Coming February 6, 2024 . . .
MURDER, POLITICS, AND THE END OF THE JAZZ AGE
by Michael Wolraich
Pre-order at Barnes & Noble / Amazon / Books-A-Million / Bookshop
Coming February 6, 2024 . . . MURDER, POLITICS, AND THE END OF THE JAZZ AGE by Michael Wolraich Pre-order at Barnes & Noble / Amazon / Books-A-Million / Bookshop |
Fun while it lasted.
Comments
Do you really think this well-known policy wonk (with significant experience in health insurance reform attempts) would advocate that something should be done about that problem, if he thought that in doing so it would risk "the beginning of the end for Obamacare"?
by artappraiser on Wed, 11/13/2013 - 1:29pm
Yes, perhaps. Obama was a bit uppity toward the Clintons and stole Hillary's chance which may never come back. So yeah, a way to mess with the guy on the cheap.
But the question here is whether this new law will ruin the whole in order to fix this one problem. Not sure if Clinton is recommending anything specific.
If there were a way to simply grandfather in all plans that people wanted to keep, then that might be okay, but apparently it wreaks havoc with all the underwriting.
And if the insurance companies rebel, then that could be the end of the ACA.
I could even see allowing everyone to keep their policy for another year...
Or what might make the most sense...allow folks to delete some of the provisions, like maternity care, which only apply to some people and only for specific times.
Other than that, the "essential services" I've seen listed strike me as fairly basic and not at all extreme. If a person's policy doesn't include those services, then it's a poor policy, IMO.
People only "like" their policies in the context of the choices they've been offered up to now. If the insurance companies were making these changes on their own, then you wouldn't hear a peep from anyone, and there'd be no one to blame.
by Peter Schwartz on Wed, 11/13/2013 - 2:44pm
The administration has said many times that the underwriting depended upon healthy young uninsured signing up, not that they were depending upon people who already had insurance switching over. (They are even acting like they hadn't a clue that so many cancellations would happen, so according to them this wasn't part of their calculations.)
I suspect Clinton understands how this will only work if there is less bad word of mouth and a lot more good word of mouth. Especially during this period when nobody is really truly required to get off the couch and sign up except those who have been cancelled. (The penalty for individuals is minor for those who don't do it by March 31, and the small business requirement was already waived for the year.)
On the other hand, as time goes on, maybe some of those people screaming now, if allowed to keep plans would learn there is something better for them on the exchange and then would sign up next year.
The idea of making this a market approach was partly not to have to force anyone to do anything, but to eventually push everyone to have health insurance, partly by beneficial tax preference to those who do. And to offer a place where one can shop for attractive options. To have an initial group of happy campers and then, with time as people learned about what those have, a lot more people chomping at the bit for the next enrollment period > growth. (I suspect there was even an intent in the law's creators that some employers would be letting go of responsibility for coverage and sending their employees to the exchange with subsidies, but only after many who had purchased in the first enrollment period showed they were happy.)
It's kind of strange seeing your argument when just a few days ago a lot of Obamacare supporters were saying that these insured people don't matter, that they are such a small number of the intended audience for the rollout.
Also, re:
I could even see allowing everyone to keep their policy for another year...
I don't see anyone suggesting much different than that. It's just a measure to stop forcing a nasty deadline on people who weren't expecting to have to change. Hey, it's true, like many say, if there wasn't Obamacare rollout and their insurance company did it to them (by say, raising their rates astronomically and/or changing their coverage,) they would be mad at their insurance company. But the Clinton/Feinstein view is like this: why does Obamacare want to be in that position, to be hated like an insurance company, to get that same kind of word of mouth?
I would argue that it's important that the first guinea pigs are thrilled previously uninsured. Especially because there seems to be a hell of a lot of very limited provider networks being offered in those plans. Those that ain't got no favorite doctor now to complain about losing access to. For those who already had insurance, it should rather work like this: it should eventually be painful to keep your plan, you should want to go to the exchange.
by artappraiser on Wed, 11/13/2013 - 5:12pm
AA, I was referring to these comments in the article. Personally, I don't see why folks can't simply be allowed to keep their policies for another year or until the benefits of switching become clear...but these folks seem to.
Which is why I was/am worried that the insurers might rebel if they're forced to continue the old policies of those who don't want to switch yet, or want to keep their plan indefinitely. And if the insurers rebel or the market goes haywire because of the considerations mentioned below, things could get bad.
"Health policy experts said the bill would substantially disrupt a core goal of Obamacare, which is to establish a basic standard of coverage and spread the risk.
"This basically repeals the market reforms," Tim Jost, a professor of health law at Washington and Lee University who supports Obamacare, told TPM earlier this month.
"You're continuing to allow people to buy a defective product. Mechanically it's very difficult and it denies people the community rating advantages that were the whole reason -- or one of the reasons -- for the law in the first place. ... So I think it would be significantly disruptive to the law's goals."
"The bill would also disrupt actuarial models by insurance companies because people on the individual market (who don't already have grandfathered plans) could end up keeping their policies rather than participate in the market exchanges. Insurers had based their menu of policies and premiums on the expectation that most of these people would be buying new insurance on the exchanges.
"Robert Zirkelbach, a spokesman for America's Health Insurance Plans, said a disruption of enrollment incentives may lead to higher costs because many healthy people won't be buying on the exchanges. "[T]he premiums health plans filed for next year would have to increase to account for fewer young and healthy people signing up for coverage," he said in an email.
by Peter Schwartz on Wed, 11/13/2013 - 8:34pm
The Senate Dems (& Clinton) are not pushing the same thing as House Repubs:
http://www.nytimes.com/2013/11/14/us/politics/democrats-threaten-to-aban...
BTW, on this:
Obama was a bit uppity toward the Clintons and stole Hillary's chance which may never come back. So yeah, a way to mess with the guy on the cheap.
You sound about 5 years behind on the ups and downs of the relationship between Obama and Bill Clinton. I would say that at least since before his 2012 re-election, Obama has looked to him for unvarnished constructive criticism which he doesn't always take. That was already pretty clear before Halperin & Heilemann's Double Down. But that book now tells us that after taking the call from Romney, Bill Clinton was the first person Obama called. (The latest: Obama is awarding him the Presidential Medal of Freedom next week.) Also a reminder: Hillary just spent 4 years working as Obama's Secretary of State. While it's true that they are not best social buddies because there's a personality clash, they are very much both on the same side.
by artappraiser on Wed, 11/13/2013 - 8:47pm
Maybe I missed it in your article, but I don't see how the two plans are different, and the article doesn't seem to say. And the House Democrats don't have anything to support other than a non-existent WH plan or Upton's.
Also, no one seems to be addressing the substantive worries that the health care experts (and insurance companies) express about the impact of allowing folks to keep their plans. I don't understand the technicalities, and personally don't see why it should be a big deal, but there seems to be a fair amount of worry from the experts.
Maybe I am behind the times; I see your point. However, Clinton's comments struck me as hostile and piling on and, if anything, were read broadly as a brush back. There may also be some ego involved in who gets credit for passing workable health care reform. Obama denied Hillary a second bite at that apple, and that may be sticking in his craw.
I admit--I have no evidence for this other than how Clinton's comments and the way they were delivered struck me.
by Peter Schwartz on Wed, 11/13/2013 - 9:13pm
Uppity?
by tmccarthy0 on Wed, 11/13/2013 - 5:06pm
Thought that term had been put to bed during the 2008 campaign. It does have a negative racial interpretation.
by rmrd0000 on Wed, 11/13/2013 - 5:24pm
I was responding to AA's question here, and saying, "Yes, perhaps."
I used "uppity" on purpose here. There's been bad blood between the two camps before, especially during the 2008 primary, and racial overtones were heard.
I wouldn't be surprised if Bill still feels that Hillary was cheated; that Hillary wouldn't have cocked up the launch of HillaryCare II; and that, thanks to this parvenu, her chances at a second bite at the apple are dimming.
Bill can't trash ObamaCare without a covering reason, and now he has one. If he'd really wanted to be helpful, he would've given the advice privately, not opined from the podium like a presidential hopeful.
by Peter Schwartz on Wed, 11/13/2013 - 8:28pm
Again, I think that's ridiculous. All indications have been that he is fully supportive of making Obamacare work. I would say it publicly if I were him because it's something that Dems in Congress and their constituents complaining to them need to hear, too.
Mho, he also still understands what is needed to sell to the middle better than any pol alive.
In a related vein, I find it kind of ridiculous how in certain circles there seems to be this unspoken rule that no Dems can disagree with the White House on any little aspect of how Obamacare is rolling out, but must participate in White House talking points. Especially since there's so many problems so far. As if one just keeps saying "everything's hunky dory" many times over and over, there'd be no problems to solve. Whatever happened to the attitude of "there's undoubtedly going to be problems and we're going to fix them as we go along?" What is this deal that people can't criticize? Why are we still letting fear of the GOP control the discourse? How long after a bill is passed can one stop propagandizing about it and get down to the nitty gritty of making the actual new policy work?
by artappraiser on Wed, 11/13/2013 - 9:01pm
Okay. It's how it struck me.
I don't know if you're placing me in those "certain circles," but I wouldn't call the article I posted "propagandizing."
However, it does seem to raise some "nitty gritty" problems with adopting Mr. Policy Wonk's suggestion that they allow folks to keep their policies.
I don't know if their technical concerns are valid or how valid they might be.
Do you?
Certainly, there is some political value in allowing folks to keep their policies, but if it fouls up the works in a fundamental way, then it may be a short-lived victory.
by Peter Schwartz on Wed, 11/13/2013 - 9:32pm
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/11/13/obamacare-is-in-much-more-trouble-than-it-was-one-week-ago/
Ezra expresses my worries in a couple of areas, including with Clinton's remarks.
by Peter Schwartz on Wed, 11/13/2013 - 9:37pm
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/11/07/wonkbook-seven-reasons-obamacare-isnt-facing-a-death-spiral/
Also good, but not quite on this topic directly...
by Peter Schwartz on Wed, 11/13/2013 - 9:52pm
You could have said that there was bad blood between the President and Bill Clinton, it would have made your intention clear. "Uppity" took the discussion away from your main point.
I think Clinton should be pressured to either correct the impression that people who are having insurance companies lie to them should be told to keep junk policies or say that he wants junk policies to remain in the marketplace.
by rmrd0000 on Thu, 11/14/2013 - 1:31am
Democrats need to stop the Obamacare freakout and take a stand.
by rmrd0000 on Thu, 11/14/2013 - 8:19am
True, and if I offended you, RMR, I apologize.
However, I don't think "bad blood" captures the sense of an interloper swooping in and taking from you what you think is rightly yours (and would've done a better job of).
Maybe interloper would've been a better word. Clinton did say at one point that he thought Obama should get some more experience before he ran. That he wasn't ready.
I injected racial overtones in part because a lot of criticism of Obama has that root, IMO, and I have a vivid recall of racial overtones from the primaries.
And because I wonder why he would make an unhelpful comment like that at a moment like this, especially as Obama had already said he was going to work to correct the situation for those people. I think I have the timing right.
There's been a fair amount of press--see TNR recently--on why Hillary may have missed her moment, so Clinton may be reacting to that. Sort of like: "If Obama had only waited until he was ready, Hillary could've had her moment and done a better job of things like foreign policy and health care. Now her star may be in eclipse."
Anyway, I seem to be the only one who felt Clinton's comments this sharply and inferred racial overtones--all without explicit evidence--so no point my continuing down this path.
by Peter Schwartz on Thu, 11/14/2013 - 1:47pm
Well, the president just finished a lengthy news conference with an announcement, including taking questions, in which he very much agreed with Bill Clinton's opinion. I watched/listened to many parts of it, and many even sounded very Clintonian. One of many news stories to come:
Obama Gives One-Year Reprieve for Canceled Policies
by artappraiser on Thu, 11/14/2013 - 2:08pm
This is a political move, AA, as was Clinton's suggestion.
What I was trying to point out is that the experts believe there are substantive reasons not to do it (possibly).
Since you've been talking about getting down into the weeds to see what's needed to make the plan actually work, I was surprised that you didn't seem interested in the substantive objections to making this move.
by Peter Schwartz on Fri, 11/15/2013 - 10:37am
No problem. Per the news conference, people are going to pay more money to keep junk policies so they will be happy for a year. More profits for the pharmaceutical industry.
I think really ticked me off was not your comment, but how bad the reporting has been by MSM on the costs of these smiley, happy junk policies. I tend to get better analysis on the net, but most folks still use the networks.
CBS created a fictional Benghazi story and now a fake a Security hole story on the ACA website. The pols go into panic mode because the public still trust the viewpoint of the MSM and the MSM is becoming less reliable.
At any rate, we're good.
by rmrd0000 on Thu, 11/14/2013 - 3:01pm
This sums up how I feel about the events surrounding Obamacare
by rmrd0000 on Thu, 11/14/2013 - 3:32pm
He says
to calm the fears of the Democrats who’ve now jumped on the “All Is Lost” bandwagon.
and I would like to point out that we are commenting on a post titled
The Beginning of the End for Obamacare
which argues that if we cater to what he calls the "all is lost bandwagon" (I don't agree with that characterization, as no Democratic representatives are talking that way,) that all is lost!
You and him see irrational panic in previous media coverage of people complaining about things that weren't working. I don't. I see the way something like this whole plan was intended to work!
I do see irrational panic in people like you and him and Peter thinking that if people publicize flaws and complaints and then other people then are inspired to try to do something about fixing them, all is lost and we are screwed.
If you listened to the president today, he very much stressed that this overhaul is very much a step-by-step process, where things will change as need be. Not that it is or should be thought of as an overnight revolution.
by artappraiser on Thu, 11/14/2013 - 3:49pm
Complain away. What I am saying is that many people will be keeping junk policies that cost more money. You can't seriously believe that my posts here actually represent the majority of opinion being represented in the MSM or on the Internet.
It was obvious that the computer glitches had to be repaired. It is also obvious that in the short term, some people will be impacted financially because they are not fully aware of their options. I don't expect the insurance companies to point out how their customers can save money, but Indo expect the media to be a moderator. That is not panic on my part.
by rmrd0000 on Thu, 11/14/2013 - 4:04pm
Here is ex-Bill Clinton appointee Robert Reich on the problem with the freak out among Democrats.
by rmrd0000 on Thu, 11/14/2013 - 4:14pm
Yes, the President might have spelled this out a bit more clearly beforehand, explaining that 95 percent of us aren't in the private insurance market to begin with and won't be affected, and that most of the 2 percent who lose their lousy policies and have to take better and more expensive ones will be subsidized.
But right now the President needs all the political support he can muster to hold insurers' feet to the fire. Democrats should stand firm for a change
Shorter Reich: "Yeah, Obama is a bait-and-switch swindler, but he's our swindler..".
by jollyroger on Thu, 11/14/2013 - 4:54pm
You think that the subsidized better coverage plan is a swindle?
so when they have to pay out of pocket for things not covered its a benefit?
by rmrd0000 on Thu, 11/14/2013 - 5:39pm
Well, not to put too fine a point on it, it appears that there was general recognition at the time of the original statement that it was in fact subject to some qualifications which were rejected as unfelicitous muddying of the message.
More widely, I experience him as promising more than he delivers, and I don't any longer put it down to simple good faith overestimation of his capacity, as much as he finds it convenient to speak in terms which give him excuses for subsequent non-delivery, which non-delivery comes as a surprise to the listener, but not to him.
by jollyroger on Thu, 11/14/2013 - 6:19pm
So cheap policies that cover nothing and will result in high out of pocket payments are OK?
by rmrd0000 on Thu, 11/14/2013 - 6:30pm
Of course not. That said, here is the statement that should have been made instead of "if you like your policy you can keep it"
"If you have a policy that meets the minimum requirements that are the heart of the ACA community rating system, you can keep it; If your policy and the premiums it commands depend upon the carrier hiding the ball, ie reserving the right to hang you out to dry in the various ways that have become the grist for horror stories of retroactive cancellation at the moment when care is urgent, you will not be left to the mercy of an avaricious counterparty, whether you are foolish enough to think it good or not."
This is called having the courage of one's convictions. Not a characteristic that I find abundant in Prez...
by jollyroger on Thu, 11/14/2013 - 6:43pm
I'd reconsider using the talking points "cheap plan" and "high out of pocket payments" as a negative if I were you. Because the Exchange Bronze Plans require 40% out-of-pocket payments for which the policy holder is liable up to $6,350 per year for a single and $12,700 for a family, and have the cheapest premiums for that very reason.
BTW, the Silver is 30%, Gold is 20% and Platinum is 10%, all with the same maximum out-of-pocket per year as the Bronze.
by artappraiser on Thu, 11/14/2013 - 6:59pm
Are you saying the personal economic requirements in the junk policies are better?
Using Romneycare as a yardstick, the same glitches including website problems and initial low enrollments. It took up to one to three years for enrollment to peak in Massachusetts. When the WaPo reviewed the early experience in Massachusetts, they had problems finding stories about the glitches because the legislature focused on improving the law. Congressional Democrats have to have the backbone to fight for the law. Repairs were obviously going to be needed. The total Democratic freakout going on is not warranted.
Woosah
by rmrd0000 on Thu, 11/14/2013 - 9:26pm
See below comment on a report rom Consumer reports on the junk policies.
by rmrd0000 on Fri, 11/15/2013 - 1:14am
I was saying that if you want to talk in favor of exchange policies, and against cancelled policies, that pointing out high deductibles in the old policies is probably not a wise point to harp on. Because the cheap exchange policies also have them. Perhaps this Bloomberg article quote might help you understand what I was saying : ...high deductibles have the potential to become the next political land mine for an administration already struggling with website outages, customer confusion over eligibility and the cancellation of existing policies....
by artappraiser on Sat, 11/16/2013 - 12:02pm
Everything about universal coverage is a land mine. You gain prescription drug coverage, wellness visits and hospitalization. We are not going to single payer in the near future unless a dramatic change occurs in Congress. Do you see any solution to the deductibles given the coverage gains?
by rmrd0000 on Sat, 11/16/2013 - 12:32pm
You have to look at what you get for your money.
• No pre-existing exclusions.
• No caps.
• No rescission.
• Many more things covered.
by Peter Schwartz on Fri, 11/15/2013 - 10:45am
Perhaps.
On the other hand, he got the law passed (something that hadn't been done in 100 years) and, to your comment about courage, you can't argue that he hasn't paid out a lot of capital on it and went against his advisors in pursuing it when he did.
What has Bernie Sanders done?
What did Kucinich do?
How about Alan Grayson?
How about Florio?
Or (take your pick)?
If he'd made a complex statement with lots of caveats, if-thens, and all kinds of other weasel words, then everyone would have been wondering "what's going to happen" and nothing would have gotten done.
Including single payer.
Better to ask for forgiveness than permission.
by Peter Schwartz on Fri, 11/15/2013 - 10:51am
this overhaul is very much a step-by-stepprocess,
When do we get to the step where the health insurance industry is declared a public utility with federally regulated rates? Hint:That was supposed to be step #1 of Health Care Refrorm
by jollyroger on Thu, 11/14/2013 - 4:57pm
How exactly was that going to happen?
by rmrd0000 on Thu, 11/14/2013 - 5:41pm
Max Baucus was going to have an untimely encounter with a truck, and Teddy Kennedy was going to survive to walk point on a bill reported out of his committee instead of Finance.
by jollyroger on Thu, 11/14/2013 - 6:20pm
LOL
by rmrd0000 on Thu, 11/14/2013 - 6:31pm
Would that be the great progressive Teddy Kennedy who co-sponsored No Child Left Behind? Friend, Teddy was a compromiser and learned a lesson when he stiffed Nixon on his health care plan. He worked regularly with Orrin Hatch fer crissakes.
If you don't like compromise...if you don't like making sausage...if you don't making a pact with the devil...if you don't like using sugar to make the medicine go down...
Then you're a fine fellow, but with no future in politics.
by Peter Schwartz on Fri, 11/15/2013 - 11:01am
Well, I certainly have no future in politics.
Withal, the scenario as spun was not aiming at verisimilitude. For one thing, in order to use (budget) reconciliation as the vehicle for avoiding the mathematics of a filibuster, the bill in question must (if I understand correctly) originate in the finance committee.
by jollyroger on Fri, 11/15/2013 - 3:56pm
I'm sorry--you're being dense, AA.
Read what I've actually posted...at first...and subsequently.
by Peter Schwartz on Fri, 11/15/2013 - 10:40am
It is a political move to helps save the seats of some southern Senators in the 2014 elections. I don't see it going anywhere. Reid will have to bring up for a vote. That will only happen if it looks like the Democrats will loose the Senate next year. GOP is in such a mess and I don't see them gaining much next year.
by trkingmomoe on Wed, 11/13/2013 - 3:00pm
PP poll just came out and shows Sen. Kay Hagan has fallen behind for the first time. She will be in a tough reelection with any of the GOP that have announced. She was ahead by 6 to 8 points six months ago with all the challengers. The poor roll out of ACA is blamed for the drop in numbers.
by trkingmomoe on Wed, 11/13/2013 - 11:47pm
So far, Obamacare isn't looking good. It's telling that many Democrats were trying to get it delayed until 2015, after the elections.
Attempts to force the market to work the way you want it to don't generally pan out too well. Single payer would have made more sense.
by Aaron Carine on Wed, 11/13/2013 - 4:03pm
Consumer Reports looked at some of the policies listed as junk insurance. Not a pretty picture.
by rmrd0000 on Fri, 11/15/2013 - 1:17am
While this McDonalds junk insurance may be a problem it is not the problem that people, who's real insurance policies are being canceled because of the ACA, are facing. Our Free Market allows this kind of junk to be sold, to fools, just like penis extender pills and gas mileage improver gadgets.
by Peter (not verified) on Fri, 11/15/2013 - 2:44pm
There have been several interviews with people who claim that that had low cost insurance that covered everything. When some of these stories were scrutinized, it was found that there was no truth to the excellent coverage statement. There's is an example of a 58 year old woman who had $300 insurance. The premium rose dramatically under Obamacare and was reported by NPR. the veracity of her payment and coverage was not addressed. Several comments on the NPR website indicated that her plan could not be as extensive as alleged.
Mother Jones found many of the complaints about canceled plans did not hold up to economic scrutiny I'm not sure that we know the true impact of what people had covered with a low- cost insurance plan.
by rmrd0000 on Fri, 11/15/2013 - 3:25pm
Here are the 10 essential benefits that must be contained for a plan to comply.
"Essential health benefits must include items and services within at least 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; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care."
With the exceptions of maternity care and pediatric services, these strike me as fairly basic and non-controversial. It would be interesting to see what the majority of canceled plans covered and matched against this list.
I could see allowing people to opt out of these two areas if they're never going to apply to them, unless doing so upends the economics such that these services have to eliminated across the board if some people opt out of them. IOW, do they have to be included in all plans for them to be included economically in the plans of the people who need them?
by Peter Schwartz on Fri, 11/15/2013 - 9:55pm
I'm not sure if the economics requires everyone to pay for maternity/ newborn coverage. If they allowed an opt out wouldn't most men opt out?
by rmrd0000 on Fri, 11/15/2013 - 10:52pm
That could be the reason so many articles say many women are charged twice as much as men. But hey, its not like men have anything to do with making babies! Its only fair women should pay more.
by ocean-kat on Sat, 11/16/2013 - 1:28am
I've read a lot over the years with evidence that women use health care services much more than men, and it's not just accountable to maternity care. Most people have anecdotals that concur, i.e., even within a family that's reasonably health-care oriented, many women have an annual gynecology appt. for pap smear and then the mammograms as well, while men don't go see a urologist once a year, their G.P. handles the sex parts stuff once every few years. (And that's without getting into the stereotype of guys who just refuse to use goddam doctors...)
by artappraiser on Sat, 11/16/2013 - 2:16pm
It may be that the stereotype of men not going to doctors for preventive care is the truth.The goal should not be to penalize women but to encourage men to use preventive measures for a number of diseases.
by rmrd0000 on Sat, 11/16/2013 - 2:24pm
One of my favorite topics and, I would argue, not as straightforward as most imagine. That all depends on the quality of preventive care. If you have a system that is not profit motivated, like NHS, it works. If your preventive care practitioner is susceptible to influence of the medical industrial complex, though, watch out, the patient could be worse off health-wise (entering a cascade of treatments causing iatrogenic illness and then counter-treatments,) while at the same time spending a lot more health care dollars.
Men have actually been a target of a lot of this in the last couple of decades. They would get all the expensive cardio tests recommended by their doc and then have gotten all kinds of dubious treatments from those results, like angioplasties which later became highly criticized treatments. Preventive care has to go back to: first, do no harm.
by artappraiser on Sat, 11/16/2013 - 2:45pm
The angioplasty story changed with the science. A blocked vessel was viewed as a bad thing.there was a move to open all vessels if possible. Studies were conducted to assess the impact of this treatment. The open all vessels did not work in patients with angina that was stable. Practice is changing
There are people with chronically occluded vessels who benefit from having those old vessels opened. In fact you may even dissect an occluded vessel and re- enter it to place a stent. Previously these vessels were thought to be just a part of the damage done by coronary artery disease with no good therapy available.
I think it is important to constantly question medical practice and the efficacy of therapy one problem that is encountered is that techniques improve over time, drug therapy changes, etc. The results of what was done five years ago does not apply to what is being done today. The observation that fewer people improve with angioplasty that expected is part of the ongoing quality analysis that is needed.
I think the angioplasty situation is much different than the low testosterone clinics popping up all over. There is essentially anecdotal data without full analysis of possible harm.
i
by rmrd0000 on Sat, 11/16/2013 - 3:35pm
To be clear, here's where I am coming from: all insurance is maddening and sucks. It doesn't seem fair that a very safe teen driver should have to pay a hell of a lot more for car insurance than a careless 40-something driver, but that's the way insurance is, it tars people with attributes of tribes.
by artappraiser on Sat, 11/16/2013 - 2:27pm
You buy insurance as an individual and use it as an individual, but you pay as a statistic.
by Peter Schwartz on Sat, 11/16/2013 - 2:47pm
I'm not sure either. Just wondering why this became one of the essential services that all plans must cover. Seems a little odd because there are plenty of people who know they will never use this benefit, unlike other benefits that will probably never be used, but always could end up being used, e.g., hospitalization for cancer treatment.
It's possible that maternity benefits are so expensive the companies need to spread the cost as widely as possible and have it borne by people who will never use it.
Just as happens with all benefits. Those who never use their benefits are always paying for those who use benefits. Otherwise, the premiums would be sky high(er), or the insurance companies would go broke quickly.
One way around this might be to allow for an opt out, but make it a permanent opt out. Or an opt-out for an especially long period to avoid people opting out until the moment before they needed the coverage. The bargain would be: It's fine if you don't want to pay for this benefit. We understand, but in return, you have to give up your access to this benefit forever, or for a long time.
(Of course, this still doesn't address the needs of people who get pregnant accidentally and want to keep the child, of whom there are many. I don't think we want the insurance company trying to decide whether a pregnancy was on purpose or an accident. So it's possible that a blanket requirement to pay for this benefit is the only reasonable recourse. Then again, I'm not sure what happens now when someone isn't carrying maternity coverage, under a pre-ACA plan, and gets pregnant. Does she or the couple have to pay for this care out of pocket? Lots of questions; few answers.)
Men who wanted to have kids or thought they might have kids (in whatever way that might happen) wouldn't opt out.
by Peter Schwartz on Sat, 11/16/2013 - 1:53pm
Wait, what?
MyThat penis extender doesn't work?by jollyroger on Fri, 11/15/2013 - 3:52pm
It's worth noting that the Obama-Clinton "fix" to this problem seems to be sowing even more confusion in the hinterland and insurance commissioners and companies are rebelling--if WaPo's story is to be believed.
If we lose big in 2014--and things aren't running smoothly--watch out below.
by Peter Schwartz on Sat, 11/16/2013 - 1:55pm
I think that things will settle down and in the final analysis, it will be a choice between folks trying to get people healthcare and other people who just want you to plan a funeral if you're sick. So I'm not yet pessimistic about 2014. Better that this is happening now.
by rmrd0000 on Sat, 11/16/2013 - 3:38pm