Monday, November 25, 2013

Why We Can't Have Good Health Insurance Nationwide (ObamaCare Is Scary To These Guys)

Obamacare (ACA) is quite scary to those who make big money by denying coverage and/or care to the healthy, sick, injured or dying.

There is no argument about this.

Not in the US anyway.

If you'd like to know why "Obamacare" is failing, just read these few paragraphs (and click on the link if you'd like the whole schmear).

The readers' comments are just too informative to be ignored.

If you want to know about the health insurance situation in the USA USA USA!!!

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Published: November 24, 2013 \  Comments

It goes without saying that the rollout of Obamacare was an epic disaster. But what kind of disaster was it? Was it a failure of management, messing up the initial implementation of a fundamentally sound policy? Or was it a demonstration that the Affordable Care Act is inherently unworkable? 

We know what each side of the partisan divide wants you to believe. The Obama administration is telling the public that everything will eventually be fixed, and urging Congressional Democrats to keep their nerve. Republicans, on the other hand, are declaring the program an irredeemable failure, which must be scrapped and replaced with ... well, they don’t really want to replace it with anything.

At a time like this, you really want a controlled experiment. What would happen if we unveiled a program that looked like Obamacare, in a place that looked like America, but with competent project management that produced a working website?
Well, your wish is granted. Ladies and gentlemen, I give you California.

Now, California isn’t the only place where Obamacare is looking pretty good. A number of states that are running their own online health exchanges instead of relying on are doing well. Kentucky’s Kynect is a huge success; so is Access Health CT in Connecticut. New York is doing O.K. And we shouldn’t forget that Massachusetts has had an Obamacare-like program since 2006, put into effect by a guy named Mitt Romney.

California is, however, an especially useful test case. First of all, it’s huge: if a system can work for 38 million people, it can work for America as a whole. Also, it’s hard to argue that California has had any special advantages other than that of having a government that actually wants to help the uninsured. When Massachusetts put Romneycare into effect, it already had a relatively low number of uninsured residents. California, however, came into health reform with 22 percent of its nonelderly population uninsured, compared with a national average of 18 percent.

Finally, the California authorities have been especially forthcoming with data tracking the progress of enrollment. And the numbers are increasingly encouraging.

For one thing, enrollment is surging. At this point, more than 10,000 applications are being completed per day, putting the state well on track to meet its overall targets for 2014 coverage. Just imagine, by the way, how different press coverage would be right now if Obama officials had produced a comparable success, and around 100,000 people a day were signing up nationwide.

Equally important is the information on who is enrolling. To work as planned, health reform has to produce a balanced risk pool — that is, it must sign up young, healthy Americans as well as their older, less healthy compatriots. And so far, so good: in October, 22.5 percent of California enrollees were between the ages of 18 and 34, slightly above that group’s share of the population.

What we have in California, then, is a proof of concept. Yes, Obamacare is workable — in fact, done right, it works just fine.

The bad news, of course, is that most Americans aren’t lucky enough to live in states in which Obamacare has, in fact, been done right. They’re stuck either with or with one of the state exchanges, like Oregon’s, that have similar or worse problems. Will they ever get to experience successful health reform?

The answer is, probably yes. There won’t be a moment when the clouds suddenly lift, but the exchanges are gradually getting better — a point inadvertently illustrated a few days ago by John Boehner, the speaker of the House. Mr. Boehner staged a publicity stunt in which he tried to sign up on the D.C. health exchange, then triumphantly posted an entry on his blog declaring that he had been unsuccessful. At the bottom of his post, however, is a postscript admitting that the health exchange had called back “a few hours later,” and that he is now enrolled.

And maybe the transaction would have proceeded faster if Mr. Boehner’s office hadn’t, according to the D.C. exchange, put its agent — who was calling to help finish the enrollment — on hold for 35 minutes, listening to “lots of patriotic hold music.”

There will also probably be growing use of workarounds — for example, encouraging people to go directly to insurers. This will temporarily defeat one of the purposes of the exchanges, which was to make price comparisons easy, but it will be good enough as a short-term patch. And one shouldn’t forget that the insurance industry has a big financial stake in the success of Obamacare, and will soon be pitching in with big efforts to sign people up.

Again, Obamacare’s rollout was a disaster. But in California we can see what health reform will look like, beyond the glitches. And it’s going to work. 


  • Karen Garcia  New Paltz, NY
If the botched rollout of the ACA proves anything, it's that public-private partnerships are deals made in free-market hell. Corporations whose motives are profits over people have shown that they can't be trusted with either our wallets or our well-being. Let the problems with a law that is essentially a mass giveaway to predatory private insurance be the death knell of neoliberalism.

But let us also rejoice that John Boehner is now the proud owner of an ACA policy himself. Kinda puts the kibosh on their whole government-is-the-problem canard, doesn't it? Even a few GOP governors appear to be tiring of their roles as Scrooges for refusing to cover their most vulnerable citizens under expanded Medicaid. The political reality is that even sadists have their limits when their own jobs are at stake.

And speaking of success stories -- what about Vermont? Having just announced plans to cover 100% of its citizens under true single payer by 2017, this is the real state to emulate. People will be green with envy when they look at the Green Mountain State and notice the plummeting medical costs and great service and democracy in action.

A website is the least of it. Because even had it worked perfectly from Day One, some 30 million people were still going to be left out of any coverage at all. And that is unacceptable.

Medicare for All would save $592 billion in the first year alone, as well as millions of lives. So what are we waiting for? Single payer, here we come!  Nov. 24, 2013

  • Anthony \  London
Um, the whole point of a Federal Government is to ensure that all citizens enjoy the same rights and privileges of citizenship. If California is working great, but Texas is still leaving millions of people uninsured, we need a national health program. How about Medicare? Eligibility age: 0. Nov. 24, 2013

  • bookmanjb  \ Munich
We moved to Germany from the US 8 years ago to start a now-thriving business. At the time we only vaguely were aware of the German health insurance system. In 2005, at the time of our departure, being self-employed, my annual premium increases were 50% - 75%, in spite of the fact that I made no claims. In order to get the increases down a few percent, I kept raising the deductible into the low thousands. Suddenly, in Germany, I had much better coverage at about 20% of the cost and NO DEDUCTIBLE (& I am privately insured here; that's right, there's a private option), better quality of care, and the intangible value of living in a society where health care is taken for granted as a right instead of a perquisite of wealth.

No one here - left, right, or center - understands the debate in the US. When we explain that a large minority of Americans are concerned about "losing their freedoms," our German friends simply think we are joking. No one, they say, even the stereotypical poorly educated, ill-informed, simple-minded American, could hold an opinion THAT ludicrous. From here, the purposeful sabotage by the Right of the ACA's implementation, along with the unintentional sabotage of the Obama administration, looks like a kind of social suicide.  Nov. 25, 2013

  • RLS  \  Virginia
Other than staging publicity stunts, attacking the ACA and other plans put forth by the Democrats, what are Republicans doing to improve the lives of the American people?

(1) What is the Republican plan for health care?

Tens of millions of Americans are uninsured and millions more are underinsured. 700,000 families face medical bankruptcy each year. More people than we lost on 9/11 – 45,000 Americans – die each year because they lack coverage. What does the GOP propose to do about these third world statistics?

(2) What is the Republican plan for creating jobs?

John Boehner and the GOP promised jobs, jobs, jobs in the 2010 election. The real unemployment rate is nearly 14 percent when the underemployed and those who have stopped looking for work are counted.

(3) What is the Republican plan for addressing growing inequality?

Corporate profits are their greatest percentage of GDP in history, while workers’ wages have fallen to their lowest share of GDP.

46.5 million Americans (21.8 percent of children) lived in poverty in 2012.

The minimum wage was last increased in 2009. Before 2007, the minimum wage was stuck at $5.15 for “ten years.”

The median wage was $27,519 last year, the lowest level since 1998.

The top 1 percent owns 38 percent of the nation’s wealth while the bottom 60 percent owns 2.3 percent.

Since 2009, 95 percent of new income went to the top 1 percent. The gap between the top 1 percent and the rest of America is the widest it has been since the 1920s.  Nov. 24, 2013

  • Ron Zaudke  \  Prescott, Wi.
California has a working website, and it also has a moderate Democratic governor and legislature. For some reason, that combination seems to work better than John Boehner's Tea Party sabateurs with their 43 separate votes to kill Obamacare, including one to shut down the entire federal government. Of course, Mr. Boehner is the same guy who as recently as last week was still referring to US health care as the "world's best" when statistically it ranks below thirty other developed nations. And is twice as expensive as other countries who manage to have universal health care. Of course, most of those are functioning democracies.   Nov. 24, 2013

  • Aaron Walton  \  Geelong, Australia
"Will they ever get to experience successful health reform?"

I reckon they will. I have a friend in Virginia who once had a six-figure job with the International Monetary Fund but in recent years has been unable to secure anything other than short-term project work with no health insurance. He emailed me the other day to say that for the first time in years he has health insurance--and dental!--at a price he can afford. He signed up using (Virginia lacks its own exchange) and completed the process is less than one hour.

My worry is that stories like my friend's will not be told. Things working smoothly as planned just isn't seen as being newsworthy.  Nov. 24, 2013

  • patti  \  california
Not only that, but we voted a tax increase a 3.5% on the top earning voters that I will gladly pay this year. We got rid of our 10 billion dollar deficit, sliced and cut the budget across the board, but refunded the university system. Thank you Governor Moonbeam Brown! Oh, and the California Obamacare website works just fine because the state cooperated with the Federal government rather than fought it every step of the way. Can we please secede now? I am really tired of sending our tax dollars to other states with small populations and overblown voting power.    Nov. 24, 2013

  • pgp  \  Albuquerque
I have an individual plan and, before accepting the ACA-compliant plan my current provider was offering me, I just used the website to comparison shop.

With regard to the website, it worked fine and allowed me to do a very thorough comparison of all competing plans very quickly.

With regard to the plans, what I found is that as of January 1, I'll be paying about 33% more for my individual health care coverage. I will, however, have a plan I can actually dare to use without fear of receiving a cancellation notice. I will also have an annual out-of-pocket cap low enough that I will no longer be one accident or serious illness away from medical bankruptcy. I'll also have a membership in a very nice fitness club and dental insurance. And if that's not enough, I know that while I will be paying more for my own insurance, several people in my extended family who could not afford insurance before today will be able to buy insurance and several others who are uninsurable due to pre-existing conditions will be insured.

All in all, a very successful trip to the Obamacare mall.   Nov. 25, 2013

  • iamcynic1  \  California
I have a small manufacturing business with 42 employees in rural California.I am a single payer advocate and was not happy with the way the insurance companies virtually wrote the ACA. I decided to run the numbers rather than retreat in bitterness and came away encouraged by what I found. I had only been able to insure 6 employees because of the high cost of private insurance. Amazingly with the ACA I am able to insure all 42 employees for less than I have been paying for 6.Part of this savings is due to the expansion of Medicaid in California.Another factor is that we have relatively unskilled employees who are not highly paid although they do make a very livable wage.I think that these are the type of people the ACA was supposed to help in the first place.

I have commented on various blogs recounting my experience and have gotten quite a few angry responses from people living in other states(Florida,Texas) stating that their insurance premiums have gone up dramatically.Of course they are in much higher income brackets than most of my employees and this may explain part of the apparent difference. In most cases the states they reside in have not accepted the Medicaid expansion which ,I think,could also affect premiums. Overall I have come away with the impression that the conservative strategy is to turn middle income wage earners against low income workers and it seems to be working.But I am curious why the premium prices seem to differ so much from state to state.    Nov. 25, 2013

  • John F. McBride  \  Seattle
. . . This country is rich. The argument about helping, and opposing Affordable Care, is posed by a relatively small minority who haven't wanted to help since FDR and actively seek to shrink government to the point that it provides only those services they support, i.e., corporate subsidies and defense.

And they control the Republican party.

Software can be fixed. Many software releases, most, have problems. The Federal site will eventually be healed.

Yelling about it is simply a feint to divert attention from the real cause which is to do away with all of these programs.

That's always been (the) intent. Allowing Affordable Care will only impede the minority's progress since Ronald Reagan in starving government to kill it.    Nov. 24, 2013

  • joel  \  oakland seems to do its similar job just fine. Makes one wonder if maybe Medicare for all... oh, never mind.  Nov. 24, 2013

  • Dagmar20  \  Los Angeles
Can Cadillac-Plan Ted Cruz and the 1% Koch brothers please explain what part of the Heritage-Foundation-Romneycare-Obamacare-ACA they don't approve of?

Is it that insurance companies can't deny insurance to people with pre existing conditions?

Is it that poor people will receive health coverage (500,000 have been enrolled under Medicaid)?

Is it that loopholes are closed in Medicare?

Is it that children under the age of 26 are covered by their parents?

Is it that they would rather have Americans pay more per capita for health care than people in any other industrialized country and in return, be sicker, die younger and be unhappier with the system?

Is it that 23% of U.S. adults either had serious problems paying medical bills or were unable to pay them, compared to fewer than 13% of adults in France and 6% or fewer in Britain, Sweden, and Norway, you know, socialist countries?

Is it that the U.S. has more patients than anywhere else using the emergency room driving up costs, with 48% of Americans using the ER in the past two years, compared to 31% in France and 22% in Germany and Australia?

Is it a report from the U.S. Institute of Medicine saying tens of thousands of Americans die every year from medical errors and drug overdoses, with the system wasting $750 billion in 2009?

Please explain, Cadillac-Plan Cruz and 1% Koch brothers, and tell us your solutions to these problems and why you don't like the ACA. Oh, and just complaining about the website won't cut it.  Nov. 25, 2013

  • Netwit  \  Petaluma, CA
I visited some Republican friends recently who had signed up for Obamacare in California despite having deep reservations about the program. They reported that their coverage had improved and their premiums had gone way down.

As a Democrat, I restrained myself from saying "I told you so," only to discover that they, too, were restraining themselves. It turns out that the great deal they got validated their worst fears about Obamacare. They viewed the savings as a pure subsidy that (a) they didn't ask for, and (b) taxpayers can ill afford.

I tried to explain that much of the savings comes from increased competition among health-care providers, and more efficient delivery of services, but they were not convinced. It was impossible for them to believe that the government is capable of making any market more efficient.  Nov. 25, 2013

  • Bob Brown  \  Tallahassee, FL
Our 57 year old housekeeper pays about $1000/month for basic catastrophic health insurance on the private market. She cleans 40 houses per month at $50 apiece, so insurance consumes fully half of her effort, before taxes. She is a classic illustration of the need for Obamacare. We live in Florida where the governor and legislature have adamantly opposed forming a state exchange, so the success of is critical. She has no computer, so I volunteered to go onto for her. It was frustrating for nearly six weeks, but recently I succeeded in getting through the website without much waiting, and here's what I found. Without federal subsidies, she can get a basic Bronze plan for $467, comparable to what she has now for $1000; with subsidy, that plan is $358, so she would save about $600/month. At the opposite end of the scale, a Platinum plan would cost $723 without subsidy, or $554 with subsidy. So for about half of her current insurance cost, she would have adult dental coverage, a group total deductible of $850, and maximum out-of-pocket of $2500, with copays of $15 primary, $20 specialist, and $10 generic prescription.

The Republicans who continue to try to destroy this program are bullies, liars, and little short of evil. We must work every day to run them out of office and regain sanity and humanity to our government.
Nov. 25, 2013

  • Robert Watson  \  New York
Republicans have been standing in the way of universal healthcare for over 75 years. It's a bankrupt party that has nothing to offer the country. The rollout is a glitch that will be solved. The major problem to healthcare remains what it has been all along: Republicans.

Republicans will come regret calling the healthcare Obamacare. It time the media starts referring to Social Security and Medicare by their proper names: Rooseveltcare and Johnsoncare. The uncaring Republicans deserve it.  Nov. 25, 2013

  • Anetliner Netliner  \  Washington, DC area
There's a second important story here, of course: that your friend in Virginia once had a six figure job with the IMF, but is now subsisting on short-term project work. The U.S. economy has shed many workers with strong skills. I'm glad that your friend has procured health insurance. Now he needs a stable job, as do so many others.  In reply to Aaron Walton  Nov. 24, 2013

  • Salman  \  Fairfax, VA
The sooner Americans realize that they are paying a massive tax to the private sector in the form of health insurance premiums and deductibles, the sooner they may realize that their money is better spent without the middle man in the picture.

Direct insurance through taxes (single payer) with the option to buy supplemental private plans (a la Medicare) will provide what will amount to be the most cost-effective and comprehensive option for Americans who want health insurance.

I understand why Americans hate paying higher taxes. I don't understand why they don't mind paying even more money to the private sector for less comprehensive returns on their investment.  Nov. 25, 2013

Wouldn't it be simply beyond words if that last comment was from Salman Rushdie?

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