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Obamacare Rolls Out: Signing Up And What’s Next

Signing up for Obamacare.  On the eve of the Affordable Care Act rollout, we look at its what, where, and how.

Maygan Rollins, 22, a field organizer with Enroll America, holds a clipboard with pamplets while canvassing at a bus stop, Wednesday, Sept. 25, 2013, in Miami. Enroll America is a private, non-profit organization running a grassroots campaign to encourage people to sign up for health care offered by the Affordable Care Act. (AP)

Maygan Rollins, 22, a field organizer with Enroll America, holds a clipboard with pamplets while canvassing at a bus stop, Wednesday, Sept. 25, 2013, in Miami. Enroll America is a private, non-profit organization running a grassroots campaign to encourage people to sign up for health care offered by the Affordable Care Act. (AP)

Whatever happens in Washington’s high-wire, high-volume, all-out budget shutdown battle, tomorrow morning an epic health care reform is on track to roll out in America.

The Affordable Care Act – “Obamacare” – formally opens to applicants tomorrow.  Many millions of Americans with relatively low incomes or pre-existing conditions will have a new path to health insurance.

The battle has been fierce, but the new way is fairly straightforward once you look at it.  And historic.

This hour, On Point:  beyond the smoke and fury, the rollout of Obamacare.  What you need to know.

- Tom Ashbrook

Guests

Jonathan Cohn, senior editor at The New Republic covering public policy and politics. (@citizencohn)

Sarah Kliff, Washington Post health policy reporter. (@sarahkliff)

From Tom’s Reading List

The Washington Post: Individuals will define Obamacare’s fate – ”Poll after poll has shown Americans remain skeptical and confused about Obamacare. And on the day enrollment opens, the federal government may shut down as part of a budget battle tied to a Republican effort to block the law’s implementation. But the law will move forward, in any case.”

The New Republic: Obamacare Is About to Go Live. Here’s Why It Was Worth the Wait. – “Obamacare’s new insurance marketplaces are scheduled to open for business on October 1, just a few days from now. For all the attention that date has received, it is less important than it might seem. Because new coverage won’t actually begin until January 1, most people looking to get insurance on their own won’t start shopping until the end of the year. But October 1 is still a milestone. And with Republicans threatening to let the government shut down or default if Obamacare takes full effect, it’s also a good moment to take a step back and assess the law—to think, in the broadest possible terms, about whether the reforms it has enacted are worthwhile.”

The Wall Street Journal: Firms Drop, Rather Than Upgrade, Cheapest Health Plans – ”The nation’s largest provider of security guards plans to discontinue its lowest-cost health plans and steer roughly 55,000 workers to new government-sponsored insurance exchanges for coverage next year, in the latest sign of the fraying ties between employment and health care.”

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  • Wm_James_from_Missouri

    “Americans remain skeptical and confused about Obamacare”, yup, that’s me !

    1. Will your plans be linked to certain areas like so many are now, preventing you from moving to areas where better jobs can be found?

    2. Will you be able to use these plans overseas or when you are traveling ?

    3. Since you are acting as an individual, not through an employer, I can assume that any legal battles with your insurance company will be through your $200 per hour attorney, no ? Good luck with that !

    4. If you have insurance now, and leave your job to look for new work, will you be fined in the interim ? Then I guess that all of those people that can’t afford any extra bills, now, will not be able to leave an employer unless they go on to apply for some kind of aid. Of course, I am assuming that if they do have some kind of assets that they were trying to build, the government will tell them they will have to use up that money first before they can get aid, thereby, pushing them farther down economic ladder.

    (As an example: to get Medicaid today you can not have more than $1000, in assets ! This is nothing ! )

    5. I pity the man that gets a divorce. His “ex” will be using the courts to force him to buy the most expensive plan out there ! Don’t even try to defend, through counterpoint, this kind of thing goes on everyday!

    6. I have said it before, and I’ll say it again. What happened to the (approximately, in real dollars) quarter of a million dollars that my employers and I have paid in for me over all of those years that I have worked ? The wealth of America continues to disappear! Hey, why not ask the Chinese to buy up our insurance companies, too. Like they are doing with every other industry ? Don’t think it is coming?

    — So, so, blind.

    • Yar

      If you want information it is out there, if you just want to be angry there is plenty of that too. At least should know what you should be mad about. Maybe you should be angry at your state legislature or Governor. As for divorce law, it is unrelated to the ACA.

      Wm_James_from_Missouri Check out your State,s website. It looks they are using the federal exchange.
      http://enrollmissouri.org/

      Then check out a Kentucky’s health exchange,
      This is what your state could have done.
      http://kynect.ky.gov/faq/

      Our Governor explained why he embraced the ACA.
      http://www.kaiserhealthnews.org/Stories/2013/September/30/Kentucky-Gov-Steve-Beshear-interview.aspx

      Or in the NYTimes,
      http://www.nytimes.com/2013/09/27/opinion/my-state-needs-obamacare-now.html?_r=0

      • Wm_James_from_Missouri

        Thanks Yar,

        The only thing that I can be sure I am angry about now, is the fact that my employer switched our insurance company and I will now have a $4000 deductible as opposed to a $2500 deductible, out of pocket. Of course I am still kicking in about $250 of my monthly salary to feed the insurance dragon. I doesn’t help that I am making just about what I made back in 1997 but my dollar buys so much less. It also is a fact that I don’t get paid overtime, or have sick days or have a pension or 401k that has any sort of matching. Quicksand, quicksand, quicksand !

        • sickofthechit

          You should be mad at the 1% who have sucked up the vast majority of the 95% in productivity gains that the American workers have produced over the last decade or so. They are the one’s robbing you.

          • fun bobby

            and how will his being mad help?

          • Wm_James_from_Missouri

            Charles,

            You are saying in effect that the 95% are not capable of overcoming the 1% OR that those who claim to represent the 95% or not capable of overcoming the all that has been done by the 1% !

            Now you may see why I can no longer support either of our two parties.

    • JGC

      Missouri -or should it be pronounced Misary- has an especially dedicated set of legislators who are indifferent to folks without proper health care. Missouri’s Republican-led legislature voted down a state-run health insurance exchange…while approved barring the provision of “assistance or resources of any kind” to the federal government to implement its own insurance exchange in Missouri.

      So how does a resident of Missouri find out information, in spite of a state government so dedicated to keeping them ignorant of their options? One place could be the Missouri Foundation for Health, a nonprofit group that is helping to promote the insurance marketplace.

      http://www.mffh.org

      Good luck!

  • John Cedar

    Obamcare “rolled out” in 2010
    The final provisions “roll out” in 2017

    • thequietkid10

      It’s brilliant isn’t it? Supporters of Obamacare have a built in excuse for it’s failures for the next four years.

      • NrthOfTheBorder

        If not the ACA then, what? Obamacare detractors are long, very long, on criticism but haven’t put forth an alternative as far as I can see.

        • thequietkid10

          Here’s a few small ideas

          1. End the giant subsides that go to employers who provide health care, restructure the system so that it is modeled after auto insurance

          2. End any mandatory coverage requirements of non catastrophic medical treatment

          3. Install a loser pays system to limit negligence suits, or at the very least permit them in some instances.

          4. Cap punitive damages in liability suits

          5. Permit contracts whereby someone with a preexisting condition can get health insurance, in exchange for waiving the right to find another provider for a set number of years.

          6. Provide subsides to health insurance companies who provide insurance to those with pre-existing conditions.

          7. Cut down on the educational requirements required to be a doctor (i.e. 3 years of post grad work for and not 4)

          8. roll back patent protections

          • NrthOfTheBorder

            Some ideas sound good, but would it result in universal/affordable health care whose costs didn’t exceed the rate of inflation?

            On law suits: I can tell you that narrowing the definition of what constitutes negligence; having judges decide civil cases (not juries), and “English Rule” where losers pay for all legal costs does away with virtually all negligence cases – while still providing avenues for redress when needed.

  • Ed75

    One problem is the increase in paperwork, another is privacy. Some doctors leaving.

    By making contraception and abortion required parts of the healthcare plans, Obamacare is the largest institutionalization of abortion since the Carhart decision in 1993. (Illegal immigrants coming across the border can’t get a sandwich at a Catholic church, but if they want an abortion or a sex-change operation, they have a right to it. Is something wrong here?)

    Part of the purpose of Obamacare was to lower costs by insuring people so they wouldn’t go to emergency rooms. Part of the purpose was to put healthcare under government control so they could push their agenda of abortion, contraception, same-sex marriage. I wonder which purpose was the greater?

    Anything that promotes abortion is doomed to fail.

    • Yar

      Listen to the Pope.
      From Steel Magnolias, for you Ed.
      Clairee: Ouiser can never stay mad at me. She worships the quicksand I walk on. (Ouiser hugs M’Lynn)
      Ouiser: M’Lynn, you’re in my prayers, honey. (Looks at a shocked Annelle.) Yes, Annelle, I pray! Well, I do! There, I said it, I hope you’re satisfied.
      Annelle: I have suspected this all along!
      Ouiser: Oh! Well don’t you expect me to come to one of your churches! One of those tent-revivals with all those Bible-beaters doin’ God-only-knows-what! They’d probably make me eat a live chicken!
      Annelle: Not on your first visit!
      Clairee: Very good, Annelle! Spoken like a true smart-ass!

      • Ed75

        That’s quite a memory!

    • Leonard Bast

      Didn’t the pope tell you to knock it off?

      • Ed75

        The pope said that if want to draw people to Christ, we need to start with the ‘sweet fragrance of the Gospel’. But I’m not trying to do that here, this is a lament.
        Any irony or message in the fact that on the day the pro-abortion Obamacare bill goes into effect, on that day, the government is shutting down?

        • keltcrusader

          Oh, so you are supposed to lure people in by lying about your true purpose?

          Yes, heaven forbid that women should be able to get health care that relates to every single part of their body, including their reproductive parts. I guess the only thing we are good for is popping out babies according to you. After menopause, we might as well curl up and die and leave it to younger women to propagate the species ad infinitum.

        • Leonard Bast

          One thing for sure: no one is going to be drawn to Christ by your lunatic rantings. If anything, they’ll keep their distance.

    • NrthOfTheBorder

      Wow!

    • Don_B1

      1) Providing contraception for women is the most effective way to prevent abortion that there is.

      2) Most people recognize that there are times when a pregnancy goes astray (note that there are probably an order of magnitude more natural miscarriages than abortions) where the health of the mother is threatened to the extent of loss of life or inability to get pregnant in the future. So to “save” (which means let the fetus die in the womb or nearly immediately after delivery) a fetus whose development has gone awry, you would risk forever preventing the woman from having a child in the future. It is for these types of failed pregnancies that the PPACA is designed to provide best practice medical care. Show me explicitly where other types of abortion are paid for except after rape.

      • 1Brett1

        Thanks. Whenever I say anything about nothing changing with the ACA from previous law regarding abortion and Federal funding (no funding other than in cases of rape, incest, or if the mother’s health is in danger), I get shouting down by conservatives…it is just unbelievable the amount of disinformation that gets disseminated.

        • keltcrusader

          gee, I wonder where they get that disinformation from??

          • Ray in VT

            I’m sure that it’s not Fox News, talk radio and interest groups backed by the usual suspects.

  • creaker

    Please provide one bit of information that most media outlets appear to be leaving out – if you already have health coverage through your employer, you most likely have to do nothing. It’s amazing (maybe not with the level of misinformation out there) the number of people who don’t know that at this point in the game.

    • thequietkid10

      assuming, of course that your employer continues to provide you with insurance.

      • 1Brett1

        If that were to happen, your employer would give you some sort of notice. So, if they haven’t, there’s a good chance they won’t be discontinuing providing you with insurance. Creaker’s comment seems to be about information, I believe.

        • Ray in VT

          I just need to know, Brett, if when next week my daughter has her semi-annual checkup she will be required to see The King’s creepy half brother or if I will need to take her to the local IRS office rather than the pediatricians office.

          • 1Brett1

            My advice is to hide her in your “panic room” (something we should all have now that the death panels are out roaming for potential victims [edit: I should say that they'll be out starting tomorrow to be accurate] and load all your weapons pointed at the front door, as the “panel” may be knocking on your front door very, very soon…Wait, was that my doorbell?!?! Whew, it’s not October first yet; it was just UPS…man, that was a close one! …I am building an underground shelter for my octogenarian, sickly parents as we speak!

          • Ray in VT

            Good advice all around. I think that I need to bar the doors and pull the metal screens down over the windows before I go to bed at night, because the panels may not wait until sunrise. It’s a good thing that I don’t have one of those old timey chimneys, or I’d have to block that too.

          • Don_B1

            Have you heard if Sarah Palin has cloned (woo!) herself so one of her clones can ride ahead of each panel to warn us of this immanent danger?

          • fun bobby

            like a painted paul revere

          • Ray in VT

            Yet another reason to oppose human cloning.

      • creaker

        Actually, as time goes on probably not – benefits continue to be cut back (which was happening long before Obamacare) – for many employers healthcare is the only benefit left they have to cut back on.

        In some states, anyway. The same gloom and doom was projected in MA under Romneycare and we have more employer coverage now than when that went into effect.

        • sickofthechit

          Did you say “RomneyCare? Do you mean to say a Republican instituted a mandatory health care program? My god, the humanity of it. It boggles the mind!

        • fun bobby

          my price has increased continually since romneycare went into effect

          • creaker

            Surprise – healthcare costs go up – last time I checked all costs are going up.

          • fun bobby

            its happened at an astonishing rate. If “all costs are going up” then that’s inflation and what is happening is our money is losing its value

          • sickofthechit

            Then there is the hidden inflation that is right under our noses. Graham crackers are no longer 16 ounces, they are 14.4 ounces. That is a nearly an 11% increase in price. Irony is that they are using the same size box, but the packages inside are shrinking.

          • keltcrusader

            I was just talking about this to my sister this weekend. They decrease amount and increase the cost – double whammy!

          • Don_B1

            If you have not seen a smaller increase for the last two or three years than what you have seen over each of the previous 10 or more years, then you were most likely one of those who were getting policies that let you avoid paying your share of the costs of health care in the past or had extremely poor coverage and are fortunate not to have had a severe medical problem.

            But then it is consistent with your ideology of preventing government oversight of the healthcare insurance market to promote people thinking that the health costs have gone up since the passage of PPACA.

          • fun bobby

            for me, the trend the last couple of years is for the price to go up and the quality of the coverage to go down at the same time. 5 years ago I had much better coverage at a much lower cost. not sure what you are talking about in terms of not “paying my share”. I pay in much more than I receive in care.
            I am not sure how you decided that that was my ideology. You must have confused me with someone else. Personally I think insurance companies should be banned.

          • Don_B1

            If you expect to get an equivalent amount of services paid for to compare with what you paid for the coverage, you need to revisit the definition of “insurance.”

            Some 80% of health care costs are incurred by around 20% of the population, although that 20% number may be growing slightly, with the way we are poisoning ourselves with pollution and bad eating habits.

            Thus most people will not see doctor, hospital and drug costs anywhere near equal to what their insurance premiums cost. But then there is the possibility that you could be one of those who is struck by cancer, have a massive heart attack (they do occur to people who don’t show signs; e.g., Len Bias of Celtics fame), or become schizophrenic, have a massive brain tumor, have a brain seizure of undetermined origin, many of which can cost more than all the premiums you have ever paid.

          • fun bobby

            yes I forgot how important it is to factor in the profits of the insurance companies.
            perhaps my money would be better spent on lottery tickets

          • John_in_Amherst

            suggestion: check the amount spent for a hip replacement, by-pass operation, cancer treatment, etc. etc., and compare the cost to what you have spent so far on insurance. You may be lucky enough to live to an advanced age without needing any care. But probably not. Insurance is paying for coverage in advance, plus a profit for the insurance company and it’s stockholders. How much better to limit the administrative overhead and dividend costs, and actively bargain with providers and suppliers to reduce costs? Oh, but wait, that would be the ACA…

          • fun bobby

            we will see if it works out that way. so far, for me, it has not. I don’t really like the idea of paying for other people’s by passes and cancers when often those are caused by poor lifestyle decisions. what incentive is there to avoid those things if you get unlimited free healthcare for them?

          • John_in_Amherst

            I hear you w/ regard to other people’s poor health choices. So how do we eliminate environmental health stressors like pollution and change health choices around “Big Gulps”, smoking butts, sitting on butts, etc without becoming the nanny state the teabaggers so endlessly whine about? Finally there are lots of people who eat right, exercise, and otherwise take good care of themselves, and still get cancer. I Know. I hope you never find out.

          • Karl Prahl

            Instead of a Federal mandate have local initiatives. That way your neighbors are actually paying for your healthcare and you theirs. If we’re “all in this together” there would be some accountability for ones actions. If you’re an off-road seatless unicyclist and you continually end up at the hospital that the town pays for, your neighbors might actually talk some sense into you and your choice in hobbies.
            If you develop a disease and it’s you and your neighbors paying for it, the circumstances would be open and clear to all. No question of “those damn freeloaders”.

          • John_in_Amherst

            interesting idea. But what of the suburban neighborhoods where the majority of folks are overfed, under-exercised and stressed to the max by work and the rest of life? What about the areas where the majority thinks they can pray themselves well? What about genetic disorders where choice is not a factor, or cancers, where choice can play a small or a great role, depending on circumstances? Firearms account for a huge number of fatalities and injuries, and we have NRA types arguing for more, more, more….

          • Karl Prahl

            We should set aside the firearms bit as NH is a great example of firearms in private hands without terror, while DC and Chicago are less so :P
            As to different neighborhoods and different levels of education. What can you say? I believe it is our duty as human beings to try and educate our fellow man as to 5w’s and how of our actions and our beliefs. If you and your town have a kickbutt health care system, show us how it’s done. But to have the audacity to assume him, her, you or I know what’s best for others health, especially when you consider the FACT that every BODY is different, it’s a recipe for abuse and disaster.
            If someone things they can pray away their disease. Good luck. If someone thinks that injecting a cocktail of 17 different drugs will treat their disease. Good luck. Unless government and insurance companies are writing blank checks for all types of treatment (they are not) then what are we signing up for? Better to put this money into education and not bureaucracy and enforcement.

          • fun bobby

            That’s one of the major concerns that I have with this road of socialized medicine. I want people to choose to die however they see fit. The soda ban supporters used the “we all to pay for your bad health choices because of socialized medicine so we can tell you what you may consume”. That’s not cool because it could be used to apply to almost anything. Why “let” people skydive or skateboard when those things can create immense medical bills? Why not mandate exercise? why not mandate a limit on how much exercise is safe because too much can also shorten your life? Although many things are beyond our control its up to each of us to make our choices and live with the consequences. That’s freedom. Want to drink and smoke every day and live a long life? make sure you earn a lot of money because that is not going to be cheap.

          • http://www.findingourdream.blogspot.com Hal Horvath

            Yes, health insurance premiums have gone up sharply year after year since 1980 at least. This year, less than most, which is interesting.

      • John Cedar

        And assuming that your employer didn’t already end coverage back in 2010.
        And assuming you don’t count as “doing something”, having to pay your share of the giant humongous record setting price increase and deductible increases that started in 2010 when the first provisions of the unaffordable healthcare act “rolled out”.

        • Ray in VT

          Huh. Large increases in price and deductible costs in health care only started in 2010? Who knew. I guess that I have been laboring under the misconception that such costs have been ballooning for more than a decade. Thanks for setting the record straight.

          • HonestDebate1

            I thought it was supposed to end in 2010.

          • Ray in VT

            Well, Obama didn’t get that magic liberty wand that the libertarians have that are supposed to fix everything, so….

          • John Cedar

            It is doubtful that you know what the word laboring means, but you did hit the target in describing your affliction… “misconception”.
            I have been purchasing health insurance on behalf of employees for longer than I care to admit. In 2010 the premiums and deductibles went up far more than they ever have in all the years that I have been shopping plans. You can fog that fact by trying to imply that I said those costs were not rising prior to 2010 but I suspect even you realize the truth. You can try to hide the fact by quoting increases as percentages instead of by dollars, but even using that metric, 2010 is the record increase for me here in NYS. YMMV

          • Ray in VT

            I’m pretty familiar with the dictionary, and I can think of a few definitions of laboring. I’m most familiar with it as to to labor, as in demanding physical work.

            I think that the available research shows that insurance costs have been rising much faster than incomes for well over a decade, and that 2010 being the largest that you have seen in your area does not change that. How about this year? The Kaiser numbers that I saw said that the increase was relatively pretty low this year.

        • keltcrusader

          Yeah, because health insurance companies have never had premium increases over the past 20 years, raised deductibles, and/or a reduction in services. They always covered people with pre-existing conditions and allowed them to stay on plans when the got sick. And companies never dropped health insurance coverage or wouldn’t cover spouses or families and dropped kids after the age of 18. Yeah, none of that ever happened before 2010.

          Oh wait, yeah that did happen, all the time. Which is why the PPACA came into being.

        • HonestDebate1

          Assuming they didn’t just close the doors altogether.

          • Don_B1

            Then they weren’t one of those great businessmen/women who can overcome immense obstacles with leaping bounds like so many others can?

          • HonestDebate1

            That’s a great point. Obama is an immense obstacle to business.

  • Matt MC

    Excited to sign up for ObamaCare tomorrow. I will probably also lump in a dental plan. It may seem corny, but it is good to know that my society cares enough about me to not let me die in the street or go bankrupt if I get sick. Thanks, America!

    • sickofthechit

      Me too!

    • Bigtruck

      Some of society. Be well

    • fun bobby

      lucky for you its not up to me

      • Leonard Bast

        What a horrible person you must be. Read what you wrote here. If it were up to you, this guy would be without health insurance. Rotten to the core.

        • fun bobby

          no, if it were up to me he would pay his own way instead of me paying for him. why should that come out of my pocket against my will?

          • keltcrusader

            Because that is the essence of how insurance pools work. Everyone pays to keep the costs down for everyone in the pool.

          • fun bobby

            i am in the pool yet my costs are going up.

          • John_in_Amherst

            welcome to the inelastic demand world of medical inflation. Under a single-payer plan, drug and device companies and medical institutions would face much more stringent bargaining to keep rates down – like medicare succeeds in doing. The “free market” will never work in medicine, because people lack the expertise, time and options to make choices.

          • fun bobby

            single payer would be preferable to this obamacare ACA give away to those companies you mentioned
            perhaps we need an app for that. there was a law in MA at one time that consumer goods had to have price tags on them at stores. lets do that with medicine.

          • http://www.findingourdream.blogspot.com Hal Horvath

            Unless you’ve made a very high income from the American economy (composed of all the rest of us, working, your customers or customers of your customers…..), you will likely pay the same or less than you would without the new Obamacare.

            But if you do make a lot from the American economy (your customers, the rest of us….), then, yeah, us Americans on the whole have decided that those that earn the most from us should pay higher taxes than most.. Frankly, I don’t know if any nation in history has ever done otherwise, except through corruption.

          • fun bobby

            did that seem coherent when you wrote it?

          • http://www.findingourdream.blogspot.com Hal Horvath

            Ok, I’ll try again. :-)
            If you earn a lot from all of us working people (your customers), then you can expect to pay higher taxes.
            It’s been the same in every nation in all of time, except in places with strong corruption.

          • fun bobby

            I am a working person. Lol tell me more about all the times and places in history where there was no corruption.

          • http://www.findingourdream.blogspot.com Hal Horvath

            Fascinating actually to see the world rankings of nations by corruption. There are top-ranked nations, with very low corruption.

          • Karl Prahl

            Whose definition of corruption?
            Is the revolving door of wall-street, defense, and government corruption? Are lobbyists writing laws and statutes that congressional members don’t read corruption? Is executive privilege corruption? Is prolific use of States Secrets corruption? Is nepotism corruption?
            Is the use of plea deals corruption? (many nations do not allow you to cop a plea for lighter sentencing.

          • http://www.findingourdream.blogspot.com Hal Horvath

            Imo, In order:
            Various organizations, according to their listed criteria.
            Totally!
            Yes.
            No.
            No.
            Not really, but can be an avenue easily.
            No.
            All just my opinions.
            Corruption involves the usually-hidden money changing hands, whether outright kickbacks, or just giving lucrative contracts to individuals/companies in reward for various bribes/benefits.

          • Karl Prahl

            Absolutely :-) Might disagree on some particulars, but that is neither here nor there. My question then becomes: Why should any government initiation that will clearly benefit private industry (is anyone out there arguing that AHA/Obamacare will hurt insurance companies?) be allowed to move forward while there are clear violations of public trust that are not being addressed(via the revolving door and the lobbying industry)?
            Is this simply a matter of the healthcare problem is too big that we must apply a bandaid, no matter the imperfections?

          • http://www.findingourdream.blogspot.com Hal Horvath

            Great questions. But if you say there is corruption, therefore government should do nothing, then you’d move to anarchy (and that is not pleasant it turns out; see Somalia). I think you have to push on all fronts regarding government. You push to expose. You push to prosecute under existing law. You push to write new law to make illegal what should be illegal. You push on any front possible at any one moment, due to public awareness.

          • Karl Prahl

            Then I think you you need to reconsider your first and second no above: executive privilege and states secrets.
            I’d rather not get into the questions of whether it is EVER appropriate to use either, but only point out the great proliferation of their use since 9/11. One of the most common sited cased for using States Secrets privilege is the Reynolds case of 1953. This is the case sited in Sibel Edmonds and Khaled El-Masri’s cases. Yet when the files for the Reynolds case were released after the 40-odd years they were classified, it showed that there were no state secrets being covered, only government negligence with noted mechanical problems.
            If the basis of our current use of States Secrets is based off false use of the privilege, doesn’t it’s continued use have to be questioned as suspect and transparency on some level required?
            With executive privilege, why is unilateral action from one branch without regard to constitutional checks and balances not corrupt?
            All these things together, along with the cosy, old-boys network of business and politicians inside the belt-way makes the push for prosecution or changes/additions/subtractions from laws less than likely. Time will tell, but history does not bode well.

          • http://www.findingourdream.blogspot.com Hal Horvath

            Well, executive privilege *could* be corrupt (also) at times, but isn’t necessarily corrupt. We need to use accurate terms. I think I’d label it “unchecked power” or some such. And, when accurate (only!), “unconstitutional”. But that is a powerful word that should only be used accurately. The President does constitutionally have certain powers that are exceptional.

          • Karl Prahl

            Do you believe there is unchecked power in the Executive currently?
            As a few examples: Guantanamo and other Black sites. Rendition. Water-boarding and other extreme interrogation technics. Spying on U.S. citizens. Spying on U.S. elected officials. Spying on Foreign dignitaries. Lethal drone strikes against U.S. citizens and their families.
            Some of these have been “approved” by congressional national security oversight committees, but I suppose the believable and trustworthiness of those eight individuals will remain unquestioned.
            There are plenty of examples of businesses taking advantage of the American public, whether lying about tobacco affects, polluting ground-water or what have you. It happens and will continue to happen.
            There are also plenty of examples of our government making the wrong decision: trail of tears and the indian wars, ww2 internment camps, tuskeegee, MKultra/Naomi, Mcnamera’s admittance that the Gulf of Tonkin incident was staged, the Northwoods document. The patriot act?
            They COULD get this right, but when do they ever get these things right? How’s social security doing these days?

          • http://www.findingourdream.blogspot.com Hal Horvath

            I’m already against the massive inflation of the security state that acts unjustly in the name of security. But that is another topic for another day.

          • Karl Prahl

            And I suppose all I am saying is that it’s the same players when you get to the money. It’s the same influence and the same story decade after decade. Money money money before the common good. Avarice and greed glorified :-)
            But as you say, for another day

          • fun bobby

            and who is spending money lobbying for those things ?

          • fun bobby

            as long as it is a Band-Aid brand bandaid

          • Matt MC

            I also pay taxes. I just happen to be in graduate school, which means when I’m out in the workforce, I’ll probably be paying more than you do.

          • fun bobby

            that conclusion requires several assumptions

          • Matt MC

            The point is it is temporary, and with a doctorate, I should be making more than the average American. So unless you’ve inherited your wealth or own your own business, I’ll probably be paying more in taxes than you.

          • fun bobby

            that’s funny

          • Matt MC
          • Matt MC

            In yo face! Muhahahahahaaha!

          • fun bobby

            i am sure your phD is women’s studies will be quite lucrative. How long until you pay off your student loans?

          • John_in_Amherst

            If you practice (as opposed to merely profess) any sort of religion, or simply have some empathy for those who are in suffering, it would not be “against your will”, and it is good for you. Obviously, I am wasting my time…

          • hennorama

            fun bobby — there’s nothing in Matt MC’s original comment that would lead you to conclude that he is NOT going to pay for his own health insurance, and in full.

            You simply have jumped to a conclusion. Not everyone qualifies for federal tax subsidies, sir.

          • fun bobby

            his cavalier attitude in signing up and lumping in dental coverage suggested as much but is not conclusive.
            you are telling me.

  • sickofthechit

    What should have been done was a gradual transition of all Americans to Medicare. Accomplish it by gradually lowering the age at which one qualifies for Medicare. First year 63, then 60 then 58 then 55, you see the pattern. Medicare delivers the most highly rated health care (by participant polling) with the lowest overhead cost and they negotiate the lowest rates of reimbursement. All while covering (let’s be honest here) our most “difficult” and expensive population healthcare wise.

    charles a. bowsher.

  • Coastghost

    The Affordable Care Tax Act. The Affordable Care TAX Act. “The Affordable Care Tax Act”. –Truth in advertising, et cetera, et cetera, et cetera . . . .

    • disqus_fw2Bu1dEsd

      A rose is a rose is a rose

    • Yar

      We have been paying a healthcare tax all along, My local hospital collects about 25 cents on the dollar they bill. So when I pay my bill I am paying for three who don’t. Sounds like a tax to me.

      • Labropotes

        Can you support the 25% figure?

      • creaker

        That’s because the ER has to treat whoever comes in regardless of ability or intent to pay – which was a huge unfunded mandate signed and delivered by Ronald Reagan.

  • NrthOfTheBorder

    Tell me is most of the consternation over the implementation of the ACA a realization that, along with the benefits which most everyone seems to like, comes an obligation to actually pay something in return?

    How many are those crying foul are the very people who believe they are somehow above it all – and to date, have chosen to go without medical coverage?

    Are the very people confused about doing this online also be flummoxed by a PC when looking for a book at their local library?

    • Joseph Rice

      On a business forum I follow, some of the business owners have been posting disingenuous “questions” about their requirements as a way to make a political statement – when a simple google search would take less time and actually provide the information they claim “Obama and his cronies” haven’t provided.

    • TFRX

      How many are those crying foul are the very people who believe they are somehow above it all – and to date, have chosen to go without medical coverage?

      It’s promising to be another JoeThePlumberFail. Never underestimate the Fuxfluffers’ ability to overrepresent and fabricate the poster child they need, so the rest of the media can’t help but say “On the other hand…”

  • Twinkie McGovern

    Some smaller states have just a few provider options and insufficient competition. Does the ACA allow for smaller states to join forces at some future date to provide a larger customer pool which would attract more competition?

  • Coastghost

    Can hardly wait to learn just how many Americans file claims between 1 Oct and 1 Jan. Can hardly wait to learn how many such claims will be denied out of hand and how many will be settled retroactive to 1 Oct.

    • Don_B1

      1 October is the start of the six-month signup period; the coverage starts on 1 January, as you are smart enough to know.

      But there is no shame gene in your brain for your proclamation of intentional ignorance.

  • rich4321

    What really does the GOP has to go against Obamacare? It seems to me it’s an excellent option for the poor, if the GOP really cares about American people, why are the so against it? Perhaps the GOP got good bribes oh I meant political contribution from the health insurance industries crooks and scumbacks to make more money at the expense of the lives of the poor people

    • fun bobby

      what makes you thing the health insurance crooks don’t love obamacare? its their perfect bill

    • creaker

      You answered your own question when you said “it’s an excellent option for the poor” – you’re talking about a group that recently cut food stamps – in OK and KS they are taking away foodstamps from the unemployed.

      • TFRX

        Nothing motivates more than unpredictable blood sugar and not knowing where your next meal is coming from.

        Nothing is more impressive at a “dress shirt” job interview than a growling stomach.

        • Ray in VT

          But if there wasn’t the motivation of hunger, then how could I possibly get anyone to carry my divan for peanuts per day?

          • hennorama

            Ray in VT — what the? Did you cut the pay of the gittyuppity poor wretches again, from $10/day, to “peanuts per day”?

            One notices peanut prices are down 7 to 8 percent YTD, per the Farm Service Agencies of the USDA, so well done, sir.

            See:
            http://www.fsa.usda.gov/FSA/epasReports?area=home&subject=ecpa&topic=fta-pn

          • Ray in VT

            Indeed I did. I found it far more efficient simply dispense with the fiat money system and pay the help in goods. I have found that approximately 50 peanuts per day allows them to be able to carry the divan. They might want to complain, but they are contractually obligated not to speak to their betters unless they are first spoken to, and I do not feel the need to ever speak to them.

          • hennorama

            Ray in VT – One assumes those are 50 shelled peanuts, which would be about 50 grams. High energy and low mass = smart, although 50 grams is pretty much starvation level for the average adult. Of course, that seems fair, as you are a saintly job creator.

            And of course there is the self-deselecting advantage, as those with allergies are “included out”. Cuts down on the interviewing process, one imagines.

          • Ray in VT

            Well, it’s there choice to have a life threatening allergy, dontcha know. That’s just freedom, liberty, choice and personal responsibility.

            Actually I give them to them in the shells, at least for now. They’re cheaper to buy that way, and they can shell them themselves, plus they can eke out a few more calories by eating the shells. As a bonus, at least for now, they can also literally eat whatever crumbs fall from my mouth. There is no need to thank, idolize or worship me for creating these jobs, but a tax break for something would be nice. That darned Obama’s tax on the divan industry is really hurting my bottom line. I could have hired someone to hold the bunch of grapes for me if I hadn’t had to pay it. Now I have to hold my own grapes. Will the injustices never end?

          • keltcrusader

            I hope you are taking into account there are generally 2 peanuts per shell!

          • Ray in VT

            Yes, I had my bean counters take that into account. If they hadn’t then I would cut back on their pay that they get in beans.

          • hennorama

            Ray in VT — hmmm … providing sufficient daily nutrition to workers? You may get booted from the WAPLL (Well Above Poverty Line League) for such extravagance.

            While awareness of the specific DDT (Damned Democrat Tax) you cited is limited, the outrage over it is not. Clearly job creators should pay NO taxes whatsoever, especially those job creators who feed their pampered workers.

            BTW — I thought it was standard policy for workers to throw in their children’s efforts as tribute to the SJC (Saintly Job Creator). Clearly the wee ones would be handy to have as grapeholders, at least those tall and strong enough to reach the mouth of the SJC.

            Unfortunately, the government makes you provide food for them too. The horror! Will these takers NEVER be satisfied?

          • Ray in VT

            They never will be. First they want food. Then they want safe working conditions. What will be next?

          • hennorama

            Free air. It’s an outrage.

          • Ray in VT

            That’s why I make them buy Perri-Air.

    • Coastghost

      What, you mean something somewhat comparable to the way liberals and progressives abuse the poor and exploit their ignorance by foisting public education on us all? Harvard seems to be making out just fine.

      • Ray in VT

        I think that the only places where public education might be fostering ignorance is in places like Texas and Kansas, where people and groups are trying to push religion into the science curriculum.

        • TFRX

          You left out a few places, I think. TN, AL, and other states which are Value-Filled want to know what they have to do to get you to recognize them.

          • Ray in VT

            Was it in Tennessee or Kentucky that had some Core Curriculum related kerfuffle recently, with people saying that teaching science was socialism or something.

    • hennorama

      rich4321 – theorizing:

      1. Actual philosophical disagreement with the concept of providing subsidies for some individuals’ health insurance, combined with opposition to Federal tax provisions designed to pay for the subsidies.

      2. Actual philosophical disagreement with the concept of additional regulation of the health insurance and health care marketplaces

      3. Republican constituencies tend to be older and non-minority cohorts, who are more likely to already have health insurance coverage, either through employers or Medicare, and therefore are much less likely to benefit directly from Obamasurance.

      Just my $0.02.

      • rich4321

        so what about the less well off Americans who can’t afford health care? Are they suppose to left to die because they are poor?

        • hennorama

          rich4321 — please note that I didn’t indicate agreement with these ideas, I was simply answering your question “…why are the[y] so against it?”

          Simple and sincere disagreement is certainly possible, wouldn’t you agree?

  • Twinkie McGovern

    Some employers are finding that insurance company offerings have changed and they can no longer provide the same coverage to their employees that they used to, at a reasonable cost. This seems to contradict the oft-stated notion that nothing will change for people getting insurance through their employers.

    Is there any plan to address this particular problem? (The Public Option would have been a great solution to this: instant competition.)

    • Don_B1

      The insurance companies have been doing that exact same thing for the last two decades, and after initially absorbing those cost impacts, employers stopped or slowed the absorption and passed more and more on to their employees.

      This is not that new and just the passage of the PPACA could not totally change that instantaneously, like waving a magic wand.

      But the average increases in health insurance costs has been growing more slowly, particularly this year, where the premiums posted by the insurance companies for this year’s signup period are considerably lower than had been predicted by a number of groups, particularly the Congressional Budget Office.

      And I agree that the inclusion of a Public Option would have been a good thing. And in future years, that could be added to the exchanges with a relatively simple law.

      But the votes were not there in the Senate for that provision back in 2009, as exemplified by the declaration by Senator Joseph Lieberman (CT, I) that he would filibuster any law with that provision. And he was not the only one, Senator Ben Nelson (NE, D) became the 60th vote just before Senate passage.

  • sickofthechit

    Is the “subsidy” a tax credit on 2014′s income tax return or is it a direct subsidy reflected in my monthly cost? charles a. bowsher

    • Labropotes

      In VT, you have the choice of a once a year reimbursement or a direct netting out from your monthly cost. Likely, most will take the net pmts option, after subsidy.

  • creaker

    If you don’t want to sign up for Obamacare, don’t. It’s your choice. If you tweak your withholding, they can’t even get the penalty from you.

    I think people are more upset that someone else will get to take advantage of a benefit they either don’t want or need for themselves.

    • NrthOfTheBorder

      Forget Obamacare – the ACA all of it. Just turn away uninsured sick and injured from the emergency room doors – and once a few people die in the street word will get out and presto – universal coverage. Americans are such wimps.

      • fun bobby

        or maybe we will solve the problem without the help of the federal govt

        • NrthOfTheBorder

          If it could shown that the Federal government could manage universal health care at a lower cost than private enterprise would you change our convictions?

          Many Americans seem to forget that the government doesn’t need to make a profit.

          On the first question be careful how you answer. Just because it’s not seemingly feasible in the US, it is done elsewhere.

          • http://www.findingourdream.blogspot.com Hal Horvath

            Be aware that an array of made-up “facts” have been developed to try to discredit the successful and efficient health care of other nations, so that American health care is the “best.”
            One of the most plausible is the assertion that other nations’ health care systems free ride on American innovation (suggesting all the world’s health care would be stuck in 1950 or so if not for America, heh heh).
            Well, no doubt there is American innovation, and that Britain, Germany, Sweden, etc., can indeed benefit from American innovation, *as we do from theirs.*
            But that is the most plausible of the assertion (‘facts’). You will encounter outlandish assertions if you read widely enough.
            One of the most trumpeted is to take some narrow little delay of some kind in the UK or Canada, and to smear their entire health systems by implication, suggesting that particular delay represents all of their health care all the time, etc.

          • Ray in VT

            I wonder why people who say that Americans (or ‘Mericans) do it better than people in other countries don’t seem to think that we could improve on the national health care model that the rest of the industrialized world uses.

          • fun bobby

            i was about to ask what country you are comparing us to. I am all for removing insurance companies from the equation. the ACA seems to do the opposite

  • Yar

    Going to the emergency room without insurance is essentially declaring bankruptcy. It follows you for life!

  • TFRX

    “If I’m sick I can just go to an emergency room…”

    Tom, can you provide attribution for this fantasy? Can we get someone to laugh out loud at this crackpot talking point, rather than

    It’s more Galt’s Gulch moocher makers and takers talk.

    “By the way, they’re going to bill you…” says Cohn.

    Don’t bury the lead: Oh, will they ever bill you.

    The treatment of this “poor people are moochers and don’t need anything better” idea permeating right-wing taste-makers, and therefore all our Beltway talkers, is “mountain into a molehill” territory. None of them have to deal with this, so they’re suckers for any fancy talk that comes along.

    • Yar

      Then you can go to the cash advance store, and then your wages will be garnisheed. Then you will work for cash under the table and then the employer has you just where they want you in economic slavery.

      • Karl Prahl

        Are you not in economic slavery as soon as the state starts garnishing your wages?

        • Yar

          Yes, and often before, the number one cause of bankruptcy is unpaid health expenses. And this is often people who have health insurance.

    • Jo Bleaux

      I live in a very poor city, and know quite a few people who work and don’t have health care plans. When they’re sick, they wait until it’s really bad, then go to the emergency room. It’s not a fantasy. They all wish they had health coverage, which isn’t available from their mostly service industry jobs.

  • Ellen

    I think it’s a myth that young people don’t want health insurance. I have two recent college grads how have been able to stay on their father’s employee provided plan and we are all very grateful for that. Telling young people that they should play the odds, gamble with their health and financial future is incredibly bad advice.

    • Karl Prahl

      I don’t think they are taking into account the entry-level salaries or the HUGE student loan burden most young people with any expendable income have.

    • TFRX

      I don’t know that it’s a myth about young people.

      I will bet you a dollar that our insulated commercial media yaksters have this incredible idea of how easy it is to sleep at night for working-class people who don’t have anything resembling the middle-class health insurance that gets worse for many of us each year.

      Inside the Beltway, they think that life is just a goddamn spreadsheet for poor people, and that not having decent health insurance doesn’t throw a worry into every parent when their kid gets into kid-style scrapes.

      (As I type this, I’m looking at the stitches I got falling off a bike at seven.)

  • MsAbila

    J.Cohn has just said that the ‘the young, healthy people are balancing the cost’. Corporations with large profits should jump in to cover the cost of ACA! But, dream on…

    • sickofthechit

      Cover the cost with a tax on financial transactions. At least then they would be doing something worthwhile.

  • fun bobby

    I bet all the Panera employees will be excited to purchase healthcare on the exchanges

    • Karl Prahl
      • fun bobby

        so if a Walton did that for a week would you give walmart a pass?

        • Karl Prahl

          That article is damning even if you don’t notice the spin. He was forced to live on a less than nutritious diet which included none of his own companies food. He noted difficulties concentrating. He noted fatigue.
          I am saying he is being hypocritical until the wages he pays and the stipend he offered show they off-set the lose of insurance.
          He’s passing the buck in the name of profits instead of doing what’s right for his employees.

          • fun bobby

            you should have just said that. lol

    • Yar

      They might, as their wages may increase and they may get insurance cheaper with a subsidy.

      • fun bobby

        you never know. have they announced higher wages beyond the one time stipend for the exchanges?

  • Satwa

    Please point out to people, that you already have to pay heavily for the emergency room. Some people make it sound like it will be a problem under ObamaCare.

    It already is a huge problem. IT IS NOT FREE.
    As a Brit., I was shocked when a friend in Vermont told me he was billed $15,000 when he broke his ankle. He was unemployed at the time, the hospital let him pay in installments, but it was still a hard-ship. Luckily he is well employed now, and can pay the bil.
    Unless you are unemployed for the rest of your life, you WILL PAY THAT $15,000, and that can really hamper upward mobility for the unemployed.

    Tom Barlow in Vermont.

    • John_in_Amherst

      people in need of emergency care cannot participate in “free market choices”. They are at the mercy (more like lack there of) of our system. We all end up paying – for exorbitant care when we get it, for the people who lack insurance and go to the ER for care when things go “critical” and we pick up there tabs and their illnesses, and for the bankruptcies incurred by people with medical care they can’t cover.

  • NrthOfTheBorder

    The ACA is a big gov’t plan attempting to give something to everyone. It’s not perfect but how about this? a) give it time, b) work on what’s not working well and fix it?

    Once that happens you’ll be able to compare outcomes with single-payer plans – and since you’ve learned to be so flexible you’ll be able to convert the “efficiency for insurer profits trade-off” to the kinds of medical coverage enjoyed by other, more advanced, countries.

    • MrNutso

      Because if we allow a., and b., to happen, that 47% will go over 50% and Republicans will never win another election.

      • keltcrusader

        ding ding ding, and we have a winner folks!

  • MsAbila

    Single payer option is the way to cover everyone equally.

    Having to buy an insurance coverage that people don’t even know what they cover is not health care!

  • sickofthechit

    Let me give my fellow Kentuckians a bit of warning about using emergency rooms here for “free” care. I used the local Universities Dental School for what I thought would be lower cost Dental care. Each filling wound up taking a separate 3 hour appointment. The student cancelled numerous appointments at the last minute (Mondays usually). I appealed the bill, wrote my reasons and the Univ. decided there was no scintilla of forgiveness to be gotten. When I refused to pay the final $500 or so it got turned over to the Ky Dep of Revenue who promptly placed a “levy” on my bank account which wiped it out and caused three checks to bounce. Nearly three years later I am two $25 payments away from paying it off. It’s just one more reason I have an extreme dislike for Lexington’s “flagship” University. Oh, I forgot to tell you, the KY Dept of Rev added a 25% collection fee to my total. charles a. bowsher

    • fun bobby

      so have you picked care from the exchange yet? how much will it cost?

      • sickofthechit

        I’m calling tomorrow or the next day. Just worried that subsidies might be via the next years tax return. I don’t know.

        • fun bobby

          we have passed the bill and we still don’t know what is in it

          • Karl Prahl

            To much to ask that our Representatives read the damn things or that the text is published without archaic language for all.

          • fun bobby

            how would that benefit cronies?

          • Don_B1

            I understand that legislators never read the actual bill; there is a “summary with details” that is readable with explanations as to what the law will mean.

            They should make that available to all.

        • hennorama

          sickofthechit — any tax subsidies you may be eligible for are paid directly to the insurer.

          To get ready for tomorrow, start here (there’s a checklist available in #3.):

          https://www.healthcare.gov/blog/10-ways-to-get-ready-for-the-health-insurance-marketplace/

          • fun bobby

            how nice, a subsidy for individuals that goes entirely to large corporations

          • Matt MC

            Not exactly, if they make a certain percentage of profit, it goes back to the consumer in the form of a check.

          • fun bobby

            yes but why should there be any profit?

          • Matt MC

            I agree. A single payer system would be cheaper for everyone. Plus, your employer could give you more money if they didn’t have to pay for your health insurance. Also, you know, that whole thing about caring about your fellow citizens and all. ;)

          • Ray in VT

            It doesn’t really make sense to me. It seems as though some things should not be made money off of, such as health insurance, where the company has an incentive to deny or limit coverage in order to create or maximize profits. It seems to be one of the necessary perils of a private health insurance market. If you are against that, then what do you favor?

          • fun bobby

            get rid of insurance companies entirely. did you hear the recent stories about how the prices for medical procedures varies widely? if all people were paying for things out pocket things would become much cheaper. no one would pay$100 for an aspirin if it come out of their pocket.
            Alternatively the Canadian healthcare system seems to work all right. in Canada when you go to the doctor they tell you to come back in two weeks. by then you will likely be dead or better. you can also get many things that require a prescription from a pharmacist there.
            another way to fix our healthcare problems would be to ban non-organic agriculture and most processed foods. a hundred years ago people spent 16% of their income on food and 8% on healthcare. now those numbers are reversed.

          • Ray in VT

            While I think that there are benefits to getting people to think about the costs of services that they get, I think that it is somewhat limited in terms of how one can apply that in many situations, just as I think that having people pay out of pocket is also limited, given the nature of medical emergencies and the degrees to which medical situations vary. For instance, I have had a couple of friends have children born with complications that required extensive stays in the NICU. That is going to be expensive no matter what, and even if they had sold everything that they had, it would not have covered the bill. What of those situations? I think that it is also the case the if people are required to pay more up front, and they don’t have the means, then small things are more likely to fester, sometimes literally, and turn into much larger, more expensive or life threatening conditions.

            I hear generally pretty decent things regarding the Canadian system, although I have heard the knock regarding waiting times, however, they must have a way to assess and handle items that are of a more immediate nature. It is not as though if you break your leg they tell you to come back in a month to get it taken care of.

          • fun bobby

            the prices are inflated now because of the insurance. perhaps with market based prices a week in the nicu would cost the same as a week at sandals.
            in Canada they will tell you to go to the ER if you need to but your DRs Appointment will be a few weeks or you could go to a pharmacist to get your opiates. I was just thinking that one obvious solution would be to legalize drugs. if people could get their opiates cheaply without a doctor that would free a lot of resources for other things. if people could get high quality cannabis cheaply without a doctor that would free up quite a bit of resources because many peoples problems could be treated easily and safely at home. I guess in Canada the govt subsidizes medical cannabis.

          • Ray in VT

            Hooking a preemie up to tubes in an incubator for weeks with round the clock care isn’t going to be cheap no matter what, neither is something like brain or open heart surgery. Could it be made cheaper, probably, but are you going to get better net outcomes by requiring someone to hock their possessions to pay for a life saving heart surgery? I don’t think so.

          • fun bobby

            neither is hooking me up to an unlimited supply of top shelf booze, 5 star food and 2 swimming pools and removing all the seaweed from the beach daily. not to mention the price includes a very nice beachfront wedding and sailing and snorkeling and 24 hr butler service. perhaps people could put money aside tax free for medical expenses. I wish I did know how to fix it but it seems pretty clear that the profits and insurance companies are not the solution because that’s what created the problem. if it cost 1/10 as much people would not need to hock all their stuff

          • Ray in VT

            Yes, but my example keeps a baby alive and yours is leisure at a resort. For those who are what one might call “the working poor”, how is letting them set aside money tax free if most or almost all of their earnings go to pay for everyday essentials like food and housing? I just think that your solution, as well as your diagnosis as to the problem, are highly oversimplified.

          • fun bobby

            so it should necessarily cost more?
            for the purposes of debate simplification is needed. I am just postulating alternatives to this debacle that both I and jefe agree is a failure.

          • Ray in VT

            I was contrasting the necessity of one versus the other, not the price. What is worth more, saving a life or sunning on a beach. I would say that the former is rather inherently worth more, but worth and cost need not correlate, although they may.

          • fun bobby

            I was just saying that the level of care at sandals is better yet it costs less. makes me think we are getting ripped off by the cost of the nicu. worth is a different discussion

          • 1Brett1

            I have friends in Canada…those “waiting” lists do get prioritized. If you need to have your allergy-related asthma meds re-evaluated, you might wait for six months. Someone who has just had an emergency, say, a heart attack, and needs an angioplasty and stent, they go to the head of the line, so to speak. This all makes sense to me.

          • http://www.findingourdream.blogspot.com Hal Horvath

            Really the solution is exactly to use the profit motive to improve health care *and* drive down costs! I describe exactly how on my blog, using “Pay for outcome”.

          • sickofthechit

            Limited to 20%. Medicare expense ratio is 10 to 11%! That’s why we need universal Health or at least universal Wellness care for all. It’s cheaper in the long run and fairer.

          • hennorama

            fun bobby — it goes to pay for private health insurance. That’s how Obamasurance works.

          • fun bobby

            yes it should be really great for private corporations

          • hennorama

            fun bobby – it MAY BE “really great for private corporations,” and it may not be. Insurance is a very tricky business, and there are plenty of, as Donald Rumsfeld would say, “known unknowns (KU).” The largest of the KU is who will actually sign up. Will there be a good cross-section of the populace, including younger healthier persons?

            There is also the factor of pent up demand for health care from those who haven’t had health insurance for some time. This means that claims in the first year will likely be higher than one would otherwise expect.

            Of course, the insurers have taken this into account in their underwriting calculations to determine their rates.

          • fun bobby

            …so they can make a healthy profit

    • jefe68

      You should have payed the bill.
      Dental care is not covered in this law.
      It should be, My dentist charges me about $200 per hour. I have to save up for about 6 months to afford a crown. Which I’m doing now. I know what it cost to make a crown, at the high end it’s about $80.
      The dentist charges $1500 for two appointments that total about an hour and 45 minutes. He has overhead and staff, but I figured out he makes over $200 an hour on my crown. Not bad.

      Lets be straight here. Our entire health care system is dysfunctional and failing and the ACA will not stop that from happening. We are a nation of fools in my view as we do not have what it takes for making serious changes in our awful health care system. Until lobbing is curtailed and special interest are told that they no longer call the shots, nothing will be done and people will still go bankrupt from medical bills.

      The GOP does not have plan other than opposing anything the Democrats put on the table.

      • fun bobby

        thank god i am not paying for you to have overpriced dental care. my guy is much more reasonable.

        • jefe68

          I’m looking for a more reasonable dentist.
          By the way you’re already subsidizing other people. Do you have dental insurance? If you do your’e paying for other people.

          What is with the selfishness of right wingers? You don’t live in your own little private world. You live in a society and that means there will be costs to help run it.

          • Karl Prahl

            So why don’t you get Corporate America, the entities that don’t have to eat or be sheltered, to pay for it? Why not go after the guilty LIBOR parties?
            Why not end the war(s)? That’s a lot o cash waiting to be used.
            How much has Apple paid in taxes over the past half decade?
            You’re trying to rob Peter to pay Paul. Justify it however you will.

          • fun bobby

            for a while i paid out of pocket. i was also unemployed so he gave me a free cleaning once and did a filling for like $50. come out to Worcester we have plenty of great dentists who do not have to pay Boston rents. Jefe you and i agree the affordable care act has made our care less affordable so why the name calling and ire?

      • Matt MC

        Actually, you’re misinformed. You can get dental coverage on the plan. I already checked.

  • TFRX

    Nomenclature alert: Tom, polling calling it the ACA comes up with better numbers than calling it Obamacare.

    You could mention that fact anytime you play a clip of some gobstopper calling it Obamacare and how it’ll be the ruin of us all.

    • MrNutso

      But ranting about keep government hands off my ACA, or the guy in Kentucky saying I hope this is better than the ACA” doesn’t have the same ring to it as Obamacare.

      • TFRX

        Don’t worry, if history holds, the “Keep government out of my Medicare” fools are about two decades away from making their “Keep the government out of my Obamacare” signs.

        • fun bobby

          maybe, but we don’t know what the impacts of obamacare will be

    • Coastghost

      But Obama consented to calling it “Obamacare” and seems quite proud of the appellation . . . so far.

      • TFRX

        Yeah, so?

        Point me to where the NPR rulebook says “take no stance, reiterate no fact, use no phrase leftwards of a Democratic president”.

        • Coastghost

          –but just think of all the objections that would ensue were we to call it “socialized medicine”.

          • Ray in VT

            Considering that it is not, then the objection would be that it is not factually accurate.

          • TFRX

            Hey, when someone who isn’t named Bernie Sanders gets single-payer for an up or down vote, let me know.

    • creaker

      It’s Romneycare – and basically the same plan the Republicans presented as their alternative to the Clinton healthcare initiative under the auspice of “personal responsibility”.

      • WorriedfortheCountry

        Sorry that is pure spin.

        In fact, in MA the small business administration is suing the Feds because Obamacare is killing them. They had no problem with Romneycare.

    • brettearle

      Which truly points out the overt and covert nature of how words/symbols affect public thinking and opinion.

      • TFRX

        But when it comes to today’s mediascape, the words and symbols are tilted towards the right.

        No matter what NPR does, purposely or reflexively, it’ll be cast as “EvenTheLiberalNPR”, and it will wonder, like a beaten spouse, why all the apologies don’t stop the abuse.

        • brettearle

          Yeah, agreed.

          But ya gotta admit, the President didn’t help his cause,

          • TFRX

            I’m half with you on that.

            Go back to my “Johnny Most calling a Celtics game” meme about what a Democrat has to do to not just be lied about outright, and a bunch of wimps like Upchuck Todd saying “It’s not our job to tell the difference between lies about the ACA and truths”.

          • brettearle

            I knew Most’s work fairly well:

            Are you referring to an analogy of how the refs disfavored the Celtics because of their physical play and because they were perennial champs….and Most had to intersperse his rhetorical flourishes to compensate?

            Todd’s comment was a copout, I agree.

            Basically it’s a rationale for journalistic apathy.

          • Ray in VT

            Well, they have to present at least two equal sides, because if they portray crackpots as such, then they would be biased.

          • brettearle

            Don’t know if your comment is tongue-in-cheek.

            If your comment is as cynical and satirical as I think it is, then I salute your point, even more:

            Exposing a crackpot as a crackpot–if specifically and concretely proven–can withstand propaganda…IF you’re willing to dwell on it enough to pound the truthful message home.

          • Ray in VT

            Yes. It was very much tongue in cheek. I find the persistence of belief in things such as “the historical non-occurence of the Holocaust” and other such amazingly false things to be almost endlessly fascinating as a topic to examine, although I cannot for the life of me understand why such things continue to have legs.

          • brettearle

            Wish I could mention some things to you about the Holocaust matter, that are DIRECTLY germane to events on this Forum.

            But we don’t have the benefit of private messages here…..

            This kind of malicious Disinformation continues to have legs–as I know you know, so I am simply underscoring it here, by mentioning it–because the stress of modern global political conflict bring out acerbic shibboleths that carry political, cultural, and racial biases:

            The Holocaust issue, of course, is nothing more than blatant anti-Semitism–which is noticeably different than criticizing Israel.

            Problem is, it is still `theoretically’ possible to criticize Israel, fairly…..

            But from what prism do you judge the comment?

            The culture of Political Correctness and the Voices of Prejudice clash, here, in an irreconcilable way.

          • Ray in VT

            I was just talking to a secular Jewish friend of mine about Holocaust denial, and he was curious if it was just blatant anti-Semitism. I am inclined to think that it is, although some may not admit it. It is a curious phenomenon.

            Sometimes it can be tough to discern what underlies someone’s comments. One can certainly think that Israel’s settlement policy is wrong without disliking the Jews as a religious or ethnic group, but someone with such prejudices can also make those same challenges.

            I generally like the “call a spade a spade” approach, although it may sometimes not do for polite conversation or certain environments. My boss sometimes laments that it is no longer acceptable to tell people when they’re being incredibly stupid, and he sees the false equivalency that takes place at times in the median environment as being a part of that.

            Did you see my other message?

          • 1Brett1

            This is kind of what I was referring to in an earlier thread about humor; essentially, it is difficult to tell what people specifically are laughing at when they find something funny.

            I might laugh at some humor that is off color for the purposes of mocking bigotry; a bigot might laugh at the same humor because of the surface part of the humor, the part that is present without interpreting the humor with its intended ironic/sarcastic/satirical quality.

            Regarding Israel and anti-Semitism, I’ve been accused of being anti-Semitic because I have expressed concern about Israel’s continued expansion of their settlements. It is difficult to defend oneself in such a situation, as saying one is NOT anti-Semitic is not enough; there are many who ARE actually anti-Semitic and denounce the settlements, and the one issue is just part of their extended list of reasons to hate Jews.

          • brettearle

            I wrote a reply to you that was clearly non-controversial–and yet I was blocked from posting it…..twice…

            ….unless it was a series of coincidental glitches

          • 1Brett1

            That’s been happening to me, as well. I know it’s not the content that gets the moderation approval stamp, as it were (and often that comment never does get “approved” and disappears altogether!). I think OP’s “moderator” algorithm is glitchy and blocks comments where words that are close to questionable words also set off sirens, but I don’t know. It’s damned annoying, I know that!

          • brettearle

            Brett–

            They published it.

            It’s a few comments above.

          • 1Brett1

            I’m not seeing it…I have a student coming so I’ll have to check it out later! I’ll look for it.

          • brettearle

            I changed a word or deleted a word–so they put in under moderation again.

            I’m being insistence in trying to catch your ear, on this one–because my comments will, hopefully, interest you.

          • 1Brett1

            Oh, man…Yeah, that is what they do; they approve it and post it. Then, if you try to edit it, they throw it back into moderation mode and you won’t be able to see it until the next day. Disqus sucks’ let’s face it! Their recent round of “improvements” seemed to solve two problems and create three more!

            Hopefully, I’ll see it tomorrow.

          • brettearle

            Thanks, Brett….

          • brettearle

            Unless it’s an Hallucination, it’s now there….

            [It's not such a big deal; at this point, I'm blowing my comments' significance out of proportion.]

            Thanks.

          • brettearle

            Disqus

          • brettearle

            Brett–

            As a Jew–especially one who deplores Israel’s position on
            Settlements but who also supports Israel–I strongly support your outspoken
            positions on Middle East issues.

            Anyone that I have confronted, here, on this Forum have exposed their true sentiments–either by their silence or by their further words, upon my prodding.

            And, without details that I cannot go into, here–I can assure you that I have been quite successful.

            Two things:

            If a person is not anti-Semitic, he might be able to defend his/her position as to why he/she is NOT.

            However, it DOESN’T mean that person is prejudiced, simply because that person can’t convince me with his/her words.

            But, almost as importantly, I am able to–and I think many
            people OUGHT to be able to–overlook or dismiss some jokes about some (not all) stereotypes that go across cultural/ethnic/religious lines.

            As a writer, I make up Jewish jokes, sometimes–and people tell me to go join the self-loathing club of Larry David and Woody Allen.

            As a writer, too, I think it is important to not let political correctness get out of control.

            However, it can often be a fine dance to ward off the self-righteous Thought Police who lurk, everywhere.

            And, truth be told, sometimes I become the Thought Police, when I feel it, appropriate.

          • brettearle

            Point me to your other messages.

            I’m a Jew and I deplore Bibi’s position on the Settlements.

            It’s as destructive, as any other problem in the Peace Talks.

            I would (sincerely) like to know what your friend thinks could be another reason for the Denial.

            I suppose it’s possible that a small number of scholarly historians might have a research incentive–one that is pristine–to look at Jewish bias coming from the other side:

            That is, distort the history (perhaps unconsciously?) to favor higher numbers–so as to increase support and to champion the cause/future security of Judaism and Israel.

          • Ray in VT

            I tried to do a message on another day’s page to see if you would see it. Do you get notifications for replies via email? I do, but I don’t know how your have things set up.

          • Ray in VT

            I think that he sees no other real alternative explanation other than anti-Semitism. I’m reading a book on it, so I could always pass along the conclusions of the authors.

            One could possibly have the sorts of figure inflation that you suggest. The numbers overall have been pretty stable over the years, although the Auschwitz numbers went down while numbers from other cites went up, and it’s pretty much been a wash. The tactic seems to be to either suggest some sort of conspiracy or to try to pick apart very minor details in order to suggest such numbers inflation.

          • brettearle

            I believe decades, ago, there was a fusion of casualties with other ethnic groups: Polish Catholics, Gypsies, etc.

            So we may have seen, before, vacillating numbers. Bur, for a while now, I think they’ve been reasonably steady.

            I’d have to check on that.

            The Holocaust–in the Imagination of the Public–even though there have been genocides since–has been, in my view, one very big deterrent that helps to discourage WWIII.

            What book are you reading? And do you know the book, CONSTANTINE’S SWORD?

            When Disqus was ?revamped?, they stopped sending me Emails.

            I haven’t forced myself to inquire as to how to recover the Email service.

            Point me to the program and I can find it by scrolling down.

          • Ray in VT

            It was here, but I edited the comment out. Do you just see whatever you happen to encounter? I admit that that has its advantages.

            I am familiar with Constantine’s Sword, although I haven’t read it. I am reading Denying History by Michael Shermer and others. They actually read the denial “literature” and talked to the deniers as part of an attempt to thoroughly understand and debunk their arguments.

            The main breakdown in rough casualty figures that I have seen is 6 million Jews and 6 million for all others combined (socialists, communists, homosexuals, gypies, etc.) across some 40,000 sites.

          • brettearle

            It is vexing, indeed –when one thinks about it–that the non-Jewish millions haven’t been emphasized enough.

            Indeed, not to do so, is to underestimate the enormity of the Egregious Crime Against Humanity.

            And, somehow, I wonder whether Hitler actually knew the estimated numbers of those slaughtered, in any case–from all ethnic groups and classifications of people.

            It seems to me that, in the broad conveyance of Evil, the contagion can easily go far beyond the vision of its Pregenitors.

            Do you see my point?

          • Ray in VT

            I think that it is unfortunate that the other millions do get a bit lost in the shuffle so to speak, as the Nazis had many lives that they considered unworthy of life. Just think about the possibilities if they had won, though. Slavs, all Semites (such as Arabs) and Africans would likely have met a similar end as those other millions.

            I can see how such a horrible world view and ideology has lived on, although in a much reduced way, and how it continues to spread its hatred and lies down to this very day. Is that what you are getting at?

          • brettearle

            Indirectly I was.

            Although, your point takes it further in, frankly, a more significant way.

            Evil and Hatred–these 2 words, of course, often lose their impact because they are being used over and over again (no surprise, there, that they have to be used so often, these days)–find opportunistic homes, in so many places, across the Planet.

            In the case of the Third Reich, one has to be cognizant of, “Hitler’s Willing Executioners”–although I am likely using this term a bit differently, than it was used by its author, Goldhagen.

            I guess I am reminded of Ralph Fiennes’ (my favorite living actor) character in “Schindler” who was gratuitous, almost unconsciously so, in his spontaneous sprees of murderous violence.

            The men of the Third Reich took on their own capacity for Evil–after taking direct cues from the Fuhrer and his close Henchmen.

            A Pernicious Virus, in any culture, will usually go out of control and take on a life of its own that wasn’t totally envisioned, in the first place.

          • 1Brett1

            Interesting…I would bet money that some within the Gestapo did actually distort Hitler’s orders/twisted philosophy even further to fulfill their own sadistic fantasies or their own capacity for evil. At points, it must’ve been like a sadist’s/psychopath’s playground. But, it is an interesting question. Hitler himself, I believe, descended into his own madness and his brain sort of caved in on itself (my opinion).

            Some say he suffered from the long-term effects of syphilis. I don’t know about that, but it was common. Some also say he was addicted to opiates; others say he was given methamphetamine everyday. Still others say cocaine. I wouldn’t be surprised at any of them. He suffered from a lot of illnesses; some complaints were verified, and legitimate problems, others were in the realm of neurotic psychosomatic conditions. Essentially, he was a mess who was exceedingly paranoid and had the power to give his madness (whatever its etiology) its full measure.

            My mother had a friend, years ago, who was a teenager in Germany during the Third Reich. You would be amazed at how she talked. I remember my mother criticizing the German people to her for remaining too passive (another topic for another forum, perhaps), and the woman began with the jaw-dropping preface, “but you don’t understand, they [Jews] were taking our jobs, our industries, our housing…” I couldn’t believe it.

            While I believe some Germans were unaware of the extent to which Jews were treated, I believe average Germans were seeing Jews removed from their homes and businesses and carted off, which was bad enough in its own right. What would we as citizens in the US do? We did watch as Japanese people were carted off to internment camps.

          • brettearle

            There are so many issues that you raise.

            One indirect way to attack this is to bring up something that appears, tragically, almost like a stale cliche; that feels remote; that remains an open wound, and yet is suffering from denial; that the world, and our country, have tossed a tarpaulin over; and wherein we can conjure many reasons for why it wasn’t prevented:

            Rawanda.

            If we were to interview President Clinton, privately, he might tell us many things, that we don’t know, that might seem convincing–as to why we couldn’t intervene.

            Nevertheless, the Atrocity speaks for itself…..

            The distorted remarks by your mother’s friend reminds me, in a kind of banal* and trivial way, of the Pathetic Right Wing Propaganda towards “The New York Times”.

            When I hear that kind of rhetorical malignancy, I feel like I should pick up the mantel of Howard Zinn, or Elie Weisel, or Noam Chomsky–for the rest of my life.

            Why?

            Well, you and I know the answer.

            Because 20 years from now, if our society continues to navigate in the direction that we are headed….

            …..there are going to be many more men and women who are going to feel the way your mother’s friend felt–not necessarily about Jews, but about all sorts of groups who are ripe to be scapegoated.

            If you could review the events in, say, “The Boston Herald”, after 9/11, you would hear how the city of Boston was in near panic.

            We heard reports–here, in Boston, for weeks, thereafter–about how men and women were going to firing ranges, anticipating civil unrest.

            I, myself, and my girl friend, encountered direct incidents of near-paranoia–and certainly excessive anxiety.

            The United States has no memory of war and war’s adversity on its own soil.

            THAT’S why OBL, in my view, supposedly claimed that America was “vulnerable”.

            That’s why, indirectly, a certain chunk of the population believes that a prolonged version of WWIII has already begun.

            The Spectre of Hitler needs to be studied, even more.

            The Phenomenon is a confounding moment that violates our basic tenets of Faith–regardless of whether we are believers in God or whether we are agnostics or atheists:

            We had an Evil Genius, of great oratorical and political skills, who emerged, opportunistically, at a time when a country was unearthly VULNERABLE.

            What an ugly synchronistic moment for the personification of the HIV virus to strike a country!!!!

            Why?

            The kind of Rage and Fear and Anger were ladled up into a thick sludge of contagion….

            and it fed and NOURISHED the dark impulses of people like your mother’s friend.

            That’s why Pol Pot, that’s why Milosevic, that’s WHY….

            * “The Banality of Evil”

          • Ray in VT

            I do think that evil and hate get thrown around too much. My son will say that he hates something, and I chastise him, telling him that he doesn’t know what real hatred is. There have been times that I have felt such a terrible hate for someone, and it is an ugly thing. At the same time I also felt it to be a somewhat intoxicating, empowering and clarifying feeling, which made it all the scarier once the rage in the pit of my stomach cooler off a bit.

            I dislike how much Hitler and Nazi references get thrown around. I think that it disrespects/downplays the true and real evil that they perpetrated.

            What is scary, I think, about the Nazi regime, is how quickly German society degenerated to that level and how so many “ordinary men” became “Hitler’s willing executioners”. I think that it says some very dark things about humans.

            I think that there crimes were terrible, although not totally far outside of the realm or humanity’s inhumanity to man, although I do think that they set a new bar for depravity and cold-bloodedness.

  • sickofthechit

    Do me, do me! Household of one . $18,000 in income

    • fun bobby

      do you live in MA?

      • sickofthechit

        Kentucky, Love it, but sometimes loathe it!

        • fun bobby

          is that counting your shine revenue or just what’s on the books? you could move to MA and make more money and always hate it

  • lmmaloney

    9.5% of income? Is that gross or net? And what if the employer covers the employee, but adding the rest of the family would cost more than 9.5% (gross or net?)

  • MrNutso

    I think Your car insurance should cover a lot of medical bills associated with an accident.

    • TFRX

      Alls I knows is that if I call my doctor’s office, about the first thing out of their mouth is “Did you get hurt in a car accident”. It really matters to them, so I guess your supposition holds.

      (Never been hurt in a car crash. And it’s not on my bucket list.)

    • sickofthechit

      PIP (Personal Injury Protection) in our state is a minimum $10,000 cover. They want to know if it is auto related because their reimbursement levels are vastly different as is all their documentation protocols and the very real fact that your health insurer doesn’t want to pay for your auto injuries.

  • Coastghost

    How long will the provision last that permits young adults coverage (to age 25 or 26, right?) under parents’/parent’s health plan last? This provision provides all the disincentive millennials will need to defer enrollment, which helps assure the arrival of the Affordable Care Tax Act death spiral within five or ten years: without under-30 participation, the ACTA dies the death it deserves, no?

    • sickofthechit

      How does a provision that only covers up to 26 preclude 27, 28 and 29 year olds from participating?

      • Coastghost

        One concept, one word: “momentum”.

  • scrabble12

    why have so many doctors and hospitals opted out of participating in the affordable healthcare act? was there a campaign to discourage them from participating? are they compensated at a much lower rate? what? why is no one really mentioning this issue. the state I’m from there are whole counties where there are no doctors or hospitals that are participating….

  • creaker

    One thing that does not get mentioned and is so important in this day and age – if you get laid off, you will have the opportunity to update your income information and get your family on a covered plan, as opposed to going without or paying outrageous prices under COBRA, as so many do now.

    • sickofthechit

      The “outrageous prices” under COBRA are actually only 103% of what you and your employer were paying in total. So that means 3% over former cost. Most people don’t realize how much their employers are paying on their behalf.

      • hennorama

        sickofthechit — actually, many employers send an annual letter to employees detailing the cost of various benefits, including and especially the cost of employer-provided health insurance.

        This lets the employee know the total actual compensation from the employer, regardless of whether it shows up in the employee’s paycheck.

        I’ve largely been out of the employment business for some time, but I ALWAYS use health insurance benefits to attract and retain employees, and always keep employees informed about the value of the benefits provided.

        This has been/is universally appreciated.

  • Karl Prahl

    If you don’t have a social security number or other state issued id number, do you have to comply with this statute/mandate? Does utilizing IRS form 521 and not getting a state issued ID mean you can opt out?

  • WorriedfortheCountry

    The BUR fundraisers a really a piece of work.

    “We love that all the guests are pushing the ACA”

    Duh, they are supporters posing as objective journOlists.

    • TFRX

      Ooh, Journolist–snap!

      You’re playing against a small, more knowledgeable crowd that knows better about your lame “burn”. Stick to the ACORN crap–no more true, but at least wider spread.

  • 65noname

    these so-called experts use terms such as it might be “a little hard” or working people might have to “tuck a few corners” to afford these plans in order to afford the $150-$250 or so a month that they will have to pay (and lets not forget the co-pays that these guys simply blow off as benig “small”) How about getting real experts who can present actual numbers and amounts and who quantify what “as little” and “a small amount” mean in terms of a family living on 20,000 to 50,000 a year. And what they actually have left after they pay food, rent, school expenses, travel to work expenses, auto insurance, etc.
    But that would require government radio to do real reporting and to get actual real reporters.

  • Coastghost

    The Affordable Care Tax Act, the “Affordable” Care Tax Act, the Affordable “Care” Tax Act . . . .

  • sickofthechit

    The caller has a Cadilac plan” is why he is being “taxed”

    • http://argonnechronicles.blogspot.com/ Dee

      And a really cheap Cadillac plan at that! I wish my Nova plan were that cheap!

      • Karl Prahl

        You should demand the same, the same coverage all those congressional aides are getting.

      • sickofthechit

        Really! he’s bitching?

    • WorriedfortheCountry

      Who defines what is “Cadillac”?

      • sickofthechit

        It has to do with the level of benefits recvd as compared to other plans. I’m not sure who determines it.

        • Karl Prahl

          Hint: Lobbyists for the Insurance industry.

      • fun bobby

        our Dear Leader and his friends

  • jefe68

    I was just looking at the web site and the Silver plan, which I think I can afford still has a deductible of $5200 per year.
    I now have a plan that I buy on the Mass Health Connector that cost me $3000 per year with affordable copays.

    So from what I see here I will pay about the same premium but my out of pocket cost go up by $5200.

    Sorry, but in my view the ACA while it does have some good things it does nothing to fix the huge mess our health care system is. Single payer is the only way to go.

    • Karl Prahl

      Our insurance companies cannot be trusted to give everyone coverage or to keep deductibles/coverage in check.
      Therefore we will empower them to insure everyone in America and mandate all citizens give these companies money.
      Huh?!

      • fun bobby

        who better to solve the problem than those who created it?

      • http://www.findingourdream.blogspot.com Hal Horvath

        Sounds like you are advocating for “single payer” (similar to Medicare)?

        • Karl Prahl

          Not at all. Townships, counties and cities can set up exchanges as they see fit. States can offer single-payer healthcare if they want.
          There are a thousand answers for a million different circumstances dealing with healthcare in America.
          This one size fits all thing is bogus. It’s relying on bureaucracy to fix what our communities should be responsible for. If our government had a better track record for fiscal responsibility then maybe I’d be less adverse, but they are anything but responsible.
          This may work for some. I am truly hopeful for anyone able to get needed healthcare because of this law. That doesn’t change this whole Hegelian situation: Problem-reaction-solution. It sure looks like the same players on all levels. Cost of care (wallstreet), cost of insurance (wallstreet), political will (wallstreet).

    • sickofthechit

      I think you need to do more research. I thought the bronze plan has a $3,000 or $4,000 deductible.

    • fun bobby

      so then you are for repeal or delay of the ACA?

  • dawoada

    What about the deductibles? I understand they will be thousands of dollars, i.e. before anything gets paid by obamacare these thousands must be paid out of pocket (unless subsidized).

    Lets face it: Healthcare is not affordable for most people unless someone else is paying for it (through taxes).

  • creaker

    I expect Obamacare has become the scapegoat for a lot of employer “cost-saving” (which just coincidentally coincides with increasing profits) decisions.

    • brettearle

      Couldn’t agree more.

      It’s easy to hide behind a cover that is laden with propagandistic beancounters who use controversy to conceal their true motives.

    • sickofthechit

      Spot on. Just another indicator of how eaten up many of us are with selfish greed.

    • hennorama

      creaker — it’s the same as when clothing retailers underperform — they blame the weather.

    • John_in_Amherst

      for about 15 minutes of fact-checked facts on why we pay so much for health care, all crammed into 7 minutes of video: http://www.upworthy.com/his-first-4-sentences-are-interesting-the-5th-blew-my-mind-and-made-me-a-little-sick-2?c=la3.
      the ACA addresses some (but not all) of these problems. so instead of complimenting (as in correcting through addition) the solutions that are in there, the GOP prefers to get rid of everything?

    • Potter

      Fine. We are on our way to single payer.

  • drwacker

    I have mixed feelings about the Affordable Care law. I hate the idea that I’m forced to support a for-profit insurance company which will surely find ways to line their own pockets at our (all of us including the government) expense. (don’t kid yourself — these guys WILL find a way to continue to make billions). On the other hand, my family may benefit greatly from this: I have been paying $1600 per month for the last five years to maintain a decent level of coverage for my family. Because our total income is less than $60.000, we would surely qualify for subsidies. I pray this thing will work.

    • Jo Bleaux

      Yes. It’s time for single-payer.

      • drwacker

        Yeah, I’ve been hoping but Congress just can’t see the wisdom of it. Why can’t we just implement a tax for health care similar to SS? if we each paid something like 6.5^ and the employer paid 6.5%, (and Congress isn’t allowed to play with those funds to cover some other area besides health care) we could all be covered without so much angst. Besides, there is precedence in the SS model.

        • Jo Bleaux

          I think it would allow for much more entrepreneurism. But, it would also cut into the profits of entrenched industries (insurance, pharma, etc.)

    • Labropotes

      Wow, that’s 35% of your income post SSI/Medicare taxes. That is true suffering, friend.

    • sickofthechit

      The insurance companies are limited to 20% overhead. Any excess has to be refunded to the customers. Still a far cry from Medicares 10-11% overhead cost all while covering our most “difficult” population. I say “difficult” because they are actuarially higher users of coverage with more involved maladies. I love old people.

    • http://www.findingourdream.blogspot.com Hal Horvath

      Actually (!) there is a limit in the law about how much profit insurers can make (!)….it is the requirement for the minimum payout ratio (aka loss ratio, aka…etc.). The % of premiums that must be paid out for care, or returned to policy holders.
      ah, I see sickofthechit also addresses this below.

      • hennorama

        drwacker, Hal Horvath, sickofthechit et al — Apologies in advance for repeating this comment from a few days ago:

        There can be a perverse disincentive for medical care cost containment for health insurers. They are now required, in effect, to spend 80% of the premiums they charge on medical care for their clients. Insurers call medical costs “losses,” and use the term “medical loss ratio” (MLR) when they talk about the percent of premiums spent on health care.

        Here’s what I mean – let’s says an insurer charges its clients a total of $100 million in premiums. If their MLR is 80%, they get to keep a maximum of $20 million for administrative expenses and profit.

        Let’s say their clients’ medical care costs are actually $77 million. This is an MLR of 77% and means that the insurer would need to refund $3 million to its clients. Trust me, this is the LAST thing insurers want to do.

        The insurer may instead be tempted to overpay medical claims by $3 million rather than give it back to clients.

        Why? For a couple of reasons:

        1. Regulators would look a bit harder at any future proposed premium increases, since the company now has a history of a 77% MLR.

        2. The $77 million spent on medical care would justify premiums of only $96.25 million, leaving a max of $19.25 million for admin. and profit. If the insurer instead paid out $80 million (an MLR of 80%) they would be allowed $20 million for administrative expenses and profit, and the vast majority of the $750,000 difference would go profits.

        According to TIME, prior to the passage of the ACA, a CBO report “…said insurers might react to new thresholds by “cutting back on efforts to restrain benefit costs through care management.” Translation: Anything that doesn’t count as “medical costs” may be on the chopping block, including exorbitant executive salaries but also programs to keep patients healthy. There is also a fear among health policy experts that some insurers could raise premiums in reaction — higher premiums means more money spent on health care, but also more left over for profits. Another unintentional consequence might be insurers overpaying for some health services to keep their MLR averages high.”

        This will be something to watch as the PPACA is fully implemented.

        Sources:
        http://www.time.com/time/nation/article/0,8599,1949390,00.html

        http://www.americanbar.org/newsletter/publications/aba_health_esource_home/Stein.html#_ftn21

        • http://www.findingourdream.blogspot.com Hal Horvath

          Right. It is interesting to read someone that has progressed to this level of detail also :-). The loss ratio requirement actually discourages insurers from negotiating better prices once they have an adequate market share (think BCBS in many states), since that would cut their own profits also (which are limited to that 1/4th of payouts!). This is one of the reasons I realized back in 2009 a fundamentally new structure was needed in payment, and proposed what I call “pay for outcome” (on my blog). Bundling is an initial step in this direction. By speeding up innovation, the entire marketplace becomes more competitive, and then the disincentive is less sticky.

      • Karl Prahl

        If they give a bonus to their executive officers, does that count as payroll and not go against profits? What if hospitals do this to raise overall cost of service?

  • Yar

    Family of 4 at 23,000 would get expanded Medicaid in Kentucky.

    • Karl Prahl

      What about 25,500? Seems arbitrary

      • Yar

        Expanded Medicaid covers up to 138 % of poverty level, and ACA provides subsides up to 400 percent of the poverty level. More importantly Medicaid did away with the limited asset requirement. It used to require a person to spend down to less than 2,500 dollars in total assets before they were eligible.

    • MrNutso

      Unfortunately, it’s a state by state crap shoot.

  • toc1234

    if there’s no big tax on plans, then why are unions ticked off about the ACA?

    • Karl Prahl

      Because companies are using the threat of healthcare cost increases to pass off more and more of the costs onto the union members.

    • MrNutso

      There’s a tax on the top of the line plans, which many unions have. I know working with union and non-union public employees, they feel they accept lower wages than the private sector in exchange for better and less costly health insurance.

  • TFRX

    Cohn is good with his info, but he should stop burying the lead.

    We’re increasing your premiums by $40 a month and Obamacare is the reason is basically a lie that companies tell people.”

    Tom, perhaps another hour should be held on the right’s disinformation “saturation bombing” campaign about healthcare costs, and Obamacare in particular.

  • MrStang

    We will pay for healthcare in the US no matter what.

    We can pay now and more people in the country will be healthier and the overall cost of healthcare will decrease, or you can pay later with continued rising health costs and vast suffering and penury.

    • WorriedfortheCountry

      Oh if it were only true.

      What we need are systemic reforms for increased competition along with increased transparency on costs and quality of medical care.

      • MrStang

        The ACA is a systemic reform for increased competition along with increased transparency on costs and quality of medical care. It is not perfect. The most important competitor (the US) has been hobbled by private sector machinations. A charitable reading of the literature and press regarding these issues would tell you that.

    • MsAbila

      Healthcare is monetized in the US to such an extent that the cost of insurance & health care services can only increase and will increase. There are lucky minority groups who are covered under good insurance plans (Congress, some large companies, wealthy who can afford high premium insurance plans), but the rest of society just goes shopping (as usual) for health care plans and hopes to be covered for various services.

      Also, buying health insurance IS NOT a guarantee that people will be healthier.

  • Coastghost

    Money is NEVER free, but if you think so, Mr. Cohn, I’ll be glad to give you a call sometime.

  • nlpnt

    -Frankly, I’d rather have an insulated bureaucrat making decisions on what my health insurance will pay for than someone with a duty to maximize shareholder value.

    -The one thing I’d like is the option of coverage that runs by the fiscal rather than the calendar year, July 1-June 31 instead of Jan 1-Dec 31. The last few times I’ve gotten sick it’s been around the end of the year…

    • http://www.findingourdream.blogspot.com Hal Horvath

      Exactly, but I’m sorry to say that your first paragraph is going to be obscure to most questioning “obamacare.”
      I say it more plainly:
      We’ve always had “death panels” — they were in your insurer, a group inside your insurance company deciding what to cover and what not to cover, hidden from you. Now we can have a public panel with open proceedings staffed not by accountants, but instead by doctors and other experts that won’t get a bonus for denying you care.

      • sickofthechit

        My mother and father lived to be in their late 80′s. When my mother had her stroke we set up an appointment with what is called a Palliative care physician who advised us on the various options for end of life care. Would we use a feeding tube if she wasn’t able to be rehab’d enough to chew and swallow safely? There were numerous issues which had to be decided on. Did we intend for her to be a “Do not Resuscitate” patient at the nursing home? etc, etc. This is the type of care that Repugnicans (copyright charles a. bowsher 2009) cynically deemed “Death Panels”. Shame on you for perpetuating that lie. charles a. bowsher

        • http://www.findingourdream.blogspot.com Hal Horvath

          Right, terms like “death panels” were meant to smear and obscure. The smear was broad enough to encompass everything for a while.

        • 1Brett1

          And, from what I understand, the only issue regarding end-of-life counseling as it applies to “Obamacare” is that now those counseling sessions will be covered under insurance plans. Prior to the ACA, those counseling services were not covered with private insurance, nor with Medicare…it has been amazing to me that the propaganda about “death panels” has even gotten any traction.

          • brettearle

            Brett–

            Never underestimate the Democrats incapacity to fight back, effectively–even WITH the 527s that might have gone after Romney’s Private Equity practices in the 2012 campaign.

        • HonestDebate1

          No one is against end of life counseling. That is not the issue at all. There is an inherent conflict of interest when the counselor is being paid by the health care provider (government). It’s an issue between the patient, the doctor, the family and their God. Government should play no role.

      • HonestDebate1

        But I have always been able to choose my death panel and decide for myself where their loyalties lie. That’s the difference.

        • http://www.findingourdream.blogspot.com Hal Horvath

          That’s fair, but we’ve simplified. The last “death panel” label I saw repeatedly pinned (2010) was on the Medicare panel that seeks to find new ways to improve efficiency. Us under age 65, non-Medicare, are now under Obamacare. We don’t have that one. You still get to choose your own to a large extent.

  • creaker

    One thing that does not get taken into account enough is the “dehomogenizing” of the US – the idea of Smalltown, USA being the same no matter where you go is rapidly disappearing. The floor is being yanked out.

    There are many states that are letting their citizens quickly descend to 3rd world standards – how Obamacare is being implemented differently depending what state you are in really accentuates that.

  • MrStang

    Single-Payer/Medicare For All is an ideal cost-effective healthy solution but the Insurance, pharma, medical device lobby are to powerful, the politicians/media too craven/gutless and the populus too powerless/ignorant.

    Thus the ACA, which will cover 30-40 million people, spawn cost cutting innovation
    help people with pre-exisiting illness who had nowhere to go.

  • Anne

    My AGI is about $70,000 and I live in Massachusetts. More than a year ago, my employer dropped our health insurance and I had to use COBRA until this August. The premiums were over $12,000 per year, that’s 12 THOUSAND for me (single woman 63 years old) and my son (25 years old).

    When COBRA ran out in August, I got a “low silver” plan from the Mass Connector. This plan is just OK, and uses a lower-rated hospital than my COBRA plan did. But guess what? It is still 12,000 per year for the premiums.

    Neither of us has used a lot of health care. My son had a minor eye problem (medical, not optometry) that cost us about $100 out of pocket with the insurance picking up the rest.

    I’d love to know if I can get a tax break for these huge premiums, which are almost 20% of my income. I bet I won’t, though.$70,000 sounds like a lot, but Massachusetts has a high cost of living (and high medical costs).

    • hennorama

      Anne — $12K/70K = 17.1%. For tax year 2013, taxpayers can claim deductions on their Federal income tax return for medical expenses not covered by health insurance (generally including insurance premiums) that exceed 10 percent of your adjusted gross income.

      Of course, you only get a net tax break if your total itemized deductions exceed your standard deduction, which (assuming you file jointly) is $12,200 for tax year 2013. (plus an additional standard deduction of $1,200 for those age 65 or older at the end of the tax year, and those who are blind).

      You may wish to consult a tax professional for more information and advice, especially for state income tax info.

      See:
      http://www.irs.gov/Individuals/2013-changes-to-itemized-deduction-for-medical-expenses

      http://www.irs.gov/taxtopics/tc502.html

      http://www.irs.gov/publications/p502/ar02.html#en_US_2012_publink1000178885

      • Anne

        Thanks for the info. I will definitely check out all the options in December while preparing my Federal taxes.

        Looking at the announced head of household std ded for 2013 (I don’t file jointly since, as I noted, I’m single.), it does look like I will get a tax break – the std ded is around 9k. This is good news.

        And 17.1% is indeed “almost 20%”.

  • myblusky

    Single insured people pay about $400 a year for the uninsured and an insured family pays about $1000 a year for the uninsured. People with insurance shouldn’t have to foot the bill for those without. Everyone should have to pay up for insurance. If you don’t want to then hospitals shouldn’t be required to treat you and then pass on the cost.

    The biggest growing problem is the fact that we live longer and collect more diseases that are expensive to treat. People just used to die and it was much cheaper to stick someone in a pine box than it was to treat them for years with expensive medicine.

    We need to figure out how to treat illnesses cheaply and effectively because the population is going to continue living longer and growing older. Alzheimer’s and cancer are going to bankrupt all countries if we don’t get a handle on the cost of treating and taking care of people with these diseases.

    • fun bobby

      the vast majority of your lifetime healthcare costs are incurred in the last year of life but Obamas death panels will take care of that

      • http://www.findingourdream.blogspot.com Hal Horvath

        The “death panels” were always hidden inside the for-profit insurance companies, where you could not know what they were doing or how they decided what to pay for and what not to pay for….
        Now they will be an open committee with open proceedings and won’t be for-profit. That’s new.

        • fun bobby

          personally i am all for death panels if I have top pay for the care of others

          • anamaria23

            There are no death panels. What may be diminished are people lingering for years with no quality of life for the lack of end of life counseling with no input for decision by the patient, the sufferer, in the event of a massive stroke or such.
            If the ill informed Sarah Palin who helped spread this monstrous lie spent a few days observing in a medical facility she may have grasped the sanity of this provision.
            There are scenarios worse than death in some cases.

          • fun bobby

            ” What may be diminished are people lingering for years with no quality of life for the lack of end of life counseling with no input for decision by the patient, the sufferer, in the event of a massive stroke or such. ”

            http://imagingenocide.files.wordpress.com/2013/05/comparesickand-healthyeugenics.jpg

          • anamaria23

            Sorry, I am too dumb to read German. What is your point?

          • fun bobby

            that does not mean you are dumb.
            the Nazis believed euthanasia was a good cost saving policy as well. the poster says that a sick person costs as much as a whole family of healthy people

          • anamaria23

            Except that if the whole family happened to be Jewish.
            Your comment is vile and deliberately represents the horrors of the Holocaust, a few survivors I happen to be acquainted with, to further your cynicism.
            ,

          • fun bobby

            you are the one arguing in favor of euthanasia here not I.

          • anamaria23

            How am I in favor of euthanasia. Please explain. You are deliberately provocative and manipulative.

          • brettearle

            anamaria–

            Why aren’t you bringing up the legal document of the Living Will?

            This usually eliminates the entire matter of input from anyone else other than the patient.

            The Family, the MDs, the Hospital, and the Community, follow the wishes and the dictates of the individual–so long as those wishes conform to State and Federal Law.

            If Living Wills weren’t effective, they wouldn’t be drawn up and used.

            Regardless of what side of the issue anyone is on, this is neither a deal maker nor a deal breaker.

            Case usually Closed.

          • anamaria23

            I believe that the conversation was around death panels. My point was that end of life counseling by an MD should not be considered a death panel.. Living Will can be drawn up in an attorney’s office, then used in hospital, but does not necessarily involve a physician’s input. The ACA will reimburse physicians for often lengthy sessions with a patient to explain medical options in the individual’s care. The patient is given input into end of life decisions based on the physician’s knowledge of them.

          • brettearle

            No input is allowed by anyone–except the wishes of the patient.

            The more Living Wills there are, the better off everyone is.

            If someone does not want a Living Will, it does nothing but to increase and encourage ambiguity.

            Theoretically, it NEVER has to come to MD input–where the false stigma of Death Panels even arises.

            Living Wills stop Sarah Palin and her minions in their tracks.

            Living Wills can allow for Life Support Systems and no DNRs.

          • anamaria23

            Living wills are an excellent guide and everyone should have one. But, it does not address the complexities of a specific illness, especially in the young. Families and patients often ask for the counsel of their physician in the course of a particular illness when decisions are difficult and imminent and the options need to be explored in the realm of “what ifs”.
            True, one could proceed without the physician part.

          • anamaria23

            That one should never need input from an MD is not consistent with my experience. I work in the field, but perhaps you do, also. Most people have limited understanding of the disease process and prognoses.
            Recently my family members required extensive counsel from their physician
            in making end of life decisions with a parent with the parent the ultimate decider, yes.

          • brettearle

            Disqus

          • fun bobby

            “people lingering for years with no quality of life”
            supporting ending that is called euthanasia.

          • anamaria23

            euthanasia: putting a person painlessly to death. this done by administrating drugs. American Heritage Dictionary.
            Allowing a person to die naturally without extraordinary means when such means prolong suffering is not euthanasia.

          • fun bobby

            you left out the morphine. are you saying morphine is not administered?
            any discussion of euthanasia is taboo in our culture so I appreciate your engaging in this discussion. the point I was trying to get it is that we have to be very careful about who decides when someone has no quality of life because the Nazis used the “no quality of life” argument as their reason for sterilizing and killing all sorts of people also they also used arguments about expense to justify their extermination of handicapped people as the cartoon illustrated.

          • anamaria23

            Morphine is administrated as a comfort measure for pain and to ease difficult breathing in the dying process.
            The Nazis put to death perfectly healthy people with their feigned and psychotic reasoning to purify and rid the world of non Aryans. Impossible to understand what the Nazis have to do with providing comfort for suffering people.
            Your reasoning is totally foreign to me and impossible to follow. so there is nothing for us to discuss.
            We are trying to have patients help us make the decisions for what they would consider a good enough life by offering MD counseling so they can make their informed desires known when confronted with a life threatening situation.

          • fun bobby

            the Nazis did not start off with the perfectly healthy. they started off with the handicapped and infirm.

          • HonestDebate1

            “What may be diminished are people lingering for years with no quality of life for the lack of end of life counseling with no input for decision by the patient, the sufferer, in the event of a massive stroke or such.”

            Who quantifies quality of life if not a death panel? Do we regard as the same the 95 year old man and the 5 year old girl when funding a kidney transplant? Who decides?

          • fun bobby

            I found that statement interesting as well

          • anamaria23

            You miss the point. It is in consideration of the individual and the individual’s wishes in the event of life threatening issues which renders the person mentally incompetent that the discussion is held. No decisions are valid as long as the person is competent.
            The 5 year old and the 95 year old are separate issues.
            I do not know of a 95 year old, and I know a few, who could survive a kidney transplant and the rigors of immunosuppressive regime thereafter.

          • HonestDebate1

            The government should not be involved. These discussions do not need a middle man.

            The term death panels is not a reach. If government is to be responsible with our money these decisions must be made by someone. You can argue that it’s a good thing or a bad thing but the dynamic must exist.

          • Ray in VT

            Well, then lets go back to the good old days before the big, bad government had a health care program for the elderly. That way elderly poor people can just have the liberty to die from lack of care like the market intended. All hail the great God Mar-Khet!

          • Karl Prahl

            Why not return to multi-generational households instead of multi-generations holding multiple mortgages?
            Take care of your parents. Take care of your kids.

          • Ray in VT

            So when my mom falls out of bed and breaks a hip I can perform the surgery at my house?

          • Karl Prahl

            This would be a good reason to know your neighbors and make sure you live somewhere with a good doctor and nurses you trust.
            Then you and your neighbors make sure their needs are taken care of and everyone is happy.
            Or live isolated and assume the strangers at the hospital will do what the law demands and they’ll save her life.

          • Ray in VT

            Maybe me and the four other families on our road can all pitch in to buy our own operating room so that we don’t have to trust those strangers at the hospital. My neighbor’s wife is a nurse, but I don’t think that any of us would want her to do major surgery on any of us.

          • Karl Prahl

            But if she is a nurse, she probably knows some good doctors and other nurses too. It’s not a matter of having every single box checked in so far as treatment. Different circumstances will require different actions (maybe you need to pool with several hundred families for a centralized hospital and ambulances/helicopters). Small towns have to recruit skilled professionals fairly regularly. It’s a matter of taking responsibility.

          • Ray in VT

            I think that our local communities already rather effectively pool our resources in the form of our local hospital where my neighbor works. It is smallish, and it has its limitations, but the largest hospital in the state is an ambulance ride away.

          • Karl Prahl

            Then I am not entirely sure what the problem is. You have a good hospital and a community that supports that hospital. If the question is then that some people don’t pay for their hospital usage, perhaps the answer is property tax or sales tax? Even a municipal or county income tax, if consented to, would accomplish the same thing without empowering Washington or private insurance companies. Retain control.

          • Ray in VT

            I think that while a national approach has some problems, I think that a state level or smaller approach to something like health care and or health care financing is likely to have other, and probably greater, issues that a larger approach might be able to better handle in some ways. I also think that the private profit motive creates issues that a publicly funded approach is likely to handle somewhat better. I thinking about differences in community or state level income inequalities that could greatly detract from the ability of some people to access decent care.

          • Karl Prahl

            So long as we’re all thinking about it, something is getting done :-)
            In so far as inequalities in locales, I really want to use what I have been told more than once “Don’t like it. Move” I know that’s not ‘fair’ or complete in it’s portrayal of the problem, but its certainly within our individual powers (mostly). People immigrate to where the good life is. If a locale can’t offer what another can, why should anyone live there?

          • Ray in VT

            I think that the problem with that approach is that some people do get basically stuck in areas and are tied to jobs or conditions that allow them to get by and live, but perhaps does not provide the best conditions. I imagine that Greenwich, CT, for instance, has some very good schools, services and hospitals, but just choosing to live there isn’t an option for many. One can also get into the issue of rural areas, where you have small towns, perhaps relying on agriculture, and low population density levels that make serving those areas with quality care difficult, and it probably would be pretty bad for us as a whole if the people there mostly just chose to pack up and move closer to a hospital.

          • Karl Prahl

            I suppose this is where we fundamentally disagree. I don’t think anyone truly gets stuck anywhere or figuratively tied to jobs or conditions.
            We choose how to live and most Americans could live on much much less. Cellphones, internet, multiple cars, single occupancy homes, throw-away clothing. You can choose not to work at some job you don’t like or that doesn’t offer you enough in benefits. I understand that everyone NEEDS food/water/shelter and in this country that requires money, but the limits on money creation are truly endless. Any limits on an individual are simply limits in perspective.
            If you don’t think you can move or you choose not to then it is on you to make your environment better. No clinic? Organize one. Truly. Looking to Washington to level the playing field is not the answer and especially not when you start at the bottom. If you want to level the playing field, start with the 1% and watch many of our every day worries wash away.

          • Ray in VT

            I think that it is rather the case that many do. I suppose that it depends upon how one defines truly. Are people literally bound to one place as a medieval serf? No, but limitations in peoples abilities, education and ultimately skills can certainly work to greatly restrict the options available to many.

            I certainly do not think that the best way to go about things is to look to D.C. for answers, but I do think that we can pool our knowledge, resources and abilities in ways that other industrialized nations have done in order to bring about what I think might be a more workable system that would better serve many in the area of healthcare. But such things take hard work to bring about, from the household all the way up to the national level, and we sometimes fail to do that well at least as a nation, but maybe as a species.

          • fun bobby

            don’t forget that California is a bigger country than Canada. Also Canada is full of Canadians and mineral wealth

          • Karl Prahl

            I absolutely agree with you (if your getting the same message ;-). We should pool our resources, knowledge and abilities to do all kinds of great and wonderful things. This should include taking care of our young, sick and elderly. This should include educating everyone and this should include everyone having “the good life”. But we have to remember that there is not one way and never should be one way to accomplish these goals. We need to become more involved in our communities and help to lift those up that are struggling to lift themselves. We don’t need welfare workers and Obamacare registrars running around signing people up for programs. We need friends and family running around showing by example and helping out where they can. We need communities, not DC committees.

          • 1Brett1

            Ray, come on, if a person doesn’t like living in rural South Carolina and hasn’t the same political views as his neighbors, he can just move to the Upper West Side of New York City or Malibu, California or something.

          • Ray in VT

            I choose to live in all of those places. Buy a home in half a dozen places. I don’t know why everyone doesn’t just make that choice.

          • 1Brett1

            My Bentley broke down yesterday, and rather than send the chauffeur to fetch the mechanic, I just gave the keys to a homeless man and told him HIS mechanic could fix it! He can now drive to a good job; he can even start his own chauffeur business; social problems solved! …I’ll bet the centralized government and all its oppressive paternalism would not be able to act so swiftly on such an individual local level!! …And, if he doesn’t like his Bentley, he can just get a Rolls!

          • Ray in VT

            You are truly a great shining light that inspires us all. You should get a tax break for that.

          • fun bobby

            sounds like you are making his point for him

          • fun bobby

            that is what they think the government is for

          • HonestDebate1

            Yea, that’s what I want.

          • Ray in VT

            Well, it would get gub’ment out of peoples’ lives, and everyone could be as free and as long lived as their money allows them to be.

          • fun bobby

            yeah that would be terrible, we would have to care for each other instead of big brother

          • Ray in VT

            Let me know how providing health care to the elderly goes without something like Medicare. I’m sure that things went swimmingly prior to that coming about.

          • fun bobby

            I believe people can do all sorts of things without the help of the federal govt.are things going swimmingly now?

          • Ray in VT

            Better than before.

          • Karl Prahl

            Can you quantify that with sources? If it’s anecdotal, I’d just suggest you go take a tour of some state run nursing homes. Mainstream news has reported plenty of horror stories that a google search should turn up plenty on nursing home abuse.

          • Ray in VT

            Not at the moment (quantify that is). But let me ask you this, prior to Medicare, which provides health care to the elderly and the disabled, what options were available to the ill elderly? Charitable care if it could be found? Lacking such resources, were there other options for care than die fast?

          • Karl Prahl

            Don’t you think people should be charitable? Is forcing people to give charity (i.e. his tax mandate or forced insurance premiums) a good way to bring about the feeling of good-will-towards-men?
            I see what you are saying. Truly. Safety nets are a necessity and one all people should recognize because, well, things happen and no one can plan for all possible situations. But that safety net does not need to be government. In fact I am arguing that government is the last group you want in charge of this (maybe the second to last after corporations).
            Before social security you had pensions if you were lucky and family/church otherwise. I don’t think you can draw a direct parallel considering medical advances and the dissemination of information via the internet, but I do concede that SS helps some people. Problem even there is Poor people get less SS because Rich people put more in. This is because any social security you get is money you have paid in already. You don’t gain anything compound interest wouldn’t do for you anyway. If you keep in mind inflation I doubt anyone comes out ahead, but that’s speculation.

          • Ray in VT

            I see many of your points, and I like charity, however I do not think that the limitations that private charity showed itself to have when attempting to combat major issues in a large, industrial society during the Depression have significantly changed since that time.

          • Ray in VT

            Well, I am heading home, but I did find this quickly:

            “The estimates are consistent with the hypothesis that the
            Medicare-induced increase in health care utilization leads to a
            reduction in days spent in bed of about 13 percent and to slower growth
            in the probability of death after age 65. Physician visits are estimated
            to have a negative effect on the male death rate, conditional on age
            and the death rate in the previous year. The short-run elasticity of the
            death rate with respect to the number of physician visits is -.095, and
            the long-run elasticity is -.497: a permanent or sustained 10 percent
            increase in the number of visits ultimately leads to a 5 percent
            reduction in the death rate.Data on age-specific death probabilities
            every 10 years since 1900, i.e., before as well as after Medicare was
            enacted, provide an alternative way to test for the effect of Medicare
            on longevity. They also provide strong support for the hypothesis that
            Medicare increased the survival rate of the elderly by about 13 percent.”

            http://ideas.repec.org/a/bpj/fhecpo/v5y2002n3.html

          • anamaria23

            yes, there are nursing home abuses, but in the overall they are not the norm. Nursing homes are the second most highly regulated industry after nuclear power.
            The reports of abuse are far outnumbered by the countless acts of loving kindness that are rendered each day and are never heard of.

          • fun bobby

            we all have to go sometime. why would bureaucrats be better deciders than the market?

          • Ray in VT

            So would it be proper to describe your plan by paraphrasing Alan Grayson: die fast.

          • fun bobby

            you don’t want to answer that question?

          • Ray in VT

            Considering that I disagree with your position that this law creates some sort of government run death panel, then I don’t think that there is a question to answer.

          • fun bobby

            I said bureaucrats butlets roll it back a bit. if the market does not decide who or what will?

          • anamaria23

            Government is not involved in these decisions except the provision that the physician be reimbursed in time spent which can be extensive. It also considers best practice.
            Read the work of Atul Gawande, MD in the New Yorker, for more info and understanding of these concerns.

          • Karl Prahl

            I asked this elsewhere, maybe you can answer with your experience: Do you know if the physician can approve and the practitioners reimbursed for non-traditional medicine and religious end-of-life requirements? Or is it limited to NIH approved medical and psychiatric care?

          • anamaria23

            That is a good question and I do not know the answer.

      • sickofthechit

        Please quit spreading your death panel lies. It is a benefit that covers the cost of Palliative Care. Which is an advisory physician who is expert/specialist in various care options and factors at the end of one’s life.

        I will repeat what I posted earlier and hopefully you will read it instead of plunging ignorantly ahead.

        My mother and father lived to be in their late 80′s. When my mother had her stroke we set up an appointment with what is called a Palliative
        care physician who advised us on the various options for end of life are. Would we use a feeding tube if she wasn’t able to be rehab’d
        enough to chew and swallow safely? There were numerous issues which had to be decided on. Did we intend for her to be a “Do not Resuscitate” patient at the nursing home? etc, etc. This is the type of care that Repugnicans (copyright charles a. bowsher 2009) cynically deemed “Death Panels”. Shame on you for perpetuating that lie. charles a. bowsher

        • Karl Prahl

          This is not a loaded question. I have not heard: Do these Palliative care physicians have the authority to authorize care based off religious or non-traditional methods not approved by the Dept of Health? Will these methods receive the same funding as traditional methods if requested?

        • fun bobby

          what exactly is the difference between palliative care and euthanasia?

          • anamaria23

            A family member was recently place in palliative care for a terminal illness when all hope for recovery was exhausted. It includes comfort measures and home care so that persons can be with family and die peacefully. Quite the opposite of euthanasia which is a complex issue and involves deliberate taking of a life.

          • fun bobby

            who decides what disease is terminal?

          • Karl Prahl

            Be nice

        • Joseph Rice

          I believe that what a number of people seized on as “death panels” was actually a plan to reimburse physicians for the time spent on counseling/informing about end-of-life care options. Currently this appointment would not be reimbursed (therefore making these discussions less common, resulting in medical care long past when it was useful or even desired by the patient). Please feel free to correct me if I am wrong about this.

          • anamaria23

            You are absolutely correct and well said.

      • tbphkm33

        The only “death panel” that is in existence is the one that the Nopublican’s are pushing through for the U.S. economy and the longterm survivability of the United States as a political entity.

    • http://www.findingourdream.blogspot.com Hal Horvath

      You raise some of the great questions, and it should come to mind to some: “why doesn’t the ‘market’ bring costs down” since the market has in fact seen costs go up and up and up, for more than 30 years.
      The reason is that health care is not like other goods — it involves often urgent and often critical services that involve life and death. Just to add into this non-market-like problem, there is also the fact that doctors in most states made competition (non certified) illegal.
      But….the market could still help some anyway, and needs innovation. Obamacare does allow this as much as before, but it was slow before. Since a lot of money is at stake, there are huge profit opportunities if a business could go big with more efficient care.

      • hennorama

        Hal Horvath — one also must consider that rational decisions about health care (not health INSURANCE) are difficult, as the life/death factor skews one’s emotions.

        Virtually no one says “Hey doc — the hospital in the next town does open heart surgery cheaper, so I’m going there.”

        [PS] – Howard Dean discussed this in depth last week during his remarks at the New Hampshire Institute of Politics & Political Library at Saint Anselm College. It’s worth a look, regardless of your opinion of his politics. The topic was “Health Care in the Private Sector.”

        See:
        http://www.c-spanvideo.org/program/DeanRe

        • http://www.findingourdream.blogspot.com Hal Horvath

          So true.

        • TFRX

          If I hear one more pundit talk about “shopping healthcare” the way one looks at the grocery store circulars, I’ll have an aneuryism.

          Remind me to call every hospital in 50 miles to find out how much an anuerism costs.

          • http://www.findingourdream.blogspot.com Hal Horvath

            Who does have the ability to “shop” healthcare….?
            Insurers.

          • fun bobby

            there was a guy on NPR who was doing just that. he actually asked his doctor how much things cost

          • http://www.findingourdream.blogspot.com Hal Horvath

            Right, and of course the doctor didn’t know.

          • fun bobby

            somehow he was able to find out

          • HonestDebate1

            I have a friend who has hepatitis and no insurance. He got a hernia and needed surgery and did exactly that. He found that doctors were quite willing to work out a deal.

          • anamaria23

            Did the hospital, anesthesiologists, the lab, and the nurses also work out a deal? Just curious. Is interesting.

          • HonestDebate1

            I don’t know how it was all arranged, I would guess the surgeon’s fee was the big chunk. I think it cost him just under $3000.

          • jefe68

            Given that a hernia operation cost between $2000 to $9000( that figure in itself is why our systems is dysfunctional) it still seems pretty cheap given that there is also the cost of the room and the anesthesiologists and lab work.

          • jefe68

            Highly unlikely that a hospital did this.
            Unless they had program in place to deal with the uninsured, but I doubt it.

          • HonestDebate1

            I didn’t say the hospital or staff complied but it’s much easier for a doctor not to have to deal with insurance companies, Medicare or Medicaid. I think the surgery was out patient anyway.

          • fun bobby

            its like how auto body work suddenly becomes much cheaper when you tell the guy you are paying out of pocket

          • HonestDebate1

            Money talks, it a lot less headache for the doctor.

          • jefe68

            You know what’s wrong with your story.
            It does not sound plausible.
            What about the hospital? What about the nurses? You can work out a payment plan but not the fees.

          • HonestDebate1

            It happens every day.

          • jefe68

            Really. Do tell. So if you need to have an operation to replace your hip your telling me that if you don’t have insurance in your area doctors will negotiate a fee?

          • HonestDebate1

            Yes.

          • jefe68

            I don’t believe you.
            Then how come you don’t have thousands of people flocking to your state looking for health care on the cheap?

          • HonestDebate1

            It’s nothing unique to my area.

          • Ray in VT

            Well, just as long as you take personal responsibility there. You don’t want to be some 47% taker or anything.

        • fun bobby

          because they are not paying for it out of pocket. if they had to they would and then the hospitals would have an incentive to control costs

          • hennorama

            fun bobby – TY for your opinion. Regardless of how payment is made, the emotions around life/death decisions skew one’s otherwise rational decision-making. Your opinion fails to take this into account.

            Health care is NOT the same as buying furniture. When you need health care, you’re often in no position to delay, bargain or choose another provider.

            TY again for your opinion.

          • fun bobby

            in cases of emergency you are right. most things are not emergencies.
            perhaps we could create an app for that. you could punch in heart attack and by the time the EMTs showed up it would have told which hospital to tell the EMTs to take you to.

          • hennorama

            fun bobby – TY for your response.

            It’s not like going to different grocery stores for better prices, selection or quality. Health care can be a very intimate undertaking. Once one establishes a relationship with a primary care physician or other health care provider, most individuals are reluctant to change solely of the basis of price.

            Your idea of a cost comparison app might be workable if several conditions were met in advance:

            1. Health care providers bundled their charges into one cohesive unit for each procedure, such as a heart attack, Of course, this not only does not happen, it also generally cannot happen due to the unpredictability of each individual’s care requirements. One patient might need significant followup care, therapy, drugs, lifestyle education, in-home care, etc., while another may not. Fee-for-service makes these charges different for each patient.
            2. Health care providers posted their prices for the public. This is really uncommon at present, but is slowly changing.
            3. In addition, there are different prices based on whether one has insurance or not, and each insurer also negotiates different fee structures with providers. In other words, there are multiple prices for the same service that is delivered, depending on patient/insurer/payer variables.

            Good luck with your idea.

          • fun bobby

            people might find themselves less attached if they found out they were paying 3 times as much as another provider.

            1. they could disclose the average cost.
            2. perhaps they pass some kind of act to make care affordable that would require those disclosures
            3. that seems like a big part of the problems we are dealing with. maybe an act could be passed that would make care more affordable by doing away with that.
            its just one idea. seems cheap and easy. no wonder they hate it

          • anamaria23

            Ever seen anyone having a heart attack?

          • fun bobby

            no but I have seen the Richard Pryor bit. Perhaps who ever dials 911 can work the app. better yet perhaps people could select in advance to be taken to the cheapest hospital and the dispatcher could use the app to tell the emts where to take you
            http://www.youtube.com/watch?v=Oc3GmvRJxcY

      • jefe68

        You forgot, we have a fee for service system and that drives up cost, a lot.

        • http://www.findingourdream.blogspot.com Hal Horvath

          Yes, it is one of the greatest opportunities too. “Bundling” is one of the approaches being tried out extensively now.
          I proposed on my own blog not only bundling, but also pay-for-outcome.

          • Karl Prahl

            Wouldn’t such schemes work better on a local level? Shouldn’t the initiative be with the State and not the Fed?

          • jefe68

            I think it should be both.
            There is a clinic in Barre Vermont that uses some federal money, and also uses a pay what you can afford scheme for those without insurance. However, it works because people with higher incomes don’t mind paying more for health care than those who are lower income.

          • fun bobby

            Panera tried that

          • brettearle

            Pay-for-outcome is an intriguing approach, –but it is too fraught, I think, with built in biases that could ultimately result in a disservice to patient care.

          • http://www.findingourdream.blogspot.com Hal Horvath

            Well, it’s more than a slogan. I worked on how to make it work correctly, wrote a long blog post, and modified it for a few months until I had something.

          • brettearle

            Ok, give me the URL….

            [I assumed that it was more than a slogan.

            What I was worried about, of course, was the disincentive for MDs to try out-of-the-box approaches that can sometimes defy evidence-based outcomes.]

          • http://www.findingourdream.blogspot.com Hal Horvath

            Pay for outcome is especially good at rewarding innovation that accomplishes a good outcome for less $, since the provider gets the to-date higher rates for a while, until competition catches up on the new lower cost innovation.

            This is an involved post, since the topic is involved:

            http://findingourdream.blogspot.com/2009/06/new-way-to-hold-down-health-care-costs.html

      • brettearle

        see way above

      • fun bobby

        one might also argue that government interference subsidies and price supports on medical care has caused market failure

        • http://www.findingourdream.blogspot.com Hal Horvath

          Unless you are in Medicaid or Medicare, there are no “price supports” in commonplace situations. Like, our family with kids perhaps had 15 visits in a year, and zero involved any “price supports” to my knowledge.

          • fun bobby

            millions of people are in those programs, they impact the market as a whole. its just basic economics

    • brettearle

      Great point.

      And it is a point that is too-often overlooked–as far as the specificity is concerned that you have identified above– in this entire debate.

      Normally, the preponderance of cost–in the last year of life, for so many–is so stacked against solvency for the entire system, that it creates an overload that can burst the system.

      The ER costs are not the only hemorrhaging (no pun intended) burdens.

    • anamaria23

      Yes and defunding scientific research into these diseases such as at the NIH has already had a crippling effect due to the sequester.

  • sickofthechit

    Healthcare should “cost” the same for each of us. They are saying that it should not “cost” more than 10% of wages. So 10% of wages equates to 10% of the hours you work or say 4 hours per week. So to be fair it should “cost” employee A earning $208,000/year ($100/hour times 2,080 hours) the same as it “costs” employee B earning $20,800/year ($10/hour times 2,080 hours). So employee A pays $400/week while Employee B pays $40/week. Each is paying the same. That is fair for something that most of us feel is a basic human right. If you aren’t working, you “pay” for it with volunteer work of four hours per week. charles a. bowsher

    • fun bobby

      so a tithe is the solution?

      • Karl Prahl

        At least it’s somewhat fair, so long as it’s everyone, Unions, Big Business and Congressional aides included. I still want to opt out though please and thank you

        • fun bobby

          its a great plan for Charles because he only makes 18k per year

    • http://www.findingourdream.blogspot.com Hal Horvath

      Actually, this is a lot like federal taxes, and….Obamacare taxes are somewhat like this also, so it’s sorta already this way. Sorta, more than not, especially when you consider the obamacare subsidies also in the picture.

  • hennorama

    Nicolas Hockenberry — you might want to look into disability insurance as well, based on your somewhat risky hobby.

  • John_in_Amherst

    for about 15 minutes of non-stop fact-checked facts on healthcare, crammed into 7 minutes : http://www.upworthy.com/his-first-4-sentences-are-interesting-the-5th-blew-my-mind-and-made-me-a-little-sick-2?c=la3

  • brettearle

    One of the biggest issues, in the Health Care debate, is preventive medicine.

    Unfortunately, my gender is woefully remiss in this area.

    THAT is why compulsory insurance, for young men and women, is fairly essential:

    More individuals–with Coverage early on–encourage preventive medicine, which, in the long run, reduces financial stress, considerably, throughout the system, for even decades to come….

    Not to mention the many lives it saves, sooner rather than later; and, as well, not to mention the many lives it ultimately, saves….

    The Libertarian Rhetoricians completely ignore this point. They are the same voices that call for cost-savings.

    • Karl Prahl

      Wouldn’t it be better to get rid of all costs associated with healthcare and just offer it to everyone equally? Why this profit-driven model for saving lives?
      If it is a matter of humanity and helping our neighbors then isn’t bringing the insurance companies into it counter productive as they are legally obliged to make profits?

      • brettearle

        You’re ascribing positions to me–or, at least, you are implying that you are–based on false assumptions.

        My comments are based on the system that is currently prescribed.

        Not the system that I might ideally support.

        • 1Brett1

          I, for one, read your comment for the practical nature of working within the structures of what is within our grasp. And, as you say about yourself, sure, we all have some vision about supporting an ideal. Often those ideals in their absolute form are not completely practical, libertarians do seem to have a blind side to practicality in their proclamations.

          • Karl Prahl

            And there in lies a problem. If you do not have a road-map to ideal then what purpose do your actions serve?
            As to this specifically, we have many solutions at our grasp. #1 Nationalize healthcare. Production lines and all. #2 Allow hospitals to charter banks along the lines of the Bank of North Dakota. Allow them the same freedoms of corporate banks as outlined by FDIC. #3 Subsidize hospitals and clinics via treasury bonds as they are doing for Wallstreet. #4 Publicize IP so that generic drugs can enter the marketplace.
            And that’s just off the top of my head.
            All those would go a long way towards affordable healthcare. All of those force business to secede profits for the public good. Who is deciding how much Socialism is too much?

          • 1Brett1

            One approach doesn’t have to exist at the exclusion of the other. We can’t completely tear down the system and rebuild it in one fell swoop, and one can keep an ideal as a goal and still work within the parameters of objectives. That is what I was saying.

            I like some of your ideas; I just don’t find them realistic in terms of giving them any chance of being implemented, especially in this political environment.

            It amounts to little more than an idealistic platitude to say “Nationalize healthcare.” I think a national single-payer system is really the only way to solve most of our problems with national healthcare,so no disagreement there. I was disappointed, for example, that having a public option on the table during the ACA negotiations didn’t even get put up for consideration. At least it could have been used as a bargaining chip even if it had no chance of staying on the table. That was telling to me, and it signaled that the ACA will be a law needing to be tweaked over and over, over a long period of time, until it actually functions well in some distant future.

          • Karl Prahl

            Then, considering the political environment and the clear divisiveness in the country, should we not simply allow individual States to pursue healthcare reform as they see fit for their own citizens? California and Massachusetts both have strong social healthcare nets that could be expanded if the political will was there. Other states could follow suit.
            Why is a national mandate necessary especially when it has to be ramrodded through the legal process? (or has congress settled the issue in the last hour?).

          • 1Brett1

            Are state legislators immune from the “political environment and the clear divisiveness”? I don’t think so.

            …But to answer your question: no, I don’t like the idea of a patchwork of healthcare reform by individual states. This also seems a bit of a contradiction on your part, particularly if one is to take this comment of yours seriously:

            ["Wouldn't it be better to get rid of all costs associated with healthcare and just offer it to everyone equally? Why this profit-driven model for saving lives?

            If it is a matter of humanity and helping our neighbors then isn't bringing the insurance companies into it counter productive as they are legally obliged to make profits?"]

            Also, could you explain, for clarification purposes, what you mean by the ACA being “ramrodded through the legal process”?

          • Karl Prahl

            I mean that there is clear resistance in congress to fund this mandate and the Executive is fighting back. As in there is no concensus.
            As to the above, I can present multiple arguments to a subject without adhering to one (or any). It’s the idea of being able to read a book by Rush Limbaugh and Al Frankin without your head exploding.
            The putting lives before profit and a single payer comment very much was meant for the socialist minded here as to why they are settling and accepting this half-ass attempt at bringing healthcare to everyone. If you simply removed the profit model from the healthcare industry the problem would be solved.
            As for a patchwork of different plans, well, I am sorry you feel that way. Local laws and statutes are common place, from gun laws, to sex laws, to business law etc. The adhere closer (hopefully) to the will of the locals and not a centralized polit-bureau. If you find your views do not align with that of your neighbors, maybe it is time to relocate.

          • fun bobby

            well said

          • 1Brett1

            Sorry, but you are talking in circles. I am also sorry if you get the idea I am pigeonholing you (I’m trying not to). You certainly seem to be trying to pigeonhole me. I will say that you take quite a self-righteous tone. You know nothing about me and how much I act on a local level or what my concerns about my community are.

            I am not really interested in talking about the merits of local versus federal laws in general (guns, sex, etc.), as much as you are confident you could show off in that way. (If you engage in oral sex in one state, you would not mind going to jail over it on another state, say, on vacation, then? Or how about one county where you live having a health insurance law, then you need to move one county over for some reason and you just loose out because that county has different laws? Yeah, that just wouldn’t work).

            I did find your allusion to “local” a bit simplistic and thought, “he’s introducing a whole lot of stuff in a very simplistic way, there.” I also don’t much have time for platitudes about what a better world it could be if others would only do x, y, and z. I find what you’re saying to be nice in sentiment but overly simplistic in its delivery. If only we’d just rise up as a peoples more and demand more, aye? Yeah, if only. (Wait, don’t tell me, if I’m not part of the solution I’m part of the problem?)

            Also: “As to the above [where I quoted you], I can present multiple arguments to a subject without adhering to one (or any). It’s the idea of being able to read a book by Rush Limbaugh and Al Frankin without your head exploding.”

            Jeesh, what? If your views on healthcare and how to service that seem contradictory, then defending that by saying you are capable of reading both Rush and Frankin, as a response (which means you totally missed my point to pointing out the contradiction), then sorry, thanks for the interaction, I just can’t waste anymore time conversing with you. Sorry, but thanks for the replies anyway.

          • Karl Prahl

            My views are not contradictory. My views are that I am not participating in this program and anyone else who does is throwing money away. That is my view. If you feel I’m pigeonholing you, that is your choice to feel that way. I don’t know what you do locally and you have no idea what I do locally. Keep the ad hominems out of it.

            As for [Or how about one county where you live having a health insurance law, then you need to move one county over for some reason and you just loose out because that county has different laws? Yeah, that just wouldn't work] It wouldn’t work because you say so? Last I checked this works fine for countries. You’ll just have to check the local hospitals along with the local schools when you’re considering a move. If it’s not good, don’t move.

            My point with the Rush/Al statement was a roundabout mention of critical-thinking. The idea that one can entertain an idea while not subscribing to it. The ability to look at a subject from multiple viewpoints while not necessarily identifying with those whose viewpoints you usurp.

            The purpose of posting on this topic is because it seems many people who listen to Tom and the penchant for one-sided presentations of problems rarely present the Gandhi/MLK form of non-aggression and non-participation. The true American way of opting out and living as an individual. “Localities” is simply a way of saying you and your neighbors, however expansive that is, need to make your own situation right and not rely on Washington to do it for you. That is the public view of this mandate: a way for daddy to take care of the healthcare issue because we just can’t be bothered doing it ourselves. We can’t be responsible for our own situations. We can’t take it upon ourselves to reform our own towns, or own cities, our own states. Let’s go straight to Big Brother to mandate for all.

    • WorriedfortheCountry

      Compulsory insurance or compulsory health care?

    • William

      Forcing people to buy something from a private company is never a good way to go for a society, especially one like ours that values individual freedom. I would rather have the government just go after people that don’t pay their medical bills instead of forcing them to buy insurance.

      • brettearle

        The Supreme Court didn’t see it your way.

        • HonestDebate1

          Yes they did or they would have ruled it Constitutional under the Commerce Clause. Instead, they ruled it a tax.

          • brettearle

            I don’t think the Supreme Court gives a Pass to White Supremacist Libertarians who barricade themselves in Wilderness Lodges in Idaho, because they refuse to pay their Federal Taxes.

          • Karl Prahl

            Is this a reference to Ruby Ridge or is there really a group of white supremacist libertarians who barricaded themselves in a lodge in Idaho because of federal taxes?

          • brettearle

            I am referring to whether Taxes come under the rubric of coercion by Government.

            The Supreme Court doesn’t see tax as a coercion.

          • HonestDebate1

            Exactly. The SCOTUS does not regard a tax as requiring someone to buy something. It seemed to me you were saying they ruled government could make citizens buy insurance. Maybe I misunderstood.

          • HonestDebate1

            Huh?

    • Markus6

      I commented on this above in a bit more detail. The total cost of health care will increase as more people use preventative care. This doesn’t mean it’s the wrong thing to do as, I think, preventative care improves people’s health. I say I think it does because it seems so logical.

      There are a lot of things that can be done to reduce costs. None of them are in ACA.

      • brettearle

        Cost-Savings from Preventive Care–that which can be outlined in specific measures–has YET to be quantified because it has YET to be implemented.

        The COST of OBTAINING Preventive Care is DIFFERENT than the REDUCTION of COSTS in the LONG RUN, AFTER receiving Preventive Care.

  • Bob

    To Steve on the air complaining that he’s going to pay a tax on his insurance plan:
    Have you not been able to deduct your payments for your current health insurance from your income taxes?
    I’m uninsured and don’t get to deduct my direct health care costs, like the $200 to walk through the door of a commercial health clinic.

  • hennorama

    A short (2:29) video explanation of Obamcare, from the TurboTax people:

    (Of course it also contains a promotional message at the end)

    https://www.youtube.com/watch?v=C2nskzMgZ_g

    • fun bobby

      I hope you are getting paid for your efforts

      • hennorama

        fun bobby — as usual, my compensation consists of your fun comments. Thank you.

        • fun bobby

          de nada. I do it for the love of the game

          • Ray in VT

            But I thought that we were talking about practice. Not a game, not a game, not a game, but practice.

          • hennorama

            Easy there, Mr. Iverson.

          • Ray in VT

            Glad you to the reference. That was over 10 years ago now, I think.

    • WorriedfortheCountry

      This OK because SCOTUS ruled Obamacare a TAX.

  • OnPointComments

    Jay Carney said today that the administration believes the ACA will drive down health care costs because people who were previously uninsured would have a primary care doctor and preventative care. I bet he’s wrong. I have clients (the largest a government with thousands of employees) that have evaluated the causes of their high health care costs, and each time it was found that the costs were high because a large percentage of the employees (primarily employees with a high school education or less) used the emergency room for their medical care, even though they had good employer-provided health insurance. Providing health insurance doesn’t necessarily change peoples’ habits.

    • Markus6

      Planet Money did a show on this and you are correct. The woman who ran the study was a big supporter of ACA and most forms of government sponsored health care. The base for the data was Oregon, I think. The situation was when Oregon was offering health care for some, but couldn’t afford to do it for everyone. This provided them with data from those that got it and those that didn’t.

      Interesting results on the actual health of both groups, but one of the obvious conclusions is that the costs of health care go up dramatically when people have better access. Preventative care may improve your health, but it will also drive your costs up.

      I’ve heard of similar results from studies in europe, but I know even fewer details.

      • hennorama

        Markus6 – you seem to be presenting the findings of the study inaccurately.

        The study also does not in any way coincide with OPC’s stated conclusion, that “costs were high because a large percentage of the employees (primarily employees with a high school education or less) used the emergency room for their medical care, even though they had good employer-provided health insurance.”

        Here are the conclusions of the study’s authors:

        “CONCLUSIONS

        “This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”

        See:

        http://www.nejm.org/doi/full/10.1056/NEJMsa1212321

        And:
        http://www.npr.org/blogs/health/2013/05/01/180292446/second-thoughts-on-medicaid-from-oregons-unique-experiment

        http://freakonomics.com/2011/07/21/oregon-medicaid-lottery/

        http://www.npr.org/blogs/money/2012/06/15/155135781/episode-379-does-medicaid-actually-help-people

        BTW – a search using the three words [planet money oregon] yielded the link directly above, and a second search using three words from that link [Oregon Medicaid lottery] yielded the others. Took all of 0.58 seconds, total.

        • Markus6

          Can’t believe I had to do this. Remember my point. It was that the total costs of health care go up when people get insurance. It was not that it didn’t result in better health or help people financially.

          I just wasted 20 minutes looking through your references. Maybe I missed something but I only found support for my point. The point is that total (not just individual) costs go up. Maybe indicative is that you only reported the time to do the search, not the time to read the articles.

          I do this with references people give me every once in a while and it always seem the same – they missed the point or misread the study.

          • hennorama

            Markus6 — Thank you for your response.

            Your original comment said nothing about “the total costs of health care go[ing] up when people get insurance.”

            You wrote ”…one of the obvious conclusions is that the costs of health care go up dramatically when people have better access. Preventative care may improve your health, but it will also drive your costs up.”

            Unfortunately, the subject study was not available without either purchasing it or subscribing to the NEJM. This therefore does not allow a discussion of the details of the study’s findings about the TOTAL costs of health care.

            The sole reference to TOTAL costs from the study’s findings was this, from the transcript of the ‘ALL THINGS CONSIDERED’ show from May 1, 2013:

            “[NPR's Julie] ROVNER: But she [Dr. Baicker] says the study also shows that Medicaid coverage comes at a cost to society and to taxpayers.

            “[Dr. Katherine Baicker, one of the leaders of the research team] BAICKER: People on Medicaid consume a lot more health care resources, and that means they spend more money.”

            It is unclear from this quote whether “they spend more money” refers to the patients’ out-of-pocket expenses, expenses covered by Medicaid, or both.

            See:
            http://www.npr.org/templates/transcript/transcript.php?storyId=180292446

            There was also a mention in the Freakonomics.com article about a much earlier working paper titled “The Oregon Health Insurance Experiment: Evidence from the First Year”:

            “The study found that having insurance boosted individual spending on medical care by an extra $778, about a 25% increase. Here’s a breakdown:

            30% increase in the probability of having a hospital admission.
            15% increase in the probability of taking prescription drugs.
            35% increase in the probability of having an outpatient visit.

            “People also sought more preventative care once they were covered:”

            See:
            http://freakonomics.com/2011/07/21/oregon-medicaid-lottery/

            It’s unclear from the quote whether “individual spending” means TOTAL spending, including both the out-of-pocket expenses incurred by patients, and the costs covered by Medicaid. Given that this was the first year after a period of being uninsured, higher utilization rates and costs would hardly be a surprise. The same can be said of the subject study, as it covered only a two-year period.

            Perhaps you can point to some other evidence supporting your new statement, “that the total costs of health care go up when people get insurance.”

            Please do so, if you are able. Otherwise, the evidence is as clear as mud.

            Thanks again for your response.

    • hennorama

      OPC – a few questions:

      1. Were the employee visits to emergency rooms pre-approved by the insurer/payer, as is often required for reimbursement?

      2. Were these employees who “used the emergency room for their medical care” all previously uninsured?

      3. Did the employers and/or insurers provide recommendations and guidelines for when using the emergency room was appropriate and when it was not? And once they saw this issue, did they provide additional training and education for the employee beneficiaries, to encourage behavior modification?

      Also, perhaps the solution to the problem is implicit in your remarks – education. You wrote “a large percentage of the employees (primarily employees with a high school education or less) used the emergency room for their medical care…” Perhaps the employers would be better served by providing incentives for their employees to obtain more education, or simply not hire anyone without a college education.

      (Tongue mostly in cheek as to the immediately preceding sentence.)

      One also must recognize the likelihood of pent up demand for health care services for the previously uninsured, who may have put off care due to economic constraints. This means that utilization and claims in the first year of employment would likely be higher than one would otherwise expect.

      The same may be true for the first year of Obamasurance, especially among previously uninsured older populations.

    • sickofthechit

      That is true, but employers, government or otherwise should be educating their employees as concerns the importance of preventive health care.

      You can’t just count on people understanding the complexities of health care.

  • fun bobby

    will obamacare cover my witchdoctor and other quackery? or am I stuck with the lousy western medicine that seems so ineffective and dangerous?

  • Zenplatypus

    Whatever else may be said of it, Obamacare will doubtless come to be regarded as the single-most damaging political miscalculation in decades. The acrimony decried in Washington and nationwide is a direct consequence of its enactment, or more precisely the manner in which it was enacted. Remember, this was a vast expansion of the welfare state — the largest in a generation, in fact — passed on a straight party line vote and despite vociferous opposition. At the time we were assured that the electorate would embrace the law, but it’s more unpopular than ever. When its deleterious economic effects come to be known, the law’s standing with the public is certain to decline further still. I say all this as someone generally sympathetic to the idea that the federal government has a role to play in health care, and as someone who has no truck with shutdown partisans. Whatever happens with respect to the debt ceiling, Obamacare has been and will increasingly prove to be an unmitigated disaster for the country.

    • jefe68

      Funny the same thing was said about Medicare, which is now very popular. YOur sky is falling right wing regressive memes are dully noted.

      What is it with the right wanting this nation to fail in terms of decent affordable health care?

      • HonestDebate1

        Advocating for Obamacare is not advocating for decent affordable health care. That’s the point.

      • Zenplatypus

        Medicare was enacted with bipartisan support. It’s duly, not dully. And as usual, your post is rife with errors of punctuation and logic. Other than that, great job!

        • jefe68

          That’s true. But in 1965 the Republican party was not controlled by extremist.
          It was still a party with a lot of moderate Republicans in it, such a Nelson Rockefeller.

          Nixon could not get nominated for the GOP presidential ticket today.

          • Zenplatypus

            Sadly indicative of an impoverished mind. Leaving aside the obvious point that one person’s extremist is another person’s principled partisan, can’t you grasp that you’ve unwittingly lent credence to my argument? Take away enactment of the Patient Protection and Affordable Care Act and you likely have nowhere near the Republican landslide of 2010 that seated hardliners, to say nothing of the Tea Party movement. That’s my point: the law and how it came to be have engendered the very political environment you now lament.

          • jefe68

            Despite your need to label me as having an impoverished mind for wanting a single payer system, or a decent health care system, I happen to agree with the idea that to many Americans were not ready for this. Funny thing though, the mandate was originally a Republican idea.

            What’s really amazing is how many people of your ilk think what we have now works.
            It does not. The number of people filing for bankruptcy who have decent health insurance is going up every year.
            We are the only industrial nation in which an individual or family can lose their home and savings due to a serious illness.
            Our health care system is dysfunctional and it will eventually bankrupt the nation.
            Put that in your regressive mind and let that stew.

          • Zenplatypus

            Do tell: Where did I advocate for the status quo? Clearly, you’re an imbecile. I make the observation on the basis of your rather obvious inability to read or express yourself intelligently, irrespective of your position on any given issue. I eagerly await your next inane post.

      • Karl Prahl

        Left/Right is a false dichotomy. Republicrats are one in the same.

    • MsAbila

      The country needs a health care reform! ACA is the beginning of this reform. For thousands of people it is a blessing because they are now cannot be denied care.
      To me it’s a shame that we Americans cannot stand up as one entity and demand a universal health care system that covers everyone equally. We seems to be so happy to engage in wars to fight for ‘democracy’ in various parts of the world where our tax dollars are being spent, but here at home we cannot agree on a universal health care system under the umbrella of our democracy.

      • Karl Prahl

        I’ll sign the petition to bring the troops home and retrain them as doctors for universal care. Turn the Pentagon into a hospital!

        Who needs Doctors Without Borders when you have the Army/Navy/Airforce/Marines carpetbombing the nation in free healthcare?

        • fun bobby

          I like it. I bet if we just brought the medical staff from the thousand (see article below) or so foreign military bases we have that would be enough to open 20 new hospitals or clinics in each state.

          “In the grand scheme of things, the actual numbers aren’t all that important. Whether the most accurate total is 900 bases, 1,000 bases or 1,100 posts in foreign lands, what’s undeniable is that the US military maintains…an empire of bases so large and shadowy that no one – not even at the Pentagon – really knows its full size and scope…An honest count of US bases abroad – a true, full and comprehensive list – would be a tiny first step in the necessary process of downsizing the global mission.”

          http://www.occasionalplanet.org/2011/01/24/military-mystery-how-many-bases-does-the-us-have-anyway/

    • nj_v2

      Zenplatypus stammers, ” Remember, this was a vast expansion of the welfare state — the largest in a generation, in fact…”

      It must be physically painful to be this clueless.

      A bill requiring the purchase of a commercial, non-government product is an “expansion of the welfare state”?

      • notafeminista

        One is eligible for a subsidy if the insurance is unaffordable. One is eligible for a subsidy if the penalty is unaffordable. A penalty still exists if the privately owned coverage doesn’t meet the standards set by the PPACA. Yes. This is an expansion of the welfare state.

        • OrangeGina

          Wrong. Expanding Medicare to all would have been an expansion of the “welfare state”. This is welfare for the Insurance industry.

          • notafeminista

            It isn’t the insurance industry counting on the subsidies and it won’t be the Federal Government held accountable should the subsidy payments be delayed or outright defaulted upon. You are incorrect.

      • Zenplatypus

        So says the dolt with exquisite diction. Come on, you’re a big girl now, reach for dictionary and tell us what stammer means …

  • Sy2502

    All I need to know about Obamacare is that Congress exempted itself, and that unions are now trying to do the same. You know the ship is sinking if the rats are running for their lives.

  • HonestDebate1

    Perfect!

  • Robert Young

    Gee, are these the best guests you can get for this important issue? I’d prefer to hear people with more answers.

  • notafeminista

    That would be the IRS at tax time.

  • hennorama

    Steph — how do you feel about auto insurance? Do you purchase it (assuming you own/drive a vehicle)?

  • HonestDebate1

    You no longer have a say about what’s for your own good in the fundamentally transformed America.

    • hennorama

      Debates Not, He — what nonsense.

      All citizens and legal residents maintain their freedom of choice. They can get coverage, pay a penalty, or do nothing.

      The economic and/or “what’s for your own good” cost/benefit calculus remains in place. Only an ignorant fool would fail to recognize this fact.

      • notafeminista

        Get coverage or pay a penalty is not exactly a choice. One chooses whether or not to buy an automobile and there is no penalty for not owning an automobile.

        • hennorama

          notafeminista — as is typical, you left out the third free choice — do nothing.

          Thanks for playing.

          • notafeminista

            Oh no no..doing nothing is not an option. If one does nothing, then one is penalized.

          • hennorama

            notalogician — Thanks again for disproving your argument with your own prior words.

            You wrote “One chooses whether or not to buy an automobile…,” which means you acknowledge that doing nothing IS a choice.

            Well done, again.

          • notafeminista

            But one cannot choose whether or not to have health insurance. To make the choice to do nothing is to be penalized, which is no choice. Are you always willfully obtuse?

          • hennorama

            notalogician – thank you again for disproving your argument with your own words, despite their nonsensical nature – “To make the choice to do nothing is to be penalized, which is no choice.”

            Perhaps you’re simply willfully ignorant of the meaning of the word “choose.” Please allow me to assist you. Per m-w.com:

            “Full Definition of CHOOSE
            transitive verb
            1a : to select freely and after consideration ”

            Perhaps you are also simply willfully ignorant of the various conservative groups promoting the idea, especially for young people, to “opt out of Obamacare.”

            Many individuals will make this choice, for political and/or economic reasons. Many others will do nothing at all, simply through inertia and/or ignorance.

            That you fail to understand such a simple concept is your issue, not mine.

            Thanks again for playing.

          • notafeminista

            You didn’t answer the question.

          • notafeminista

            And once again, why don’t you explain to the class what kind of choice comes from following the intent of the law (presumably to ensure everyone is insured) then receiving a penalty for abiding by the law?

          • hennorama

            Satan — Info Time:

            You might want to become better informed about the law before repeating your assumptions. The PPACA has multiple purposes, which are stated in several of the Title sections of the law:

            TITLE I–QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS
            TITLE II–ROLE OF PUBLIC PROGRAMS Subtitle A–Improved Access to Medicaid
            TITLE III–IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
            TITLE IV–PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH
            TITLE VI–TRANSPARENCY AND PROGRAM INTEGRITY
            TITLE VII–IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES
            TITLE X–STRENGTHENING QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS

            See:
            http://www.govtrack.us/congress/bills/111/hr3590/text (text of H.R. 3590 (111th): Patient Protection and Affordable Care Act)
            http://thomas.loc.gov/cgi-bin/bdquery/z?d111:HR03590:@@@D&summ2=m& (Congressional Research Service Bill Summary, H.R.3590, 111th Congress)

          • notafeminista

            The purpose of the law is to make sure everyone has health insurance. Blather on all you like, but that is its purpose. Otherwise all the nonsense about x million Americans who are uninsured is academic and there would be no need to penalize those who do not have insurance.

            (edit added) …and by the by you have not answered the questions…plural now. Telling indeed.

          • notafeminista

            .

          • hennorama

            Mitt’s Inane Oaf – that is merely your opinion. Even if there is 100 percent compliance, millions of US residents will still have no health insurance, for multiple reasons.

            That you find a discussion “about x million Americans who are uninsured” to be both “nonsense” and “academic” is unsurprising. You seem completely ignorant of the fact that many will actively choose to not obtain health insurance. There will also be those who qualify for subsidies and/or Medicaid that will not obtain health insurance, or will not enroll in Medicaid, and who will also pay no Federal penalty whatsoever.

            Ignorance is not bliss.

            If you have questions for me, please state them. Sifting through your questions to sort out the non-rhetorical ones is tedious, but I’ll answer those that you pose.

          • notafeminista

            The questions have been posed…some more than once. You have chosen thus far not to answer the questions. I’ve noticed in all of the tedious sifting you’ve already completed, you’ve not once addressed me on the substance of the actual law.
            Willfully obtuse.

          • hennorama

            notafeminista – if your point is that I haven’t answered some of the questions in your posts, I readily concede. As stated, sifting through your questions to sort out the non-rhetorical ones is tedious.

            If on the other hand you have actual non-rhetorical questions to which you want answers, please repeat them. It’s far simpler for you to select them.

            If you have points to make about the PPACA, please do so. My original point that “All citizens and legal residents maintain their freedom of choice. They can get coverage, pay a penalty, or do nothing” not only remains completely intact, it also has been expanded.

          • notafeminista

            There are any number of circumstances about the law on which I’ve posted. You’ve not addressed one of them..which is typically your M.O.
            Let’s start with the provision in the law that penalizes consumers for not having the right kind of insurance. What say you?

          • hennorama

            notafeminista – Thank you for your response.

            Your question contains multiple issues precluding a cogent answer.

            Please provide more details, such as a code section of the PPACA for this “provision,” or other relevant factual information. Please also define your terms “penalizes,” “consumers,” and “the right kind of insurance.”

            Thank you in advance for your clarification of your question.

          • notafeminista

            The question is not unclear. You’ve already demonstrated you have easy access to the information you need. I should think it would be ridiculously easy to refute my claim. On the other hand perhaps not, as I’m sure you would have done so already. Please tell the class what “a legal citizen” of the US, who has purchased his own health insurance coverage independent of the exchange will face should the coverage he has purchased(and presumably suits his needs as he sees fit)not meet the standards set by the PPACA.

          • hennorama

            notafeminista – Thank you for your partially clarifying response.

            The answer depends on a number of factors, such as annual income and family size, but in general, purchasing non-grandfathered and non-qualified health insurance results in two outcomes:

            You are not eligible for premium support through Federal Premium Tax Credits.
            You may be liable for a fee/penalty/tax (pick the term you prefer).

            One other factor is that such non-qualifying insurance plans will likely be very difficult to come by, as few insurers may be motivated to offer them, due to low demand.

          • notafeminista

            My goodness. A long way round we had to go for you to say I’m right. A choice for which one is presumably “free to make” and is then assessed a fee/penalty/tax for having made that choice, is in fact, no choice at all.
            Now then. What purpose does it serve to assess said “legal citizen” a fee/penalty/tax for having the wherewithal to do the research, find health insurance coverage that fits his needs, but doesn’t meet the standards of the PPACA?

          • hennorama

            notafeminista — not only is that a free choice, making such choice does not necessarily subject one to any fee/penalty/tax, making your conclusion invalid.

          • notafeminista

            The choice is not free when coercion is attached. Do this…or there will be a fee/penalty/assessed. The conclusion is not invalid and once again, you’ve ignored the question.

          • hennorama

            notafeminista — as with all laws, one can freely choose to ignore, disobey, or comply with the PPACA. If you believe that a potential fee/penalty/tax is “coercion,” you are free to enjoy your belief. If your standard for “coercion” is a potential penalty for non-compliance, then you must think that virtually all laws are coercive.

            If you believe the PPACA is coercive, which other laws that have potential fees/penalties/taxes associated with non-compliance do you find coercive?

            You are also free to pose any questions you wish, and I am free to answer them or ignore them or do nothing at all. My answer to your prior question, specifically, is:
            I don’t know, I haven’t given it a single moment’s thought, and won’t be anytime soon. Thank you for asking.

            If your aim is to simply ask a series of hypotheticals about the purpose of the PPACA, I won’t be participating.

            If you need more information about the PPACA’s purpose, you can read the law, contact those who wrote it, or discuss it with someone else.

            Thank you for your interest. I look forward to the answer to my question.

          • notafeminista

            You didn’t read my response closely. Try again – it is not that I find a discussion “about x million Americans who are uninsured” to be academic. Nor is it my opinion that “x million Americans” are uninsured.

          • fun bobby

            and what is the current tax/penalty for not purchasing a car?

          • hennorama

            fun bobby — I did not make the original rather silly comparison between obtaining health insurance and purchasing an automobile. One suggests you refer your questions to the originator of the comparison.

          • notafeminista

            Then what was your intent in questioning Steph’s feelings about automobile insurance? Seems to be otherwise random.

            “Steph–how do you feel about auto insurance? Do you purchase it (assuming you own/drive a vehicle)?”

        • jefe68

          The false equivalency angle. Good one.

          • notafeminista

            When in Rome. Perhaps you missed hennorama’s post.

      • notafeminista

        Oh, and even better. Should I decide to purchase insurance on my own, and it does not meet the standards of the PPACA I will still pay a penalty. Some choice.

        • hennorama

          notalogician — Thank you for pointing out yet another free choice.

          Well done.

          • notafeminista

            Just bugs you that you can’t anagram my name into a cutting and clever version of your own doesn’t it.
            So I choose to purchase insurance outside the exchange, and I still get penalized? Clearly the objective here is NOT to get people insured.

          • hennorama

            notalogician — TY for disproving your own argument, by using the word “choose” in your response. Very well done.

            “Clearly the objective here is NOT to [be logical].”

            Glad to see that you enjoy your nickname. As to your remark that I “can’t anagram [your moniker] into a cutting and clever version” — untrue. As you are clearly a minor and infrequent contributor, I simply haven’t expended the time and energy involved in the process. Off the top of my head, there are multiple fun combinations using “satan” as part of the resultant anagrams. One also sees the words inane, insane, anemia, etc., right off the bat.

            Again, glad to see that you enjoy your nickname.

          • notafeminista

            Ah but you just can’t make it work can you? Darn it all.
            Why don’t you explain to the class how being penalized for following the law is a viable choice. Assuming the intent of the law is to get everyone insured and not to force a particular standard.

          • hennorama

            notalogician – your premise as to “the intent of the law is to get everyone insured and not to force a particular standard” is not accepted. The PPACA has multiple purposes.

            As to available choices – repeating, for the slow and the stubborn:

            All citizens and legal residents maintain their freedom of choice. They can choose to get coverage, choose to pay a penalty, or choose to do nothing.

            In addition, as you have pointed out, they can purchase health insurance that does not comply with the law.

            Finally, as Mitt Romney stated so eloquently, “The answer is self-deportation.”

            Also as previously stated, there are a number of conservative groups who are actively promoting the idea, especially for young people, to “opt out of Obamacare.”

            In case you fail to understand the term “opt out,” please allow me to again cite m-w.com:

            “Definition of OPT OUT

            “ to choose not to participate in something —often used with of {opted out of the project}”

            Please note the word “choose” in the definition above, and recall the previously cited definition.

            Thank you again for playing.

        • hennorama

          Mitt’s Inane Oaf – please allow me quote Mr. Willard Mitt Romney, in order to point out another obvious choice that you have:

          “The answer is self-deportation.”

          Thanks again for playing.

  • sickofthechit

    In a 2013 Bloomberg study, the United States ranked 46 or 48 of the most industrialized nations as far as effiiency of health care dollars spent. We spend more per capitpa and as a % of GDP yet we have left 40,000,000 Americans with no coverage while the other nations cover everyone. Not real hard to figure out that we are way behind the times. The Affordable Health Care Act was a start. I think we would have been much better off with a system where we systematically reduce the age of Medicare Recipients on a 3,2,3,2…..year pattern until the whole nation is covered.

    You could also get a good intro from the Wikipedia entry on “Health care in the United States”.

    If you are 25 years old you should be on your parents policy until you are 26.

  • anamaria23

    I hope not having health insurance works out for you and may you remain healthy and never need it.
    There are obligations within the ACA that will verify compliance or not. The most you will pay is a small fine.
    My son, working per diem without health insurance recently ran up $2700.00 ER bill for a minor, but urgent injury. He will be paying that off for some time.

    • notafeminista

      Define small. In 2014 the flat dollar penalty is $95 for each uncovered adult. In 2015 it goes up to $325 and in 2016 it goes up to $695 – per uncovered adult. Or, if it is greater, 1% of your adjusted gross income in 2014, 2% in 2015 and 2.5% in 2016. The penalty is capped at the average cost of a Bronze plan which is estimated to be $4,000-$5,000. Per uncovered adult.

      http://www.healthinsurance.org/learn/obamacare-penalty-calculator/

      • fun bobby

        estimated but who knows? the calculator npr had posted did not actually have data for MA

  • notafeminista
  • jefe68

    You’ll be paying for it at tax time.
    If you don’t get a serious illness, or have a serious accident it wont cost you that much for the first year or two.

    The thing is you might get more back in a tax break so buying insurance might be worth it.

    • notafeminista

      You might….or you might not.

      • jefe68

        Really smart answer there.

        • notafeminista

          It’s the honest answer. Do not pretend like you know.

  • fun bobby

    whether this obamacare thing stands up or not in the future the bulk of your non emergency and non surgical healthcare will come from the internet and Wal-Mart and Walgreens.

    • fun bobby

      sorry to burst your bubble jefe

  • JGC

    My sister, when she was in her mid-20s, was poised to begin her first career employment after college, when she was struck with abdominal pain just a few days before she began her first day on the job. She was not covered yet by her employer’s insurance. It turned out to be a burst appendix, was a major health emergency, sidelined her for a very, very long time. And then there were complications from the resulting interior scarring, that closed off her intestine a couple months later, resulting in more emergency surgery. And it didn’t end there…

    I want to give a nod to anamaria23. We cannot pick and choose when we are suddenly faced with a health crisis. Get the insurance. Age 25: maybe there is still a possiblity you can be covered through one of your parent’s plans for one more year.

    • notafeminista

      I may be incorrect, but I don’t think Steph is concerned about lack of health insurance.

      • JGC

        How sad, you may be right about that. OK, I’ll answer her real question, about how the enforcing agency will find her out: the NSA will forward it to the IRS. Feel better now?

  • anamaria23

    Living Will is valuable in the event of sudden loss of competence. Those contemplating extraordinary measures specific to their disease when competent almost always need professional guidance. DNR, intubation, tube? No.
    Another round of chemo or radiation, heart or liver transplant. Maybe.
    Would that it be so black and white as you suggest. It just isn’t.

    • brettearle

      Not sure I understand what the boundaries and limits are before there is the assertion of Death Panels.

      The Counseling aspects cannot include an option of the refusal of treatment–because refusal of treatment is ALREADY a fundamental right..

      If the GOP avers that a reminder of the Right of the refusal of treatment is a Death Panel, then the ACA is woeful in its own self-definition and making it clear to the American public, of what it is that they are doing, with the End-of-Life strategies.

      Another round of Whatever treatment has NOTHING to do with Death Panels.

      THAT is the point of the argument–an argument against counseling that must be seen for what it is: a way to prevent patients from knowing their rights and options for treatment or non-treatment–no matter what.

      The counseling does not force anyone to do anything. And it must be assumed that the patient will hear all aspects of the consequences of a decision.

      THAT is not Death Panels.

      Why can’t people in this so-called Final Line of Medical Combat explain this, much less sometimes, realize this?

      The way it is being explained suggests that some may not actually realize this!

      A hospital would be in violation of the law if they refused treatment to a patient who wanted it.

  • Logicalfarmgirl

    Reference caller, “Steve”, who was concerned about an increase in his monthly contribution (currently $50) to his employer provided health insurance program. Steve pays $50 per month. $50!!!! He’s selfish and lucky. I pay $700 for my individual (not family) insurance plan. I am lucky I can afford it. How many working poor can?

    • notafeminista

      Doesn’t matter. The working poor will get subsidies if the coverage is unaffordable. The working poor will get subsidies if the penalty is unaffordable. If the working poor should find coverage suitable to their needs outside the exchange that does not meet the standards of the PPACA there is a penalty.

      It is not unreasonable to surmise the tax on medical devices will be a hefty one, and it is no surprise young people (say under 35yoa) are strongly encouraged to enroll. Someone needs to fund the subsidies.

      http://www.healthinsurance.org/

  • hennorama

    Snuffy2U — proof of financial responsibility for one’s own health care might be a reasonable option for future consideration. However, predicting the size of one’s future health care needs and costs is no simple task, and is considerably different from predicting the most likely costs of an auto accident.

    Indeed the charges for health care can be difficult to discern and to justify, and this is an important issue.

    No single law can solve all the problems related to health care, as is manifest in the PPACA. However, short of completely discarding the present system and instituting a single-payer system, Obamasurance is a reasonable compromise.

    Thank you for your thoughtful response.

  • marygrav

    Why is it that everything to benefit Americans is called Entitlements? We pay for them with money and blood, aren’t we entitled to enjoy the crumbs from our rich men table. Even the dogs get to enjoy the crumbs while the 99% are not entitled to a fraction of the wealth that they have created and paid for out of their own wages slaving for the 1%.

    WE are the government, not those running dogs who serve in Congress at the will of AIPAC. This is not anti-Semitism, because Jews and Gentiles suffer alike suffer at the hands of a Congress that wants to deny US that benefits that WE are entitled.

    We serve in the military–send our sons and daughters to the military to protect the wealth of 1%, then WE are told that we are not entitled to what every other Industrialized Westernized country has: National Health. We live and die in fear of sickness and poverty because the Wealth of the Nation belongs only to a few.

    The next politician that tells you that Entitlements are or have ever bankrupted the US, ask them about the Wars that have to be paid for and the Industrial Military Complex that eats up treasure and lives of our young people.

  • Carolynn Gockel

    I think you’re being extremely foolish. I know several people your age who thought the same thing and wound up with cancer, getting hit by a bus (no, really), and pregnant.

    If you earn less than $45,000 a year, you can get tax credits. Also, a basic plan that will keep you from running up health bills over $6,000 costs about $100/month (in a less urban area it might be considerably less–I just checked on coverage in Chicago)

  • Guest

    What would happen to you if your employer gave you a project to complete within three years, spent _illions on the project (millions or billions, who knows), and you utterly failed?

    “The Affordable Care Act’s new health insurance exchange websites were supposed to be up and running on Tuesday morning. But as of Friday afternoon, more than 80% of them still weren’t working.

    “There’s increasing evidence that hardly any American has been able to purchase a plan through healthcare.gov, the trouble-plagued federal website that serves as the nexus for 36 states’ insurance exchanges.”

    http://www.forbes.com/sites/dandiamond/2013/10/04/42-obamacare-exchange-websites-still-plagued-with-problems/

    I bet no one is fired for the failure, and that they will probably receive bonuses at taxpayer expense.

ONPOINT
TODAY
Apr 24, 2014
Senate President Pro Tem Darrell Steinberg, D-Sacramento, left, talks with Sen. Ed Hernandez, D-Covina at the Capitol in Sacramento, Calif., Monday, April 21, 2014. Hernandez proposed a constitutional amendment that would ask voters to again allow public colleges to use race and ethnicity when considering college applicants. The proposal stalled this year after backlash from Asian Americans. (AP)

California as Exhibit A for what happens when a state bans affirmative action in college admissions. We’ll look at race, college and California.

Apr 24, 2014
A Buddhist monk lights the funeral pyre of Nepalese mountaineer Ang Kaji Sherpa, killed in an avalanche on Mount Everest, during his funeral ceremony in Katmandu, Nepal, Monday, April 21, 2014.  (AP)

A Sherpa boycott on Everest after a deadly avalanche. We’ll look at climbing, culture, life, death and money at the top of the world.

RECENT
SHOWS
Apr 23, 2014
Attendees of the 2013 Argentina International Coaching Federation meet for networking and coaching training. (ICF)

The booming business of life coaches. Everybody seems to have one these days. Therapists are feeling the pinch. We look at the life coach craze.

 
Apr 23, 2014
In this Thursday, Dec. 20, 2012, file photo, Chet Kanojia, founder and CEO of Aereo, Inc., shows a tablet displaying his company's technology, in New York. Aereo is one of several startups created to deliver traditional media over the Internet without licensing agreements. (AP)

The Supreme Court looks at Aereo, the little startup that could cut your cable cord and up-end TV as we’ve known it. We look at the battle. Plus: a state ban on affirmative action in college admissions is upheld. We’ll examine the implications.

On Point Blog
On Point Blog
The Week In Seven Soundbites: April 18, 2014
Friday, Apr 18, 2014

Holy week with an unholy shooter. South Koreans scramble to save hundreds. Putin plays to the crowd in questioning. Seven days gave us seven sounds.

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Our Week In The Web: April 18, 2014
Friday, Apr 18, 2014

Space moon oceans, Gabriel García Márquez and the problems with depressing weeks in the news. Also: important / unnecessary infographics that help explain everyone’s favorite 1980′s power ballad.

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Some Tools And Tricks For College Financial Aid
Thursday, Apr 17, 2014

Some helpful links and tools for navigating FAFSA and other college financial aid tools.

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