[Winstonm]

 FM75, on 2013-November-08, 21:56, said:

Ok. He is sorry.
No "The buck stops here." from Obama. You probably won't hear him admit that he lied, either.

From Bloomberg News:
"Yet, administration officials knew by June 2010 that as many as 10 million people with individual insurance probably would be thrown off existing plans. The cancellations are a result of provisions in the act, which Obama signed into law in March 2010, that say policies that fail to offer benefits such as prescription drug coverage and free preventive care can't be sold after this year even if they're [sic] cheaper."

No "My bad", 3 months after signing the bill, or for that matter 3 years later.



Also from Bloomberg:
"Obama's pledge that individuals would be able to keep their coverage and their doctors was a central selling point of his health-care overhaul, aimed at calming consumers concerned that they would be forced to give up policies and doctors they liked as the program expanded coverage to many of the nation's 48 million uninsured."
The administration had set a target of 800,000 Obamacare enrollments for the first two months. Speaking to a Senate panel on Nov. 6, Health and Human Services Secretary Kathleen Sebelius said the initial enrollment for the first month of the program, which will be announced by the administration next week, will be "very low," though she declined to provide specific figures.




OK - Let's do the math.

First let's assume that they could meet their target of 800,000 for first 2 months. That is 400,000 / month. So the 10 million that they knew they had lied about would take 25 months to get through the system. So Jan 2016 - I guess on average half of them will get one full year of tax penalties in addition to losing their coverage.

Now let's do the math on the 48 million. At 400,000 per month, it will only take 10 YEARS to get them signed up.

Give me a break. Everybody who voted/signed this into law should go back to grade school.

Your conclusion is a non sequitur - how would a return to grade school by voters and the president alter the facts you present? What is your gripe? Do you believe that people who work in low-paying industries that do not provide healthcare should not have health insurance? Do you think that allowing young and healthy citizens to bypass health insurance, thereby creating a pool of unhealthier and more costly candidates, is the proper model for risk taking of healthcare insurance? Do you think health insurance companies should be allowed to deny coverage for pre-exisiting health conditions?

What you are griping about is the implementation of the law. If you have a gripe about the law, you should post facts that support that claim. I think everyone will agree that the implementation has been a fiasco - but I and millions more are unwilling to lay that turkey solely at the feet of the President.

I do know this: if your figures are correct, the initial concept was for 8 million per month capacity to enroll - but much of the success of the ACA relied on state exchanges being set up. What almost no one considers is the S.C. decision that states could opt out, which the politically red states mostly did, which created a huge influx of additional applicants for whom the federal health exchange had to provide. How many of those 8 million were turned away by their own state's failure to incorporate a state health exchange?

Should the federal government been ready for this after the SC decision. I think so. But I also think Obama has repeatedly and consistently failed to grasp the degree of anger and degree of ideological faith held by his opponents. He does not seem to grasp that his most ardent opponents have as much rationality as a rabid dog.

This, IMO, has always been Obama's big mistake - assuming some degree of rationality by his most ardent opponents. I do not think this president could ever imagine the degree of consistent and concerted effort to derail and dismantle the ACA that has occurred, that entire sections of the country would refuse to cooperate.

In a sense, the strategy to be as uncooperative as possible has worked as it has made implementation of the ACA a nightmare for the federal government. This is a multiple failure caused by: a law that allowed a loophole for states, the SC decision, red states opting out, poor preparedness by the federal government, and a concerted effort to derail implementation.

Who holds the most blame? It is always the guy in the hot seat, isn't it?

[kenberg]

Irratioality gets spread around. I had a very depressing experience the other night. It was too early to go to bed but I really did not feel like thinking so I was flipping through channels. Not much there. Bill Maher was on. I never watch him but I was desperate. His first guest was Ann Coulter, his second a Democratic Congresswoman. My impression was that Ann Coulter is smarter than Bill Maher, or more accurately Bill Maher is dumber than Ann Coulter, and the Democrtic Congresswomen was dumber than either of them. I can't tell you who came next, as I watched part of an old movie, I forget which one, until bedtime.

[Trinidad]

After reading Ken's post and my own, I realized that there is a very important difference in the way American governments (federal, state or local) communicate to their citizens and the way most European governments that I know communicate to their citizens.

In the USA there is basically NO communication from governments to their citizens. Citizens have the right to know, everything is open, but citizens need to read the bills themselves to know what they say. So there is little information actively flowing from the government to the people, other than politically motivated press conferences. Information campaigns seem to be limited to signs along the freeways like "Click it or ticket".

If something like the introduction of Obamacare, or similar, happens in Europe, there would be a series of prime time TV commercials, telling the people what Obamacare is, what it does and what the people need to do:
- Under what circumstances can you keep your current insurance?
- If you can't keep your current insurance, then why is that?
- What do you need to do to be insured?
- And -finally- what happens if you do nothing?

These campaigns are objective and fact driven. They are not political.

A government won't work if it isn't communicating (honestly, objectively and reliably) with its citizens.

Rik

[HighLow21]

 kenberg, on 2013-November-09, 07:54, said:

We look at what is taking place and we ask: Do his words conform to reality? Is it working? The answers so far are not encouraging.

The short answers are:

1. He lied, repeatedly, and he should just own up to it. Chris Christie gave him great advice on this issue -- stop lawyering it, and just apologize and move on. THEN, if you want, you can try to explain where the disconnect causing this lie came from. People will give you some leeway if you admit an obvious lie and apologize for it.
2. The website has been terrible but the PLAN behind it is a solid step forward. And over time the site WILL be fixed.
3. As a result, public opinion about Obamacare is already starting to uptick, IN SPITE of the problems. And over time, I believe public opinion of it is going to rival that of Medicare. I can provide a link later showing this uptick but I have to run out the door for now.

-T

[kenberg]

This is in response to Rik.

Certainly the politicization of information is a serious issue. Not that it hasn't always happened, but as with electronic snooping part of the problem is that we have just become way too good at it. Well, maybe "good" is not the right word. But everything gets chewed over by the political folks before anything is said. The case at hand "If you like the policy you have, you can keep it. Period!" is certainly an example. Ideally, the prez would ask technical advisers whether this was true. It seems likely that this PR line came from political advisers who did not much care whether it was true.

But also, surely part of the problem is the complexity. The Website doesn't work right. No doubt that is partly due to the complexity. The political advisers who turned a blind eye to the problems certainly are greatly at fault, but no doubt the thing is complex. Computers are great at carrying out procedures, but only if the procedure can be programmed, and that means that the whole plan has to be very thoroughly understood.

After a lifetime of good health (mostly still continuing) I have had some issues over the last fifteen months. So have some family members, so have some friends. Sort of a tough year. My assessment is that medical technology is amazing, far more exciting and effective than I would have expected. Docs are quite good, some are extraordinary, some you have to avoid. The weak link in the chain is bureaucratic stuff. Far and away, the majority of problems come from the difficulty in coping with a complex system, For complex problems, a hospital (at least in some cases) provides the patient with a "navigator". This navigator does not do anything medical, s/he helps the patient cope with the system. It's good we have them, we need them.

Since some of this complexity seems to me to be just modern life, I assume that it is not confined to the U.S. But in the case of medical care, it may be that we do an exceptional job of making it difficult.

[blackshoe]

"Mr. Obama, did you lie?"

"No, I just parroted something one of my political flacks handed me."

Sheesh.

Personally, I think a law should not be passed if when a copy of that law is handed to "the man (or woman) in the street" he or she cannot read and understand it in a few minutes.

[Trinidad]

 kenberg, on 2013-November-09, 11:25, said:

Since some of this complexity seems to me to be just modern life, I assume that it is not confined to the U.S. But in the case of medical care, it may be that we do an exceptional job of making it difficult.

I don't know the ins and outs of the US system, but the Dutch system is fairly simple. (That means that I don't have any trouble understanding the basics of it):

The market parties:

• There are several commercial free market health insurance companies with share holders, etc. (Some americans will say that this market isn't free, but don't let that distract you.)
  
• There are independent hospitals, medical centers and doctors. Most are on a not for profit basis, others are just as commercial as any other company.

The insurance policies:

• The default (standard minimum) insurance
  
• Additional insurances

What is covered under the default insurance is decided by the government. It is adjusted yearly. The price for the treatments that are covered by this default insurance are negotiated between the joined health insurers and the joined health care providers. These prices are then fixed nation wide for a year.

The conditions:

• Every insurer has to offer the default insurance
  
• Everybody has to have the default insurance
  
• The insurer decides freely on the price for the default insurance. The insurer has to offer the default insurance to everybody for this price. They are not allowed to refuse anyone. Prices vary from insurer to insurer, but all customers of a given insurance company pay the same.

There are no conditions for the additional insurances. Any insurer or patient or health care provider can do as they like.

To get an idea of what is covered by the default insurance: Everything "normal" in health care: preventive health (including vaccinations for certain diseases or risk groups of people), family physicians, hospital treatments, diagnostics (tests, X-rays, MRIs, PET scans, you name it), medication.

The most notable thing that is not covered under the default is dentistry. Also things like physiotherapy are limited to about 10 treatments per year. So these can be insured separately, along with e.g. the cost of a taxi to get you to your health care provider and several exotic or luxury treatments (think of haptonomy, health spas or vaccinations for those who travel to far away countries).

The system is based on the doctors deciding (together with the patient) about the best (=medically and financially optimal) treatment. Doctors are checked by an independent board whether their past decisions have been "best". In that way, they stay "calibrated".

This is the basic part. Now, in comparison to the USA, the Netherlands is a fairly socialist country, so we have added a twist to it: High incomes pay a health care tax on their income tax. (This only depends on your income, not on your insurance.) The tax is passed over to low income families to help them pay for their health insurance.

Rik

[kenberg]

I really like the detail of the above post. I think I also like the plan.

[helene_t]

I always found the Dutch health insurance system extremely complex, compared to the Danish and the British ones. And some Dutch GPs complain a lot about spending almost more time dealing with insurers than dealing with patients. But it sounds as if it might be even more bureaucratic in the US.

[HighLow21]

 Trinidad, on 2013-November-09, 14:43, said:

I don't know the ins and outs of the US system, but the Dutch system is fairly simple. (That means that I don't have any trouble understanding the basics of it):

The market parties:

• There are several commercial free market health insurance companies with share holders, etc. (Some americans will say that this market isn't free, but don't let that distract you.)
  
• There are independent hospitals, medical centers and doctors. Most are on a not for profit basis, others are just as commercial as any other company.

The insurance policies:

• The default (standard minimum) insurance
  
• Additional insurances

What is covered under the default insurance is decided by the government. It is adjusted yearly. The price for the treatments that are covered by this default insurance are negotiated between the joined health insurers and the joined health care providers. These prices are then fixed nation wide for a year.

The conditions:

• Every insurer has to offer the default insurance
  
• Everybody has to have the default insurance
  
• The insurer decides freely on the price for the default insurance. The insurer has to offer the default insurance to everybody for this price. They are not allowed to refuse anyone. Prices vary from insurer to insurer, but all customers of a given insurance company pay the same.

...

This sounds a lot like Obamacare/ACA would be if there were a public option. Sadly, the Dems removed the public option in the attempt to get some Republican support for it and got none anyway.

[Trinidad]

 helene_t, on 2013-November-09, 16:42, said:

I always found the Dutch health insurance system extremely complex, compared to the Danish and the British ones.

I agree. (Funny for someone who just wrote that the dutch system was simple. But that shows how complicated they make it in the USA.)

The system that I liked best was the Swedish one. The basic idea is that health care is paid for by the government from tax payer's money.

As a patient, you can see a nurse for free. The same is true for any emergency.

Anytime you went to see a family physician, you paid a small fee. IIRC, ten years ago this was 40 Swedish crowns. (Americans, please sit down before you read on: this is about $5. It is more expensive to go to a bridge club.) These 40 crowns were the door to everything. It could be that the doctor said: "Rest and drink a lot of orange juice." or he could send you to a specialist or hospital with extensive testing, surgery and what do I know. In both cases you pay 40 crowns for your medical treatment.

For medication there was a step wise deductible: the first part you paid in full, the next part only half and anything more was completely covered. (There may have been more steps. I don't remember. It was calculated automatically at the cash register of the pharmacy.)

In my experience, they had the best doctors and the best hospitals. (Better than in the USA and better than in the Netherlands.)

Rik

[Trinidad]

 HighLow21, on 2013-November-09, 17:25, said:

This sounds a lot like Obamacare/ACA would be if there were a public option. Sadly, the Dems removed the public option in the attempt to get some Republican support for it and got none anyway.

That doesn't surprise me, since Hillary Clinton studied the Dutch system extensively during the Clinton years. For Americans it had the advantage that it was based on free market insurance companies. This is closer to the American idea than a government run health care system. (The government run health care systems work better, though.)

Rik

[Vampyr]

 blackshoe, on 2013-November-09, 13:58, said:

Personally, I think a law should not be passed if when a copy of that law is handed to "the man (or woman) in the street" he or she cannot read and understand it in a few minutes.

So much of what is said on the internet is said merely for the effect. You know as well as I do, blackshoe, that the above is totally unworkable, but it is fun to say,

 Trinidad, on 2013-November-09, 14:43, said:

I don't know the ins and outs of the US system, but the Dutch system is fairly simple.

Right. Ours is free at the point of service. No insurance, no fees etc. Except that we do have to play £7.80 for prescriptions unless we are under 16, over 60, have certain conditions or are poor. But you can buy a yearly prepayment card which is approximately the equivalent of one prescription per month, and it entitles you to all prescriptions you need for the year.

Dentistry is mixed. The NHS will fill your cavities, but if you want a white filling you have to pay for it, as it is a "private" product. So many dentists' bills have an NHS and a private portion.

[bd71]

 Winstonm, on 2013-November-09, 08:36, said:

I do know this: if your figures are correct, the initial concept was for 8 million per month capacity to enroll - but much of the success of the ACA relied on state exchanges being set up. What almost no one considers is the S.C. decision that states could opt out, which the politically red states mostly did, which created a huge influx of additional applicants for whom the federal health exchange had to provide. How many of those 8 million were turned away by their own state's failure to incorporate a state health exchange?

The Supreme Court decision did NOT give states the right to opt out and not run their own Exchange...that was always part of the law. The SC decision allow states to opt out of the Medicaid expansion and still retain the federal subsidies for their pre-existing Medicaid programs.

[blackshoe]

 Vampyr, on 2013-November-09, 17:49, said:

You know as well as I do, blackshoe, that the above is totally unworkable

Do I? I know that an awful lot of people think it's totally unworkable, and even more people will argue against it for other reasons, but since it's never been tried, I don't think anyone truly knows whether it's workable, unworkable, or somewhere in between.

[Vampyr]

 blackshoe, on 2013-November-09, 19:38, said:

Do I? I know that an awful lot of people think it's totally unworkable, and even more people will argue against it for other reasons, but since it's never been tried, I don't think anyone truly knows whether it's workable, unworkable, or somewhere in between.

Have it your way. Great idea.

[Cthulhu D]

 kenberg, on 2013-November-08, 08:13, said:

Yes, this is true. It is also true that the president emphatically claimed that this would not happen. If he, or his advisers, did not anticipate trouble when these opposing facts collided then they are totally out of touch with reality. "So I lied, so what, get over it" doesn't play well in Peoria or anywhere.

I imagine that they figured that with the website up and running and millions of people happily signing up, no one would pay much attention to this little detail. Oh well, another plan gone wrong.

This is a lie. The law says that legacy plans can be preserved as-is even if they do not meet the requirements. The choice to cancel the plans is the insurance companies, they are not being forced to do so by legislation.

What's happening is that the insurance companies are rolling out significant changes, losing the legacy protection (because it counts as a new plan and thus must meet the minimum standards), and are blaming everything on the government, and you, the people, are being duped by capital and concluding it's Obama's fault. If they just kept the existing plan as is and put the price up, every existing plan could be kept.

[blackshoe]

"Capital" is a thing, not a person. You mean, I think, that we're being duped by the insurance companies. That may be so, but what does "capital" have to do with it?

[Cthulhu D]

Corporations are things, not people, and yet can engage in deceptive practices. Corporate entities are accumulations of capital. You are being duped by corporations, and thus capital. Indeed, without capital, the US medical insurance business could not exist in it's current form, and would have to be restructured into some sort of cooperative or government based system. So in this instance it is very specifically accumulations of capital that are hoodwinking you.

It's also amusing to me because it helps make it very clear as an outside observer that you, the working man (or, perhaps, labour), are being bent over a barrel by big business (or, perhaps, the capitalists) and are not even aware of how it's going down! So yes, I think it's very relevant to note that capital is doing it to you in this specific case.

How do you tolerate being lied to like this for what are blatantly the profit motives of the companies involved at the expense of you the working consumer? Then blame someone else!

[kenberg]

A story in the Post today displays an attitude that is depressingly common:


http://www.washingto...ry.html?hpid=z1

Quote

The Obama administration's broader cooperation with insurers is a tacit acknowledgment that the federal insurance exchange — fraught with software and hardware flaws that have frustrated many Americans trying to buy coverage — might not be working smoothly by the target date of Nov. 30, according to several health experts familiar with the administration's thinking.
White House officials reject the idea that the strategy represents a contingency plan in the event that the online system continues to falter.

"We are working 24-7 to ensure that the site is working smoothly for the vast majority of users by the end of November," said Chris Jennings, deputy assistant to the president for health policy. He said the administration remains confident that the site, HealthCare.gov, will be ready by the end of the month and that the White House always envisioned insurers' direct enrollment of customers would be important to the law's success.

Several things come to mind. If they find themselves needing to work the celebrated 24/7 then the needed length of time is not clearly predictable . But even if they are confident, having a contingency plan is something to celebrate, not something to deny. We got into this pickle because there was no back-up plan for the Oct 1 roll-out, and apparently a denial that any such preparation was necessary.

Back in my teaching days it was not unusual for a student to say something such as "Prof., I just can't understand how I could have failed. I stayed up all night studying for the exam." Which prompts the (usually unstated) thougt: "You are telling me you have not been keeping up on a daily basis, at the last moment you crammed a lot of stuff into your head, you came in bleary eyed from lack of sleep, you have not had the time to organize the material you crammed into your head, and you don't understand why this didn't work well, is that what you are saying?" I regard "we are working 24/7" as an indication of poor planning, not as an indication of devotion to the job.

I think if the WH folks said "We are pretty sure it will be working by Nov 30 but we have a back-up plan in case it isn't", I would say "Good thinking". I might attach "and it's about time" to my praise though.