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Dean F.
(acrosome) - MLife

Locale: Back in the Front Range
Re: Re: "Tea Party Haters" on 10/27/2013 09:41:58 MDT Print View

@Tom "I know a lot of docs up here who seem to be doing just fine, and almost all of them tell me that they would gladly settle for less money if they could eliminate all the hassles of dealing with insurance companies and go back to practicing medicine."

That's one reason that I work for who I do- I make less than half of what I could, but I find it fulfilling. Many docs (particularly ER and trauma) recoup only about a third of what they bill. Another third is lost to the uninsured and underinsured, and one third is lost to underhanded ploys from insurance companies. It's been that way for a very long time.

But that argument doesn't work for Medicare, because if a doctor/hospital/whatever ONLY takes Medicare patients (without supplemental plan) then it isn't that they are making less money, but rather they are damned close to operating at a LOSS. You cannot make a living on Medicare patients without some sort of further subsidy, for instance a tax-supported county hospital.

As a philosophical issue a single-payer system looks pretty good, even to me. And you are correct, a lot of other people make it work. But I'm not sure if it would work well for modern America, if for no other reason than at this point I just don't trust congress and the Medicare administration. There, I said it. They have been playing games with Medicare and Medicaid for decades and I don't see why they would stop if it were the only game in town. They have a nasty tendency to set limits on what medicare will pay for a service, and they set it far below market rate.

If they stopped such shenanigans I might take the proposition more seriously.

*** Studiously not engaging Fred, though he is clearly begging for it ***


Also- wow. I do tend to be oblivious about interpersonal stuff but I had NO IDEA about this acrimonious Kat/Ken warfare. Clearly, we need to lock them both in Thunderdome and let them work it out. I'll run book at 2:1 in Kat's favor- she seems fiesty, and Ken has revealed chronic medical conditions. :)

Speaking of which, have any of you all read the "Presidential Knife Fight" thing? Hilarious.

@ Tom "I would feel better if this were amended to say "self sacrifices". As things stand, innocents other than ourselves are usually sacrificed in the pursuit of our version of justice. Not surprisingly, they often refuse to go quietly into the night and, to our self righteous consternation, we find ourselves making a few sacrifices of our own."

Gee, Tom, you are psychologically incapable of passing up even the thinnest opportunity to voice criticism on every foreign policy decision the US has ever made, aren't you? :) Please don't make semantic quibbles with me- I was clearly referring to SELF sacrifices. There are always effects from everything we do, but justice is a basic human psychological need, and is one function that governments have assumed. A system of automatic universal punishmentless forgiveness for all crimes obviously would be disastrous, for instance. The example given was clearly a repugnant crime and does deserve it's own punishment, but a blanket statement about forgiveness is not realistic, either. When people are wronged they need redress. If they can swallow something like Truth and Reconciliation a la South Africa or Rwanda, all the better. But that's a big pill since, clearly, one end result is that a gawdawful lot of horrible crimes go unpunished. People don't like that. So I guess all that I'm saying is that I tend to be a realist about the issue and think that there is a time for Truth and Reconciliation, and a time for justice.

Edited by acrosome on 10/27/2013 10:38:55 MDT.

jerry adams
(retiredjerry) - MLife

Locale: Oregon and Washington
Re: Re: Re: "Tea Party Haters" on 10/27/2013 10:32:34 MDT Print View

Medical costs have been rising faster than inflation. Medicare and Medicade taxes have not been rising as fast. As a result, they have not raised Medicare and especially Medicade to keep up with rising costs.

I don't think it's that the Medicaire administrators are bad people, they're "between rock and a hard place". We need to control medical costs.

For example, pharmaceutical companys try to develop "blockbuster" drugs. Produce statistically questionable data that shows it's more effective, heavily market it, charge high price for it. It would be cheaper and just as effective to just use a generic drug. That's what we have to do to reduce medical costs.

But there are lots of similar problems that have to be solved, it's not just one thing. Pharmaceutical companies are not "boogymen". We just have to change the system so we have effective and cost effective medical care and don't do expensive and ineffective care.

Dean F.
(acrosome) - MLife

Locale: Back in the Front Range
Re: Re: Re: Re: "Tea Party Haters" on 10/27/2013 10:48:44 MDT Print View

@ jerry--

I'm glad that you included that final paragraph. I tend to get feisty at blanket bashing of the pharmaceutical companies. Clearly they suffer from the evils inherent to any for-profit coporation, and I'm quite willing to criticize them, but without an opportunity to make a profit NO progress would be made at all. (The system that I work in is heavily into generic drugs.)

Regarding Medicare reimbursement, I doubt that the administrators are "evil" as well (though I have my doubts about congress)- but you missed something there. It isn't just that Medicare costs "don't keep up with medical costs." In fact recently the Medicare limits on reimbursement for many things have actually been cut! Actual dollar amount- not adjusted for inflation or anything else- so it's actually a sort of double-cut. In fact there are laws that *automatically* cut the reimbursement for some things periodically. (Several common surgical procedures are among them- that's how I know this.) How in the hell is THAT sustainable?!?

This does cut both ways, though. For instance a while ago it became clear that doing more than a 4-vessel coronary bypass was almost always pointless (they do increase blood flow and thus theoretically should provide benefit, but studies show no better survival) so Medicare stopped reimbursing beyond 4 and all insurance companies immediately followed suit... and the days of 7-vessel coronary bypasses ended. This was probably a good thing "big picture", even if it does mean that hospitals and doctors have to suck it up when a rare individual patient actually does need more than 4 (incredibly rare, and usually due to a technical problem).

Edited by acrosome on 10/27/2013 10:56:36 MDT.

jerry adams
(retiredjerry) - MLife

Locale: Oregon and Washington
Re: Re: Re: Re: Re: "Tea Party Haters" on 10/27/2013 10:53:52 MDT Print View

see - I probably agree with you more than anyone else : )

it's just the system that we have randomly evolved into

at the heart of it is that we have a bought government. We have to fix that or it's almost impossible to fix everything else.

Dean F.
(acrosome) - MLife

Locale: Back in the Front Range
Re: Re: Re: Re: Re: Re: "Tea Party Haters" on 10/27/2013 10:54:32 MDT Print View

Ok, now you're goading me into a Citizens United rant. Troll. I'm on to you.

Dave Stoller
Propaganda from right-wing rag LA Times! on 10/27/2013 11:13:07 MDT Print View

"Thousands of Californians are discovering what Obamacare will cost them — and many don't like what they see.

These middle-class consumers are staring at hefty increases on their insurance bills as the overhaul remakes the healthcare market. Their rates are rising in large part to help offset the higher costs of covering sicker, poorer people who have been shut out of the system for years.

Although recent criticism of the healthcare law has focused on website glitches and early enrollment snags, experts say sharp price increases for individual policies have the greatest potential to erode public support for President Obama's signature legislation.

"This is when the actual sticker shock comes into play for people," said Gerald Kominski, director of the UCLA Center for Health Policy Research. "There are winners and losers under the Affordable Care Act."

Fullerton resident Jennifer Harris thought she had a great deal, paying $98 a month for an individual plan through Health Net Inc. She got a rude surprise this month when the company said it would cancel her policy at the end of this year. Her current plan does not conform with the new federal rules, which require more generous levels of coverage."

Pretty much the opposite of "You can keep your plan" and "You will save $2,500.00 per year".

Fred Thorp
(BFThorp) - F
Re: Propaganda from right-wing rag LA Times! on 10/27/2013 11:33:58 MDT Print View

These middle-class consumers are staring at hefty increases on their insurance bills as the overhaul remakes the healthcare market. Their rates are rising in large part to help offset the higher costs of covering sicker, poorer people who have been shut out of the system for years.

No way.

Ian B.

Locale: PNW
Re: Propaganda from right-wing rag LA Times! on 10/27/2013 11:35:31 MDT Print View

I've only had an opportunity to see a grand total of 1 quoted rate for ACA. The person in question is making close to minimum wage, single, and is buying a modest house. The business he works for isn't contributing to his premiums.

What I don't understand for this guy is that there are two lines which quote him his premiums. Total premium is $190.15 but his cost is $34 for bronze level coverage. Since his premiums aren't being subsidized by his employer, I'm assuming that he'll be reimbursed the difference between the two at the end of the year?

Bronze level coverage is catastrophic coverage and has a high yearly deductible of $6000 individual and $12000 family. It's nice that he won't have to lose his house in a worst case scenario but he'll have to opt for a higher option if he want preventative care and physicals.

I'm not trying to sound callused to his situation (as I've had to live on minimum wage as well) but worse case scenario, if he can't free up enough income to cover the $190, he's probably a candidate for Medicaid. If it's $34 then that's quite a deal in my opinion.

Dean F.
(acrosome) - MLife

Locale: Back in the Front Range
Re: Propaganda from right-wing rag LA Times! on 10/27/2013 11:46:11 MDT Print View

Pretty sure Obama said that you could keep your insurance provider, not the exact same plan. I could be wrong, though. I'll look it up.

The $98 plan mentioned was discontinued my her provider because it didn't meet minimal requirements- in other words, it was a trash plan. She can still keep her insurance provider, just not the same plan. In fact, further on the article cited even mentions that people are being offered to be automatically enrolled in the most comparable plan available if theirs is cancelled. Yes, she is one of the young invincibles that the ACA is trying to force to either get insurance if they have none or to get adequate insurance if theirs sucks (as her does). Yes, they will have to pay more in either case. But the price of two identical plans pre- and post-ACA should still go down on average. Her $98 plan simply sucked. It was probably one of those scam catastrophic plans that young healthy people tend to get.

She's pregnant? She'll recoup any increase in the form of free preventive care rather handily.

And if you read the rest of the article you'll see that they still predict lower premiums in the long term. This *should* be a short-term problem. Basically, the entire second page of the article- which you cut- covers this, and includes comments from some people who say that they are OK with the increases in their premiums if they can be controlled in the long run.

All of that said, yes, I'm sure that some people (the fraction from among the fraction who buy private insurance who will see a rise) are unhappy. But, really, their plans probably suck and they will get more value for their money. And in the long run premiums will improve. Are people curmudgeonly and get annoyed when they have to change plans? Yes, clearly. They'll get over it.

Edited by acrosome on 10/27/2013 11:49:04 MDT.

jerry adams
(retiredjerry) - MLife

Locale: Oregon and Washington
Re: Propaganda from right-wing rag LA Times! on 10/27/2013 11:47:23 MDT Print View

I talked to my health insurance company. My rates will go down slightly, but it's difficult to do apples to apples comparison. $617 a month last year. $588 a month next year under ACA. Same $30 copay to see doctor. The last time I had a colonoscopy I had to pay about $200 but under Obamacare it will be free. I'm not sure how other co-pays and deductibles compare.

But health care has been, in general, rising from year to year so I would expect it to have gone up some. And I was in a pool so I was not subject to pre-existing conditions. I probably could have found a cheaper policy but then I would have had to gone through under-writing and my minor pre-existing conditions may have been a problem. And I don't know how such a policy would change over time. Easier to just stay with what I had.

My point is, that it is so complicated you can not do a good apples to apples comparison. I'm skeptical of anyone that says their rates under Obamacare have gone up or down. I think that all you can say is that rates will be about the same.

What I was talking about was a policy that has no subsisdy or tax credit. If I made less than $50K a year for 2 people in the home, I would become eligible for tax credit. Somewhere less than that and I would be eligible for subsidy. When I asked them about this, they said I would have to wait for that to work. They couldn't give me any rates or anything. gave me numbers and a list of policies, but when it comes to doing anything it doesn't work yet. They sure have clever commercials though : )

Again, I'm skeptical of anyone that says Obamacare will cost more or less - system doesn't work yet so you can't get numbers out of it. Maybe other states are working better though.

I think there's a flaw in the law. They have removed income verification from the IRS out of fear that the "Gestapo IRS" is going to do bad things to people. That makes it almost impossible to verify income, so it's going to be difficult for this to work smoothly. This is just me conjecturing based on my interacting with them.

They should just have the subsidy, tax credit, and mandate penalty handled by the IRS - lines on the 1040 form or whatever. This was not politically possible then and it doesn't seem likely the Tea Party will go along with anything but repeal Obamacare.

But I'm okay - forget about the tax credit, I could sign up tomorrow. Thanks to Obamacare I won't be subject to pre-existing conditions. Thanks to Obamacare there are some minimum care and preventative care standards I didn't have before. I'll save an insignificant amount on costs.

Fred Thorp
(BFThorp) - F
? on 10/27/2013 11:53:09 MDT Print View

Ian. My understanding is most of the applicants that get through are being routed to Medicaid. Anyone else see the humor here? Anyone understand the impact potentially to the ACA numbers? Any intelligent guesses?

Lots of unanswered questions but who picks up the deductible shortfalls? What if premiums aren't maintained? On a sadder note... Applicant ratios that I've seen are roughly 7:1. 7 being applicants who can't afford coverage and are denied vs. 1 who can afford coverage. This shouldn't have surprised anyone either.

Edited by BFThorp on 10/27/2013 12:00:01 MDT.

Dean F.
(acrosome) - MLife

Locale: Back in the Front Range
You can keep your plan... on 10/27/2013 12:00:38 MDT Print View

Looks like Obama may indeed have put his foot in his mouth on that one, by not being explicit enough...


Claim: If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor. Misleading.

Obama has repeatedly made this claim, and the White House continues to use the line on its website. The law doesn’t force Americans to pick new plans or new doctors, but the president simply can’t make this promise to everyone. There’s no guarantee that your employer won’t switch plans, just as companies could have done before the law. And if you switch jobs, your new work-based coverage might not have your doctor as an in-network provider, either.

As we mentioned above, some employees won’t have an offer of insurance and will look for a new plan on the exchanges. Some small businesses could drop their current plans and join the exchanges, too. Grocery store chain Trader Joe’s, for instance, announced that it will direct its part-time workers (less than 30 hours per week) to the exchanges for health coverage and provide them with $500 to help purchase it, as of Jan. 1, 2014. The company, which has provided coverage to such workers, said “many crew members should be able to obtain health care coverage at very little, if any, net cost.”


There is a similar analysis on PolitiFact. When you follow the links on where they try to clarify this they backpedal a bit. They say "your plan will probably be strengthened", by which they mean that it will now have to meet the new minimum requirements. This is why crappy plans are being discontinued and replaced with better ones that offer more coverage- so you certainly get to keep at least the same coverage. It probably will cost more, though- but then, you get better coverage.

This is really what is happening to almost everyone who is seeing an 'increase' in premiums, by the way- they are just being forced to get better coverage. Understandably, this is unpopular, because people have trouble thinking long-term. (And generally does not affect the 80% of Americans who get their insurance through their employer- assuming that the employer doesn't pull any shenanigans, but that's on them.)

Still, yeah, foot-in-mouth. I understand that he needs to keep the sound bites short and simple, but he could have done better, there.

OTOH, Politifact recently made a synopsis of Ted Cruz statements:

Apparently the only thing he's said that they rate TRUE is "We have a federal government that thinks they have the authority to regulate our toilet seats." Because the federal government does, apparently, regulate toilet seats under the Commerce Clause.


None of his MOSTLY TRUE or HALF TRUE statements were about the ACA, either...

Edited by acrosome on 10/27/2013 12:28:28 MDT.

Ken Thompson
(kthompson) - MLife
Re: You can keep your plan... on 10/27/2013 12:10:13 MDT Print View

I make just enough to not qualify for assistance. Looking at over $450 a month for health insurance is just not possible. I have no car payment, just a mortgage that 's not even that much. No credit card bills. Need to eat and buy fuel to get back and forth to work. Even taking the bus only saves me $60 a month and uses more of my time.

What's plan B? Paying the fine I guess. Under duress.

Dean F.
(acrosome) - MLife

Locale: Back in the Front Range
Re: Re: You can keep your plan... on 10/27/2013 12:13:46 MDT Print View

EDIT--- Retracted. Inquiries about people's income is rude.

Edited by acrosome on 10/27/2013 12:35:21 MDT.

Fred Thorp
(BFThorp) - F
Re: Re: You can keep your plan... on 10/27/2013 12:18:52 MDT Print View

Ken. Work a cash deal with your employer so you can slide under the benefit threshold. It's not like you'll be the only one.

Dean F.
(acrosome) - MLife

Locale: Back in the Front Range
In the interests of fairness... on 10/27/2013 12:37:47 MDT Print View

Here are some things that the pro-ACA people end to say that PolitiFact doesn't like:

A few of them are "Promises Broken" that he could not pull off politically, like open negotiations or the public option.

I'd say that this list compares favorably...

Edited by acrosome on 10/27/2013 12:40:17 MDT.

Ken Thompson
(kthompson) - MLife
Re: You can keep your plan... on 10/27/2013 12:45:32 MDT Print View

No problem Dean. With needed prescriptions for my wife the Silver Plan is a way better choice than the Bronze plan that doesn't pay for hardly anything. Anthem Blue cross wants $427 a month Blue Shield wants $459 a month. We make a combined income of less than $60k annual.

@ Fred. My employer (Bien Padre Foods LLC) has no interest in their employees health. We are to fend for ourselves. I'M SURE I'm not the only one.

They actually just reduced my wages without prior notice. They're awesome. There will be an opening there just as soon as I can make one.

Tax credits. What kind of game is that?

I have no secrets. Ask away.

I just love how things like mortgages and insurance are figured on your gross earnings, Not on what is actually left over to spend. Take 25% off the top and it makes a huge difference.

As far as hate for the Tea Party. Don't care. All politics in government is shameful. We must strive for all encompassing change in the way Americans think. Good luck with that.

Edited by kthompson on 10/27/2013 13:03:43 MDT.

Dean F.
(acrosome) - MLife

Locale: Back in the Front Range
Re: Re: You can keep your plan... on 10/27/2013 13:36:36 MDT Print View

Ok- I thought that under Covered California the point at which you get no subsidy was around $95k? Where are you looking?

EDIT--- Ah, never mind. That's a family of four...

Edited by acrosome on 10/27/2013 13:38:05 MDT.

Ken Thompson
(kthompson) - MLife
Re: You can keep your plan... on 10/27/2013 13:37:45 MDT Print View

Those figures are straight from the covered ca website.

Dean F.
(acrosome) - MLife

Locale: Back in the Front Range
Re: Re: You can keep your plan... on 10/27/2013 13:39:08 MDT Print View

Yeah- see my edit: I was thinking of a family of four. I saw it in an article, somewhere, and misremembered. It's $62,040 for two, just as you said.

What insurance do you have pre-ACA? And you're 55, right?

Edited by acrosome on 10/27/2013 13:42:38 MDT.