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Woman writes of struggle to keep the doctors who keep her alive
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Hambone10 Offline
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Post: #21
RE: Woman writes of struggle to keep the doctors who keep her alive
(11-11-2013 08:22 AM)RiceLad15 Wrote:  I'm not trying to demonize this healthcare company, but instead try to illustrate a point I have been trying to make on this thread since my first comment, and perhaps I should have been more clear.

FTR, I didn't mean to imply you did. MANY certainly do. It was part of how Obamacare was sold.

Quote:When I first saw this article, it was being touted by many as basically the "Obamacare is going to kill me article." When I read it with that in mind, I was expecting to find some piece of the legislation where a specific rule had deemed the high-end insurance illegal, thus reducing the woman to finding someone else to provide her care. But what I found was an article about a company who is dropping the coverage of all individuals in California for an unspecified reason.

Unspecified reason? Really?

Quote:Instead of immediately assuming that it was unprofitable to cover those 8,000 individuals now (because Hambone, as you said, it may have already been unprofitable, and if so, why were they doing it in the first place?) I wanted to investigate and understand why the company would discontinue covering individuals, but not large groups and businesses in California.

When did I say it may have already been unprofitable? Whether they actually made money at it or not, certainly you'd agree that they THOUGHT it would make money. Now they don't. What changed? Of course, it COULD be mere coincidence, but if so, why did they cancel the policies rather than sell them to another company offering similar/competitive policies? The insurers have contracts with the doctors and those contracts have value. The company cancelled the contracts rather than sell them. It makes zero sense that they would make a decision to close a business unit and then not try and sell/consolidate the assets of that unit, unless "overhead" wasn't the problem.

Quote:And this is where I got confused. Ham, as you have now stated in two separate posts, businesses wouldn't engage in actions that intentionally cost them real money, but since they are now dropping the coverage, they must have been engaging in actions that intentionally cost them money. Wait, what?

Yes, exactly wait, what? I never said anything like that. They're dropping the coverage now because they can no longer make money at them (if they did already) or they no longer see a WAY to make money at them (if they didn't already).

Quote:And since I haven't read an article that discusses the pre and post finances of United Healthcare and the rational behind removing themselves from the individual market in California, I will continue to be interested in why they made such a decision, and not make a foregone conclusion that it was because it was so unprofitable.

First, my comment about profit was in direct response to your comment that "they were in the business of helping people". No they aren't. They are in the business of making money. Why else would you think they would stop offering a product? You may not accept the obvious reason, but I seriously can't think of another rational one.

They stopped offering these policies because they no longer believe they can make money at them... whether it is because the policies no longer meet the minimum requirements (unlikely given the individual's circumstances, but still possible) or because it changes the math to profit or because it changes the size of the potential market.

If they had simply changed their minds about being able to penetrate the market, they would have sold the contracts to a competitor who already had penetration.

Quote:I'm not a gigantic fan of the mandate in the ACA (I'm all for getting rid of preexisting conditions, allowing you to stay on your parents insurance until 26, and capping the amount one can spend on insurance in a year), but I'm certainly not against it. Instead, I'm pretty much someone who better understands why the ACA was passed as opposed to why it wasn't. There are probably better healthcare alternatives out there (as Owl69/70 often points out), but perhaps I don't fully comprehend the effects of this law yet, and that's why I am not fully in one corner or the other.

You understand the "feelings" and "excuses" behind the ACA. It appears that you don't understand the realities of it at all.

When talk of the ACA first came about, even under CLinton... all anyone talked about was how we didn't have enough PCPs for our population. How can you deliver more healthcare to people if you don't have more doctors? What does the ACA do about this?

Nothing.

While certainly, lifetime caps affect real, live individuals... in aggregate, they amount to LITERALLY a few dollars (my best math says <$3, but I'll allow that it might be $10) on every policy.

If you look at a standard individual policy before and a standard individual policy today, the differences to cover these PECs should have been a few hundred billion dollars per year... Instead, we're paying more than a trillion per year. PECs are generally covered in corporate policies as a matter of course and account for the vast majority of the difference between what was, and what is now in individual policies.

Keeping kids on your policy isn't always a financial positive. SUre, if you have 5 kids it is, but not if you have one. Why? Becuase "family" policies generally assume 1 male and 1 female child for a set cost. If you have more, you get a break. If you have fewer, you are probably better off with an individual policy for them. All the individual mandate is is a way to keep healthy, financially stable people from skipping the insurance that they don't need. It's an out-and-ought tax on healthy, young, financially stable people. There's an old rule that what you tax, you get less of... so I'm wondering why this is a "good" feature of Obamacare?

One other thing the ACA doesn't do is encourage responsible behavior and "wellness". It rewards doctors for treating symptoms of things like heart disease and obesity and can actually hurt them significantly if they tell people to eat less bacon and fried foods, stop smoking and drinking, cut out the sodas and exercise and lose weight.

Seriously, exactly WHAT is good about the ACA? That it uncaps policies? That could have been fixed in 3 words. No policy limits. That it covers PECs? That could have been fixed by turning individual policies into what corporate policies are... 4 words. No exclusions from coverage. Keeping kids on until 26? Not always the best financial decision... but fine. How many words would THAT have taken?

Nothing else in the thousands of pages is "positive" for healthcare.... and they didn't address the two major ones...
1) numbers of doctors and
2) encouraging "wellness"

How would you do this? Instead of funding all the crap, fund more residency slots. Simple and straightforward... but expensive. You COULD copy Europe and demand 2- 4 yrs of PCP or emergency practice in exchange for this... or they can fund it themselves.

Instead of purporting to cover "everything" which we clearly don't have the money or manpower to do which means some form of rationing... either literal or merely functional (so many hours in the day and so many docs)... we could have had a "hole" in the middle... where sniffles and wellness are covered, as are serious diseases... but if you sit on your hands and let a cold turn into the flu, or do stupid things like on ******* and get hurt, or need fluids because you got so drunk you almost vomited yourself to death, or if you smoke or dip and get lip cancer... you don't get HAMMERED, but you DO have to pay more out of pocket for those stupid decisions... which discourages those activities and encourages



(11-11-2013 10:05 AM)OptimisticOwl Wrote:  united Healthcare used to cover 8k people in California.
now they don't .

what changed? what is the difference between now and then?

Seems pretty obvious.
(This post was last modified: 11-11-2013 01:09 PM by Hambone10.)
11-11-2013 01:07 PM
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RiceLad15 Offline
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Post: #22
RE: Woman writes of struggle to keep the doctors who keep her alive
(11-10-2013 05:48 PM)Hambone10 Wrote:  They aren't in business to help people, but to make money. Of course, MANY businesses and people are happy to make a living by helping people, but who would intentionally engage in a business that "costs" them real money?

If we were just talking about a reduction in profit as you allude to, they would either accept the slight reduction, or raise their prices so that they didn't lose money.

This is where you posted that the insurance company wouldn't engage in the act of losing money, and would instead raise prices of accept a cut in profits, suggesting that United Healthcare was making profit off of individual plans.

(11-11-2013 12:04 AM)Hambone10 Wrote:  Maybe I'm missing your issue then.

If that's the only event you're speaking of then the answer is obvious. They already aren't making money in the market and this just makes it harder, not easier.... Because insurance is about making a few bucks on thousands of policies... And there is a fair amount of overhead involved in it.

Here is where you suggested they must have been engaging in business that would lose them money since they must have left since they are going to lose more money.

If I have read these posts incorrectly, that could be the case. But this is why I would still rather hear the company put out a statement that says "the ACA would cause us to do X, Y, and Z, and this is why we are leaving," then to make an assumption as to what X, Y, and Z are.

I understand many of your points that you've raise, and it's been a joy (yet somewhat stressful since tonality via text is often lost...) reading many of the thoughts in this part of the board on the healthcare law, but my time has come to go back to just browsing the Quad for a bit.
11-11-2013 02:44 PM
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Hambone10 Offline
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Post: #23
RE: Woman writes of struggle to keep the doctors who keep her alive
(11-11-2013 02:44 PM)RiceLad15 Wrote:  If I have read these posts incorrectly,

You have. It's an either/or of yours I am trying to respond to. You have suggested that there is possibly another reason for them to drop these plans... and I am giving you the myriad of reasonable assumptions that still lead to the same conclusions. Either they are making money or they are not. I'm letting you pick since we don't really know... If they are making money, apparently now they don't think they will anymore. If they aren't making money, certainly they expected to at some point. Now they apparently don't expect to anymore.

Why not?

I don't care or need to know which is true to know that they didn't engage in this business planning to lose money, and they didn't decide to stop because the financial prospects improved.

Quote:But this is why I would still rather hear the company put out a statement that says "the ACA would cause us to do X, Y, and Z, and this is why we are leaving," then to make an assumption as to what X, Y, and Z are.

Why would they ever do that? So that certain people could target them for wanting to profit from their business... putting profits over people?? That would be horrible business advice. As I said, these people are in business, not politics.... and they want to sell tens of millions of policies to Democrats as well as Republicans.

I don't need to know what X,Y and Z were to know that the major difference between 2013 and 2014 is that in 2013, the ACA wasn't in place and they offered these plans... and in 2014 it is and they have stopped. At least as far as the OP was concerned... PECs isn't an issue because she is currently insured and she didn't seem worried about the lifetime caps.

Quote:I understand many of your points that you've raise, and it's been a joy (yet somewhat stressful since tonality via text is often lost...) reading many of the thoughts in this part of the board on the healthcare law, but my time has come to go back to just browsing the Quad for a bit.

That's certainly your choice. If you sense tone it's because you don't seem interested in taking my or sharing your own educated perspective on the issue... merely saying, since I can't prove to you EXACTLY why something is happening, you'll just assume the best and let things happen. Kinda a tough pill to swallow on a board sort of dedicated to things like politics.

I'm fine with people who disagree on this or any other issue, but I expect them to know something I don't and be willing to share it and educate me, or have a different goal than I and try to articulate it.

I don't understand the goal of Obamacare if it doesn't accomplish the important stated goals of Obamacare. Who cares "why" UHC dropped this plan if the stated goal of Obamacare was to let you keep plans and doctors and it doesn't? Unless you're trying to argue that UHC's doing it purely for political reasons... which I could equally respond... until they TELL me that is why, I'll choose not to merely assume it... particularly when so many of its directors and share holders come from each party. The traditional response that "this plan is better" sort of falls flat when the complainant is clearly an already heavy user of healthcare.

The whole purpose of the quad is to engage in philosophical/political debate.
(This post was last modified: 11-11-2013 03:13 PM by Hambone10.)
11-11-2013 03:08 PM
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75src Offline
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Post: #24
RE: Woman writes of struggle to keep the doctors who keep her alive
What was really frighting about Obama's speech was that there is a crisis and Obama is more interested in blaming others rather than working the problem. He says that there he did not know there was a problem with the website before October 1. It is not his fault that he does not know what his subordinates are doing. He has appointed incompetant people to his cabinet and agencies but he will not get ride of them. Our Pete Olson is moving to bring articles of impeachment against Eric Holder, the attorney general.
11-14-2013 04:02 PM
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GoodOwl Offline
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Post: #25
RE: Woman writes of struggle to keep the doctors who keep her alive
Here's another one, this time in FLorida. What did she do wrong to deserve this? How is Obamacare helping her by taking away what she has that is working to keep her alive? Death panels, anyone? Sadly, they are here now thanks to the ACA. A bit sooner than was probably thought is the only surprise.

"Woman With Cancer Dropped from Insurance Due to Obamacare"
November 14, 2013

http://www.weeklystandard.com/blogs/woma...67085.html
11-14-2013 07:38 PM
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georgewebb Offline
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Post: #26
RE: Woman writes of struggle to keep the doctors who keep her alive
(11-14-2013 04:02 PM)75src Wrote:  What was really frighting about Obama's speech was that there is a crisis and Obama is more interested in blaming others rather than working the problem.

Hasn't that been his entire career?
11-14-2013 09:05 PM
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GoodOwl Offline
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Post: #27
RE: Woman writes of struggle to keep the doctors who keep her alive
http://www.reviewjournal.com/news/obamac...-time-work

"Obamacare is supposed to be helping those who can’t afford insurance, but it’s actually hurting them by forcing their bosses to cut back on hours,” said Randi Thompson, state director of the National Federation of Independent Business."

Added Yvanna Cancela, political director of the hospitality union Culinary Local 226: “Hard-working Americans will be taking a giant step back rather than a big step forward when it comes to health care.”

"You know things are bad when labor unions use studies from the U.S. Chamber of Commerce as ammunition. (Since when have the two agreed on anything?) But that’s what’s happening with the 30-hour rule."

"Cancela pointed to chamber studies showing that 31 percent of franchised small and medium-sized businesses have already cut hours more than a year before the employer mandate takes effect on Jan. 1, 2015.

Another 27 percent said they’ve replaced full-timers with part-timers. Among nonfranchised businesses, 12 percent have cut hours, and 12 percent have swapped out full-timers."

Sooo...Obama hurts the very people who voted for him! Great leader does it again!
12-03-2013 05:54 PM
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GoodOwl Offline
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Post: #28
RE: Woman writes of struggle to keep the doctors who keep her alive
Things have changed: No one is required to have health insurance until 2017 at the earliest. Obama recently gutted the individual mandate, but he is trying to lie and hide this fact from people. Don't fall for the lie that is the ACA. You don't have to sign up for anything. Apply for an exemption if you want to. No proof necessary, according to Obama:

Obama Just Snuck In the Biggest Change to the Individual Mandate That Nobody Knows About
By Emily Hulsey IJReview Wed., March 13, 2014

In case you haven’t noticed (which, if you’re like most of us, you haven’t), there has been yet another change to the Affordable Care Act, and this time it’s a big one.

But amid the post-rollout political backlash, last week the agency created a new category: Now all you need to do is fill out a form attesting that your plan was cancelled and that you “believe that the plan options available in the [ObamaCare] Marketplace in your area are more expensive than your cancelled health insurance policy” or “you consider other available policies unaffordable.”

This lax standard—no formula or hard test beyond a person’s belief—at least ostensibly requires proof such as an insurer termination notice. But people can also qualify for hardships for the unspecified non-reason that “you experienced another hardship in obtaining health insurance,” which only requires “documentation if possible.” And yet another waiver is available to those who say they are merely unable to afford coverage, regardless of their prior insurance. In a word, these shifting legal benchmarks offer an exemption to everyone who conceivably wants one.
03-17-2014 06:28 PM
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RiceLad15 Offline
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Post: #29
RE: Woman writes of struggle to keep the doctors who keep her alive
(03-17-2014 06:28 PM)GoodOwl Wrote:  Things have changed: No one is required to have health insurance until 2017 at the earliest. Obama recently gutted the individual mandate, but he is trying to lie and hide this fact from people. Don't fall for the lie that is the ACA. You don't have to sign up for anything. Apply for an exemption if you want to. No proof necessary, according to Obama:

Obama Just Snuck In the Biggest Change to the Individual Mandate That Nobody Knows About
By Emily Hulsey IJReview Wed., March 13, 2014

In case you haven’t noticed (which, if you’re like most of us, you haven’t), there has been yet another change to the Affordable Care Act, and this time it’s a big one.

But amid the post-rollout political backlash, last week the agency created a new category: Now all you need to do is fill out a form attesting that your plan was cancelled and that you “believe that the plan options available in the [ObamaCare] Marketplace in your area are more expensive than your cancelled health insurance policy” or “you consider other available policies unaffordable.”

This lax standard—no formula or hard test beyond a person’s belief—at least ostensibly requires proof such as an insurer termination notice. But people can also qualify for hardships for the unspecified non-reason that “you experienced another hardship in obtaining health insurance,” which only requires “documentation if possible.” And yet another waiver is available to those who say they are merely unable to afford coverage, regardless of their prior insurance. In a word, these shifting legal benchmarks offer an exemption to everyone who conceivably wants one.

Yup, the rollout has been all over the place.

Am I understanding this correctly in the sense that you have three options: either go without insurance and get taxed, go without insurance and apply for a waiver to avoid being taxed, or have insurance that is currently offered?

There is no option to revert to any coverages that are below the minimum standard with this change, right?
03-17-2014 06:34 PM
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OptimisticOwl Offline
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Post: #30
RE: Woman writes of struggle to keep the doctors who keep her alive
(03-17-2014 06:34 PM)RiceLad15 Wrote:  Yup, the rollout has been all over the place.

The Yugo had a bad rollout too. But once they got past that, the inherent quality of the product became apparent.
03-17-2014 08:07 PM
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NolaOwl Offline
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Post: #31
RE: Woman writes of struggle to keep the doctors who keep her alive
(03-17-2014 08:07 PM)OptimisticOwl Wrote:  
(03-17-2014 06:34 PM)RiceLad15 Wrote:  Yup, the rollout has been all over the place.

The Yugo had a bad rollout too. But once they got past that, the inherent quality of the product became apparent.

Yes, indeed. That is why Car Talk rated it "the worst car of the millenium."

http://www.cartalk.com/content/whats-wor...llennium-0

Sounds like an apt comparison to Obamacare.
03-18-2014 12:28 AM
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GoodOwl Offline
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Post: #32
RE: Woman writes of struggle to keep the doctors who keep her alive
(03-17-2014 06:34 PM)RiceLad15 Wrote:  
(03-17-2014 06:28 PM)GoodOwl Wrote:  Things have changed: No one is required to have health insurance until 2017 at the earliest. Obama recently gutted the individual mandate, but he is trying to lie and hide this fact from people. Don't fall for the lie that is the ACA. You don't have to sign up for anything. Apply for an exemption if you want to. No proof necessary, according to Obama:

Obama Just Snuck In the Biggest Change to the Individual Mandate That Nobody Knows About
By Emily Hulsey IJReview Wed., March 13, 2014

In case you haven’t noticed (which, if you’re like most of us, you haven’t), there has been yet another change to the Affordable Care Act, and this time it’s a big one.

But amid the post-rollout political backlash, last week the agency created a new category: Now all you need to do is fill out a form attesting that your plan was cancelled and that you “believe that the plan options available in the [ObamaCare] Marketplace in your area are more expensive than your cancelled health insurance policy” or “you consider other available policies unaffordable.”

This lax standard—no formula or hard test beyond a person’s belief—at least ostensibly requires proof such as an insurer termination notice. But people can also qualify for hardships for the unspecified non-reason that “you experienced another hardship in obtaining health insurance,” which only requires “documentation if possible.” And yet another waiver is available to those who say they are merely unable to afford coverage, regardless of their prior insurance. In a word, these shifting legal benchmarks offer an exemption to everyone who conceivably wants one.

Yup, the rollout has been all over the place.

Am I understanding this correctly in the sense that you have three options: either go without insurance and get taxed, go without insurance and apply for a waiver to avoid being taxed, or have insurance that is currently offered?

There is no option to revert to any coverages that are below the minimum standard with this change, right?

Those are the three options that seem available. With the individual mandate on hold until 2017 for now, all one has to do if they lost their coverage due to this law or don't have it at all and cannot afford the ridiculously inefficient and needlessly expensive cost of Obamacare premiums where less coverage = more cost expenditures, is sign a hardship wavier.

Most people will not be able to revert to older policies as the state insurance commissioners in many states are trying to follow the laws instead of making things up like a bat-$3!% crazy dictator. So most people who lost their perfectly good insurance coverage due to Obama telling them he didn't like them having insurance are out of luck there.
03-19-2014 07:47 PM
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RiceLad15 Offline
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Post: #33
RE: Woman writes of struggle to keep the doctors who keep her alive
(03-19-2014 07:47 PM)GoodOwl Wrote:  
(03-17-2014 06:34 PM)RiceLad15 Wrote:  
(03-17-2014 06:28 PM)GoodOwl Wrote:  Things have changed: No one is required to have health insurance until 2017 at the earliest. Obama recently gutted the individual mandate, but he is trying to lie and hide this fact from people. Don't fall for the lie that is the ACA. You don't have to sign up for anything. Apply for an exemption if you want to. No proof necessary, according to Obama:

Obama Just Snuck In the Biggest Change to the Individual Mandate That Nobody Knows About
By Emily Hulsey IJReview Wed., March 13, 2014

In case you haven’t noticed (which, if you’re like most of us, you haven’t), there has been yet another change to the Affordable Care Act, and this time it’s a big one.

But amid the post-rollout political backlash, last week the agency created a new category: Now all you need to do is fill out a form attesting that your plan was cancelled and that you “believe that the plan options available in the [ObamaCare] Marketplace in your area are more expensive than your cancelled health insurance policy” or “you consider other available policies unaffordable.”

This lax standard—no formula or hard test beyond a person’s belief—at least ostensibly requires proof such as an insurer termination notice. But people can also qualify for hardships for the unspecified non-reason that “you experienced another hardship in obtaining health insurance,” which only requires “documentation if possible.” And yet another waiver is available to those who say they are merely unable to afford coverage, regardless of their prior insurance. In a word, these shifting legal benchmarks offer an exemption to everyone who conceivably wants one.

Yup, the rollout has been all over the place.

Am I understanding this correctly in the sense that you have three options: either go without insurance and get taxed, go without insurance and apply for a waiver to avoid being taxed, or have insurance that is currently offered?

There is no option to revert to any coverages that are below the minimum standard with this change, right?

Those are the three options that seem available. With the individual mandate on hold until 2017 for now, all one has to do if they lost their coverage due to this law or don't have it at all and cannot afford the ridiculously inefficient and needlessly expensive cost of Obamacare premiums where less coverage = more cost expenditures, is sign a hardship wavier.

Most people will not be able to revert to older policies as the state insurance commissioners in many states are trying to follow the laws instead of making things up like a bat-$3!% crazy dictator. So most people who lost their perfectly good insurance coverage due to Obama telling them he didn't like them having insurance are out of luck there.

Just want to throw out some reporting/info on this topic that I found interesting (some from this morning even):

http://www.politifact.com/truth-o-meter/...ed-obamac/

http://www.forbes.com/sites/rickungar/20...ing-begin/

http://www.washingtonpost.com/blogs/fact...obamacare/

http://money.cnn.com/2014/03/19/news/eco...e-doctors/

http://www.forbes.com/sites/theapothecar...y-in-2015/

Within the last few weeks there has been a lot of information coming out as the ACA has continued to be rolled out and there is actually enough information to start teasing out what IS happening versus what people think WOULD happen. I find it interesting to see what is actually going on, changes that are being made to the law (constantly), and how both sides are playing politics with the law.
03-20-2014 08:30 AM
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Hambone10 Offline
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Post: #34
RE: Woman writes of struggle to keep the doctors who keep her alive
Honestly, Lad... Most of what you post there is pretty meaningless to the reality on the ground... It seems to be a mixture of someone's logical and rational opinion about what will happen based on what we have been told... and then someone coming in afterwards and pointing out where the prediction was wrong, but ignoring WHY it was wrong.

Fact 1 says that Boehner said the government said that 6mm people lost coverage and 4,2mm people signed up... and to him, that sounds like a net loss in insured people. While that may not actually be what it is, it certainly does sound that way to me.... and would to anyone else as well.

Fact 2 confuses actions as a result of the ACA with actions as a result of an improving economy. The fact that employment is growing and part-time employment is falling doesn't in any way prove that things wouldn't have been even better without the ACA... or that the delays and waivers and everything else haven't impacted those numbers

Number 3 is the same thing....

#4 is anecdotal, but says exactly what opponents have said...

#5 is an opinion piece based on what we know today.... Obviously things keep changing... but that doesn't mean that based on the information available when people said things, that they weren't functionally accurate... or that delaying something certainly changes what happens today, but doesn't change what is coming.

OF COURSE people are signing up for Obamacare now IF it is free for them or saves them money over what they were doing before (because it is subsidized, not because it is actually any less expensive to deliver).... but now that its implementation has been delayed... meaning the people we are FORCING to buy insurance who don't NEED it so that we can afford all of these subsidies haven't yet done so and likely won't until 2017 or unless they need it.


You can't get more of something by demanding more of it, paying less for it and not licensing more people to do it.

You CERTAINLY can't get 'better' something by doing so.

You can't raise a businesses costs without them raising their prices or otherwise seeking to avoid the vast majority of those expenses. Whether that means cutting hours or hiring fewer people or demanding more output or charging more or redesigning the business is a matter for each business... but NONE of them will simply 'eat' the costs. Whole Foods is a great place, but there is a REASON why the same products cost more there than at WalMart.

The comments about what IS happening include thousands of factors on top of the ACA.... but that doesn't make the simple truth's about what happens when labor costs increase any less true.
(This post was last modified: 03-21-2014 02:03 PM by Hambone10.)
03-21-2014 02:01 PM
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Post: #35
RE: Woman writes of struggle to keep the doctors who keep her alive
I'll admit, I haven't been following this thread, but I didn't want to start a new one on Obamacare.

1) I have a question for the anti-Obamacare people. On some level is getting 10 million uninsured insured not a good thing? I realize you don't like the way it was done, but other things being equal, isn't that better from a moral perspective and/or a practical one? (On the latter point, preventative care is MUCH cheaper than waiting until you need to go to the ER, and has better outcomes.) Or is the government being involved in it so inherently bad that it outweighs any positive? Just trying to understand the perspective.

2) For the love of god, can you get your fellow travelers to understand Orwell? I'm sure you guys know this, but if I hear one more conservative quoting Orwell then saying he was warning us about "socialism" and "socialized medicine" I think my head will explode. Orwell was a committed democratic socialist, and a fairly left leaning one at that. He was a strong supporter of the NHS which, unlike Obamacare, is real, honest to god, "socialized medicine".

3) What does Benghazi have to do with Obama care? Several times I've seen someone discussing the evils of Obamacare and then their response to something is basically "Because Benghazi!" OK, that's an exaggeration, but not by that much.

(2) and (3) I admit are more just me venting than questions. But I'm genuinely curious about (1)...
04-02-2014 07:47 AM
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Hambone10 Offline
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Post: #36
RE: Woman writes of struggle to keep the doctors who keep her alive
(04-02-2014 07:47 AM)JustAnotherAustinOwl Wrote:  1) I have a question for the anti-Obamacare people. On some level is getting 10 million uninsured insured not a good thing? I realize you don't like the way it was done, but other things being equal, isn't that better from a moral perspective and/or a practical one? (On the latter point, preventative care is MUCH cheaper than waiting until you need to go to the ER, and has better outcomes.) Or is the government being involved in it so inherently bad that it outweighs any positive? Just trying to understand the perspective.

Health insurance isn't health care. The belief that being insured will improve outcomes relies on the ability to deliver MORE primary care than we currently have. This argues that the ONLY reason these people don't get primary care is because they can't afford it... Yet ALL of the arguments about this before the passage identified an already existing shortage of primary care doctors, and NOTHING in the ACA addresses this. If you consider that 'the way it was handled, then I guess I don't know how to respond. If you don't address the primary need you identified and the results you claim are dependent upon doing so, then I GUESS someone could argue that it was merely not handled correctly. The ACA spends trillions of dollars to exacerbate rather than solve an already existing problem and then implies that we will magically get better results anyway.

Further, there are ALL SORTS of examples of choices made by people based on whether or not their choices carried consequences. By implying that everyone has coverage regardless of their choices... or better said, by making 'basic' and 'catastrophic' policies illegal (leaving a hole that is either filled with cash out of pocket or by healthy choices) and only allowing 'soup to nuts' coverage, 'wellness' is actually discouraged.

Quote:2) For the love of god, can you get your fellow travelers to understand Orwell? I'm sure you guys know this, but if I hear one more conservative quoting Orwell then saying he was warning us about "socialism" and "socialized medicine" I think my head will explode. Orwell was a committed democratic socialist, and a fairly left leaning one at that. He was a strong supporter of the NHS which, unlike Obamacare, is real, honest to god, "socialized medicine".

3) What does Benghazi have to do with Obama care? Several times I've seen someone discussing the evils of Obamacare and then their response to something is basically "Because Benghazi!" OK, that's an exaggeration, but not by that much.

(2) and (3) I admit are more just me venting than questions. But I'm genuinely curious about (1)...


2 is either a history or english debate. I don't know exactly what you are referring to so don't take me literally... But people tend to quote people because their words are fitting to their view of the current situation and eloquent... and NOT to claim that the speaker's belief system was worth emulating.

3 sounds more like them merely venting to you. Not "because Benghazi", but perhaps in their minds 'similar' to Benghazi in some way. Again, not my comment so I can't speak to it exactly... SOME people just aren't smart and can't tell you why they are upset, but they know the keywords they hear from others whom they THINK are smart and they can parrot them. Comes from both sides of the aisle.
(This post was last modified: 04-02-2014 01:24 PM by Hambone10.)
04-02-2014 01:20 PM
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georgewebb Offline
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Post: #37
RE: Woman writes of struggle to keep the doctors who keep her alive
(04-02-2014 01:20 PM)Hambone10 Wrote:  
(04-02-2014 07:47 AM)JustAnotherAustinOwl Wrote:  1) I have a question for the anti-Obamacare people. On some level is getting 10 million uninsured insured not a good thing? I realize you don't like the way it was done, but other things being equal, isn't that better from a moral perspective and/or a practical one? (On the latter point, preventative care is MUCH cheaper than waiting until you need to go to the ER, and has better outcomes.) Or is the government being involved in it so inherently bad that it outweighs any positive? Just trying to understand the perspective.

Health insurance isn't health care. The belief that being insured will improve outcomes relies on the ability to deliver MORE primary care than we currently have. This argues that the ONLY reason these people don't get primary care is because they can't afford it... Yet ALL of the arguments about this before the passage identified an already existing shortage of primary care doctors, and NOTHING in the ACA addresses this. If you consider that 'the way it was handled, then I guess I don't know how to respond. If you don't address the primary need you identified and the results you claim are dependent upon doing so, then I GUESS someone could argue that it was merely not handled correctly. The ACA spends trillions of dollars to exacerbate rather than solve an already existing problem and then implies that we will magically get better results anyway.

Hambone, there you go again: trying to judge policies their results. For Pete's sake! Don't you know that for leftists, intent alone is a sufficient measure of policy? And since leftist intent is always, by definition, noble, the resulting policies are necessarily meritorious, and opposition to them is necessarily dishonorable. Your mind will rest much easier once you absorb this truth.
04-02-2014 01:30 PM
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Hambone10 Offline
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Post: #38
RE: Woman writes of struggle to keep the doctors who keep her alive
You made me laugh George.

Often, bad policy starts with a good idea and is turned bad by the conflicting interests of the parties... sort of the 'a camel is a horse designed by a committee' argument...

This policy WAS designed by a committee, but it is a rare example where it was entirely made up of one party. To me it proves that the government is a bad place for solutions... because even when people generally agree, they turn their ideas to crap. "Best Practices" is often used by companies, but it seems almost NEVER by government.

Yes, I believe that improving healthcare for all is a noble cause, and that affordability is part of that... but AVAILABILITY is a MORE important part, and one clearly identified by both parties going back to at least Reagan and specifically articulated by Obama. It doesn't matter how much the Ice Cream costs if they don't make more of it.

It seems to me that the better approach (buying into the idea that the articulated approach by the left and the idea that the government needed to do something for the sake of argument) would have been to open more public clinics and fund more Family Practice residency slots and create incentives to enter family practice... like higher, not lower payouts in private practice and educational grants for working at the clinics. These are things often currently funded by Medicaid (the states). You should also expand the 'catastrophic' policy coverage for all... this is currently funded through ERs and Medicare. There should be a HOLE in the coverage (as there is in virtually ALL private policies) where you have a deductible. So a typical policy would cover preventative care with little or no copay... have perhaps a 2,000- 20,000 OOP deductible (giving people who buy their own policy the ability to swap monthly premium for OOP risk, encouraging behavior... but still limiting them to a financially manageable maximum. You can still cover PECs and you can still uncap the policies. It changes the math and everyone will pay a bit more as a result, but I don't think you'd get that big a push back if that were the only problem. Note that even under Obamacare, someone who needs $1mm in care will STILL have a 6 figure bill after insurance. Most of the people who supported it under the guise that it would help people avoid financial ruin because of an accident don't know this. An 80/20 policy (which is usually the BEST policy under the ACA) with $1mm in care will owe around 200k. No it's not that simple, but it's also not simply 'covered' like people think.
04-02-2014 01:57 PM
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Post: #39
RE: Woman writes of struggle to keep the doctors who keep her alive
(04-02-2014 07:47 AM)JustAnotherAustinOwl Wrote:  On some level is getting 10 million uninsured insured not a good thing?

I think you've seriously misstated the question here. For the record, I will answer the question as formulated by saying yes. The level on which it is a good thing is if it can be accomplished without doing harm elsewhere.

And that's the rub. I don't think it can be done without doing harm elsewhere. As an old boss of mine was fond of saying, "There ain't no free lunch." And if it is going to do harm elsewhere, then the benefit of getting 10 million people insured must be measured against that harm elsewhere.

What I expect the harm to be is ultimately serious disruption and impairment to a system that was working reasonably well by any number of measures for some 80-85% of the population. You may wish to dismiss that as partisan, but I would remind you that CBO has expressed the same concern. Remember their letter saying it would "reduce the deficit" (the sound byte that got the air play)? Well, it just so happens that back on page 19 of that letter, talking about the projected slow down in the growth of health care costs, the assumption on which their deficit reduction conclusion rests, they said, "It is unclear whether such a reduction in the growth rate could be achieved, and if so, whether it would be accomplished through greater efficiencies in the delivery of health care or would reduce access to care or diminish the quality of care." I think every effort will be made to achieve that reduction. I don't think the addition of additional layers of federal bureaucracy including IPAB, HCC, and CCO can possibly increase efficiency. Therefore it seems to me that we're down to reduced access and diminished quality. And if that's the cost, then no, it's not a good thing to add 10 million more insureds.

We may disagree on that impact analysis. But I think we would both have to admit it's in the range of possible outcomes. So, quite frankly, I will admit that somehow reducing overhead through IPAB, HCC, and CCO is also in play--but that's not what I'm expecting.

I would add one other huge cost--the opportunity cost of pursuing a less than optimum solution. And no, I certainly don't think single-payer or single-provider is optimal. The systems that do best worldwide are the Bismarck systems that combine the improved general health produced by universal basic and preventive care with the better response to illnesses in a fee for service system. The Bismarcks do best, particularly in larger populations, for a reason--or actually several reasons. But we never looked at that approach here. Why not? I'm sorry, but that omission still leads me to wonder if this was about improving health care or something else. By going the Boismarck route, we could have insured 100%, not just 10 million out of 40 million uninsured, and we could have left in place the fee-for-service system that has people coming from all over the world to obtain health care here in the USA.

So I would restate your question a bit. What harm elsewhere are you willing to accept in order to add 10 million more insureds?
(This post was last modified: 04-02-2014 04:35 PM by Owl 69/70/75.)
04-02-2014 04:32 PM
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Post: #40
RE: Woman writes of struggle to keep the doctors who keep her alive
As a Rice geek who likes to get off on a tangent would note:

TANSTAAFL - There Ain't No Such Thing As A Free Lunch (grammatical inaccuracy intentional)
Rebert Heinlein, "The Moon Is A Harsh Mistress"

Though the phrase originated before that book was published.
04-03-2014 03:11 PM
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