Will Obamacare succeed where term limits failed?

[Montmorency]

Furthermore: Get providers to treat tried-and-true technologies and procedures with more respect, as opposed to pushing the latest pricy-yet-ineffective 'device of wonder' on credulous or bewildered patients. It makes no sense to invest hugely in expensive-but-unproven techs, especially with short-term obsolescence being the norm, unless it's all just a marketing trick on the part of hospitals, far closer to rock-walls and multimedia centers at colleges than anything else...

This hi-tech fetish has permeated American culture for something like a century, though, so - tied closely to the end-of life care issue, it is urgent that the public at large be divorced from such notions of 'newer is better', 'more expensive is better', and most importantly: 'I deserve the best!'

[Seamus Fermanagh]

To which I would add the biggest rotting apple in the barrel: Unrealistic pricing.

You don't see many $500 hammers like you did in the old days of government contracting, but now you see plenty of $800 bags of saline solution that cost $1 to manufacture and distribute.

Price gouging, like so many government functions, has been privatized.

Most of which is nothing but a game. The manufacturer pays 1, charges more makes profit. The hospital charges 800 to offset costs on other levels. Insurance pays 32. The whole thing is a damn shell game.

[Seamus Fermanagh]

...This hi-tech fetish has permeated American culture for something like a century, though, so - tied closely to the end-of life care issue, it is urgent that the public at large be divorced from such notions of 'newer is better', 'more expensive is better', and most importantly: 'I deserve the best!'

Now you're calling on a full-on alteration of a culture. Such changes rarely happen swiftly and virtually never by fiat. In fact, that last statement -- I deserve the best -- is much of the practical motivation behind the ACA, at least as far as creating the political support for it.

[Montmorency]

Heh, maybe there could be workarounds that don't entail tackling it head-on?

I'm just outlining detrimental elements of the system; of course I lack the ability to compel them out of existence by "fiat".

I'm just one of the tourists.

[a completely inoffensive name]

This hi-tech fetish has permeated American culture for something like a century, though, so - tied closely to the end-of life care issue, it is urgent that the public at large be divorced from such notions of 'newer is better', 'more expensive is better', and most importantly: 'I deserve the best!'

Nonsense. Science and technology will deliver unto us all, heaven on Earth. Who are you to decide that my grandma should not get as many procedures and machines as possible?

DEATH PANELS

[Lemur]

The manufacturer pays 1, charges more makes profit. The hospital charges 800 to offset costs on other levels.

There's truth in what you say, but the bolded bit is ... shall we say an extremely generous interpretation of hospital behavior.

[Seamus Fermanagh]

There's truth in what you say, but the bolded bit is ... shall we say an extremely generous interpretation of hospital behavior.

Well, one of the costs they are offsetting is that of indigents and illegals receiving primary care in hospital emergency rooms on a (like it or not) pro bono basis. It must mount up somewhere, because as a sector health care facilities don't show huge profit margins compared to pharmaceuticals (license to print money) or biotechnology (license to print money in large denominations).

Still, it must be noted that the ACA is an attempt (how effective we shall see) to stop the entirely pro bono care in emergency rooms in favor of complete health coverage and increased preventative care.

[Kralizec]

Out of random curiosity...

Mandatory insurances have existed in the Neth's for a considerable time now in some form or another. There is a group of people here, which was never that big and is considerably diminished today, which is opposed to the very concept of insurance on religious grounds. I gather that their idea is that random misfortunes are not random at all, but the Will of God, and that it's blasphemy or at least hubris to try to avoid the consequenses.

Is this line of thought at all common in the US?

[Seamus Fermanagh]

Out of random curiosity...

Mandatory insurances have existed in the Neth's for a considerable time now in some form or another. There is a group of people here, which was never that big and is considerably diminished today, which is opposed to the very concept of insurance on religious grounds. I gather that their idea is that random misfortunes are not random at all, but the Will of God, and that it's blasphemy or at least hubris to try to avoid the consequenses.

Is this line of thought at all common in the US?

No. Those who believe in full and complete pre-ordination are quite rare.

[The Lurker Below]

I can't help but think that actually lowering costs across the board would be more effective as regards the Democrats' ideological goals than merely increasing the costs while forcing more individuals to pay toward them.

Not sure if serious. I enjoyed the chuckles anyhow. Liberals feel less miserable only when everybody feels some of the misery.

[Papewaio]

Not just for the reasons you mention. What happens to prices when you increase demand for a good or service while having the same or decreased supply?

Increased demand causes increased cost.

However you need to do a couple more iterations on this one or all you will do is prove firemen cause fires.

There is also the reduced cost in supplying something that is mass manufactured particularly designed once electronically manufactured many times.

There is no overall increased demand for being ill. People get sick regardless of having insurance or not. The overall healthcare system ie private and public has to care for the people and with chronically ill rarely if ever recovers any money.

What is increasing is demand for the insurers product. Which is highly scalable. What isn't is the doctors and hospitals so the insurers will be in a bidding war and/or build their own training hospitals to provide sufficient coverage. If anything they will make it scalable by trading between each other at a pittance and making the patients pay a significant markup ie ATMs

[Papewaio]

Nonsense. Science and technology will deliver unto us all, heaven on Earth. Who are you to decide that my grandma should not get as many procedures and machines as possible?

Given how much Monty spanks your butt I always assumed Monty was your grandma...

[Montmorency]

Given how much Monty spanks your butt

???

...

Oh.

OOOOHHHHH

...

How much do you want?

[Proletariat]

But the loser of the game is the self covered or out of pocket customer. They get the full 800$ charge for salt water in a plastic wrap and are charged 2 dollars each Tylenol administered when a bottle of hundreds costs under a few dollars at Costco. The problem of the insane pricing and the 'charge list' charade was examined in Time magazine a year back really well. It's what's wrong with healthcare and no one gets into it. Much more important than tort reform second maybe only to national health care or public option decision. That its just standard to not be told what any of the arbitrary or jacked up charges are being leveled at you by your healthcare provider is maddening. No one would accept buying software or food this way. So the freemarket works there in a way it can't in healthcare.

What I've learned as a therapist in the US army, some hospitals and some nursing centers for ten years. We're all being fleeced.

Most of which is nothing but a game. The manufacturer pays 1, charges more makes profit. The hospital charges 800 to offset costs on other levels. Insurance pays 32. The whole thing is a damn shell game.

[Xiahou]

I few years ago I had to get a chest x-ray and I didn't have insurance coverage. I called several hospitals... and none of them could tell me what a chest x-ray would cost me out of pocket. They honestly did not know. I was transferred to different departments, talked to different people, I never got a clear answer. Basically, I would have to come get the x-ray and they'd bill me- then I'd know what it costs.

Finally I found an outpatient surgery center in the phone book and they told me- $80. So guess where I went?

The point is- healthcare providers and consumers are both far isolated from the actual costs of their services. There is zero incentive on either side to keep costs low. If you want to see costs go down, you have to make people care what their healthcare costs.

If my car needs work done, I shop around for the best deal. People need to do the same for healthcare. For emergencies, you don't have much choice- but for everything else, there should be a price incentive.

There is no overall increased demand for being ill. People get sick regardless of having insurance or not. The overall healthcare system ie private and public has to care for the people and with chronically ill rarely if ever recovers any money.

This is a gross oversimplification. The threshold at which people seek treatment can vary greatly. If you have costly coverage or no coverage, you're less likely to go to a doctor for less serious problems.

[Seamus Fermanagh]

But the loser of the game is the self covered or out of pocket customer. They get the full 800$ charge for salt water in a plastic wrap and are charged 2 dollars each Tylenol administered when a bottle of hundreds costs under a few dollars at Costco. The problem of the insane pricing and the 'charge list' charade was examined in Time magazine a year back really well. It's what's wrong with healthcare and no one gets into it. Much more important than tort reform second maybe only to national health care or public option decision. That its just standard to not be told what any of the arbitrary or jacked up charges are being leveled at you by your healthcare provider is maddening. No one would accept buying software or food this way. So the freemarket works there in a way it can't in healthcare.

What I've learned as a therapist in the US army, some hospitals and some nursing centers for ten years. We're all being fleeced.

When I've insisted on paying out of pocket, or when the mother in law goes out of pocket to her dentist, there are different prices available. One can even negotiate a bit on them (the mother in law has few teeth left of her own, getting her cleanings done at the pediatric rate by arrangement).

On the other hand, prole', I do not doubt that many (most? all?) of us ARE being over-charged. As you have direct industry experience and I have not, your points carry weight with me. I've argued before that the current system is, in some ways, the proverbial camel (horse designed by committee) with too many in-built gaffes and shenanigans. It is neither a fee-for-service with insurance negotiated to suit each client situation NOR a government mandated and controlled system that is applied equally to all. It is a Frankenstein of both.

My thrust here has been to argue that the ACA is not going to get the job done in terms of making things better.

[Xiahou]

As the reports come in documenting the logistical train wreck that has been the Obamacare exchanges, we're beginning to hear murmurs that suggest that it may be postponed anyway, lest it collapse under it's own fail.

Obamacare Website Failure Threatens Health Coverage For Millions Of Americans

Under these circumstances, the lion's share of the people who do whatever is necessary to sign up through HealthCare.gov are likely to be the sickest and most expensive to cover because they have the greatest need, Laszewski said. That would make the pool of people covered very costly, causing health insurers to lose money and likely rethink whether they want to participate in the exchanges, he said. "The fundamental threat to Obamacare is we don't get enough healthy people in the pool to keep the rates reasonable, and they are in grave danger of that problem," he said.

If these problems persist longer -- weeks, months, a whole year -- the entire Obamacare project falls apart, Laszewski said: "It's a holy shit moment."

[Lemur]

"Under these circumstances, the lion's share of the people who do whatever is necessary to sign up through HealthCare.gov are likely to be the sickest and most expensive to cover because they have the greatest need"—yup, that's the scariest part.

Interesting that the Obama campaign was a best-practices model of how to do web, but once normal federal procurement is the basis, it all breaks down. Ah, dysfunction. Good article about it here.

The launch of the federal Obamacare website has been unforgivable, for a variety of reasons. Just a shocking mess. And I suspect it was preventable.

[Xiahou]

"Under these circumstances, the lion's share of the people who do whatever is necessary to sign up through HealthCare.gov are likely to be the sickest and most expensive to cover because they have the greatest need"—yup, that's the scariest part.

Are you being serious? .....I cant tell.

[Lemur]

Of course I'm being serious. The whole Swiss/Heritage Foundation/Romneycare/Obamacare premise is based on the idea of broadening the insurance pool so that the high-risk, high-usage patients are balanced out by healthy people. A system that (through incompetence) encourages only the high-risk people to enroll is broken, utterly broken. It's bad news. It flips the bird at the whole let's-do-universal-insurance-with-private-insurers concept. It's nine or ten shades of bad.

[a completely inoffensive name]

Given how much Monty spanks your butt I always assumed Monty was your grandma...

[Xiahou]

Well, October is drawing to a close, and Healthcare.gov is still a virtually unusable mess.

The administration is now promising that the site's problems will be, for the most part, resolved by the end of November. Yet even if the technical glitches on HealthCare.gov are resolved, this week revealed that the new insurance marketplaces the site serves still need to overcome huge hurdles, both technically and politically, to succeed.

The end of Novermber? Awesome.

Now we're also learning that at least part of the reason for the website's failed rollout was due to political concerns...

CBS News' Sharyl Attkisson has been digging into the cause of the delays in preparing the website for the government's health insurance market and has learned was a major interruption in the months before President Obama's re-election. At the height of the 2012 presidential election campaign, it was crunch time for the Obama administration to release key instructions so contractors could work toward the October 2013 deadline.

But a Health and Human Services official who was closely involved tells CBS News that in late summer, the administration stopped issuing proposed rules for the Affordable Health Care Act until after the election.

The result was what many viewed as a serious delay as contractors, states and insurance companies awaited crucial guidance to move forward.

And at the risk of beating a dead horse, if you like your insurance.... no, you can't keep it.

Gerry Kominski, director of public health policy at UCLA said: "About half of the 14 million people who buy insurance on their own are not going to be able to keep the policies that they had previously."

Lastly, the administration has been trying to point to the state-run exchanges as an Obamacare success. Some of them aren't experiencing the same level of technical glitches, but not everything is unicorns and rainbows there either- new Medicaid enrollments (expanded under Obamacare) are far outpacing actual insurance registrations....

a CBS News analysis shows that in many of the 15 state-based health insurance exchanges more people are enrolling in Medicaid rather than buying private health insurance. And if that trend continues, there's concern there won't be enough healthy people buying health insurance for the system to work.

As the Obamacare website struggles, the administration is emphasizing state-level success. President Obama said Monday, "There's great demand at the state level as well. Because there are a bunch of states running their own marketplaces."

But left unsaid in the president's remarks: the newly insured in some of those states are overwhelmingly low-income people signing up for Medicaid at no cost to them.

Matt Salo, executive director of the National Association of Medicaid Directors, said, "We're seeing a huge spike in terms of Medicaid enrollments."

He says the numbers have surprised him and state officials.

The technical incompetence of the web portal, at least, could have been avoided. However, all these other "unforseen" problems have been pointed out repeatedly- before, during, and since the law's passage.

[Xiahou]

According to an NBC investigation, Obama knew he was lying when he repeatedly stated "If you like your heath insurance, you can keep it.", and the law was written in such a way to make it almost impossible for a plan to get 'grandfathered' in.

President Obama repeatedly assured Americans that after the Affordable Care Act became law, people who liked their health insurance would be able to keep it. But millions of Americans are getting or are about to get cancellation letters for their health insurance under Obamacare, say experts, and the Obama administration has known that for at least three years.

Here's the real money shot from the article:

George Schwab, 62, of North Carolina, said he was "perfectly happy" with his plan from Blue Cross Blue Shield, which also insured his wife for a $228 monthly premium. But this past September, he was surprised to receive a letter saying his policy was no longer available. The "comparable" plan the insurance company offered him carried a $1,208 monthly premium and a $5,500 deductible.

And the best option he’s found on the exchange so far offered a 415 percent jump in premium, to $948 a month.

"The deductible is less," he said, "But the plan doesn't meet my needs. Its unaffordable."

"I'm sitting here looking at this, thinking we ought to just pay the fine and just get insurance when we're sick," Schwab added. "Everybody's worried about whether the website works or not, but that's fixable. That's just the tip of the iceberg. This stuff isn't fixable."

And that, folks, will be why the ACA fails.

[ICantSpellDawg]

Of course I'm being serious. The whole Swiss/Heritage Foundation/Romneycare/Obamacare premise is based on the idea of broadening the insurance pool so that the high-risk, high-usage patients are balanced out by healthy people. A system that (through incompetence) encourages only the high-risk people to enroll is broken, utterly broken. It's bad news. It flips the bird at the whole let's-do-universal-insurance-with-private-insurers concept. It's nine or ten shades of bad.

I've been as patient as an ideological opponent can possibly be. When a law passes called "the affordable care act" is it ignorant to believe that at least someone wants it to make care more affordable? It is now less affordable for everyone I've spoken to, blue collar, white collar, no collar.
My healthy brother had a $98 catastrophic policy. It cancels in January because it fails to adhere to new insurance guidelines and has been replaced by a $260 per month catastrophic policy which he intends to drop and instead pay the $300 per year penalty (approx 1% of his income). His unhealthy brother (me) had a $510 policy which cancels in January and is replaced by a $628 per month policy. Additionally, my gastroenterologist is not covered under this plan.

My idiotic friend who loves everything Barack Obama and is an environmental science major and started his own business is super excited to find a policy that he can finally afford. The site doesn't work. If he couldn't afford the $98 per month policy that my brother had, what makes him think that he can suddenly afford the $300 policy that may or may not be available if the website starts working?

The apocalyptically stupid rollout has led me to suspect my base assumption is true. This is an attempt to make health care so unaffordable that people begin to clamor for single payer. It cannot happen. There are ways to fix even this broken system and keep many of the things that were fixed by the ACA. Single payer must not happen, even though I would be tremendously benefitted by it, but something radical must be done to make health insurance more like car insurance, possibly coupling it to a minimal extent with government subsidy.

Personally, I would like to see itemized and standard deductions on tax returns for health costs eliminated and see HSA's open up to everyone regardless of the deductible size of their health plans, for starters. I'm open to mandating that employers make an HSA available to all employees for pre-tax deduction of income. Likewise, I'm open to forcing employers to make health insurance portable, pre-tax for employee the and cutting employer benefit. These are things that shouldn't cost the employer money, but will merely give all employed individuals access to these things and allow individuals to get the tax relief. It will also allow the individual to shop around and simply let his employer know when he or she has signed a contract with a new company. This will also help avoid individuals lapsing coverage. This type of competition has led to low cost of car insurance and has never thrived in the health insurance market.

As a former insurance agent and claims adjuster, irresponsible people will NEVER fail to lose coverage through non-pay termination. This is because poor people are too physically or mentally I'll, or are morons (by nature, culture, or opportunity). Something as important as health insurance cannot be allowed to expire like a morons car insurance.

[Seamus Fermanagh]

I've been as patient as an ideological opponent can possibly be. When a law passes called "the affordable care act" is it ignorant to believe that at least someone wants it to make care more affordable? It is now less affordable for everyone I've spoken to, blue collar, white collar, no collar.
My healthy brother had a $98 catastrophic policy. It cancels in January because it fails to adhere to new insurance guidelines and has been replaced by a $260 per month catastrophic policy which he intends to drop and instead pay the $300 per year penalty (approx 1% of his income). His unhealthy brother (me) had a $510 policy which cancels in January and is replaced by a $628 per month policy. Additionally, my gastroenterologist is not covered under this plan.

My idiotic friend who loves everything Barack Obama and is an environmental science major and started his own business is super excited to find a policy that he can finally afford. The site doesn't work. If he couldn't afford the $98 per month policy that my brother had, what makes him think that he can suddenly afford the $300 policy that may or may not be available if the website starts working?

The apocalyptically stupid rollout has led me to suspect my base assumption is true. This is an attempt to make health care so unaffordable that people begin to clamor for single payer. It cannot happen. There are ways to fix even this broken system and keep many of the things that were fixed by the ACA. Single payer must not happen, even though I would be tremendously benefitted by it, but something radical must be done to make health insurance more like car insurance, possibly coupling it to a minimal extent with government subsidy.

Personally, I would like to see itemized and standard deductions on tax returns for health costs eliminated and see HSA's open up to everyone regardless of the deductible size of their health plans, for starters. I'm open to mandating that employers make an HSA available to all employees for pre-tax deduction of income. Likewise, I'm open to forcing employers to make health insurance portable, pre-tax for employee the and cutting employer benefit. These are things that shouldn't cost the employer money, but will merely give all employed individuals access to these things and allow individuals to get the tax relief. It will also allow the individual to shop around and simply let his employer know when he or she has signed a contract with a new company. This will also help avoid individuals lapsing coverage. This type of competition has led to low cost of car insurance and has never thrived in the health insurance market.

As a former insurance agent and claims adjuster, irresponsible people will NEVER fail to lose coverage through non-pay termination. This is because poor people are too physically or mentally I'll, or are morons (by nature, culture, or opportunity). Something as important as health insurance cannot be allowed to expire like a morons car insurance.

Gelcube will get his wish and you will not get yours.

As the adverse selection bias by higher risk insureds magnifies the functional cost of the plan -- since it will be cheaper to pay the penalty than the premiums -- the strain on the insurance industry will force the government to make changes to maintain healthcare affordability and rescue the system.

In fairly rapid stages, this will lead us to a national health system. This has been a major goal among numerous democratic party leaders for a generation. This is simply a step on the path.

Establishment of a national health care system will bring us in line with the developed countries and will almost complete the social safety network that is expected in a developed country (Old Age Pension, minimum subsistence allowance for the indigent, healthcare, education [partial]). Once undergraduate education is placed under government control the support network will be complete. The current administration has already begun that part of the process as well.

[ICantSpellDawg]

We'll see what happens. Who knows. I don't believe in pre-destination and I don't believe that Democrats are particularly competent. I know that Republicans aren't competent, they don't even pretend to be. They just want to take the power away from the incompetent narcicists.

One could say; if they can't be trusted to put out a website, why should we just ante up and put something so important in the hands of fools?

Republican strategy is to throw a monkey wrench in government. If the Democrats think that ruining government will make people want more, I would suggest that they are mistaken.

[Beskar]

Reality has a liberal bias.

[Husar]

The website problems are a bit overblown. Name any online product that had to meet that kind of demand on launch and succeeded... you can't. Overflowing servers are the norm with any launch.

"I could give a 12-year old a hundred bucks and he'd make me a website in three hours..."

It is indeed amazing how a government healthcare database is now equal to a myspace page. But it proves the Republicans right in that people are spoiled and want things they cannot afford.

[Seamus Fermanagh]

"I could give a 12-year old a hundred bucks and he'd make me a website in three hours..."

It is indeed amazing how a government healthcare database is now equal to a myspace page. But it proves the Republicans right in that people are spoiled and want things they cannot afford.

Oh come on. That kind of line is the usual snide political hyperbole. Such cheap shots have been a political norm, I feel certain, at least since the Greek city states. I dare say you could find a few home-grown German examples without stressing your google-fu all that much.

Gelcube is correct about the overwhelm factor. I put down most of the initial problems to the volume thing. Only the most recent spate of issues can be said to be design problems. It still wasn't that well thought out a web-site system -- they were planning on hits in the millions from the outset. That was the point of the program. Trouble free was never possible, but this was still a bit sloppy.

[Xiahou]

The website problems are a bit overblown. Name any online product that had to meet that kind of demand on launch and succeeded... you can't. Overflowing servers are the norm with any launch.

I agree insofar as the website not being the "big" story, but the magnitude of the technical failure that is heathcare.gov is most definitely not being overblown....

They didn't begin any actual testing of the site until just a couple weeks before launch- far too late to make any significant changes. But, even with the testing they did, the website was crashing under a load of just a few hundred users- on a website that was expecting to receive millions. Some problems are to be expected when you roll out a major e-commerce portal. The problems with heathcare.gov go far beyond that. It was essentially non-functional on its go-live date.

The President's healthcare sign-up web page was supposed to handle tens of thousands of people at once. But in a trial run days before its launch, just a few hundred users flatlined the site.

Despite the problems, federal health officials pushed aside the crash cart and rolled out HealthCare.gov on October 1 as planned, The Washington Post reported.