Michael Wolraich's picture

    Dear angry American who has to pay more for better health insurance,

    Bummer. I know the premiums are steep. I've been there. I remember when I moved from Philadelphia to New York City, and my rate jumped from $200 to $800--without even changing my plan. I received a letter saying that my premium might rise. The next thing I knew, boom, $800 charged to my credit card.

    At least you get better coverage out of the deal. I still had to pay for my ER visit because it fell under my $3000 deductible. But what could I do? This America. Private companies are supposed to wring people out like dirty washcloths. It's called a free market.

    But this is different, isn't it? It's not the free market that's squeezing you dry. It's the government. Government isn't supposed to squeeze people. It's supposed to get out of the way and let the free market squeeze people.

    I hear you. At least you had a choice in the free market. When one company squeezed you, you could go to another company that squeezed you slightly less. Unless you had a preexisting condition. In that case you'd be lucky to have any insurance at all.

    But that's not you, of course. If you had a preexisting condition, you wouldn't be complaining about your premium. You'd be screaming hallelujah that someone finally forced the free market to serve people with preexisting conditions.

    No, your problem is that you're healthy. Why should you have to pay more for a better health insurance plan that you don't need right now? OK, OK, I'm not going to lecture you about health insurance. I'm sure you're smart enough to realize that the point of health insurance is to cover care that you don't need right now (which is why they call it health insurance). If you want to take your chances, I don't really care.

    But here's the thing, I see no need to let other folks suffer just so that you can take your chances on lower premiums. Millions of folks have been driven into bankruptcy and lost their lives because they couldn't get health insurance. Did you give a damn about them? No, I didn't think so. So tell me, why should I give a damn about your premiums?

    The press is on your side these days, telling everyone about your misfortunes. So are the Republicans of course. If you listen to them, you might think that a great anti-Obamacare movement is about to sweep the nation and save you from higher premiums.

    Let me tell you something. They're using you. The press is using you to sell copy. The Republicans are using you as ammunition in their war against Obamacare. But neither of them gives a damn about you. The press will last another few weeks until the story goes stale. The Republicans will keep playing you as long as they get mileage out of it, but that won't last long either.

    The truth is that most Americans don't care about your premiums. As long as their rates aren't going up, the hell with you. We Americans are selfish that way. That's why it took us so long to pass a health care law in the first place.

    You get that, right? I mean, you're just as selfish as the rest of us. Maybe even a little more.

    I tell you what, if the insurance companies try to screw you, let me know. In the meantime, enjoy your health.


    Best regards,

    Michael W.


    Oh snap, that was an awesome read. 

    Well done Michael W.

    I have been following this issue on MSNBC and the web and...

    There are or were insurance policies out there that covered NOTHING!

    A couple hundred a month, and you have a 10,000 buck deduction and then you might have coverage as long as you do not demonstrate a pre-existing condition.

    Just look at the Rain Maker.


    Or what about Helen Hunt's film, As Good As It Gets


    The reason these films really grabbed America and the media was because truth was contained within their parameters.

    A kid has asthma and if he could no longer breath, you have to get him to the ER!


    Of course the Ghost Buster shows up and saves the day....hahaahahahah

    Yeah, some folks have to pay more now so that when they collapse from capitalistic nervous breakdowns they might have received some relief from the insurance monopoly.

    I have a granddaughter who has all these ailments and there is no issue concerning helping the little waif.

    That is enough of that.

    Oh, Barry has lied to us.

    No he hasn't.

    These people were never given the right to choose their doctors.

    Good post.

    I am sorry, as you already know after all these years, I must rant.

    It is a mental illness I have. hahahahahh

    This might be my very first comment ever on the health insurance controversies. I like what you say a lot in this blog but there is still a fundamental problem with it. You need to condense it to fit on a bumper sticker so the bleapin' morans can understand it.

      You really think it doesn't matter that Obamacare is raising premiums? It seems like a bad thing to me. It means people are being "squeezed".

      I think many people whose premiums are going up do care about other people lacking insurance, and even if they don't care, that isn't a very good reason to raise costs.  Is national health care supposed to be punitive?  Some people(I don't know how many) are getting bumped off their plans, which Obama promised wouldn't happen.

     I like intervening in the market for the sake of justice, but when state control becomes excessive, things tend to get screwed up.

    We must bury the notion that any financial burden, any constraint on choice is excessive government. It's a Republican sham that has somehow sucked in the entire establishment. The impact of the ACA is miniscule compared to the kinds of programs this country once tolerated. According to contemporary standards, Social Security, Medicare, public education, and numerous other institutions would never have come into existence.

    As for the political consequences, the number of people who think of themselves as being "squeezed" is a small constituency. This can only become an enduring problem if a larger number of Americans come to believe that their health insurance is not secure. That is the only risk here.

      Every  constraint on choice isn't excessive--minimum wage and the eight hour day are desirable constraints on the choices of capitalists, as is the FDA and the FTC--but some  constraints ARE excessive.  Attempts to force the economy to work the way we want it to usually haven't been too successful. And forcing individuals to buy a product is something I can't accept. Single payer would make more sense.

      It will be good if things work out the way Ocean-Kat says they will, but I don't know if they will.

    I don't understand this reasoning. How is single-payer, which would require people to buy government health insurance, less excessive than ACA, which requires people to buy private health insurance. And why do you refuse to accept the latter?

    I didn't claim that things will work out. I just disagreed with your opinion that some people are getting squeezed. There are a lot of problems with the ACA and it might be a disaster even after the website is fixed. In addition, unlike the problems with Medicare part D which the democrats accepted after it was passed and helped to fix, the republicans will not help to fix Obamacare at all.

    Yes Obama lied. He shouldn't have. But no one is getting squeezed. Most of the people losing their plan and having to pay more are getting a better plan. The plan they had which they "liked" was useless. Insurance companies never should have been allowed to sell them. That's one of the things governments do, protect people from shoddy products. Its a good thing that these shoddy plans can no longer be sold.

    Some of those people may decide not to buy a better plan and pay the fine. They might claim they used to have insurance but now they don't because they can't afford it. That's not really true. They never really had insurance which they would have discovered if they ever had to use it.

    By the way, its about 3% of the population that had these shoddy plans. Not all of them will have to pay more. Some might get subsidies.

    I don't think "this is a small portion of our population" is a functional argument about those unhappy about Obamacare exchange results. Because the exchanges are a program targeted to the minority who do not have coverage from employers! It's for those previously uninsured and for those previously buying in the individual market, that's the target users, a minority.

    (Until, that is, the government and the majority finds out what subsidies might end up costing them in taxes, and whether they feel it is worth it. Let me be clear where I am coming from here: if it's successful, that cost could be like zero! And lower the cost of employer-provided insurance to boot. Either that or employers will just start to get out of the business of providing it because it's cheaper to pay their employees to buy from the exchange.)

    I think the best argument in support of the Obamacare exchanges is that the same system is working in Massachusetts.  Period.

    Unfortunately, so far I also think Romney and his former MA people do seem to have a point that they were better at setting it up. We wait to see whether they are wrong.

    The plans being eliminated just... don't qualify as insurance.  If you're going to allow under insurance, you might as well just allow people to go without insurance and scrap the mandate.

    The financial proposition here is incredibly stupid.  A diamond costs $10,000.  I don't want to pay that.  So, I'll give you $7,500 for a fake gem worth $1 and then get mad if you make fake gem sales illegal?

    You guys that are arguing that these were shoddy plans and not real insurance are not going to get anywhere convincing people who lost them. Because all of them weren't. I don't know how many of them, but neither do you.

    I know for a fact, because my spouse had one. It was an Emblem Health plan, very respectable company, now offering other plans in the NY exchange. The plan was high deductible in order to qualify to be used with a Health Savings Account to cover that deductible. That annual deductible, BTW, wasn't any higher than the highest one being offered by some Obamacare plans, certainly not higher than the $6,000 or so that the new law requires, it was lower than that. But it also offered preventive care free of charge like a full annual physical. It was a Preferred Provider Plan, where you could use their network of doctors for full reimbursement (which was a large network across the country) or go out of network to any doctor or specialist with a 20% co-pay, without any restrictions and no referrals required. Not only that, as of 2010, it also already included a lot of Obamacare provisions, as stated on page 2 of this 69 page PDF booklet.

    For whatever reasons, they decided to discontinue the plan as of Dec. 31. And to offer different plans. I don't really understand all the reasons yet, I don't think anyone really does. It's surely financial. This graph from a Forbes article by one of the gripers gives a clue:

    Now, insurers can’t decide eligibility — or even tweak premium rates — based on applicants’ medical histories. In the individual-coverage market, we’re all being billed a much higher blended rate that reflects the needs of people with bigger health problems.

    Spinning it that they were all shitty plans isn't going to play because a lot of people who had them know they weren't. Rather, the only argument that's going to work is the one along the lines of what Mike W. is making. That people who don't qualify for a subsidy and will be paying more for a different plan than they were used to will have to eat that for a while so that we can get going on covering everybody and thereby start reforming the health care system and it's costs.

    The eligibility rating thing is key, key to understanding what is really going on. Yes, you can't be dropped anymore from that plan you liked or be hit with major raises in rates once you start making claims. But that's not the full story of what's going to happen as we go forward. As Ezra Klein has stated, the key to solving a lot of this trouble is the sign up of healthy young people! If that doesn't happen, EVERYONE'S premiums will go up! Not just those griping now! A certain profit above costs is allowed by this law! So premiums will go up for many more if the healthy don't sign up! Conversely, if it does happen, if lots of healthy young people sign up, everyone's premiums may go down within a year or two, including for the currently disgruntled! If it doesn't happen, a lot more people will be griping and the GOP and the currently disgruntled will say "I told ya so." If it does, the griping will stop and it will be just like the introduction of Medicare or Medicare Part D, where when people finally got adjusted to it, they liked it.

    This is the major reason why the website problems are extremely dangerous to the whole program.

    Not to mention, the inability of those who have been dropped as of  Dec. 31 who have to use the Federal exchange to shop and carefully consider the plans being offered in time to continue coverage is causing a lot of anxiety.  In the past when a plan they liked was discontinued, they were not told they would have only a two week period to investigate alternatives for a major decision that might affect lots of other life and financial considerations.  And that two weeks is if the administration is lucky and gets the system working by the end of the month. The extension of any deadline isn't a workable alternative. Because the insurance companies have already transitioned away from the plans they are ending and into other things, either in the exchanges or out of them. The website had to work and it didn't, it really is a disaster that it didn't. Especially if a lot of young people don't sign up in the open period. Because then the insurance companies will be able to raise rates on everyone in the pools to cover the pool they have at the time.

    BTW, if you want to talk "shitty" health insurance, check out some of the new "Bronze" plans. They are apparently still being allowed to offer "shitty."cheeky

    Key quote from Ezra Klein's piece for those too lazy to read the whole thing, my bold:

    To the White House, the difference between success and failure is straightforward: They need to entice a sufficient number of young and healthy adults into the new insurance marketplaces that open Oct. 1.”

    I want to be clear on this: No one said that success was letting kids up to age 26 stay on their parents' insurance plan. No one said it was regulating insurers or covering preventive care. Instead, everyone in the White House shared a singular definition: Success meant setting up the exchanges and attracting enough young people that premiums stayed low.

    This was true even when the conversation turned to Medicaid, which is responsible, in theory, for half of the health-care law's coverage expansion.


    Sicker, older people, the administration figured, would be desperate to sign up for health insurance. In a sense, that was the problem: They'd be so eager that they'd sign up in much greater numbers than the young, healthy people needed to keep premiums low. Attracting those young and healthy people was thus the core challenge. The White House figured that if they got 7 million people to sign up for the exchanges in the first year, about 2.7 million needed to be young.

    That is followed by an explanation of how the lack of Medicaid expansion makes this even more crucial. Keep in mind that with so many poor falling into a gap where they are still not covered, we continue to have the expense problem of unpaid emergency care. So every state that changes its mind and expands Medicaid helps to make Obamacare more successful, and that probably won't happen unless the exchanges become more popular. You can't make something popular by screaming at people that they should stop complaining and be grateful for what happened to them, you have to make them like what happened to them. And for this program to work, healthy people have to like what happens to them on it.

    Oh my my my .  .  .

    Ezra's words...

    "There are dimensions to these arguments that really center on the job of the journalist..."


    Yes... And there's Ezra and his editor doing their job.



    You guys that are arguing that these were shoddy plans and not real insurance are not going to get anywhere convincing people who lost them. Because all of them weren't. I don't know how many of them, but neither do you.

    Yes you're correct. If you look at my comment I was very careful to not say "all." There is another group of people who will see cancelations and many will likely have to pay higher premiums for equivalent products. But they aren't getting "squeezed" as Aaron posted. They're losing an unfair advantage they never should have had. The only way insurance companies could offer such low prices to some is by refusing to cover people with pre-existing conditions, or to exclude or limit the number of older people, or by  using unethical business practices to toss people off their insurance and refuse to pay when they needed it. The market for those without employer based insurance was a mess and needed to be reformed. When you remove discriminatory and unethical business practices those who benefited from them will lose their advantage and pay more.

    I know this isn't the best way to sell Obamacare changes to the people. I'm not trying to spin it for my "side." I'm not a big supporter of the ACA and I have no idea if it will be successful. But even if there was no Obamacare, no individual mandate, no mandate for employers, no subsidies, I'd still support many of the reforms of the individual insurance market.

    To add, those with pre-existing conditions are not necessarily sicker than those without nor will they inevitably cost more. Many if not most of them are no more risk than a healthy person. They are just riskier as a group and there's no way to tell which ones will cost more. So all of them were refused insurance.

    For example my mother got ovarian cancer at 45. She's 84 now and never had a relapse. Yet if my father wasn't working for the Bethlehem Steel she would likely never had insurance after that until medicare.

      "We're making you pay more because you don't deserve the good plan you have" does not seem to me to be reasonable, and you're right, it isn't going to persuade people to like Obamacare.  It seems punitive.

    But of course. Anytime you end discrimination it feels punitive to those who are losing their privileges. Just as discriminatory systems feel punitive to those discriminated against. I tend to stand with the victims of discrimination rather than those hurt by the loss of their privileges.

    If I had time I could fill  pages with links to articles and heartbreaking stories of people with pre-existing conditions who can't get insurance or of people who have paid insurance for years only to be kicked off their plan for spurious reasons when they finally needed it. Most readers would say that's wrong, that's unfair, that's punitive,   something should be done. What would often be unspoken is, "Something should be done as long as I don't lose the advantage those practices give me. As long as I don't lose my privileges."

    The fact is most of those advantages are directly correlated to the disadvantages of the  victims. You can't have one without the other. The fact that the insurance companies are acting as a go between so the folks with the "good" plans don't have to stand directly on the backs of their victims doesn't morally absolve them.

      I don't know; should we blame people for having good health insurance? Helping people becomes problematic if you do it by lowering the quality of life of other people.

    Yeah, I know what you mean. Its sad that teen age girls are dying in collapsing and burning factories in Bangladesh and I'd like to do something about it. But not if it means I have to pay more for socks. Helping people is ok but not if it means lowering the quality of life for other people.

    Its one thing for a person to participate in a system where their quality of life is improved by feeding off the misery of other people when they have little choice or power to change it. Its quite another for a person  to complain about the increased costs incurred because the government stopped them from feeding off other people's misery.

    Your husband's plan sounds like a number of them I had over time.

    What did he "like" about it?

    I'll tell you what I liked about mine: I was covered. Period. Whatever expenses it paid for--check-ups, medicines, etc.--was gravy. Also, I had about two insurers to choose from, so it wasn't as if I had a lot of choice or opportunity to shop, and I lived in D.C. And when I did "shop," good luck understanding the plans and comparing them.

    The only way to get an affordable premium was to choose a high deductible, which meant the plan didn't pay for anything unless I was REALLY sick, which I never was.

    The HSA component was fine. But all I did was funnel money through the HSA (and it wasn't all that convenient to put money into my account or find out how much I had left in there or even figure out "who was on first" since the insurance company did NOT manage the account) for the tax break.

    I didn't have the money to pay for my check ups AND put money aside and allow it to build up tax-free, IRA style. And put money away for retirement. And put money away to buy a car or a house. So if I hadn't been able to benefit from a tax break, the HSA would have amounted to nothing more than an administrative hassle.

    The free market idea behind HSAs was that you'd be spending your own money so you'd spent it more wisely, shop more, bargain more, etc, instead of just going to the doctor because someone else was paying an unknown amount for you to go.

    Not true. How many people make frivolous, money-wasting visits to the doctor? Most people don't go often enough. Most men never go. They also don't take their medicine. The idea that HSAs were going to empower consumers and bring down medical costs was always nonsense.

    Moreover, the big ticket items that drive up costs are not the kinds of items that most people can pay for through their HSAs. I'm not going to pay for a triple by-pass with the 10K built up in my HSA (and it never got that high).

    This fixation on being able to "keep your doctor" is also strange. Most of my doctors were "out of network," so I mostly paid them out of pocket. For decades. Whenever someone said, "So and so is a great doctor," it was certain money that he or she out be out of network.

    And when I searched for doctors "in network," it mostly meant I had to "give up my doctor" because he or she was not in network. Most of the "good" doctors didn't participate in insurance plans because they didn't want the administrative hassle. So, where's the "choice" in all of this?

    The fact is, insurance companies constantly canceled certain plans and simply shunted their policyholders into new plans or gave them an array of incomprehensible choices of "new" plans.

    The big danger lay in ever allowing your insurance to lapse, because then you'd NEVER get picked up. EVER. But now that danger has been eliminated, so if someone goes a month or two without insurance while the system gets worked out, it's not as if he will be barred from signing up because his coverage lapsed.

    One of the good things about that plan, when used with an HSA, is that you could easily go outside network to anyone really, and have that 20% they wouldn't pay covered by your HSA. That basically gave the freedom of Medicare fee-for-service when you might want that for a specialist. (In Manhattan, you can run into that there are plenty of top-notch specialists who don't accept any insurance at all, and your primary care doctor will say "I would say you should really see this guy, but warning, he doesn't accept insurance." Even that would be covered 80%, if you paid him with a credit card and then filed the claim yourself.) Their own network was pretty good and it was nationwide.

    If you had something catastrophic happen, you would, of course, eventually go within plan because of the co-pay expense going over your HSA and then over anything you could afford. But unlike some HMO's of the past, they never showed any reluctance to pay claims involving a condition because you had been previously treated by someone for that same condition outside of plan. Some HMO's used to deny based on that, that if you went out-of-plan and out-of-pocket for something, if they found out about it, they would say they would not cover the condition because you didn't use their "trusted" providers and managers for treatment. They paid what and how they said they would pay and wouldn't argue about who you went to see or the treatments you and your providers decided upon. (As with many insurers these days, it seems, as long as the diagnosis codes were accurate, they paid.)

    People who think the ACA has done away with high out-of-pocket costs for the insured are in for a rude surprise.  The Bronze plans  are allowed to have such costs:

    Bronze Plans are designed so that insurance companies will pay 60% of covered healthcare expenses with the remaining 40% to be paid by consumers. The consumer’s expenses will be in the form of out-of-pocket fees over and above the cost of the plan’s monthly premium. Out-of-pocket expenses for individuals is expected to be capped at $6,350 annually starting in 2014.

    The 40/60 percentages are based on projected use of healthcare services by plan members. The actual out-of-pocket expenses of any single beneficiary may work out to be more or less than this ratio but should remain within the range. Those people whose out-of-pocket limits reach the annual maximum could see their share of healthcare costs fall until a new calendar year begins and the annual limit reset.

    Out-of-pocket expenses include fees like deductibles, copayments, or coinsurance. Different plans will approach the 40/60 split in various ways (see the table below) so it is important to research the financial details of a specific plan before deciding which one to purchase. For example, a person who has frequent medical expenses may want a Bronze Plan with a lower deductible (depending on premium) while a healthy person may want the opposite.

    It's going to take that Chinese food delivery guy a long time to pay off that $6,350 if something catastrophic happens to him.

    I imagine, but I don't know for sure yet, that most of those are going to have tight and inconvenient in-network requirements because that is the way the insurer keeps the cost down, by recruiting providers willing to take lower pay and making it up in volume. (Which also can mean capitation requirements where each patient ends up with only 10  minutes with the doctor and then they are pushed out the door.)

    I read somewhere, vaguely remember it, that some of the highest deductible plans would be age-limited to the young, but I am not sure is that is correct. I do know for sure that they are "Bronze" because they will have the lowest premiums.

    I am in the process of checking out whether HSA's are still allowed, so far I have seen a lot of articles suggest they still are, but nothing definitive.

    One of the good things about that plan, when used with an HSA, is that you could easily go outside network to anyone really, and have that 20% they wouldn't pay covered by your HSA.

    But this assumes one has the money to put in to the HSA.

    My employer puts enough money into my HSA to cover the deductible. I'm not sure if that is always the case.

    It makes no sense to me that rates would go up for anyone. The ACA is adding millions of people to the market for private health insurance and guaranteeing the premiums. Why on earth are they not negotiating better rates? Are they even negotiating rates at all?

    Shopping for insurance as an individual is different from shopping as the sponsor of a group. At least in the past, the larger the group, the lower individual premiums were. ACA is the motherload of all groups but individual rates are the same or higher than ever? It does not compute.

    The only thing I can think of that even begins to rationalize it is the expectation that there will be a surge in medical claims resulting from expanding coverage. That may prove true but since it looks like the Affordable Care Act is turning out not to be all that affordable, it may well not.

    The more I read about it the more it seems like it was designed by people who are more interested in discrediting government-sponsored enterprises than actually helping people.


    See Ezra Klein article above. The way I understand it, current rates are really just based on guesses on who will sign up. If only sick people sign up, its going to fail.

    I think the government doesn't have much role of negotiating rates in ACA? They are instead regulating profit, a percentage above cost, while leveling the playing field with the rules of coverage so that everyone had to offer certain things under certain conditions. Rates will be what the pool requires them to be, plus a percentage profit. And the government is totally responsible for any subsidies. The insurance companies that agreed to participate in the exchanges were gambling that it's going to work, that they will get big diverse pools, big enough and diverse enough where that profit allowed will turn out to be dandy for them.

    From what I've read, that's why the insurance cos. are upset and nervous about the website problems, too, as they can't get any reliable data on what the pools are going to be like.

    Thanks for the info. See below for how I expected it to work. I even considered that too big a subsidy to the financial-medical complex given that the federal government is the insurer of last resort for everything.


    re: too big a subsidy to the financial-medical complex given that the federal government

    What I was sort of trying to get to on Maiello's thread where you asked those good questions was in a situation where eventually the plans were very clear and easy to understand and people understood what they were buying and how much it cost to add different things. And also where cost went over the line, where most people might consider some things not worth the amount it would cost. That from that, the government would have eventually have its ass covered on controlling the medical industrial complex, it would know what people felt was reasonable for everyone, paid by taxes if need be, and what wasn't.

    Especially if one imagines ACA as an eventual transition to single payer, it's real important that people understand exactly what they and others are paying for and how much. That they start to learn the costs, yes, by shopping. To make it another mystery is just landing us back where we were, where people not only have no idea what the insurance companies are paying the providers and how it impacts what insurance costs, but don't care.

    How private group sponsors of health insurance like big employers, big unions, AARP, etc. do or once did it. 

    They have or assemble a group and calculate premiums for a basic plan based on overall group demographics. They buy a catastrophic plan for the group for a much smaller premium. They keep the premium difference in a separate fund that they manage and invest themselves. 

    In other words, they self-insure and reinsure for risk management and administrative support. With a large enough group, insurance companies are more than ready, willing and able to help set up the system for them.


    Hillarycare was on that principle, except it was substituting establishment of corporate "regional alliances" of health providers for insurance companies. The core element of the proposed plan was an enforced mandate for employers to provide health insurance coverage to all of their employees through competitive but closely regulated health maintenance organizations. There was still choice of plans, and "shopping," so it wasn't like single payer at all, really. It was just cutting out the insurance role, but it was still based on market principles.

    I thought ACA was botched from the start. For all its flaws (like over-long waiting lists), government-funded single payer remains the only way to go.

    My son-in-law stuck his finger in a plugged-in blender last month. Stitched up in ER, then called back the following week for what turned into 4 1/2 hours of top-notch nerve-reattachment surgery. Cost to him: nada. Cost to me, via my income tax: something -- but still less than the average American has to pay for insurance.

    For-profit health care is the problem, and the U.S. public has to wake up to that fact. While paying less, Canadians live to 82 (tied for fourth in the world). Americans live to 79 (tied for 33rd). How much is three years of life worth to you? Why are you paying more to die earlier? So you can boast about how great the free market is?

    It isn't as if the majority of American's wouldn't want your system acanuck, because we do, we would, yes, we would love that. But we have a reality, a terrible reality, where corporate lobbyists control much of the regulatory legislation that is able to pass both houses. The Citizen's United decision didn't make matters better either, it made it more likely that elected officials would become much more beholden to the corporate lobbyist rather than the constituent in his or her district. Until we are somehow able to get rid of the 4th rail of government, the government lobbyist, we will never ever get to what you and others in the civilized world have. It is a shame, but it is our reality.  ACA is what we could get, that's it, we couldn't get any better. We coudn't get Max Baucus to cut his ties to insurance lobbies. We got what we could get by appeasing in some way those lobbyists, that is what modern governing is all about. Is it disgusting? Yes. Does it need to be changed? Yes. Will it change any time soon. No. So we have to suck it up with a second rate system, that attempts to cover those who have never had access to preventive care until we can get the stranglehold of lobbyists off our collective backs.

    Do I envy what you Canadians have. Yes, yes I do.

    I totally understand, and totally agree. It's not like Canada doesn't have corporate lobbyists and special interests; our politicians are as eager to sell out as yours are.

    But it's harder here; despite having a vestigial Senate, our system is basically unicameral. The party that can claim a majority in Parliament names the prime minister. There's a single locus of power, so you don't get three branches -- Senate, House and White House -- squabbling to dominate and eager for deep-pocketed allies.

    You also don't get each one rewriting rules to push the limits of its influence, as via the gridlock-producing Hastert rule or the Senate's single-member hold. Here, it's a 50-per-cent majority, not 60. And there are always at least three parties represented in Parliament, so it's risky to just trample on the opposition. Bottom line: ignoring the wishes of three-quarters of the population gets you unelected sooner.

    So what I appear to be saying is not only do you need to emulate single-payer health care, you need to switch to a Canadian-style parliamentary system, too. Sorry about that.

    Yah, that would be good too.  

    Its probably more than three years for many people. I'd like to see life expectancy by income level. At a certain income level there is likely no difference in life expectancy between the US and Canada.. But I'll bet that the further down the income level one goes the greater the difference between the US and Canada.

    Your second sentence contains the real issue. If you're wealthy enough, it's even likely that your life expectancy is greater in the US than in Canada. This is a completely unresearched supposition, but regardless of whether it's true, most people in the US probably think it's true (that's also an unresearched supposition, but it definitely has a feel of truthiness), and most people in the US still seem to think that if they work hard enough they can be wealthy enough to fall into this category.

    It's good to see someone from Canada explaining how real Healthcare compares to the Health Insurance Industry we have  here in the US. It's also interesting to see Michael lecture people who are upset because our "Affordable Health Insurance" program will cost them thousands of dollars more each year. Michael, you do know that the cheaper plans that are being canceled are Major Medical plans that cover emergencies and serious diseases while limiting routine coverage. I've been reading other sites where people who are actually affected by this Corporate Health Bill are commenting and they are not too happy about having to pay more to maintain Insurance Industry profits while they are not complaining about paying more to help cover others. The real issue here is once this monster program is operational and those who have actually been helped by it are marched in front of the cameras to glorify it, it will be used as a model to expand while dismantling the dirty un-American, Socialist Medicare.

    It's a little hard to know what people mean when they say they "like their insurance plan." Plans aren't like cars: You don't use them every day like a car. You don't test their handling, braking, and stopping power the way you do a car. You don't buy gas for them.

    Most people who aren't very ill don't use their insurance policies all that much. And when they use them, they tend to accept the results as the results. That's because it's not that easy to change plans, even if you have no pre-existing conditions. People don't trade in their plans like they do cars they no longer like or want to upgrade.

    Most plans are really only tested when the big whammy hits, and they find out whether the plan is really going to help them and they "like" their plan.

    I'm also not clear why ACA has to perform well right out of the gate. It would be nice if it did, if millions of young, healthy people signed up for it, but I expect that that will take some time. Gradually, more and more of them probably will, and the ACA will work better and better as they do.

    I'm told the MA plan didn't run perfectly at first, and they only attained 97% coverage over time. Why not here, too?

    Most plans are really only tested when the big whammy hits, and they find out whether the plan is really going to help them and they "like" their plan.

    Hence, the unhappiness of some to be forced by totally unexpected  (i.e., if you like your plan, nothing wil change) cancellation of a plan that in some cases they had grown used to and understood how to use.

    I'm told the MA plan didn't run perfectly at first, and they only attained 97% coverage over time.

    Just 123 people signed up during the Bay State's first month of open enrollment.

    I would argue that that's because it's a rare person who actually likes being a guinea pig for a start-up experiment when there are no results to judge and no boots-on-the-ground testimonials and they are not desperate to be part of the experiment.

    Yet, with ACA, all the people with cancellation notices are being forced to be guinea pigs, they must get into the system with a deadline of Dec. 15, or find something else, And some of them, who have to use the Federal exchange, don't know if they will have adequate information in time to make a proper decision. When they were planning on not having to do anything for a much longer time. Because they weren't one of those unfortunate people who didn't have insurance, they thought they could take their time to check out ACA exchanges after they had some proven results.

    And some ACA supporters think it is wise to yell at them, call them selfish whiners who don't care about the poor and uninsured, or imply they are all stupid idiots that don't know bad insurance or a good deal when they see it, or are unwitting pawns of the GOP....

    AA, I only partially agree with your normally astute analysis. By "whammy" I meant a serious illness. And if, by "whammy," we mean plans changing under our feet or our premiums going up, well, that's what we've had, or many people have had. It's just that we accepted it, like the weather, and we'd grumble accordingly or complain about how the drought ruined our crop and how would we ever recover.

    When I was on the individual market for decades, I had regular increases in my premiums from the 1970s onwards. I clearly remember hopping around, joining this membership organization and that, trying to get a better deal. And every better deal only ever went up in their premiums after I joined. Like clockwork. I "accepted" this because what else was I going to do? Go without insurance? Go without, and you never got back in. Going uninsured even for days was fatal. You were out, and there was no appeal; underwriting had an unlisted number. And there were only two companies.

    Who ever really gets to test a plan before they buy it? Like with a car, say? Including the one they have now? Even an HSA. How did we know upfront THAT was going to work? Every time I signed up (and I sold insurance), I looked at the specs, made a guess as to my needs, tried to keep my premiums and co-pays down, looked at the extras, and signed. What else? And that's what we have now, only "better." I mean we are still talking about the same insurance companies writing plans they understand, which is all they ever did and all we ever bought, I'd submit.

    Who knew if $2 million of major-medical was ever going to be "enough" or "right"? Even if you could evaluate the hopelessly vague and general language used to describe all the MM stuff they covered, you had no idea what sort of illnesses and maladies you were going to suffer or the treatments you'd need? You had no idea.

    If anything, we're closer to the ideal of testing driving policies now because it will be easier to change and upgrade your policy if you don't like your former one. It will also be easier to understand what it is you're buying because the explanations are at least supposed to be clearer and the comparisons easier to make.

    But in the old days, if you got cancer under Plan A, and Plan A pooped out or threw you off the plan, you couldn't toddle over to the dealership and ask to test drive the new year's model. You were SOL. Perhaps dependent upon the beneficence of tax payers' funding Medicaid.

    I agree that calling people whiners is unproductive and not nice. But don't, then, the "whiners" have some duty to address the former inequities and suggest a way forward? Even if that way means making a fix here or there to the ACA? Studying the MA model might be a good way to start. Understanding also that the 50 states were each meant to have their own exchanges and not dump the whole burden onto the HC.gov would also be good.

    Politically, we'd be a whole lot better off if one party (or industry) wasn't dead set against ANYTHING improving. That's the bottom line. Oh yes, they blather on about cross-border competition among insurance companies (read Klein on that non starter). Or tort reform. But the fact is, ObamaCare was THEIR idea, an idea they adopted ONLY, as far as I can tell, in order to STOP HillaryCare. It could have been DoleCare or HeritageCare if they had actually supported it. And now they are trying their darndest to scuttle ObamaCare with "something else" they'll also oppose as soon as some Democrat comes out in favor of it.

    This cycle has to stop, and Obama, IMO, deserves enormous credit for insisting on changing up the music, good, bad and ugly, and expending huge political capital on it.


    Then there's this little tidbit, which I'm sure all you ex-TPMers have read. This does reinforce AA's point about the necessity of getting the Web site, i.e., exchange, up and running. Otherwise, people are just sitting ducks, as far as I can tell.

    from that link:

    UPDATE: I confess that I missed the early link in the WaPo article to David Cutler's May 11, 2010 memo to Larry Summers, calling for a new institutional structure to manage ACA implementation. While not focused on development of the website, it does give one pause regarding the alleged management shortcomings in the existing institutions.  The fact that Austin Frakt gives weight to the memo and the WaPo article carries weight with me, too.

    What's said in the links within that quote is very depressing. I hope the actual current situation is better than what's said.

    Well yes, but it doesn't give much in the way of particulars. Hard to know what he means, exactly, or what it all amounts to. Below that, the principal author adds this:

    "I should add, too, that in saying 'sabotage works,' I mean it does material damage, not that it will succeed in its ultimate goal.  I believe the ACA will ultimately succeed notwithstanding the spiteful, intellectually corrupt GOP campaign to destroy it."

    I understand your impatience with cheerleading and booing the law on all sides, but I can't help but think that it's early days to pronounce it dead or alive. And that's what the media is determined to do.

    Even a much less contested roll out in MA and with Part D took some doing to iron out the kinks and make it work. This may sound pollyannish or too cheerleaderish, but getting this law on the books was, IMO, a HUGE achievement, and it shouldn't be pissed away because there are challenges.

    (Including the fact that some people may come out worse.)

    One reason there may be so little information about what is happening and how things are working is that the plan has been under REAL attack by people with a REAL ability to damage it badly since forever.

    Not only has the WH not had a "partner for peace" in the House who might have helped work out problems, but they've even had to go outside government, hat in hand, for implementation funds that should have been there. Some states I hear have passed or tried to pass laws banning, outlawing, navigators from helping people find there way around the site! Good fucking grief!

    This has all been a bit like trying to open an umbrella against gale-force winds that with just a slight change in angle could blow the thing out of your hands.

    Within the confines of the blogosphere, we're free to argue the pros and cons and come up with solutions, but it shouldn't be forgotten that there is a powerful movement that really does want to repeal the thing. It's not easy to mount a legal challenge that goes all the way to SCOTUS, and they did it, and they had some success AFTER the thing was law.

    This, mho, is a very good fair and accurate article on the topic:

    The Truth About Those Canceled Health Plans by Jeffrey Young @ Huffington Post Business, Nov. 1. It's also loaded with lots of good links.

    If this piece of paternalistic propaganda is what you consider " fair and accurate" I have to question your judgment, Art. Anytime someone from the MSM claims to have a monopoly on the "truth" and is so benevolent as to share it with the unwashed masses I cringe and look for my pitchfork. This is just another well-insured minion of the chattering class telling us to "shut up and eat your peas".

    Oh puhleez, you're just being ridiculous now. Sharing understanding of a system is not propaganda for that system.

    Edit to add: just the opposite, doing so halts the ability to propagandize. I am soooo very sick of the political talking points and spin on Obamacare coming from all directions (very much including the administration, but also anti-Obama lefties like you and anti-Obama righties) and am verging on getting really angry that people keep doing it. It's over people, the fight is over, don't you get that? This is the system we got by law, cut the crap fur or agin, and let's try to understand what it is first and how it will affect people  (and by people I most definitely do not mean politicians up for re-election) before continuing on to either supporting it or fighting to change it or repeal it.

    Art, now you are contradicting yourself about talking points. Reread the article you linked to and just look at the attitude of the author through how he couches the questions some uninformed rube is asking. I think most people, especially those who actually have to use this program, realize that resistance is futile but that doesn't mean they have to submit in silence.  I base my contempt for this law not on partisan talking points but my understanding of what it is and will be in the future and on the personal accounts of people who are actually affected by its implementation. I am glad to see that your anger is being directed at both sides of this fiasco which gives me some hope that the conditioning we all have been subjected to can be overcome.

    especially those who actually have to use this program

    There are plenty of people who actually have to use this program who are finding good policies at cheaper prices. As someone who spent decades in the individual market, I can tell you that the policies I see on my exchange are far better and far cheaper than anything I ever had.

    Now, it may be that all those people who actually have to use the system have been clamoring for a single payer system--but they haven't managed to exert sufficient upward pressure to get the political class to hove to. And they haven't managed to convince the 85% of their fellow Americans who get coverage from their employers to clamor either.

    Failing that, it's hard to see why ACA is a contemptible plan.

    To be sure, there have been polls showing something like 75% support for a single payer program. And it might have been easier over all to sell a plan that said, "You all understand Medicare. Well now, everyone is going to be covered under it, and its name will now be AmeriCare."

    But polls don't necessarily translate into votes nor into the money candidates need nor into political protection when hundreds of thousands of people who used to work for insurance companies lose their jobs. Until they do, this is clearly a step forward.


    You are making assumptions here PS without any actual personal involvement. I'll wait for the people who have purchased these cheap insurance policies to report what kind of health care they get from them before drawing conclusions. The massive  support for a single-payer system and the nonexistent desire by the Ruling Class to supply one is telling, the People have almost no power over their Leaders or their Corporate handlers. The important thing the ACA does is it takes another large "step" away from ever allowing single-payer to supply healthcare directly to people.

    Actually, I did go shopping and found more than one good policy at a "reasonable" price as these things go. Friends have, too.

    You should read more right-wingers: They think the ACA is the final step before single payer is imposed on them.

    The government also forces me to buy a car with all these fussy "safety" regulations, when it would be a lot cheaper to take them off.

    Why should I HAVE to buy a car that won't explode on impact? I'm not planning to hit anything! It makes no sense.

    Good one Doc... Boy Howdy! 
    I can visualize the person picking his face off on the hood of his car after blowing through the windshield saying this...
    "The government also forces me to buy a car with all these fussy 'safety' regulations, when it would be a lot cheaper to take them off."

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