required to carry liability insurance in order to protect other people, not themselves.  That makes sense to me, and if you don't drive a vehicle you (obviously) aren't required to buy it.  I'm trying to think of something you are legally obligated to purchase just because you are an American and health insurance is all I can come up with. 
Since I have employer-provided insurance that was pretty good to begin with Obamacare hardly affects me at all, but I'm completely against it from a principle standpoint.

Also, why is it you suspect you were paying for everyone else's surgery in that room?  How do you know that "it was a group that wasn't rich"?

The difference in our stances seems to come down to where we value our freedom to make our own decisions. 

[mrpink]

Maybe states with bigger populations have decent insurance pools, but most smaller states don't. When we moved to Arkansas in 2006, there was one private health insurer in the state -- BCBS. We weren't in the high-risk age groups yet -- I was in my 40s and my wife in her 30s. They rejected me for having mild asthma and high cholesterol, both of which are easily treated with generic prescriptions. They rejected my wife for a history of childhood epilepsy and, believe it or not, being "reproductive age." That's what it said on the rejection letter -- a functional uterus was considered a pre-existing condition.

Once we were rejected, our only choice for private insurance was to go into the state pool for uninsurable people. Guess who ran the pool ... BCBS, but with state subsidies. The state pool was originally made for people with cancer and heart attacks, and ended up covering asthma and high cholesterol. And it was incredibly expensive. Our regular monthly bill for premiums and prescriptions was over $1000 a month, and that was several years ago. Add in office visits or an unplanned trip to the ER, and it went much higher.

Now, with Obamacare, we can get a plan with much better coverage, and we can also include my college-age son on it. And with subsidies the premiums will cost between $100 and $200 a month. Thanks Obama.

What I never understood is why insurers can't sell across state lines.  All I know is it has to do with the commerce clause.  Does anyone have a good understanding of why the commerce clause is important and restricting the sale of insurance across state lines is a good idea?

[Limey]

What I never understood is why insurers can't sell across state lines.  All I know is it has to do with the commerce clause.  Does anyone have a good understanding of why the commerce clause is important and restricting the sale of insurance across state lines is a good idea?

States' rights.

[HudsonHawk]

The difference in our stances seems to come down to where we value our freedom to make our own decisions. 

The difference in yours and my stances is that I think people should be required to pay for their own care instead of sponging off of the public.  Freedom to decide to sponge off of me shouldn't be an option.  If you feel differently, OK.

[jbm]

People are required to carry liability insurance in order to protect other people, not themselves.  That makes sense to me, and if you don't drive a vehicle you (obviously) aren't required to buy it.  I'm trying to think of something you are legally obligated to purchase just because you are an American and health insurance is all I can come up with. 

If it was a government run health care system and your taxes were used to fund it, would you similarly say "I'm trying to think of some other legally obligated government program my taxes pay for?"

  

[Limey]

People are required to carry liability insurance in order to protect other people, not themselves.  That makes sense to me, and if you don't drive a vehicle you (obviously) aren't required to buy it.  I'm trying to think of something you are legally obligated to purchase just because you are an American and health insurance is all I can come up with. 
Since I have employer-provided insurance that was pretty good to begin with Obamacare hardly affects me at all, but I'm completely against it from a principle standpoint.

Also, why is it you suspect you were paying for everyone else's surgery in that room?  How do you know that "it was a group that wasn't rich"?

The difference in our stances seems to come down to where we value our freedom to make our own decisions. 

You (or anyone else) having health insurance protects the rest of us from picking up your ER bills.  It's making you take responsibility for your own health risks rather than just proclaiming "I'm good for it" and then failing to live up to that obligation when the bill comes due and you don't have the resources to pay it.  This has been reiterated multiple times in this thread.

[mrpink]

States' rights.

Um, thanks?

[NeilT]

People are required to carry liability insurance in order to protect other people, not themselves.  That makes sense to me, and if you don't drive a vehicle you (obviously) aren't required to buy it.  I'm trying to think of something you are legally obligated to purchase just because you are an American and health insurance is all I can come up with. 
Since I have employer-provided insurance that was pretty good to begin with Obamacare hardly affects me at all, but I'm completely against it from a principle standpoint.

Also, why is it you suspect you were paying for everyone else's surgery in that room?  How do you know that "it was a group that wasn't rich"?

The difference in our stances seems to come down to where we value our freedom to make our own decisions. 

As an American, if you live in an urban area, you are required to purchase sewage treatment.  You are not allowed to shit where you please.

Only the tiniest fractional part of those surgeries--it's a societal cost, not just mine.  I assumed they weren't rich because they didn't look rich.  If you want to see the urban unhealthy--overweight, amputations, wheelchairs--go hang out in the waiting room of an eye surgery.  Clearly it was my judgment, and they could have all been rich as Croesus.  They could have all worked for companies with great medical benefits.  I could be wrong, but I didn't think they were, and I don't think they did.

And as for freedom to make your own decisions, I don't place any value on other people's rights to make decisions that cost me money.  Why should I?

[Limey]

If it was a government run health care system and your taxes were used to fund it, would you similarly say "I'm trying to think of some other legally obligated government program my taxes pay for?"  

You can't opt out of Medicare/Medicaid...or VA services.

[mrpink]

The difference in yours and my stances is that I think people should be required to pay for their own care instead of sponging off of the public.  Freedom to decide to sponge off of me shouldn't be an option.  If you feel differently, OK.

I agree you shouldn't be allowed to sponge; there has to be repercussions for your actions.  I don't have the solution, but that doesn't prevent me from saying this isn't it.

[Limey]

Um, thanks?

The States want to control, amongst other things, the minimum level of coverage and solvency of carriers selling in their State.  If you override that option, all insurers will move to the State with the laxest rules, and sell from there (just like how all credit cards are sold from Delaware).

ETA:  You can only buy auto and homeowners insurance from State-approved ("admitted") insurers too.  They are required to have a minimum amount of security posted in-State, to give the State something to seize in the event of insolvency.

[mrpink]

If it was a government run health care system and your taxes were used to fund it, would you similarly say "I'm trying to think of some other legally obligated government program my taxes pay for?"

I'm against a government run health care system and requiring someone to purchase a product from a for-profit company is different than taxation.

[Limey]

I'm against a government run health care system and requiring someone to purchase a product from a for-profit company is different than taxation.

So you are against Medicare?

[HudsonHawk]

I agree you shouldn't be allowed to sponge; there has to be repercussions for your actions.  I don't have the solution, but that doesn't prevent me from saying this isn't it.

You're free to say whatever you want.  That doesn't mean you're right.

[mrpink]

As an American, if you live in an urban area, you are required to purchase sewage treatment.  You are not allowed to shit where you please.

Only the tiniest fractional part of those surgeries--it's a societal cost, not just mine.  I assumed they weren't rich because they didn't look rich.  If you want to see the urban unhealthy--overweight, amputations, wheelchairs--go hang out in the waiting room of an eye surgery.  Clearly it was my judgment, and they could have all been rich as Croesus.  They could have all worked for companies with great medical benefits.  I could be wrong, but I didn't think they were, and I don't think they did.

And as for freedom to make your own decisions, I don't place any value on other people's rights to make decisions that cost me money.  Why should I?

You don't have to live in an urban area, but if you choose to live in this country you must buy health insurance.
The decision that those people made that are costing us money was the one to forego earlier, cheaper treatment, as you pointed out.  That could be due to apathy just as much as lack of health insurance.  I don't think Obamacare solves this problem unless it starts requiring routine checkups.

[mrpink]

The States want to control, amongst other things, the minimum level of coverage and solvency of carriers selling in their State.  If you override that option, all insurers will move to the State with the laxest rules, and sell from there (just like how all credit cards are sold from Delaware).

ETA:  You can only buy auto and homeowners insurance from State-approved ("admitted") insurers too.  They are required to have a minimum amount of security posted in-State, to give the State something to seize in the event of insolvency.

There's a good amount of federal regulation dealing with credit card companies now.  Maybe health insurance is a situation where federal oversight would be more appropriate than state-level oversight.  I think that would lower costs across the board and at least fix the situation Craig found himself in.

[Limey]

You don't have to live in an urban area, but if you choose to live in this country you must buy health insurance.
The decision that those people made that are costing us money was the one to forego earlier, cheaper treatment, as you pointed out.  That could be due to apathy just as much as lack of health insurance.  I don't think Obamacare solves this problem unless it starts requiring routine checkups.

It doesn't require routine checkups, but it does make them free.  For the 30 million-or-so Americans who didn't have insurance because they couldn't afford it, routine checkups were not an option, apathy or no.  Now they are.

[Limey]

There's a good amount of federal regulation dealing with credit card companies now.  Maybe health insurance is a situation where federal oversight would be more appropriate than state-level oversight.  I think that would lower costs across the board and at least fix the situation Craig found himself in.

Obamacare is federal oversight of healthcare insurance.  It does lower costs across the board (it knocks nearly $800 billion off the federal deficit in its first ten years, and the savings accelerate after that).  It did fix Craig's situation.

I'm not sure what your point is here.

[jbm]

I'm against a government run health care system and requiring someone to purchase a product from a for-profit company is different than taxation.

Well, your government decided differently.  Just as a pacifist has to endure their taxes used to fund a military, or an arsonist who doesn't want a fire department, their individual desires are trumped by societies as promulgated by their government.

The taxation vs purchase discussion is purely result of how the government decided to fund their new program.  Instead of taxes, they chose a different method.  If they had chosen pure taxes, your question would disappear.

[mrpink]

So you are against Medicare?

No, I was talking about an entire government-run health care system.  Medicare has its place, although it seems to be run poorly (the Scooter Store saga has been huge news in New Braunfels the past couple of years).  

[Ty in Tampa]

I'm against a government run health care system and requiring someone to purchase a product from a for-profit company is different than taxation.

That's why health care should be not-for-profit.

[subnuclear]

No, I was talking about an entire government-run health care system.  Medicare has its place, although it seems to be run poorly (the Scooter Store saga has been huge news in New Braunfels the past couple of years).  

60%+ of healthcare spending goes through Medicare.

[mrpink]

It doesn't require routine checkups, but it does make them free.  For the 30 million-or-so Americans who didn't have insurance because they couldn't afford it, routine checkups were not an option, apathy or no.  Now they are.

That's not true.  Just because you can't afford insurance doesn't mean you can't afford a checkup.  You can pay for things out of pocket.

[Ty in Tampa]

That's not true.  Just because you can't afford insurance doesn't mean you can't afford a checkup.  You can pay for things out of pocket.

Your ideals are clashing with reality.

[subnuclear]

That's why health care should be not-for-profit.

I would say that it needs price controls of some sort. Even if you make health insurance non-profit, you still have to deal with the rest of the health care industry.

[subnuclear]

It doesn't require routine checkups, but it does make them free.  For the 30 million-or-so Americans who didn't have insurance because they couldn't afford it, routine checkups were not an option, apathy or no.  Now they are.

Routine check-ups have never been very expensive.

[HudsonHawk]

Routine check-ups have never been very expensive.

According to something I just read the other day, the cost without insurance of a routine physical in the US averages $199/person (a little less for younger people, a little more for the older folks).  For a family of four, that's almost $800, and it doesn't include immunizations, blood work, etc.

[subnuclear]

According to something I just read the other day, the cost without insurance of a routine physical in the US averages $199/person (a little less for younger people, a little more for the older folks).  For a family of four, that's almost $800, and it doesn't include immunizations, blood work, etc.

Places that deal with a lot of uninsured charge a lot less.

[HudsonHawk]

Places that deal with a lot of uninsured charge a lot less.

I'm sure there's someone out there who'll give you the once over for $5.  I'm just pointing out the average cost for an exam by a physician.

[Limey]

That's not true.  Just because you can't afford insurance doesn't mean you can't afford a checkup.  You can pay for things out of pocket.

I would posit that the vast majority of those uninsured through their inability to afford insurance, also cannot afford checkups.  The main thrust behind Obamacare was to take those 30+ million citizens who were uninsured not by choice, and give them a way to become insured so that they could have access to preventative healthcare that was otherwise beyond their reach.

If everyone could pay for their own doctor visits, this whole subject would be moot.

[subnuclear]

I'm sure there's someone out there who'll give you the once over for $5.  I'm just pointing out the average cost for an exam by a physician.

No these are clinincs are run by physicians. I used to go to one and it wasn't great, but it wasn't terrible.

[subnuclear]

I would posit that the vast majority of those uninsured through their inability to afford insurance, also cannot afford checkups.  The main thrust behind Obamacare was to take those 30+ million citizens who were uninsured not by choice, and give them a way to become insured so that they could have access to preventative healthcare that was otherwise beyond their reach.

The people who can't afford check-ups qualify for Medicaid. They also qualify for CHIP which covers their kids. Obamacare is about everything else.

[Limey]

Routine check-ups have never been very expensive.

They are cheaper than, say, a year's premium.  "Expense" is all relative.  The real problem was that anything the doctor found, for which you might have needed insurance, would have been excluded as a pre-existing condition if you then went to buy insurance to cover your treatment.

[subnuclear]

They are cheaper than, say, a year's premium.  "Expense" is all relative.  The real problem was that anything the doctor found, for which you might have needed insurance, would have been excluded as a pre-existing condition if you then went to buy insurance to cover your treatment.

Yes that's the purpose of Obamacare. However, I am skeptical whether there will be a rise in routine doctor visits. 

[Limey]

The people who can't afford check-ups qualify for Medicaid. They also qualify for CHIP which covers their kids. Obamacare is about everything else.

Obamacare is about the 30+ million citizens who fell into the gap between those who qualified for Medicaid and those who had access to affordable insurance.

[subnuclear]

Obamacare is about the 30+ million citizens who fell into the gap between those who qualified for Medicaid and those who had access to affordable insurance.

Yes but that group is a mixed bunch that includes many non-poor people.

[Limey]

Yes that's the purpose of Obamacare. However, I am skeptical whether there will be a rise in routine doctor visits. 

Even if the same (or less) people go for their routine checkups, society as a whole is better off.  Obamacare knocks a ton of money off the federal deficit and relieves the taxpayer at large from the burden of paying for the healthcare of the intentionally or unintentionally uninsured.

[Limey]

Yes but that group is a mixed bunch that includes many non-poor people.

Nope.  The total number of uninsured in the U.S. is about 50 million.  The 30+ million figure already excludes those who can, or believe they can, pay as they go for healthcare.

[HudsonHawk]

No these are clinincs are run by physicians. I used to go to one and it wasn't great, but it wasn't terrible.

And do you think that these physicians simply worked for $10/hour, or that their operation was subsidized?

[subnuclear]

Nope.  The total number of uninsured in the U.S. is about 50 million.  The 30+ million figure already excludes those who can, or believe they can, pay as they go for healthcare.

It still a mixed group and unless they asked them explicitly whether they could afford routine check-ups then you don't know that number.

[subnuclear]

And do you think that these physicians simply worked for $10/hour, or that their operation was subsidized?

They mostly dealt with Medicaid/Medicare/Chip patients, but a lot of the people did not have insurance. I paid about $35 for about a 20 minute visit. I had no idea how profitable it was.

[Limey]

It still a mixed group and unless they asked them explicitly whether they could afford routine check-ups and then you don't know that number.

You are clutching at straws.  Incorrect straws.

Key Facts about the Uninsured Population

Uninsured individuals report that cost poses a major barrier to purchasing coverage. In 2012, 61% of adults said that one of the reasons they are uninsured is either because the cost is too high or because they lost their job, compared to 1.5% who said they are uninsured because they do not need coverage.

[subnuclear]

You are clutching at straws.  Incorrect straws.

Key Facts about the Uninsured Population

No I'm not. I'm just pointing out that the uninsured are people who don't qualify for Medicaid and therefore would have enough to get check-ups. They may not have enough to get health insurance or get other medical services which is generally what they ask for in those surveys.

[HudsonHawk]

They mostly dealt with Medicaid/Medicare/Chip patients, but a lot of the people did not have insurance. I paid about $35 for about a 20 minute visit. I had no idea how profitable it was.

Here's a hint:  It wasn't.  It was subsidized...either by the government, by insurance companies, by pharmaceutical companies, by private charities, etc.  Like many, you seem to want unsubsidized health care, but for a fraction of the actual cost.  It doesn't work that way.  Someone else is paying the other $164 of your visit.

[Limey]

No I'm not. I'm just pointing out that the uninsured are people who don't qualify for Medicaid and therefore would have enough to get check-ups. They may not have enough to get health insurance or get other medical services which is generally what they ask for in those surveys.

Clearly, you didn't bother to read anything on the link I provided.  Here's a snippet:

The uninsured report higher rates of postponing care or forgoing needed care or prescriptions due to cost compared to those enrolled in Medicaid and other public programs.

The plight of the uninsured isn't a mystery that no one has tried to solve.

[subnuclear]

Here's a hint:  It wasn't.  It was subsidized...either by the government, by insurance companies, by pharmaceutical companies, by private charities, etc.  Like many, you seem to want unsubsidized health care, but for a fraction of the actual cost.  It doesn't work that way.  Someone else is paying the other $164 of your visit.

Oh I know. I was only arguing that people who don't qualify for Medicaid could afford health check-ups. How the doctor made money was irrelevant to that and I'm for Obamacare. Just don't like to get sloppy with the facts.

[subnuclear]

Clearly, you didn't bother to read anything on the link I provided.  Here's a snippet:

The plight of the uninsured isn't a mystery that no one has tried to solve.

I did in fact read it and the quote you listed mention perscriptions and needed health care not routine check-ups. Those aren't the same thing.

[Limey]

Oh I know. I was only arguing that people who don't qualify for Medicaid could afford health check-ups. How the doctor made money was irrelevant to that and I'm for Obamacare. Just don't like to get sloppy with the facts.

Except when you do it in the space of a single two-line post?

[HudsonHawk]

Oh I know. I was only arguing that people who don't qualify for Medicaid could afford health check-ups. How the doctor made money was irrelevant to that and I'm for Obamacare. Just don't like to get sloppy with the facts.

But it's not irrelevant.  The argument is that the cost of routine exams is $20, so people shouldn't have to have insurance for that, they should simply pay that out of their pocket.  But it's only $20 because it's underwritten by someone else.  You're still asking someone else to help pick up the tab.  That's simply got to stop.

[Limey]

I did in fact read it and the quote you listed mention perscriptions and needed health care not routine check-ups. Those aren't the same thing.

Now you are being willfully ignorant.

[subnuclear]

Except when you do it in the space of a single two-line post?

You have not proven that people who make enough not to qualify for Medicaid can't afford routine check-ups. You have not provided any evidence to the contrary.

[subnuclear]

Now you are being willfully ignorant.

No I'm being very specific.

[Limey]

You have not proven that people who make enough not to qualify for Medicaid can't afford routine check-ups. You have not provided any evidence to the contrary.

And you have not provided any evidence to support your theory.

[Limey]

No I'm being very specific.

Picking nits to avoid the bigger issue is a better description.

[subnuclear]

But it's not irrelevant.  The argument is that the cost of routine exams is $20, so people shouldn't have to have insurance for that, they should simply pay that out of their pocket.  But it's only $20 because it's underwritten by someone else.  You're still asking someone else to help pick up the tab.  That's simply got to stop.

That is still going to go on under Obamacare, since there are a lot of non-citizens who get health care here. In any case, I'm glad people will be able to get health insurance, but I don't think routine check-ups will increase very much.

[HudsonHawk]

That is still going to go on under Obamacare, since there are a lot of non-citizens who get health care here. In any case, I'm glad people will be able to get health insurance, but I don't think routine check-ups will increase very much.

Yes it will still go on, but 1) people will at least have to pay *something* into the pot, and 2) it should drive down the overall consumer cost of preventative care, as there is a larger, more diverse pool of participants drawing from the pot.

[Jacksonian]

I would say that it needs price controls of some sort. Even if you make health insurance non-profit, you still have to deal with the rest of the health care industry.

The price control is education.  The more doctors and scientists in all areas of the field the more likely the costs will reduce.  We are extremely far from that saturation point though.

[NeilT]

My physicals are more expensive than that I suspect, but then I guess I'm paying for the joy of a prostate exam.

[Mr. Happy]

Even if the same (or less) people go for their routine checkups, society as a whole is better off.  Obamacare knocks a ton of money off the federal deficit and relieves the taxpayer at large from the burden of paying for the healthcare of the intentionally or unintentionally uninsured.

Do you really believe that horseshit about it saving money? The Congressional Budget Office and several thinktanks have debunked that myth. That was merely a talking point.

[Limey]

Do you really believe that horseshit about it saving money? The Congressional Budget Office and several thinktanks have debunked that myth. That was merely a talking point.

The CBO is the non-partisan arbiter of such things, and it projects the act to have a small net benefit to the budget over the next 10 years.  My apologies for suggesting the savings were bigger - that was wrong.

[Mr. Happy]

The CBO is the non-partisan arbiter of such things, and it projects the act to have a small net benefit to the budget over the next 10 years.  My apologies for suggesting the savings were bigger - that was wrong.

I've seen estimates of it actually costing money in the long run.

[Limey]

I've seen estimates of it actually costing money in the long run.

Not from the CBO you haven't.

[Mr. Happy]

Not from the CBO you haven't.

I never said the CBO. I said that I've seen numbers from at least two thinktanks that demonstrate that the costs of Obamacare will far exceed the taxes raised to pay for the subsidies.

[HudsonHawk]

My physicals are more expensive than that I suspect, but then I guess I'm paying for the joy of a prostate exam.

And it's worth every penny.

On an unrelated note...a doctor friend of mine used to describe the process of practicing prostate exams in medical school.  The drunker we all were, the more hilarious the story was.

[Limey]

I never said the CBO. I said that I've seen numbers from at least two thinktanks that demonstrate that the costs of Obamacare will far exceed the taxes raised to pay for the subsidies.

You said "The Congressional Budget Office and several thinktanks have debunked that myth.".

As for thinktanks, I'm sure I can match you tank-for-tank with ones who agree with the CBO on savings, or even go further.  Regardless, the CBO says it saves money in the long run, and here's a simple explanation of how.

[NeilT]

And it's worth every penny.

On an unrelated note...a doctor friend of mine used to describe the process of practicing prostate exams in medical school.  The drunker we all were, the more hilarious the story was.

I hate to ask, but how do you find willing practice subjects?  Do they have special practice dummies, or is it like hiring artist models? 

Never mind.  I really don't want to know.

[Limey]

I hate to ask, but how do you find willing practice subjects?  Do they have special practice dummies, or is it like hiring artist models? 

I suspect that may have been made more fun by alcohol, too.

[mrpink]

Well, your government decided differently.  Just as a pacifist has to endure their taxes used to fund a military, or an arsonist who doesn't want a fire department, their individual desires are trumped by societies as promulgated by their government.

The taxation vs purchase discussion is purely result of how the government decided to fund their new program.  Instead of taxes, they chose a different method.  If they had chosen pure taxes, your question would disappear.

Yes it did, and I'm disappointed in that.

[mrpink]

That's why health care should be not-for-profit.

That sounds like a bad idea to me because I think when you take the profit motivation out of the picture innovation takes a nosedive.

[Limey]

That sounds like a bad idea to me because I think when you take the profit motivation out of the picture innovation takes a nosedive.

Yes.  There was never any innovation in...well...anything...until corporate profits were invented.

[BudGirl]

This thread is the new Sarah Palin thread.  Definitely somewhat entertaining and informative during the Void.  Keep up the great posts boys.

[HudsonHawk]

I hate to ask, but how do you find willing practice subjects?  Do they have special practice dummies, or is it like hiring artist models? 

Never mind.  I really don't want to know.

Sorry, you asked.  They were volunteers, who were paid a modest fee.  Most, my friend said, were homeless men, or pretty close to it.

[NeilT]

Sorry, you asked.  They were volunteers, who were paid a modest fee.  Most, my friend said, were homeless men, or pretty close to it.

That's just humiliating all the way around.  How can someone take something life-affirming like a prostate exam and make it so . . . so . . . dirty.

[Limey]

That's just humiliating all the way around.  How can someone take something life-affirming like a prostate exam and make it so . . . so . . . dirty.

Dirtier than a homeless man's tea towel holder?

[mrpink]

Yes.  There was never any innovation in...well...anything...until corporate profits were invented.

I can't fight hyperbole.

[HudsonHawk]

That's just humiliating all the way around.  How can someone take something life-affirming like a prostate exam and make it so . . . so . . . dirty.

It's as bad as selling sperm for beer money.  Or so I've heard.

[Limey]

I can't fight hyperbole.

But you're happy to use it.

[Ty in Tampa]

That sounds like a bad idea to me because I think when you take the profit motivation out of the picture innovation takes a nosedive.

That's the tack all free-market thinkers take but the reality is is that virtually everything that is wrong with the health care industry can be traced to profit-taking.

[Limey]

It's as bad as selling sperm for beer money.  Or so I've heard.

Better than selling beer for sperm.

[Fredia]

and what would one do with the sperm

[HudsonHawk]

and what would one do with the sperm

Well, you see, there's a mommy and a daddy.  The mommy has these things called "eggs"...

[austro]

My physicals are more expensive than that I suspect, but then I guess I'm paying for the joy of a prostate exam.

Interestingly, I had my annual physical on Monday, and my doctor skipped the prostate exam because she said that the new guidelines suggest that it's unnecessary unless there are also other symptoms present. I know that PSA tests can be unreliable, and that there is concern about unnecessary procedures where the cure is worse than the disease (particularly for older men with non-aggressive cancers, where something else is likely to take you down before prostate issues do), but I assumed that the prostate exam was still in the happy zone for cost-effectiveness and accuracy.

[HudsonHawk]

Interestingly, I had my annual physical on Monday, and my doctor skipped the prostate exam because she said that the new guidelines suggest that it's unnecessary unless there are also other symptoms present. I know that PSA tests can be unreliable, and that there is concern about unnecessary procedures where the cure is worse than the disease (particularly for older men with non-aggressive cancers, where something else is likely to take you down before prostate issues do), but I assumed that the prostate exam was still in the happy zone for cost-effectiveness and accuracy.

Depending on who's giving it, it's in the happy zone alright.

[Limey]

Depending on who's giving it, it's in the happy zone alright.

Depends how many fingers they use.

[Ty in Tampa]

Depends how many fingers they use.

"Mooooon Riv-er!"

[Limey]

Back on topic...healthcare.gov handled 1 million visitors on Monday with no major issues.

Meanwhile, Consumer Reports - who told people to stay away from the bug-plagued website after its launch - has upgraded its opinion.

“Now we’re saying, ‘it’s time,’” Metcalf said, in particular praising the new window-shopping function, in which users can peruse health plans without registering with the site. The requirement to make an account before viewing options was considered one of the main causes for the site’s initial traffic bottleneck. “It’s terrific, I’ve tried it, it was working yesterday through the busiest times.”

[Randy Watson]

Opponents of Obamacare have been breathless and apoplectic about people getting their insurance cancelled.  While this is a concern, the vast majority of those getting cancelled can get equivalent or better coverage through the exchanges, their old policies having been cancelled due to them no longer being Obamacare compliant. 

Bullshit.  The policies aren't better.  You are just forced to buy coverage for bullshit you don't need.

Why should someone who does not want or can't have kids be forced to buy maternity coverage?  Or someone who is childless is required to be covered for pediatric dental care? 

Most people would be better served with HSAs for routine shit and catastrophic coverage for the shit that can bankrupt them.  For the routine shit HSAs where you pay with your HSA debit card means people would actually shop around for the best deal and not necessarily see a doctor and get a prescription every time they have the sniffles or a tummy ache.  Get rid of the employer deduction for health care so insurance is separated from employment and people can choose the policy that fits them best.  If you want to have a mandate, only mandate catastrophic coverage.  Not coverage for birth control, physicals,

There are studies out there also that say preventative health care actually does not save money.  The best preventative care -- and cheapest -- is to have a proper diet.

Obamacare is nothing more than a wealth redistribution scheme with an added layer of massive government bureaucracy.  It does nothing to control costs.  It merely shifts them around.  It is a massive cluster fuck.

Again, you want to fix health care in this country?  Get government out of it.  Get rid of the tax deduction for employer plans.  People biy what they need.  Encourage HSAs and high deductible catastrophic plans.

People that cannot afford health care go on medicaid or go to charity hospitals.

(One other fact about why our health care is so expensive compared to other countries -- we do most of the research and other countries spend little on it)

[Randy Watson]

Wait, someone really believes that Obamacare will reduce the deficit?

Holy shit!

Government fucking programs always cost 10x what they claim.

[Fredia]

from what i understand the insurance companies dont even know what they will be paid as that is not working on the website

[Limey]

Wait, someone really believes that Obamacare will reduce the deficit?

Holy shit!

Yes.  It's the people who are paid to run the numbers on the deficit.

As for your prior missive, I'll just let you catch up on the rest of the thread where your issued are already asked and answered.

[Randy Watson]

Back on topic...healthcare.gov handled 1 million visitors on Monday with no major issues.

Meanwhile, Consumer Reports - who told people to stay away from the bug-plagued website after its launch - has upgraded its opinion.

What a badass website we have already sunk a billion dollars into.  (Of course the website is about .001% of the problem with this fucking disaster as the real fun starts when the employer mandate kicks in):

here’s still one hitch. HealthCare.gov doesn’t work, at all. Sure, it provides a remarkably realistic user experience, but as of now it’s basically a video game. A really, really boring video game. Call it Sim Healthcare.

This is because the so-called back end essentially doesn’t exist. That’s the part of the site that talks to the insurance companies, processes payments, and actually, you know, gets people enrolled on insurance plans.

Reports vary on whether it needs to be “fixed” or whether it still needs to be built. On November 19, Henry Chao, the administration official in charge of overseeing the site, told Congress that “the accounting systems, the payment systems, they still need to be” created. Going by the rosy version of Chao’s estimate, that was roughly 30 to 40 percent of the system.

“It’s not built, let alone tested,” one insurance executive told the Washington Post last week.

http://www.jammiewf.com/2013/great-news-obamacare-website-has-no-system-for-exchange-payment/

[Randy Watson]

Yes.  It's the people who are paid to run the numbers on the deficit.

As for your prior missive, I'll just let you catch up on the rest of the thread where your issued are already asked and answered.

We can just bookmark this and come back in a few years.  I will be the one saying "I told you so."

[Randy Watson]

from what i understand the insurance companies dont even know what they will be paid as that is not working on the website

You'd think the one thing govt. could get right was creating a way for people to give it their money.

Of course these fucktards couldn't run a lemonade stand.

[Limey]

What a badass website we have already sunk a billion dollars into.  (Of course the website is about .001% of the problem with this fucking disaster as the real fun starts when the employer mandate kicks in):

http://www.jammiewf.com/2013/great-news-obamacare-website-has-no-system-for-exchange-payment/

You know that healthcare.gov is only meant to be a portal, right?  It lets you shop various insurance plans and then connects you to your chosen insurer where you then complete the transaction.

[Limey]

We can just bookmark this and come back in a few years.  I will be the one saying "I told you so."

You might not be saying "I told you so", but I'm pretty certain that you won't be calling it "Obamacare" any more.

[subnuclear]

Randy, a lot of what you said is wrong, but unfortunately I have to get some work done this morning. But I will point out that Obamacare allowed HSAs to rollover from year-to-year making them much more useful. Also, the reason medical care is so expensive in this country is that there are multitude of cartels extracting rents in also sorts of non-productive ways.

[Randy Watson]

You know that healthcare.gov is only meant to be a portal, right?  It lets you shop various insurance plans and then connects you to your chosen insurer where you then complete the transaction.

Maybe you should let the Obama administration know. 

"On November 19, Henry Chao, the administration official in charge of overseeing the site, told Congress that “the accounting systems, the payment systems, they still need to be” created. Going by the rosy version of Chao’s estimate, that was roughly 30 to 40 percent of the system."

http://www.jammiewf.com/2013/great-news-obamacare-website-has-no-system-for-exchange-payment/

[jbm]

What a badass website we have already sunk a billion dollars into.  (Of course the website is about .001% of the problem with this fucking disaster as the real fun starts when the employer mandate kicks in):

http://www.jammiewf.com/2013/great-news-obamacare-website-has-no-system-for-exchange-payment/

Hey, if Jimmie says so, and adds a neat picture with "Fail" on Obama's forehead, it must be true.

[Limey]

Maybe you should let the Obama administration know. 

"On November 19, Henry Chao, the administration official in charge of overseeing the site, told Congress that “the accounting systems, the payment systems, they still need to be” created. Going by the rosy version of Chao’s estimate, that was roughly 30 to 40 percent of the system."

http://www.jammiewf.com/2013/great-news-obamacare-website-has-no-system-for-exchange-payment/

Here's a quote from a slightly larger news source:

Applicants’ payments are processed directly with the insurance issuer, outside the marketplace, CMS officials clarified on a conference call with reporters.  However, any government subsidy payment to the issuer would rely on the system in question.

“We do not need that online until about the middle of January given how the payment schedule works and we’re on track to do that,” CMS communications director Julie Bataille said on the call.

[Ty in Tampa]

Jammie Wearing Fools is your critical information site? Well done.

[Limey]

Hey, if Jimmie says so, and adds a neat picture with "Fail" on Obama's forehead, it must be true.

At least it wasn't a Hitler 'tache.

[BizidyDizidy]

Randy, a lot of what you said is wrong, but unfortunately I have to get some work done this morning. But I will point out that Obamacare allowed HSAs to rollover from year-to-year making them much more useful. Also, the reason medical care is so expensive in this country is that there are multitude of cartels extracting rents in also sorts of non-productive ways.

I don't really give a shit about any of this (although I just found out this morning that my premiums are going up 50%), but HSAs have always been able to be kept year-to-year. FSAs are the use it or lose it ones (from a quick look, it seems like maybe a $500 or so can now be carried forward, which is maybe what you are referring to)?

[subnuclear]

I don't really give a shit about any of this (although I just found out this morning that my premiums are going up 50%), but HSAs have always been able to be kept year-to-year. FSAs are the use it or lose it ones (from a quick look, it seems like maybe a $500 or so can now be carried forward, which is maybe what you are referring to)?

I think I've been confused on this by my HR dept. We got HSAs for the first time this year.

[HudsonHawk]

People that cannot afford health care go on medicaid or go to charity hospitals.

This...this right here...is the problem.  I'm tired of people asking me to cover them because they they make a "personal choice" to not fend for themselves.  THIS is why we need mandated healthcare coverage.

[BizidyDizidy]

I think I've been confused on this by my HR dept. We got HSAs for the first time this year.

I had one at my last job (including an employer contribution and a high deductible plan) - loved it.

[HudsonHawk]

I don't really give a shit about any of this (although I just found out this morning that my premiums are going up 50%), but HSAs have always been able to be kept year-to-year. FSAs are the use it or lose it ones (from a quick look, it seems like maybe a $500 or so can now be carried forward, which is maybe what you are referring to)?

Just for the sake of balance...my premiums went down for 2014. 

[Bench]

I had one at my last job (including an employer contribution and a high deductible plan) - loved it.

I have what I assume that plan is: an HSA account and a plan where you pay 100% of costs up to the deductible and then 0% beyond the deductible.  I came out well ahead with the healthcare costs associated with the last nine months.  It's terrific.

[Mr. Happy]

I have what I assume that plan is: an HSA account and a plan where you pay 100% of costs up to the deductible and then 0% beyond the deductible.  I came out well ahead with the healthcare costs associated with the last nine months.  It's terrific.

I've been doing that for a long time. It works. High deductible plans combined with HSA's make sense.

[Navin R Johnson]

You are just forced to buy coverage for bullshit you don't need.

Why should someone who does not want or can't have kids be forced to buy maternity coverage?  Or someone who is childless is required to be covered for pediatric dental care? 

Why am I forced to pay real estate taxes to fund schools when I don't have kids? 

[Randy Watson]

Yes.  It's the people who are paid to run the numbers on the deficit.

As for your prior missive, I'll just let you catch up on the rest of the thread where your issued are already asked and answered.

The CBO merely takes its inputs from the people who created Obamacare. 

The ones who brought us:  "If you like your health insurance, you can keep it.  Period."

[Noe]

Why am I forced to pay real estate taxes to fund schools when I don't have kids? 

To keep them off your lawn?

[BudGirl]

To keep them off your lawn?

What if you don't have a lawn??

[Limey]

The CBO merely takes its inputs from the people who created Obamacare. 

The ones who brought us:  "If you like your health insurance, you can keep it.  Period."

You realise that the "C" in "CBO" stands for "Congressional", right?

[Noe]

What if you don't have a lawn??

VOUCHERS!

[Bench]

You realise that the "C" in "CBO" stands for "Congressional", right?

And who do you think passed the ACA, amirite?

[Knoxbanedoodle]

I'm in North Carolina, where ransacking Republicans in Raleigh, binging on power after a century on the bench, have done everything in their power to undermine the ACA. BCBS is essentially the only shop in town. My wife and I buy our own insurance and our employer (it's a very small business) reimburses us. Our plans, which pretty much sucked, were not going to be renewed--so we were among the several million nationally who received the "Sorry, you can't can keep your insurance after all..." letters. I got on the Exchange as soon as I could and it was a disaster. Waited a few weeks, went back on, no problem. Our rates have gone up a bit but we're actually getting good coverage now and won't be too much out of pocket if our employer keeps up his generous program. He says he's willing to reimburse $200 a month per employee. We should have to make up $60 a month total between us, which I'm happy to do for a good plan. I'm 33, she's 28, we're healthy for now, we're eligible for a small subsidy but we're going to defer and take the tax credit instead. I like it.

It might be worth some of the detractors considering one aspect of John Roberts' (decisive) opinion on the ACA: I don't have it in front of me but it had something to do with how every day each one of us makes a slew of decisions, and if enough people decide not to do something, that can have a powerful effect on the health of the nation overall. I think this was a key part of his upholding the individual mandate.

It's annoying to be compelled by anyone to do anything, but WFW.

[HudsonHawk]

It's annoying to be compelled by anyone to do anything, but WFW.

If we ("we", as in collective society) hadn't done such a piss poor job of managing it up til now, the mandate wouldn't be necessary.  But "we" have fucked up.  Time to pay the fiddler.

[Mr. Happy]

If we ("we", as in collective society) hadn't done such a piss poor job of managing it up til now, the mandate wouldn't be necessary.  But "we" have fucked up.  Time to pay the fiddler.

Amen.

[Randy Watson]

You realise that the "C" in "CBO" stands for "Congressional", right?

Yep.  The same mother fuckers who had to pass it to know what's in it.

[Limey]

Yep.  The same mother fuckers who had to pass it to know what's in it.

Not quite...or at all, really.  But you keep getting your info from Jammie Wearing Fools if that suits you.

[Mr. Happy]

Not quite...or at all, really.  But you keep getting your info from Jammie Wearing Fools if that suits you.

Wait a minute, Limey. Are you denying that Nancy Pelosi actually said that? If so, you are full of shit, sir. I heard her say it.

[Bench]

Yep.  The same mother fuckers who had to pass it to know what's in it.

Wow.  I thought I was being cartoonishly sarcastic. 

[Limey]

Wait a minute, Limey. Are you denying that Nancy Pelosi actually said that? If so, you are full of shit, sir. I heard her say it.

The "news" was distorted to infer something different from realty.  That's my point.

[Mr. Happy]

The "news" was distorted to infer something different from realty.  That's my point.

She said that you had to pass the bill to see what was in it. That's an outrage.

[Bench]

Wait a minute, Limey. Are you denying that Nancy Pelosi actually said that? If so, you are full of shit, sir. I heard her say it.

I'm not sure what you are intending to reply to, but Pelosi isn't part of the CBO either. 

[Limey]

She said that you had to pass the bill to see what was in it. That's an outrage.

OK.  Now I'm not sure what you're getting at.  My swipe at JWF was because they went all hyperbolic (along with much of the rest of the right-wing media) because there was no payment system in the healthcare website.  That was true, but it wa also about 25% of the truth - the balance being that the punters pay their insurer directly, the missing payment system was for government subsidies only and that part of the site would be in place before it was actually needed.

What Pelosi said, or didn't say, was not anything to do with my post.

[Limey]

She said that you had to pass the bill to see what was in it. That's an outrage.

Here's the link Randy Watson posted.  Pelosi isn't mentioned on that page.

[BudGirl]

Pelosi and Obama are the blame for EVERYTHING.  Especially the records of the Astros and Texans.

[Limey]

She said that you had to pass the bill to see what was in it. That's an outrage.

Funny.  Once again, about a fraction of the truth is being used to fuel outrage.  Here's a paper bag to blow into:

Speaker Nancy Pelosi said Tuesday that people won’t appreciate how great the Democrat’s health plan is until after it passes.

“You’ve heard about the controversies, the process about the bill…but I don’t know if you’ve heard that it is legislation for the future – not just about health care for America, but about a healthier America,” she told the National Association of Counties annual legislative conference, which has drawn about 2,000 local officials to Washington. “But we have to pass the bill so that you can find out what is in it – away from the fog of the controversy.”

So, when she was talking, she was talking to the public, not Congress.  When she said "we have to pass the bill so that you can find out what is in it", she meant we in Congress have to pass the bill so you the public can see it in action and see its benefits.

The suggestion that the ACA was forced through Congress in the dead of night without debate* is laughable.  It was the subject of "lively" debate and discussion going back to the election campaign.  Obama was elected in 2008 and the bill passed in 2010.  It was not a shock or surprise to anyone that it was brought up and anyone who cared to read it had plenty of time to do so.


* That was the unfunded Medicare Part D - the most expensive expansion of the welfare system in the history of the U.S.

[HudsonHawk]

Funny.  Once again, about a fraction of the truth is being used to fuel outrage.  Here's a paper bag to blow into:

So, when she was talking, she was talking to the public, not Congress.  When she said "we have to pass the bill so that you can find out what is in it", she meant we in Congress have to pass the bill so you the public can see it in action and see its benefits.

The suggestion that the ACA was forced through Congress in the dead of night without debate* is laughable.  It was the subject of "lively" debate and discussion going back to the election campaign.  Obama was elected in 2008 and the bill passed in 2010.  It was not a shock or surprise to anyone that it was brought up and anyone who cared to read it had plenty of time to do so.


* That was the unfunded Medicare Part D - the most expensive expansion of the welfare system in the history of the U.S.

Next you're going to tell me that Al Gore didn't say "I invented the internet".

[Limey]

Next you're going to tell me that Al Gore didn't say "I invented the internet".

He didn't build that!

[HudsonHawk]

He didn't build that!

At leas he didn't "make the pie higher".

[Limey]

At leas he didn't "make the pie higher".

Nope.  To do that you have to "put food on your family."

[Fredia]

no but he wont have obama care nor will anyone in congress

[NeilT]

I am so glad someone started this conversation. We didn't have any discussions about politics at the family table on thanksgiving, and I missed it.

[Trey]

Guys, I read all 12 pages, but what I really want to know is if Obamacare is going to cover vet bills for this turtle I found?

[HudsonHawk]

I am so glad someone started this conversation. We didn't have any discussions about politics at the family table on thanksgiving, and I missed it.

We discussed Johnny Manziel and whether or not the Texans should draft him. I called him a poor man's Vince Young.  That livened up the mashed potatoes.

[chuck]

We discussed Johnny Manziel and whether or not the Texans should draft him. I called him a poor man's Vince Young.  That livened up the mashed potatoes.

Speaking of turtles I was talking with Alkie a year ago or so and I described Manziel as the new Vince Young and he informed me that he no longer watches college football at all. So who the hell knows what he talked about at his Thanksgiving table.

[Mr. Happy]

I am so glad someone started this conversation. We didn't have any discussions about politics at the family table on thanksgiving, and I missed it.

No talk of upcoming bond issues?

[HudsonHawk]

No talk of upcoming bond issues?

Neil saves that for the pillow talk with the misses.

[Fredia]

so they get kinky with glue?

[NeilT]

Neil saves that for the pillow talk with the misses.

I keep telling her my name is Bond, Muni Bond. She doesn't think that's funny either.

[Limey]

I am so glad someone started this conversation. We didn't have any discussions about politics at the family table on thanksgiving, and I missed it.

Politics?  We've been talking about the practical application of the ACA.  If you want to talk politics, I can go off on a rant about how I think that giving taxpayer money to insurance companies for them to cream off overhead and profit and pay some of that to doctors - instead of giving it straight to doctors and cutting out the insurance companies - is complete bullshit.

The ACA is unpopular with the majority of Americans only because the 38% who oppose it because it goes too far is supplemented by the 16% of us who think it doesn't go far enough.  Medicare for All !

[subnuclear]

Politics?  We've been talking about the practical application of the ACA.  If you want to talk politics, I can go off on a rant about how I think that giving taxpayer money to insurance companies for them to cream off overhead and profit and pay some of that to doctors - instead of giving it straight to doctors and cutting out the insurance companies - is complete bullshit.

You need someone to say 'no' to doctors, hospitals, etc. Whether you call that insurance companies or Meidcare actuaries, there is nothing bullshit about it. 

[Limey]

You need someone to say 'no' to doctors, hospitals, etc. Whether you call that insurance companies or Meidcare actuaries, there is nothing bullshit about it. 

Medicare actuaries don't have to worry about profits, dividends, C-suite bonuses etc.  Medicare runs at an overhead of about 3%*, meaning that 97c of every dollar is spent on actual care.  The ACA forces healthcare insurers to spend 85c of every dollar on actual care - before the Act they would spend between 60c and 75c.


* Medicaid runs at about 7%, still way better than commercial insurers.

[Jacksonian]

Politics?  We've been talking about the practical application of the ACA.  If you want to talk politics, I can go off on a rant about how I think that giving taxpayer money to insurance companies for them to cream off overhead and profit and pay some of that to doctors - instead of giving it straight to doctors and cutting out the insurance companies - is complete bullshit.

LOL

[BizidyDizidy]

Medicare actuaries don't have to worry about profits, dividends, C-suite bonuses etc.  Medicare runs at an overhead of about 3%*, meaning that 97c of every dollar is spent on actual care.  The ACA forces healthcare insurers to spend 85c of every dollar on actual care - before the Act they would spend between 60c and 75c.


* Medicaid runs at about 7%, still way better than commercial insurers.

Limey, it's over, the Berlin Wall has fallen, free-markets won out. Welcome to the future.

[Limey]

Limey, it's over, the Berlin Wall has fallen, free-markets won out. Welcome to the future.

The country that was split by the Berlin wall has universal single-payer healthcare.

[subnuclear]

Medicare actuaries don't have to worry about profits, dividends, C-suite bonuses etc.  Medicare runs at an overhead of about 3%*, meaning that 97c of every dollar is spent on actual care.  The ACA forces healthcare insurers to spend 85c of every dollar on actual care - before the Act they would spend between 60c and 75c.


* Medicaid runs at about 7%, still way better than commercial insurers.

How well they do their job is a different criticism than the purpose of their job which is what you were criticizing. The idea that Medicare/Medicaid flows directly to doctors is incorrect.

[BizidyDizidy]

How well they do their job is a different criticism than the purpose of their job which is what you were criticizing. The idea that Medicare/Medicaid flows directly to doctors is incorrect.

More strangely, aren't you in the insurance business?

[Mr. Happy]

Funny.  Once again, about a fraction of the truth is being used to fuel outrage.  Here's a paper bag to blow into:

So, when she was talking, she was talking to the public, not Congress.  When she said "we have to pass the bill so that you can find out what is in it", she meant we in Congress have to pass the bill so you the public can see it in action and see its benefits.

The suggestion that the ACA was forced through Congress in the dead of night without debate* is laughable.  It was the subject of "lively" debate and discussion going back to the election campaign.  Obama was elected in 2008 and the bill passed in 2010.  It was not a shock or surprise to anyone that it was brought up and anyone who cared to read it had plenty of time to do so.


* That was the unfunded Medicare Part D - the most expensive expansion of the welfare system in the history of the U.S.

Limey: It is hardly laughable. Most of that debate centered around the fact that Democrat leadership had drafted the bill without input or even any chance of reviewing it in committee hearings. The Republicans complained bitterly about that aspect of the process. The bill was a monolith. Just about all who voted for or against it didn't read it before voting.

[Limey]

How well they do their job is a different criticism than the purpose of their job which is what you were criticizing. The idea that Medicare/Medicaid flows directly to doctors is incorrect.

Agreed.  But it's not a question of just doing a job well, it's also about commercial insurers having to satisfy stockholders with profits and dividends.  If you cut that out of the healthcare equation, the savings are enormous.

Also, universal healthcare relieves employers of the burden and expense of providing healthcare plans for employees.  This also then adds to the mobility of workers who aren't tied to an employer solely for the benefits (although this has been somewhat mitigated by the prohibition of pre-existing condition exclusions).


FWIW, the company I worked for in the UK provided a comprehensive benefits package in order to attract and retain top talent.  One of the things they did was provide an umbrella healthcare insurance program that gave us access to a network of private hospitals.  You could still use your national insurance for any and every healthcare issue, but the private plan meant that you could cut the lines and access nicer facilities.  Even better, the plan qualified employees for a tax break.

[Limey]

Limey: It is hardly laughable. Most of that debate centered around the fact that Democrat leadership had drafted the bill without input or even any chance of reviewing it in committee hearings. The Republicans complained bitterly about that aspect of the process.

Do you not remember the "Gang of Six"?  It is simply not true that Republicans weren't given an opportunity to participate in the crafting of this bill.  They were.  For the most part, however, they chose simply to try to obstruct, rather than help construct, the bill.

The bill was a monolith.

Yes it was.  Your point?

Just about all who voted for or against it didn't read it before voting.

Which is true of pretty much every bill passed by Congress.

[Jacksonian]

Agreed.  But it's not a question of just doing a job well, it's also about commercial insurers having to satisfy stockholders with profits and dividends.  If you cut that out of the healthcare equation, the savings are enormous.

I think that assertion is suspect.

[Limey]

I think that assertion is suspect.

Actually, they're demonstrable.

[Jacksonian]

Actually, they're demonstrable.

That's not it.  What you would save by cutting out the privates and having the government run the program you will lose in the massive inefficiencies and fraud in that government run program.  There is no good solution.

[Limey]

That's not it.  What you would save by cutting out the privates and having the government run the program you will lose in the massive inefficiencies and fraud in that government run program.  There is no good solution.

If government run programs are so inefficient and wracked by fraud, how does Medicare run at a fifth of the (mandated maximum) overhead of commercial insurers?

[Mr. Happy]

Do you not remember the "Gang of Six"?  It is simply not true that Republicans weren't given an opportunity to participate in the crafting of this bill.  They were.  For the most part, however, they chose simply to try to obstruct, rather than help construct, the bill.

The gang of six didn't share the bill with the rank-and-file.

Yes it was.  Your point?

It was too large to pass without any committee hearings. That's how legislation used to be fashioned before the days of hopeless gridlock. The result is that the poor public, who is saddled with the law, never got a reasonable chance to review it prior to the votes.

Which is true of pretty much every bill passed by Congress.

That's not true. At least the member's staff has read most bills and are intimately familiar with them to brief the member. The staff of the Republicans was completely shut out of the process of drafting Obamacare. I maintain that the reason for so much antithesis against the law is that it really was enacted under color of night in less than transparent circumstance. In my opinion, that's also why most of the public disapproves of the law. Had this been fairly and openly drafted and debated, I maintain that the law would look much differently than what you wound up with.

[subnuclear]

If government run programs are so inefficient and wracked by fraud, how does Medicare run at a fifth of the (mandated maximum) overhead of commercial insurers?

I think its just a matter of size. Big insurance companies are also more efficient than small ones. Doesn't the IRS enforce Medicare deductions? That's nice, too. Also, totally different population.

The problem with Medicare that I know a little about is that the rates are influenced by organized lobbying, so factory medicine (like CT scans) have an exaggerated reimbursement versus more personal medicine (like geriatric care). Most Radiology/Radiation Oncology departments are cash cows because of the Medicare reimbursement.

[Limey]

The gang of six didn't share the bill with the rank-and-file.

It was too large to pass without any committee hearings. That's how legislation used to be fashioned before the days of hopeless gridlock. The result is that the poor public, who is saddled with the law, never got a reasonable chance to review it prior to the votes.

The Senate Finance Committee held 31 meetings on the bill.  You can look that up.  The Senate voted on the bill.

That's not true. At least the member's staff has read most bills and are intimately familiar with them to brief the member. The staff of the Republicans was completely shut out of the process of drafting Obamacare. I maintain that the reason for so much antithesis against the law is that it really was enacted under color of night in less than transparent circumstance. In my opinion, that's also why most of the public disapproves of the law. Had this been fairly and openly drafted and debated, I maintain that the law would look much differently than what you wound up with.

"Color of night" and "less than transparent" is just rhetoric...and not true.  The bill was crafted and debated over the course of a year, and was voted on in both houses at least twice.  Non-participation by Republicans was their choice, as they had been invited into the process early before abandoning participation in favour of simple obstruction.

If members of Congress chose not to read the bill - which they had ample time to do - that's on them.  Claiming this was sprung on Congress and rammed home in the dead of night is just false revisionism.

[jbm]

That's not true. At least the member's staff has read most bills and are intimately familiar with them to brief the member. The staff of the Republicans was completely shut out of the process of drafting Obamacare.

The Republicans can't have it both ways.  They might pay occasional lip service to the idea of working with Obama, but they won't actually participate in anything constructive.  So, if their actions and words scream "we won't play at all with you, you piece of Kenyan crap," they shouldn't act bemused when the ball doesn't come their way.  That attitude by the Republicans has really hurt this country. 

[Limey]

The result is that the poor public, who is saddled with the law, never got a reasonable chance to review it prior to the votes.

Just one thing on this point in isolation:  You know there's been an election since then, right?  The guy whose name is attached to the bill was re-elected comfortably.  The Republicans, who campaigned from top to bottom on "repeal and replace", lost.  Democrats increased their majority in the Senate, narrowed their deficit in the House and won the national popular vote in all cases.

The public had a chance to comment on the ACA, and they did.

[Jacksonian]

Just one thing on this point in isolation:  You know there's been an election since then, right?  The guy whose name is attached to the bill was re-elected comfortably.  The Republicans, who campaigned from top to bottom on "repeal and replace", lost.  Democrats increased their majority in the Senate, narrowed their deficit in the House and won the national popular vote in all cases.

The public had a chance to comment on the ACA, and they did.

For accuracy's sake that's the second vote since the ACA was enacted.  After the first vote the Democratic Party lost the House and seats in the Senate.  My view of the second election was that the public was already getting tired of Republican Party idiocy and that the ACA wasn't as much a factor.

[Limey]

For accuracy's sake that's the second vote since the ACA was enacted.  After the first vote the Democratic Party lost the House and seats in the Senate.  My view of the second election was that the public was already getting tired of Republican Party idiocy and that the ACA wasn't as much a factor.

Good point.  However, the debate during the 2010 election was overrun my misinformation about death panels and how the ACA was going to cut Medicare benefits, none of which was true, but it fired up seniors to vote to save their Medicare*.  Also, the sitting President's party almost always gets its hat handed to it in the midterms, although 2010 was a shoeing by any measure.

You are correct about Republican dick-stomping in the 2012 election, though, it was more ripe with it than the Texans' sideline.  45%?  Legitimate rape?


* Ironically, the ACA preserved Medicare benefits while cutting costs.  Ryan's plan was to turn it into a voucher system.  Even more ironically, Ryan has absorbed the cost savings and revenue generation of the ACA into his subsequent budget proposals, while still pushing the voucherisation of Medicare.

[Jacksonian]

Good point.  However, the debate during the 2010 election was overrun my misinformation about death panels and how the ACA was going to cut Medicare benefits, none of which was true.  You are correct about Republican dick-stomping in the 2012 election, though, it was more ripe with it than the Texans' sideline.  45%?  Legitimate rape?

IMO, 2010 wasn't just about the ACA.  The Democratic Party did its own dick stomping.  They very much appeared to be overly concerned about the ACA passage rather than the high unemployment at the time.  As I recall Obama did little to address jobs issues relative to his work on ACA.  Recall too that at the time the Democratic Party had overlord level control of Washington.  They could have done anything they wanted with jobs issues and didn't.  That unemployment wasn't #1 on their list in 09 and 10, IMO, ruined their chances of keeping Washington.

[Limey]

IMO, 2010 wasn't just about the ACA.  The Democratic Party did its own dick stomping.  They very much appeared to be overly concerned about the ACA passage rather than the high unemployment at the time.  As I recall Obama did little to address jobs issues relative to his work on ACA.  Recall too that at the time the Democratic Party had overlord level control of Washington.  They could have done anything they wanted with jobs issues and didn't.  That unemployment wasn't #1 on their list in 09 and 10, IMO, ruined their chances of keeping Washington.

They passed a stimulus bill that, in the spirit of bipartisanship, included a slew of tax cuts as preferred by the Republicans.  It helped a lot, but it wasn't enough action on jobs, though.  Even so, in 2010 the Republicans successfully bashed the Democrats for being "tax and spend", even saddling Obama with TARP (conflating the stimulus with the bank bailout) although it was passed under the Bush administration.

[Bench]

I maintain that the reason for so much antithesis against the law is that it really was enacted under color of night in less than transparent circumstance.

Willful ignorance is not color of night. 

[Mr. Happy]

Willful ignorance is not color of night. 

Two Republican friends of mine who are members of the House told me personally that they had no real review of the bill that came out. I rather doubt that they are lying to me.

[Jacksonian]

They passed a stimulus bill that, in the spirit of bipartisanship, included a slew of tax cuts as preferred by the Republicans.  It helped a lot, but it wasn't enough action on jobs, though.  Even so, in 2010 the Republicans successfully bashed the Democrats for being "tax and spend", even saddling Obama with TARP (conflating the stimulus with the bank bailout) although it was passed under the Bush administration.

I would love to see that graph mapped against gasoline prices.

Again, it's my memory working here but as I recall the People didn't care so much about a one time check as they did being gainfully employed.

[Bench]

Two Republican friends of mine who are members of the House told me personally that they had no real review of the bill that came out. I rather doubt that they are lying to me.

I'm not calling them liars (but *cough* congressmen *cough*).  No real review of the bill is not no opportunity to review the bill or to even gain knowledge of its working parts in the years leading up to its passage. 

[Limey]

Two Republican friends of mine who are members of the House told me personally that they had no real review of the bill that came out. I rather doubt that they are lying to me.

It's not like they didn't have time.  They don't seem to be doing much else.  The current Congress in on pace to pass about a third fewer bills that the previous record of legislative futility, and nearly a tenth of the bills passed by the "Do Nothing" Congress.

[ybbodeus]

You guys are arguing with the wrong people.  You need to be persuading all those young voters to start enrolling, not beating each other up over friggin' rates--or which coverage one should or shouldn't have--or what Nancy meant we she said "we"-- (is "we" the new "is"?).

I am a little bothered by the notion that some get "exempted" from the enforcement of this great plan, primarily allies of government types it would appear (I hope there are some R's in that camp to keep it fair).  However, reading the words of Representative Pelosi and others--that we'll thank them one day for this great program--shouldn't Senator Reid be announcing that he's actually punishing those aides he advised could keep....I mean, MUST keep their government policies?

[Limey]

I am a little bothered by the notion that some get "exempted" from the enforcement of this great plan, primarily allies of government types it would appear (I hope there are some R's in that camp to keep it fair).  However, reading the words of Representative Pelosi and others--that we'll thank them one day for this great program--shouldn't Senator Reid be announcing that he's actually punishing those aides he advised could keep....I mean, MUST keep their government policies?

Congressional staff were never exempt from the ACA; they were already covered by the Federal government's "Cadillac" policy for its employees.  This misinformation was taken to its extreme when Chuck Grassley (IIRC) engaged in some impish brinkmanship and introduced an amendment (to a bill that was never debated, seen or read...) to say that Congressional employees, including Congressmen...and Women (thank you, Stan) ...had to use the exchanges to get their health insurance.

He expected the Democrats to balk, walking face first on to his extended fist.  Instead, they said "sure", and the amendment passed at a canter.  This, of course, lead to more hilarity when Speaker Boehner tried to make a show of failing to sign up through the website, but succeeded in dick-stepping his way to new coverage.

[Jacksonian]

Congressional staff were never exempt from the ACA; they were already covered by the Federal government's "Cadillac" policy for its employees.  This misinformation was taken to its extreme when Chuck Grassley (IIRC) engaged in some impish brinkmanship and introduced an amendment (to a bill that was never debated, seen or read...) to say that Congressional employees, including Congressmen...and Women (thank you, Stan) ...had to use the exchanges to get their health insurance.

He expected the Democrats to balk, walking face first on to his extended fist.  Instead, they said "sure", and the amendment passed at a canter.  This, of course, lead to more hilarity when Speaker Boehner tried to make a show of failing to sign up through the website, but succeeded in dick-stepping his way to new coverage.

Apparently they can be exempted.  But only Harry Reid has allowed his staff to exercise that exemption.  All other congressional staff apparently don't get to use that cadillac plan.

[Limey]

Apparently they can be exempted.  But only Harry Reid has allowed his staff to exercise that exemption.  All other congressional staff apparently don't get to use that cadillac plan.

That's bullshit on Reid's part.  He deserves to get pounded for that one.

[NeilT]

Limey: It is hardly laughable. Most of that debate centered around the fact that Democrat leadership had drafted the bill without input or even any chance of reviewing it in committee hearings. The Republicans complained bitterly about that aspect of the process. The bill was a monolith. Just about all who voted for or against it didn't read it before voting.

You could tell something was wrong with the process.  It was the first and only time that the Republicans have ever complained bitterly.

[Noe]

That's bullshit on Reid's part.  He deserves to get pounded for that one.

Maybe his staff is part of a union?

[HudsonHawk]

Apparently they can be exempted.  But only Harry Reid has allowed his staff to exercise that exemption.  All other congressional staff apparently don't get to use that cadillac plan.

That's not exactly true.  Other congressman have exempted some of their staff as well.  And the exempted staff are not the Congressman's personal staff, it's committee personnel who otherwise already have federal government benefits.  In short, Reid, like other Congressman, have told their non-personal staff "if you like your current plan, you can keep it". 

[Limey]

New figures out show that enrollment rates are accelerating, and that over 1.2 million people have sign up for coverage under Obamacare.  On a single peak day, 27,000 people signed up and, as the Jan 1 deadline for having coverage approaches, enrollment is expected the accelerate further.

[ybbodeus]

Is that AP or the Coach's Poll? 

[geezerdonk]

New figures out show that enrollment rates are accelerating, and that over 1.2 million people have sign up for coverage under Obamacare

800,000 of which is Medicaid. Free medicine, free doctors, free nurses (oh yeah), free hospitals and the best part is that those greedy, selfish, rich assholes have to pay for it - every single penny.

[Uncle Charlie]

800,000 of which is Medicaid. Free medicine, free doctors, free nurses (oh yeah), free hospitals and the best part is that those greedy, selfish, rich assholes have to pay for it - every single penny.

...and the remainder have selected, but not necessarily paid.  That's where the proof will be in the pudding.

[Limey]

800,000 of which is Medicaid. Free medicine, free doctors, free nurses (oh yeah), free hospitals and the best part is that those greedy, selfish, rich assholes have to pay for it - every single penny.

So, same as it was before then.  Except now, they have access to cheap preventative healthcare, instead of expensive ER healthcare.

[Limey]

...and the remainder have selected, but not necessarily paid.  That's where the proof will be in the pudding.

Huh?

Approximately 365,000 of those people have purchased private insurance...

You know how this works, right?  People go to an exchange, where they shop for healthcare products and, once they've decided which to buy, they are connected to that insurer to sign up and pay.

[NeilT]

Someone mentioned to me yesterday in the elevator that Obamacare prohibited payments on insurance with credit cards.  That seems odd.

[Limey]

Someone mentioned to me yesterday in the elevator that Obamacare prohibited payments on insurance with credit cards.  That seems odd.

As you suspect, it's not true.

[juliogotay]

Sebilius said enrollments don't mean they've paid. They haven't paid. And the enrollment # coming out the administration is under 400,000,   not over a million.
Those were her words.

[Uncle Charlie]

Huh?

You know how this works, right?  People go to an exchange, where they shop for healthcare products and, once they've decided which to buy, they are connected to that insurer to sign up and pay.

Poor reporting.  The reporter assumes that everyone who "selected" has paid.  That's not how it works.  People using the exchange have effectively 5 steps:
1. Sign Up for the website
2. Receive plan offers
3. Select a plan
4. Pay for the plan
5. Recieve benefits for the plan (roughly 2 weeks later)

Steps 1-3 are free.  Note that in the article, the one piece of data directly sourced (the graph) says "Selected".  The problem is the rubber meets the road at step 4 where people have to separate themselves from their money to gain access to the plan.  I can go select a car on a lot and tell the manager I will buy it, but until I give him cash, I cannot drive off the lot with it.

[Limey]

Poor reporting.  The reporter assumes that everyone who "selected" has paid.  That's not how it works.  People using the exchange have effectively 5 steps:
1. Sign Up for the website
2. Receive plan offers
3. Select a plan
4. Pay for the plan
5. Recieve benefits for the plan (roughly 2 weeks later)

Steps 1-3 are free.  Note that in the article, the one piece of data directly sourced (the graph) says "Selected".  The problem is the rubber meets the road at step 4 where people have to separate themselves from their money to gain access to the plan.  I can go select a car on a lot and tell the manager I will buy it, but until I give him cash, I cannot drive off the lot with it.

So you think people are going to go through all that effort and then not pay?  Buying insurance is not fun; shopping for cars can be.  It's been hard to sign up, but being uninsured is worse.

This is something that has become clear to me in my most recent interviews, talking to people who have now spent two months trying to buy insurance coverage. These are the people who have made upwards of 100 attempts at buying insurance coverage.

They're the ones trying the Web site at different times of day and in different Internet browsers. Some incorporate it into their daily routines; logging on to HealthCare.gov has become the first thing they do when they wake up, the last thing they do before falling asleep.

They are frustrated, especially those who supported the health-care overhaul. But they are not quitting. I have not yet found a HealthCare.gov shopper who has thrown up his hands and said: “I’m done with this. I’ll pay the penalty for going uninsured instead.”

[Limey]

Sebilius said enrollments don't mean they've paid. They haven't paid. And the enrollment # coming out the administration is under 400,000,   not over a million.
Those were her words.

1.2 million is a combination of 300-and-something thousand signing up for private coverage plus the 800-and-something thousand newly qualified for Medicaid.  Both of which are components of "Obamacare".

[Bench]

Buying insurance is not fun; shopping for cars can be. 

I wish I could just buy a car online.  I hate shopping for cars.

[Limey]

I wish I could just buy a car online.  I hate shopping for cars.

I shop in person, then buy over email/phone.  Never negotiate in the dealership.

[NeilT]

I wish I could just buy a car online.  I hate shopping for cars.

Because we live in a conservative free-market state, state law prohibits you from buying a car online. 

[Bench]

Because we live in a conservative free-market state, state law prohibits you from buying a car online.  

I wish I could order a case of wine online to drink while I wait for the car.  

[Limey]

I wish I could order a case of wine online to drink while I wait for the car.  

That's the trouble with the internet; there's just nothing on there to do to while away time.

[chuck]

When my Saturn finally gives up the ghost (I reckon I'll get another hundred and fifty miles out of her) I'm just going to head straight to that BMW dealership downtown and buy what they recommend. I've heard great things about those folks.

[NeilT]

I wish I could order a case of wine online to drink while I wait for the car.  

I believe you can order the case of wine.  I have from time to time.  Drinking it while waiting for the car is a problem, though you could think of it as being the same as waiting for Godot.  As long as you don't expect it to ever actually arrive you can have a fine old time.

[NeilT]

When my Saturn finally gives up the ghost (I reckon I'll get another hundred and fifty miles out of her) I'm just going to head straight to that BMW dealership downtown and buy what they recommend. I've heard great things about those folks.

Didn't you accidentally leave out the thousand?  Don't Saturns run forever?

[geezerdonk]

Estragon, is that you?

[Bench]

I believe you can order the case of wine.  I have from time to time.  Drinking it while waiting for the car is a problem, though you could think of it as being the same as waiting for Godot.  As long as you don't expect it to ever actually arrive you can have a fine old time.

I thought one couldn't order a case of wine from outside of Texas anymore? If that isn't the case, can anyone recommend a good website for ordering wine?

[HudsonHawk]

I thought one couldn't order a case of wine from outside of Texas anymore? If that isn't the case, can anyone recommend a good website for ordering wine?

As of 2005, you can have wine shipped directly to you in Texas.  There is a limit, and that limit (since 2009) is 9 gallons per month with a max of 36 gallons per year.

[Bench]

As of 2005, you can have wine shipped directly to you in Texas.  There is a limit, and that limit (since 2009) is 9 gallons per month with a max of 36 gallons per year.

Huh. I guess I inflated remembering articles like this one explaining that online wine retailers (wine.com, etc...) stopped shipping to Texas because of permit requirements.  Apparently it's fine if directly from the winery, but not okay from a retailer.

Looking at wine.com now it appears that there is no problem selling their wine to customers in Texas.  I have been denying myself for no reason all the years. 

[HudsonHawk]

Huh. I guess I inflated remembering articles like this one explaining that online wine retailers (wine.com, etc...) stopped shipping to Texas because of permit requirements.  Apparently it's fine if directly from the winery, but not okay from a retailer.

Well, you're *allowed* to order and have wine shipped to you.  Whether or not someone will be willing to do it is another matter.

I guess it's kind of the inverse of buying Cuban cigars abroad.  It's perfectly fine for a retailer in Canada or the UK to sell you Cuban cigars.  They're not violating any laws, in the US or within their own countries.  But it's against US law for a US citizen to buy one, anywhere, from anyone.

[Bench]

Well, you're *allowed* to order and have wine shipped to you.  Whether or not someone will be willing to do it is another matter.

I guess it's kind of the inverse of buying Cuban cigars abroad.  It's perfectly fine for a retailer in Canada or the UK to sell you Cuban cigars.  They're not violating any laws, in the US or within their own countries.  But it's against US law for a US citizen to buy one, anywhere, from anyone.

Wine.com evidently has a warehouse in Houston for Texas consumers.  It was really easy to sign up for the website, receive wine offers and select wines, but I have yet to pay for the wine or receive the benefits of the wine.  Close enough for Sebelius I guess?

[NeilT]

I thought one couldn't order a case of wine from outside of Texas anymore? If that isn't the case, can anyone recommend a good website for ordering wine?

If you like zinfandel, get on Turley's annual mailing list.

[NeilT]

As of 2005, you can have wine shipped directly to you in Texas.  There is a limit, and that limit (since 2009) is 9 gallons per month with a max of 36 gallons per year.

That's probably enough for me.  I don't know what Kris would do though.  She'll have to order her own.

[HudsonHawk]

Wine.com evidently has a warehouse in Houston for Texas consumers.  It was really easy to sign up for the website, receive wine offers and select wines, but I have yet to pay for the wine or receive the benefits of the wine.  Close enough for Sebelius I guess?

Out of curiosity, is there a particular wine you want that you can't get locally?  Or are you just wondering in general?

[Bench]

Out of curiosity, is there a particular wine you want that you can't get locally?  Or are you just wondering in general?

Just wondering out of general laziness.  The house has a decently sized built-in wine fridge that I can never keep stocked and in addition to the convenience of having wine delivered to me, ordering online would probably allow for more informed experimentation rather than just grabbing a random bottle off the shelf at Specs.  Plus I assume an order history would be a convenient place to keep a record of which wines I liked for future recognition.  Also I've heard that the best way to start a proper collection is to purchase wine that won't be ready for a few years, which seems easier to accomplish through ordering.    

[Limey]

Just wondering out of general laziness.  The house has a decently sized built-in wine fridge that I can never keep stocked and in addition to the convenience of having wine delivered to me, ordering online would probably allow for more informed experimentation rather than just grabbing a random bottle off the shelf at Specs.  Plus I assume an order history would be a convenient place to keep a record of which wines I liked for future recognition.  Also I've heard that the best way to start a proper collection is to purchase wine that won't be ready for a few years, which seems easier to accomplish through ordering.    

Also, you will be spending all your sleeping hours awake now, so you have time to research.

[Ron Brand]

Estragon, is that you?

Didi! Gogo! Sorry I was late. I got caught up in traffic. Were you waiting long?

[Duke]

Well, you're *allowed* to order and have wine shipped to you.  Whether or not someone will be willing to do it is another matter.

I guess it's kind of the inverse of buying Cuban cigars abroad.  It's perfectly fine for a retailer in Canada or the UK to sell you Cuban cigars.  They're not violating any laws, in the US or within their own countries.  But it's against US law for a US citizen to buy one, anywhere, from anyone.

With Obama mingling with Castro in South Africa we must be well on our way to normalizing relations with Cuba.  Maybe it won't be long until I can stroll down to Legends and legacies to pick up a box of Cohiba Robustos.

[HudsonHawk]

With Obama mingling with Castro in South Africa we must be well on our way to normalizing relations with Cuba.  Maybe it won't be long until I can stroll down to Legends and legacies to pick up a box of Cohiba Robustos.

Well, I suspect it'll still be a while. But it's hard to point to another diplomatic policy that's been as much as an abject failure as the US policy towards Cuba. 50 years ago, no one could have imagined that we'd have normalized relations with places such as Vietnam long before Cuba.

[Limey]

Well, I suspect it'll still be a while. But it's hard to point to another diplomatic policy that's been as much as an abject failure as the US policy towards Cuba. 50 years ago, no one could have imagined that we'd have normalized relations with places such as Vietnam long before Cuba.

See also Ya, Lib and Sia, Rus.

The only reason there's still an embargo is because Florida is a pivotal swing state and it's full of vehemently anti-Castro Cuban exiles.

[Duke]

Well, I suspect it'll still be a while. But it's hard to point to another diplomatic policy that's been as much as an abject failure as the US policy towards Cuba. 50 years ago, no one could have imagined that we'd have normalized relations with places such as Vietnam long before Cuba.

Let's hope it doesn't take that long.  Cuba is beginning to allow some quasi-free market activity. 

[Limey]

Let's hope it doesn't take that long.  Cuba is beginning to allow some quasi-free market activity. 

It used to be the gamblers paradise.  It will be again, as soon as the embargo goes.  And I will arrive shortly thereafter.  Tables for me; beaches for the missus and rum for everyone!

[NeilT]

It used to be the gamblers paradise.  It will be again, as soon as the embargo goes.  And I will arrive shortly thereafter.  Tables for me; beaches for the missus and rum for everyone!

My experience with Cuban cigars is limited, but enough to question whether I'd choose a Cuban over something else.  There is supposed to be good bonefishing though.

[Limey]

My experience with Cuban cigars is limited, but enough to question whether I'd choose a Cuban over something else.  There is supposed to be good bonefishing though.

I found Dominican cigars to be quite fabulous, and communism-free.

[WakePhil]

There is supposed to be good bonefishing though.

Let me tie this back into politics to get this thread back on its awful track...

Wasn't Bush (the HW) a big fly fisherman and a foreign policy guy? What a missed opportunity, bet it was on his second term agenda.

[Limey]

Let me tie this back into politics to get this thread back on its awful track...

Wasn't Bush (the HW) a big fly fisherman and a foreign policy guy? What a missed opportunity, bet it was on his second term agenda.

Googling "bush sr cuba" yields an amazing haul of truth and facts about how he was behind the assassination of JFK.

So, now we know.

[subnuclear]

Well, I suspect it'll still be a while. But it's hard to point to another diplomatic policy that's been as much as an abject failure as the US policy towards Cuba.

I would point to the embargo on Iraq as one.

[juliogotay]

I found Dominican cigars to be quite fabulous, and communism-free.

They often use seeds from Cuban tobacco I believe in the Dominican?

[WakePhil]

Googling "bush sr cuba" yields an amazing haul of truth and facts about how he was behind the assassination of JFK.

So, now we know.

Googling "George Bush Sr. fake moon landing" resulted in this amazing headline: Apollo Mission Hoax Provided Secret Funding of Satellite and Scalar Weapons to Create Today’s “Climate Change”

[Limey]

They often use seeds from Cuban tobacco I believe in the Dominican?

I believe they pick the leaves and roll the smokes with the same soft hands of children, too.

[juliogotay]

I believe they pick the leaves and roll the smokes with the same soft hands of children, too.

They may but I actually wasn't tryng to denigrate your choice in cigars. I think Domincans are a great alternative to Cubans and the reason stated is probably a significant reason why. I used to enjoy them myself when I smoked.

[Limey]

They may but I actually wasn't tryng to denigrate your choice in cigars. I think Domincans are a great alternative to Cubans and the reason stated is probably a significant reason why. I used to enjoy them myself when I smoked.

No worries.  I was just cracking wise.

I've had what are alleged to be Cubans* and I've had cigars from the DR.  Now, I'm no afficionado, just an occasional indulger, but I really don't remember there being a significant difference (at my price point, which is on the reasonable end) between the two origins.  I probably couldn't tell them apart from a cigar competently rolled in a trailer in Bandera, either, so there's that to consider too.


* I was in a cigar shop in London one time, and they very kindly offered to re-wrap - in labels from the DR - any Cubans I cared to buy.  [NSA] I didn't buy any Cubans [/NSA], mostly because it occurred to me that they could be re-wapping DR cigars in the spare Cuban labels and upcharging for them.  I still suspect that a lot of what goes around the U.S. as Cuban cigars is just Dominicans with switched out labels...like Albert Pooholes.

[NeilT]

No worries.  I was just cracking wise.

I've had what are alleged to be Cubans* and I've had cigars from the DR.  Now, I'm no afficionado, just an occasional indulger, but I really don't remember there being a significant difference (at my price point, which is on the reasonable end) between the two origins.  I probably couldn't tell them apart from a cigar competently rolled in a trailer in Bandera, either, so there's that to consider too.


* I was in a cigar shop in London one time, and they very kindly offered to re-wrap - in labels from the DR - any Cubans I cared to buy.  [NSA] I didn't buy any Cubans [/NSA], mostly because it occurred to me that they could be re-wapping DR cigars in the spare Cuban labels and upcharging for them.  I still suspect that a lot of what goes around the U.S. as Cuban cigars is just Dominicans with switched out labels...like Albert Pooholes.

The last time I bought any Cuban cigars was in Argentina.  I'm still not convinced they weren't from Uruguay, except as I recall they smoke other stuff in Uruguay. 

[Bench]

I'm still not convinced they weren't from Uruguay, except as I recall they smoke other stuff in Uruguay. 

And it's easier than ever to do so.

[HudsonHawk]

No worries.  I was just cracking wise.

I've had what are alleged to be Cubans* and I've had cigars from the DR.  Now, I'm no afficionado, just an occasional indulger, but I really don't remember there being a significant difference (at my price point, which is on the reasonable end) between the two origins.  I probably couldn't tell them apart from a cigar competently rolled in a trailer in Bandera, either, so there's that to consider too.


* I was in a cigar shop in London one time, and they very kindly offered to re-wrap - in labels from the DR - any Cubans I cared to buy.  [NSA] I didn't buy any Cubans [/NSA], mostly because it occurred to me that they could be re-wapping DR cigars in the spare Cuban labels and upcharging for them.  I still suspect that a lot of what goes around the U.S. as Cuban cigars is just Dominicans with switched out labels...like Albert Pooholes.

About 90% of the cigars sold in the world as "Cuban" are fakes.  But an authentic Cuban cigar is significantly different and immediately recognized.  That doesn't mean there aren't good cigars from the DR or Nicaragua.  There are.  But they're not Cuban. 

[HudsonHawk]

The last time I bought any Cuban cigars was in Argentina.  I'm still not convinced they weren't from Uruguay, except as I recall they smoke other stuff in Uruguay. 

If you bought it outside of Canada, London, or SE Asia, there's a 99% chance it's fake.  If you buy it in Cuba, it's only a 50/50 shot it's fake.

[Limey]

Back on topic, all Obamacare horror stories trumped, in one go.

“He wouldn’t be here with me or my children if it weren’t for the Obamacare”

[Randy Watson]

Anyone else gotten their $2,500 check yet?

[Limey]

Can't resist resurrecting this thread with a little Perry-related hilarity:

Having rejected using the Medicare expansion in Obamacare - paid for entirely by federal dollars - to help out those who fall between Medicare "classic" and being able to afford insurance on their own, Perry appointed a panel of experts to figure out how to get this done Texas-style.  The 15-member, hand-picked panel mused on this problem for 3 years, and came back with the answer:  take the fucking money you pussy!

“We’re trying to look at actions whereby more Texans can be covered,” said board chairman Steve Berkowitz. “We’re trying to take the politics out of it.”

Exactly.

[Bench]

Can't resist resurrecting this thread with a little Perry-related hilarity:

Having rejected using the Medicare expansion in Obamacare - paid for entirely by federal dollars - to help out those who fall between Medicare "classic" and being able to afford insurance on their own, Perry appointed a panel of experts to figure out how to get this done Texas-style.  The 15-member, hand-picked panel mused on this problem for 3 years, and came back with the answer:  take the fucking money you pussy!

Exactly.

I don't see how that money is going to keep ISIS from smuggling ebola across our border. 

[Limey]

I don't see how that money is going to keep ISIS from smuggling ebola across our border. 

We need to build a fence...between here and Dallas.

[NeilT]

We need to build a fence...between here and Dallas.

to heck with that, I got appointed to a death panel!