Friday, January 29, 2016

Deadline for a government mandated product.

The Yahoo homepage had some nice reminders all day today and I found this graphic of the fine schedule.  Git yer "affordable" healthcare by Sunday! (FYI - being forced to buy health insurance does not equal affordable healthcare)...and use eHeath because the $850 million government website still has flaws.  I wonder how long it will take before the fines for not having health insurance will grow to the point where they are actually more than the cost of insurance (and where do those fines go?).  My guess is that the Obamacare system will implode before that happens.  60,71,33,0,B

79 comments:

Barney (The Old Fat Man) said...

I sure am glad Obamacare does not apply to me.

Gene Adcock said...

Political - not TFL News and happenings.

John Wells said...

There is more to life than just living off the grid...

Larry G said...

lots of disinformation flying about. the facts are there for those that really want them.

The max penalty if you make more than 400% of poverty level ($47,000) is $975.

but then there are a crap load of exemptions:

You were homeless
You were evicted or were facing eviction or foreclosure
You received a shut-off notice from a utility company
You experienced domestic violence
You experienced the death of a family member

You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property

You filed for bankruptcy

You had medical expenses you couldn’t pay that resulted in substantial debt

You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member

You expect to claim a child as a tax dependent who’s been denied coverage for Medicaid and CHIP for 2015, and another person is required by court order to give medical support to the child. In this case you don’t have to pay the penalty for the child.

As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace in 2015

You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid in 2015 under the Affordable Care Act

Your individual insurance plan was cancelled after June 30, 2013 and you believe other Marketplace plans are unaffordable

if marketplace insurance costs more than 8.05% of your income -you are exempt.

if you don't make enough to file taxes -you are exempt.

and if you do qualify for a hardship exemption -you can then buy Catastrophic insurance and that counts as valid coverage and protects you from bankruptcy.

if you make LESS than $47K a year - you very likely will get a sliding-scale premium tax credit which can reduce the monthly cost to as low as 100-200.... or lower

yes - the lower priced insurance has high deductibles but it does StiLL provide "free" cancer and other disease screening, vaccinations, and once the deductible is met -everything beyond that is covered and your assets are not going to be lost to bankruptcy.

trying to figure out what would be better... for most folks... the crap insurance that was being sold before?

John - I would think that you of all people you should know from personal experience how one single accident can cost tens of thousands of dollars and deplete your savings and/or threaten to leave you virtually penniless from collection agencies.

you can get guaranteed coverage that cannot deny pre-existing conditions and protect yourself from losing your assets... if you have another injury or contract a serious illness.






John Wells said...

Wow...that was a mouthful. Does the affordable healthcare act do anything to make healthcare affordable? Only if someone else pays for it.

Larry G said...

do you KNOW - HOW it is funded John?

do you realize that people with employer-provided get that insurance tax free and that its the govt that prevents those insurance companies from cancelling pre-existing conditions?

if you pay more for the premiums the deductibles are less - that's the way insurance should work AND you pay more - as much as 50% more if you smoke.


It's "affordable" because it DOES cover cancer and other disease screening and vaccinations for no extra cost and protects you from bankruptcy once you exceed the out-of-pocket -

John - what happens if you have another accident or you have an unexpected serious illness that could cost you even more than this one did?

you're a smart man ... think about this.






Jeff P said...

I lived (worked) in the Bahamas four years and they had National Health Care. It was paid for with money from import tariffs. So, if we want to provide insurance for Grandmothers and whomever. My suggestion would be to charge an import tariff on Chinese "stuff". The addtional cost would then make USA more competitive to manufacture the "stuff" and in turn maybe provide more jobs so people wouldn't need National Health Care. I myself do not need it, but, for those who do. I agree, National Health Care should not be a mandate to buy insurance, because that sounds like some sort of deal to me.









John Wells said...

ponzi scheme comes to mind...a fraudulent investment operation where the operator, an individual or organization, pays returns to its investors from new capital paid to the operators by new investors, rather than from profit earned by the operator.

Bryan Campbell said...

The only thing the obamacare does is make the politicians and lobbyists richer.

coffeebottlerocket said...

John,

I reckon that if the fines for obamacare skyrocket and people can not afford the insurance the only logical result will be to quite your job, get a lower paying job or stop working all together and go on the government dole.

Now someone can be a housepainter, electrician or some other occupation where someone can work for barter or for a gratuity under the table. I hate saying this but the 'oldest occupation' known to man may make a big comeback for single women that have been forced out of the workforce due to obamacare.

what gets me is that obamacare was written by the insurance companies? That's like allowing the fox to guard the henhouse.

WhyR said...

Larry G: you are doing wonderful work providing actual facts- news that people can use- but you are paddling upstream against a strong current of outright lies and misinformation served up by Fake News Corp and literally thousands of misleading sites and AM radio bloviators with an ideological ax to grind.
Every other developed country on Earth has long ago figured out how to get affordable healthcare for its people, but it just can't be done here because powerful entrenched interests like it that way.

Steve said...
This comment has been removed by the author.
Ted Webb said...

The official name for “ObamaCare” is the Patient Protection and Affordable Care Act (PPACA), or Affordable Care Act (ACA) for short. • The ACA was signed into law to reform the health care industry by President Barack Obama on March 23, 2010 and upheld by the Supreme Court on June 28, 2012.Lets not appeal it lets improve it!

Bill R said...

I had always assumed that a large factor in high health insurance cost was that those of us who have insurance were having to absorb the cost the industry incurred for treating the uninsured masses. But I have seen no relief in that area since ACA has become law. Instead the reality is just what most thinking people instinctively knew it would be. The cost of insurance is rising and the quality of coverage is declining.

Janet said...

I've heard the saying "you can never go back." We had more freedoms before the proliferation of "positive" laws. That shalt do this and this and this or else. The older I get it becomes impossible to remember all of them or keep up with them all. I'm still trying to figure out my cell phone.

Ted Webb said...

Larry G said... ( WORTH REPEATING )
lots of disinformation flying about. the facts are there for those that really want them.

The max penalty if you make more than 400% of poverty level ($47,000) is $975.

but then there are a crap load of exemptions:

You were homeless
You were evicted or were facing eviction or foreclosure
You received a shut-off notice from a utility company
You experienced domestic violence
You experienced the death of a family member

You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property

You filed for bankruptcy

You had medical expenses you couldn’t pay that resulted in substantial debt

You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member

You expect to claim a child as a tax dependent who’s been denied coverage for Medicaid and CHIP for 2015, and another person is required by court order to give medical support to the child. In this case you don’t have to pay the penalty for the child.

As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace in 2015

You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid in 2015 under the Affordable Care Act

Your individual insurance plan was cancelled after June 30, 2013 and you believe other Marketplace plans are unaffordable

if marketplace insurance costs more than 8.05% of your income -you are exempt.

if you don't make enough to file taxes -you are exempt.

and if you do qualify for a hardship exemption -you can then buy Catastrophic insurance and that counts as valid coverage and protects you from bankruptcy.

if you make LESS than $47K a year - you very likely will get a sliding-scale premium tax credit which can reduce the monthly cost to as low as 100-200.... or lower

yes - the lower priced insurance has high deductibles but it does StiLL provide "free" cancer and other disease screening, vaccinations, and once the deductible is met -everything beyond that is covered and your assets are not going to be lost to bankruptcy.

trying to figure out what would be better... for most folks... the crap insurance that was being sold before?

John - I would think that you of all people you should know from personal experience how one single accident can cost tens of thousands of dollars and deplete your savings and/or threaten to leave you virtually penniless from collection agencies.

you can get guaranteed coverage that cannot deny pre-existing conditions and protect yourself from losing your assets... if you have another injury or contract a serious illness.




Larry G said...

RE: " I had always assumed that a large factor in high health insurance cost was that those of us who have insurance were having to absorb the cost the industry incurred for treating the uninsured masses. But I have seen no relief in that area since ACA has become law. Instead the reality is just what most thinking people instinctively knew it would be. The cost of insurance is rising and the quality of coverage is declining. "

it's not going to bend - right away.

the problem is that docs get paid for the services they provide - not whether those services resulted in better health so basically the more services they sell - the more they make and the more it boosts costs to those treated.

Obamacare was never designed to directly cure that.

Obamacare was designed to convince people to go to primary care doctors rather than the ER which in theory would catch disease early and make it less expensive to treat than if it waiting undiscovered then you hit the ER and 10 times the costs involved.

it will take some years of people who never had a primary care doc - to start using one regularly - meanwhile - all the folks before that - still have advanced diseases and still getting treated for it - whether charity care at hospitals or newly covered in Obamacare.

once disease has advanced - you cannot roll those costs back.... you have to START with people getting care to detect disease BEFORE it goes undiscovered and much more costly.

I don't know if the above made it more clear or just confused it further... ;-)

Bill R said...

Regarding the concerns I expressed, I don't have any anticipation of the ACA providing any relief in the foreseeable future. I only expect what I said in my last sentence to continue. Get back with me when that trend turns significantly.

Larry G said...

you're expecting something from the ACA it was not designed to do. It was designed to respond to a very real issue but not the one you think it was.

Steve said...

I say overturn ACA and go back to what we had. We can all watch our healthcare cost balloon uncontrolled far more than they have since the ACA was passed into law. And if you truly do get very ill or severely injured (like crashing a 4-wheeler for instance), don't be surprised by the insurance company using recission to "evict" you from coverage. Oh, and for all of you folks with risk factors or preexisting conditions, get ready to open up your wallet and/or cash in your 401K. It ain't gonna be cheap. Then, we can all remember the "good old days" of the ACA.

Ted Webb said...

Not a thing wrong with A C A ,it just needs to be improved

Bill R said...

I'm worried about a plan to address healthcare issues that opens by burdening taxpayers with the additional overhead associated with wrapping it in a multiple tens of billion dollar bureaucracy.

Excuse my skepticism, but I don't see that work very often.

Larry G said...

a valid concern. do you know how it is funded?

do you know that it is not funded from general revenues?

Bill R said...

There are essentially no revenues other than what is provided by the individual taxpayer, so yes I know who is funding it. Any cost incurred by any entity other than the individual taxpayer is immediately passed right back to you and me as either a tax or as an increase in the cost of goods and services.

I'm paying for it. And maybe you are. We're all either paying for it, benefiting from it, or ignoring it.

Larry G said...

not true. there are a series of dedicated/earmarked taxes that fund the premium tax credits and cost sharing.

you are ALSO paying for employer-provided which is not taxed as income just like other tax breaks.

you and I are ALSO paying to fund charity care at hospitals for people without insurance.

we are ALSO paying for Medicare and Medicaid and TRICARE and the VA health care.

right?

pamit said...

It is an uphill battle, Larry G, to put the facts in front of folks and expect them to respond with logic and reason. Good on you for taking it on in this small forum.

John, you could take a leaf from Larry's book and avoid the knee-jerk sarcasm when posting your beefs with the ACA. I daresay Larry can address any *real* criticism you have of it. You are lucky to have such an informed reader.

My own recent datapoints on the ACA are still unrelentingly positive. My poverty-level friend in TX had her premiums double this year, from $89 a month last year to $150 or so this year. BUT she is getting regular medical workups and recently had a small dermal carcinoma removed. Without the ACA, I'm pretty sure she would have *no* insurance and not gotten treatment. Her biggest beef with the ACA is no dental coverage. (I've actually helped her get dental treatment with small personal loans.)

AND I myself just blew out my knee skiing, torn ACL and MCL. Looking at a possible surgery, but my doc is treating me conservatively and thinks there's a good chance I won't need an operation. Start PT next week. So far I have paid three $35 copays and $600 for an MRI (because my deductible is $800). Not bad for a severe injury. I'm sure I will pay more before the end, but I'm quite satisfied so far with my coverage and treatment. I get my coverage (Aetna) through my job, pay about $60 a month. Can you imagine how much I'd be out-of-pocket without insurance coverage??? Yowza!

Larry G said...

Many of the low cost premiums under the ACA have high deductibles and if you want lower ones - you have to pay higher monthly premiums.

that keeps costs under control for the insurance companies which could go away if costs are not contained.

so it's a balance between how much care- and what it costs - for people who probably would not have insurance at all without it and who will go to the ER when they get sick enough.

what they DO get is two important things:

1. - they get "included" cancer and disease screens and they get vaccinations
2. - if they do get sick/injured, once they reach the deductible - they're protected from bankruptcy

so - say you had a bad accident and broke your leg or pelvis or whatever and had 50-80 thousands of dollars of care. so after you reached the 10,000 deductible - yes a lot of money. but everything over that is covered and collectors are not going to come after your home or other assets.

it's a long long way from what people would like - no question about it.

lots and lots of room to gripe -

what's the alternative?

we get to vote about this in a bit don't we?

Quinn Satterwaite said...

what's the alternative?

Maybe use an insurance product the way it is intended to function mathematically: take an unlikely risk with a high cost and turn it into a manageable cost that is certain to occur. So a house fire that is unlikely but will wipe out $250K of value can be turned into an home owners insurance policy that has 100% chance of needing to be paid.

Using an insurance product for "included" cancer screens and check ups is stupid because there is a 100% chance of that needing to happen.

Likewise you probably have a good idea of what a 90% confidence your yearly medical costs will be. If you knew what you are going to spend why would you ever buy an insurance product to make the spend for you. Of course not, since it would be more expensive buying outright. Now you have all the insurance overhead and paperwork shuffling in the way.

The cheapest way to guy medical care is to just go in and pay cash. And not make the doctors office wait months to get paid. The only downside is the wild card where you need an MRI, have to get chemo etc. Those are unlikely event with a high cost- that is what insurance is for.

Consequently the optimal approach would be pay out of pocket for routine medical expense and ask for a cash discount. Then buy a catastrophic care policy that would cover you cancer, hospitalization etc.

EXCEPT that Obamacare made that illegal to do.

When the Obamacare cartoon is forced to buy a policy for $2000 what are they going to do? Use the hell out of health insurance to tray and get their money back. That is why there is little to no price sensitivity to Obamacare and the system will collapse.

Quinn Satterwaite said...

for instance, Cosmetic Surgey isnt overed by insurance and people are much more price sensitive paying out of pocket.

Hence there Cosmetic procedures have seen a much slower rate of cost increase than other medical areas.

"http://www.ncpa.org/pub/st349

The price of medical care has increased an average of 118 percent. The price of physician services rose by 92 percent. All goods, as measured by the inflation rate, increased by 64 percent. Cosmetic surgery prices only rose only about 30 percent. - See more at: http://www.ncpa.org/pub/st349#sthash.0mCFlm6F.dpuf

"

Steve said...

What is "that" that you're referring to?

If you want a catastrophic policy, there are plenty of those available. And with a catastrophic policy, you're going to be paying for your office visits, meds, etc. out of pocket anyway. If you do hit your deductible with a catastrophic policy, that would mean you're one sick fellow, or you bought the wrong policy to begin with.

Unfortunately, the concept of "wellness" is utterly lost on most Americans (and doctors for that matter). It's far cheaper to maintain health than to treat someone when they're sick. The way the system is currently set up, doctors make money by treating sickness, not preventing it. Many of the countries who offer single payer health systems learned that lesson long ago. That's one key way they are able to provide healthcare with costs far lower than in the US. Perfect example would be diabetes. Work with the patient who has risk factors on how to manage their health to avoid slipping into type 2 diabetes vs. having to pay for lifelong medication, and the resulting complications that result. You don't find dialysis centers all over the place in Europe like you do here. There's a reason why that is. Their populations have a significantly lower incidence of diabetes.

To make an analogy, if you bought a new car, you would change the oil and filters periodically, replace tires when they're worn, and do tune-ups periodically, right? Imagine if you bought that same new car and didn't do any maintenance. After about 30K miles your engine would be destroyed from never changing the oil.

Larry G said...

that's not an unreasonable alternative. tell me what countries on earth - 200+ do that?

or show me that proposal from those who oppose Ocare and promise a "replace".

and show me a proposal that works the same way for everyone and not an inequitable approach where the govt creates winners and losers with tax breaks for those who want govt-guaranteed rules health insurance to protect them from the insurers cancelling them for having cancer or a chronic disease.

so UNLIKE employer-provided where you actually WILL -use he hell out of it - you cannot do that with most Ocare policies unless you buy the high end which WILL cost you a pretty penny and do NOT get the premium tax credit.

I'd quibble with you about the cancer screens.. it's like not having your brakes inspected because the inspection will cost you money and not "save" you money...

and you're actually wrong about Ocare...

it does pretty much what you say it does not - it does NOT pay for routine (non preventative) care but it protects you from catastrophic risk - i.e. high deductibles - but 100% paid after satisfied so that DOES encourage people to "shop for lower cost routine care - AND those cosmetic, non-necessary medical...

AND you CAN buy a catastrophic-only policy if your income is too low for the Bronze and Silver plans.

so when I hear the opponents - get together and AGREE on an alternative that they will push and support as a legislative alternative I'll listen up.

otherwise - various individual people with "ideas" don't really count as real alternatives.

get it on the table - and have it compete as a real proposal.


Steve said...

@Quinn

The NCPA is typically classified as a "right wing think tank", so there's no surprise they're cherrypicking and distorting the numbers. That's part of the problem. So many people have an agenda, getting factual information is nearly impossible these days.

Larry G said...

more important - what they advocate for - does it get turned into REPLACE legislative proposals?

if not - then what is their motive ? Are they truly looking for alternatives?

Quinn Satterwaite said...

"The NCPA is typically classified as a "right wing think tank", so there's no surprise they're cherrypicking and distorting the numbers. That's part of the problem. So many people have an agenda, getting factual information is nearly impossible these days"


So out-of-pocket cosmetic surgery rate of inflation is increasing faster than general medical costs? Post your peach picked numbers.

Larry G said...

you would expect and I would agree on things like cosmetic surgery , corrective lens, basic hearing aids, and routine dental that folks cover these things out of pocket and let the free market work. That's the way original Medicare worked before we added Medicare Advantage and those things were covered - and Advantage is virtually 100% subsidized by taxpayers.

HOWEVER - take something pretty basic. A guy has a history of cancer and he wants to buy Catastrophic insurance. Do you think insurance companies are going to "compete" for his business to the degree that he's going to find an affordable policy?

or if someone already HAS insurance and then gets a very expensive disease - do you think the insurance company - if left alone to do what it wants to do - is going to keep that customer and get ready to pay big claims?

When you listen to NCPA, Heritage and others - they keep talking about discretionary medical and the free market - but they say nothing about how people with serious health conditions will be able to obtain coverage.

I will tell folks - if you want to see a govt-sanctioned approach that incorporates BOTH the free market for discretionary medical AND catastrophic for all including low income - such an approach DOES exist. It's the way that Singapore's health care works. You're REQUIRED to save money to pay for guaranteed catastrophic. The rest goes into an HSA that you can spend for the lowest cost providers and services you can find - AND the govt REQUIRES - ALL providers, stores, drugs, even hospitals to disclose the costs of their services.

and What I would especially point out here - is that it DOES take the govt to establish that framework. If you left that to the market - it would never happen.

so back to NCPA, Heritage, American Enterprise, CATO, etc - WHERE are their SINGAPORE-type proposals or are they just going to continue to be critics with no alternative proposals?

Steve said...

Well, to begin with Quinn, the article you cite is almost 3 years old. A lot has changed in the past 36 months.

Steve said...

@Larry

The conservatives have been all-in on the repeal bandwagon for years now. In all those years, they've never offered an alternative. Trust me, they have no alternative. Not one single plan has been put forth as an alternative. All they've managed to do is attempt to overturn ACA 65+ times in Congress, never once expecting to actually pass anything.

They're still occupied with trying to make Obama a "one term president."

Larry G said...

Well Steve - I'm trying to take them - at their word. I listen to the GOP candidates and I keep expecting them to say "REPEAL" and here's what I would do instead - and I'm perfectly find if they say "nothing".. they just need to say what their approach will be and then let voters decide.

they're going to have to do it - at some point - they're going to be in a debate with the Dems and the Dems are going to challenge them to say what they will do and I do not think voters are going to buy "wait until I get elected and I'll tell you then".

LOTS of dishonesty in this. Time for folks to be honest.

Quinn Satterwaite said...

"HOWEVER - take something pretty basic. A guy has a history of cancer and he wants to buy Catastrophic insurance. Do you think insurance companies are going to "compete" for his business to the degree that he's going to find an affordable policy?"


You are ignoring the proper function of insurance. Mathematically what are the insurance premiums going to be on a cost that occurs 100% of the time?

Obamacare derided catastrophic care policies as "junk" and prohibited or severely restricted their use. This is precisely the opposite of the approach we should be adopting.


The HSA-heavy approach is the one favored by Cato. It for out of pocket expense to be pre tax and price sensitive customers to guard against service padding. As long as uncle sugar is paying the bill its MRI's all around!

Steve said...

Agreed. There has been ample opportunity to present a plan, even in a rough form, over the past 7 years. I would like to see some improvements to the ACA, but given that Congress is unable to pass even basic legislation, I'm not hopeful that will happen until one party holds majority in Congress and the White House.

It's been interesting to see how the recently elected Gov. of Kentucky, who ran on repealing ACA, has suddenly fallen silent about what he promised in the election. When he realized what would happen if he followed through on his campaign promises, he had a change of heart. If he had followed through, the governors mansion would have been overrun by Kentuckians wielding pitchforks and axes.

Larry G said...

re: " You are ignoring the proper function of insurance. Mathematically what are the insurance premiums going to be on a cost that occurs 100% of the time?"

not unless you want national policy that some people who get life threatening diseases are not going to be able to get insurance and we are 1. going to pay for their care or 2. let them die.

make your choice - but don't pretend something.

also - you DO REALIZE that employer-provided CANNOT do what you advocate. Insurance companies cannot refuse coverage to those with Employer-provided because of HIPPA which prohibits insurance companies from denial of cover under employer-provided.

do you want to get rid of that also?


"Obamacare derided catastrophic care policies as "junk" and prohibited or severely restricted their use. This is precisely the opposite of the approach we should be adopting."

again - "junk" was policies that would not pay and/or would dump you if you got sick. You paid a premium - when you got sick - the fine print said "too bad - you're only covered for peanuts and now we dump you.

and again - if you want this kind of insurance - then are you saying you do want it to be our policy ? you're going to deny coverage to the seriously sick and:

1. - either taxpayers pick up the costs or
2. - these folks just die...

what I'm advocating is that you do disclose your approach... if we're going to treat
health insurance as like other insurance.

Larry G said...

re: " the governors mansion would have been overrun by Kentuckians wielding pitchforks and axes."

yeah but.. don't Kentuckians do that anyhow? ;-) just kidding

Quinn Satterwaite said...

"also - you DO REALIZE that employer-provided CANNOT do what you advocate. Insurance companies cannot refuse coverage to those with Employer-provided because of HIPPA which prohibits insurance companies from denial of cover under employer-provided."


Eh? You are merging two different things. The existence of catastrophic care policy is completely different from "must cover".

Mathematically, catastrophic are the best best in most cases.
Obamacare premise of covering more people, for more things for less money doesnt make sense.

And beyond that Obamacares broad prohibition against catastrophic care insurance is a disaster because it does nothing to control costs. The miscalculation of medical loss ratios got these high deductible policies classified as "junk" when in reality they are working as designed.

http://www.dailyfinance.com/2012/07/13/obamacare-could-kill-one-type-of-cheap-health-insurance/


Failing exchanges, failing websites, risk corridors being violated and the government is forcing people in to this with ever higher taxes? [who is Yahoo to claim this is a "penalty"? There has already been a SCOTUS decision about this which the corporate media doesnt get to override]. Why shouldnt people be allowed to comment on this lousy plan?

Larry G said...

Quinn - people with employer-provided - have guaranteed catastrophic insurance - the company cannot do what you say - "do the math".

the govt REQUIRES them to do - what market insurance until Ocare did not have to do.

Market insurance goes year-to-year.

you have to renew. If the company thinks you have become too big a risk or too expensive - they decline to offer you insurance.

Ocare was NOT designed to control costs - which is a problem with ALL health insurance - employer-provided AND Medicare AND TRICARE...

it was never designed to do that. It was designed to encourage people to visit a doctor, get preventative services like cancer screens and vaccinations and not wait until they have advance disease to visit the ER - at which point taxpayers are on the hook to pay for something - had it been detected with an earlier screen would have been far cheaper - and far less burden on taxpayers.

"failing exchanges" are you kidding? you're drinking way too much koolaid.

but lets pretend they do fail -

is it your position that we'll then just pay for ERs for folks who don't have insurance?

choose your poison.

Quinn Satterwaite said...

"Ocare was NOT designed to control costs - which is a problem with ALL health insurance - employer-provided AND Medicare AND TRICARE..."

You had better tell Obama because that is not what he promised everyone when he was pitching this:

In an interview with WaPo lots of talk about him "bending the cost curve". Remember that? But most damning:
" Hiatt: But if you got a bill that was universal access paid for but didn't have things you think are key to bending the curve, would you accept it?

Obama: No. And I've been clear about that. And then the reason is because over time, what would happen would be that even if we had paid for it in the first 10 years, in the next 10 years if health care inflation went up faster than whatever revenue source we had we'd be adding to the deficit then. And that's just not sustainable. And I've said as much to members of Congress; we've got to do both. "

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/22/AR2009072202522.html

Larry G said...

re: what was promised.. in the law - not what the POTUS said off the cuff...

there are TWO costs - one is the ever escalating costs of health care itself no matter what kind of insurance.. whether you have employer-provided or Medicare - both costs escalate higher than inflation.

the SECOND cost was the cost of hospital charity care for the uninsured.

he said BOTH - yes - but he never said that Ocare would deal with the inflation part and even if he had - it would have been a contradiction of what the legislation was addressing.

it did not address the increasing cost overall - JUST the costs at the ERs.

you and I pay those costs -both as taxpayers for subsidies for charity care - AND whatever those subsidies do not cover -the hospitals will cost shift to those who do have insurance, e.g. $10 aspirin...

People do not understand ... and they listen to commentators who have agendas... and who color their commentary according to their agenda and many Conservative sources are opposed to the govt being involved in health care - at all - including Medicare...

it's fine to have that view -but I think if you are, once you lay out your criticisms of why you think what we have does not work - you need to say what you really want to do.

and I ask - what do we want to do ?

do we want to pay for people to go to the ER? (that would be EMTALA)

OR - in addition - to repealing Ocare - do we ALSO want to repeal EMTALA and no longer
force hospitals to take people who cannot pay.

what do we choose?

I think each of us - if we are going to hold an opinion - need to be honest enough to say whether or not we will treat people who do not have money or insurance - or not.

we need to be honest about what we want to do.

Quinn Satterwaite said...

ER visits are up under Obamacare.
http://www.usatoday.com/story/news/nation/2015/05/04/emergency-room-visits-rise-under-affordable-care-act/26625571/
Which is exactly what people had predicted based on the the Oregon experience with a medicaid expansion a few years earlier, so that was inconvenient math for the Obamacare acolytes who they engaged in some magically thinking that there was a big cost take out there.

You install an sunk cost system and people use more of the resources- who could have predicted it? Oh yeah everyone who has ready an accounting text book. Thats why membership clubs and Amazon Prime exist. Once you have paid the upfront cost, by God you will find a way to consume it.

Likewise they invented the accounting fiction that preventative care was going to save tons of money when the inconvenient fact is that it does not.
http://www.politifact.com/truth-o-meter/statements/2012/feb/10/barack-obama/barack-obama-says-preventive-care-saves-money/



AND whatever those subsidies do not cover -the hospitals will cost shift to those who do have insurance, e.g. $10 aspirin...

You can only have $10 aspirin and $100 for a hammer when the people receiving the item arent the ones who are paying the bill. Centralize procurement, vague price schedules, no ability to compare cost verse value- those are all "features" of having some insurance company maybe bill you incur 6 months from now.

You really think the $10 aspirin and the $800 toilet seat would exist if it was cash on the barrel head from your pocket?

Larry G said...

ER visits are not going to change overnight - with folks who have traditionally not gone to primary care.. it will take some time especially since many states did not expand Medicaid and those folks do not get insurance.

here's another study to add to your knowledge:

http://www.cha.com/documents/press-releases/cha-medicaid-expansion-study-june-2014.aspx

Executive Summary

 The Medicaid proportion of patient volume at hospitals in states that expanded Medicaid
increased substantially in the first quarter of 2014. At the same time, the proportion of selfpay and overall charity care declined in expansion-state hospitals.

 Medicaid, self-pay and charity care showed no change outside normal variation for hospitalsin non-expansion states in 2014.

 The increase in Medicaid volume, which occurred only in expansion states, is due to
Medicaid expansion. The parallel decrease in self-pay and charity care shows that
previously uninsured patients are now enrolled in Medicaid.

I think MANY $10 aspirin will exist as long as someone with an undiscovered cancer shows up and needs 80K worth of treatment and has no money.

how do you fix that?

do you have an answer to this question?

it easy to criticise - now what do you want to do instead?

come on Quinn -stand for something here ... be honest.






Quinn Satterwaite said...

"not what the POTUS said off the cuff..."

This is like Hillary calling the FBI the Department of Reaching Out.
The SCOTUS decision is 193 pages and they barely got 5 people to squeak this through as a tax. Legally it is in no way a "penalty" or a "fine" as Yahoo tried to claim.

Larry G said...

Quinn - we're talking about what you'd do about people who do not have insurance and go to the ER for charity care.

how would you handle that if you don't like this way?

you non-answer is fairly typical among the critics... I don't understand.

if you feel strongly enough to oppose - what do you want to do instead?

one more try then I give up on you.

Quinn Satterwaite said...

"The parallel decrease in self-pay and charity care shows that
previously uninsured patients are now enrolled in Medicaid."


They are still showing up, and increased numbers, in ER. This is the opposite of what was claimed would happen.

"it easy to criticise - now what do you want to do instead?"

I think I'd start by not trying to use the government's force to muscle people into buying a product they dont want or need.

Thats the whole scheme here- the "young invincibles" have next to no medical costs. "But wait I paid nothing during my 20's but I blew my knee out when I was 33. Gee I was sure glad I could give the bill to someone else." Yeah thats not what we are talking about.

Obamcare is predicated on forcing people to buy a product that they dont want and, actuarially, dont need and then using the excess profit from the young to pay for everyone else. It doesn't account for that maybe after they spend $2-$5K that they are going to find a way to use more services. And when these guys get older where are we going to continue to find young suckers to fund the growing ponzi scheme?

Why do you object so strenuously to John pointing out the obscenity of a private company pimping for the government forcing people to buy a product they dont want or need?

Larry G said...

I don't object to it - I say you are entitled to criticize and I gave an alternate view but I ALSO DID ASK

what you would do instead - an honest answer...

specifically about people going to ERs to get their care.

do you want to pay for them or not?

HEY - I did not mention the govt - I asked what to do instead ...

do you want to pay for people's care at ERs and if not what?

come on guy... is it that hard?





Quinn Satterwaite said...

" Quinn - we're talking about what you'd do about people who do not have insurance and go to the ER for charity care."

Paying directly to the service provider is enormously cheaper, usually 25-50%. Here are some anecdotes.
http://www.huffingtonpost.com/2012/06/18/pay-cash-to-your-doctor-s_n_1571564.html

Take the current subsidies and turn them into HSA contributions. The money can be rolled over and represents a real savings account for the consumer so they are price sensitive about the medical services they are buying.

http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.2520:


The currently government doesnt like this approach because then people actually know how much is in their own accounts. Rather than being strung along on government promises that a greater sucker will be found to pay the liabilities in the future.

Larry G said...

I'm confused.. how do we pay for those who go to ERs and can't pay?

how do we deal with that?

I only see two answers -

either we don't pay - and they get turned away
or we do pay - and just have to figure out the most cost effective way

are there other options?

Quinn Satterwaite said...

Well I guess one way is to have them show up in increased numbers and then claim victory because now some of them have subsidized Obamacare policies. And so we are paying out of the left pocket instead of the right pocket.

Larry G said...

okay. thanks much for the conversation... and keeping it civil..

pamit said...

My sister-in-law and brother, pre-Obamacare, were not covered by health insurance because neither of their employers offered it. They are in their late 40s, early 50s. My sister-in-law had gall bladder surgery via an ER visit. She did have a very bad "quack" doctor who wouldn't charge her much, that she used for that very reason. (He was also under indictment for various things in their small Southern town, but she still went to him because he was "affordable".) After the gallbladder surgery diagnosed by an ER, they knew they'd only have to pay like $30 per month, being practically indigent; this was their health care alternative for an emergency health crisis! Very, very bad way to get your healthcare. My sis-in-law came through the emergency surgery OK, she was lucky.

I'm bringing up this because it illustrates what Larry G keeps trying to get Quinn to answer: is the ER where we want poor people to get their (crisis) health care??? In other words, sub-standard care that we all pay for through higher costs? That's what we had pre-Obamacare.

Now, my relatives have coverage. Being poorly-educated folks in the South, they continuously gripe about the costs. They are too stupid (hey, they're my relatives so I can say that) to realize that they have much, much better care now, and their care is more equitable in that THEY are footing the bill more than others are.

Regarding control of costs: I always understood that Obamacare would control costs OVER THE LONG TERM, not one or two years after. It's the long game, darlings.

Larry G said...

interesting story about your relatives! I too know folks who by the Grace of God dodged soe medical bullets - and bankruptcy - lucky... others not so lucky - glass jars in 7-11s begging to pay for someone's operation or they'll die.. and they do ...die..

yes ACA - was designed to try to convince people who rely on ERs for their care - over a long period of time - to get used to going to docs - and the ERs would join in the effort when they showed up at the ERs - to get told to go to their PC not the ER... and the ACA actually lowered subsidies to ERs - on that premise so that hospitals knew they could lower their costs if they could legitimately tell folks that the ER would not care for them because they now had a Primary care doc.

old habits die hard.. and it's going to take a while.

worse - the ACA was supposed to expand Medicaid to the working poor - literally people who work full time at jobs where there is no insurance... they were supposed to get Medicaid and did not - so those folks STILL use the ERs... so that part of the ACA is not doing what it was intended .

think of tradesmen... who repair plumbing or HVAC... or others who work in 7-11s.. or clean offices at night - daycare providers.. all kinds of folks who provide services to the rest of us - they and their family have no insurance and no way to get help when they get sick so they wait until they think they're going to die and they head down to the ER... where often as not - bad things are discovered that had been festering for a while and never seen by a doc.

and the thing is - the costs to run the ER are real. when someone goes there and uses 20K worth of MRI and such - that's real money that the hospital have to get from somewhere to pay for - when the MRI needs a repair - the repair folks are not doing it for free. If you want nurses at the ER -you have to pay them. You have to pay folks to come in and clean them after every client... etc...

all across the US in poor rural and poor city areas - the last-resort "charity" hospitals are deteriorating.. using old equipment.. leaking plumbing... bad electricity-- many look like 3rd world hospitals.. because most of their clients cannot pay... and so these hospitals are on the edge of disaster..and yes.. they are closing... and people end up 4o-50 miles from the next one.

So I "get it" - people do not like the ACA approach and if they get lucky come the next election - we'll shut down the ACA ...


If that's the will of the voters - so be it.





Quinn Satterwaite said...

"is the ER where we want poor people to get their (crisis) health care??? In other words, sub-standard care that we all pay for through higher costs? That's what we had pre-Obamacare."

Well that is what you have more of post-Obamacare as per the link I posted, and the experience in Oregon and with Romneycare, so if ER visits is your criteria then Obamacare is a failure.


The cost saving that were claimed never happened and now we have an economy where employers dont want to hire full time because then they subject to higher employee premiums or fines.

pamit said...

Yes, ER visits are up, mostly because newly-enrolled Medicaid patients have a shortage of docs that will take them. I'd love to see a comparision of ER *costs*, not just number of visits. And as someone mentioned above, it takes awhile for folks that have *never* had insurance to learn to use it properly, as in go to the doc BEFORE you are in extremis. ER gallbladder surgery, one can imagine, is a lot more dangerous and expensive that the same procedure scheduled before the patient is about to die.

ER visits aren't the only criteria of the success of ACA, and again...the cost savings will be long term. As for employers not wanting to hire fulltime - how does that impact higher employee premiums? I think you mean that the # of fulltime workers affects whether the employer must offer coverage. Frankly, it's a nice side effect of the ACA that workers aren't left in the lurch if the employer decides to drop coverage or raise premiums. Let the marketplace drive the type of employee those bottom-liners attract.

Steve said...

@Quinn

Ask anybody with a pre-existing condition who were unable to get insurance before ACA if they think it's a failure. Or ask anybody who came down with an expensive sickness or suffered a significant injury who were kicked off their policy through recission if they think it's a failure.

ER can't be used as the only criteria. Granted, the ACA isn't perfect. I'm still waiting to hear a single Republican congressman offer up any improvements. If they are so laden with good ideas, why haven't they come forth with any of them? My guess is because they don't have any. And no, Ted Cruz filibustering for 21 hours 19 minutes on the floor as part of his effort to damage the ACA is not what I would consider a "good idea." The only thing Cruz managed to do was get our AAA rating lowered, costing the US tax payers millions.

Steve said...

Sorry, I need to correct one of my earlier comments. I said the GOP had made 65+ attempts to overturn the ACA. Actually, with their vote today it was only the 63rd attempt. My apologies for the error.

Quinn Satterwaite said...

"Yes, ER visits are up, mostly because newly-enrolled Medicaid patients have a shortage of docs that will take them. I'd love to see a comparision of ER *costs*, not just number of visits. And as someone mentioned above, it takes awhile for folks that have *never* had insurance to learn to use it properly, as in go to the doc BEFORE you are in extremis" "

Do you have any citations for this speculation? I gave you a link showing that ER visit where in fact up.

The important thing to note is that Obama's promise to "bend the cost curve down" and not to add the deficit was *wrong*. He factored in ER saving and not only did those savings not occur, the visits increased. Based on his stated critera in the WaPo interview he should not have approved the bill.

Of course all of this math was know at the time since Oregon and more limited MA experience pointed to exactly the opposite account assumptions being fed to the CBO.

Maybe visits will go down in the future. Maybe people who are bad at planning will continue to be bad at planning. Its a moot point since all of the cost savings that were supposed to have been booked never happened.

"And no, Ted Cruz filibustering for 21 hours 19 minutes on the floor as part of his effort to damage the ACA is not what I would consider a "good idea."

Well if you lost your job or had your hours cut to part time you might disagree.
If you are one of the millions you had your health insurance you were perfectly happy with canceled by Obamacare you might disagree.
I will grant you if you are Democrat lobbyist having light thrown onto the something rammed through on a pack of lies isnt a "good idea".

I'm still waiting to hear a single Republican congressman offer up any improvements
I guess you didnt bother to follow the Thomas link posted above.

Larry G said...

did not see the Thomas link- was it legislation passed by both houses and sent to POTUS?

Quinn Satterwaite said...



Wait you wanted to know where the plan was... now the goal posts are moving?

Larry G said...

"ideas" are not legislative action

anyone can "propose" - did you vote on it and move it to be signed or vetoed?

bogus to the bone...

"you gotta elect us to find out what we will do"

Steve said...

The way I see it, if they haven't managed to come up with any legislation over the past 7 years while bitterly complaining the entire time about the current law, I will guarantee you they aren't going to. I suspect we'll see attempt number 64 to overturn the ACA within the next couple of weeks.

The thing I just don't get is all the vitriol surrounding this issue. I think we can all agree affordable healthcare is something we all want. And we want ins. policies that can't be taken away or denied if we have a preexisting condition, or come down with a potentially costly illness. Less complaining and fighting and more constructive discussion would probably get us there a lot quicker. I think politicians really prefer to have the ongoing battle between parties – that way they can stand up there and talk about "fighting" and "winning" and at the end of the day not do sh*t about solving the issues that this country faces. The only way things get resolved are through negotiation – give and take. Congress knew how to do that years ago. Now it's all about winner take all, and we see where that's gotten us. Absolutely nowhere.

Quinn Satterwaite said...

" I think we can all agree affordable healthcare is something we all want."

I would like my own personal Pegasus. That doesnt mean it exists.

Nor does the math of covering more people, for more things for less money exist.


The American people were repeatedly lied to about Obamacare. And not the kind of lies where someone guessed wrong, or there were unknowns. The lies where politicians tell things they are know are false to deceive voters.

"fraud

n. the intentional use of deceit, a trick or some dishonest means to deprive another of his/her/its money, property or a legal right. "


"If you like your private health insurance plan, you can keep your plan. Period."- Obama promised while getting ready to fleece his marks.
That as we now know was an entire lie and he knew it at the time. He is the one who had HHS write rules which stripped over 5 million people of plans that they liked and could afford. Those 5 million people then had to buy Obamacare policies and he was able to crow about meeting the target of 7 million policies.
http://www.politifact.com/truth-o-meter/article/2013/dec/12/lie-year-if-you-like-your-health-care-plan-keep-it/

And of course there are all of the accounting lies. Repeatedly Obama promised that he wasnt going to sign any bill that was revenue negative, ie raised the deficit. See the WaPo interview I posted before. So the administration engaged in lies. We know now that there was no savings in ER vistis- in fact they increased. But this was knows, and pointed out to the Democrats, back in 2009 based on the Romneycare and Oregon experiences. It was completely dishonest to include phantom savings in the calculation. Add to that the medical device tax, the Cadillac health plan tax, the delays on the individual mandate and corporate mandate taxes there are giant holes in the accounting. Add to that the they havent been able to get young invincibles to get fleeced at the fanciful rates they promoted. Obamacare *is* adding to the deficit and things are going to get worse in the coming years.

Of course Obama and Peolsi wont be around to take and responsibility. Are they the ones who will pay the bills? Or the American taxpayer.

And all of these lies were cynically calculated.
Jonathan Gruber confessed that all of the lies and obfuscation in Obamacare were intentional. The writers were trying to fool "stupid American voters" to fraudulently represent the actual bill.
http://www.cnn.com/2014/11/14/politics/obamacare-voters-stupid-explainer/


So topping off lie on lie, fraud upon cynical fraud we have a chippie Yahoo graphic depicting the US taxpayer as nondescript cartoons waiting to be fleced by a noon-existent "penalty".

Whats not to like!

Larry G said...

I have zero problems with an actual competitive alternative - one that is proposed - voted on and sent for signature.

but as pointed - that's NOT what is going on.

we have complaints - hate, anger but no support of anything different.

and as we see here - when we ask what they actually want to do - they start blathering nonsense about the free market - and refuse to discuss specific proposals that will actually get voted on and moved on to go with the REPEAL vote - as the alternative.


if what they really want to do is REPEAL ONLY and nothing else the they ought to be honest
enough to stand for election on that basis and let the voters decide.

you can't beat something with nothing.

and what these folks are essentially saying is that those without health insurance can continue to go without - even though we are the ones that are going to pick up the tab
for their ER use.

it's like dealing with 5 years who don't like any option.



Quinn Satterwaite said...


"we have complaints - hate, anger "


Why cant people get on board with being lied to and deceived in a calculated way. Then stuck with bills for years to come. Then have Yahoo shill for it.


Some things we may never be able to understand.

Larry G said...

let's say it's true. I don't agree. I don't think people understand the current system before Ocare... most folks are clueless how employer-provided works ...nor understand that those on employer-provided get tax breaks for their insurance and those that have to buy on the open market - do not. It was a system of winners and losers and the losers got their care from the ERs and the winners paid for it through subsidies and higher premiums for their own insurance. That's driven up prices for 30 years to the point where we pay twice as much for health care than any other industrialized nation - on earth.

how many care about that?

but how does your hate and anger about something you don't like - how does that keep you from addressing the issue itself and say what you want instead?

do you have any ideas on a better way to deal with the issue or do you just
want to go back ?


Quinn Satterwaite said...

Let me get this straight- after Polifact awarding Obama the prestigious Lie of the Year?; after architect Jonathan Gruber confessing on tape, multiple times, that they put this together to deceive the "stupid US voter", you disagree that this was sold on deceit?

I dont think that is a fact based option available to you.


At least you should be able to understand why people complain why they are lied to and bullied by their government and shill corporations.

Larry G said...

No I do not agree - but I WILL AGREE with you just to settle that argument if you will THEN be honest enough to tell me what you want to do instead.

you cannot help people with cancer or other serious disease by letting the free market work.

how do you want to do health care for those that don't have it?

you're using the "lie" thing as an excuse... to do nothing, right?

Larry G said...

when someone like John - goes to the ER severely injured - and has no insurance or has crap insurance - what do you want to do? Do you want to give him 80K in treatments and then bill you for that?

Steve said...

<>

Yeah, I couldn't agree more. Kinda like the last republican administration and their weapons of mass destruction cynically calculated lies. All to the tune of $720 million per day, or $500,000 per minute. And this went on for close to 10 years.

Were you as outspoken about that, Quinn?

http://www.washingtonpost.com/wp-dyn/content/article/2007/09/21/AR2007092102074.html

pamit said...

Quinn, here's a good link discussing why ER visits are up. I'm sure you will cast aspersions on it because it has positive things to say about the ACA, but here 'tis:

http://obamacarefacts.com/2015/05/05/study-shows-er-visits-up-under-aca/

Quinn Satterwaite said...

"Quinn, here's a good link discussing why ER visits are up. I'm sure you will cast aspersions on it because it has positive things to say about the ACA, but here 'tis:

http://obamacarefacts.com/2015/05/05/study-shows-er-visits-up-under-aca/"



Isnt that the standard that was set? People had the vapors because I posted a link to ncpa.org.


" Kinda like the last republican administration and their weapons of mass destruction cynically calculated lies."

Tell me when Yahoo push a glib cartoons in favor of the lie telling you to suck it up.

Steve said...

Once again, $720 million per day. For 10 years. That's roughly 3,650 days. Do the math. Where's the outrage over those lies, my friend?

pamit said...

Quinn, no, I don't think "dissing" a link because it's left or right wing is the standard here. Your ncpa.org is funded by Koch Bros and the insurance industry (check out wikipedia), and does not present any balance at all when critiquing the ACA ("preverse", "bizarre", "impossible"... no one looking for facts would continue reading). On the other hand, obamacarefacts.com doesn't have a political affiliation. If you'll look at it, you'll see it presents pros and cons of the ACA in a balanced fashion. You didn't have any response to the info it laid out about why ER visits are up...care to comment?