Open Thread
Good news everybody
by David Anderson| 83 Comments
This post is in: Anderson On Health Insurance, Open Threads, All we want is life beyond the thunderdome, The Math Demands It
by David Anderson| 83 Comments
This post is in: Anderson On Health Insurance, Open Threads, All we want is life beyond the thunderdome, The Math Demands It
Comments are closed.
Mike J
Tyranny!
jl
Thanks for your informative posts on the nightmare of Obamacare, that the vast majority of the US population hates (I know because McConnell told me so).
The green line on this graph is starting to go down, and down is bad, so I am sure this is bad news. Seems like one disaster after another keeps unfolding before our eyes.
My wrath is righteous and my bile is extra bitter.
Anyway, thanks for the news. Always nce to see more evidence against the BS that has been flung around against health care reform.
Edit: Only problem is that that green line needs to go down a lot more. What does RM think about reasonable expectations for how much of population will have health insurance in a another five years?
piratedan
well Thank God that the GOP was here to implement Romneycare to help out millions of uninsured Americans!
David Koch
Kill the Bill!
satby
It is good news. Now we’re going to get to see how the new nimrods in Congress screw it up.
jl
Also, I been looking for more commentary on recent red state sign ons to Medicaid expansion. If I understood the story correctly, Texas has signed on. And TPM says NC has given in too.
Seems to me that is very very good news, right? Should see that green line make another big drop soon. And won’t that weaken the effect of any SCOTUS BS on federal subsidies? How many states will be left that would be affected by the decision, and will they be big enough to have much impact on the overall sustainability of the program.
I don’t have time to keep track and make sure I understand that issue, so would be interested in RM’s analysis.
JPL
@piratedan: The chart tells me that we still have too many uninsured. The GOP will save the day.
lol
Elizabelle
I’m thrilled. I am one of the formerly uninsured.
Thanks Obama!
Reminds me it’s time to check in with Kaiser and get some checkups scheduled.
Belafon
@jl: The medical advisory board in Texas said that the state should agree to the expansion. I believe the Republicans here have so far stuck their fingers in their ears and screamed “LA LA LA!”
Citizen_X
I blame Obama.
Trentrunner
My own pet peeve, but it’s misleading that the y-axis goes from 12 to 19 instead of 0 to 19.
We really need to to see the full volume of the uninsured.
Omitting 0-12 makes it look like we’ve made more dramatic progress than we actually have.
jl
@Belafon: Thanks. That is too bad.
Mike in NC
It sucks how the Kenyan-born dictator is forcing affordable health insurance and cheap gasoline down our throats.
David Koch
but, but…. telephone metadata!
Mike J
@Trentrunner:
No. The size of the scale is dependent on the importance of the size of the change. When the unemployment rate goes from 7 to 6 percent that’s a big deal. A 0-100 scale would be misleading about the importance of a 1% swing.
Similarly, this chart would be less honest with a scale that minimized the movement.
Another Holocene Human
@jl:
Exactly.
Medicaid expansion states are looming large here.
Adam
@David Koch:
CATFOOD COMMISSION
priscianus jr
According to Huffpost Pollster, corresponding to the huge drop in uninsured seen on this graph which began about August of last year, the oppose/favor spread on Health Care among registered voters has gone from a high of 54/37 (16 points) in mid-December 2013, to 48.9/39 (just under 10 points) as of Dec 9, 2014. So that’s still a big spread, but it has been gradually decreasing over the past year.
http://elections.huffingtonpost.com/pollster/us-health-bill
Lavocat
How is this good news for Republicans? Oh, I’m sure they’ll find a way with some sort of heads-you-lose-tails-I-win kind of logic.
Another Holocene Human
@jl: I’m sure Texas has found a way to fuck it up, just like they fucked up CHIP.
I have a question for Mayhew. Florida has SCHIP but everybody I know who has to apply for it says it takes F.O.R.E.V.E.R to get approved. Oh, and the dental is worthless in our area because nobody takes it. (If your kids have healthy teeth just pay for cleanings OOP of course that is tough if you rely on locally grown greens for nutrition because our soil here is deficient. Er, pay for those fluoride treatments! Worked for me, no cavities yet.)
I thought I saw something about applying for Medicaid through HHS and not the state? Is SCHIP still a state thing? Does ACA do anything to make it easier for working class parents to get their kids into SCHIP and save the family finances from the premium alligator? Kids will get sick. Big premium, big deductible, coinsurance, coinsurance on scrips, it’s just too much. But Florida makes people eligible for partial subsidy wait forever with no transparency to get their child into Florida Healthy Kids (SCHIP).
Kerry Reid
Now that I am no longer shelling out the equivalent of a mortgage payment for my individual policy (my premium with an ACA Silver PPO plan, with subsidy, is over $400 less per month than my old non-ACA plan), I will have more money to give to Dems who don’t run away from Obamacare. Too bad they are rather thin on the ground.
Another Holocene Human
@Lavocat: It’s great news for the GOP, they can expand Medicaid then take credit for historically reducing uninsured. The gimmick is to do some sort of “market-based” medicaid, showboating as your first 3 offers get rejected in DC. Like Arkansas did and seem determined to drop. This then becomes “proof” that Republican ideas work.
Turgidson
Paul “Zombie-Eyed Granny Starver” Ryan is so distressed by the truly revolting, anti-American idea of takers getting health insurance that he deemed the ACA “beyond repair” the other day.
Earnest liberal bloggers like Steve Benen accused him of not knowing what he was talking about, or being mendacious. What he doesn’t realize is that assholes like Ryan think a system that prevents poors from getting health care is the way it should be. Since Obamacare interferes with his preferred natural order of things, it is indeed “beyond repair” from his perspective.
It’s time we all move on from the fiction that GOPers actually care whether their policy ideas, particularly in the economic, health care, immigration areas, are good or bad things for the American people. They don’t care. If they can make some bullshit argument in defense of their shitty policies so as to make it easier to dupe voters into letting the GOP implement them, that’s fine with them. But they truly don’t care. There is no mountain of evidence high enough to get them to give up on their “tax cuts 4ever!” dogma. Because they don’t care what macroeconomic effect they actually have. They just want to cut f’ing taxes. And they don’t want poor people to have stuff.
Another Holocene Human
@Kerry Reid: I’ll donate to whomever Obama endorses at this point.
Assuming it’s actually him and not just his name on some DCCC/DSCC junk mail.
Trentrunner
@Mike J: Your analogy is also misleading. 100% unemployment is not possible (unless we’re in a Cormac McCarthy novel), but 0% uninsured is.
I stand by my peeve.
David Koch
We should have primaryed Obama when we had the chance.
Another Holocene Human
@Turgidson: Paul Ryan wants to “win” without exerting any effort, the epitome of the lazy narcissist. It’s of a piece with his mountain climbs and running times, since they are nothing more than a fantasy nothing more than that is required of him yet he gets that momentary attention and adulation he craves.
Deep underneath the bravado is the narcissist’s carefully hidden self-loathing. Fortunate son Paul must secretly believe he isn’t really worthy or good enough as himself, Paul Ryan. He believes others would reject his genuine self or efforts. Therefore he presents the fakery he secretly believes others are seeking. It allows him to avoid the anxiety of trying without knowing if you will succeed or fail and provides the candy of cheap affirmation while remaining as physically and intellectually lazy as ever.
The joke is on Paul as his brain is probably prematurely rotting from disuse.
Another Holocene Human
@Trentrunner: I think you missed the point. He’s talking about a relative change or margin. It might be instructive to see a chart from zero because you can visually see the percentage change better.
One thing I like about this chart is that it shows the necessity of ACA when it was passed. After all of the drama we’re only back to pre-recession coverage of the population.
It would be nice to see a chart back to say 1980 that starts at zero which would put the last few years in context.
Still, any way you slice it, 18% to 13% is an enormous relative drop.
Smedley Darlington Prunebanks (formerly Mumphrey, et al.)
Does this mean that we’re a communist dictatorship now?
RSA
@Trentrunner: Me, I’m curious about what looks like a fairly steady increase from 2008 through 2014. But Table 1 on p. 9 here [PDF] gives the numbers going back to 1972. If the numbers are roughly comparable (I don’t know if they are), then today’s 12.9% uninsured is as low as it’s been since 1980.
Mike in NC
@jl: I liked this comment at TPM:
McCrony is a despicable weasel whose strings are tightly held by Art Pope and the Koch brothers. This cannot happen here unless enough wealthy people can skim a profit.
Redshift
Clearly, the prospect of Republicans control in Washington motivated people to get insurance. Free market argle bargle. /mcconnell
Richard Mayhew
@jl: Depends —
If the Supreme Court follows precedent and the current trend of Red states getting Healthy Utah like waivers for Medicaid expansion continues, we can probably get it down to 6% of all adults in that; If we restrict to US citizens only, 3%
If the Supreme Court has a majority of sadists and sociopaths who want to get their rocks off this summer by destroying administrative law to stick it to the lower middle class — 13% is a floating point where there would be a litlte movement one way or another after an initial upwards spike.
JPL
@Richard Mayhew: The Supremes already ruled that the mandate stays in place. GA did not set up an exchange so folks on insurance through the federal exchange would still have to pay a mandate if they don’t get insurance elsewhere. That could lead to lots of unhappy folks.
Am I missing something?
jl
@Richard Mayhew: Thanks. I hope SCOTUS does not try to rewrite common understanding of the English language. From looking at other countries’ experiences, need to get closer to 3% to 6% than 13% to avoid noticeable problems with cost-shifting due to uncompensated care, etc.
jl
@Mike in NC: OK, thanks, I guess. Too bad. I thought more progress was happening on Medicaid expansion.
Richard Mayhew
@JPL: If the insurance is unaffordable, there is a hardship exemption where the mandate penalty does not apply. The vast majority of people receiving subsidies from healthcare.gov would fall under the hardship exemption.
The mandate still applies, but the taxes would fall to far fewer people. Plus the decision to pay 2.5% income in mandate penalty is a piss poor decision when the cost of a Silver policy with subsidy is 2.4% of income, and it is probably a bad decision when that same policy at a different income level is 6.5% of income after subsidy, but paying 2.5% to avoid paying 8.75% for a shitty Bronze plan in SW Georgia is a very rational decision for people who are generally healthy.
JPL
@Richard Mayhew: We live in strange times.
Health insurance has been rising about ten percent for about a decade. Since the ACA, that rate has fallen dramatically. The news media is still focusing on the increase without mentioning how it is rising at a lower rate.
A graph highlighting this might be interesting. Just sayin..
Thank you for all your information.
KG
@Lavocat: well, now that they’re requiring the CBO to use dynamic scoring, I’m sure they’ll find a way to make this into terrible news for the country.
Villago Delenda Est
Good news? I think not! It reduces The Fear!
/channelling Repukes and the corporate tyrants of the 1%
JPL
@KG: I sat down and did some dynamic scoring. If my investments triple, like I expect them to, I can buy an Audi now and take advantage of low interest rates. At the end of the year, I’ll pay off my loan. See dynamic scoring isn’t all bad.
Another Holocene Human
@JPL: The parts of ACA that attack out of control costs are very important and arguably don’t go far enough but there are so many butts hanging over the frying pan here that it’s very tough politically to do more.
Bullshit like widely variant MRI charges are the obvious edge of a morass of interests (hospitals, equipment manufacturers, practices, medical personnel, pharmaceutical companies, teaching institutions, non-profits, & so on, & so forth) who are making a huge buck off the death and misery business. A buck that free market magic, aka the insurance industry, has failed to rein in.
But look for more “cost-sharing” as hapless consumers with no bargaining power are somehow expected to impose “discipline” on hospitals, FDA equip’t manufacturers, Big Pharma, etc.
PS: some of the high costs of American healthcare goes back to American workplaces. How about funding OSHA and PREVENTING a lot of this occupational injury and disease that all of us are fucking paying for? Where’s the outrage?
Another Holocene Human
@Richard Mayhew: Until they get into a motorcycle accident on a country road or their pit bull mauls them.
AFLAC isn’t health insurance.
JPL
@Another Holocene Human: I can’t disagree with you. MRI’s are more expensive than other countries because the lobbyists want them to be. There is no supply and demand. Health care should never have been part of the marketplace because you always have to regulate against greed. If a loved one is having a heart attack, is that the time to shop for a heart specialist? That is the system we have though.
Another Holocene Human
@RSA: Interesting.
I’ll be that the CHIP and SCHIP laws made a dent in uninsured rates. All 50 states had implemented all or part (Texas bringing up the rear) prior to the 2008 recession (Great Recession). Without SCHIP the uninsured rates going into the recession would have been a lot worse, assuming that those CDC numbers include children. (The chart says “persons aged under 65 years” so I’m going to say yes.) There’s no CHIP break point because states implemented changes at different times and then at some point the law was expanded and not all states took advantage of this.
Davis X. Machina
@Another Holocene Human:
Directed at our neighbors. They look funny, and pray the wrong way. And have you heard their ‘music’?
Another Holocene Human
@JPL: The system has infected research institutions as well. We used to say that the taxpayer paid twice for medication, once for basic research at state and private institutions and then again to cover pharm co’s R&Ds. But now even land grant colleges are trying to patent and make a buck off of research (coincident with basic research grant money drying up). Innovations are no longer released into the public domain “for the good of Science” or “for the good of humanity”.
Salaried, stable-funded basic research teams not under a profit-gun from millionaire university admins would be more inclined to release such things. Read a fascinating (if often flawed) book about the lady whose cancer cells have been cloned for all kinds of medical research. The medical tissue was donated without much disclosure of the research purpose, then shared freely for several years. That world seems all but gone with the SCOTUS allowing the patenting of genes and our public research institutions being turned into profit mills.
eta: The Immortal Life of Henrietta Lacks
Another Holocene Human
Richard, are you going to answer my question about SCHIP in another post?
jl
@JPL: I agree I think a chart of historical data on comparable premiums would be interesting. Maybe RM knows where to find interesting numbers.
I can’t find data on comparable premiums across years. The Commonwealth Fund has data on cost of of premiums and deductibles from 2003 to 2010. They did not use a standard reference policy, but a weighted average of single-person and family group policies. For employment based policies they included both enrollee and employer shares, and I don’t see a breakdown of the two separately. The enrollee pays most of the employers share through lower money wages and other benefits, but that is not directly observable.
Anyway, from 2003 to 2010, premiums increased at an average rate of 6 percent per year, and deductibles by 10 percent per year (edit: in current, nominal, dollars)
State Trends in Premiums and Deductibles, 2003–2010: The Need for Action to Address Rising Costs
Commonwealth Fund Report
http://www.commonwealthfund.org/Publications/Issue-Briefs/2011/Nov/State-Trends-in-Premiums.aspx
Edit: No data on individual insurance market premiums, which I suspect would show even worse trends.
BTW, while looking for these data, I found the Census Bureau data on insurance coverage, which gave more confirmation to my opinion that under our current misguided philosophy of government in the US, each group is harmed the most in its own special way. White males have been slammed the most in terms of losing health insurance coverage between 1999 and 2009. They have higher rates of coverage than most other groups, but have experience the greatest percentage average decrease in coverage.
You would think White males would be one of the groups most grateful for health insurance reform. Well, in my opinion, we shouldn’t do anything for this community until they get their act together and show appropriate thankfulness for all we do for them.
Comrade Nimrod Humperdink
I FIXED THE POISON SLIME PIPES!
Lee
As others have pointed out Texas is not yet onboard with expanding medicaid.
What is going to happen is the hospital chains will eventually tell the Republicans to either expand Medicaid or they are going to start funding Dems.
jl
@jl: Average inflation was about 2.4 percent per year over those years. So annual increase in real premiums was about 3.5 percent per year, and in deductibles was about 8 percent, with some discrepancy due to rounding error.
JPL
@jl: Those numbers indicate why the Romney/Ryan plan on privatizing Medicare would hurt most seniors. They would only cover the raise in inflation, not the increase in health care costs. Of course, MSM explained this to most seniors. hahah
Violet
@Another Holocene Human:
I’ve posted twice on my experience with imaging last year. I had hoped Richard would address it but so far no luck.
General story: Exact same ultrasound at exact same facility on exact same insurance resulted in two different charges. Charges are not transparent because the Imaging Facility sends the charges to a Middleman Company who then bills the Insurance Company.
The “Provider” shows up on the Explanation of Benefits as the Middleman Company. The actual Imaging Facility is not listed and their charges are completely hidden. When I called them I found out the charges they sent to the Middleman Company were exactly the same ($500) but I had no way of knowing that because it was nowhere on my paperwork. Unless the billing person at the Imaging Facility told me, that charge was unavailable to me, the consumer. They are not obligated to tell me.
The Middleman Company turned $500 into whatever charge they sent to the Insurance Company. That charge was different, despite it being for the exact same procedure.
The original charge is utterly hidden from view. I can’t believe this is legal to do and I hope Richard will post on it. The Explanation of Benefits listing some other Middleman Paperwork Processing Company (that’s all they do, according to their phone rep) as the “Provider” is unethical. It should be illegal. As should hiding the actual charges from the patient.
Villago Delenda Est
@Another Holocene Human:
Repressive tyranny of our munificent job providers.
Mike in NC
@JPL: But remember the rancid Romney/Ryan privatization scheme only would have applied to those under age 55.
Besides, anybody pinched for money could simply borrow $30,000 from their parents to cover the bills.
Villago Delenda Est
@Violet: What this helps explain is how the “magic” of the free market is ruthlessly squashed by anyone with a financial interest in doing so.
The glorious thing that the vile fuckhead self-proclaimed greedhead fans of Adam Smith always miss is that for the market to function as it does in Econ 101, there has to be transparency for all involved in a transaction. 100% perfect intelligence on every aspect of the transaction proposed.
As you’ve explained, that does not exist in the real world, by design. Parties who have an information advantage over the consumer will utilize that advantage ruthlessly and guard it with greater fervor than they’d protect their own children.
This is why a third party (the government) must step in to brutally tyrannize the jerb creators and put them all on trains heading east to be “resettled”.
Villago Delenda Est
@Mike in NC: Or liquidate some of that quarter million in securities they received as wedding gifts.
I mean, come on, really, this is all so “duh?”
jl
@Villago Delenda Est:
” The glorious thing that the vile fuckhead self-proclaimed greedhead fans of Adam Smith always miss is that for the market to function as it does in Econ 101, there has to be transparency for all involved in a transaction. 100% perfect intelligence on every aspect of the transaction proposed. ”
That vile worthless commie Adam Smith clearly explained in the Wealth of Nations how the breakdown of needed assumptions on information caused market failure in the market for loans and led to bank failures and panics. Interesting. Probably Adam Smith did not wear Adam Smith ties and could not think straight on some issues. That is my bet.
Villago Delenda Est
@jl: They’ve never read The Wealth of Nations because there aren’t enough graphs in it to explain the concepts.
Villago Delenda Est
I also think that the current structure of the banking industry would cause Smith to turn even whiter than a Scotsman would normally be. Because he was pretty clear that he didn’t think banking should be a “profit center”, since banks don’t produce tangible goods that are the basis of a sound economy, and are the foundation of the wealth of the nation.
jl
@Villago Delenda Est: I think Smith’s idea of productive and unproductive enterprise was mostly wrong (not totally, but mostly). Smith retained some bad physiocrat ideas.
But Smith’s analysis of informational failure in financial markets is very clear. I have actually put it side to side with them damn new-fangled articles with graphs and stuff to help get the intuition behind the analysis.
I think the application of the same ideas to almost completely opaque markets in medical care services is obvious too, even if such application would not please our crony capitalist titans.
Ella in New Mexico
I’m sorry to pop the party balloons and point out the obvious, (well, no I’m not). But how is a 1.5% decline in the uninsured from 2009, when there was no ACA, to 2014 all that much to cheer about, especially given the shit-ton of political grief from Obama and the Dem’s opponents and the slew of consumer complaints that have occurred during ACA’s implementation? Not to mention the way most people’s employer-provided health insurance actually covers LESS of your expenses now?
I know, I know, nobody wants to see the Obamacare Emperor naked, but a lot of people have been unfairly fucked over by this law’s complicated and arcane rules and the new, ginormous out-of-pocket costs that insurers are now cramming down our throats, and yet have not seen raises in their incomes for years. Ooooh, it’s called cost sharing because I supposedly now have the ability and options for my health care to “choose” what places I get my healthcare from. Except nobody is actually being transparent with their charges in most markets because they’re making us pay our share before they’re making them tell you their costs.
All we did is create a law that insurers can massage to their hearts content, while penalizing those with the least power to control what happens in their healthcare market.
So please forgive me if I don’t think 1.5% is a change I will actually drag my ass out of my chair and tap dance over. We’d have done better by just encouraging the growth of HMO’s and making it impossible to deny coverage to people, plus the ability to keep your kid on your policy until age 26.
Roger Moore
@Villago Delenda Est:
I think it has more to do with it contradicting the holy writ of Ayn Rand.
Villago Delenda Est
@Roger Moore: Most of them haven’t read it, so they don’t know it contradicts the holy writ of Ayn Rand.
It’s always fun to copy and paste quotations from Das Kapital that were in turn lifted from The Wealth of Nations just for the thrill of glibertarian haids kerploding.
They just assume (magic word, that) Ayn Rand was in part inspired by Smith. Perhaps she was, but she didn’t bother to read it, either.
jl
@Ella in New Mexico: Because any reduction is better than continued increase, which has been the trend for over a decade.
And more people who are covered, and have an immediate stake in good performance in the health insurance and medical care services market, the more likely the crummy parts of the law will be reformed due to pressure from voters.
It is a small start but a start. The problems of loss of reliable and affordable health care, and soaring health care costs were considered insoluble until very recently. So any start is a good start. And we have a start.
jl
@Villago Delenda Est:
‘ They just assume (magic word, that) Ayn Rand was in part inspired by Smith. Perhaps she was, ”
I think it is very doubtful Rand was much influenced by orthodox economic thought, either liberal or conservative (used in the modern US sense of the word). Most orthodox economic theory is based on the idea of maximizing some measure of total social welfare. Ayn Rand did not believe such a thing existed. Her sympathies were more with Austrian economics, though many of her ideas were nutty even by Austrian standards, and like most economists, I think Austrian economics is mostly incoherent mumbo-jumbo and sophomoric philosophical ramblings of a very bad and boring kind.
I don’t think any established school of economic thought (even most of Austrian economics) wants any credit for Ayn Rand’s economics. And lucky for them, they don’t deserve any credit.
Which is not a good commentary on the clarity of Greenspan’s thinking when he was a youngin’ and an Ayn Rand groupie.
Another Holocene Human
@Villago Delenda Est: Even better, in a world with fair competition and total price transparency, assuming that the gov’t is not also protecting rents in some way, profits are zeroed out and even go into negative territory.
That’s both econ theory and econ fact (dig into commodity farm products, 19th and 20th centuries if you’re curious).
Although Adam Smith felt that you could reliable extract a profit from an arbor. (Tabacky was the savior of the Virginia Colony). So you can make a profit in a crowded field assuming your product gets people high. Then they will pay you a premium for some fucking reason. If it’s a product people need to live, you won’t be able to live off the proceeds.
You could say same of oldest profession. The other oldest profession, midwifery, of humans or livestock, is not consistently profitable. Sometimes it’s a living, sometimes a good living, sometimes it’s not. Interference in the market by government or government subsidy or lack thereof seems key. But sex work seems to be high profit, I guess the utility of pleasure is pretty high!!
Ella in New Mexico
@jl: It was a small start, all right. For a huge price.
We really could have done a lot better for a lot less of a political and social cost by addressing key separate issues first, not with this gigantic turd of ticking timebombs and poison pills that ended up further dividing the nation into haves and have-nots. Like I said, above, smaller battles win wars. Outlawing pre-existing condition denials, keep young adults with no coverage on parental insurance plans, support the growth of high quality coverage by non-profit HMO’s and PPO’s, offer larger tax breaks for small business to insure it’s people–those would have been popular with people on both sides of the political aisle, and would have made huge differences not only in coverage but in cost controls. We could have done things that took the financial burdens–and thus the ultimate ability for sabotage-away from the states, like making Medicaid coverage and low-cost insurance plans available through the Federal Government.
ACA is a big fricking unwieldy mess from “Meaningful Use” to it’s new nightmare ICD-10 coding system that was designed to make healthcare employers now have to spend MORE to give you less, and for your doctor and nurse to now spend 100% more time on the computer documenting in quadrupulate bull shit that will NOT make you any healthier.
And now, thanks to just how much everyone hates the Democrats, we are on the brink of two years of a fully Republican legislature. The only thing that could save the ACA would be a good faith effort on the part of Congress and the President of the United states to repair many of it’s serious, serious flaws over the next two years. And then that Congress NOT just repeal all of it’s best benefits when Obama leaves office and we get Jebby Bushco in.
Good luck with that. And as for “any reduction is better than continued increase” I’d argue that what good is insurance coverage if you can’t afford to use it for much more than a 10 minute annual physical and a pap smear?
Another Holocene Human
Remember Jezebel, she murdered a man for a vineyard….
Another Holocene Human
@Ella in New Mexico: The what now?
SCOTUS broke the country into haves and have-nots, that was not Congress’ doing. Most observers did not expect the outcome of the SCOTUS decision because it broke with established law.
And the computerization and digitization was broken off as a separate chunk. That law was passed well before ACA. I know doctors call it ACA, but they are engaging in a good, old fashioned medical practice known as lying.
I can’t make heads or tails of the rest of your rant.
Another Holocene Human
@jl:
Austerian economics has been proven face-plantingly wrong about everything in the only laboratory that matters, real national economies. Time to throw that baby out with the bathwater. There’s nothing left to salvage.
As for Ayn Rand, there’s nothing in her writing that seems to echo, answer, reject, grapple or even show basic awareness of Adam Smith at all. Nor did she consider herself an economist, although she did and does attract goldbugs. Goldbugs is believing in fairies for grownups so it’s not surprising that the willfully self deluded believe in two preposterous fantasies. I mean, look at Paul Ryan, he was into health nuttery like P90X and fantasizes about being a star athlete. Plenty of idjits on health blogs are goldbugs as well.
No, Ayn Rand is more of a spin on Social Darwinism, the plutocrat’s apology for the Gilded Age. It’s the same shit, just rebranded, more in your face, more reflective of her own narcissism. Rand’s big innovation is that Social Darwinists claimed they were improving the race and Rand says, no, there is no race, there are moochers and looters and then there are Rand’s elect. So it’s Social Darwinism crossbred with Jehovah’s Witness.
There’s an echo of Nietzsche there, although I doubt Rand would have given him any credit, plus I don’t know what the man himself would have made of her classic NPD passive aggressive tantrums. If she is borrowing from Nietzsche it was because pop-Nietzsche was in the water, not because she seriously read him as it’s quite likely she did not. The Nazis had a bit of Nietzsche faddism going on even though he spared nothing in his utter contempt for anti-Semites.
Nietzsche more or less calls people sheeple, which appeals to the paranoid-persecuted types who think they have special insights that the world is too dumb/corrupted/bought off/arrogant to recognize. Nietzsche says the Overman isn’t really worried about getting his ass kissed, that’s why he dares to zig while society zags, knowing he’ll get called a fool or worse. Narcissistic Overman wannabes always pretend they’re hard and cool but desperately want society to fear/love/respect/feed their egos. The threatened tantrum of going Galt is supposed to induce the love-object to fall over themselves begging the Galter to return.
Kafka’s anti-hero in the metamorphosis really does withdraw. Instead of begging for his return his boss comes around and tells the family “His position … is not the securest.”
Another Holocene Human
@jl: They’re fans. Nobody said they had to read Adam Smith, never mind for comprehension.
Mnemosyne (iPhone)
@Ella in New Mexico:
The problem with Obamacare is that some states are getting hosed and some aren’t. Californians are doing just fine with Obamacare, because we have the population to get genuine market competition. Smaller Western states like CO and NM are getting hosed, because they’re small population states with high-cost areas, so only one or two insurance companies are interested in being in that market.
The problem is your state, not Obamacare. And unfortunately your Republican governor is probably more interested in screwing you over than in figuring out how to make Obamacare work.
Ella in New Mexico
@Another Holocene Human:
Well, no offense intended, but maybe that’s because you live in some kind of protected bubble. I don’t.
I’m personally experiencing many of the consequences of THIS law, from the nearly daily onslaught of new time-consuming and energy draining rules, requests, redundant paperwork and documentation that DO NOT MAKE ANYONE HEALTHIER and are directly attributed to ACA at the hospital where I work. It literally takes me at least one hour more a day to complete my documentation activities–that’s one hour less I spend with your grandma who’s on the fucking ventilator. Oh, and I got a 1% raise for four years straight because of losses they also blame on this fucking monstrosity.
I’m also witnessing several family members and friends of modest means literally suffering through conditions they formerly could have afforded to address, all now due to negative changes to their employer-subsidized health plans. My single parent of three, one income co-worker has to decide between going without a specialized MRI which will cost her the max out of pocket “cost share” of $3600 dollars to determine if her Brac 1/Brac2 gene has finally kicked in with neoplasm,when two years ago her co-pay would have been $500. Thanks to her divorce, her credit’s in the shitter, so she’s considering a title loan while we speak.
We also have so much political turmoil that hundreds of thousands, maybe millions of folks are still going without health insurance or Medicaid. And Scotus would never have had the chance to fuck us if there was no enormous, arcane ACA to pick through.
We should have kept it simple stupid, that’s all I’m saying.
Randy P
@Ella in New Mexico:
Perhaps my memory is faulty but I thought the exchanges opened in Jan 2014. So the effect of the exchanges would not be seen in 2010, or 2011, or 2012, or 2013.
And passed that simple law decades ago. Yet somehow health care reform had been failing for DECADES.
GHayduke (formerly lojasmo)
@Ella in New Mexico:
John Boehner, is that you?
That is absolutely a lie.
Mnemosyne (iPad Mini)
@Ella in New Mexico:
I see the other part of the problem — your employer is burdening you with extra work without extra compensation and claiming that Obamacare is making them do it. I hate to tell you, but I’m pretty sure your employer is lying to you.
Out here in California, at least one insurance company sent letters to all of its individual policyholders claiming that they were all going to be switched to $500 a month Platinum policies because Obamacare was forcing them to do it. Turned out to be a giant steaming load of bullshit — they were hoping people would just sign back up without bothering to check the Exchanges and discover that the insurance company was full of shit.
Lots of insurers and providers are claiming that “Obamacare” is forcing them to screw people. Don’t believe them.
Turgidson
@Ella in New Mexico:
Maybe I completely misunderstand everything I’ve read about the ACA, but your claim that Congress could have passed a simple bill outlawing discrimination against pre-existing conditions is contradicted by pretty much all of it. In the absence of single-payer or a robust public option, the three-legged stool of the ACA was necessary precisely because you can’t just tell insurers to stop discriminating without inviting a cost death spiral, making everyone’s premiums go up astronomically. You needed the mandate to balance out the risk pool, and the subsidies to make it affordable to the working poor who don’t qualify for Medicaid. You can’t do one without the rest.
Also, I obviously don’t know the particulars of your negative experience with the ACA, but anecdotally, a lot of the horror stories I’ve come in contact with are from people complaining about things that were happening (and often more so) prior to the ACA – rising premiums, deductibles, etc. One of the ACA’s biggest political problems has been that employers/insurers/providers who wanted to fuck around with premiums or deductibles or whatever else can now blame their doing so on Obamacare, whether the law actually has anything to do with it or not. I’m not sure what could have been done to avoid this other than doing nothing, but it’s a real issue.
Legislation this consequential, almost by definition, has winners and losers. There’s just no avoiding it. The ACA is no different, and in fact has it particularly hard because the “losers” are disproportionately rich assholes with outsized political clout. The ACA should make our health care system better in the long run – mostly by reducing cost inflation (which will have positive effects on the rest of the ecosystem, including customer premiums and deductibles over time), and eventually most people should feel it in some way or another (even if they still think they hate the law). The aggregate figures are already mostly showing that it’s working as intended. In the meantime, it’s lamentable but unavoidable that the reforms will work out better for some and worse for others. There was never any way to avoid that. Governing is really hard sometimes.
Mnemosyne
@Turgidson:
In theory, we should have had a Democratic Congress for the past 6 years that could have passed further bills to smooth out some of the rough edges and tweak some of the provisions when problems cropped up. Sadly, no.
Another Holocene Human
@Ella in New Mexico: Just because hospital staff are cursing Obama doesn’t mean all the changes have to do with ACA. There’s been a ton of that going on, it’s all bullshit.
Insurance co’s are charging different amounts based on zip code. I absolutely see the negative living in rural Florida–no Medicaid expansion and high premiums in the exchange (and with many employers). The reason? Well, it turns out that hospitals around here charge us more. We’re told there’s less competition, which would lower costs for patients, and I suspect that we’re getting kind of dinged for uncompensated care as well which has to be a mess given that uncompensated care payments went bye bye but Medicaid expansion has yet to happen.
Palm County premiums are half of premiums in this county.
More states need to put in a public option, I think it’s called a public coop or something. But ultimately there needs to be more cost-saving (death panels!!) and there’s nothing simple about it. It’s fucking complicated.
We tried pushing the easy button before. “HMOs will save us!” “Use drugs, not surgery!” That shit never works. Medicare has a lot of moving parts, too. Today’s GOP is more interesting in breaking them (Medicare Part D anyone?) rather than fixing things.
Fix who’s in Congress and we can fix ACA.
The biggest problem with ACA bar none is the loss of subsidy for premiums for household members where one person has employee coverage available at work. That’s effed up.
Richard Mayhew
@Ella in New Mexico: Ella — was there something going on in 2008/2009 that may have led to a massive drop in employer sponsored coverage as well as tightened eligibility for Medicaid — why yes, the economy went in the tank, state governments contracted and a lot of people had the rug pulled out from underneath them.
The long term trend had been increasing percentages of uninsured. The great recession accelerated that trend, and then there is a huge discontuinity against trend that reverese the entire impact of the Great Recession and some of the underlying trend in under a year.
Yeah, that is a big fucking deal.
Ella in New Mexico
@GHayduke (formerly lojasmo): ? You know, I REALLY resent you calling me a liar. I actually am in the trenches. I do the work–you, apparently, don’t. I know what I do and how long it is taking me outside of what it took 2-3 years ago. Between the new “paperwork” (computer based, paperless charting in reality) and the cuts made by our hospital to pay for all the new crap they claim they have to do, the ACA does take away my time at the bedside with my critically ill patients.
My hospital is not the Mayo or Cleveland Clinic, it is an average community hospital owned by a profit grubbing corporation that trades on the stock market, so it’s philosophy is “get it done the cheapest way possible”. Because of new rules and added expenses for the full implementation of the ACA, we are now doing more computer entry of all activities, orders, documentation and follow up documentation than we ever did. It’s slow, time consuming and frustrating. Why? Because we have old, shitty computer equipment and software, for one thing. Because it can’t handle the requirements with one or two screens, you’re going all over the Goddamn place just to chart a drug administration.
At the same time my hospital has cut our CNA and support staff and dumped more of the routine work on the RN’s at my hospital. So who do you think gives all the baths, feeds the patients, assists them to the bathroom or refills their water pitchers? We do. Who answers all the phone calls to the Unit now? We do. Who has to stop and respond to every call light before we actually accomplish a possibly more important task with our own patient? We do. Who has to answer the door bell for visitors because no longer can afford a person to sit in our lobby and direct visitors? We do. So ask yourself, if you suddenly had to do 50% more grunt work in addition to a bunch of new paper work, just how long after YOUR 12-13 hr shift would you like to stay to make it up?
@Mnemosyne (iPad Mini):
And yet, they still are screwing us, and getting away with it. I have no doubt that my employer is lying about how little money they are making after the ACA, but given that they are pretty much the typical exhibit for a profit-making hospital chain, I doubt they are much different than many other hospitals out there. They cannot miss a single penny of profit for the BOD or the shareholders. So it comes out of our hides, period. Which was not happening at this level prior to 2011, when they started trying to plan for the changes of ACA. And again, the hospital’s corporate parent is the one that negotiates our insurance programs, and they have markedly reduced the quality of the plan available to my co-workers. I was never so grateful that my husband has a stable job with the Feds as I am now, because for some reason, OPM has not chucked it’s commitment to Federal employees getting affordable and quality health care coverage.
And your statement
is precisely my point. We should have had tweaking going on, but the frigging war on Dems and Obama because he managed the “Victory” of passing the ACA has meant that the final 6 years of his term, the A-hole R’s were able to use everyone’s fear and outrage to halt any and all reforms. I have practically no hope it’s gonna get fixed over the last two years he’s in office, and I have ZERO hope it will be any better after 2016 because I really believe it’s gonna be a Republican trifecta in power after that.
@Richard Mayhew: 1.5% more people buying health insurance, no matter how crappy or useless, was not my dream when I supported Obama and PPACA’s reforms.
Seriously, things were ridiculously bad in some situations before the law. Now we have improvements, but still tons of sad and frustrating stories about people with insurance who are being gouged in ways they were not prior to ACA. On one hand, I hear people like you and other’s in this thread saying “it’s not perfect but it’s a start” when faced with what are very real, unacceptable harms created by this law. On the other, you use anecdotes from before the ACA’s passage to justify it–but in the end, don’t we just have a lot of the same crap, wrapped up in different tissue paper?
Why is it not concerning to you and others that working, middle and barely upper middle families—many of whom just started making the peak salaries of their careers and so have a lot of making up to do– have been saddled with additional out-of-pocket costs for the same employer sponsored insurance they had before? Is it fair that at the same time we are trying to pay for our kids educations, help our aging parents out with their needs and save for retirement we now have to spend $12,500 bucks a year before our insurance kicks in? Is it right to force people to pick between spending the money to get uncovered services for an accurate diagnosis of a life threatening condition and paying for their childcare?
One thing I can’t stand about too many of us on the left: we simply cannot admit it when something we like is fucked. Which is ANOTHER reason I worry this damn law won’t get fixed: if you can’t admit the parts of it that are failures, then you’ll never figure out how to fix them.