Slightly Skeptical View on Health insurance

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It's hard to find products, services and companies that provide honest health service, good monitoring devices and, in general, quality products. This is especially true about medical insurance. Everything (or almost everything is spoiled by obsessive, destructive marketing). Not only USA health system is drug obsessed and test driven to the extent that serious mistakes are possible, it is based of strange symbiosis between doctors and health insurance companies in which each party tries to fool the other. In addition, many doctors became more pharmacy salesmen then real health specialists.  This father complicates the picture. 

In fact, anybody with health problems need to participate in complex poker match between insurance and doctors where you just a minor card.  There are several dangers here

Distortions created by the US healthcare model

This is a very complex issue but some visible problems are as following:

None of these key issues is addressed by the new legislation, hence the support from the Pharmaceutical Companies and Insurers. Nothing will change and the US will continue to pay double the share of GDP with worse outcomes in comparison to other developed countries.


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Old News ;-)

[Jul 25, 2017] Congress is obviously determined to replace Obamacare this year, without a viable alternative, and I think lobbying from hedge funds may be one of their motivations

Notable quotes:
"... Congress is obviously determined to replace Obamacare this year, without a viable alternative, and I think lobbying from hedge funds may be one of their motivations. ..."
"... All this comes back to the mystifying need in congress to enact a new healthcare bill this year that basically just removes a few key components of Obamacare. One of those key components is the Net Investment Income Surtax, which is a 3.8% tax on investment income that is used to increase Medicaid's coverage of people with low incomes. Is it possible that the urgency to pass a new healthcare bill this year is primarily related to its removal of a tax which helps calculate the $25-$100 billion that hedge funds will owe the government next year? If so, my guess is this will also have some influence on any tax cuts included in next years budget. ..."
"... "When asked if they would feel safe using a self-driving car, just 34% said they would while 67% said they would not." Huh? ..."
"... in the form of an amendment to the Republican bill ..."
"... unless you give them your personal information. ..."
"... a high-risk investment in undeveloped and unproven ..."
Jul 25, 2017 | www.nakedcapitalism.com

JimTan , , July 25, 2017 at 3:16 pm

"And a majority doubt that President Trump .has a clear plan to replace Obamacare if Congress manages to repeal it."

Congress is obviously determined to replace Obamacare this year, without a viable alternative, and I think lobbying from hedge funds may be one of their motivations.

Hedge funds are compensated for their investment services using the standard 2 an 20 model, which means a management fee of 2% of all assets under management, and a performance fee of 20% of profits over a predetermined benchmark. Annual performance fees depend on how well the fund invests; low or no performance means no performance fee. This performance fee is classified by hedge funds as Carried Interest , which is a tax loophole that allows them to pay a low tax rate on these profits.

Annual management fees are independent of performance, and are always large numbers calculated as 2% of their multi-billion dollar assets under management. This management fee is commonly used to fund an offshore 'reinsurance company', because another tax loophole allows profits invested in these offshore insurance companies to be deferred indefinitely.

Apparently the 2008 bank bailout ( Emergency Economic Stabilization Act of 2008 ) closed this loophole and gave hedge funds until April 2018 to pay taxes on all these management fees they have been deferring in these offshore companies. On July 20th, the Wall Street Journal and CNBC estimated hedge fund managers collectively owe between $25-$100 billion in taxes on this money.

According to the article some hedge-fund managers face personal tax bills of over $100 million including Steven Cohen ( formerly SAC Capital ), David Einhorn ( Greenlight Capital ), and Daniel Loeb ( Third Point LLC ).

The article also says these deferred fees lower a hedge funds compensation costs, which suggests that many high level employees have past bonuses tied up in these offshore entities which are about to be taxed. To avoid some of these impending taxes, there is apparently an exodus of hedge funds moving to Florida which has no state income tax.

All this comes back to the mystifying need in congress to enact a new healthcare bill this year that basically just removes a few key components of Obamacare. One of those key components is the Net Investment Income Surtax, which is a 3.8% tax on investment income that is used to increase Medicaid's coverage of people with low incomes. Is it possible that the urgency to pass a new healthcare bill this year is primarily related to its removal of a tax which helps calculate the $25-$100 billion that hedge funds will owe the government next year? If so, my guess is this will also have some influence on any tax cuts included in next years budget.

IowanX , , July 25, 2017 at 7:08 pm

Hmmm. Tim Kaine was gushing on NPR yesterday about if the D's and R's worked together, what are the "fixes" and he's got a bill for "re-insurance"–but I don't know the details. Favorable tax treatment (I would guess) is almost certainly part of the bill.

Tim , , July 25, 2017 at 3:16 pm

"When asked if they would feel safe using a self-driving car, just 34% said they would while 67% said they would not." Huh?

Lambert, I think what is going on is driving used to be fun when there weren't very many cars on the road, now driving is so congested and commutes are so long that it is not only not fun, it is extremely stressful, so people are willing to take a hear no evil see no evil approach to driving just so they don't have the stress of doing the driving themselves.

The move to self driving cars is about safety at a society and government level, but at the individual level it is just about de-stressing and saving your concentration for other tasks.

I live 5 miles from work in a fully built out part of San Diego with good road infrastructure, so driving is still fun for me and I drive a stick shift, but I can see the guy stuck in LA traffic for 2-3 hours every day wanting to disconnect from that driving experience as soon as possible even if it may be less safe.

ChrisPacific , , July 25, 2017 at 7:30 pm

What's going on is that the poll is completely useless. I would like my next car to be autonomous. If it can fly, run without fuel, and transform into a magic fairy that cooks dinner and does the dishes, I'd like that too. Am I willing to entrust my safety to the current models on offer from the likes of Google and Uber (or their near term evolutions) knowing what I know about them and about their respective attitudes to regulatory and safety compliance? That's a totally different question.

What was the methodology for the survey? Who funded it? Where is the raw data? Providing disclosure on these points is standard surveying best practice. None of them are answered. The embedded links go to reportlinker.com which is a for-profit organization that produces business analytics. Who was their client in this case? I couldn't find that answer either.

I would file this one under advertising if I'm being kind, or propaganda otherwise.

River , , July 25, 2017 at 7:54 pm

If the car was like Ahmed from Count Zero , then sure I'd take one.

https://books.google.ca/books?id=dFX1xN7q-AgC&pg=PA113&lpg=PA113&dq=count+zero+ahmed&source=bl&ots=UwuJ_cxJpN&sig=Djqvols6Uu39bkQjnm2fOaocExY&hl=en&sa=X&ved=0ahUKEwim1NK20KXVAhWBzIMKHQGyDe8Q6AEIOTAC#v=onepage&q=count%20zero%20ahmed&f=false

page 112-113.

Mo's Bike Shop , , July 25, 2017 at 8:46 pm

Will our self driving cars be powered by the hydrogen economy?

Is SDC all unicorn feed, or is there some real tech being spun? I find everything bewildering about SDC evaporates when, like a fortune cookie, you add "on a battlefield" to the end.

Lambert Strether Post author , , July 25, 2017 at 3:21 pm

And :

Vice President Mike Pence cast the tie-breaking vote, clearing the procedural motion and allowing the Senate to begin debating an ObamaCare repeal.

On to the skinny bill, and then to the conference? But wait! Under reconciliation, there's the vote-o-rama to come:e

Those rules, defined by law, include allowing only 20 hours for debate but it also includes a process called "vote-a-rama," in which amendments may be proposed and must be voted on before the final passage of the bill. That's where Levin's idea comes in: He proposed introducing tens of thousands of amendments that would need to be voted on before the Senate's bill could be passed. In theory, Levin figured, Democrats could introduce enough amendments to shut down the Senate for a year.

It would be hilarious if Sanders introduced his single payer bill in the form of an amendment to the Republican bill . I don't know if that's possible under the rules, but why putz around with 1000s of little amendments?

mary , , July 25, 2017 at 3:26 pm

It would even more hilarious if the Senate Dems then all voted for it.

IowanX , , July 25, 2017 at 7:12 pm

+++++++100! Perfect. I think such an amendment would entirely be "in order". Lambert, you are a genius, and also a funny, funny man.

Cujo359 , , July 25, 2017 at 8:14 pm

I don't know what the rules allow, either, but you'd think that re-writing the House Medicare for All bill (HR 676) to be an amendment wouldn't take long. Neither the OC Repeal bill nor M4All is all that complex..

MikeW_CA , , July 25, 2017 at 3:31 pm

"Why Republicans should keep doing nothing" is a brilliant recommendation as far as I'm concerned, but at some point, don't even Republicans have to do something to deliver the goods their clients are paying for? What's the point of holding out for 2018 when you already have what should be the power to do whatever you want?

jo6pac , , July 25, 2017 at 3:39 pm

http://start.att.net/news/read/article/the_associated_press-the_latest_trump_keeps_up_twitter_pressure_on_heal-ap

Done and now part 2

Jim Haygood , , July 25, 2017 at 4:06 pm

Record closes today for the S&P 500 (at 2,477) and Nasdaq Composite.

This puts the "round number strange attractor" into effect: 2,500 or bust.

Dead Dog , , July 25, 2017 at 4:12 pm

Thank you, Lambert. Haven't posted a comment for a few days. Timing thing

Lots of news and links, but it feels less suspenseful at the mo – ie after the last 18 months or so – elections (US, UK, France), Brexit, Trump, Sanders, Corbyn, North Korean, the Russians, Yemen, Qatar and on, and on

Probably a good thing, I get more things done.

My home town of Cairns ticks along, same as. Well, as long as those pesky tourists keep coming (damn you Barrier Reef).

And, at least in my pub, the locals pay no attention whatsoever to anything happening south of Gordonvale (about 20k away). No, we are sophisticated. No politics, geo, neo, or whatever, or you have no friends. So, we sit there and take the piss out of everyone and we focus on footy, golf, the price of beer, cars, bikes, boats, fishing, camping and gossip.

I mean, why be curious like me? Nothing they can do to change things. And, as my partner says, I just don't want to know about that stuff (eg climate change, politics).

!!

One of the hidden news stories here in Oz is that a growing number of politicians (two Greens Senators, incl the QLD leader) have had to resign because of dual citizenship. ie you must be an Australian, and only an Australian (in our Constitution). (For example, I never renounced my UK citizenship (Anfield Boy) and would need to if I were to nominate to enter an election (not gonna happen).

The latest is our Resources Minister, Matt Canavan – who has resigned from the Parliament, after being told by his mother he was Italian, as well as Australian. See https://www.macrobusiness.com.au/2017/07/dual-citizenship-claims-canavan/

You can't make this up, eh? Hope they make him pay back the salary he has received during the years since he was elected.

To use the local venacular, Gold, pure Gold

6 am, still dark, cold, like about 17 degrees

Have a great day everyone

The Rev Kev , , July 25, 2017 at 7:11 pm

This story is hilarious. The ruling conservatives tore the Greens a new one last week over how they showed "extraordinary negligence" and "incredible sloppiness" over not checking that if their people had dual citizenship. Now it has come back to bite them hard and I heard that there may be about two dozen others from both major parties in the same boat.
Most people here say if you don't want to give up your other citizenship to serve another country in government, then don't bother putting your name in.The local 'intelligentsia'(?) are making noises that this is wrong and we should abolish that clause in our constitution. This clause does stop a country from flying in a bunch of carpetbaggers, err, technocrats and making them citizens on the spot to serve in government (I'm looking at you Ukraine).
Apparently countries like the US have no real problem with dual citizens serving in government ( http://thehill.com/blogs/congress-blog/homeland-security/240572-when-dual-citizenship-becomes-conflict-of-interest ) but at the end of the day, you have to wonder who they are actually serving at time. Could you imagine how it would look if, on CNN, if the members of the Senate and House of Reps were asked to put their hands up in the air if they were also citizens of another country? Not a good look I would imagine.

Dead Dog , , July 25, 2017 at 7:19 pm

Thank you, Kev, as you say, hilarious.

Now that the LNP have been caught being as sloppy as the greens, they've tried to argue that Canavan knew nothing, it was a staffer's fault, so he should be fine.

If you are right and this is start of a few more, then the make up of the Senate and the power therein could change in a bielection. Australians unlikely to vote in a party's replacement candidate – just the way we see things.

I didn't know the law officer ha ha

And, pay the family blog money back. Have to sell a few IPs?

Too sad

The Rev Kev , , July 25, 2017 at 8:12 pm

Sounds like he tried the Sergeant Schultz defense ( https://www.youtube.com/watch?v=UmzsWxPLIOo )
Come to think of it, didn't Shane Warne blame his mother too when accused of performance-enhancing drug taking?

Synoia , , July 25, 2017 at 10:06 pm

So, we sit there and take the piss out of everyone and we focus on footy, golf, the price of beer, cars, bikes, boats, fishing, camping and gossip.

All male group? No discussion of women? Or by women?

clarky90 , , July 25, 2017 at 4:40 pm

"The Democrats' 'Better Deal' is a box-office dud"

The cute, sad eyed puppy (The Democrats), that we brought home has grown up to be a thuggish Pit Bull Terrier. If it would only stop mauling the local children! So embarrassing. We must stare intensely at this dog with love- using positive affirmations. Then our Pit Bull will magically turn into a Labrador? (I don't think so.)

IMO, the democrats are hopeless. It is better to start a new party, or join the Republicans and influence that party? (Can I say this?)

The Dems are no longer the party of FDR. The Dems were pro slavery in the 1800s. Lincoln's Party was the Republicans.

"Anitya, anitya, anitya" (Impermanence). Everything changes. IMO, the Democrats are "a dead horse". Horse whispering will not work. Whipping will not work. Stand back and let time turn the carcass back into soil.

diptherio , , July 25, 2017 at 4:42 pm

Venezuela Constituent Assembly YES! Interference NO!

The U.S. State Department, the oligarchy and the Venezuelan right, together with the regional and European right have not let up in their attempt to destroy the enormous achievements accomplished by the Bolivarian Revolution of Venezuela and the Government of Nicolas Maduro.

The main objective that drives them, constantly and permanently, is to put into practice various methods of war in order to take control of the vast natural resources of the country, especially oil. Since Chavez, all those resources have been put in the hands and stewardship of the Venezuelan people.

It is the first time in two hundred years of history that this has happened, thanks to the emancipatory and anti-imperialist efforts of Commander Hugo Chávez – a direction continued by the Government of Maduro. The oil income is now at the disposal of huge projects aimed at benefiting those who were always forgotten and humiliated; the people, workers, farmers, blacks and native people.

Also for the first time in the history of Venezuela, illiteracy has been eradicated; more than 1,500,000 affordable homes have been built, education, culture and sports now reaches every corner and mountain top of the country and is no longer just a privilege to be enjoyed by the rich. Women have recaptured their dignity and today they occupy important positions at all levels of the life of the country, including the armed forces. Social missions have been multiplied to give a roof, work and land to those who never had anything .

Imperialism just could not stand what was happening.
So they plotted and invented a humanitarian crisis, by urging the Venezuelan right and the oligarchy to hide and destroy food and medicine while the imperialists themselves prevented shipments of these vital items. They gave cover to the cowardly terrorist imperialist right who have systematically refused to engage in dialogue while failing to organize even one "peaceful demonstration" that even remotely matched the size that the legitimate government of Maduro has been able to bring together.
Instead they have resorted to the most inhumane extreme tactics by funding, providing and sponsoring mercenaries that kill in the most horrendous ways any young man who looks like they could be a supporter of Chavez. Many times the color of their skin is enough to be set on fire.

http://theinternationalcommittee.org/venezuela-constituent-assembly-yes-interference-no/

curlydan , , July 25, 2017 at 4:42 pm

Maybe I'm the old hag. Anytime I read a summary of a Twitter fight (e.g. Joan Walsh), I get nauseous.

PKMKII , , July 25, 2017 at 4:56 pm

And tweetstorms. If you have that much to say, take it to a blog or Facebook.

clarky90 , , July 25, 2017 at 4:58 pm

Did South Park invent the alt-right?
http://www.avclub.com/article/south-park-raised-generation-trolls-258253

"South Park turns 20 years old this summer .The show celebrated this existential crisis-inducing fact last year with a tongue-in-cheek ad, depicting South Park as a sort of benevolent guarantor keeping reliable watch over a girl from infancy until her first trip to college. It was a typically self-effacing joke, but it's true: Our world is now filled with people for whom South Park has always been there, a cultural influence that, in some cases, is completely foundational to their point of view. The ad doesn't end with the girl logging onto Twitter to complain that social justice warriors are ruining the world, but otherwise, spot on."

polecat , , July 25, 2017 at 5:19 pm

You could say the same for, say, SNL no?
.. comedy of a different face, but still

MyLessThanPrimeBeef , , July 25, 2017 at 5:48 pm

Should I not have quit watching TV?

The quoted passage sounds quite foreign to me.

Richard , , July 25, 2017 at 9:07 pm

I used to frequent AV Club religiously, until they lost most of their best, veteran writers in what seemed like a purge a few years ago. Whenever I peeked in in '16, it seemed like Team Blue Central, shoehorning every feature into a critique of Trump, stupid conservatives, ignorant deplorables, etc.
That said, Sean O'Neill (a holdover from that earlier period) is an awesome writer, who has always had a penchant for holding elites (mostly cultural elites) up to well deserved ridicule in his news updates. And this is a fine piece. I wouldn't go as far as the title suggests, and neither does O'Neill actually; he backs down a bit in his conclusion.
I have real respect for South Park. Its writers have always understood an essential component of satire that liberal darlings (on the same network!) like the Daily Show and the Colbert Report tended to miss: you have to be merciless, and you can't make nice afterwards. You need to keep your distance.
It's possible the South Park and NC are a match made in heaven even! Co-creator Matt Stone's comment, " I hate conservatives, but I really (family blogging) hate liberals!"

Daryl , , July 25, 2017 at 9:40 pm

I don't think South Park is foundational to anyone's world view.

ewmayer , , July 25, 2017 at 5:49 pm

"At its core, the Times's internal transformation focuses on upending the paper's copy desk blah blah blah" [Vanity Fair] ! VF writer expends much digital ink fretting over the Verwandlung of the NYT, somehow omits the "and it's *still* an elite establishment propaganda rag which for the good of humankind would best be taken out into the alley and shot" bit.

Pat , , July 25, 2017 at 6:09 pm

OMG, the comedy just writes itself. McCain gets up after the vote to proceed and announces he won't vote for the bill itself because it is a shell of a bill. And then begs his fellow senators to work together. While it isn't quite Hillary Clinton giving an impassioned speech noting all the reasons NOT to vote for AUMF before voting for it, it is still pretty high up on the 'have it both ways' thing. And the bargaining begins.

McConnell better have lots left in that slush fund.

https://www.washingtonpost.com/news/the-fix/wp/2017/07/25/were-getting-nothing-done-john-mccains-no-holds-barred-lecture-to-the-senate-annotated/?utm_term=.30aa247203f5

Mad Pear , , July 25, 2017 at 6:25 pm

A better bad deal is still a bad deal. America doesn't need a better bad deal. America needs a good deal.

Steely Glint , , July 25, 2017 at 7:02 pm

2018, what is needed is a full throated roar of money is not speech, except in the "Market" and politics do NOT belong in the market sphere. That is why Bernie's message resonated, and why his list is so important! The 90 percent will be heard. And until the " little" people who are waiting for this to happen get a response, important matters like health insurance, demise of monopolies in agriculture "Red State" fly over country matter a great deal. Want to know why consumer spending on new cars are falling? Look no farther than the gig economy, where today's paycheck may be gone tomorrow, due to H1B visas, or what ever trade agreements have locked us into. Sorry, mic drop.

Oregoncharles , , July 25, 2017 at 7:18 pm

" an out-of-work auto mechanic whose nerve-damaged shoulder makes it impossible to lift his 11-month-old baby. " Or work.

Good luck to him. When my shoulder was damaged (admittedly, by doing something dumb), medical care was considerably worse than useless. Nerve damage? I know of nothing that will help that.

3.14e-9 , , July 25, 2017 at 7:18 pm

OT question for NC readers familiar with auto lending:

I recently got an auto loan from my credit union (awesome deal on a hybrid SUV on eBay, but that's another story). At the signing last month, I had to provide proof of insurance meeting minimum requirements, standard for auto loans: comprehensive and collision, max $1,000 deductible, with credit union listed as lienholder. I had it all set up beforehand, the loan officer approved it, so far, so good.

Then, in yesterday's mail, I received a letter saying that the credit union had received "evidence of insurance," but was "unable to fully accept this policy," because it didn't include comprehensive or collision coverage. I'm like, WTF? My policy actually exceeds the requirements, with $500 deductible C&C, plus an added premium for the balance to be paid to the lender in case something happens to the car before the loan is paid off.

I emailed the loan officer, and here's where it gets interesting. She apologized for the inconvenience and said it likely was because the credit union recently partnered with a third party for their insurance paperwork. She called it Allied Insurance, but a quick search showed that it's actually Allied Solutions LLC, which is a subsidiary of Securian. I'm not exactly sure what they do or why the credit union partnered with them, but alarm bells are going off in my head, starting with what they're doing with my private information.

After a few exchanges with the loan officer, I'm told that the proof-of-insurance form I signed authorized the credit union to provide its "Insurance Service Center" with the necessary information to verify coverage. Why they would need verification when they had the policy right in front of them is beyond me. More to the point, though, it doesn't say "third-party" insurance center. The average borrower/CU member could be excused for thinking this was an internal department.

I looked back over the letter I received last night. Nowhere does it identify the sender as Allied Solutions – not even on the outside of the envelope – and in fact it has my credit union's logo in the upper left-hand corner. It is signed simply, "Insurance Service Center." Further, it said I could have my insurance company forward a copy of my policy or, "for [my] convenience," I could verify the information online by accessing "my account" on myinsuranceinfo.com, or my insurance company could do it. Deafening alarm bell.

The letter not only was threatening ("You don't have the proper insurance on your car!"), but it essentially was accusing me of changing my insurance policy after the fact, since the loan officer had already approved it. Meanwhile, the loan officer is telling me I gave the credit union permission to share my insurance information with this company, even though they aren't named on the insurance paperwork or even identified as a generic "third party," and didn't identify themselves as such on their correspondence. Does this just "border on" fraud, or is it outright fraud?

The loan officer also sent me a copy of the CU's privacy policy saying they can legally share personal information for "everyday business purposes." Is the average bank/CU customer supposed to somehow just assume this means their auto insurance policy can be shared with third parties? And that they don't have to be notified about how that third party will use their private information?

In fact, the "terms of service" page on myinsuranceinfo.com says that any information you give them in feedback, comments, and the like, becomes theirs to use as they please. They collect personal information about visitors to the site only for statistical purposes, blahblah, unless you give them your personal information. Here's the exact language:

Allied Solutions will not obtain personally-identifying information about you when you visit our site, unless you choose to provide such information to us, nor will such information be sold or otherwise transferred to unaffiliated third parties without the approval of the user at the time of collection.

Well, now, how do you sign into "your account" and verify your insurance without providing them your personal information? I don't know, because I didn't even consider signing in.

I did a little more research and found a few credit union sites that link to myinsuranceinfo as a "service" to their members. From what I can tell, Allied offers the same service to banks.

In addition to the above questions, can any NC readers in financial services explain what's really going on here? Or maybe this is normal, and I should hop back on the turnip truck? Of course, that's not all Allied does. It looks to me like maybe they buy and sell auto loans, but I concede that I never understood that whole process, so I could be mistaken. What I do know – well, from what I've read in comments on NC – is that there's some weird activity going on lately with auto loans. Does the situation I describe fit into that in any way?

THANKS!!!

Jean , , July 25, 2017 at 9:17 pm

I wish I could help. Commiseration count? It's almost like a sci-fi plot – the mind-fuck of it.

Altandmain , , July 25, 2017 at 8:04 pm

Chlorinated chicken? Yes, we really can have too much trade
https://www.theguardian.com/commentisfree/2017/jul/25/chlorinated-chicken-trade-britain-us-food-standards-globalisation

Quite alarming if you think about US food standards.

Democrats Don't Know the First Thing About "Chasing" Rural Voters
http://progressivearmy.com/2017/07/25/democrats-dont-know-first-thing-chasing-rural-voters/

More policing, less spent on social programs
https://blavity.com/center-popular-democracy-policing-budget-study

alex morfesis , , July 25, 2017 at 8:30 pm

This day which will live in infamy lost behind the Trumpcare kabuki of john mccain & the declaration of war against russia, iran & 1dumbsun (419-3 ww3 here we come ) as the queen bee has previously pointed out litigation futures of darkoynz bit and ether and lite et al

sec comes out with report suggesting ico nonsense is actionable

https://www.sec.gov/litigation/investreport/34-81207.pdf

although "no action" for some reason on this german firm they go beyond just the indiviual
coynz themselves and insist the "exchanges" must also register as a National Securities Exchange

wow know a handful of securities attorneys who could probably clean up and fix the ico messes

but how many firms have actually worked on the being registered as an exchange side of things heck how many tall building law firms can even suggest they can do it

https://www.sec.gov/news/press-release/2017-131

and in all the risk factors suspect not even one ICO had the sec favored language of:

a high-risk investment in undeveloped and unproven

although this could get somewhat interesting if the sec allows a flood of these ico national security exchanges, it will possibly open up the scenario of local stock exchanges or "angel" exchanges much like in the days prior to the "big bang"

but the queen bee was spot on

most of these ico things will probably need to do roll ups and merge just to sustain the costs involved even if they go ahead and have a nice healthy carl icahn "end of the world" 2 inch thick litigation proof set of potential risk disclosures it will be interesting

sorry about the bold here .tried to cut and paste and redo and could not figure out how to make it go away..

[Jul 25, 2017] Dont underestimate how personally piqued McCain is over President Obama, taking McCains turn, when it comes time for a vote. McCain is a nasty man

Notable quotes:
"... One of my neighbors has this to say about McCain: "I worked for American Continental. So I know what kind of a crook he is!" Said neighbor is also of the "McCain was a traitor while in North Vietnamese custody!" school. ..."
"... As to your neighbor's opinion of McCain as a collaborator, this post from Ron Unz of the Unz Review is rather eye-opening . ..."
"... McCain comes back from getting health care to help make sure others don't get health care. That's nice. ..."
"... One would have though McCain's incessant pounding on the war drums would have been enough to turn people off. I can't understand how he is so eager to send people off to repeat what happened to him. ..."
"... It probably doesn't matter whether Arizonans notice or not. McCain isn't up for reelection until 2022, so even if he survives longer than the average person with his type of cancer, in 2022 he'll still probably be dead or too weak to campaign for another term. ..."
Jul 25, 2017 | www.nakedcapitalism.com

NotTimothyGeithner , July 25, 2017 at 2:31 pm

Don't underestimate how personally piqued McCain is over President Obama, taking McCain's turn, when it comes time for a vote. McCain is a nasty man. Now that Herr Trump beat Hillary, even McCain might have done it.

Pat , July 25, 2017 at 5:11 pm

Which only proves that McCain truly is an idiot, or doesn't expect to live for another two or so years. Having a signature 'achievement' fail outright to be far more embarrassing than repealing it and having your version of healthcare, whatever it is, fail as badly or worse than ACA would, Especially since delusional folk will still think we would be in the best shape ever if only the big bad Republicans hadn't repealed Barack Obama's health reform plan. There is no such glittery unicorn if ACA continues and dies of its own weight.

(I should note that for those us not under the media induced delusion of McCain as mavericky upstanding moral leader McCain being a vindicative idiot is very old news.)

Arizona Slim , July 25, 2017 at 6:19 pm

One of my neighbors has this to say about McCain: "I worked for American Continental. So I know what kind of a crook he is!" Said neighbor is also of the "McCain was a traitor while in North Vietnamese custody!" school.

JerseyJeffersonian , July 25, 2017 at 6:51 pm

As to your neighbor's opinion of McCain as a collaborator, this post from Ron Unz of the Unz Review is rather eye-opening .

Worthy of a read, particularly for the links to researchers' posts on the matter.

JohnnyGL , July 25, 2017 at 3:09 pm

McCain comes back from getting health care to help make sure others don't get health care. That's nice.

Tim , July 25, 2017 at 3:21 pm

I noticed that irony too, I don't see how anybody in the public would NOT notice that irony, since it is a well known fact that congress gets their own health care guaranteed.

Roger Smith , July 25, 2017 at 3:40 pm

Maybe if they have brain cancer they wouldn't notice . oh.

One would have though McCain's incessant pounding on the war drums would have been enough to turn people off. I can't understand how he is so eager to send people off to repeat what happened to him.

Vatch , July 25, 2017 at 5:33 pm

It probably doesn't matter whether Arizonans notice or not. McCain isn't up for reelection until 2022, so even if he survives longer than the average person with his type of cancer, in 2022 he'll still probably be dead or too weak to campaign for another term.

Arizona Slim , July 25, 2017 at 6:22 pm

And he keeps getting weak opponents on the D side of the ballot. In 2016, it was Ann Kirkpatrick. To this day, I can't figure out why she was so compelling to the Arizona Democratic Party establishment. Oh, in 2010, you're gonna love this: Rodney Glassman. Guy didn't even complete a single term on the Tucson City Council, but he thinks he can go up against one of the best-known names in American politics. Epic fail.

[Jun 28, 2017] Follow the Money: Non-Profit Hospital CEOs Quietly Collect Their Millions While US Health Care Reform Battle Rages by Roy M. Poses MD

Jun 28, 2017 | hcrenewal.blogspot.com
June 22, 2017 In Washington, DC the health care policy wars continue, with a few Republican senators working behind closed doors on a bill to "repeal and replace" Obamacare, aka the Affordable Care Act, and Democrats decrying their secrecy. Just as during the era in which Obamacare was enacted, there is constant discusison of how US health care costs continually rise, driving up insurance premiums, and how access to health insurance is continually in peril.

However, while the current Republican process to write new legislation seems strikingly opaque, in neither era has there been a frank discussion of why US health care costs are so amazingly high, and disproportionate to our mediocre health care outcomes. In particular, there has hardly been any discussion of just who benefits from the rising costs, and how their growing wealth may impede any real cost-cutting measures.

An obvious example is the gravity defying pay given to top health care managers, particularly the top managers of non-profit hospital systems.

Such systems provide much of the hospital care to Americans, and most have declared their missions to be providing the best possible care to all patients, or words to that effect. Many explicitly include care of the poor, unfortunate and vulnerable as a major part of their missions. As non-profit organizations, their devotion of mission provides some rationale to their freedom from responsibility for federal taxes.

As we last discussed in detail in May, 2016 , we have suggested that the ability of top managers to command ever increasing pay uncorrelated with their organizations' contributions to patients' or the public's health, and often despite major organizational shortcomings indicates fundamental structural problems with US health, and provides perverse incentives for these managers to defend the current system, no matter how bad its dysfunction.

In particular, we have written a series of posts about the lack of logical justification for huge executive compensation by non-profit hospitals and hospital systems. When journalists inquire why the pay of a particular leader is so high, the leader, his or her public relations spokespeople, or hospital trustees can be relied on to cite the same now hackneyed talking points.

As I wrote in 2015, and in May, 2016 ,

It seems nearly every attempt made to defend the outsize compensation given hospital and health system executives involves the same arguments, thus suggesting they are talking points, possibly crafted as a public relations ploy. We first listed the talking points here, and then provided additional examples of their use. here , here here, here , here, and here , here and here .

They are:

Yet as we discussed recently , these talking points are easily debunked. Additionally, rarely do those who mouth the talking points in support of a particular leader provide any evidence to support their applicability to that leader.

Boston, Massachusetts area, August, 2016 ( Per the Boston Business Journal )

West New York State, August, 2016 ( Per the Buffalo News

New Jersey, September, 2016 NJ Advance Media)

Top 10 hospital CEOs received total compensation from $1.94 million to $4.7 million

New Orleans, Lousisiana, September, 2016 (Per the Times-Picayune)

Gastonia, North Carolina, February, 2017 (Per the Gaston Gazette )

York County, Pennsylvania, April, 2017 (Per the York Daily Record)

Tri-Cities region, Tennessee and Virginia, June, 2017 (Per WJHL )

Connecticut, June, 2017 ( Per the Connecticut Post)

Summary and Conclusions

The current inflamed discussion of "Obamacare" and Republican attempts to "repeal and replace" it focuses on the costs of care and how they affect individual patients. Examples include concerns about health insurance premiums that are or could be unaffordable for the typical person; insurance that fails to cover many costs, and thus may leave patients at risk of bankruptcy due to severe illness; poor people unable to or who might become unable to obtain any insurance, and perhaps any health care. Yet there is little discussion of what really drives high and ever increasing health care costs (while quality of health care remains mediocre).

That may be because those who are benefiting the most from the status quo want to prevent discussion of their role. There are many such people, but top management of non-profit hospitals provide a ready example. Their institutions' mission is to provide care to sick patients. Many such hospitals specifically pledge to provide care to the poor, vulnerable, and disadvantaged. Non-profit hospitals have no owners or stockholders to whom they owe revenue.

Yet these days the top executives of non-profit hospitals receive enough money to become rich.

See the examples above.

The justification for such compensation is pretty thin. Consider the talking points above. Apparently hospitals are extremely concerned about paying top management enough to recruit and retain them. Yet there is much less evident concern about paying a lot of money to recruit and retain the health care professionals who actually take care of patients to fulfil the hospitals' mission. Hospital CEOs are frequently proclaimed to be brilliant, visionaries, or at least incredibly hard workers with very complex jobs. I wonder if those who make such proclamations have any idea what it takes to be a good physician or a good nurse. Yet such health care professionals' hard work, long training, devotion to duty, and ability to deal with trying situations and make hard decisions rarely inspire hospitals to shower them with money.

Furthermore, hospital CEO compensation is almost never justified in terms of their ability to uphold and advance the fundamental hospital mission, taking care of sick people. The articles above do not contain any justifications of generous CEO compensation based on hospitals' clinical performance or health care outcomes. At best, hospital executive pay seems to be justified by the hospitals' financial, not clinical performance.

As we discussed here , there is a strong argument that huge executive compensation is more a function of executives' political influence within the organization than their brilliance or the likelihood they are likely to be fickle and jump ship for even bigger pay. This influence is partially generated by their control over their institutions' marketers, public relations flacks, and lawyers. It is partially generated by their control over the make up of the boards of trustees who are supposed to exert governance, especially when these boards are subject to conflicts of interest and are stacked with hired managers of other organizations.

Furthermore, such pay may provide perverse incentives to grow hospital systems to achieve market domination, raise charges, and increase administrative bloat. As an op-ed

Outrageous pay gives top executives an incentive to behave outrageously. To hit the pay jackpot, they'll do most anything. They'll outsource and downsize and make all sorts of reckless decisions that pump up the short-term corporate bottom line at the expense of long-term prosperity and stability.

So I get to recycle my conclusions from many previous posts....

We will not make any progress reducing current health care dysfunction if we cannot have an honest conversation about what causes it and who profits from it. In a democracy, we depend on journalists and the news media to provide the information needed to inform such a discussion. When the news media becomes an outlet for propaganda in support of the status quo, the anechoic effect is magnified, honest discussion is inhibited, and out democracy is further damaged.

True health care reform requires publicizing who benefits most from the current dysfunction, and how and why. But it is painfully obvious that the people who have gotten so rich from the current status quo will use every tool at their disposal, paying for them with the money they have extracted from patients and taxpayers, to defend their position. It will take grit, persistence, and courage to persevere in the cause of better health for patients and the public.

And for our musical interlude, the beginning of "For the Love of Money," sung by the O'Jays, used in the official intro of season 2 of guess what show?

https://www.youtube.com/embed/rgr6EuG6zBw

[Jun 28, 2017] Trump betrayed all three his electin time promises about changes to Oabamacare: everybody got to be covered, no cuts to Medicaid, and Every bit as good on pre-existing conditions as Obamacare

Jun 28, 2017 | economistsview.typepad.com

im1dc June 25, 2017 at 09:27 AM

Here is a 5 day old article on Trump deregulating Big Pharma that directly impacts the skyrocketing costs of American Health Care to go with the above posts re the Republican Party's AHCA cutting of coverage and transfer of wealth to the wealthiest in America

Trump is the #1 problem with American Health Care today, he works for the interests of the corporations not the people's

https://www.nytimes.com/2017/06/20/health/draft-order-on-drug-prices-proposes-easing-regulations.html

"Draft Order on Drug Prices Proposes Easing Regulations"

By SHEILA KAPLAN and KATIE THOMAS...JUNE 20, 2017

"In the early days of his administration, President Trump did not hesitate to bash the drug industry. But a draft of an executive order on drug prices appears to give the pharmaceutical industry much of what it has asked for - and no guarantee that costs to consumers will drop.

The draft, which The New York Times obtained on Tuesday, is light on specifics but clear on philosophy: Easing regulatory hurdles for the drug industry is the best way to get prices down.

The proposals identify some issues that have stoked public outrage - such as the high out-of-pocket costs for medicines - but it largely leaves the drug industry unscathed. In fact, the four-page document contains several proposals that have long been championed by the industry, including strengthening drugmakers' monopoly power overseas and scaling back a federal program that requires pharmaceutical companies to give discounts to hospitals and clinics that serve low-income patients.

Mr. Trump has often excoriated the drug industry for high prices, seizing on an issue that stirs the anger of Republicans and Democrats alike. He has accused the industry of "getting away with murder," and said that he wanted to allow the federal government to negotiate directly with drug companies over the price of drugs covered by Medicare.

But the proposed order does little to specifically call out the drug industry and instead focuses on rolling back regulations, a favorite target of the administration..."

im1dc -> im1dc... , June 25, 2017 at 09:37 AM
Additional evidence of Trump lying about his and the Republican AHCA repeal of Obamacare

https://www.usatoday.com/story/news/politics/2017/06/24/promises-trump-made-health-care-repeal-plans/426089001/

"3 promises Trump made about health care that repeal plans haven't kept"

Eliza Collins , USA TODAY ...June 24, 2017

"...Here are three promises Trump made that will not come true under the current bills moving through Congress:

  1. 'Everybody's got to be covered.'...
  2. 'No cuts' to Medicaid"...
  3. 'Every bit as good on pre-existing conditions as Obamacare.'...
im1dc -> pgl... , June 25, 2017 at 11:53 AM
Cuts, cuts, and more cuts to reimbursement that's the Trump Republican AHCA in a nutshell.

All it will accomplish is to transfer $Billions to 'Trump's People', his fellow $Billionaires and MegaMillionaires.

It will not deliver on any Promise Trump made on Health Care and when he and the Republicans say it does they are lying, pure and simple.

More care does not come from far less money spent especially as the need increases due to population and need.

im1dc -> im1dc... , June 25, 2017 at 09:45 AM
I don't know the reason for persistence at attempts to understand the Economics of Trump's and the Republican various remake of the American Economy from an academic Economics perspective by this blog.

It is not possible to do any such rational analysis, b/c as Paul Krugman has pointed out recently and pointedly, there is no rhythm or reason to what they are doing except to obtain the sole single outcome of a major transfer of wealth to the wealthiest Americans in the form of a huge tax cut for most of America's Billionaires and Mega-Millionaires by eliminating as much as possible of the American Safety Net and other protections from the 99%.

[Jun 28, 2017] We can spend endless amounts of money on the NSA, wars overseas, political campaigns and bailing out banks, tha we canaffort single payer helathcare system

Jun 28, 2017 | economistsview.typepad.com

Christopher H. , June 28, 2017 at 08:10 AM

We can spend endless amounts of money on the NSA, wars overseas, political campaigns and bailing out banks, but PGL and the weak tea centrists demand "how are we going to pay for it???" now that single-payer is becoming a real possibility. Every other advanced nation does it better with massive savings for their taxpayers.

http://www.latimes.com/opinion/op-ed/la-oe-pollin-single-payer-healthcare-healthy-california-20170621-story.html

Op-Ed Single-payer healthcare for California is, in fact, very doable

by Robert Pollin

June 21, 2017

The California Senate recently voted to pass a bill that would establish a single-payer healthcare system for the entire state. The proposal, called the Healthy California Act, will now be taken up by the state Assembly. [not]

The plan enjoys widespread support - a recent poll commissioned by the California Nurses Assn. found that 70% of all Californians are in favor of a single-payer plan - and with good reason. Under Healthy California, all residents would be entitled to decent healthcare without having to pay premiums, deductibles or copays.

But as critics of the bill have pointed out, a crucial question remains: Is Healthy California economically viable? According to research I conducted with three colleagues at the University of Massachusetts, Amherst, the answer is yes.

Enacting Healthy California would entail an overhaul of the state's existing healthcare system, which now constitutes about 14% of California's GDP. In particular, it would mean replacing the state's private health insurance industry with government-managed insurance. Our study - which was also commissioned by the California Nurses Assn. - concludes not only that the proposal is financially sound, but that it will produce greater equity in the healthcare sector for families and businesses of all sizes.

California will spend about $370 billion on healthcare in 2017. Assuming the state's existing system stayed intact, the cost of extending coverage to all California residents, including the nearly 15 million people who are currently uninsured or underinsured, would increase healthcare spending by about 10%, to roughly $400 billion.

That's not the full story, though. Enacting a single-payer system would yield considerable savings overall by lowering administrative costs, controlling the prices of pharmaceuticals and fees for physicians and hospitals, reducing unnecessary treatments and expanding preventive care. We found that Healthy California could ultimately result in savings of about 18%, bringing healthcare spending to about $331 billion, or 8% less than the current $370 billion.

How would California cover this $331-billion bill? For the most part, much the same way it covers healthcare spending right now. Roughly 70% of the state's current spending is paid for through public programs, including Medicare and MediCal. This funding - totaling about $225 billion - would continue, as is required by law. It would simply flow through Healthy California rather than existing programs.

The state would still need to raise about $106 billion a year to cover the cost of replacing private insurance. This could be done with two new taxes.

First, California could impose a gross receipts tax of 2.3% on businesses, but with an exemption for the first $2 million of revenue. Through such an exemption, about 80% of all businesses in California - small firms - would pay nothing in gross receipts tax, and medium-sized businesses would pay an effective tax rate of less than 1%.

Second, the state could institute a sales tax increase of 2.3%. The tax would not apply to housing, utilities, food purchased for the home or a range of services, and it could be offset for low-income families with a 2% income tax credit.

Relative to their current healthcare costs, most Californian families will end up spending less, even with these new taxes, and some will even enjoy large gains. Net healthcare spending for middle-income families would fall by between 2.6% and 9.1% of income. Most businesses would also see a drop in spending. Small firms that have been providing health insurance for their workers will see costs fall by 22% as a share of payroll. For medium-sized firms, costs will fall by an average of between 6.8% and 13.4% as a share of payroll. Even most large firms will see costs fall, by an average of between 0.6% and 5% of payroll.

At the moment, about 2.7 million of California's residents, or about 8% of the population, have no health insurance. Another 12 million residents, or about 33% of the population, are underinsured. A large proportion of the remaining 60% of the population who are adequately insured still face high costs, as well as anxiety over President Trump's proposal to repeal and replace Obamacare.

Healthy California is capable of generating substantial savings for families at most income levels and businesses of most sizes. These savings are in addition to the benefits that the residents of California will gain through universal access to healthcare.

[Jun 28, 2017] how many people know, understand or even care what an "individual mandate" is

Jun 28, 2017 | economistsview.typepad.com

JohnH , June 28, 2017 at 08:17 AM

The message matters...something that eludes comprehension by Democrats... Question is are they really this stupid, or are they paid to be this stupid?

"How did [the healthcare debate] get to this point? A point where Harvard researchers are warning of 217,000 additional deaths over the next decade from a loss of health coverage? Part of the blame has to lie with the Democrats, who failed to heed Luntz's advice to the Republicans...

First, in defending Obamacare, they lacked "words that work." For instance, how many people know, understand or even care what an "individual mandate" is? How about insurance "exchanges"? Or the "public option"? These technical terms and phrases have obscured more than they have clarified. They have also played into the hands of the Republicans, who have worked hard to ensure that the public view health care only through a partisan lens.

Remember: around one in three Americans is unaware of the fact that there is no difference between Obamacare and the Affordable Care Act (ACA) - they are one and the same. Many of these people tell pollsters that they like the ACA but dislike Obamacare. (Isn't it odd how so many Americans' view of a health care system changes when you put the foreign-sounding name of a black man in front of it?)

Second, Democrats have turned down opportunity after opportunity to offer a comprehensive health care alternative that guarantees coverage to all Americans (unlike Obamacare, which leaves around 27 million Americans uninsured.) During the Democratic primaries, Hillary Clinton said a single-payer "health care for all" system would "never, ever come to pass." Inspiring, huh?

As for those on the left like Bernie Sanders and - belatedly - Elizabeth Warren, who are keen to offer a progressive alternative to both Trumpcare and Obamacare in the form of guaranteed, government-funded health care for all, they may have a clear and inspiring policy alternative but whether they have a clear and inspiring message for it remains to be seen. For example, according to a February 2016 poll by the Kaiser Family Foundation, "nearly two thirds (64%) of Americans say they have a positive reaction to the term 'Medicare-for-all,' and most (57%) say the same about 'guaranteed universal health coverage.' Fewer have a positive reaction to 'single payer health insurance system' (44%) or 'socialized medicine' (38%)."

The words don't work and, as a result, ignorance abounds.
"About half (53%) of Democrats say they have a very positive reaction to 'Medicare-for-all' compared with 21 percent who say the same for 'single payer health insurance system,'" according to the Kaiser poll. But to be clear: "Medicare-for-all" and "single payer" refer to the same exact thing.
So then "Medicare-for-all" must be the way to go, right? Rather than the bureaucratic-sounding and yawn-inducing "single payer"? Perhaps. Invoking Medicare to make the case for a system in which the government covers the cost of all health care claims, however, may not be the silver bullet that some on the left seem to think it is. Not everyone associates Medicare with the government. Remember the anti-Obamacare town halls in the summer of 2009, where attendees carried placards that read "Keep government out of my Medicare"? An August 2009 poll found that 39% of Americans said they wanted government to "stay out of Medicare" - which is, of course, impossible.

Why don't progressives go with the simpler option of calling their single-payer proposal "universal health care"? Or "health care for all"? In San Francisco, a single payer system called "Healthy San Francisco" was launched a decade ago and has had very high approval ratings. How about Sanders, Warren et al push for a federal version called "Healthy America"?"
https://theintercept.com/2017/06/28/memo-to-democrats-you-need-a-clear-message-for-universal-healthcare/

[Jun 25, 2017] Obama basically decided against marketing his healthcare plan.

www.unz.com

JohnH -> kurt... , June 23, 2017 at 07:05 PM

Jun 25, 2017 | economistsview.typepad.com
Obama basically decided against marketing his healthcare plan. In February, 2009 the Obama campaign contacted campaign workers and asked them to convene neighborhood groups to make suggestions for the plan. My wife and eye convened such a group. We believed it was to be part of a national grass roots push to overwhelm the naysayers.

We sent in the neighborhood's suggestions. We were told they would get back to us. They never did. Grassroots organizing was eliminated. There was no grassroots push. Obama hardly marketed his plan, letting Republicans define it for him.

That was when I began to smell a rat...

JohnH -> sanjait... , June 23, 2017 at 07:48 PM
"It's the Message, Stupid"
http://inthesetimes.com/article/5030/its_the_message_stupid

Back in 2009, Greenberg, Carville and Bauman developed a strategy for selling healthcare reform to the public...most of which Democrats just ignored. http://www.democracycorps.com/wp-content/files/dcorps-healthcare-062509.pdf

Much of it still applies today, but Democrats are clueless...they fear their big donors would revolt if they actually stated what the American people want and need.

JohnH -> mulp ... , June 23, 2017 at 08:06 PM
"actually works" is in the eye of the beholder.

Numbers of economists defended Bernie's proposals...but establishment ones linked with the Democratic Party did not.
http://observer.com/2016/02/liberal-economists-defend-bernie-sanders-against-a-chorus-of-critics/

Bill Black and Jaimie Galbraith were among the most prominent...but you never heard about their push-back because the liberal media blocked it out.

pgl , June 23, 2017 at 12:04 PM
Steve Beshear who was the Democratic Kentucky Governor who did a great job of implementing Obamacare for his state was asked about the stances of his state's two Senators. He really laid in McConnell which was no surprise. His comment re Rand Paul? Senator Paul wants to take our nation back to the 18th century.
jonny bakho -> Lee A. Arnold ... , June 23, 2017 at 05:12 PM
Please... Susan Collins is just as bad as the rest of them. Her carefully crafted public image is all show.

GOP moderates always cave because they are not moderates, they just play to the tastes of their purple states

The GOP will throw a few crumbs, make a big show about the "moderates" improving the bill and then they will be free to vote for it.
Trump, ever the con artist will sell it as Trump steak

JohnH -> kurt... , June 23, 2017 at 04:05 PM
Oh, BS. That the party is corrupt was made evident to anyone who watched Bubba sign away Glass-Steagall, just in time for Hillary to announce her run for Senator from New York/Wall Street. Of course, Bubba insists that there was no quid quo pro. Those who believe him would be good customers for buying the Brooklyn Bridge...

Since then, it's only gotten worse.

[Jun 24, 2017] The Secret Republican Plan to Unravel Medicaid by Robert Reich

Jun 24, 2017 | economistsview.typepad.com

Christopher H, June 23, 2017 at 01:23 PM

http://robertreich.org/post/162168911075

The Secret Republican Plan to Unravel Medicaid

by Robert Reich

FRIDAY, JUNE 23, 2017

Bad enough that the Republican Senate bill would repeal much of the Affordable Care Act.

Even worse, it unravels the Medicaid Act of 1965 – which, even before Obamacare, provided health insurance to millions of poor households and elderly.

It's done with a sleight-of-hand intended to elude not only the public but also the Congressional Budget Office.

Here's how the Senate Republican bill does it. The bill sets a per-person cap on Medicaid spending in each state. That cap looks innocent enough because it rises every year with inflation.

But there's a catch. Starting 8 years from now, in 2025, the Senate bill switches its measure of inflation – from how rapidly medical costs are rising, to how rapidly overall costs in the economy are rising.

Yet medical costs are rising faster than overall costs. They'll almost surely continue to do so – as America's elderly population grows, and as new medical devices, technologies, and drugs prolong life.

Which means that after 2025, Medicaid will cover less and less of the costs of health care for the poor and elderly.

Over time, that gap becomes huge. The nonpartisan Urban Institute estimates that just between 2025 and 2035, about $467 billion less will be spent on Medicaid than would be spent than if Medicaid funding were to keep up with the expected rise in medical costs.

So millions of Americans will lose the Medicaid coverage they would have received under the 1965 Medicaid act. Over the long term, Medicaid will unravel.

Will anyone in future years know Medicaid's unraveling began with this Senate Republican bill ostensibly designed to repeal and replace the Affordable Care Act? Probably not. The unraveling will occur gradually.

Will future voters hold Republicans responsible? Again, unlikely. The effects of the unraveling won't become noticeable until most current Republican senators are long past reelection.

Does anyone now know this time bomb is buried in this bill?

It doesn't seem so. McConnell won't even hold hearings on it.

Next week the Congressional Budget Office will publish its analysis of the bill. CBO reports on major bills like this are widely disseminated in the media. The CBO's belated conclusion that the House's bill to repeal and replace the Affordable Care Act would cause 23 million Americans to lose their health care prompted even Donald Trump to call it "mean, mean, mean."

But because the CBO's estimates of the consequences of bills are typically limited to 10 years (in this case, 2018 to 2028), the CBO's analysis of the Senate Republican bill will dramatically underestimate how many people will be knocked off Medicaid over the long term.

Which is exactly what Mitch McConnell has planned. This way, the public won't be tipped off to the Medicaid unraveling hidden inside the bill.

For years, Republicans have been looking for ways to undermine America's three core social insurance programs – Medicaid, Medicare, and Social Security. The three constitute the major legacies of the Democrats, of Franklin D. Roosevelt and Lyndon Johnson. All continue to be immensely popular.

Now, McConnell and his Senate Republican colleagues think they've found a way to unravel Medicaid without anyone noticing.

Don't be fooled. Spread the word.

[Jun 19, 2017] Republicans are embarrassing Democrats by showing them how legislation gets passed with a bare majority, when Democrats failed with a filibuster proof majority

Jun 19, 2017 | economistsview.typepad.com

JohnH, June 19, 2017 at 06:48 AM

Republicans are embarrassing Democrats by showing them how legislation gets passed with a bare majority...when Democrats could barely get anything done with a filibuster proof majority!

Moral of the story? Democrats under Obama didn't really want to get much done. Rather, they preferred to do nothing and blame Republicans instead. Worse, now that Republicans want to destroy what precious little Democrats managed to accomplish, Democrats are just standing around, frozen like deer in the headlights, clueless as to how to use their 48 votes.

How pathetic can Democrats get?

libezkova, June 19, 2017 at 06:40 PM
"Republicans are embarrassing Democrats by showing them how legislation gets passed with a bare majority...when Democrats could barely get anything done with a filibuster proof majority!"

Not only that.

Neoliberal stooges like Krugman now shed crocodile tears after pushing Sanders under the bus.

They essentially gave us Trump and now have an audacity to complain. What a miserable hypocritical twerp this Nobel laureate is!

Where is the DemoRats "Resistance" now? Are they fighting against the war in Syria on behave of Israel and Gulf states? Protesting sanctions against Cuba? Complaining about the record arms sale with Saudi Arabia (with its possible 9/11 links ?)

No, they are all on MSNBC or CNN dragging out a stupid investigation all the while pushing Russia to war. And congratulating themselves with the latest Russian sanctions designed to block supplies of Russian gas to Western Europe...

I want to repeat this again: Neoliberal Democrats created Trump and brought him to the victory in the recent Presidential elections.

[May 22, 2017] Medical insurance coverage is measure of social security for nearly everyone amd as such is close to Four Freedoms that were articulated by FDR

Notable quotes:
"... Being able to access care is an important freedom as well ..."
"... Trump as candidate promised no cuts to Medicaid. But then he had to get the Paul Ryan seal of approval so it is a massive cut that will leave 10 million people uninsured: ..."
"... Republicans have been using free lunch economic theory to make increasingly bigger promises leading to Trump promising universal health care with no taxes or mandates that will give everyone many more choices on getting far more health care with it costing much less. Trump won by being more extreme and explicit in the free lunch promises the Republican started making with Reagan. ..."
"... It's just standard Reaganomics... the same propaganda (trickle-down & rising tides) & standard tax cuts for the rich based on supply side b.s. ..."
May 22, 2017 | economistsview.typepad.com

Sanjait, May 22, 2017 at 11:36 AM

This is an important concept that has been fought for but hasn't been well articulated by Dems since Four Freedoms.

ACA is an example. It provides insurance coverage for many and a measure of security for nearly everyone. It reduces the risk of living as an American, nominally limiting the "freedom" to benuninsurednor buy crappy insurance in exchange for giving everyone enhanced ability to access preventative and major medical care, even if low income or stricken with a pre-ex medical condition.

Being able to access care is an important freedom as well .

Dems really face planted politically trying to sell this notion, but now that it is under threat of being taken away, Americans suddenly realized they like it and think it is right that people should have this access.

pgl - , May 22, 2017 at 11:50 AM
Exactly. I wonder if the folks have this captured in their little freedom indices.
ilsm - , May 22, 2017 at 03:32 PM
my freedom index has nothing to do with hospital insurance, or NCA. DNC (as good as Cato's) freedom index very far right of Thoreau!
DrDick , May 22, 2017 at 03:32 PM
For conservatives, freedom means the freedom of the rich and corporations from taxes and restrictions on their actions and nothing else.
pgl , May 22, 2017 at 11:53 AM
Trump as candidate promised no cuts to Medicaid. But then he had to get the Paul Ryan seal of approval so it is a massive cut that will leave 10 million people uninsured:

https://www.washingtonpost.com/business/economy/trump-to-propose-big-cuts-to-safety-net-in-new-budget-this-week/2017/05/21/62c01f44-3e34-11e7-adba-394ee67a7582_story.html?utm_term=.01d130c2f913

More tax cuts for the rich! That is their entire agenda.

mulp - , May 22, 2017 at 12:44 PM
Progressives see conservatives as winning by hijacking the Republican Party and being more and more radical, making Congress totally incapable of doing anything and increasingly popular, and getting Trump elected with a minority of the vote to an environment where he can accomplish even less that very moderate Obama and a Democratic majority, and they want Democrats to become more like Republicans:

able to win power, but unable to deliver on anything.

Republicans have been using free lunch economic theory to make increasingly bigger promises leading to Trump promising universal health care with no taxes or mandates that will give everyone many more choices on getting far more health care with it costing much less. Trump won by being more extreme and explicit in the free lunch promises the Republican started making with Reagan.

Progressives want a Bernie elected making big free lunch promises.

It's not about delivering, but about winning.

TANSTAAFL

Longtooth , May 22, 2017 at 03:38 PM
It's just standard Reaganomics... the same propaganda (trickle-down & rising tides) & standard tax cuts for the rich based on supply side b.s.

[May 08, 2017] Can we rescue the individuals with no exchange choices by allowing them to buy into MediCare

Notable quotes:
"... We have more good cop/bad cop. We are supposed to forget that the DNC democrats gave us deregulation, killed Glass-Steagall, refused to prosecute banksters, gave us a hokey republican health insurance plan, tried to give us TPP, continued more ME wars, screw with Russia, etc. ..."
May 08, 2017 | economistsview.typepad.com
paine , May 08, 2017 at 05:47 AM
Pk instead of keening away over
her lead role in the latest

FED borg folly

Trumpcare is a nasty

paine -> EMichael... , May 08, 2017 at 06:47 AM
A simple side swipe at trumpcare
to wield against yellen and the fed borg

Now is the moment to

RC AKA Darryl, Ron -> paine... , May 08, 2017 at 06:47 AM
The Fed Borg has not done anything unexpected whether we are basing that on Krugman's expectations or the expectations that you and I shared of her way back when she lead the Fed to liftoff. Now, we might have had different hopes and maybe even Krugman as well had different hopes, but none of us ever expected anything different than what the Fed actually did from then to now. We all know that we have a bankers' Fed and not a people's Fed.

OTOH, Krugman had very different expectations about the 2016 POTUS election than what actually happened in November. Krugman is just dealing with his disappointment in the best way that he can. It at least creates the illusion that he is making a difference and perception is at least 90% of reality for intellectual elites.

RGC , May 08, 2017 at 06:06 AM
"This is an act of deliberate betrayal":

PK knows whereof he speaks.

We have more good cop/bad cop. We are supposed to forget that the DNC democrats gave us deregulation, killed Glass-Steagall, refused to prosecute banksters, gave us a hokey republican health insurance plan, tried to give us TPP, continued more ME wars, screw with Russia, etc.

The bad cop tells us he is going to have some guys beat us up and then he has some guys beat us up. The good cop tells us he is going to take care of us and then he has some guys beat us up.

How long do people fall for that game?

RGC -> RGC... , May 08, 2017 at 06:24 AM
Pelosi Refuses to Back Single Payer, Despite GOP Deathmongering Suddenly Taking Center Stage

"No, I don't," Rep. Nancy Pelosi (D-Calif.) promptly said, when asked by a reporter if she thinks single payer should be in Democrats' 2018 party platform.

"I was carrying single payer signs probably around before you born, so I understand that aspiration," the House Minority Leader told Vice's Evan McMorris-Santoro. She then claimed that "the comfort level with a broader base of the American people is not there yet," with single payer.

"So I say to people: if you want it, do it in your states. States are laboratories," the Dem leader added. "States are a good place to start," she also said.

Pelosi's assertions about single payer's popularity, however, are called into question by public polling.

http://rinf.com/alt-news/newswire/pelosi-refuses-to-back-single-payer-despite-gop-deathmongering-suddenly-taking-center-stage/

RGC -> RGC... , May 08, 2017 at 06:35 AM
Nancy Pelosi Feels the Bern, Faces Pro-Sanders Primary Challenger

House Minority Leader is 'really out of touch'

http://observer.com/2017/04/nancy-pelosi-pro-sanders-primary-challenger-stephen-jaffe/

DeDude -> pgl... , May 08, 2017 at 09:14 AM
Yes and you can cherry pick pools (that have deliberate or unintended flaws) such that you can get one answer or the other. So you have to get consistency of pooling on an issue before you even consider trusting them. The good news is that Pelosi does not write the Democratic platform, the delegates do. If a majority of democratic party actives believe we are ready to include a national health care plan in the platform, then it will become the dems policy and I will support them. If they refuse to get it in there then we are not ready and I will support that position.
paine -> RGC... , May 08, 2017 at 06:49 AM
Rescue the exchanges
with a pub op

That is all dems should push

DeDude -> paine... , May 08, 2017 at 09:19 AM
Or we could rescue the individuals with no exchange choices at all - by allowing them to buy into MediCare. That way we would not need to "build" a public option (that could be attacked). We could also claim to have given the private sector the opportunity - and only let the government step in when private sector solutions fail. Most importantly the GOP would suddenly start doing everything they could to help the exchanges rather than trying to sabotage them.
paine -> DeDude... , May 08, 2017 at 12:45 PM
Excellent
libezkova -> DeDude... , May 08, 2017 at 07:10 PM
The costs are not going away in your solution.

I understand that we spend much more on bombing brown people, but still uncontrolled expansion of Medicare is somewhat problematic solution.

Simple question to you -- treatment of opiates epidemics victims -- who should pay for their treatment and multiple conditions they already have? Normally private insurers avoid those people as a plague.

Alaska model ( compensating private insurers for most complex and expensive cases -- outliers in costs) also can work. On state level more in known about those people and some measures can be legislated to cut the costs of most egregious cases connected with neoliberalism as a very cruel social system.

For example, homeless people are periodically taken to the hospital and then released to the streets to get in to hospital again and again until they die; some have dangerous for public infections (such a tuberculosis).

RGC -> RGC... , May 08, 2017 at 06:51 AM
Three More Join HR 676 Single Payer Bill in House

Three more members of the House of Representatives have signed on as co-sponsors of HR 676, the single payer bill in the House.

Carolyn Maloney (New York), Adriano Espaillat (New York) and Nanette Barragan (California) - signed onto HR 676 yesterday, bringing the total number of co-sponsors to 72.

https://www.singlepayeraction.org/2017/03/23/three-more-join-hr-676-single-payer-bill-in-house/

JohnH -> pgl... , May 08, 2017 at 08:57 AM
Who's talking about giving up? The Washington Generals always made it a good show against the Harlem Globetrotters...and lost by design...kind of like corrupt, sclerotic Democrats...

[May 08, 2017] How Alaska fixed Obamacare

Notable quotes:
"... That's when Wing-Heier and other Alaska officials had an idea. The state already had a tax on insurance plans (not just health but also life and property insurance). Usually the money goes to a general Alaska budget fund, but the state decided to divert $55 million of the tax revenue into a reinsurance program. ..."
"... The new reinsurance program convinced Premera to only raise rates 7 percent in 2017. Alaska suddenly went from having one of the highest rate increases in the nation to one of the lowest. ..."
"... This didn't just save customers money. The federal government subsidizes premium costs for 86 percent of Alaska's Obamacare enrollees. With cheaper premiums, the federal government didn't have to spend as much money. The cost of these subsidies fell by $56 million when Alaska created the reinsurance fund. ..."
"... If the waiver does go through - and Wing-Heier says she is "confident" the Trump administration will approve it - Alaska expects that Obamacare rates might actually do something unheard of in 2018: They might decrease. The state estimates that an additional 1,650 people will join the marketplace due to the lower premiums. ..."
Apr 17, 2017 | economistsview.typepad.com
im1dc , April 16, 2017 at 09:39 AM
"How Alaska fixed Obamacare"

A potential model that could save and expand Obamacare that the Trump Administration apparently agrees with

http://www.msn.com/en-us/news/us/how-alaska-fixed-obamacare/ar-BBzNr7p

"How Alaska fixed Obamacare"

by Sarah Kliff...Vox.com...4-16-2017...4 hrs ago

"Last year, Alaska's Obamacare marketplaces seemed on the verge of implosion. Premiums for individual health insurance plans were set to rise 42 percent. State officials worried that they were on the verge of a "death spiral," where only the sickest people buy coverage and cause rates to skyrocket year after year.

So the state tried something new and different - and it worked. Lori Wing-Heier, Alaska's insurance commissioner, put together a plan that had the state pay back insurers for especially high medical claims submitted to Obamacare plans. This lowered premiums for everyone. In the end, the premium increase was a mere 7 percent.

"We knew we were facing a death spiral," says Wing-Heier. "We knew even though it was a federal law, we had to do something."

Now other states are interested in trying Alaska's idea, especially because Wing-Heier is working with the Trump administration to have the federal government, not the state, cover those costs.

There are rampant concerns about the future of Obamacare right now. We don't know whether its marketplaces will remain stable in 2018 or, as the president has predicted, explode as premiums rise and insurers drop out. But Alaska's experiment is a reminder that the future of Obamacare isn't entirely up to Republicans in Washington. The work happening 3,000 miles away in Alaska shows that states have the ability to fix Obamacare too - and that the Trump administration might even support those policies.

How Alaska prevented an Obamacare horror story - and is trying to make the federal government pay for it

Premiums in the individual market went up a lot last year. The national average was a 25 percent hike. Alaska was bracing for an even higher 42 percent increase from its one remaining Obamacare insurer, Premera Blue Cross.

That's when Wing-Heier and other Alaska officials had an idea. The state already had a tax on insurance plans (not just health but also life and property insurance). Usually the money goes to a general Alaska budget fund, but the state decided to divert $55 million of the tax revenue into a reinsurance program.

This would give Obamacare insurers - at this point, just Premera - extra money if they had some especially large medical claims. Reinsurance essentially backstops insurers' losses; it guarantees they won't be on the hook for the bills of a handful of exceptionally sick patients.

The new reinsurance program convinced Premera to only raise rates 7 percent in 2017. Alaska suddenly went from having one of the highest rate increases in the nation to one of the lowest.

This didn't just save customers money. The federal government subsidizes premium costs for 86 percent of Alaska's Obamacare enrollees. With cheaper premiums, the federal government didn't have to spend as much money. The cost of these subsidies fell by $56 million when Alaska created the reinsurance fund.

This got Wing-Heier thinking: Why shouldn't we get that money back?

"Why shouldn't the money come back to us to fund the reinsurance program?" she recalls thinking. "It was that simple."

Alaska applied for a waiver in late December, asking the federal government to refund its spending. The state got conditional approval in mid-January from former Health and Human Services Secretary Sylvia Mathews Burwell. Current HHS Secretary Tom Price has spoken favorably of the Alaska approach too.

In a letter last month to governors, he described their idea as an example for other states to follow. It was, he said, an "opportunity for states to lower premiums for consumers, improve market stability, and increase consumer choice."

Alaska officials say the Trump administration has so far been easy to work with, helping them make sure the application looks right and moves quickly toward review.

If the waiver does go through - and Wing-Heier says she is "confident" the Trump administration will approve it - Alaska expects that Obamacare rates might actually do something unheard of in 2018: They might decrease. The state estimates that an additional 1,650 people will join the marketplace due to the lower premiums.

Other states want to get that same kind of funding too

Alaska's marketplace is far from perfect. The state only has one insurance plan selling coverage on its Obamacare marketplace, and doesn't project any more to join in 2018. Premiums are high in Alaska; the state is large and rural, which means it can be expensive to get patients to a hospital or a specialty doctor. A midlevel plan on the Obamacare marketplace there cost, on average, $904 in 2017.

But even with those problems, Wing-Heier says, it's still a whole lot better than where the state would have been without this policy change.

"Do I think it's a perfect solution? No, but it works for us," she says. "It's working in the right direction. It did what it was intended. It brought stability to our market, and the waiver is going to bring funding to us."

Alaska's approach has inspired other states. Minnesota is looking into building a reinsurance fund. At the insurance conference I went to last weekend, regulators from New York were asking lots of questions about Alaska's approach.

It's easy to see why this is appealing to other states, given the combination of additional federal money and lower Obamacare premiums. Most interesting, though, is that Alaska's approach is something the Trump and Obama administrations apparently agree on. There aren't many examples of that right now - so the ones that exist are certainly worth watching."

EMichael -> im1dc... , April 16, 2017 at 10:09 AM
Strange for Kliff not to mention in her piece the effects of the GOP destruction of the risk corridor program on premiums, amount of insurance companies participating, and co-ops.

Alaska's actions are why the risk corridor program was in the ACA.

"The risk corridors were intended to help some insurance companies if they ended up with too many new sick people on their rolls and too little cash from premiums to cover their medical bills in the first three years under the health law. But because of Mr. Rubio's efforts, the administration says it will pay only 13 percent of what insurance companies were expecting to receive this year. The payments were supposed to help insurers cope with the risks they assumed when they decided to participate in the law's new insurance marketplaces.

Mr. Rubio's talking point is bumper-sticker ready. The payments, he says, are "a taxpayer-funded bailout for insurance companies." But without them, insurers say, many consumers will face higher premiums and may have to scramble for other coverage. Already, some insurers have shut down over the unexpected shortfall.

"Risk corridors have become a political football," said Dawn H. Bonder, the president and chief executive of Health Republic of Oregon, an insurance co-op that announced in October it would close its doors after learning that it would receive only $995,000 of the $7.9 million it had expected from the government. "We were stable, had a growing membership and could have been successful if we had received those payments. We relied on the payments in pricing our plans, but the government reneged on its promise. I am disgusted."

Blue Cross and Blue Shield executives have warned the administration and Congress that eliminating the federal payments could have a devastating impact on insurance markets.

Twelve of the 23 nonprofit insurance cooperatives created under the law have failed, disrupting coverage for more than 700,000 people, and co-op executives like Ms. Bonder have angrily cited the sharp reduction in federal payments as a factor in their demise."

https://www.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-affordable-care-act.html?_r=0

trump is continuing the attack.

im1dc -> EMichael... , April 16, 2017 at 11:18 AM
Not so strange imo b/c Rubio's undermining of the Obamacare subsidies happened years ago and the Alaska Obamacare subsidies are today and forward looking not back looking.
EMichael -> im1dc... , April 16, 2017 at 11:42 AM
To a point, but what happened this year in Alaska would not have happened if the risk corridors were not unfunded.

Moving forward, once the insurance companies had a realistic basis for the respective markets, they would stabilize. That was the plan at the very beginning.

Everyone knew that new markets would be incredibly risky for insurance companies. But that given a couple of years, they would figure out the price levels. They also knew that the first year or two would be really rough, as people who had gone without insurance put off healthcare for decades.

According to the CBO (who has been pretty accurate throughout) premiums are stabilizing. If Rubio and the GOP's attack had not happened, Alaska would not have to have done this.

Course, no one can figure out what other attacks will happen, but if they stopped with the risk corridors Alaska will have no need to do such in the future.

I will not bet that the GOP will not make it even worse, so they can just say the ACA collapsed upon itself.

im1dc -> EMichael... , April 16, 2017 at 06:06 PM
Agreed but the point is that the Obamacare Risk Corridors did not work as hoped but this Alaska workaround appears to be working in its place.

I am sure you and I don't care how we get there as long as we get there, saving Obamacare for 30,000,000 Americans.

I don't trust Trump or the Conservative Tea Baggers in Congress either. If they can they will pull defeat from the jaws of victory and call themselves saviors.

They are not nice or caring or smart, just ideologues without a clue to what they are doing.

cm -> im1dc... , April 16, 2017 at 07:05 PM
TLDR: The fedgov pays a significant part of this reinsurance scheme. (According to the article funds that come out of "saved" premium subsidies? - not clear.)

But one can argue this is how it is supposed to work. It doesn't really matter at what "level" the subsidizing happens.

im1dc -> cm... , April 17, 2017 at 04:42 AM
Agreed.

[May 08, 2017] Under the most recent version of the GOP repeal bill, states would be allowed to opt out of requiring insurers to cover everyone at the same price and to offer all 10 essential health benefits in all policies

May 04, 2017 | www.nakedcapitalism.com
MyLessThanPrimeBeef , May 4, 2017 at 4:27 pm

From the CNN article in the Links:

Prior to the health reform law, consumers who have or who previously had medical issues - even if it were years earlier and completely resolved - could be denied coverage or charged much more in premiums. Obamacare remedies that by requiring insurers to cover everyone and charge them the same amount, regardless of their health history. Also, it mandates all policies cover 10 essential health benefits, including prescription drugs, hospitalization and doctors' visits , so the sick could be assured their treatments are covered.

"The rules under Obamacare were comprehensive," said Karen Pollitz, senior fellow at the non-partisan Kaiser Family Foundation.

This expansive coverage, however, comes with a high price tag. It bumps up the cost of premiums for everyone. That's why the conservative Freedom Caucus set its sights on getting rid of these popular provisions.

Related: Key GOP lawmakers flip on health care after Trump meeting
Under the most recent version of the GOP repeal bill, states would be allowed to opt out of requiring insurers to cover everyone at the same price and to offer all 10 essential health benefits in all policies. This would likely lead insurers to jack up rates for those with pre-existing conditions who didn't maintain continuous coverage and to offer skimpy plans that don't pay for the treatments the sick need.

---

1. Is it still a plan if it doesn't offer 'doctors visits?'

That is scary. And I have to ask, is it me not reading it correctly, or is it on the writer?

2. It bumps up the cost of premiums for everyone those popular provisions.

Probably the situation is more complex. Intuitively, more costly for everyone is not often associated with being popular.

3. jack up rates for those with pre-existing conditions who didn't maintain continuous coverage.

Those with pre-existing conditions are today covered for those who are not paying a penalty. They are in 'continuous' coverage, are they not? And the risk is jacked up rates – that is, a money issue.

The difference between Medicare for All, and Free Medicare for All is also a money issue.

Ian , May 4, 2017 at 4:30 pm

This is a gift to the corporate democrats as it provides cover for and shifts blame to the GOP in regards to a system that was well on its way to painfully dying. The people that keep focus on single payer will be blamed even more as well for worsening the situation. A lot more revisionism is coming our way as the terrible reality that was Obama will be made out to look like Trump is the root cause of what is going on. As stated earlier, if Trump wanted to destroy the Dems all he'd have to do is let ACA be run by the Dems and let that run it's natural course, now the GOP own it. As shown by the first commenter. Political Kabuki.

[May 08, 2017] There are three general types of universal health care systems: socialized medicine, single-payer, all payer

Apr 21, 2017 | economistsview.typepad.com
RGC , April 20, 2017 at 05:00 AM
Different Universal Health Care Systems
17 Apr 2017

Jon Walker

There are three general types of universal health care systems. Each system, which other industrialized democracies rely upon, has its quirks.

Socialized medicine
Examples: United Kingdom, Norway, and Denmark
Closest American analogy: Veterans Health Administration


Single-payer
Example: Canada
Closest American analogy: Medicare


All-payer
Examples: Belgium, Japan, Germany, Switzerland
Closest American analogy: Federal Employer Health Benefits, ACA exchanges
.....................
https://shadowproof.com/2017/04/17/road-single-payer-understanding-different-universal-health-care-systems/

Fred C. Dobbs -> RGC... , April 20, 2017 at 05:25 AM
FWIW,

Should there be 'bare counties' (no insurance
plans offered) under ObamaCare in the coming
year it *might* be possible that a Medicaid
Buy-in plan would be offered.

NYT: Katherine Hempstead, who studies health insurance markets at the Robert Wood Johnson Foundation, was more confident than former Obama administration officials that a motivated executive branch could devise new policies to help people in bare counties, such as letting them buy a Medicaid plan, or including them in the state employee benefit pool. "I do think there will be solutions," she said. ...

Bare Market: What Happens if Places Have No
Obamacare Insurers? https://nyti.ms/2pxTTEY
via @UpshotNYT - Margot Sanger-Katz - APRIL 18

RGC -> Fred C. Dobbs... , April 20, 2017 at 05:40 AM
How about a Medicare plan, instead of Medicaid?
Fred C. Dobbs -> RGC... , April 20, 2017 at 06:05 AM
Personally, I'm guessing that
the latter is more likely, but
not much more so, than the former.
paine -> RGC... , April 20, 2017 at 06:17 AM
Yes the public option
at least in counties under provided
By corporate insurers

[May 07, 2017] The Unspeakable

Notable quotes:
"... The Donald did not care what bill was passed, as long as he ended up with something that would allow him to say he kept his promise and could claim as an accomplishment. He is all appearance over substance. ..."
May 07, 2017 | jessescrossroadscafe.blogspot.com
"A culture that does not grasp the vital interplay between morality and power, which mistakes management techniques for wisdom, and fails to understand that the measure of a civilization is its compassion, not its speed or ability to consume, condemns itself to death."

Chris Hedges


"In this way people are thrown aside as if they were trash."

Francis I


"Those who are at present so eager to be reconciled with the world at any price must take care not to be reconciled with it under this particular aspect: as the nest of The Unspeakable. This is what too few are willing to see."

Thomas Merton, The Unspeakable

The French elections will be this weekend, with market pricing in a win by the Europhile businessman Macron over the nationalist right with Le Pen.

The SP and Nasdaq closed at all time highs today. Gold and silver continued to move sideways. The dollar also moved lower. Must have been a 'risk on' day for the one percent and their financiers.

The Health-scare Bill (sic) passed by the House is widely being disregarded by the more astute observers as a cynical exercise in political flimflammery. It is so outrageously bad that the Senate is unlikely to pass it at anything like its current form. It is yet another of their symbolic repeals of a healthcare system formulated by the conservative Heritage Foundation and embraced by the Wall Street wing of the Democrats under Obama and Clinton. The Donald did not care what bill was passed, as long as he ended up with something that would allow him to say he kept his promise and could claim as an accomplishment. He is all appearance over substance.

No matter if this legislation would devastate members of the woeful working class who carried him into office. He and the Congressmen cared so little for the consequences of this law to the public that they did not even wait for the impact analysis that is customary for major legislation.

The House GOP took advantage of Donald's egomania by passing a bill which would deny affordable healthcare insurance to millions of Americans, the weak, the poor, and the elderly, in order to finance a $600 billion tax cut over the next ten years for the richest of the one percent. And afterwards they all celebrated with a beer party in the Rose Garden.

It would have been better for them if they had never been born.

[May 05, 2017] William Binney - The Government is Profiling You (The NSA is Spying on You)

Very interesting discussion of how the project of mass surveillance of internet traffic started and what were the major challenges. that's probably where the idea of collecting "envelopes" and correlating them to create social network. Similar to what was done in civil War.
The idea to prevent corruption of medical establishment to prevent Medicare fraud is very interesting.
Notable quotes:
"... I suspect that it's hopelessly unlikely for honest people to complete the Police Academy; somewhere early on the good cops are weeded out and cannot complete training unless they compromise their integrity. ..."
"... 500 Years of History Shows that Mass Spying Is Always Aimed at Crushing Dissent It's Never to Protect Us From Bad Guys No matter which government conducts mass surveillance, they also do it to crush dissent, and then give a false rationale for why they're doing it. ..."
"... People are so worried about NSA don't be fooled that private companies are doing the same thing. ..."
"... In communism the people learned quick they were being watched. The reaction was not to go to protest. ..."
"... Just not be productive and work the system and not listen to their crap. this is all that was required to bring them down. watching people, arresting does not do shit for their cause ..."
Apr 20, 2017 | www.youtube.com
Chad 2 years ago

"People who believe in these rights very much are forced into compromising their integrity"

I suspect that it's hopelessly unlikely for honest people to complete the Police Academy; somewhere early on the good cops are weeded out and cannot complete training unless they compromise their integrity.

Agent76 1 year ago (edited)
January 9, 2014

500 Years of History Shows that Mass Spying Is Always Aimed at Crushing Dissent It's Never to Protect Us From Bad Guys No matter which government conducts mass surveillance, they also do it to crush dissent, and then give a false rationale for why they're doing it.

http://www.washingtonsblog.com/2014/01/government-spying-citizens-always-focuses-crushing-dissent-keeping-us-safe.html

Homa Monfared 7 months ago

I am wondering how much damage your spying did to the Foreign Countries, I am wondering how you changed regimes around the world, how many refugees you helped to create around the world.

Don Kantner, 2 weeks ago

People are so worried about NSA don't be fooled that private companies are doing the same thing. Plus, the truth is if the NSA wasn't watching any fool with a computer could potentially cause an worldwide economic crisis.

Bettor in Vegas 1 year ago

In communism the people learned quick they were being watched. The reaction was not to go to protest.

Just not be productive and work the system and not listen to their crap. this is all that was required to bring them down. watching people, arresting does not do shit for their cause......

[Mar 23, 2017] Paradoxically, we appear to be seeing a coalescence and consolidation of insurers, we will end up being delightfully exceptional, again- effectively being single-payer, private sector, paying a monopoly an add-on cost of 35-40% to a parasitic industry whose executives and employees do not contribute to the CARE equation.

Notable quotes:
"... Why Steve Bannon Wants You to Believe in the Deep State" [Politico]. "Like the Death Star, the American Deep State does not, of course, exist. " ..."
Mar 23, 2017 | www.nakedcapitalism.com
djrichard , March 22, 2017 at 5:35 pm

Just a bit of a thought experiment, building on some thinking from a comment yesterday by jefemt

Paradoxically, we appear to be seeing a coalescence and consolidation of insurers, we will end up being delightfully exceptional, again- effectively being single-payer, private sector, paying a monopoly an add-on cost of 35-40% to a parasitic industry whose executives and employees do not contribute to the CARE equation.

Taking jefemt's thinking further, imagine the health insurance provider was not only monopolistic (owned the entire market), but was also a GSE (government sponsored enterprise). Now take it one more step and imagine it was an actual part of the government and not merely a GSE.

Conceivably, it wouldn't even have to live off appropriations from congress, assuming it was equally as extractive from the private sector as it is now (i.e. revenue model is the same). Talk about good living. Who knows, maybe they pocket their proceeds into some kind of surplus in Treasury dept.

But let's assume they had to give up on revenue models. [Afterall, it's easier to find partners in congress when you have an appropriations process that binds you to them.] Then they would be exposed. Somebody would get the bright idea that this agency doesn't need as much staffing since they are no longer revenue oriented. That indeed, they could have the same staffing profile as the agency responsible for medicare. Indeed they could be folded into medicare.

I was thinking of this too as a reponse to Why Steve Bannon Wants You to Believe in the Deep State" [Politico]. "Like the Death Star, the American Deep State does not, of course, exist. "

Indeed, I think of the insurance industry as being part of the deep state already. It seems that congress's preference is that this part of the deep state is outsourced. So that's it not a GSE, and not even a monopoly, but maintained as an oligopoly. And then, well hey whatever surplus it can hoover up is fair game. After all free-hand of the market and all that. [And heaven knows, we don't want to crowd that out.]

In contrast to other parts of the deep state that don't really have a revenue model. In which case, those parts need to be insourced by the Fed Gov.

human , March 22, 2017 at 7:46 pm

The CIA has a long history of drug trafficking. The FBI traffics in blackmail. The NSA in network surveillance. DIA, special ops. NRO, satelite throughput. 11 more in the US of A and countless more globally. They all have opaque resources outside of regular channels.

Ernesto Lyon , March 23, 2017 at 12:09 am

Great documentary about the 80's cocaine business in Miami called "Cocaine Cowboys." It's real life Scarface.

Guess who the Feds sent to get a handle on the cocaine smuggling?

See-eye-aye man George H.W. Bush. Coincidence?

[Mar 22, 2017] The Men Who Stole the World

Notable quotes:
"... History will look back at us with the same wonder that we look back on the mad excesses of certain nations founded in devotion to extreme, almost other-worldly, ideologies of the last century. ..."
"... Apparently the slashing of health benefits for the unfortunate is not severe enough in the proposed Trump/Ryan plan. Our GOP house neo-liberals are enthusiastic to unleash the wonders of the cure-all deregulated market on the American public, again. Like a dog returns to its vomit. ..."
Mar 22, 2017 | jessescrossroadscafe.blogspot.com
"The problem of the last three decades is not the 'vicissitudes of the marketplace,' but rather deliberate actions by the government to redistribute income from the rest of us to the one percent. This pattern of government action shows up in all areas of government policy."

Dean Baker

"When the modern corporation acquires power over markets, power in the community, power over the state and power over belief, it is a political instrument, different in degree but not in kind from the state itself. To hold otherwise - to deny the political character of the modern corporation - is not merely to avoid the reality.

It is to disguise the reality. The victims of that disguise are those we instruct in error."

John Kenneth Galbraith

And unfortunately the working class victims of that disguise are going to be receiving the consequences of their folly, and then some.

Secure in their monopolies and key positions with regard to reform and the law, the corporations are further acquiring access to the protections of the rights of individuals as well, it appears, at least according to Citizens United .

Maybe our leaders and their self-proclaimed technocrats will finally do the right thing. I personally doubt it, except that if they do it will probably be by accident.

More likely, the right thing will eventually come about the old-fashioned way- under the duress of a crisis, and the growing protests of the much neglected and long suffering.

History will look back at us with the same wonder that we look back on the mad excesses of certain nations founded in devotion to extreme, almost other-worldly, ideologies of the last century.

... ... ...

Apparently the slashing of health benefits for the unfortunate is not severe enough in the proposed Trump/Ryan plan. Our GOP house neo-liberals are enthusiastic to unleash the wonders of the cure-all deregulated market on the American public, again. Like a dog returns to its vomit.

Better if they start breaking up corporate health monopolies and embrace real reform at the sources of the soaring costs. The US pays far, far too much for drugs and healthcare, and deregulating the markets is not the solution. We do have the example of the rest of the developed world for what to do about this. It is called 'single payer.'

But players keep on playing. And politicians and their enablers in the professions will not see what their big money donors do not wish them to see. And that is one of their few bipartisan efforts.

Might one suggest that our political animals stop trying to do all the reforming and cost controls bottom up, while applying the stimulus top down? That approach they have been flogging to no avail for about thirty years is a recipe for a dying middle class.

Here is a short video from the Bernie Sanders WV town hall that shows The Face of American Desperation. By the way, the governor of West Virginia is a Democrat. He wasn't there.

...

[Mar 14, 2017] No wonder the unemployed increasingly kill themselves, or others. The whole economy tells them, indirectly but unmistakably, that their human value does not exist.

Mar 14, 2017 | economistsview.typepad.com
Noni Mausa : March 13, 2017 at 04:13 PM

What the wealthy right wing has decided in the past 40 years is that they don't need citizens. At least, not as many citizens as are actually citizens. What they are comfortable with is a large population of free range people, like the longhorn cattle of the old west, who care for themselves as best they can, and are convenient to be used when the "ranchers" want them.

Of course, this is their approach to foreign workers, also, but for the purpose of maintaining a domestic society within which the domestic rich can comfortably live, only native born Americans really suit.

With the development of high productivity production, farming, and hands-off war technology the need for a large number of citizens is reduced. The wealthy can sit in their towers and arrange the world as suits them, and use the rest of the world as a "farm team" to supply skills and labour as needed.

Proof of this is the fact that they talk about the economy's need for certain skills, training, services and so on, but never about the inherent value of citizens independent of their utility to someone else.

No wonder the unemployed increasingly kill themselves, or others. The whole economy tells them, indirectly but unmistakably, that their human value does not exist. ken melvin : , March 13, 2017 at 04:48 PM

Can someone get me from $300 billion tax cut for the rich to getting the markets work for health care?
ken melvin : , March 13, 2017 at 04:54 PM
It isn't about 'markets', never is. It is about extraction of as much profit as possible using whatever means necessary. This is what the CEOs of insurance companies get payed to do. Insurance policies they don't pay out, the ones Ryan is referring to, are as good as any for scoring.
libezkova : , March 13, 2017 at 07:09 PM
"It isn't about 'markets', never is. It is about extraction of as much profit as possible using whatever means necessary. This is what the CEOs of insurance companies get payed to do."

What surprises me most in this discussion is how Obamacare suddenly changed from a dismal and expensive failure enriching private insurers to a "good deal".

Lesseevilism in action ;-)

ilsm : , March 13, 2017 at 01:41 PM
When the PPACA band-aid is pulled off the US health care mess the gusher will be blamed on "the Russians running the White House".

Cuba does better than the US despite being economically sanctioned for 55 years. Distribution of artificially scarce health care resources is utterly broken. This failed market is financed by a mix of 'for profit' insurance and medicare (which sublets a big part to 'for profit' insurance).

Coverage!!! PPACA added taxpayers' money to finance a bigger failed market. It did nothing to address the market fail!

Single payer would not address the market failure. Single payer would put the government financing most of the failed market.

Democrats have put band-aids on severe bleeds since Truman made the cold war more important than Americans.

At least we know what Trump stands for!

jeff fisher said in reply to ilsm... , March 13, 2017 at 01:58 PM
Cuba is the shining example of how doing the first 20% of healthcare well for everyone gets you 80% of the benefit cheap.

The US is the shining example of how refusing to do the first 20% of healthcare well for everyone only gets you 80% of the benefit no matter how much you spend.

jonny bakho : , March 13, 2017 at 12:09 PM
Mark's very nice argument does nothing to address The Official Trump Counter Argument:

[Shorter version: Obamacare is doomed, going to blow up. Any replacement is therefore better than Obamacare; Facts seldom win arguments against beliefs]

"During a listening session on healthcare at the White House on Monday, President Donald Trump said Republicans "are putting themselves in a very bad position by repealing Obamacare."

Trump said that his administration is "committed to repealing and replacing" Obamacare and that the House Obamacare replacement will lead to more choice at a lower cost. He further stated, "[T]he press is making Obamacare look so good all, of a sudden. I'm watching the news. It looks so good. They're showing these reports about this one gets so much, and this one gets so much. First of all, it covers very few people, and it's imploding. And '17 will be the worst year. And I said it once; I'll say it again: because Obama's gone."

He continued, "And the Republicans, frankly, are putting themselves in a very bad position - I tell this to Tom Price all the time - by repealing Obamacare. Because people aren't gonna see the truly devastating effects of Obamacare. They're not gonna see the devastation. In '17 and '18 and '19, it'll be gone by then. It'll - whether we do it or not, it'll be imploded off the map."

He added, "So, the press is making it look so wonderful, so that if we end it, everyone's going to say, 'Oh, remember how great Obamacare used to be? Remember how wonderful it used to be? It was so great.' It's a little bit like President Obama. When he left, people liked him. When he was here, people didn't like him so much. That's the way life goes. That's human nature."

Trump further stated that while letting Obamacare collapse on its own was the best thing to do politically, it wasn't the right thing to do for the country.

http://www.breitbart.com/video/2017/03/13/trump-republicans-putting-bad-position-repealing-obamacare/

[Feb 26, 2017] Clowbacks to benefits manager is "It's like crack cocaine," said Susan Hayes, a consultant with Pharmacy Outcomes Specialists in Lake Zurich, Illinois. "They just can't get

Feb 26, 2017 | economistsview.typepad.com
im1dc : February 24, 2017 at 05:26 PM , 2017 at 05:26 PM
Real World Economics

"You're Overpaying for Drugs and Your Pharmacist Can't Tell You"

https://www.bloomberg.com/news/articles/2017-02-24/sworn-to-secrecy-drugstores-stay-silent-as-customers-overpay

"You're Overpaying for Drugs and Your Pharmacist Can't Tell You"

by Jared S Hopkins...February 24, 2017...9:52 AM EST

> Gag clauses stop pharmacists from pointing out a cheaper way

> Cigna, UnitedHealth and Humana face at least 16 lawsuits

"Eric Pusey has to bite his tongue when customers at his pharmacy cough up co-payments far higher than the cost of their low-cost generic drugs, thinking their insurance is getting them a good deal.

Pusey's contracts with drug-benefit managers at his Medicap Pharmacy in Olyphant, Pennsylvania, bar him from volunteering the fact that for many cheap, generic medicines, co-pays sometimes are more expensive than if patients simply pay out of pocket and bypass insurance. The extra money -- what the industry calls a clawback -- ends up with the benefit companies. Pusey tells customers only if they ask.

"Some of them get fired up," he said. "Some of them get angry at the whole system. Some of them don't even believe that what we're telling them is accurate."

Graphic

Clawbacks, which can be as little as $2 a prescription or as much as $30, may boost profits by hundreds of millions for benefit managers and have prompted at least 16 lawsuits since October. The legal cases as well dozens of receipts obtained by Bloomberg and interviews with more than a dozen pharmacists and industry consultants show the growing importance of the clawbacks.

"It's like crack cocaine," said Susan Hayes, a consultant with Pharmacy Outcomes Specialists in Lake Zurich, Illinois. "They just can't get enough."

The cases arrive at a critical juncture in the quarter-century debate over how to make health care more affordable in America. President Donald Trump is promising to lower drug costs, saying the government should get better prices and the pharmaceutical industry is "getting away with murder." The Pharmaceutical Care Management Association, a benefits-manager trade group, says it expects greater scrutiny over its role in the price of medicine and wants to make its case "vocally and effectively."
Racketeering Accusations

Suits have been filed against insurers UnitedHealth Group Inc., which owns manager OptumRx; Cigna Corp., which contracts with that manager; and Humana Inc., which runs its own. Among the accusations are defrauding patients through racketeering, breach of contract and violating insurance laws.

"Pharmacies should always charge our members the lowest amount outlined under their plan when filling prescriptions," UnitedHealthcare spokesman Matthew Wiggin said in a statement. "We believe these lawsuits are without merit and will vigorously defend ourselves."

Mark Mathis, a Humana spokesman, declined to comment. Matt Asensio, a Cigna spokesman, said the company doesn't comment on litigation.

"Patients should not have to pay more than a network drugstore's submitted charges to the health plan," Charles Cote, a spokesman for the Pharmaceutical Care Management Association, said in a statement.

Read more: Escalating U.S. drug prices -- a QuickTake explainer

Benefit managers are obscure but influential middlemen. They process prescriptions for insurers and large employers that back their own plans, determine which drugs are covered and negotiate with manufacturers on one end and pharmacies on the other. They have said their work keeps prices low, in part by pitting rival drugmakers against one other to get better deals.

The clawbacks work like this: A patient goes to a pharmacy and pays a co-pay amount -- perhaps $10 -- agreed to by the pharmacy benefits manager, or PBM, and the insurers who hire it. The pharmacist gets reimbursed for the price of the drug, say $2, and possibly a small profit. Then the benefits manager "claws back" the remainder. Most patients never realize there's a cheaper cash price.

"There's this whole industry that most people don't know about," said Connecticut lawyer Craig Raabe, who represents people accusing the companies of defrauding them. "The customers see that they go in, they are paying a $10 co-pay for amoxicillin, having no idea that the PBM and the pharmacy have agreed that the actual cost is less than a dollar, and they're still paying the $10 co-pay."

On Feb. 10, a customer at an Ohio pharmacy paid a $15 co-pay for 15 milligrams of generic stomach medicine pantoprazole that the pharmacist bought for $2.05, according to receipts obtained by Bloomberg. The pharmacist was repaid $7.22, giving him a profit of $5.17. The remaining $7.78 went back to the benefits manager.
Opaque Market

Clawbacks are possible because benefit managers take advantage of an opaque market, said Hayes, the Illinois consultant. Only they know who pays what.

In interviews, some pharmacists estimate clawbacks happen in 10 percent of their transactions. A survey by the more than 22,000-member National Community Pharmacists Association found 83 percent of 640 independent pharmacists had at least 10 a month.

"I've got three drugstores, so I see a lot of it," David Spence, a Houston pharmacist, said in an interview. "We look at it as theft -- another way for the PBMs to steal."

Lawsuits began in October in multiple states, and some have since been consolidated. Most cite an investigation by New Orleans television station Fox 8, which featured interviews with Louisiana pharmacists whose faces and voices were obscured.
Tight Restrictions

Many plans require pharmacies to collect payment when prescriptions are filled and prohibit them from waiving or reducing the amount. They can't even tell their customers about the clawbacks, according to the suits. Contracts obtained by Bloomberg prohibit pharmacists from publicly criticizing benefit managers or suggesting customers obtain the medication cheaper by paying out of pocket.

Pharmacists who contract with OptumRx in 2017 could be terminated for "actions detrimental to the provider network," doing anything that "disparages" it or trying to "steer" customers to other coverage or discounted plans, according to an agreement obtained by Bloomberg.

"They're usually take-it-or-leave-it contracts," said Mel Brodsky, who just retired as chief executive officer of Pennsylvania's Keystone Pharmacy Purchasing Alliance, which buys drugs on behalf of independent pharmacies.

OptumRx is among the three largest benefit managers that combine to process 80 percent of the prescriptions in the U.S. The other two, Express Scripts Holding Co. and CVS Caremark, haven't been accused of clawbacks. CVS doesn't use them, it said in a statement. Express Scripts is so opposed that it explains the practice on its website and promises customers will pay the lowest price available.
Potential Death Blow

Pharmacies fear getting removed from reimbursement networks, a potential death blow in smaller communities. But some pharmacists jump at opportunities to inform customers who question their co-pay amounts.

"Most don't understand," said Spence, who owns two pharmacies in Houston. "If their co-pay is high, then they care."

States are responding. Last year, Louisiana began allowing pharmacists to tell customers how to get the cheapest price for drugs, trumping contract gag clauses. In 2015, Arkansas prohibited benefit managers and pharmacies from charging customers more than the pharmacy will be paid.

"The consumers don't know what's going on," said Steve Nelson, a pharmacist in Okeechobee, Florida. "We try to educate them with regards to what goes into a prescription, OK? You've got to kind of tip-toe around things."

ilsm -> im1dc... , February 24, 2017 at 07:08 PM
pharma to USG

like drug cartel in Mexico

except no briefcases

im1dc -> ilsm... , February 24, 2017 at 07:47 PM
That's a valid observation.

[Feb 19, 2017] As Democrats stare down eight years of policies being wiped out within months, but those policies did virtually nothing for their electoral success at any level.

Notable quotes:
"... This point has been made before on Obamacare, but the tendency behind it, the tendency to muddle and mask benefits, has become endemic to center-left politics. Either Democrats complicate their initiatives enough to be inscrutable to anyone who doesn't love reading hours of explainers on public policy, or else they don't take credit for the few simple policies they do enact. Let's run through a few examples. ..."
"... missed the point the big winner is FIRE. ACA should have been everyone in medicare, and have medicare run Part B not FIRE. Obamcare is welfare for FIRE, who sabotage it with huge deductibles and raging rises in premium.. ..."
Feb 19, 2017 | economistsview.typepad.com
Peter K. -> Chris G ... , February 18, 2017 at 07:35 AM
via J.W. Mason (lots of F-bombs!):

http://democracyjournal.org/arguments/keep-it-simple-and-take-credit/

Keep It Simple and Take Credit

BY JACK MESERVE
FROM FEBRUARY 3, 2017, 5:42 PM

As Democrats stare down eight years of policies being wiped out within months, it's worth looking at why those policies did virtually nothing for their electoral success at any level. And, in the interest of supporting a united front between liberals and socialists, let me start this off with a rather long quote from Matt Christman of Chapo Trap House, on why Obamacare failed to gain more popularity:

There are parts to it that are unambiguously good - like, Medicaid expansion is good, and why? Because there's no f!@#ing strings attached. You don't have to go to a goddamned website and become a f@!#ing hacker to try to figure out how to pick the right plan, they just tell you "you're covered now." And that's it! That's all it ever should have been and that is why - [Jonathan Chait] is bemoaning why it's a political failure? Because modern neoliberal, left-neoliberal policy is all about making this shit invisible to people so that they don't know what they're getting out of it.

And as Rick Perlstein has talked about a lot, that's one of the reasons that Democrats end up f!@#$ing themselves over. The reason they held Congress for 40 years after enacting Social Security is because Social Security was right in your f!@ing face. They could say to you, "you didn't used to have money when you were old, now you do. Thank Democrats." And they f!@#ing did. Now it's, "you didn't used to be able to log on to a website and negotiate between 15 different providers to pick a platinum or gold or zinc plan and apply a f!@#$ing formula for a subsidy that's gonna change depending on your income so you might end up having to retroactively owe money or have a higher premium." Holy shit, thank you so much.

This point has been made before on Obamacare, but the tendency behind it, the tendency to muddle and mask benefits, has become endemic to center-left politics. Either Democrats complicate their initiatives enough to be inscrutable to anyone who doesn't love reading hours of explainers on public policy, or else they don't take credit for the few simple policies they do enact. Let's run through a few examples.

...

ilsm -> Peter K.... , February 18, 2017 at 12:47 PM
missed the point the big winner is FIRE. ACA should have been everyone in medicare, and have medicare run Part B not FIRE. Obamcare is welfare for FIRE, who sabotage it with huge deductibles and raging rises in premium..

[Jan 16, 2017] Trump said he will target pharmaceutical companies over drug prices and demand that they negotiate directly with Medicaid and Medicare.

Jan 16, 2017 | economistsview.typepad.com

pgl -> Fred C. Dobbs... , January 16, 2017 at 05:57 AM

If Trump is serious about what he said - expect a real battle with Speaker Ryan.
DeDude -> pgl... , January 16, 2017 at 06:57 AM
That may be exactly what Trump is counting on. Trump is a classic bully, he gets back at people (to make an example and reduce future "resistance"). It would be very difficult for the GOP to fight with Trump publicly in the first year. Question is what his specifics are. He may even be able to get bipartisan support and split the GOP, the way Bush did with his prescription drug plan for seniors.
reason -> DeDude... , January 16, 2017 at 07:35 AM
Trump doesn't do details. Details are for little people.
libezkova -> DeDude... , January 16, 2017 at 07:44 AM
Crushing Speaker Ryan is not bulling per se. This is a great service for the country.

He is definitely out of touch with reality.

Peter K. -> Fred C. Dobbs... , January 16, 2017 at 05:55 AM
"We're going to have insurance for everybody," Mr. Trump said. "There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us."

In the interview, Mr. Trump provided no details about how his plan would work or what it would cost. He spoke in the same generalities that he used to describe his health care goals during the campaign - that it would be "great health care" that left people "beautifully covered."

Single payer!

ilsm -> Peter K.... , January 16, 2017 at 06:10 AM
Trump would have to sell it, but in the past he has praised European style single payer, but said it would be a hard sell in the US.

If Nixon could go to China.

MLK would observe "if US can pay to gut the world, it can afford a little for the home front".

Peter K. -> ilsm... , January 16, 2017 at 06:52 AM
"Beautifully covered."

Can't wait!

Fred C. Dobbs -> Fred C. Dobbs... , January 16, 2017 at 06:00 AM
The GOP's strategy for Obamacare? Repeal and run.
http://www.bostonglobe.com/opinion/2017/01/15/gop-strategy-for-aca-repeal-and-run/aCcjrJWQDjx4r4aRxkMCaL/story.html?event=event25 via @BostonGlobe
Elizabeth Warren - January 15, 2017

For eight years, Republicans in Congress have complained about health care in America, heaping most of the blame on President Obama. Meanwhile, they've hung out on the sidelines making doomsday predictions and cheering every stumble, but refusing to lift a finger to actually improve our health care system.

The GOP is about to control the White House, Senate, and House. So what's the first thing on their agenda? Are they working to bring down premiums and deductibles? Are they making fixes to expand the network of doctors and the number of plans people can choose from? Nope. The number one priority for congressional Republicans is repealing the Affordable Care Act and breaking up our health care system while offering zero solutions.

Their strategy? Repeal and run.

Many Massachusetts families are watching this play out, worried about what will happen - including thousands from across the Commonwealth that I joined at Faneuil Hall on Sunday to rally in support of the ACA. Hospitals and insurers are watching too, concerned that repealing the ACA will create chaos in the health insurance market and send costs spiraling out of control.

They are right to worry. Massachusetts has worked for years to provide high-quality, affordable health care for everyone. But there's no magic wand we can wave to simply snap back to our old system if congressional Republicans decide to rip up the Affordable Care Act and run away.

Health care reform in Massachusetts wasn't partisan. Democrats, Republicans, business leaders, hospitals, insurers, doctors, and consumers all came together behind a commitment that every single person in our Commonwealth deserves access to affordable, high-quality care. When Republican Governor Mitt Romney signed Massachusetts health reform into law in 2006, our state took huge strides toward offering universal health care coverage and financial security to millions of Bay State residents.

That law was a major step forward. Today, more than 97 percent of Bay Staters are covered - the highest rate of any state in the country.

But Massachusetts still has a lot to lose if the ACA is repealed. One big reason for our state's health care success is that we took advantage of the new opportunities offered under the ACA. In addition to making care more accessible and efficient, our state expanded Medicaid, using federal funds to help even more people. And we combined federal and state dollars to help reduce the cost of insurance on the Health Connector.

When the ACA passed, Massachusetts already had in place some of the best consumer protections in the nation. But the ACA still made a big difference. It strengthened protections for people in Massachusetts with pre-existing conditions, allowed for free preventive care visits, and - for the first time in our state - banned setting lifetime caps on benefits.

If the ACA is repealed, our health care system would hang in the balance. Half a million people in the Commonwealth would risk losing their coverage. People who now have an iron-clad guarantee that they can't be turned away due to their pre-existing conditions or discriminated against because of their gender could lose that security. Preventive health care, community health centers, and rural hospitals could lose crucial support. In short, the Massachusetts health care law is a big achievement and a national model, but it also depends on the ACA and a strong partnership with the federal government.

If the cost-sharing subsidies provided by the ACA are slashed to zero, Massachusetts will have a tough time keeping down the cost of plans on the Health Connector. The state can't make funds appear out of thin air to help families on the Medicaid expansion if Republicans yank away support. And our ability to address the opioid crisis will be severely hampered if people lose access to health insurance or if the federal funding provided through the Medicaid waiver disappears. Even in states with strong health care systems - states like Massachusetts - the ACA is critical.

The current system isn't perfect - not by a long shot. There are important steps Congress could take to lower deductibles and premiums, to expand the network of doctors people can see on their plans, and to increase the stability and predictability of the market. We should be working together to make health care better all across the country, just like we've tried to do here in Massachusetts.

This doesn't need to be a partisan fight. But if congressional Republicans continue to pursue repeal of the ACA with nothing more than vague assurances that they might - someday - think up a replacement plan, the millions of Americans who believe in guaranteeing people's access to affordable health care will fight back every step of the way.

Repeal and run is for cowards.

pgl -> Fred C. Dobbs... , January 16, 2017 at 06:00 AM
"Providing health insurance to everyone in the country is likely to be very costly, a fact that could diminish support from fiscal conservatives."

Herein lies the real issue. Of course we could reduce these costs by ending the doctor cartel, ending the oligopoly power of the health insurance giants, and pushing back on Big Pharma. Alas, Speaker Ryan is not interested in any of these things.

Fred C. Dobbs -> Fred C. Dobbs... , January 16, 2017 at 06:01 AM
Rand Paul says he's drafting
a measure to replace Obamacare http://www.bostonglobe.com/news/politics/2017/01/15/rand-paul-says-drafting-measure-replace-obamacare/y6wMEPKjbi1oEkj9TkekSO/story.html?event=event25 via @BostonGlobe
Miles Weiss - Bloomberg - January 15, 2017

Republican Senator Rand Paul said he's drafting legislation for a health-care insurance plan that could replace Obamacare, including a provision to ''legalize'' the sale of inexpensive insurance policies that provide abbreviated coverage.

''That means getting rid of the Obamacare mandates on what you can buy,'' Paul said in an interview on CNN's ''State of the Union'' on Sunday. Obamacare, which Republicans are moving to repeal, requires insurers to cover a number of procedures -- such as preventive care and pregnancy -- that Paul said drives up the cost.

The Kentucky Republican said he'll propose helping people pay for medical bills through tax credits and health savings accounts, which allow users to set aside money tax-free to pay for medical expenses. His bill would allow individuals and small businesses to form associations when buying insurance, giving them more leverage, he said.

''There's no reason why someone with four employees shouldn't be able to join with hundreds and hundreds of other businesses'' to negotiate better prices, Paul said. Becoming part of larger pools would help small companies secure coverage ''that guarantees the issue of the insurance even if you get sick.'' ...

Paul said his legislation is meant to address concern among Democrats and some Republicans that ending Obamacare would also end health-care coverage for many of the 20 million people who acquired insurance under the law. While Republicans move ahead with their plans to eradicate Obamacare, they have yet to outline an alternative.

''It's incredibly important that we do replacement on the same day as we do repeal,'' Paul said on CNN. ''Our goal,'' he added, is to ''give access to the most amount of people at the least amount of cost.''

Fred C. Dobbs -> Fred C. Dobbs... , January 16, 2017 at 07:28 AM
(I urge that Dr Paul's plan include
guv'mint-supplied snake bite kits
for all. That could save a bundle.)

[Jan 16, 2017] The Biggest Changes Obamacare Made, and Those That May Disappear

Jan 16, 2017 | economistsview.typepad.com
Fred C. Dobbs : January 15, 2017 at 08:37 AM , 2017 at 08:37 AM
The Biggest Changes Obamacare Made, and Those That
May Disappear https://nyti.ms/2itydsr via @UpshotNYT
NYT - Margot Sanger-Katz - January 13, 2017

It looks like the beginning of the end for Obamacare as we know it.

After years of vowing to repeal the Affordable Care Act, as it is formally known, Republican lawmakers in both chambers of Congress have now passed a bill that will make it easier to gut the law.

Because they are using a special budget process, Republicans won't be able to repeal all provisions of the health law. But it seems like a good time to look at the major changes Obamacare brought to health care, which of those changes may now disappear, and what might replace them.

An important note: We still don't know the details of a repeal bill, and passage is not guaranteed. But Republicans passed a similar package in 2015, vetoed by President Obama, that provides a rough template. Republicans have also said they hope to make further changes through additional legislation. We'll provide updates when new legislative language arrives, expected in several weeks.

1) Obamacare insured millions through new insurance markets.

The health law reduced the number of uninsured Americans by an estimated 20 million people from 2010 to 2016. One of the primary ways it did so was by creating online markets where people who didn't get insurance through work or the government could shop for a health plan from a private insurer. The law offered subsidies for Americans with lower incomes to help pay their premiums and deductibles.

What would happen? The Republican bill is expected to eliminate the subsidies. This would make insurance unaffordable for millions of Americans and sharply reduce the number who buy their own health coverage.

With many fewer people buying coverage, the insurance markets are likely to become increasingly unstable. Many insurers will stop offering policies, and the remaining customers are likely to be sicker than current Obamacare buyers, a reality that will drive up the cost of insurance for everyone who buys it, and force more people out of the markets. The Urban Institute estimates that the change would cause a total of 22.5 million people to lose their health insurance.

What might replace it? Separate legislation may include some new form of subsidy to help people afford insurance. Plans from House Speaker Paul Ryan and the budget committee chairman Tom Price, President-elect Donald J. Trump's pick to lead the Department of Health and Human Services, would both offer a flat tax credit to help buy insurance that varies by age. A proposal from the House Republican Study Committee would give all Americans a standard tax deduction to buy insurance.

2) Obamacare insured millions more by expanding Medicaid.

The health law provided federal funds for states to offer Medicaid coverage to anyone earning less than about $16,000 for a single person or $33,000 for a family of four. Not every state chose to expand, but most did.

What would happen? The Republican plan is expected to eliminate federal funding for the expansion. An estimated 12.9 million people would lose Medicaid coverage, according to the Urban Institute's projections.

What might replace it? Republican leaders have discussed reforming the remaining Medicaid program to give states more autonomy and to reduce future federal investment.

3) Obamacare established consumer protections for health insurance.

One of the law's signature features prevents insurance companies from denying coverage or charging a higher price to someone with a pre-existing health problem. The law included a host of other protections for all health plans: a ban on setting a lifetime limit on how much an insurer has to pay to cover someone; a requirement that insurers offer a minimum package of benefits; a guarantee that preventive health services be covered without a co-payment; a cap on insurance company profits; and limits on how much more insurers can charge older people than younger people. The law also required insurance plans to allow adult children to stay on their parents' policies until age 26.

What would happen? These rules can't be changed using the special budget process, so they would stay in place for now. But eliminating some of the other provisions, like the subsidies, and leaving the insurance rules could create turmoil in the insurance markets, since sick customers would have a much stronger incentive to stay covered when premiums rise. .

What might replace it? Mr. Trump has said that he'd like to keep the law's policies on pre-existing conditions and family coverage for young adults, but Senate Republicans recently voted against nonbinding resolutions to preserve those measures, suggesting they may be less committed. Some of the other provisions would probably be on the table if there were new legislation. Republicans in Congress would probably eliminate rules that require a minimum package of benefits for all insurance plans and allow states to determine what insurers would have to include. Mr. Trump has said he'd like to encourage the sale of insurance across state lines, a policy likely to make coverage more skimpy but less expensive for many customers. Republicans would also like to expand tax incentives for people to save money for health expenses.

Many of the Republican proposals would also establish so-called high-risk pools, which would provide subsidized insurance options for people with chronic health problems who wouldn't be able to buy insurance without rules forcing insurers to sell them coverage.

4) Obamacare required individuals to have health insurance and companies to offer it to their workers.

To ensure that enough healthy people entered insurance markets, the law included mandates to encourage broader coverage. Large employers that failed to offer affordable coverage, or individuals who failed to obtain insurance, could be charged a tax penalty.

What would happen? The bill is expected to eliminate the mandates. Some experts think that eliminating the individual mandate, in particular, could destabilize insurance markets by reducing incentives for healthy people to buy coverage. The mandate had less of an impact on the employers, which had already been offering coverage.

What might replace it? Some Republican plans would allow insurers to charge much higher rates to customers who allow their coverage to lapse than to those who renew their policies every year. Such a system might provide a different financial incentive for healthy people to stay insured.

5) Obamacare raised taxes related to high incomes, prescription drugs, medical devices and health insurance.

To help pay for the law's coverage expansion, it raised taxes on several players in the health industry and on high-income earners.

What would happen? The G.O.P. package may roll back those tax increases, though there is some disagreement among Republican lawmakers about the deficit impact of such changes.

What might replace it? Republicans have not discussed raising new taxes to replace those in the Affordable Care Act. But some of their plans would limit the tax benefits offered to people who get their health insurance through work. That change would increase tax revenues, but would increase the cost of health insurance for many people who get it through work.

6) Obamacare made major reforms to Medicare payments.

The law cut the annual pay raises Medicare gives hospitals and reduced the fees Medicare pays private insurance companies. It created new incentives for hospitals and doctors to improve quality. It also set up a special office to run experiments in how Medicare pays doctors and hospitals for health care services. Those experiments are now widespread and have begun changing the way medicine is practiced in some places.

What would happen? The new legislation is expected to leave these changes alone, even though many have come under criticism by Republicans in Congress over the years, including from Mr. Price, an orthopedic surgeon. Many of the experiments could be reshaped or eliminated through regulation or through a future budget process.

What might replace it? Republicans in Congress have long talked about even more ambitious changes to Medicare, intended to move more beneficiaries into private insurance coverage. Mr. Trump has said that he does not want to make major changes to Medicare, so it is unclear if such a proposal would move forward.

7) Obamacare made many smaller changes that will probably last.

Obamacare had a range of policies meant to improve health and health care, including requirements that drug companies report payments made to physicians, a provision written by the Iowa senator Chuck Grassley, a Republican; a requirement that chain restaurants publish calorie counts on their menus; and a rule that large employers must provide a space for women to express breast milk.

What would happen? When Republicans talk about repealing Obamacare, they tend to focus on the parts of the law that expanded insurance coverage and regulated health insurance products, not these ancillary parts. That means that portions of the Affordable Care Act that people don't associate with the word "Obamacare" are likely to endure.

Fred C. Dobbs -> Fred C. Dobbs... , January 15, 2017 at 08:42 AM
Perhaps the most horrendous loss
(to Big Healthcare) will be if ~20M
people lose coverage, even if it is
high-deductible 'catastrophic' coverage,
hospitals will lose billions in insurance
reimbursements for 'free care', which had
*much* to do with why/how Massachusetts
got the ball rolling in the first place.
im1dc -> Fred C. Dobbs... , January 15, 2017 at 11:32 AM
Every time I read an article about the Republicans 'Repeal of Obamacare' I remind myself that Trump has not said he would sign Repeal only.

Rather, he repeatedly has said and recently reiterated that he wants Repeal to coincide with Replace, hours, days, not weeks, months, or years.

That sets up an Executive Branch vs Legislative Branch conflict.

One of the party's pledges will have to give to the others, either Trump or the Speaker Ryan House Republican majority and or the Majority Leader McConnell's Republican majority Senate.

Today I'm guessing Trump gets his wish.

But that leads me to ask what are the Republicans going to substitute for PACA/Obamacare that is 'cheaper and provides more and better health care' that Donald Trump promised, repeatedly.

If it is exciting to watch a train wreck then it is exciting to watch this budding and self-inflicted catastrophe develop in Republican controlled D.C., although I would rather not.

DeDude -> im1dc... , January 15, 2017 at 12:49 PM
"what are the Republicans going to substitute for PACA/Obamacare that is 'cheaper and provides more and better health care' that Donald Trump promised"

Yes my guess is that TrumpCare will not be bigger and better. More likely it will be small - like his hands

DeDude -> Fred C. Dobbs... , January 15, 2017 at 01:02 PM
She missed the biggest and most important part. ACA reduced the size of the doughnut hole in Medicare part D. Indeed ObamaCare was going to make the doughnut hole go completely away by 2020. So if we go back to the old Bush part D there will suddenly be a $4000 gap of no coverage for prescription drugs for our seniors. What are the GOPsters going to do about that?
Fred C. Dobbs -> DeDude... , January 15, 2017 at 01:19 PM
Get rich(er), I'd guess.

[Jan 14, 2017] Insurance overhead runs are probably the best argument for single payer

Jan 14, 2017 | economistsview.typepad.com
pgl -> Fred C. Dobbs... , January 13, 2017 at 06:14 AM
There are 3 ways we could reduce what we pay for health care:

(1) Ending the oligopoly power of the health insurance companies;

(2) Ending the doctor cartel;

(3) Reducing the monopoly power of Big Pharma.

Alas, the Republicans have no intention in doing any of this. So when they tell people they want to lower their costs, they are talking to rich people. The cost to the rest of us will go up if they have their way.

Observer -> pgl... , -1
From what I read, and recall from data Anne has posted a number of times, pharma costs are about 10% of total health care costs, and run about 2X EU average, or Canada, if we adopt that as a reference baseline. If we cut it in half, that would reduce our costs about 5%.

Doctors fees (physicians and clinical services in this reference) are about 20%. I think you have mentioned before we pay about 2X typical EU wages. So if we cut that in half, it reduces our costs about 10%.

Taken together, that's ~ 15% reduction. Not nothing, but in a few years of cost growth we are back to current cost levels.

Do you see that differently?

I don't have offhand figures for what insurance overhead runs. I think reducing that is probably the best argument for single payer, although comparisons to medicare overhead seem suspect (I'd expect much lower overhead percentages when much of your costs you are processing are $40K end of life hospital events vs. routine GP visits.) So one might zero out the profit, and reduce costs by having one IT/billing system. What's the scale of the opportunity here - another 15%?

https://www.cdc.gov/nchs/fastats/health-expenditures.htm

[Jan 13, 2017] Reducing the cost of healthcare

Jan 13, 2017 | economistsview.typepad.com
pgl -> Fred C. Dobbs... , January 13, 2017 at 06:14 AM
There are 3 ways we could reduce what we pay for health care:

(1) Ending the oligopoly power of the health insurance companies;

(2) Ending the doctor cartel;

(3) Reducing the monopoly power of Big Pharma.

Alas, the Republicans have no intention in doing any of this. So when they tell people they want to lower their costs, they are talking to rich people. The cost to the rest of us will go up if they have their way.

Observer -> pgl... , January 13, 2017 at 07:12 AM
From what I read, and recall from data Anne has posted a number of times, pharma costs are about 10% of total health care costs, and run about 2X EU average, or Canada, if we adopt that as a reference baseline. If we cut it in half, that would reduce our costs about 5%.

Doctors fees (physicians and clinical services in this reference) are about 20%. I think you have mentioned before we pay about 2X typical EU wages. So if we cut that in half, it reduces our costs about 10%.

Taken together, that's ~ 15% reduction. Not nothing, but in a few years of cost growth we are back to current cost levels.

Do you see that differently?

I don't have offhand figures for what insurance overhead runs. I think reducing that is probably the best argument for single payer, although comparisons to medicare overhead seem suspect (I'd expect much lower overhead percentages when much of your costs you are processing are $40K end of life hospital events vs. routine GP visits.) So one might zero out the profit, and reduce costs by having one IT/billing system. What's the scale of the opportunity here - another 15%?

https://www.cdc.gov/nchs/fastats/health-expenditures.htm

anne -> Observer... , January 13, 2017 at 07:37 AM
https://www.nytimes.com/2017/01/12/us/politics/health-care-congress-vote-a-rama.html

January 12, 2017

Senate Takes Major Step Toward Repealing Health Care Law
By THOMAS KAPLAN and ROBERT PEAR

In its lengthy series of votes, the Senate rejected amendments proposed by Democrats that were intended to allow imports of prescription drugs from Canada, protect rural hospitals and ensure continued access to coverage for people with pre-existing conditions, among other causes....

[Nov 07, 2016] The Cigna CEO took home $49 million in total comp last year – and wasn't the highest paid Cigna executive

www.nakedcapitalism.com

Knifecatcher November 7, 2016 at 2:59 pm

Today our HR department revealed the "new and improved" 2017 benefits package… and it's massively crapified. But good news! The "High Deductible Health Plan" is now a "Consumer Driven Health Plan" thanks to our good friends at Cigna, who kindly reminded us that we just haven't been doing our part as active health care consumers to help reduce health care costs. Because the real problem with health care today is obviously branding.

Knifecatcher November 7, 2016 at 3:27 pm

The consultant they brought in to dump this on us actually said "most people spend more time shopping for the best price on shoes than they spend shopping for the most cost-effective health care."

I had the temerity to point out what I've learned from firsthand experience – that there is NO WAY TO KNOW what a provider will charge for a particular procedure beforehand. The response was that they'd follow up with me later. :)

Apropos of nothing, the Cigna CEO took home $49 million in total comp last year – and wasn't the highest paid Cigna executive.

Waldenpond November 7, 2016 at 5:26 pm

Have you seen the commercial where a female basketball player is goofing off for her child in the house… falls and injures herself. Later she's in a sling and grabbing a small trampoline and in response the 'husband' is on the phone. I guess the inference is he's calling the insurance company but I think it makes more sense to be calling for a price check.

The next time you have a compound fracture, remember to stay calm, and get the best price.

Tvc15 November 7, 2016 at 3:28 pm

And my company is offering a new 2017 "benefit"; Critical Illness Insurance to provide financial protection for an illness such as cancer, stroke or heart attack.

Uh, okay, I thought that is why I pay $6,000 / yr for my high deductible medical plan, not including company subsidy, dental or vision.

Maybe they should have asked marketing to help with the branding.

jrs November 7, 2016 at 3:38 pm

I think it's not actually for medical costs in most cases. It's for the cost of say not being able to work due to cancer and so on. Or that's what I've seen out there, obviously I don't know about your particular plan.

Waldenpond November 7, 2016 at 5:33 pm

Check the policy. Some policies are very specific in that they will include specific cancers and exclude others. The additional can cover illnesses not covered by the initial contract, lost wages, support, and unemployment in case your employer fires you. It may apply to Cobra costs in case of job loss so a person can maintain continuity of care.

Knifecatcher November 7, 2016 at 4:03 pm

We got that too, along with a number of other optional programs. My assumption is that once you get past medical, dental, and vision all those other post-tax "benefits" (pre-paid legal, long term care insurance, etc) are just profit centers, and that the provider gives the employer a kickback for allowing them access to a captive customer base – with payments automatically deducted from each paycheck! I don't know that for sure, but it's the only explanation I can see as to why HR pushes those so hard.

[Oct 15, 2016] The Breakaway insurance plan amounted to a reverse Ponzi scheme where unsuspecting employers expecting to buy affordable policies instead bought costly reinsurance requiring them to cover each others losses

Notable quotes:
"... Breakaway, with about 300 employees, accused Berkshire and Applied of "siphoning" premiums through a web of illegal shell companies, with diverted premiums going to unlicensed out-of-state insurers, the wire agency said. ..."
"... The plan amounted to a "reverse Ponzi scheme" where unsuspecting employers expecting to buy affordable policies instead bought costly "reinsurance" requiring them to cover each other's losses, leaving taxpayers on the hook for shortfalls when too many workers are injured on the job, Breakaway said. ..."
Oct 15, 2016 | www.nakedcapitalism.com

Cry Shop September 13, 2016 at 1:11 am

Class Warfare:
http://www.ejinsight.com/20160913-buffett-flagship-sued-over-workers-compensation-siphoning/

Breakaway, with about 300 employees, accused Berkshire and Applied of "siphoning" premiums through a web of illegal shell companies, with diverted premiums going to unlicensed out-of-state insurers, the wire agency said.

The plan amounted to a "reverse Ponzi scheme" where unsuspecting employers expecting to buy affordable policies instead bought costly "reinsurance" requiring them to cover each other's losses, leaving taxpayers on the hook for shortfalls when too many workers are injured on the job, Breakaway said.

[Oct 09, 2016] What is Insurance Fraud

Notable quotes:
"... Medical provider knowingly submits false medical bills by billing for services not rendered, billing for wrong procedure codes or billing for procedures of a medical necessity when procedures may have been elective or cosmetic in nature and not covered by health insurance. ..."
Oct 09, 2016 | insurance.ca.gov
Medical Medical

Inflated Billing - Inflated billing by any medical facility, doctor, chiropractor, laboratory, etc.

Healthcare

Billing Fraud - Medical provider knowingly submits false medical bills by billing for services not rendered, billing for wrong procedure codes or billing for procedures of a medical necessity when procedures may have been elective or cosmetic in nature and not covered by health insurance.

[Aug 29, 2016] Audits Of Some Medicare Advantage Plans Reveal Pervasive Overcharging

Aug 29, 2016 | www.npr.org

…The Center for Public Integrity recently obtained, through a Freedom of Information Act lawsuit, the federal audits of 37 Medicare Advantage programs. These audits have never before been made public, and though they reveal overpayments from 2007 - money that has since been paid back - many plans are still appealing the findings.

Medicare Advantage is a privately run alternative to standard Medicare; it has been growing in popularity and now enrolls more than 17 million seniors. In 2014, Medicare paid the health plans more than $160 billion.

But there's growing controversy over the accuracy of billings, which are based on a formula called a risk score; it is designed to pay Medicare Advantage plans higher rates for sicker patients and less for people in good health. In a series of articles published in 2014, the Center for Public Integrity reported that overspending tied to inflated risk scores has cost taxpayers tens of billions of dollars in recent years. …

[Aug 29, 2016] Patriotically, your higher costs of health care are added to America's anemic GDP figures

Notable quotes:
"... New ways to prepare your ramen. Rice in 50 pound sacks. Beans galore. ..."
Aug 29, 2016 | www.nakedcapitalism.com
OpenThePodBayDoorsHAL , August 29, 2016 at 3:50 pm

Ah yes, but think patriotically, your higher costs of health care are added to America's anemic GDP figures, everybody needs to do their bit. Forward Soviet!

RabidGandhi , August 29, 2016 at 3:53 pm

For $1500 you could have flown to Argentina and been treated for free, and still have another $500 left over for Evita t-shirts .

fresno dan , August 29, 2016 at 4:06 pm

allan
August 29, 2016 at 3:33 pm

You have the common, but naive idea that health insurance pays for health related services and/or materials. Yes, that is how it used to be, but actually the medical insurance complex follows the Mickey Mouse (i.e., Disneyland model). This is much more efficient and synergistic at leveraging resources to separate you from all your money.

What is the Disneyland model? Health insurance lets you SEE (and I mean this literally) your doctor, just like a ticket lets you into Disneyland, and you can see all you want.
Now if you want to ride or enter an attraction, or eat something, that is separate.
Now you can see a doctor. Asking him/her a question is a separate charge. The answer is a separate charge. A correct answer requires a specialist…..

cwaltz , August 29, 2016 at 5:14 pm

Isn't it fun?

You get told by the insurance company that it's the hospital/providers fault because of how they coded something and then you get told by the hospital that it's the insurance company's fault.

Meanwhile all you care about is why you are being charged the amount you are being charged and it appears to get more and more complicated as you find yourself charged more than once for a lab or procedure. It's gotten to the point where I've been billed by a doctor for READING a test that they ordered(uh I'm pretty sure there is no point in ordering a test if it isn't going to be read.) That's in addition to now being billed for the lab tech drawing the blood and the lab that has the technicians that read and record the values. And even more maddening, it isn't consistent. Some places bill me for the doctor's time for reading my labs, others do not and good luck figuring out which places are which short of trial and error.

Tom , August 29, 2016 at 7:27 pm

How does it feel to be an unpaid worker in the health insurance industry? I kid, because my wife and I spend a lot of time ourselves straightening out screwed-up bills almost every time one of us sees a doctor. And I mean that. Almost every single time there's an error - either on the doctor's part, the doctor's office staff, the doctor's billing company or the insurer. And god help us if there is a hospital or clinic involved! We are at the point now where we go in knowing the various procedure codes for what we want done and going over them with everybody involved, repeatedly. It helps, although things still get screwed up. Ya gotta love our 'system!'

Bob , August 29, 2016 at 3:32 pm

'We need fundamental changes': US doctors call for universal healthcare
https://www.theguardian.com/us-news/2016/may/05/us-doctors-calling-universal-healthcare-system-affordable-care-act

fresno dan , August 29, 2016 at 4:17 pm

Pat
August 29, 2016 at 2:34 pm

Health Care
UPDATE Here's a handy chart [Wall Street Journal, "Burden of Health-Care Costs Moves to the Middle Class"].

===========================================
I was looking at that, and it seemed it so contradicted all sorts of sources I had read about inflation in items like education as well as health care, energy, food, etcetera. As I have frequently noted, flat screen TV are super cheap, but non edible….unless your very, very hungry.
And than I realized I was reading something into the chart that the chart wasn't addressing at all – it wasn't talking about inflation – it is talking about expenditures.
If medical care is going way up, well than of course other expenditures, especially if salaries are stagnant, HAVE TO GO DOWN.

cwaltz , August 29, 2016 at 5:18 pm

You silly! That's what Care Credit and the rest of the credit vultures are for. They will be more than happy to finance that necessary crown or essential surgery you need.

Left in Wisconsin , August 29, 2016 at 5:48 pm

Yes, that chart is way more shocking than simple inflation. Health care costs are eating the economy. Although I'm sure Krugman will tell us it's because consumer preferences have changed – the middle class apparently just isn't as interested in food or housing as it used to be.

trent , August 29, 2016 at 2:45 pm

with regards to the wall street stating we are only paying more for healthcare

http://menus.nypl.org/menu_pages/24283/explore menu from brooklyn place in 2005-7

https://www.yelp.com/menu/diner-brooklyn current day menu for same place

Look at the price of a burger, eating out is so much more cheaper!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

trent , August 29, 2016 at 2:49 pm

if you're too lazy to click on the links

a cheeseburger from 2005-2007 era was $9.50

now a cheeseburger is $16

nooooooooooooooooooo inflation

John k , August 29, 2016 at 8:22 pm

Go to CA, stop at in-n-out, pay 3.45 for double double, a great burger.
Worth the trip.

nippersmom , August 29, 2016 at 2:50 pm

Actually, they didn't say eating out was cheaper, just that people are spending less of their income on it. I read that as eating out less often or at different types of establishments.

trent , August 29, 2016 at 2:54 pm

haha yes you got me, but i'm still angry about the price of burgers. I'll gladly pay you tuesday for a burger today

MyLessThanPrimeBeef , August 29, 2016 at 4:33 pm

How are you going to compete with energy-efficient, eco-friendly (to ensure a beautiful green world in the future) solar-powered robots when you need to eat cheeseburgers often (or less often)?

Enquiring Mind , August 29, 2016 at 3:00 pm

Income optimization techniques for the modern serf.

New ways to prepare your ramen.
Rice in 50 pound sacks.
Beans galore.

Don't forget your vitamins.

Jeremy Grimm , August 29, 2016 at 3:30 pm

Thanks for reminding me! I need to start up another batch of beans.

But I still buy my rice in 25 pound sacks. I splurge on perfume rice and sometimes I'll have an occasional meal with Korean brown rice although I buy it in 5 pound bags - its a little pricey. Next trip to the store I'll buy a big sack of parboiled rice to make my other rice last longer. I'm still learning how to grow potatoes and I need to build up the soil in my postage stamp garden space.

AnEducatedFool , August 29, 2016 at 4:10 pm

I am a vegetarian on SNAP. I do not know how meat eaters are able to eat a healthy diet on anything less that 750-1000 a month for a family of 3. Even at 1000 a month you are forced to eat a lot of food that is essentially poison.

I recently ran out of my 25 lb Lunderberg brown rice but no one sells that around here. I moved onto quinoa for now. I found a great deal on two 4 lb bags. Once that is gone I'll move onto whatever organic grain is cheapest per serving. I have not seen a lot of organic brown rice recently.

I buy organic beans to avoid Round Up which is used on beans and grains once they are finished growing. Apparently round up decreases the drying time so you get to eat a higher quantity of round up thanks to this process. I avoid it in my house so I only buy organic grains and flours.

If you make your own bread a good food processor makes it an easier and faster process. A few good recipes are found in How to Cook Everything: Vegetarian. My old Kitchen Aid stand mixer is great for ciabatta (Paul Hollywood recipe) but I do not use it all that often now.

If you can afford it buy cedar wood to frame a raised bed that is 3 x 10. 10 ft is ideal since that is the length of electrical conduit to make a quick and easy trellis. 3 feet is ideal because you do not want to step into your bed ever. One of my favorite books on back yard gardening is called Mini Farming: Self Sufficiency on 1/4 acre.

inode_buddha , August 29, 2016 at 5:13 pm

I imagine it depends on where you live: in my part of N.Y. you can eat like a king on 200 a month in food stamps. I know, because I did just that in 2011 or thereabouts. About 25% meat by volume in my diet.

AnEducatedFool , August 29, 2016 at 6:52 pm

200 for a single person is not bad. I spent about that while I was in college while a meat eater and that would work around here for a single person.

3 people make things harder. Due to allergens we need to skip eggs and avoid most conventional food due to stomach issues which I personally lean towards glyphosate causing stomach problems. Avoiding round up is only possible by purchasing organic produce which is primarily frozen for us or out of my garden. We use the dirty dozen and the clean list to purchase produce that is not organic.

A lot of our food needs to be produced by me due to necessity and loaf of organic bread costs between 3.40 and 5.50+ but the price per oz is similar. I make french baguettes and ciabatta bread at least once a week each which brings down food costs as well.

One of the worst moments of the past 6 months was when I had to explain to my son that he could not have cherry tomatoes from the store. I usually tell him know but its rarely over money but we were too low on money at the time and we couldn't justify the expense. He eats about a pint of cherry tomatoes out of my garden per day now.

But the term "eat like a king" needs updating. If you are the king then you can buy local organic produce, grass fed beef, free range chicken/fowl and afford to head out to high end restaurants. That far surpasses 200 a month and is closer to 2000 a month if you actually eat 3 meals a day plus 2 or 3 snacks.

I am outside of Philadelphia.

nippersdad , August 29, 2016 at 7:10 pm

That would depend upon what kind of meat eater you are talking about. Steaks every day or bits of one steak for eight meals over a few months? We buy large chunks of whatever on sale, have it ground up and/or sliced, freeze it and then live on it for years. Literally. We still have most of last year's Thanksgiving turkey ($7.00) frozen in its' own stock, for example. One freezer bag of that should make all the soup we could possibly want to eat, two or three meals worth, and then we freeze what's left for later. You can make a gallon or two of potato soup using little bits of ham and stock for a couple of bucks.

Soups, stews, stir fries, chili; you would be surprised at how far you can make, say, thirty dollars go. If you do the same thing with veggies, buy corn on sale (10 ears for two dollars, say) and cream sacks of it, for example, you can bring down the veggie bill as well. We have gotten to the point where planting a garden is more expensive than just buying the stuff.

And carbs are cheap; rice, potatoes, pasta…as are teabags.

It seems to me that it is largely a matter of time or money. The more time you put into your cooking (making stocks, for example) the less you will ultimately have to spend…..to eat at home, anyway. My habit is to never to make anything that one cannot freeze more than half of, and it seems to work out pretty well.

Carla, August 29, 2016 at 7:38 pm

Educated? For sure. A Fool? Not so much.

One of my favorite ways to turn cold, leftover vegetables into an elegant meal? A generous dollop of curried mayonnaise.

JTMcPhee , August 29, 2016 at 5:37 pm

This is how we get "Chained CPI" shoved in through the back door… http://www.huffingtonpost.com/news/chained-cpi/

[Aug 29, 2016] UN insurance companies as the Department of Denial

www.nakedcapitalism.com
Pat

Looking at that rather stunning graph above, I wonder if all the pundits and so-called experts who keep wondering why the consumer economy is stalled could finally get that it was hijacked by government for the private insurance companies, with a little bit for drug companies and health care providers.

No wait, that would be too sensible, realistic and yes not what they are paid to notice.

Arizona Slim

Private health insurance companies need to go away. Period.

Pat

That would be the logical conclusion of anyone looking at health care as provided, and the costs of providing that health care to the public in other first world countries. The very clear rent extraction that provides little value overall would be rapidly clear.

But unfortunately the people who profit from that…

allan

I just received an Explanation of Benefits [sic] from my insurance, explaining [sic] why they don't want to pay over $1500 in charges from months ago. How much time am I going to spend talking with my provider's front office and the insurance company to try to get this reversed, and who's going to pay me for my time [sic]?

hunkerdown

Worse, who's going to pay your provider for the time? Who's going to pay your insurer to push back at you? You, of course. It's sicker than anything the industry purports to cure.

Roger Smith

They will direct you to their new consumer affairs to voice your concerns.

Best of luck

JTMcPhee

As a nurse, spending hundreds of hours trying to gain authorization for medications and procedures for patients who demonstrably needed and were entitled to them, from the various intermediary and "utilization managment" bits of the private UNsurance thingie, it finally occurred to me that I was being connected to the "Department of Denial," where the cheery or sullen human I finally was able to reach, after persisting and hacking my way through the thorns of the phone tree thicket, would in effect say, "Department of Denial! How may I not help you?"

[Jan 30, 2016] Thoughts on the Cadillac Tax part of the ACA

Notable quotes:
"... Now, suppose we move to single payer. Employer is off the hook for insurance. Will my employer shift that $14k discount to my gross pay and then tax it at the rate necessary to make single payer work (i.e. 40% 10k family)? I doubt it, I think the employer will grab the money (they never gave it to me in the first place). But, this is not a flaw of single payer or the tax required to fund it, its rather my lack of bargaining power with my employer. Under the insurance system, I have virtually no bargaining power with insurers or providers (other than opting out, to which they respond Its your funeral. ). ..."
"... However, you noted that the price of insurance companies pay is not what it costs them. So if they do raise wages, as I believe will happen eventually, it will be at their net cost. In addition, Sanders counts new taxes on that increase of income on employees at the level of what the employees pay insurance companies(without thinking of the tax break) in order to make his numbers make sense(and even with that they dont). ..."
economistsview.typepad.com

EMichael : January 26, 2016 at 09:30 AM

I asked Sarah above what what her thoughts on the Cadillac Tax part of the ACA.

I'd like to have everyone in here(well, not John H) state their opinion on it.

And yes, there is somewhat of a "trap" here. But it is not meant to be mean and/or a "gotcha" kind of thing.

lower middle class said in reply to EMichael...
I vote yes to progressive redistribution with top marginal rate of 40% in excess of 10,400 (27,500 family). Insurers that offer prices below the threshold can use it to compete.
lower middle class said in reply to lower middle class...
How many Health Points do I lose for triggering the trap? Will it affect any of my stats STR, CON, VIT, SPD, INT, END? Is there any loot to add to my pack?
Syaloch -> lower middle class...
You made a successful save vs. Rescission so you're only stunned for six rounds.

When you recover you find that the opened trap contains a Green Lantern of Infinite Griping and a pile of gold coins.

(However upon closer inspection you find that the coins are only novelty Bitcoins and therefore worthless.)

cawley -> EMichael...
I am against the Cadillac tax.

I understand the economic argument but I believe it is just another example of a race to the bottom, especially if it moves people out of plans that cover good utilization into HD plans that put more of the cost on the consumer and discourage good, preventive, early diagnostic utilization.

I would prefer to see measures that strengthen the connection between patients and good primary care.

mulp -> cawley...
In other words, you think Sanders is dead wrong in his claim that better coverage can be provided for 75% or even 50% of the trigger point for the caddy tax? You are arguing that US health care spending is too low.
cawley -> mulp ...
I didn't say any of that.

Costs are too high. Outcomes are not good enough.

I don't know that "Cadillac Plans" are a significant driver of those costs or results. I'm not convinced that driving people out of "Cadillac Plans" will significantly reduce costs, let alone improve outcomes. I think that depends a great deal on the benefit design of the products they wind up in and systemic reform of the delivery network.

So, while I did say that I understand the economic argument, what I didn't say clearly enough is that I have serious reservations about the validity of the economic argument.

Syaloch :
[Class Wars Episode VI: Return of the Occupiers]

http://www.nytimes.com/2011/10/07/opinion/krugman-confronting-the-malefactors.html

Confronting the Malefactors

By Paul Krugman | Oct. 6, 2011

There's something happening here. What it is ain't exactly clear, but we may, at long last, be seeing the rise of a popular movement that, unlike the Tea Party, is angry at the right people.

When the Occupy Wall Street protests began three weeks ago, most news organizations were derisive if they deigned to mention the events at all. For example, nine days into the protests, National Public Radio had provided no coverage whatsoever.

It is, therefore, a testament to the passion of those involved that the protests not only continued but grew, eventually becoming too big to ignore. With unions and a growing number of Democrats now expressing at least qualified support for the protesters, Occupy Wall Street is starting to look like an important event that might even eventually be seen as a turning point.

What can we say about the protests? First things first: The protesters' indictment of Wall Street as a destructive force, economically and politically, is completely right.

A weary cynicism, a belief that justice will never get served, has taken over much of our political debate - and, yes, I myself have sometimes succumbed. In the process, it has been easy to forget just how outrageous the story of our economic woes really is. So, in case you've forgotten, it was a play in three acts.

In the first act, bankers took advantage of deregulation to run wild (and pay themselves princely sums), inflating huge bubbles through reckless lending. In the second act, the bubbles burst - but bankers were bailed out by taxpayers, with remarkably few strings attached, even as ordinary workers continued to suffer the consequences of the bankers' sins. And, in the third act, bankers showed their gratitude by turning on the people who had saved them, throwing their support - and the wealth they still possessed thanks to the bailouts - behind politicians who promised to keep their taxes low and dismantle the mild regulations erected in the aftermath of the crisis.

Now, it's true that some of the protesters are oddly dressed or have silly-sounding slogans, which is inevitable given the open character of the events. But so what? I, at least, am a lot more offended by the sight of exquisitely tailored plutocrats, who owe their continued wealth to government guarantees, whining that President Obama has said mean things about them than I am by the sight of ragtag young people denouncing consumerism.

Bear in mind, too, that experience has made it painfully clear that men in suits not only don't have any monopoly on wisdom, they have very little wisdom to offer. When talking heads on, say, CNBC mock the protesters as unserious, remember how many serious people assured us that there was no housing bubble, that Alan Greenspan was an oracle and that budget deficits would send interest rates soaring.

A better critique of the protests is the absence of specific policy demands. It would probably be helpful if protesters could agree on at least a few main policy changes they would like to see enacted. But we shouldn't make too much of the lack of specifics. It's clear what kinds of things the Occupy Wall Street demonstrators want, and it's really the job of policy intellectuals and politicians to fill in the details.

Rich Yeselson, a veteran organizer and historian of social movements, has suggested that debt relief for working Americans become a central plank of the protests. I'll second that, because such relief, in addition to serving economic justice, could do a lot to help the economy recover. I'd suggest that protesters also demand infrastructure investment - not more tax cuts - to help create jobs. Neither proposal is going to become law in the current political climate, but the whole point of the protests is to change that political climate.

And there are real political opportunities here. Not, of course, for today's Republicans, who instinctively side with those Theodore Roosevelt-dubbed "malefactors of great wealth." Mitt Romney, for example - who, by the way, probably pays less of his income in taxes than many middle-class Americans - was quick to condemn the protests as "class warfare."

But Democrats are being given what amounts to a second chance. The Obama administration squandered a lot of potential good will early on by adopting banker-friendly policies that failed to deliver economic recovery even as bankers repaid the favor by turning on the president. Now, however, Mr. Obama's party has a chance for a do-over. All it has to do is take these protests as seriously as they deserve to be taken.

And if the protests goad some politicians into doing what they should have been doing all along, Occupy Wall Street will have been a smashing success.

Julio -> Syaloch...
Excellent! Thanks for digging this up.
mulp -> Syaloch...
I've never figured out how Krugman and Sanders did not favor responses in 2008-2008-2010 that would not have screwed me a bank customer.

And how can Sanders not be promising to screw me, a bank customer of BofA by four acquisitions that Sanders failed to block by convincing his peers in Congress to prohibit. Now he's promising to force me to get my money from the bank and put it in a new bank and then figure out the dozens or so institutions who need to be told and then checked to change the account number they use to credit or debit. You can't break up big banks without closing a hundred million bank accounts.

Michael :
Democratic socialists don't necessarily believe in state ownership, but democratically means of ownership (e.g. think of worker cooperatives or Mondragon). Bernie has been a strong advocate of worker cooperatives.
http://www.berniesandersvideo.com/3-creating-worker-co-ops.html

Outside of single payer, I have not heard of Bernie advocating government take-over of industries.

But Bernie is doing himself a disservice by using the 'socialist' label. It just creates confusion and not necessarily an accurate label. He is basically a liberal who never took a right turn during the Reagan Revolution.

As you can see, in this speech, Sanders is basically a New Deal liberal.
http://www.motherjones.com/politics/2015/11/bernie-sanders-socialism-speech-georgetown

The revolution Sanders is talking about is about changing hearts and minds, not just about policy. Both Hillary and Sanders will have an uphill battle with a Republican Congress when it comes to enacting policy. However, Sanders is pushing for another Reagan Revolution - influence well beyond policy that he can personally enact.

For example, Obama turned out to be a transformative President on the policy level (healthcare reform, financial reform, civil rights, etc.), but his influence will end once he leave office. Reagan's influence though can still be felt today (Wisconsin, Kansas, every single Republican tax plan, a hatred or distrust of the government, deregulating industries, attacking unions, etc.). Three-four decades we are steal dealing with the Reagan Revolution.

It was a time when "liberal" became a dirty word and people started to run away from it. Instead, people were proud "conservatives", but often in name only. Once you wipe the vague generalities of small government, guns, traditional values, most Americans are liberal, even when it comes to crime and welfare (See Table 1).
http://matthewg.org/ideologicalrepublicans.pdf

One of Bernie's goal is turn the tides and have Americans become more accepting of New Deal liberalism. In way, he is already accomplishing this (for example, today Hillary is a progressive, not a moderate or a Goldwater Girl).

As for electability, Sanders holds up as well, if not better than Hillary in a general match up against Republicans. However, there is more risk/variance associated with Sanders. Hillary is pretty much well-known. People's opinions and views will not change during the general election. There is more risk/variance with Sanders People are still learning about Sanders and working around the confusion of the "socialist" label.

EMichael -> Michael...
"As for electability, Sanders holds up as well, if not better than Hillary in a general match up against Republicans."

Yeah, before he campaigns against Republicans.

Worthless polls until that happens.

Michael -> EMichael...
Worthless projection on your part until (or if it) happens.

If you have an actual point, don't be afraid to make it.

EMichael -> Michael...
I have made it a hundred times in here.

Has Hillary called Sanders a dirty commie?

Of course not.

Ya' think the Reps will not do so?

EMichael :
Well, no answers on the Cadillac Tax and tee time is at 12:30, so I will spell it out.

We have dealt with the "hippy punching" of Sanders by various liberals regarding his healthcare and financial reform platforms. And it seems to me that very little has been said about his healthcare plan, thus my question.

If you opposed the Cadillac Tax, then you should oppose Sanders plan.

https://berniesanders.com/wp-content/uploads/2016/01/Medicare-for-All.pdf

Maybe not totally, but at least in terms of the loss of income the vast majority of insured Americans would see, because it eliminates employer provided insurance when it uses the tax expenditures savings to help pay for his reform(and the numbers still do not work out with that $310 billion).

Now many have been attacked for their commentary on Sanders' plans, yet somehow there has been almost no conversation on what those plans do, and how they do it.

Campaigns are about dreams and goals, but if numbers and details are provided, they should be discussed without the authors of those discussions being attacked.

Julio -> EMichael...
I happen to think that prioritizing the changeover to single payer is a mistake, much like the timing of the ACA was. Too many people are reasonably comfortable with what they have, and we have other, more urgent fights.

Sanders need to focus on the stuff that gets people to the rallies and on the streets. He is doing a good job with inequality. But there is a reason why there was an Occupy Wall Street but no Occupy Blue Cross.

EMichael -> Julio ...
Yep.

But Sanders could not run just on attacking Wall Street and inequality.

lower middle class said in reply to EMichael...
Anecdata below:

My employer claims to spend $19k for family insurance. They sell it to me at a $14k discount and add the discount to my Total Compensation Statement. I don't know the actual price they pay, it may be 100% of what I pay to my employer via pre-tax deductions, or it may be less, who knows.

Now, suppose we move to single payer. Employer is off the hook for insurance. Will my employer shift that $14k discount to my gross pay and then tax it at the rate necessary to make single payer work (i.e. 40% > 10k family)? I doubt it, I think the employer will grab the money (they never gave it to me in the first place). But, this is not a flaw of single payer or the tax required to fund it, it's rather my lack of bargaining power with my employer. Under the insurance system, I have virtually no bargaining power with insurers or providers (other than opting out, to which they respond "It's your funeral.").

Michael -> lower middle class...
It is a strong consensus among economists that the employee bears the burden of payroll taxes and benefits, through lower wages.

Here is a nice graph showing this. The faster healthcare cost rise, the slower wage growth.
http://voices.washingtonpost.com/ezra-klein/2009/10/will_lower_health-care_costs_m.html

If the literature is correct, then moving to a single payer system would increase wages as workers capture some of the previously paid benefits by employers.

Julio -> Michael...
Yes. The question is whether employees will capture those gains.
cawley -> Julio ...
Considering the direction labor share of income has been moving, I think it is a highly dubious proposition that labor will capture a significant portion of reduced employer health care costs in increased wages.

If the labor market were tighter, unions more powerful or regulations more effective, maybe. But not in the current circumstance.

EMichael -> lower middle class...
And I think that compensation is fungible. But Sanders has taken all the cash from employer provided insurance and used it to gain revenue for his plan.

However, you noted that the price of insurance companies pay is not what it costs them. So if they do raise wages, as I believe will happen eventually, it will be at their net cost. In addition, Sanders counts new taxes on that increase of income on employees at the level of what the employees pay insurance companies(without thinking of the tax break) in order to make his numbers make sense(and even with that they don't).

Meanwhile, Obama and the ACA were attacked as killing unions with the Cadillac tax. Yet Sanders' plan is a much more expensive attack on those plans while insuring they receive less health insurance benefits.

Yet, I am missing the attack on Sanders for killing unions.

Strange, huh?

Dan Kervick :
I think the revolution he is talking about is based on the idea that, win or lose, he is going to keep his coalition mobilized and build on it. The goal is a permanent transformation of the American political and ideological landscape, and probably also a drive to recapture the Democratic Party from the "New Democrat" group who took it over in the 90's, and return the party to something more like the more traditional economic left politics exhibited before that takeover.

I think he's going to win; but even if I am wrong, remember that Reagan ran a strong primary campaign in 1976 against Ford before taking over the party in 1980. This move to the left going to happen eventually, because the neoliberal capitalism of 2016 is stagnant, dysfunctional, grossly inegalitarian, oppressive and unpopular. The Clintons represent an old politics that is dying. It might give up the ghost this time, as I think it will, or hang on for one more cycle. But it's not going to last.

I agree that it doesn't make a whole lot of difference whether you call it Democratic Socialism or New Deal Liberalism or something else. Whatever you call it, the program is the broader socialization of health, education and retirement; a "trust-busting" assault on Big Capital, and a variety of moves to empower workers and dramatically compress the income gap.

mulp -> Dan Kervick ...
Sanders was never a Democrat, so he has zero reason to complain about Democrats evolving rightward with voters who bought the free lunch economics of conservatives who shifted Republicans about three times further right.

The conservative policies are free lunch because their tax cuts will never cut the free stuff you expect from government, the getting government out of your life means others won't get a free pass to kill you or harm you or take your stuff, and enforcing morality will never result in your being a rested and convinced for believing in (the wrong) god. Citizen run health care insuranxe means repealing Obamacare so you can cut your rates and increase your benefits (by insuring yourself).

And conservatives have proven TANSTAAFL but even progressives join with conservatives in blaming Democrats and Obama for failed Republican laws.

If Sanders wins the White House with Republicans controlling the House and Senate, my bet is Bernie blames Democrats for failing to pass his laws through Congress.

Dan Kervick -> mulp ...
It has nothing to do with Bernie Sanders or any personal gripes he does or doesn't have the right to have with Democrats. Clearly he is doing so well in Iowa and New Hampshire and elsewhere because millions of *Democrats* prefer the Sanders direction for their party.

I went to a State Democratic Party event here in New Hampshire four or five years ago, where Sanders was the (sole) invited speaker. He didn't crash the gate; he was invited because lots of Democrats love him. The (very big) progressive wing of the Democrats recruited Sanders for this run.

Julio :
With due respect to our host, I'm sick and tired of the "unelectable" argument, especially at this stage in the campaign.

Part of the argument seems to be that if we nominate Sanders, we risk ending up with the eminently electable... Trump! Wasn't he an unelectable joke not so long ago?

lower middle class said in reply to Julio ...
Jeb! leading the Red Team Endorsement Primary. Slytherin - 51 Points!

http://projects.fivethirtyeight.com/2016-endorsement-primary/

Now, look at Clinton's staggering lead. Hufflepuff! (but don't inhale)

lower middle class said in reply to lower middle class...
http://www.theatlantic.com/entertainment/archive/2015/09/hufflepuff-rules/405937/

In Defense of Hufflepuff
The much-maligned house of the Harry Potter series doesn't get nearly enough attention or praise for its egalitarian ethos.

EMichael -> Julio ...
Sarah fen Palin got close to the White House.
Julio :
After reading today's comments, I am more convinced than ever that socio-anarcho-demo-progressivism will not triumph until we sweep demo-anarcho-progressive-socialism to the dustbin of history.
RGC :
Semantics:

democratic socialist vs social democrat

how about

democratic capitalist vs capital democrat

The reality is that capitalism and socialism are both extremes. If you have government you have a mixed economy. Public vs private is an alternate dichotomy.

Most people who have a lot of money think you should be able to make money from money ( Marx's m -> m'/ Marx thought it should be M-> c -> m') ( c being a product or service). But this eventually arrives at Piketty's dilemma of inequality.

So, to the degree we have capitalism, we should be aware of the danger of m -> m'. IOW, if we don't severely limit the FIRE sector, we will proceed to Dickensian England.

Lafayette :
STAND AND DEFEND

{MT: He has qualified his statements to make it clear that he is a democratic socialist, but that term fails to convey what he really has in mind, or at least I think it does. ...}

Social Democracy is explained here*: http://en.wikipedia.org/wiki/Social_democracy. Succintly, it is the implementation of Social Justice, which is also explained here: http://en.wikipedia.org/wiki/Social_justice

And if that is not enough, let's just say that the principal vector of a Social Democracy is to "level the economic playing field".

How to do it is the key debate. And to my mind, excuse my repetition of the formula employed in this forum. The prime attributes of a Social Democracy, in terms of tangible Public Services are the following:
*Prepare individuals for their roles as both workers and citizens by means of a primary, secondary and tertiary education that is free, gratis and for nothing.
*Institute a National Health Service that covers all citizens of the country at a modest annual cost, and implement it for both curative and preventive purposes.

The rest of what Social Democracy is can be found on the web-site of Congressional Progressive Cause (which presently constitutes 15% of the HofR, and only one Senator - a guy by the name of Bernie Sanders.)

The CPC Progressive Promise that resumés very succinctly its goals can be found here*: http://cpc.grijalva.house.gov/the-progressive-promise/

Now, who thinks all that is just a load of BS ... ?

Lafayette -> Lafayette ...
Frankly, I think that's a pretty good platform to run on. However many elections it takes to teach Americans what Social Democracy really means.

And get a progressive representation in (at least) the HofR to implement progressive legislation.

But, first, we have to make illegal the long-standing election process (since the 1830s) of "gerrymandering". Which is an artificial way of arranging voting districts so that either party "owns the seat".

THEN, AND ONLY THEN, WILL REAL "SOCIAL JUSTICE" BE ALLOWED TO STAND IN THE UNITED STATES.

Bud Meyers :
It doesn't matter if Bernie is a socialist, a democratic socialist, a social democrat, a Marxist or a communist - unless he also had a majority of like-minded people in congress. If your are in doubt about Bernie, you'd only have to fear him as a dictator. Neither Bernie nor Hillary can do much with a GOP dominated congress. At least Bernie moves the Overton window back to the left (true center), whereas the "moderate" Hillary keeps the status quo. Here are two recent posts on this subject.

The Future of the Democratic Party

http://baselinescenario.com/2016/01/26/the-future-of-the-democratic-party/

Hillary Clinton's Lobbyist Fundraisers Want Baby Steps: America Needs a Political Revolution

http://wallstreetonparade.com/2016/01/hillary-clintons-lobbyist-fundraisers-want-baby-steps-america-needs-a-political-revolution/

www.facebook.com/profile.php?id=560338458 :
Universal health insurance, elections that are not bought, the end of the prison state, free college tuition, expanded social security, and a concerted, breaking up the big banks, a clear and practical plan to combat climate change... Surely you can see something socialist in that. The social institutions that have been eviscerated by current establishment politics revitalized.

Incremental won't do it. Impractical is the current trajectory. Revolution means revolution. He cannot get it done alone, that is clear. Doesn't mean we can't get it done together.

[Jan 12, 2016] ObamaCare's Neoliberal Intellectual Foundations Continue to Crumble by Lambert Strether

Obama is a neoliberal who campaigned as a leftist but has governed as a right-winger.
Notable quotes:
"... By Lambert Strether of Corrente . ..."
"... ObamaCare is a Bad Deal (for Many) ..."
"... they do not comparison shop. ..."
"... very ..."
"... Obama was never in favor of single payer, ever. Wash your mouth out for even suggesting that ..."
"... He had health care lobbyists draft the legislation ..."
"... He's got a history of being a fake leftist going back to his days in Chicago. Obama, Michelle, and Valerie Jarrett were the black faces that legitimated the plan by the Pritzkers and local finance interests to gentrify near South Chicago and push the black community 3 miles further south while giving them nothing. ..."
"... And he's never been a real prof. This constitutional law talk is a crock. No one can remember him teaching any courses (he appears to have taught a couple but made no impression). This was a resume-burnishing post and he did the bare minimum. ..."
"... After he had had told the story of sitting with his dying mother on her death bed, surrounded by paperwork, trying to sort out the restrictions of her employer-based insurance policy and there wasn't a dry eye in the gymnasium, everyone THOUGHT he said, "When I am President, I will fight tooth and nail for single payer for every single American." ..."
"... Nevertheless, as a former Obot who worked tirelessly to get him elected on almost the sole basis of the genuine emotion he exhibited when he told this awful story and how he promised to rectify the situation in the future, I felt the dagger of betrayal when the first thing he said during the health care debate was, "I'm taking single payer of the table." ..."
"... Now, it's the "let's turn everything into a market" game. Don't want to play? Screw you–we'll make it mandatory, and, of course, punitive. This goes way beyond Obamacare into every facet of our lives. Public utilities? Hell no–give them "choice"! Community schools? No way–can't have the races and the classes and the ability levels mixing in such a promiscuous manner–let's go charter "academies", or vouchers. It's a normative takeover under the guise of "rational" "scientific" "efficiency". ..."
"... thatworddoesnotmeanthat ..."
"... Were the architects of RomneyCare (and it's national extension Obamacare) attempting to recreate a golden age, of 11th century free peasants– happily enjoying the abundant commons of medical care, in the carefree forests and dales, before they slipped under the Norman Yoke of feudal exploitation? ..."
"... The record is irrefutable–the ACA was written by the insurance companies with a wink and a nod to Big Pharma and the HMOs. Unless you are going to seriously entertain the notion that these are "communist" institutions, or give a rats ass about anything but making money, you can't really believe what you wrote. You are just angry about something and projecting your fears onto this travesty. ..."
"... As Martin Shkreli put it, he has the perfect "price inelastic" product. Patients are a captive market that's easy to exploit. Either they get what they need or they die. You can charge what you want. ..."
"... Let's not forget why politicians love the sickcare complex. The more an industry turns into a cartel, the easier it is to raise both economic and political rents from it. Let's be honest here and call a spade a spade. Politicians like this system because it easily feeds campaign dollars into the system. It may not be efficient for treating patients, but it's quite efficient for extracting political re ..."
"... It's nearly impossible to "comparison shop" if you're part of an HMO these days. The only choice one really has is to select their PCP. After that the PCP pretty much forces you to see docs and get tests within the hospital system – presumably for "coordinated care". And this for nearly $1000/mo for a single person not receiving much in the way of "healthcare". That which can't continue, won't…. ..."
"... However, for those in that 55-65 age bracket, there is an estate clawback provision that effectively acts as a lien on your estate: once you die your assets will be seized by the state to satisfy all medicaid provided healthcare expenses. ..."
"... When Obama was inaugurated he had more political capital in his pocket than any president in recent memory. The repubs were on the ropes. ..."
"... The United States National Health Care Act, HR 676 ..."
January 12, 2016

By Lambert Strether of Corrente .

ObamaCare is, of course, a neoliberal "market-based" "solution." ObamaCare's intellectual foundations were expressed most clearly in layperson's language by none other than the greatest orator of our time, Obama, himself ( 2013 ):

If you don't have health insurance, then starting on October 1st, private plans will actually compete for your business, and you'll be able to comparison-shop online.There will be a marketplace online, just like you'd buy a flat-screen TV or plane tickets or anything else you're doing online, and you'll be able to buy an insurance package that fits your budget and is right for you.

Let's leave aside the possibility that private plans are phishing for your business, by exploiting informational asymmetries, rather than "competing" for it. Obama gives an operational definition of a functioning market that assumes two things: (1) That health insurance, as a product, is like flat-screen TVs, and (2) as when buying flat-screen TVs, people will comparison shop for health insurance, and that will drive health insurers to compete to satisfy them. As it turns out, scholars have been studying both assumptions, and both assumptions are false. "The dog won't eat the dog food," as marketers say. This will be a short post; we've already seen that the first assumption is false - only 20%-ers who have their insurance purchased for them by an institution could be so foolish as to make it - and a new study shows that the second assumption is false, as well.

ObamaCare's Product Is Not Like a Flat-Screen TV

Here's the key assumptoin that Obama (and most economists) make about heatlth insurance: That it's a commodity, like flat screen TVs, or airline tickets, and that therefore , there exists a "a product that suits your budget and is right for you" because markets. Unfortunately, experience backed up by studies has shown that this is not true. From ObamaCare is a Bad Deal (for Many) . From Mark Pauly, Adam Leive, Scott Harrington, all of the Wharton School, NBER Working Paper No. 21565 ( quoted at NC in October 2015 ):

This paper estimates the change in net (of subsidy) financial burden ("the price of responsibility") and in welfare that would be experienced by a large nationally representative sample of the "non-poor" uninsured if they were to purchase Silver or Bronze plans on the ACA exchanges. The sample is the set of full-year uninsured persons represented in the Current Population Survey for the pre-ACA period with incomes above 138 percent of the federal poverty level. The estimated change in financial burden compares out-of-pocket payments by income stratum in the pre-ACA period with the sum of premiums (net of subsidy) and expected cost sharing (net of subsidy) for benchmark Silver and Bronze plans, under various assumptions about the extent of increased spending associated with obtaining coverage. In addition to changes in the financial burden, our welfare estimates incorporate the value of additional care consumed and the change in risk premiums for changes in exposure to out-of-pocket payments associated with coverage, under various assumptions about risk aversion. We find that the average financial burden will increase for all income levels once insured. Subsidy-eligible persons with incomes below 250 percent of the poverty threshold likely experience welfare improvements that offset the higher financial burden, depending on assumptions about risk aversion and the value of additional consumption of medical care. However, even under the most optimistic assumptions, close to half of the formerly uninsured (especially those with higher incomes) experience both higher financial burden and lower estimated welfare ; indicating a positive "price of responsibility" for complying with the individual mandate. The percentage of the sample with estimated welfare increases is close to matching observed take-up rates by the previously uninsured in the exchanges.

So, for approximately half the "formerly uninsured," ObamaCare is a losing proposition; I don't know what an analogy for flat-screen TVs is; maybe having to send the manufacturer money every time you turn it on, in addition to the money you paid to buy it? That's most definitely not a "package that fits your budget and is right for you," unless you're a masochist or a phool. Second, the portion of those eligible that does the math probably won't buy the product if they're rational actors (and Obamaare needs to double its penetration of the eligible to avoid a death spiral ). That again is not like the market for flat-screen TVs; the magic of the ObamaCare marketplace has not operated to produce a product at every price point (or a substitute).[1] Bad marketplace! Bad! Bad!

Health Care "Consumers" Tend not to Comparison Shop

We turn now to a second NBER study that places even more dynamite at ObamaCare's foundations. From Zarek C. Brot-Goldberg, Amitabh Chandra, Benjamin R. Handel, and Jonathan T. Kolstad, of Berkelely and Harvard, "What Does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics" NBER Working Paper No. 21632 ( PDF ), the abstract:

Measuring consumer responsiveness to medical care prices is a central issue in health economics and a key ingredient in the optimal design and regulation of health insurance markets. We study consumer responsiveness to medical care prices, leveraging a natural experiment that occurred at a large self-insured firm which required all of its employees to switch from an insurance plan that provided free health care to a non-linear, high deductible plan[2]. The switch caused a spending reduction between 11.79%-13.80% of total firm-wide health spending. We decompose this spending reduction into the components of (i) consumer price shopping (ii) quantity reductions and (iii) quantity substitutions, finding that spending reductions are entirely due to outright reductions in quantity. We find no evidence of consumers learning to price shop after two years in high-deductible coverage. Consumers reduce quantities across the spectrum of health care services, including potentially valuable care (e.g. preventive services) and potentially wasteful care (e.g. imaging services). We then leverage the unique data environment to study how consumers respond to the complex structure of the high-deductible contract. We find that consumers respond heavily to spot prices at the time of care, and reduce their spending by 42% when under the deductible, conditional on their true expected end-of-year shadow price and their prior year end-of-year marginal price. In the first-year post plan change, 90% of all spending reductions occur in months that consumers began under the deductible, with 49% of all reductions coming for the ex ante sickest half of consumers under the deductible, despite the fact that these consumers have quite low shadow prices. There is no evidence of learning to respond to the true shadow price in the second year post-switch.

So, empirically, these "consumers" just don't act the way that good neoliberal Obama says they should; they do not comparison shop. That alone is enough to undermine the intellectual basis of ObamaCare. If there's no comparison shopping going on, there's no competitive pressure for health insurers to improve their product (assuming good faith, which I don't).

(We can leave aside the issue of motivation, but to speculate, I've found that when I talk to people about health care and health insurance; they're very defensive and proprietary about whatever random solution they've been able to cobble together; and if you'd been sold an exploding flat-screen TV, and had somehow been able to use duct tape and a well-timed fist to the housing to get it work, most of the time, wouldn't you be rather unwilling to go back to the same store and buy another? So there is evidence of "learning"; the lesson learned is once you've got something that seems to works, don't on any account change it, and we "bear those ills we have," rather "than fly to others that we know not of.")

Moreover, the population studied has more ability to comparison shop than ObamaCare's. From page 4 of the study :

Employees at the firm [in the study] are relatively high income ( median income $125,000-$150,000 ), an important fact to keep in mind when interpreting our analysis

The top income for a family of four eligible for ObamaCare is around $95K (and not eligible for subsidy). Do people think this ObamaCare-eligible population has more ability to comparison shop, compared to a population with a $125K median income for individuals, or less ability? To put this more tendentiously, if a population that can afford accountants or at least financial planners doesn't comparison shop, how likely is it that a population that cannot afford those personal services will do so?

Even worse, the population studied reduces costs, not by comparison shopping, but by self-denial of care. From page 6 of the study :

In our setting consumers were provided a comprehensive price shopping tool that allowed them to search for doctors providing particular services by price as well as other features (e.g. location).

So, just like the ObamaCare "marketplace online" front end (at least after they got it working). And what happened?

We find no evidence of price shopping in the first year post switch . The effect is near zero and looks similar for the t -1 - t 0 year pair (moving from pre- to post-change) as it does for earlier year pairs from t 4 to t 1 . Second, we find no evidence of an increase in price shopping in the second year post-switch; consumers are not learning to shop based on price. Third, we find that essentially all spending reductions between t 1 and t 0 are achieved through outright quantity reductions whereby consumers receive less medical care . From t 1 to t 0 consumers reduce service quantities by 17.9%. Fourth, there is limited evidence that consumers substitute across types of procedures (substitution leads to a 2.2% spending reduction from t 1 - t 0 ). Finally, fifth, we find that these quantity reductions persist in the second-year post switch, as the increase in quantities between t 0 and t 1 is only 0.7%, much lower than the pre-period trend in quantity growth. These results occur in the context of consistent (and low) provider price changes over the whole sample period.

Now, it could be that the study population is reducing items like cosmetic surgery and not items like dental care (assuming they've got dental); the Healthcare Economist summary of this study says no. In fact, says the study, some of the foregone services were "likely of high value in terms of health and potential to avoid future costs." And it could be that the lower-income ObamaCare-eligible are smarter shoppers (dubious: Shopping is a tax on time a lot of working people can't pay). That said, it looks like ObamaCare has replaced a system where insurance companies deny people needed care with a system where people deny themselves needed care; which is genius, in a way. However, if any doctors or medical personnel continue to support ObamaCare politically, they should consider closely whether they're violating the principle of non-maleficence - "First, do no harm" - and halt their support, if so. Bad marketplace! Bad, bad!

Conclusion

Shopping for health insurance under ObamaCare is nothing at all like shopping for a flat-screen TV. First, there's a sizeable population who, if they are rational actors, just won't buy health insurance at all; the ObamaCare "marketplace" is not capable of adjusting prices to get such "consumers" to enter the market. Second, people don't comparison shop; they reduce needed care. (To flog the flat-screen TV metaphor even further, if the screen is so defective it's painful to watch, people don't reduce the pain by comparison shopping for a better TV; they reduce the pain by watching less, and keep the TV they have.)

So, with ObamaCare, and thanks to the dogmas of neoliberalism, we have a "marketplace" that repels "consumers" from entering it, and repels people from shopping if they do enter. Perhaps there's a better solution out there?

NOTES

[1] It may be that the ever-increasing mandate penalties will force enough people into the marketplace to make ObamaCare actuarially stable ; needless to say, we don't see Federal agents forcing people into Best Buy to buy TVs, although the social pressure of Black Friday comes close.

[2] Again, much like ObamaCare plans, which are increasingly high-deductible.

brian t , January 12, 2016 at 3:23 am

The author seems to have forgotten that the kludge called "Obamacare" is not the single payer solution that this Obama wanted. What you have is what was able to get past a Congress after intense lobbying by HMOs and insurers. I see little evidence of ideology in the result, "neoliberal" or otherwise. It does nothing to address the insane-and-rising cost of healthcare, because the vested interests are OK with that.

Yves Smith , January 12, 2016 at 5:12 am

Let me clue you in: the readers here are way WAY too clued in to buy your Big Lie.

1. Obama was never in favor of single payer, ever. Wash your mouth out for even suggesting that

2. He had health care lobbyists draft the legislation

3. He used the "public option" as a bright shiny toy. He was so uncommitted to it he didn't even trade it away. He gave it up as a free concession. A basic principle in negotiating is you NEVER make a free concession. The fact that he just threw it away is proof he never meant it as anything more than a talking point

I hope you are paid to dispense this blather. I really feel sorry for you if you actually believe it. Obama is a neoliberal who campaigned as a leftist but has governed as a right-winger. His apologists have regularly used the meanie Republicans as excuses for his selllouts, when Obama gets what he wants when he wants it, and there's no evidence that his center-right results are at all at odds with what he intended to achieve.

Yves Smith , January 12, 2016 at 4:31 pm

Huh? Obama has proven to be an extremely skilled political infighter when he wants something done. And as to him being center-right, all you have to do is look at his staff, most important his economics team.

He's got a history of being a fake leftist going back to his days in Chicago. Obama, Michelle, and Valerie Jarrett were the black faces that legitimated the plan by the Pritzkers and local finance interests to gentrify near South Chicago and push the black community 3 miles further south while giving them nothing. See here for details:

http://www.nakedcapitalism.com/2012/05/exclusive-how-obamas-early-career-succes-was-built-on-fronting-for-chicago-real-estate-and-finance.html

And he's never been a real prof. This constitutional law talk is a crock. No one can remember him teaching any courses (he appears to have taught a couple but made no impression). This was a resume-burnishing post and he did the bare minimum.

Hayek's Heelbiter , January 12, 2016 at 12:55 pm

Beg to slightly differ regarding Obama and single payer (if the transcripts of his campaign rally speech in Jersey City before he was nominated hadn't been scrubbed from the Internet, I'd have the exact wording).

After he had had told the story of sitting with his dying mother on her death bed, surrounded by paperwork, trying to sort out the restrictions of her employer-based insurance policy and there wasn't a dry eye in the gymnasium, everyone THOUGHT he said, "When I am President, I will fight tooth and nail for single payer for every single American."

And the gymnasium absolutely erupted in applause. Apparently, he said something very CLOSE to that, but when the sentence is carefully parsed, did not mean that all.

Nevertheless, as a former Obot who worked tirelessly to get him elected on almost the sole basis of the genuine emotion he exhibited when he told this awful story and how he promised to rectify the situation in the future, I felt the dagger of betrayal when the first thing he said during the health care debate was, "I'm taking single payer of the table."

Lambert Strether Post author , January 12, 2016 at 1:58 pm

I hate to say this, but a lot of us at Corrente did try to keep track in 2008, and I can't remember any reporting on this at the time, and we were also strongly for single payer, which we also kept track of. Not to say that we couldn't have missed something, but a link to something contemporaneous would be helpful.

Michael Hudson , January 12, 2016 at 2:32 pm

I know that I've said this on NC before, but Yves is absolutely right - and THEN some. When Dennis Kucinich tried to introduce EVEN A DISCUSSION of single payer in Congress, the Democratic Party leadership blocked him from even bringing it up. Pelosi et al. were absolutely committed to the Republican neoliberal policy.

This led us to discuss whether the only way to get progressive health care policy was to start a new party, now that the Democrats have become the Wall Street wing of the Republican Party's natural resource monopolists.

Hayek's Heelbiter , January 12, 2016 at 3:37 pm

If you could locate a transcript, I would dearly love to read what he ACTUALLY said.

Cameras and recording devices were strictly forbidden, and this was in the days before everyone had cellphones that could record anything.

meeps , January 12, 2016 at 6:44 pm

I don't know the date of this speech (the upload predates the 2010 debacle), but Obama stated, "I happen to be a proponent of single payer health care…"

That said, we got hosed. Each of us must now decide whether to roll over and take the corn, or, to demand single payer and the re-regulation of industry (the pharmaceutical industry and others that affect health tangentially).

meeps , January 12, 2016 at 7:38 pm

I've not been able to resolve the technical reason behind my missing links. You'll find the 53 second clip on youtube channel 6y2o12la titled: Obama on single payer health insurance.

sierra7 , January 12, 2016 at 1:57 pm

Oh, My! My!
Thank you Yves!!!!!!!!
You go to (as you are now) the head of the class!

nigelk , January 12, 2016 at 2:33 pm

One imagines Yves with a large staff and flowing robe…

"O-bots…YOU…SHALL…NOT…PASS!"

barutanseijin , January 12, 2016 at 5:28 am

You mean vested interests as represented by Obama and the Democrats.

Paul P , January 12, 2016 at 5:40 am

"the single payer solution that this Obama wanted"

Obama kept single payer off the table from the start. He would have had to decide to fight the industry and take the fight to the country. Medicare for All is a simple idea. He could have done a 50 state whistle stop tour. He could have saturated any Congressional district opposing Medicare for All with the same message. That wasn't his plan.

I attended one of his community meetings on health care, held around the country prior to him adopting Romney Care as his proposal. One of the organizers of the meeting starts off by complaining to the group about not just telling Obama we want single payer.

cwaltz , January 12, 2016 at 9:09 am

One of the first things Obama did was make the GOP party point men on health care(Olympia Snowe anyone?)

And it was Nancy Pelosi who called it impractical and took it off the table, heck she even went so far as to have some of the activists committed to being heard arrested for being disruptive. She then promptly gave a minority Blue Dog group the opportunity to co opt the debate to grandstand on abortion.

It's positively revisionism to blame the health care mess on GOP. It was Democrats who screwed it up from start to finish.

Paper Mac , January 12, 2016 at 6:11 am

The first step is admitting you have a problem, brian.

Myron Perlman , January 12, 2016 at 8:58 am

"Obama wanted'? Single payer was ruled out from the beginning. Advocates for that position were not permitted to be part of the discussion. Who knows what Obama wanted? Look at his actions on this and other issues to make a better judgment. My take is that it was a presidency of symbolism not substance when it came to policies.

Lambert Strether Post author , January 12, 2016 at 11:47 am

Not to pile on or anything, but I think a review of the bidding is in order:

I suggest the real constraints came from three sources, as indicated by their behavior from 2009, when battle for health reform was joined: (1) The Democratic nomenklatura , which censored single payer stories and banned single payer advocates from its sites , and refused even to cover single payer advances in Congress , while simultaneously running a "bait and switch" operation with the so-called "public option," thereby sucking all the oxygen away from single payer; 1 (2) Democratic office holders like Max Baucus, the putative author of ObamaCare - Liz Fowler, a Wellpoint VP, was the actual author - who refused to include single payer advocates in hearings and had protesters arrested and charged ; (3) and Obama himself , who set the tone for the entire Democratic food chain by openly mocking single payer advocates ( "got the little single payer advocates up here" ), and whose White House operation blocked email from single payer advocates , and went so far as to suppress a single payer advocate's question from the White House live blog of a "Forum on Health Care." (Granted, the forums were all kayfabe, but even so.) As Jane Hamsher wrote, summing of the debacle: "The problems in the current health care debate became apparent early on, when single payer advocates were excluded [note, again, lack of agency] from participation."

In short, if single payer was "politically infeasible" - the catchphrase of that time - that's because Democrats set out to make it so, and succeeded.

Brian, could you ask your boss to send us smarter trolls?

nigelk , January 12, 2016 at 2:52 pm

I appreciate that such takedowns are always link-filled and impeccably sourced, and though combativeness in the comments is not the prevailing tone of this website (happily), damn if I don't pump my fist when I read a troll getting cut down thusly.

Fake leftist trolls are the worst.

GlobalMisanthrope , January 12, 2016 at 12:48 pm

Maybe you're not an incredibly lame troll. Maybe you're just a poor beginner who unwittingly wandered onto the Varsity field. But if you "see little evidence of ideology in the result," you may want to look up the definitions of "evidence," "ideology" and "result."

James Levy , January 12, 2016 at 6:17 am

Educated elites with a modicum of leisure always love to play these games. It took them decades and the most draconian policies imaginable to break the habit of workers early in the industrial revolution of trading off pay for leisure time. The basic notion of every capitalist scold throughout the ages has been that this is irrational laziness, even if your job is a physically exhausting and soul-crushing exercise–you must work more, or you are a bad person who should be punished.

Now, it's the "let's turn everything into a market" game. Don't want to play? Screw you–we'll make it mandatory, and, of course, punitive. This goes way beyond Obamacare into every facet of our lives. Public utilities? Hell no–give them "choice"! Community schools? No way–can't have the races and the classes and the ability levels mixing in such a promiscuous manner–let's go charter "academies", or vouchers. It's a normative takeover under the guise of "rational" "scientific" "efficiency".

Jim , January 12, 2016 at 8:54 am

Wow, this is so right!

JustAnObserver , January 12, 2016 at 2:14 pm

Minor correction:

Public utilities? Hell no–give them Lead!

ilporcupine , January 12, 2016 at 6:06 pm

So true. Ask them about their golf game. It is only YOUR leisure time at issue, not theirs. Don't you wish you could count as "work" blathering your stream of conciousness on CNBC day after day?

ambrit , January 12, 2016 at 6:57 am

I remember that one of the 'talking points' in favour of Heritage Foundation Care (HFC) was that "pre-existing" conditions were not to be allowed to deny anyone coverage. Using that logic, it can be asserted that 'Poverty', absolute or relative, a pre-existing condition if there ever was one, denies 'patients' useful medical care.

The system as administered is internally contradictory. Taken one step farther, the HFC can be defined as a "Faith Based Service Provider." This would be an insult to actual traditional Faith based providers. Most "real" FBPs are governed, at least in theory, by ideologies that counsel 'compassion' when dealing with the less fortunate. As has been demonstrated, the HFC program counsels exploitation when dealing with the less fortunate. A case in point; this week a local religious charity opened a 'Free Clinic' in our town of 45,000 or so souls. The local paper put this on the front page. Buried in the body of the article was the mention that this clinic was fully booked up for the first, and probably second month. All this before public mention of it's existence. There's your 'Marketplace' in action. As I discovered when I looked into signing up for the Mississippi Medicaid program for myself, a family cannot have over 2,500 USD in 'assets.' There is an ongoing dispute as to whether or not an automobile classifies as an item counted toward this limit. Thus, those in our state who do qualify for Medicaid are poor indeed.

Carolinian , January 12, 2016 at 9:21 am

Using that logic, it can be asserted that 'Poverty', absolute or relative, a pre-existing condition if there ever was one

Great point. In the US we have a health care system that saves people's lives while–in many cases–taking away their means of living it. The Hippocratic Oath should be modified to read: first do no harm to Capitalism.

Ulysses , January 12, 2016 at 2:58 pm

Yes, it is an intriguing suggestion. Does commenter thatworddoesnotmeanthat care to elaborate? Were the architects of RomneyCare (and it's national extension Obamacare) attempting to recreate a golden age, of 11th century free peasants– happily enjoying the abundant commons of medical care, in the carefree forests and dales, before they slipped under the Norman Yoke of feudal exploitation?

Or, is the reference to some non-Western communist society that flourished in the mid-11th century? Perhaps thatworddoesnotmeanthat has studied early communist cultures in South Asia, America, or Africa that distributed healthcare in a way that eerily foreshadows what Romneycare did in Massachusetts?

James Levy , January 12, 2016 at 1:36 pm

The record is irrefutable–the ACA was written by the insurance companies with a wink and a nod to Big Pharma and the HMOs. Unless you are going to seriously entertain the notion that these are "communist" institutions, or give a rats ass about anything but making money, you can't really believe what you wrote. You are just angry about something and projecting your fears onto this travesty.

Disturbed Voter , January 12, 2016 at 7:37 am

The subsidies of Obamacare, if you qualify for them, requires the IRS to get intimately involved with your checkbook. Just like middle class folks want recipients of SNAP to be regulated with every food and drink purchase … matching what the bourgeoisie thinks matches their own moral rectitude.

I prefer not to make the IRS my intimate partner … helping me to define what is an asset and what is income to the last penny.

Wade Riddick , January 12, 2016 at 8:12 am

The idea behind high deductibles is that you'll force consumers to economize. It's kind of like telling science, "Hey. This patient needs ten pills to live? Let's give him eight and see what happens."

Medical treatment is a science issue. A treatment's either effective or it's not. You can negotiate the cost – *with the supplier* – but you can't bully a disease or injury into behaving the way you want. You certainly can't bully the sick person and they're in no position to negotiate with the supplier. They have none of the necessary experience or health. That's exactly the wrong time to try to educate someone about their "options."

But then that's the whole point. The medical market is intentionally littered with opacity. There is nothing transparent about insurance, much less drugs or surgeries. Medicine is increasingly dominated by complex bureaucratic cartels for exactly that reason – so you *won't* find out how things work. They don't want you comparison shopping for drugs, surgeries, therapists. Everything about the modern medical system is precisely about robbing "customers" of human agency.

The whole idea of shopping for health insurance itself is absurd. It requires you figuring out exactly how sick you'll be in the next year and then inventing a time machine to travel back so you can pick the Pareto optimal policy with exactly the best deductible – which really won't matter because then they'll find a way to make sure your E.R. wasn't in network nor your anesthesiologist and the only drug to keep you alive won't be "covered" and then you'll wish it was only an Arnold Schwarzenegger skin-wearing android sent to kill you 'cause that would be way easier.

They're removing choice left and right and destroying scientific information through lobbying. The people responsible for creating diseases aren't being held responsible for them but the victims suffering from them are.

When multiple sclerosis organizations are run by drug companies selling $50K+ a year drugs, do you think they want those customers finding out that deworming society is what created the risk for M.S. in the first place?

As Martin Shkreli put it, he has the perfect "price inelastic" product. Patients are a captive market that's easy to exploit. Either they get what they need or they die. You can charge what you want.

Do you think lazy executives looking to bump up next quarter's earnings are going to invest heavily over the long haul in scientific models of effective disease prevention and treatment or are they simply going to squeeze people a little more and a little more?

Let's not forget why politicians love the sickcare complex. The more an industry turns into a cartel, the easier it is to raise both economic and political rents from it. Let's be honest here and call a spade a spade. Politicians like this system because it easily feeds campaign dollars into the system. It may not be efficient for treating patients, but it's quite efficient for extracting political re

Crazy Horse , January 12, 2016 at 12:48 pm

Comparison shop for medical care in the USA? You've got to be kidding.

Case in point. My doctor recommended a cardiovascular "stress test" for diagnosis of heartburn symptoms to make sure that it wasn't cardiovascular in nature. I traveled to a regional heart specialist center for the test, but based upon previous experience refused to undergo the test until they put the bill for the procedure in writing including my deductible cost. The intake administrator acted shocked by such a request, and it took 30 minutes of increasingly strongly worded demands on my part before they finally produced a verbal quotation – which I recorded for future use if they decided to bill $12,000 for 10 minutes on a treadmill.

The world's most expensive health care extortion system at work.

Jim Haygood , January 12, 2016 at 1:49 pm

NBER: 'There is no evidence of learning.'

As Barry O. likes to joke, mimicking George W. Bush's drawl, "Is our consumers learning? Ha ha ha!"

Wade Riddick , January 12, 2016 at 8:15 am

political rents. (Got cut off for some reason. Arnold got me, I think.)

Winston , January 12, 2016 at 8:44 am

It's nearly impossible to "comparison shop" if you're part of an HMO these days. The only choice one really has is to select their PCP. After that the PCP pretty much forces you to see docs and get tests within the hospital system – presumably for "coordinated care". And this for nearly $1000/mo for a single person not receiving much in the way of "healthcare". That which can't continue, won't….

Jim in SC , January 12, 2016 at 8:49 am

One of the things that distinguishes the US from other countries is our high level of tax compliance. I'm concerned that these Obamacare penalties will lead to diminished compliance, both because people resent the penalties, and because it is such an intellectually frustrating exercise to try and estimate future income.

HotFlash , January 12, 2016 at 11:44 am

Perhaps not so ? Can you give me a link? TIA.

Jim in SC , January 12, 2016 at 10:08 pm

http://www.pappastax.com/american-tax-compliance-rates-highest-in-civilized-world/

allan , January 12, 2016 at 9:39 am

More like a flat screen TV, rented from Samsung, that functions like one of those old British hotel radiators that you have to feed with pence $60 copays every 10 minutes in order for Time Warner not to interrupt the streaming.
And then you get balance billing from Disney for the content.

Chromex , January 12, 2016 at 9:42 am

My experience is that there IS no "competition" in any product field that involves actuarial calculations. I get a subsidy and I am 63. There were about 50 plans offered in my area. A few were OVERpriced, yes, but the vast majority offered very similar premium prices, and identical elephantine deductibles, which means that except for aspects of the annual physical, it will "cover" ( assuming cover means pay for) jack. "Coverage" is not care, it is nothing to brag about. I am "covered" for expenses beyond my deductible as a form of catastrophic insurance but the plan will never pay for anything else and actuarially, it is easy to calculate a premium that guarantees that companies will make lotsa money while paying out less. Needless to say the "product" is outrageously overpriced for what it covers and puts people like me _- close to medicare but limited income and owns own house free and clear in a far far worse position than before the law. ( eg medicaid asset recovery if I dare to state a lower income etc etc). So I'm "covered" , so what. I have far less actual care. And that , it appears to me , is deliberate.
Even if it were "competitive" there is not much point in comparison shopping for flat screen tvs.. for a flat screen tv with X features made by brand "A" the price difference for a tv with the same features ( and longevitiy) of brand "B: will in the vast majority of online offerings, be so close as to not be worth the effort. This is even more true with insurance.

Like most politicians, Obama wanted to "do something" and a have a bill he could hold up in front of Everybody and say "see this is mine". My experience with such legislators/administrators is that they have a lot of hubris and grees for the bill to pass and do not subject potential downsides to any critical analysis so that advisers get the message "construct something that will pass" .The fact that he was dumb enough not to see this coming suggests that his "ideology" was driven by his advisers- who are definitely neocons IMO not neoliberals unless the term "liberal" is used in its classic economic sense.

And while we are on the subject, "Health care" is not really subject to "market" principles. Start with the fact that most people in this country have less than 1K savings, which means that they cannot cover the ginormous deductibles most "silver" plans offer or the premiums of better plans. Then add in the fact that these people cannot predict how much care will be needed in a given year or what the final cost of that care will be. What's the "market " for that? Under these two facts mandatory "insurance"with high deductibles and narrow networks simply functions as a wealth transfer from strapped lower-middle and middle class adults to Insurance company shareholders and CEOs.

Even assuming that Obama "wanted" single payer- an assumption that has been ably refuted in this string already, had he given "what can get passed" a moment's critical analysis, he might have realized that he- with his insistence on change for change's sake- was making it worse for so many Americans. I for one , could care less that pre-existing conditions are now "covered" if I can't actually use the coverage- pre existing survives, its now called high deducitlbes and narrow networks.

macman2 , January 12, 2016 at 9:59 am

Actually, as Winston Churchill famously noted, "Americans manage do the right thing after they have exhausted all of the wrong choices firs"t. So it is that had we gone right to single payer without this "market based" attempt, we would have heard howls of capitalistic remorse, etc.

So I am glad that Obamacare was attempted and that it is failing predictably. It is pretty clear to even the free marketers that high deductibles only impoverish Americans, that "skin in the game" does not make people better shoppers for the highly technical world of medicine, that price transparency is essentially worthless if nobody is comparison shopping while they are bleeding out from every orifice, etc.

Medicare for All is arguably catching on. Bernie Sanders poll numbers have not taken a dive with this promise and the sputtering Obamacare is only putting more fuel to this fire. Hillary's tax scare attempt will turn flat on its face. People know bad value when they see it, and the current market based health reform is failing into the predictable death spiral. View Bernie's ascendency as evidence that the American people think health care is a right and it is time to fund it that way.

marym , January 12, 2016 at 12:26 pm

Is the argument here that it was necessary for millions of people to suffer from lack of access to affordable healthcare, and tens of thousands to die, to teach us a lesson, because designing, advocating for, and rapidly deploying a simple, effective single payer system that would bring both immediate and long-term benefits that would silence even its would-be detractors is impossible even to imagine? This is why Democratic Party and Obama cheerleaders have no credibility anymore.

http://www.pnhp.org/news/2015/july/medicare-turns-50-and-we-have-much-to-celebrate

Also, while it's great that Sanders is bringing attention to this topic, it's not surprising that people are responding favorably People have been polling in favor of a Medicare-type single payer program for decades.

http://pnhp.org/blog/2009/12/09/two-thirds-support-3/

James Levy , January 12, 2016 at 1:44 pm

Americans have not and will not "do the right thing" on this issue because the entrenched interests that are making money off of the current atrocity that passes for a healthcare system are too strong to displace. Europe got single payer after WWII because the only institution in society left with access to money was the State, so doctors and hospitals after the war were going to sign on for socialized medicine because societies at large were destitute. Whatever the government will pay is better than grandpa's watch (if some conquering army hadn't stolen it) or a chicken (ditto). Until this situation comes into being here in the USA we're not going to see single payer tax-based healthcare.

Ulysses , January 12, 2016 at 3:13 pm

Your argument would make sense if Canada, which, like the U.S., never suffered the same WWII devastation as Europe, hadn't managed to build a national single-payer health system.

sleepy , January 12, 2016 at 10:16 am

And let's not forget the medicaid clawback provisions for those between 55-65. If you apply for Obamacare, and your income level is below a certain threshhold, you are not eligible for subsidies. You are placed into medicaid.

However, for those in that 55-65 age bracket, there is an estate clawback provision that effectively acts as a lien on your estate: once you die your assets will be seized by the state to satisfy all medicaid provided healthcare expenses.

Prior to Obamacare, in order to qualify for medicaid, not only was there an income requirement, but your assets also had to be below a certain, very low, amount. With Obamacare however, the asset requirement is waived for those in that age bracket.

What happens? Many who now are eligible for medicaid via Obamacare will now own a house as their primary asset of any significance. But once enrolled, that house will be sold on the insured's death to pay medicaid. I would assume that in states that have privatized medicaid, these sums will also include all premiums paid by medicaid on the insured's behalf-even if no claims are ever filed.

If that's not bad enough, under Obamacare to satisfy the law, the consumer is forced into this by the mandate. There is no choice. Beyond that, if the insured had an income level a few dollars higher, he/she would be eligible for subsidies which, of course, need not be paid back on the insured's death.

Clawback provisions, though with many exceptions particularly for those under age 55 have always been required under medicaid, but now medicaid enrollment will be required by law with actual assets available.

Medicaid is essentially a reverse mortgage.

sleepy , January 12, 2016 at 10:31 am

In terms of the assets issue, my comment is applicable to those states that have adopted the expanded medicaid features of Obamacare. As mentioned by a poster in Mississippi, states that have not, still have the old rules on having virtually no assets in order to qualify.

Spring Texan , January 12, 2016 at 11:56 am

Thanks, your comments are accurate; and this is something that is too little discussed.

ilporcupine , January 12, 2016 at 5:49 pm

I have seen this stated here on many occasions, over the course of the OCare debate. While the law seems to give authorization to clawback, in my state it only seems to have been used for nursing home and other long term care. I can state from my experience, I was never queried about assets, and was qualified only on income. I just lost the person with whom I have shared my life for 30 years, and her assets, went to her daughter without any claim from the state. Hers was an expensive battle with cancer, and did rack up a pile of charges. ( In my state, Medicaid is paying a private insurer to cover Medicaid patients). I have been reading here for a long time, rarely posting, I tend to agree mostly with the view here, but this seems to be widely different between states. I have no issue with Yves or Lambert on this, they have done yeoman work trying to get to the bottom of these issues. Just felt I needed to weigh in for the sake of completeness. Yves and Lambert you have my email if you want to discuss my experience, it is all to fresh a wound to discuss in this public forum.

Rob Lewis , January 12, 2016 at 10:39 am

No argument that Obamacare has some serious problems. But placing ALL the blame on the President seems excessive. Even if he had come out strongly for single payer, there are more than enough DINOs in Congress in thrall to Health Care, Inc. to have prevented its passage. And the Republicans would have dialed up their anti-reform propaganda to new levels of hysteria (Remember the anti-Hillarycare saturation media campaign? I'll bet Obama does.)

sleepy , January 12, 2016 at 10:55 am

When Obama was inaugurated he had more political capital in his pocket than any president in recent memory. The repubs were on the ropes.

Sure, the repubs could have gone all out in opposition, but as another poster mentioned Obama could have gone all out as well and blitzed the country. And in the first few months of his presidency, my bet would have been on him more than on the repubs.

Of course he did nothing. And to say he did nothing because of fear of the repubs at that point is silly. He empowered the repubs. He didn't even pretend.

HotFlash , January 12, 2016 at 11:33 am

Even if he had come out strongly for single payer…

Oh, but he didn't! If pigs had wings, perhaps they could fly? He could have, he didn't even pretend (like he did with closing Gitmo). Oh, concerned about his legacy? No problem, $peaking fees from insurance companies, pharmacos, $eat on bds of directors, his future will be golden!

Hello. "Leaders", elected or otherwise, sell out locals to corps = banana republic.

Have a banana.

Lambert Strether Post author , January 12, 2016 at 11:48 am

"placing ALL the blame on the President"

Match for that straw?

fb , January 12, 2016 at 4:43 pm

"All health insurance plans purchased through Covered California must cover certain services called essential health benefits. These include doctor visits, hospital stays, emergency care, maternity care, pediatric care, prescriptions, medical tests and mental health care. Health insurance plans also must cover preventative care services like mammograms and colonoscopies. Health insurance companies cannot charge copayments, coinsurance or deductibles for such services."

Yves Smith , January 12, 2016 at 7:05 pm

By taking that out of context, you've considerably overstated what Covered California covers.

Just as in the rest of the US, the "metal levels" have the same meaning. For instance:

Bronze: On average, your health plan pays 60 percent of your medical expenses, and you pay 40 percent.

This is the language from their "Essential Health Benefits" section:

Essential Health Benefits

All health insurance plans now share some common characteristics. The Affordable Care Act requires that all health insurance plans offered in the individual and small-group markets must provide a comprehensive package of items and services, known as essential health benefits.

These benefits fit into the following 10 categories:

Ambulatory patient services.
Emergency services.
Hospitalization.
Maternity and newborn care.
Mental health and substance use disorder services, including behavioral health treatment.
Prescription drugs. For more information about prescription drug benefits, visit the page Prescription Drugs.
Rehabilitative and habilitative services and devices.
Laboratory services.
Preventive and wellness services and chronic disease management. For more information about preventive services with no cost sharing, click here.
Pediatric services, including dental and vision care. Dental insurance for children will be included in the price of all health plans purchased in the exchange for 2015.
The requirement for insurance plans to offer essential health benefits is just one of many changes in health coverage that began in 2014.

So this is just ACA boilerplate. I do recall reading that Covered CA does require some services be provided irrespective of the deductibles (beyond the ACA-mandated preventive care items like mammograms, which separately are a bad test), but after 10 minutes of poking around the Covered CA site and other Googling, I can't find any evidence of what those other services might be. I thought it was at least a doctor visit or two, but I can't even find that.

And 75% of Covered CA plans have narrow networks, compared to 41% for the US as a whole, which among other things means you might not be able to get a specialist you need:

http://touch.latimes.com/#section/-1/article/p2p-84275268/

The site and web service are also terrible, see the long horror stories at Yelp:

http://www.yelp.com/biz/covered-california-sacramento

And see this from Kaiser News:

Most Insurance Exchanges Just Got Bigger. Covered California Is Getting Smaller.

http://khn.org/news/california-healthline-fewer-insurers-on-online-marketplace/

RUKidding , January 12, 2016 at 11:52 am

Obama NEVER tried one iota to go for Single Payer. Nada, Zip, Nothing.

Ergo, I place ALL the blame on Obama. IF he had tried even a teeny tiny bit, I could perhaps place some blame elsewhere. But factual reality refutes that.

I also do recall the POTUS taking Dennis Kucinich up in Air Force One, and when they landed, suddenly Kucinich had changed his mind and was (reluctantly in my viewpoint) giving an thumbs up on ObamaCare. Kucinich was the longest hold out advocating for Single Payer. Obama basically took him to school and forced him in some way to STFU and say Obamacare was the best.

Baloney. Obama sold us all to BigInsurance, BigPharma, BigHospital, BigMedDevice, and I'm sure he was handsomely rewarded.

This one, imo, is all on Obama. It was what he wanted, and it's what he now touts as being this very great thing, which it's not.

so , January 12, 2016 at 12:38 pm

No amount of dem. or repb. BS will ever persuade me to participate in national politics again.
obamas handling of the ongoing financial and health care crisis finished it for me.
It's so clear to me where were at. The corruption is sickining. EVERY DAY the stories. I keep thinking…."all the kings horses and all the kings men couldn't put Humpty back together again." Read The Archdruid Report for some insight. Everybody wakes up sooner or later.
In this life or the next

tegnost , January 12, 2016 at 11:30 am

Yes, definitely better to give up without a fight. Have you noticed that in spite of what is essentially a media blackout Bernie is likely leading in the polls? As to your opening statement "No argument that Obamacare has some serious problems" you admit to ACA shortcomings, maybe you would like to offer up some of what you see as good aspects of the ACA? Further, "there are more than enough DINOs in Congress in thrall to Health Care, Inc. to have prevented its passage. " there was and is a DINO in the oval office "in thrall to Health Care, Inc." who made no other option impossible. So much for the vaunted "free market" The ACA was designed and implemented as socialism for the 20% (h/t Lambert and others who have noted the upper class and their minions occupy the top quintile) whose medical care was getting too expensive, and whose medical (device, pharma patents, and insurance co.) investments were not being supported by demand, so the ACA created demand for them. Medicare for all, and get rid of the clawbacks, I personally would rather chromex's heirs get his assets rather than Blackstone, thank you.

Ulysses , January 12, 2016 at 3:25 pm

You jest, but in many late medieval and early modern Italian city-states there were ruthlessly enforced minimum consumption levels for salt. Prior to refrigeration salt was more of a food preservation necessity, but the huge consumption taxes placed on salt made them a fiscal necessity as well. Our word salary derives from the fact that so many government officials were paid from the revenues collected through salt taxes.

The much-hated gabelle in pre-Revolutionary France was a salt tax!

http://www.academia.edu/18012323/_Un_popolo_che_non_vorrebbe_sentire_nominare_dazi_esenzioni_privilegi_e_traffici_illeciti_tra_Brescia_Cremona_e_Mantova_nel_Settecento_versione_provvisoria_

Lord Koos , January 12, 2016 at 3:53 pm

No, a better solution would be forcing everyone to go in debt to own a large SUV… hybrids don't qualify.

tegnost , January 12, 2016 at 11:45 am

this was meant as a reply to rob lewis' post at 10:39

Rob Lewis , January 12, 2016 at 2:03 pm

I doubt you're really interested in a discussion, but here are a few very good things about Obamacare:
1. Elimination of pre-existing conditions as a reason for being refused coverage
2. Requirement that insurers spend at least 80% of their revenue actually paying benefits
3. Preventive care must be free
4. Expansion of Medicaid (where permitted by states) brings coverage to millions of previously uninsured
5. Standardization of plans makes is possible (if not easy) to compare them

And this is my opinion, but I don't think it would have been possible to get Medicare for All through Congress, even with Democrats nominally in control, for the reasons already stated.

Anyway, my whole point is that Obama doesn't deserve ALL the blame. Are you arguing that the public and Congress were ready and willing to enact single-payer, and Obama somehow prevented it?

Katiebird , January 12, 2016 at 3:44 pm

1. Pre-existing condition with the caveat that you must live in an area served by a medical establishment that specializes in your possibly rare illness.

2. 80% Yay! It's almost like Christmas! …. Cold comfort to those who must cough up $10,000 or more before getting any benefit from trom their policy at all.

3. Preventative care must be free. OK. So the $10,000 get's them a colonoscopy and a glucose meter.

4. Expanded Medicaid … In the states where it happened, anyone over 55 years old subject to an undisclosed clawback of benefits from estates. Wow.

5. I cannot imagine how you come up with the comparison justification. People have to sign up for plans without final commitments of which doctors or hospitals are included. And even then they are subject to change!

"Democrats nominally in control" … This is a pure deception. They had overwhelming majorities and wildly popular President. Do you seriously think that if faced with Obama's shaking finger and an enticing promise, that any Democrat would have defied him during those first 100 days. I laugh at the thought. He could ave gotten Expanded Medicare for All passed in those first 100 days with one hand tied behind his back.

bob , January 12, 2016 at 3:46 pm

Are you arguing that any single one of your bullet points is true?

For instance #1- covered? Covered by what? You can be covered and still not be able to afford the deductibles, or even the premiums.

The rest is talking point BS, tiny little grain of some sort of truth wrapped in ponies.

tegnost , January 12, 2016 at 9:55 pm

Thanks for responding. Yes it's good that pre-existing conditions no longer can be refused coverage,but one still needs to be able to afford coverage, so not being refused is not the same as receiving care, no? Your second point also has some merit as it appears intended to contain profiteering, but as one can see from martin shrkeli there's nothing stopping the greater healthcare marketplace from increasing costs, so the 80% becomes ambiguously beneficial. I did not know preventative care is free, but if that means as implied by another comment colonoscopies and other rather invasive procedures that might be seen as a cash cow with once again ambiguous benefits to consumers, really they are actually insureds, not consumers, as the prices are beyond peoples ability to pay, only insurers can ably do that, so the consumer is consuming insurance not care, I'm arguing for a gov't insurance and appreciate your opinion that it couldn't have been pulled off, as I think you are aware that my opinion is that they not only didn't try, indeed the executive branch stood between private sector healthcare industries and reform in the same way it stood between the banksters and those pitchfork wielding crazy people. Whatever your feelings about all that saving the economy stuff, it was largely and in many aspects a giveaway to people who were on the brink of disaster, a little more give and take would have been appropriate and the hope and change mandate provided the executive with considerable clout. Also, the medicaid expansion is a wolf in sheep's clothing as the clawback is regressive and punishes low income people as well as some probably good sized portion of people who will find themselves unceremoniously dumped into medicaid when their insurance and other medical bills drive them into financial distress. Lastly, the standardization of plans was in fact useful for me to figure out i couldn't afford it without taking to much time. I'll dilute my criticism of the president to be more inclusively the executive branch and their collective agenda, but basically the O man is the CEO so gets to be the hero, or the goat…

Adrienne Adams , January 12, 2016 at 11:35 am

As Chromex notes, Obamacare "coverage" is high-deductible catastrophic, so all day-to-day "care" is paid for out of pocket. But just try finding out how much a procedure costs… I needed an MRI on my knee, and it took three phone calls to find out how much I would be paying for the procedure. First you need to know the exact billing code for the procedure, which means you need to find the person in the doctor's office who is anointed in the mystical realm of billing codes; then you need to call the insurance company customer service rep, who is initially mystified that you are actually trying to find out how much something costs; then you (hopefully) transferred to someone in the billing department (who has never spoken to an actual patient before); and finally, if you are lucky, in two or three weeks you will revive a letter from another anointed person giving the actual out of pocket cost of the procedure-which will probably be different after the fact as "adjustments" are made between provider and insurer.

If we had to buy anything else in this fashion, we'd all be naked, starving, and out-of-doors.

craazyboy , January 12, 2016 at 11:50 am

It's a market.

nowhere , January 12, 2016 at 2:06 pm

Did you misspell racket?

ProNewerDeal , January 12, 2016 at 1:34 pm

I recall seeing a stat that the median adult net worth of USians was only US$37K, whereas in Canada it is US$80K. I wondered if the primary reason for the huge difference, is the presence of Canada-style MedicareForAll in Canada. It appears the US health system bankrupts you rapidly as in literal medical bankruptcy as per indivduals' examples in the "Sicko" documentary"' or bankrupts you slowly, as in these crapified ACA policies that charge ~$12K/yr before paying for anything besides the annual physical exam even within your "narrow network".

Yves, are you aware of any economist study which estimates the differential in financial net worth between barbaric USA & civilized Canada?

sleepy , January 12, 2016 at 3:16 pm

Apparently what the masters of Canada can't extract through healthcare debt, they do it through astronomically high real estate prices, exceeding our bubble high of 2007. Though there are signs of deflation, tiny 2 bedroom bungalows in Winnipeg–depressed Canadian flyover country–go for $300K. The same dump in Minneapolis is yours for $175K. And that's comparing economically challenged Winnipeg with relatively prosperous Minneapolis.

Yes, not paying $1200/month in health insurance premiums can go to that overpriced Canadian mortgage, but that's sort of my point.

And to ward off some comments–I am in no way stating that Canada's national health program causes high housing costs.

Crazy Horse , January 12, 2016 at 4:40 pm

And the median net worth in Australia and Italy, among other countries is well over 100k. Makes you wonder about American Exceptionalism.

ProNewerDeal , January 12, 2016 at 11:24 pm

America is exceptionally wack & Crapified (c) Yves, as far as life for the 99%ers probably in the lowest quintile within the OECD, even when including the don't-really-belong members like Mexico & Turkey. Meanwhile Murica, from everyday people to the elites, drink Murican Exceptionalist Kool-aid on how Murica is Always The Best, no need to ever learn from any other nations on anything.

ProNewerDeal , January 12, 2016 at 1:46 pm

I wonder if the "net present value" of money/time/stress cost of emigrating to a civilized nation like Canada for those USians fortunate enough to have a chance of doing so, is likely to be much less than the equivalent money/time/stress cost of living an entire life in the US & having to deal with the US Sickcare Mafia.

hemeantwell , January 12, 2016 at 3:03 pm

Lambert said:

I've found that when I talk to people about health care and health insurance; they're very defensive and proprietary about whatever random solution they've been able to cobble together

In my limited conversations I've noticed that, too. I've been left wondering if it is hard to for them to give a clear answer since they've had to engage in guessy speculation about what they, and their families, might come down with, and they end up having to imagine awful stuff and then discount the possibility of it occurring, so too bad for little Susie if awful occurs. Trudy Lieberman has given emphasis to the absurdity of asking people to bet on their health, and I'm guessing it's not just a matter of feeling embarrassed about weak actuarial skills.

Shilo , January 12, 2016 at 6:46 pm

Talking about how you coped with Obamacare gives a clear insight into your personal finances, something a lot of people are hesitant to discuss.

When I was young I was taught never to ask a rancher how many head of cattle he ran, because it's no different that saying, "Hey, How much money are you worth?"

jonf , January 12, 2016 at 4:21 pm

So where do we go from here? Help the republicans repeal it? Fix it? Frankly I don't know. We don't have a congress to fix or replace it -even if Sanders wins. I think it helps some people, mostly those on Medicaid. So repealing it doesn't make sense unless it can be replaced. Even saying this is a marketplace is an outright lie. These bastards are just stealing from us all. Rock and a hard place. Sanders is the only hope and that at times seems vanishingly small.

nihil obstet , January 12, 2016 at 5:16 pm

When Obama took office, The United States National Health Care Act, HR 676 , for a single-payer system of expanded Medicare for All, was in the House of Representatives. If I remember correctly, it had over 100 Democratic Congresspeople co-sponsoring it. Part of the Obama administration's efforts on its own health insurance bill were aimed at getting the bill withdrawn.

afreeman , January 12, 2016 at 8:31 pm

Thanks for that reminder. Reading the recent book, American President (from Teddy to Bill) helps one's recall considerably-telling contrasts between Presidents who knew how to pass legislation and the flukes (if assassination can be called a fluke, i.e. Devil's Chessboard) that brought them our way against those who didn't. For instance, LBJ compared with JFK, who had enough legislative service to learn a thing or two if he were interested, that is.

Too bad the book's so damn thick-well written and lively though it may be. Voters not likely to read it. Should though.

Malcolm MacLeod, MD , January 12, 2016 at 9:21 pm

Lots of arguing and different thoughts, but one primary fact remains. Obama was a bald-faced
lier from the get-go, and has remained true to that principle. He hasn't really tried hard to
question that. The amount of damage done to this nation during his tenure amounts to that
amount perpetrated by a traitor. Just being bad was "W"; this is actually far worse.

Malcolm MacLeod, MD , January 12, 2016 at 9:34 pm

Lots of arguing and different thoughts, but one primary fact persists. Obama has been a
bald-faced liar from the get-go, and has remained true to that principle. He really hasn't
tried hard to dispute that. The amount of damage done to this nation during his tenure
amounts to that amount perpetrated by a traitor. "W" was just bad; This is far worse.

ewmayer , January 12, 2016 at 9:41 pm

Related: Kentucky governor to dismantle state's health insurance exchange: newspaper | Reuters

Now, Kentucky being Kentucky, the motives here may be such that it is difficult for critics of the ACA to claim as any kind of 'win' – would any of our Kentuckian readers care to comment?

[Nov 05, 2015] Fake herbal supplements are more common then you think

observer.com

observer.com

Earlier this year, the New York AG investigated supplements at major retailers and found that four out of five didn't contain any of the labelled herbs. They contained "cheap fillers like powdered rice, asparagus and houseplants, and in some cases substances that could be dangerous to those with allergies." We're not talking fly-by-night Internet products; these are glossy bottles of so-called Gingko Biloba and Echinacea and Garlic, sold in stores like GNC and Target and Walgreens, with relaxing names like "Herbal Plus" and "Spring Valley":

1-rMEC1moEKkOBfuiGvH8Czg

When you buy a supplement, then, you're effectively on your own - not just in determining whether the supplement is safe and effective, but even in deciding whether you're eating what you think you're eating. Reload's packaging suggests it's an "herbal blend" full of plants like Gingko Biloba and Saw Palmetto, but tests show that it actually contains sildenafil, the strong prescription chemical found in Viagra itself.

This is a much freer market than people are accustomed to when they purchase anything from a reputable retailer, let alone something they plan to swallow. Absent stricter regulation, busy citizens count on the media to inform.

[Sep 06, 2015] ObamaCare to Crapify Health Insurance at 26% of Employers with Cadillac Tax

"...Btw a healthcare plan that impoverishes the middle class (who mostly do have employer provided insurance) to subsidize the poor (though Medicaid or lousy subsidized ACA plans) is a perfect way to divide and conquer most of the country, to set them against each other: "poor people and their ACA stole my health insurance!". While the hospitals and health insurers and PHARMA make off like bandits. Now you could have a health plan that is more likely to unite people than divide them but they didn't. Funny that."
.
"...The best plan is single payer. The big loser is insurance plans. Fairness doesn't result in insurance company skyscrapers and multimillion dollar salaries."
.
"...the HSA is its own kind of scam, with all sorts of mysterious fees and an inducement to put this money into suspiciously high-fee mutual funds… the privilege for which is yet another monthly fee."
.
"...Another thing about the job market is those full time jobs are becoming rarefied things, contract work is increasing. But even with one of those lucky full time jobs, the provisional with no benefits thing for 3 months is bound to cause problems."
.
"... Insurers are also tempted with the growth of the individual market instead of employer or government based Healthcare because an individual has no power."
Sep 05, 2015 | Economist's View
Sep 04, 2015 | naked capitalism
Praedor September 4, 2015 at 12:50 pm

Hell, even without the "cadillac tax" in effect, just plain old ACA, my healthcare has already been crapified. Before Obamacare, the wife and I had health insurance from our university that we both liked. It worked. It was based on the co-pay system and the co-pay was never onerous. Since ACA, however, the healthcare plans at the university have gone to shit. To keep health insurance that was at all similar to what it was pre-ACA would cost us an arm and a leg, and no, our wages are not high (by a LONG shot). Instead, we've been stuck with a deductible shitpile with a deductible high enough to really hurt ($3000) PLUS shitty coverage on top of that. Last year I thought that since I'd gone through my deductible for some back injury treatments, that a subsequent procedure would be rather cheap (to me). HAH! Got hit with THOUSANDS of dollars in bills leaving me to wonder just what the FUCK is the deductible for! Can't WAIT to see what happens after the cadillac tax goes into effect. Will the shit I've got now hit that threshold? What knock-on effects will there be? What will be the neoliberal trickle down?

Our pay will NOT be going up in any case. It has been YEARS since anyone but some useless administrators got any kind of pay increase. Pay increases, such as they are, for the real staff have been in line with the interest you can make on a savings account at a bank. Whooopie!

reslez September 4, 2015 at 5:15 pm

My employer offered a co-pay style plan until 2 years ago (ACA hello!) and now exclusively offers a high-deductible plan with a Health Savings Account. And yes, the deductible only applies to some charges, there are actually multiple deductibles, so you end up forking over a slice of your paycheck for potential access to care, but the insurer never pays a single thing, they only negotiate what you pay. And yet the threat of medical catastrophe and being driven into bankruptcy for a single incident (a vehicle accident, for example) looms over all of us. The neo-liberal world sheds no tears, it only counts money.

And the HSA is its own kind of scam, with all sorts of mysterious fees and an inducement to put this money into suspiciously high-fee mutual funds… the privilege for which is yet another monthly fee.

NotTimothyGeithner September 4, 2015 at 6:39 pm

The Obots will blame you for not clapping, not Obama or anyone who conned them. The one thing people hate more than con men is being conned themselves. The bright, wonderful people who snicker at Palin can't be had. They are just sports fans for the most part except for a sport even more harmful than the NFL.

If they hit rock bottom, they might recognize the connection.

Sean September 4, 2015 at 1:03 pm

I love the fact when I don't have a job (like now), I get penalized for not buying a product I actually can't buy because the "marketplace" closes in March.

Also, how am I going to pay these premiums without income? How do I pay my taxes without a job?

Neoliberalism has to die. Somehow. Or else it will kill us all.

jrs, September 5, 2015 at 9:13 pm

Something I have noticed about the job market, more and more employers for full time jobs won't pay for health insurance until your about 3 months into the job. So what are people supposed to do for those 3 months? Live without health insurance? Risky, but more importantly what about the penalties? Could those kick in if you don't have healthcare for 3 months? Does the ACA require continuous coverage to avoid penalty? Use Cobra from a prior job? It's insanely expensive. Private marketplace outside the exchanges? Might work depending.

Another thing about the job market is those full time jobs are becoming rarefied things, contract work is increasing. But even with one of those lucky full time jobs, the provisional with no benefits thing for 3 months is bound to cause problems.

oho , September 4, 2015 at 1:23 pm

perhaps in 2016 the nearly-always-thrown-under-the-bus Democratic foot soldiers finally wake up to the mistreatment that they've suffered at the hands of the Progressive Policy Institute/DLC/corporatist crowd .

OIFVet, September 5, 2015 at 5:34 pm

now they're holding up the bad parts they insisted on, ignoring the good ones, like access to health care for chronic conditions and previous flaws in health

What "access"? Take the narrow networks and the very high deductibles that are the mainstay of the "exchange", and what you call "access" is no better than what came before Obamacare. Many people still can't afford to go see a doctor because of that $6k annual deductible plan, the only one they could afford, and if they do have a serious health event they can't even know ahead of time if all of their medical team is in their plan, or will they end up paying for out-of-network providers. So you can easily throw another thing Obamacare failed to fix: bankruptsies due to medical costs.

Confirmation bias my a$$, I spent literally days of my life (the "time tax" Lambert talks about) trying to find the least awful plan my mother could actually afford, on a malfunctioning "exchange" offering very little useful info on the various plans' provider networks.

It's an overpriced PPO plan that I found. It has a 6,500 deductible, but it has one semi-decent feature: large provider network. Everything else about it is awful, so it is simply a catastrophic plan, at best. For some chronic conditions my mother does have it is useless, she refuses to go see a doctor because she can't afford the out-of-pocket costs and refuses to allow me to pick up any of her costs. You call that access? You are a bloody Obot apologist, and that makes you an awful person. Yet here you are blaming me and others here for having the gall to point out the load of crapiness that is Obamacare. Go eff your righteous self.

jrs, September 5, 2015 at 9:06 pm

FWIW those who have talked about personally experiencing increased access in my experience have mostly been those with expanded Medicaid who are not actually dealing with the exchanges. Medicaid is a mixed bag and often partly privatized as well, but I don't think it has the huge deductibles (there are clawbacks but not everyone cares). Of course they could have just expanded Medicaid without even bothering with the entire rest of the ACA and it would just be straight expansion of an existing government program.

OIFVet, September 5, 2015 at 9:46 pm

Right, Medicaid. For those who actually work there is no Medicaid, just some subsidies for lower middle incomes and no subsidies at all for some with higher income (in Chicagoland, the cutoff for subsidies based on the second lowest Silver plan premium is just under $40k, which is hardly "high income".

For them, crappy plans are the norm. Then there is the shrinking pool of providers who will accept Medicaid patients, and the clawbacks that can become an issue for some later on. Some may benefit, but those are mostly the ones with comfortable incomes and preexisting conditions. For the rest, "access" is a theoretical concept at best.

I take this very personally because of my prior family history. My father died at the ripe old age of 62 for lack of access. For him it was a choice between paying the mortgage or paying a high medical bill (preexisting condition). He could have never have afforded to pay the Obamacare premiums and their high deductibles, and he wouldn't have qualified for the expanded Medicaid. What would one do, give up his income to qualify for Medicaid and lose his home in the process?

Obamacare does absolutely nothing for those hard working lower middle class incomes, but here is this bloody Obot talking out of his a$$ about stuff he has no experience dealing with. So eff him and his effing hobby horse he rode in on. People like that are part of the effing problem, but he has the gall to lecture us about this travesty. Eff him, it's been years since my dad passed but it still hurts given the circumstances and what they reveal about the priorities of our elites. I simply couldn't let this douchebag spout his damned nonsense about the great "access" our oh-so-benevolent Barry has so graciously provided for a few people.

Praedor, September 4, 2015 at 4:14 pm

The biggest flaw with ACA or any other scheme ALLOWED to be considered by the Dems or GOP is that they always start with the question, "What's good for business?" instead of, "What's good for patients?" Starting off with the conceit that any healthcare setup MUST be good for business, first and foremost, automatically creates crap. The ONLY question that should be considered with designing or changing the healthcare system is, "What's good for patients?"

What will see people, regardless of economic class, receiving the healthcare they need to lead happy and healthy lives? It is totally irrelevant if a healthcare system design hurts insurance companies, private hospitals, etc. Healthcare isn't there to provide profits for CEOs and shareholders, it is there to provide HEALTHCARE. The poorest poor should receive the exact same level of care as the richest crook. The poorest poor should receive equal cancer treatments to the richest hedge fund looter, should receive knee replacement surgery equal to that of George Soros. Period. Any doctor that wants to be a doctor to get rich should lose his/her license to practice medicine. The Hippocratic Oath says nothing about getting rich, driving the finist Mercedes, or living in the Hamptons.

Oregoncharles, September 4, 2015 at 5:11 pm

Since you didn't get to the politics, a quick review:

The ACA passed WITHOUT ONE SINGLE REPUBLICAN VOTE. The big, bad Rethugs were irrelevant, and had been all along. This is absolutely something the Democrats did, all by themselves, complete with botches and knives in the back for their supporters – who in some cases still support them.

greensachs, September 4, 2015 at 6:19 pm

—the barriers to care will rise for an increasing number of Americans who won't be able to pay the high out-of-pocket expenses required.——- And when they develop major medical problems for which care is essential, they will face the difficult choice of paying for the needed care and having to default on their mortgages and other financial obligations, or not obtaining the medical treatments required.—

There is a reality that is altogether being omitted from the above truthful, yet pathetic narrative.

Many, are altogether avoiding treatment or trying DIY remedies. Even if there's an effort for partial diagnosis and/or treatment, again, many cancel or no-show the follow ups. Together, all of these, make U.S. "healthcare" a word with very little meaning. Hope, becomes your default coverage.

Welcome to the Neo (new) liberalism…the "free" (manipulated, fixed & phony) markets.

…the market based Hopium, which the last two administration have prescribed so unconditionally, is stamping out and forcing downward our humanity.

LAS, September 5, 2015 at 10:59 am

Economically, this kind of insurance transitioning was happening well BEFORE ACA (Obamacare). Expensive health insurance plans were going out of existence due to adverse selection anyway. Adverse selection was driving them out of existence before ACA (Obamacare). Read "Paying for Health Insurance: The Trade-Off Between Competition and Adverse Selection" by Cutler and Reber.

I think you attribute to ACA changes that are really due to healthcare economics. The ACA makes a nice target but it is not the root of what's happening.

tegnost, September 5, 2015 at 11:10 am

Au contraire! The ACA was designed to save those insurance companies whose business model was failing.

jrs, September 5, 2015 at 4:51 pm

If it's happening anyway why literally penalize employers that offer good insurance? No, I'm not buying it. While I agree it may have already been a trend to some extent this simply has to have an effect and magnify it, 40% tax hits do change employer behavior.

Ormond Otvos, September 5, 2015 at 4:55 pm

The best plan is single payer. The big loser is insurance plans. Fairness doesn't result in insurance company skyscrapers and multimillion dollar salaries.

Ormond Otvos, September 5, 2015 at 4:58 pm

In the absence of such studies of medical bankruptcies, one would be advised to have a tentative opinion, labeled as a guess.

And the confounding factor, thank you Mr Biden, is the rewritten bankruptcy laws immediately preceding the ACA.


jrs, September 5, 2015 at 2:22 pm

Btw a healthcare plan that impoverishes the middle class (who mostly do have employer provided insurance) to subsidize the poor (though Medicaid or lousy subsidized ACA plans) is a perfect way to divide and conquer most of the country, to set them against each other: "poor people and their ACA stole my health insurance!". While the hospitals and health insurers and PHARMA make off like bandits. Now you could have a health plan that is more likely to unite people than divide them but they didn't. Funny that.

Ormond Otvos, September 5, 2015 at 5:00 pm

A very insightful comment. Politics is run by lobbies who are paid by corporations. No one likes to admit that we, the voters, enable all this crapification by having little knowledge or interest until the financial pain finally hits.

Too late, then. Vote for Bernie.

Davidt, September 5, 2015 at 8:00 pm

There is and has been a trend to shift more of health care costs away from "insurance" or "government" (Social Security) onto having the individual pay more out of pocket.

Insurance companies have reduced payments to doctors, hospitals and we can be sure the drug companies. The drug companies have responded by raising the "list" price of drugs. This may be one of the reasons for the rapid rise of drug prices. Cost shifting from insurance companies to individuals. The question is where is that reflected in the price of insurance. Are the books of the insurance companies audited? Why the shift to individuals for increased medical costs. Most medical costs are not optional, they are controlled by the ordering physician. Hospital costs are worse. There is no way for an individual to control or influence most hospital costs.

Why not only measure outcomes for doctors but also costs of medicines?
My doctor claims he does not know the prices. This is a big problem.

Who benefits, what started this, and why is this taking place?

NotTimothyGeithner, September 5, 2015 at 8:46 pm

Ted Kennedy was the primary sponsor of the HMO Act of 1973 which ended the ban on for profit medicine. Even Dick Nixon thought the legislation sounded fishy. The health care system in this country was largely built by non-profit operators and small time independent agents (doctors). They would have been the primary distributor of pharmaceuticals and wouldn't have had incentive to collude for fear of prison.

Even now, I would contend insurers are a bit of a red herring compared to Big Pharma and the HMOs. They aren't seeing honest bills either. Insurers are also tempted with the growth of the individual market instead of employer or government based Healthcare because an individual has no power. If an employee where my father was an attorney had a health insurance issue, he would call the relevant regulators who would take his call because there was a working relationship. If there was guff, they would sue anyone and everyone. They would act, but the woman who sells tea cozies at the community market doesn't have a team of lawyers on hand in a private market place. Small companies had problems with insurance for similar reasons. If I recall, 93 Hillary care was very concerned with creating pools for the small operators.

The doctors and nurses ideally learned about medicine. Accountants and actuaries handled the other side and still do, but now everyone works for share holders not non-profit boards. The guy with his name on the building will be well cared for, but the hospital didn't exist to enrich him beyond advertising.

[Oct 28, 2013] OBoZoCaRe BoNaNZa!

Zero Hedge

Below is Kunstler's description of our medical situation. All that needs to be pointed out is that the republicans are primarily the ones responsible for opposing the kinds of fixes that would have gone a long ways to remedy the situation. A single care provider approach means cutting out the sleazy tribe of middle-men who make our way of fleecing the ailing public so profitable. The prime directive of the republican party is at all costs protect the unholy wealth of those who already have most of it...

The ObamaCare piece of the picture is a mere pathetic soap opera compared to the first two quandaries. The 2000-page law did nothing to address the core tragedy of medicine in America — namely, that it has evolved into a hideous hostage racket. You go to a hospital with a terrifying illness and you are susceptible to fleecing by the so-called “care-givers” for the promise that you may get to live. No prices for treatment are never discussed. They are presumed to be astronomical — but who cares if you end up dead, and if you do get to live, you’ll figure that out later. If you hold an insurance policy, these charges will be subject to a fake negotiation between grifting insurance companies and grifting hospitals, physicians, and drug companies. The price “settlements” are only slightly less a joke than the actual charges, and are obfuscated in documents designed to bewilder even well-educated policy-holders.

Even if you are insured, the charges may bankrupt you. A typical one-day charge for “room and board” in a non-specialized hospital in-patient bed runs $23,000 at my local hospital. For what?

Half a dozen blood-pressure checks and three bad meals? You can be sure that ever-fewer families will be able to fork over $12,000-a-year for basic coverage.

The ObamaCare legislation and its laughable rollout of a useless website is just a punctuation mark at the end of the soap opera script.

The result eventually will be the complete implosion of the medical racket and a return to a very primitive clinic system, with payment in chickens or cords of stove-wood. The smaller number of surviving humans will surely enjoy better health, and greater piece of mind, when this monster racket expires of inertia, bad faith, and deceit.

[Nov 03, 2011] The profit in keeping you ignorant by Wendell Potter

iWatch News

Health insurance industry and its corporate allies are fighting requirement that policies be understandable By Wendell Potter6:00 am, October 31, 2011 Updated: 1:21 pm, October 31, 2011 PrintE-mail6 inShare. Columnist Wendell Potter Robin Holland If you have no idea what you’re paying good money for when you enroll in a health insurance plan, there’s a good reason for that: insurers profit from your ignorance. And they’re waging an intense behind-the-scenes campaign to keep you in the dark.

In my first appearance before Congress after leaving the insurance industry, I told members of the Senate Commerce Committee that insurers intentionally make it all but impossible for consumers to find out in advance of buying a policy exactly what is covered and what isn’t and how much they’ll be on the hook for if they get sick or injured. Insurers are quite willing to provide you with slick marketing materials about their policies, but those materials are notoriously skimpy when it comes to useful information. And the documents they provide after you enroll are so dense few of us can understand them.

In the months following my Senate testimony, lawmakers drafting health reform legislation included a provision requiring insurers to both provide comprehensible disclosures of health plan benefits and make that information available to anyone shopping for coverage. Despite repeated attempts by industry lobbyists to get that provision stripped out of the final bill, the Affordable Care Act as signed by President Obama last year requires that all private health plans provide consumers with a concise and understandable Summary of Benefits and Coverage (SBC) form. In addition, they must provide a uniform glossary of medical and insurance terms.

If you think that sounds like a reasonable request, you’re not an insurance company executive who is rewarded more for meeting Wall Street’s profit expectations than assuring that consumers know what they’re buying.

Now the Obama administration is trying to figure out how to enforce this new requirement, and so health insurers and their allies have launched a full-court press to persuade government officials to gut it by exempting policies sold where people work. Because the vast majority of Americans who have coverage get it through their employers, this would mean that most of us would, for all practical purposes, continue to have to buy a pig in a poke.

Fortunately there are several organizations, including Consumers Union, publisher of Consumer Reports , that are fighting the good fight. They’re demanding that Obama officials write the regulations to apply to all health plans, regardless of whether they are sold on the individual market or through employers, unions or other groups. They insist that Congress intended for the standard form, which would allow “apples-to-apples” comparisons of health plans, to apply across the board.

As Consumers Union noted in comments sent to the administration, the booklet describing benefits that most employers currently provide their workers “is a bulky, legalistic document that few consumers can understand.” It cited one study which concluded that the typical benefit description document provided by employers is written at a college reading level. Most Americans have trouble understanding information written above the 6 th to 8 th grade level.

Insurers and their corporate allies, including the U.S. Chamber of Commerce and the National Association of Health Underwriters, are claiming in comment letters to the administration that providing a uniform, simplified and understandable version of those documents would cost so much money they would have to increase premiums.

America’s Health Insurance Plans (AHIP), the lobbying and PR group for insurers that says it represents more than 1,300 health plans covering 200 million people, contends that the cost of implementing the proposal would be $188 million. In addition, AHIP says, the annual cost of providing the information would be $194 million. Would insurers consider absorbing those costs? Of course not.

“The benefits of providing a new summary of coverage document, in addition to what is already provided to consumers, must be balanced against the increased administrative burden that drives up costs to consumers and employers,” AHIP said in its letter.

Nonsense. Consider this: the five largest insurers (UnitedHealth, WellPoint, Aetna, CIGNA and Humana) over the past week have reported profits exceeding $2.6 billion for just the three months that ended September 30, 2011. Over the past 10 years, those five companies have recorded profits of more than $50 billion. Imagine what the total would be if you added in the profits of the other 1,295 health plans AHIP says it represents.

The industry could even pass a hat among the CEOs of those big insurers and come up with the additional money without any one of them giving until it really hurt. UnitedHealth’s Stephen J. Hemsley is the highest paid CEO in America, according to Forbes magazine. He hauled in more than $100 million last year alone. When H. Edward Hanway, my former CEO at CIGNA, retired at the end of 2009, he walked out the door with $111 million. When you consider the money those two guys have made over the years, they alone could cover the cost of providing consumers with information they can understand.

I’d advise everyone to keep their eyes on this skirmish. If the administration caves to the insurers’ demands on this, we’ll know who really is calling the shots when it comes to implementing health care reform.

[Feb 08, 2011] guest-post-why-small-business-isnt-hiring-and-wont-be-hiring

by cxl9
on Tue, 02/08/2011 - 12:49
#943358

$1000/month for health coverage? Really? I am a 43-year old man who pays $369/mo. for a Kaiser gold policy + prescription. A young person could expect to pay half that. Anyone who believes health care is overpriced or unaffordable is simply hoping the government will force someone else will pay his medical bills.

by docj
on Tue, 02/08/2011 - 13:01
#943378

Good luck finding a "state approved" health insurance policy in the People's Republic of MA for under $1K/mo. (Thanks for that, Mitt Romney.)

by ThirdCoastSurfer
on Tue, 02/08/2011 - 14:31
#943751

Thanks to QE2 I have High Blood Pressure and "suddenly" don't qualify for traditional insurance. I applied for and qualified for "Obama Care" through www.pciplan.gov.

For $400 a month it carries a $2,000 deductible and a $5950 Out of Pocket max (OOP). http://www.pciplan.com/forms/pdfs/2011BenefitsSummary.pdf

So, from Year to Year, I can expect to pay $4800 in premium and $2,000 deductible equaling $6,800 before coverage begins and then I'll pay 20% of the next $19,750 before the OOP max is reached.

It was hard for me to fathom why I would chose (or in 2014 be forced) to accept such terms rather than just pay cash in the hopes that no one annual bill would amount to more than $10,750 (Premium + OOP) until I looked at the cost of random things like an appendectomy or a ER visit for a broken bone, each of which can easily cross $20,000 in expense because of the way hospitals, and health care in general, "upcharge" and "unbundle" their charges. Apparently, no one pays the listed price, so why all the confusion? I have no idea but is it possible that for tax purposes the difference can somehow be applied as a taxable loss as a business expense?

"Talk about what a tangled web we weave"

by blunderdog
on Tue, 02/08/2011 - 15:54
#944043

If all this info is accurate, and you're not happy with the "Obamacare" option, why not just skip the health-insurance and pay the fuckin' tax penalty?

Who in the world even wants health-insurance?

It's the ultimate definition of a sucker bet: insurance against shit you could *never* want to happen in the first place. If it pays off, you lose. If it doesn't, you lose.

I *know* some of these folks, and I'd predict: if something horrible happens to you and fucks your world, you're really not going to give a shit whether you can pay your bills for the emergency surgery.

by Dr. Sandi
on Tue, 02/08/2011 - 17:56
#944520

Once you get on the actuarial bad side of 55, the odds look a lot different.

You can stiff the hospital and all the various hangers-on for the first visit. But you're screwed if you ever have to go back there and don't have cash or credit card in your drooping paw.

by blunderdog
on Tue, 02/08/2011 - 18:09
#944556

Yes, I do actually appreciate that, which is why I say "IF" it looks like a bad deal, fuck it.

What I can't get over is listening to folks bitching about health-insurance costs on the one hand, taxes on the other hand, and outrageous health care expenses on the third hand. No one HAS TO take BP medicine. No one HAS TO have dialysis (or their kidneys replaced) after a decade of *not* taking BP medicine.

The money either has to come from somewhere or it doesn't--if it doesn't, just stop paying and die already. It's no one's fault that people get old and die, right? Your health is going to fail you no matter who you are or what you've done. If you don't want to pay for health-care, DON'T.

Just don't whine about it if you choose to pay. And don't blame government for the fact that you want the best possible care available and "money is no object" as soon as you reach that point, but it's a waste of your tax dollars as long as you feel ok.

Most people I know are completely infantile on this subject. It's no wonder no one's happy with our "policies."

by braveneweconomy
on Tue, 02/08/2011 - 12:55
#943379

Same here. I'm an independent contractor mid-40's and pay about $400/mo. for great coverage. I'm always perplexed by the people who scream about health care being too expensive.

by minus dog
on Tue, 02/08/2011 - 13:26
#943496

Sure, you can get insurance for $250/mo (assuming you can afford that - many cannot) but it doesn't do you any damn good for the sort of routine medical care someone my age actually uses. I typically get a huge cash discount, so my bill is essentially the same as if I were paying for the services with insurance... and without the monthly overhead.

Even at 250 a month, I'd be paying about 10x as much per year for medical and dental expenses. Even with the occasional serious injury every 3-4 years (about $3k a pop) I'm still coming out ahead.

Complaints about "freeloading" are going to fall on deaf ears - two words: Social Security.

This article is spot on; the system exists to fuck us and empty our pockets, why the hell would be participate in it?

by RKDS
on Tue, 02/08/2011 - 13:37
#943517

It would've been interesting for you to provide a salary for comparison, because to someone making $30K and taking home less than $2K per month, $400 right off the top actually _is_ expensive. And it's even worse if your employer doesn't offer coverage and you have to pay even more on the individual market.

by minus dog
on Tue, 02/08/2011 - 18:24
#944590

And, as people seem to keep forgetting, median individual income is somewhere around $26K

by HungrySeagull
on Tue, 02/08/2011 - 14:00
#943602

I know one retired dentist who endured 1200 dollars coverage per month for the wife. The moment the wife hit 65, medicare kicked in and he pockets the 1200 dollars per month.

HOORAY!

And if anything happens beyond what medicare pays, cash paid to billing all done.

by Mercury
on Tue, 02/08/2011 - 12:57
#943391

The acid test isn't whether or not your premium checks get cashed but whether or not you get what you need when you blow a gasket.

by tmosley
on Tue, 02/08/2011 - 13:15
#943456

Exactly. My company changed insurance this year and I went to the dentist for a regular checkup+x-rays. The insurance only covered half of the cost! This policy was the same price (to me) as the older one.

I would hate to see what happens if I were to actually have to go to the doctor or have some surgery.

by TheDriver
on Tue, 02/08/2011 - 13:40
#943556

I'm happy to fill you in on those details. As a 40 yo with reasonably priced coverage who had to face 2 unexpected, unrelated surgeries in as many years, I can tell you how bad things really are. I'll leave the country for future surgeries and pay cash. Even with airfare and lodging costs, it would be cheaper than having the work done in the US.

by HungrySeagull
on Tue, 02/08/2011 - 14:04
#943615

I had two insurance policies.

Both of them fought over a 16,000 dollar Ride in a MRI machine some time ago. They paid it. Then they fight over several surgeries I have had. They paid that too.

The moment Obamacare became law, I canceled both insurance companies and go to cash. If my doctor can fix a boo boo, great! Otherwise I make do.

I learned a month after cancelling for myself and spouse, our premiums would have gone up from about 870 a month to 1450 a month and some services cut back or disallowed.

Sorry. I am not putting money after a company that is cutting back.

Oh the small details about hospice, burial, cremations and all of that is already prepaid and arranged. One phone call does it all.

by baserunr
on Tue, 02/08/2011 - 14:07
#943631

See, here's a disconnect. Insurance is to cover the cost of expensive, unexpected-type events that have a small chance of occuring. If you are going to the Dentist for a "regular" check-up, that doesn't meet the criteria of what "insurance" is designed to cover. Many insurers have found a way to earn additional premium by expanding the boundaries of what they will "insure". That doesn't mean it is such a great deal for the insured; it just means the company can earn additional premium. If you work to keep the insurance for large, unlikley, and calamitious expenses, you'll probably find it very affordable. Pay cash for the rest.

by cxl9
on Tue, 02/08/2011 - 13:44
#943565

Agreed. I have been with Kaiser for years, and I can say that the service has been great. I have no complaints whatsoever with the medical treatment. I plan to stay with them for as long as I possibly can, at least until private health providers are eliminated in the United States and all of us are waiting in line down at the Post Office to get our health care.

by Thunder Dome
on Tue, 02/08/2011 - 12:58
#943394

I'm covering a family of four in the great state of Illinois--$20,000/yr not including dental.

by Threeggg
on Tue, 02/08/2011 - 15:32
#943955

Thunder you are doing better than me. (by $18 dollars) I pay $1718.00 for a Blue Cross Blue Shield Policy in Illinois. (it includes dental) That is for 3 people that are healthy.

I am looking into a major medical policy with a large deductable as I will pay for the regular medical expenses out of my pocket.

The medical sham put forth by Bamy raised all the prices. Now that they have the prices up over the rainbow they now want to repeal it. !

Prepare yourselves peeps as this running financial shit-train is pulling into the station.

[Mar 29, 2010] Will the GOP Remain the Party of No?

This is from The Myrtle Beach Sun:
DeMint, Graham let S.C. down on health care overhaul, by Isaac Bailey, The Myrtle Beach Sun: Two South Carolina legislators had the opportunity to shape the historic health care bill President Obama signed into law on Tuesday... Because the Senate version of the bill was going to be the foundation of the law, Sens. Lindsey Graham and Jim DeMint were our only two politicians who could have forced even more conservative ideas into the legislation. ... Neither did. Both shirked their responsibility to the state to walk lockstep with the GOP.
There was little reason to expect anything different from DeMint, who represents the party's Rush Limbaugh-wing. He didn't begin the debate saying we must find a way to bring down S.C.'s high percentage of the un- and underinsured. He didn't say we must find a way to stem costs that are spiraling out of control, bankrupting hard-working people for the sin of getting too sick. He didn't say the days of uninsured families having to leave coffee cans decorated with a sick loved one's photo on convenience store counters must end. He didn't say that if reform included strong tort reform so doctors would no longer feel the need to perform unnecessary tests that he would vote for it.
Instead, he said reform's defeat would be Obama's "Waterloo", that it would break the president. Only after his comments ignited a firestorm did DeMint propose a policy that most experts considered laughable. He was focused on politics, not people.
Sen. Graham began the debate differently. He knew if nothing changed, our health care system would eventually bankrupt us, which is why he initially supported the bipartisan Bennett-Wyden bill. ... But the proposal went nowhere fast. Instead of Graham engaging in the fight to incorporate the best parts of Wyden-Bennett - or any other effective plan - he fell in line with the rest of the GOP caucus.
He, too, became more concerned about his party's positioning for November than the people he was sent to Washington to represent...
The most vulnerable South Carolinians ... needed Graham and DeMint to lead. ... They didn't. Instead, they stood for the petty and ignored the real needs of the people. History won't forget. And neither should we.

And, from the local paper this morning:

Move past ‘repeal, replace’, Editorial, Register Guard: Republicans are preparing to march into the 2010 election under the dubious banner of “Repeal and replace!”
It’s a losing strategy, one that GOP lawmakers should rethink before venturing too far down that road. The health care reform bill has been signed into law. ... The Republicans should turn the page on health care if they want to shed the “party of no” label that served both the GOP and nation poorly in the debate over health reform.
That doesn’t mean that House Minority Leader John Boehner and other Republican leaders should publicly embrace Obamacare. That’s unrealistic; their philosophical differences with Democrats on reform are too deep and broad, and Republicans resentment over President Obama’s historic achievement precludes even the pretense of a political truce.
But Republicans face long odds in any attempt to repeal and replace health care reform, and they know it. ... As Sen. Jon Kyl, R-Ariz., acknowledged, repeal “is not realistic because Barack Obama would veto the bill and we don’t have the votes to override it.”
For Republicans such as Boehner, Kyl and DeMint, “repeal and replace” is an election strategy and not a practical legislative goal. ...
Repeal-and-replace Republicans eventually must face the difficult task of explaining why their apocalyptic predictions — everything from the death panels to the dismantling of democracy — didn’t come true. In the months and years to come, many Americans, even those skeptical about the reform effort, will come to see the scare tactics as hyperbolic depictions of a bill whose moderate approach incorporated many Republican ideas.
Republicans have just suffered a devastating legislative defeat, and they are entitled to nurse their wounds. But the GOP’s political aspirations — and the nation’s interests — would be best served by full engagement on the many critical issues facing Congress, from financial regulatory reform to immigration to unemployment. ... Republicans remain fixated on their loss on health reform — so much so that some, including Sen. John McCain, R-Ariz., have publicly ruled out any bipartisan cooperation for the remainder of the current session.
The American people need — and deserve — a legislative process in which both parties are engaged and bring competing views to the table. By clinging to the cold corpse of the health care debate, Republicans will miss an opportunity to express a clear, compelling vision on other issues — a vision that could do far more to sway voters to their side this fall than continuing to flail away over health care. ...
While there is still time, Republicans should repeal and replace their catchphrase, and substitute another that bodes better for their party’s future.

There's an inconsistency between free market ideology and the need for reform in areas like health care and financial services. One of the first steps in reforming the system is to acknowledge that the market won't take care of the problems itself. Once that is acknowledged, i.e. that regulation is needed to fix these market failures, the only question is whether that regulation will be of the "market-based" variety or by edict (e.g. this is the difference between system of tradable carbon permits that allow least cost carbon reduction strategies to emerge and a government set emission limit for each industry which generally does not achieve ca4rbon reductions at least cost).

With Democrats mostly opposed to old fashioned edict style regulation -- with their willingness to embrace market-based solutions to regulatory issues -- and with Republicans unwilling to embrace anything that Democrats propose, there is little ground left for those Republicans who are willing to admit that markets sometimes fail to stand upon. Democrats have taken the middle ground -- market based regulation -- from Republicans. This leaves Republicans with a choice of going along and compromising (and thereby embracing proposals they have made in the past, e.g. the health care bill looks an awful lot like the health care program Romney put in place in Massachusetts), or standing in opposition simply because it is a Democratic proposal. The choice they've made, standing in opposition to everything, is a losing strategy that allows policy to be shaped entirely be the other side. It will be interesting to see if a fissure develops within the Republican Party over this.

Will Republicans be able to share the market-based regulatory ground Democrats have taken away? There are already signs that Republicans will work with Democrats on financial reform, but there were early signs of a bi-partisan effort on health care as well, so we'll see how this plays out. I think people are fed up with banks and want something to be done, and Republican attempts to block legislation won't play well with the public at all. So I expect the coalition of no to be broken -- some legislators will see that they cannot continue just saying no and expect public support -- but not without big fights within the Republican Party between the extremists and the centrists. If Republicans do move in this direction, and it's more likely they'll do so on financial reform than on climate change legislation, you'll see an attempt to reclaim these policies as Republican (here's a great example: Health Care Reform--A Republican Idea?). And given the administration's centrist tendencies, in many cases they'll have a pretty good argument.

Posted by Mark Thoma on Saturday, March 27, 2010 at 10:34 AM in Economics, Financial System, Health Care, Politics, Regulation Reblog Permalink Comments (32)

Comments

roger said...

MT, you write about the Dems "willingness to embrace market-based solutions to regulatory issues" - I'd read that a little differently: with the Dems "unwillingness to embrace regulatory solutions to market-based problems."

That, I think, is a more accurate index of the Democratic party's conservatism.

howard said...

we can only hope that the gop will go all-in on repeal....

jrossi said...

This bill has lots of problems from where I sit. One comes to mind immediately: Medicaid reimbursements will increase for us primary care docs, but will be cut for specialists. This essentially turns the primary doc's office into a Community Health Center (poverty medicine clinic), where the primary is left holding the bag.

For example, suppose a Medicaid pt comes to my practice who needs immediate specialty care (draining a peri-tonsillar abscess, for example), but who will be unable to see one because none of the local ENT docs will take the risible payment. So I"m stuck, with an acutely ill pt that I can't help. Well, I could spend a hour on the phone begging someone to take him, or I could send the pt to the ER and move on to my next pt, so I can actually stay in business and keep my practice open. This kind of crap happens every single day in poverty medicine and is one of the main reasons why it can be so hellish to take care of people without adequate insurance. Begging the GI guy to see your rectal bleeder, begging the surgeon to see your hernia case, begging the neurologist to see your headache pt. Make no mistake about it, insurance that specialists refuse is inadequate. Better for mental health and, usually, the bottom line of the primary doc to refuse to take part.

Get to work on this, politicians of America.

OhNoNotAgain:

The big question is: are the Medicaid rates for specialists enough for them to make a profit and cover their costs ? If so, then I think these specialists are going to find themselves in a lot of trouble if they keep up the practice of refusing to see patients because the payments aren't as high as they want them to be.

jrossi:

That is a big question. Profit is total revenue minus total expenses. What you're really asking is whether the marginal cost of seeing a Medicaid pt is greater than the marginal revenue you get from seeing the pt. Well, it depends on the practice's variable cost structure, doesn't it?
Another interesting question is opportunity cost. If you can see a private pt at $200 and a Medicaid pt at $75, the choice is easy, if you can pick and choose.
Will the specialists be in a lot of trouble? Again, it depends. If I send the ENT 9 paying pts for every Medicaid one, he risks losing a lot of money by pissing me off and refusing to see my Medicaid pt. If I send 2 paying pts for every 8 Medicaiders, well, he might not care for my business.
The devil is in the details in HC reform.

anne:

J Rossi:

This bill has lots of problems from where I sit. One comes to mind immediately: Medicaid reimbursements will increase for us primary care docs, but will be cut for specialists. This essentially turns the primary doc's office into a Community Health Center (poverty medicine clinic), where the primary is left holding the bag.

For example, suppose a Medicaid pt comes to my practice who needs immediate specialty care (draining a peri-tonsillar abscess, for example), but who will be unable to see one because none of the local ENT docs will take the risible payment. So I"m stuck, with an acutely ill pt that I can't help. Well, I could spend a hour on the phone begging someone to take him, or I could send the pt to the ER and move on to my next pt, so I can actually stay in business and keep my practice open. This kind of crap happens every single day in poverty medicine and is one of the main reasons why it can be so hellish to take care of people without adequate insurance. Begging the GI guy to see your rectal bleeder, begging the surgeon to see your hernia case, begging the neurologist to see your headache pt. Make no mistake about it, insurance that specialists refuse is inadequate. Better for mental health and, usually, the bottom line of the primary doc to refuse to take part.

[I know, I know and this is quite important and especially worrisome since there are supposed to be further limits to physician payments to come and the limits are to be selective in terms of area of practice.]

Hal:

The GOP seems headless. One would think McCain would be the leader, but he is so weak and desperate he needs Palin to help him keep his senate seat. When Palin is the GOP's not so secret weapon you can be pretty sure the party is headless, or better, brainless. What is frightening is that brainless might win lots of votes in 2012 if Americans are still angry and uninformed.

anne:

J Rossi:

This bill has lots of problems from where I sit. One comes to mind immediately: Medicaid reimbursements will increase for us primary care docs, but will be cut for specialists. This essentially turns the primary doc's office into a Community Health Center (poverty medicine clinic), where the primary is left holding the bag....

http://www.nytimes.com/2010/03/26/health/policy/26docs.html

March 25, 2010

More Doctors Giving Up Private Practices
By GARDINER HARRIS

The delivery of medical care is changing as more young physicians take jobs with heath systems and older doctors sell their practices to those same systems.

[Also, the nature of what a community doctor is and how much leeway such a doctor may have is changing and seemingly quickly.]

alan :

There are a lot of strange distortions in the medical system right now - probably a lot to do with malpractice system. For example, I went to doctor to get finger stitched, was told I needed a surgeon and had to go to ER. All I got was 5 stitches! Maybe the primaries and nurse practitioners will have to get on with doing real care instead of referring, and maybe we'll have to figure out how to get the gun-for-hire lawyers to back off.

jrossi :

That's weird Alan. This family doc sews people up all the time, and so does my NP. You must live in the East or in a big city.

jrossi :

Anne, Independent family docs have been a dying breed for years, but now it's hitting the specialists--and quick. I don't know if it's good or bad. Interesting times.

Fred C. Dobbs:

I wonder, is there any other reason for this than specialists getting much better salaries?

It is true, apparently, that doctors are 'practicing differently' these days.

http://www.nytimes.com/2010/03/26/health/policy/26docs.html

NYT - March 25, 2010
More Doctors Giving Up Private Practices
By GARDINER HARRIS
WASHINGTON — A quiet revolution is transforming how medical care is delivered in this country, and it has very little to do with the sweeping health care legislation that President Obama just signed into law.

But it could have a big impact on that law’s chances for success.

Traditionally, American medicine has been largely a cottage industry. Most doctors cared for patients in small, privately owned clinics — sometimes in rooms adjoining their homes.

But an increasing share of young physicians, burdened by medical school debts and seeking regular hours, are deciding against opening private practices. Instead, they are accepting salaries at hospitals and health systems. And a growing number of older doctors — facing rising costs and fearing they will not be able to recruit junior partners — are selling their practices and moving into salaried jobs, too. ...

jrossi:

It's the money, Fred. If PCPs could make a reasonable living we would not group up much. Actually, a small single-specialty group is fine, mainly because you can share on-call and overhead, plus a lot of us like a small group--two or three heads are better than one. But most docs, myself included, would avoid multi-specialty groups, where PCPs are low men on the totem pole, and hospital or health system owned groups, where a@@holes in business suits call the shots. Most docs like to be independent. But you can't make much of a living doing this, so we are forced to group up. There's a recent post at Kevinmd about a doc worried about cuts in Medicare putting him out of business (he's an internist so he should be OK at least temporarily with the 10% increase), but the details of the doc's practice finances are interesting. Revenue 800k, Costs 720k, take home 80k. He shoulda gone to nursing school, probably would get paid more.

Fred C. Dobbs:

I think it's interesting that doc's like to be businessmen, get the revenues, don't like the costs, complain about the net. Forget nursing; go be a (salaried!) hospitalist. On the other hand, you guys are heroes & life-savers. Deal with it!

You want $$$, go be investors.

Zephyr:

The healthcare system is being choked by the pressures of the insurance system. Insurance is the biggest problem with our healthcare system. We need to remove the insurance bureaucracy from the healthcare dollar. This applies to government insurance and private insurance.

We need publicly funded clinics and hospitals available equally to all.

We have public roads, public defense, public schools...
...why not public healthcare?

Fred C. Dobbs:

Just 4 years ago, Mitt Romney was getting along wonderfully with the Democrat-controlled MA legislature, famously establishing universal health care (which was good enough to become the model for the US plan). Things were looking up for him and the Republicans, sort of. Then the election campaign of 2008 happened and the Republicans soiled themselves. The question has to be, can they swallow their pride, clean themselves up, and return to rational political discourse? The country sorely needs to have two functional parties, for balance if nothing else. It's not looking good, yet.

Fred C. Dobbs:

'Things were looking up for him and the Republicans, sort of': aside from a furious
urgency to get past the Bush Jr years a.s.a.p.

anne:

Alan:

"There are a lot of strange distortions in the medical system right now - probably a lot to do with malpractice system."

The effect of malpractice concerns has been repeatedly studied and found to have a minimal effect on health care cost. A sense of this is that by the beginning of 2005, there were already a majority of states with malpractice suit limits in effect and the difference has been minimal if any. Nonetheless, there is a sense that malpractice makes a difference in costs even among doctors even in states with the strictest limits such a Texas. This would seem quite wrong.

Fred C. Dobbs:

It's arguably effective that doctors would have us believe that they need high pay to cover their
malpractice premiums, even if it's only anecdotal.

anne:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

June 1, 2009

The Cost Conundrum: What a Texas town can teach us about health care.
By Atul Gawande

“It’s malpractice,” a family physician who had practiced here for thirty-three years said.

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

“Practically to zero,” the cardiologist admitted....

Fred C. Dobbs:

Interesting , but as the article says:

'McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care.'

What does this 'teach us about health care'?
Don't do it like they do it in McAllen TX.

Fred C. Dobbs:

Even more interesting, the article says:

'The Medicare payment data provided the most detail. Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.' ...

I believe I have read that this has to do with physician-entrepreneurs 'providing' (selling?) diagnostic testing to their patients. Very profitably too. Personally, I think testing is a great idea, when done ethically & cost-effectively.

Fred C. Dobbs:

By the way, many doctors think
'the world' of Atul Gawande, MD.
http://gawande.com/about
Brigham and Women’s Hospital
Department of Surgery
gawande@gawande.com,
etc.

Reality Bites:

The cap instituted in Texas is not the malpractice reform that was proposed and rejected. Notice that only pain and suffering is capped at $250,000. A doctor could still get sued for millions if he fails to test for an obscure ailment that eventually leads to a loss of function or life. Thus the need to practice defensive medicine.

Republicans aren't on board on this bill. Their proposals voiced during the "debate" with Obama were rejected. There's no reason why they should lend support to a bill they believe will be very harmful to the country and end up raising health care costs.

ken melvin said...

If there really was a god, those who keep on yapping about malpractice would be among those who got their brains fried and the letter of apology cause see MO has a $250k cap.

beezer said...

The 800 lb gorilla in the room is the doctors, or lack thereof.

We don't graduate enough physicians because it's pretty much financially out of reach for most of those smart and talented enough to compete. Too few of anything is going to raise labor rates.

Also, we've turned physicians into businesspeople first. Got to make that real big "nut." Not really the right focus for medical care overall, and certainly not for producing affordable care specifically.

Too many doctors today got there in order to become wealthy. And as long as that is the primary motivation, health care will always be far too expensive.

Open up education by subsidizing medical education so all the bright young ones can compete, in return for guaranteed salaries. We'll get a stronger corps of physicians overall, as well as physicians who have the right motivation to begin with.

History:

Per Uwe Reinhardt, who knows about these things, US medical costs are too high because we pay too much for things. (Not that McAllen-style overuse isn't a problem also). The things are:
1) Medical bureaucracy, i.e. insurance companies.
2) Drugs
3) Doctors, who are paid about twice what they are in the rest of the world relative to prevailing incomes.

Our gross overpayment per year (compared to other advanced countries) is about $1T/yr,
split $300B, $300B, $400B.

We're discussing point three. The main reason (along with what beezer correctly said) for this situation is that Lyndon Johnson bribed the AMA into letting him pass Medicare. The bribe took the form of allowing arbitrary pricing for new procedures, under the rubric "usual, customary, and reasonable". In this scenario a procedure might cost $50 and a somewhat improved one $5000. I actually saw one instance of this apparently absurdly exaggerated increase cited; although I'm too lazy to look it up.

The doctors who are highly paid are the ones who do procedures. Hence, a lot of procedures.

Cutting procedure reimbursement rates is indispensable to cutting costs. The solutions to monopoly-based price increases are: 1) regulation, or 2) monopony; you take our business because there is no other.

[Mar 29, 2010] Booming business helps patients navigate medicine - The Denver Post

By MIKE STOBBE AP Medical Writer Article Launched: 07/24/2008 12:21:20 PM MDT NORCROSS, Ga.—After three surgeries, Judy Sherer still had chronic pain in her left shoulder. She'd lost faith in her doctors, and in despair tried a new health benefit offered by her employer.

The service, Health Advocate, is a call-in center that helps customers find the right doctor, haggle over insurance coverage and manage other medical system headaches.

An advocate helped Sherer find a new surgeon—one who found metal shavings left in her shoulder by a previous doctor. The advocate also negotiated the charge for her physical therapy down to $40 per visit from the $200 she was told initially.

"It saved me a ton of money," said Sherer, 63, of Norcross, Ga. "I'm very, very pleased."

Health Advocate is one of a growing number of U.S. companies offering some form of advocacy services to medical consumers. Revolution Health—the Web-based medical consumer services company overseen by AOL co-founder Steve Case—has been considering getting into the same business.

"It's a really interesting industry that's just taking off," said Carol Fischer, a spokeswoman for Pennsylvania-based Health Advocate, a 12 million-member organization.

Currently, the health advocacy business is an industry with about $50 million to $75 million in annual revenue but only about a dozen companies of any significant size, said Richard Rakowski of Intersection LLC, a Connecticut-based investment and development firm that has researched the field.

But those numbers have grown from a few years ago, and it may be on track to become a $1 billion industry based on the demand for the service, said Rakowski, the firm's principal.

The field is blossoming in the wake of cutbacks in corporate health benefits, an overhaul of Medicare and other changes that have forced medical consumers to shop more for medical care.

More than ever, people need help negotiating the medical system, said Jessica Greene, a University of Oregon health policy analyst.

"We're asking consumers to make more complicated decisions, but the numeracy and health literacy skills of many consumers are not at the level needed to handle this new responsibility," Greene said.

Though some consumers are savvy enough to beat a billing overcharge or probe doctors' litigation histories, they don't have the time for such labors, experts said.

Indeed, the largest customers of health advocacy services are companies, not individuals. "The employers are interested because it means their employees are not on the phone taking care of doctor's visits" during work hours, Fischer said.

The companies grouped into the health advocacy business range from small regional firms operating out of home offices to companies with national call centers the size of football fields. No one seems to have an exact count, but Flagship Global Health, Care Counsel and Enhanced Care Solutions are among the more visible names.

Health Advocate claims to be the largest. Founded in 2001, it now has more than 3,500 companies, unions and other organizations as clients, including Johnson & Johnson, American Express and The Home Depot Inc.

Altogether, about 2.6 million employees, or members, are signed up with Health Advocate. But the number who can use it is actually higher: Members can share the call-in number with spouses, children, parents and parents-in-law—including elderly kin who need help picking a Medicare prescription drug plan, finding a nursing home or arranging transportation for health care. With all relatives added in, Health Advocate's membership as roughly 12 million, Fischer said.

About 180 advocates staff Health Advocate's call center in suburban Philadelphia. It's usually registered nurses who talk to the patients, and each patient gets an advocate who stays with the case and is the recurring contact. The staff also includes behind-the-scenes workers who help with insurance claims and other administrative questions.

"I'd say 80 percent of (our) people call Health Advocate because they have trouble with billing," said Andrew May, a human resources vice president for Wells Real Estate Funds, the Georgia-based company that employs Sherer.

Initially, May said, he doubted Wells employees would use Health Advocate, thinking they would instead continue to come down to human resources for help rather than turn to a 1-800 number.

But some of Wells' 400 employees started using it and having great experiences, he said. Company executives appreciated the help, calling the $5,700-a-year cost a good deal.

"We're not billing specialists. We're not registered nurses. To have that resource is much more powerful—it gets to the bottom of things quicker," said Susanna Johnson, a Wells human resources manager.

Health Advocate in May began to sell its services straight to individuals, as a $365-a-year service.

Some other companies have always focused on individuals, especially rich ones.

One example is $10,000-a-year PinnacleCare, founded in 2002 by John Hutchins, who created a concierge-like service at the Cleveland Clinic. He later used his connections to build a national network of doctors for his private health advisory start-up.

The Baltimore-based company is essentially a club for millionaires and billionaires that puts nurses and social workers in touch with members. Not only will they help members find top-level care, they will get them moved to the head of the line. PinnacleCare advisers will even meet the patient at a doctor's office or hospital.

PinnacleCare has about 1,700 member-families. One satisfied customer is Kirk Posmantur, 45, the founder and chairman of Axcess Luxury & Lifestyle. His Atlanta-based company markets handmade watches, private jets and other luxury items to the affluent.

"It's a no-brainer for those who've got net worth of $5 million or more," he said. "You've got people who advise you on your taxes. You've got people who advise you on how to manage your money. But what's more important than your health?"

Not every health advocacy group is a for-profit business.

The Patient Advocate Foundation provides free help to people with chronic, debilitating and life-threatening conditions. Founded in 1996, the Virginia-based organization has 113 employees and an annual budget of about $8.5 million. It handled nearly 45,000 cases in 2007—most of them cancer patients.

The organization's founders initially expected many clients to be uninsured. As it turns out, about 80 percent have at least some health insurance but are dealing with pre-approval authorizations, medical debt from incomplete coverage or other problems, said Nancy Davenport-Ennis, the group's chief executive and co-founder.

Companies like PinnacleCare are a blessing "for those consumers that can afford to have a boutique service," she said.

She wishes, however, that companies would provide more pro bono service. "The concern is those that need help and can't afford something like that," Davenport-Ennis said.