Originally Posted by JohnMc82

I need to vent just a little bit...

My fiancee had some swelling & pain in a finger so she went to the campus clinic. The nurse freaks out and assumes some kind of infection, so they start running some blood tests. No signs of infection so they take her over to the local hospital for an X Ray and insist on an MRI (ouch).

Anyway, it's a little stress fracture and the recommended "treatment" was that she should try to avoid using it for a while.

The bill? Well, the doctors have already collected $2,000 from the insurance company, and they want another $600 from us because $2,000 isn't enough! $2600 to say "Don't use your finger for a while!"

So... this is why having insurance doesn't fix a damn thing that is wrong with our medical system, and this is why voters aren't exactly thrilled with the ACA.

Ok. End rant. Back to writing a nice "no way in hell" letter to the doctor.

In this case, the failure was medical. Writing the doctor is the right option.

One of the suggestions in the discussions on deficit reduction, is means testing in regards to Medicare. It was brought to my attention today that we already have means testing. I guess we learn something everyday.

If we already have it, then why is it being touted as a new way forward in these so called deficit discussions?

The Facts

Premiums for Medicare Medical Insurance (Part B) and Medicare Prescription Drug Plans (Part D) are already tied to beneficiaries’ income levels. In a more indirect form, Medicare Hospital Insurance (Part A) is also tied to income.

Medicare Part B Premiums By Income in 2013

If your yearly income in 2011 was
File individual tax return	File joint tax return	2013 premiums
$85,000 or less	$170,000 or less	$104.90
above $85,000 up to $107,000	above $170,000 up to $214,000	$146.90
above $107,000 up to $160,000	above $214,000 up to $320,000	$209.80
above $160,000 up to $214,000	above $320,000 up to $428,000	$272.70
above $214,000	above $428,000	$335.70

Source: www.medicare.gov


The costs of a Part D plan vary and include monthly premiums, yearly deductibles, co-payments and costs in the coverage gap (also known as “donut hole”). In addition, those who meet certain income requirements (both high and low) will have different plan costs.

Another one bites the dust -

http://tpmdc.talkingpointsmemo.com/2...ref=fpnewsfeed

John Kasich Accepts Obamacare’s Medicaid Expansion



Ohio Gov. John Kasich announced Monday that he will accept the Medicaid expansion under the Affordable Care Act, becoming the fifth Republican governor to embrace the provision of the health care reform law that the Supreme Court made optional.

The governor unveiled the decision as part of his budget proposal.

“We are going to extend Medicaid for the working poor and for those who are jobless trying to find work,” Kasich said at a press conference in Columbus. “It makes great sense for the state of Ohio because it will allow us to provide greater care with our own dollars.”

The four other Republican governors to back the Medicaid expansion are Brian Sandoval of Nevada, Susana Martinez of New Mexico, Jack Dalrymple of North Dakota and Jan Brewer of Arizona. About a dozen GOP governors from red states have rejected the expansion; others from mostly blue and purple states have yet to decide. Democratic governors have broadly embraced it.

If you have no clue what this is about, odds are you're not a Progressive.

Brad DeLong is maintaining the list -

The Governors who are innumerate dorks are, so far: Indiana Governor Mike Pence, Michigan Governor Rick Snyder, Nebraska Governor Dave Heineman, Florida Governor Rick Scott, Oklahoma Governor Mary Fallin, South Dakota Governor Dennis Daugaard, Louisiana Governor Bobby Jindal, Texas Governor Rick Perry, Alabama Governor Robert Bentley, Georgia Governor Nathan Deal, Idaho Governor C.L. Otter, Maine Governor Paul LePage, Mississippi Governor Phil Bryant, South Carolina Governor Nikki Hale, and Wyoming Governor Matt Mead.

I think Brad is beng nice with his "innumerate dorks" label. I think "shit for brains" is much more descriptive.

Budget Report: More Employers Than Previously Estimated Will Drop Health Coverage


About 7 million people, nearly double the earlier estimates, will no longer get health insurance from their employers because of changes to the tax code made by the health law, according to CBO projections.


The Fiscal Times: 7 Million Will Lose Employee Coverage Under Obamacare
A new report from the Congressional Budget Office estimates that nearly 7 million people will lose their employer-based health insurance coverage under President Obama's signature health care law, nearly twice the previous estimate. Changes to the tax code under Obamacare, said the CBO, have altered the incentives for the business sector, which will likely prefer to pay the penalty rather than the cost of workers’ health insurance. Overall, 27 million people are expected to gain coverage by 2017, roughly 5 million less than originally projected (Ehley, 2/5).


Bloomberg: Obama's Health-Insurance Expansion Eroding, CBO Projects
The number of Americans projected to gain insurance from the U.S. health care law is eroding, by at least 5 million people, as the Obama administration struggles to implement the $1.3 trillion overhaul amid Republican opposition. About 27 million people are expected to gain coverage by 2017, according to a report today from the Congressional Budget Office (Wayne, 2/5).


National Journal: Budget Office Predicts Rocky Start For Health Care Law
The Obama administration has been publicly upbeat about the coming rollout of its health care law. But a new report from the nonpartisan Congressional Budget Office suggests that at least one set of influential observers anticipates some turbulence in the law’s first years. On several important measures of the law's success, CBO's numbers are pessimistic compared with earlier estimates: Fewer uninsured people will get coverage, insurance options will be more limited, and more employers will stop covering their workers (Sanger-Katz, 2/6).


National Journal: Budget Office Predicts Rocky Start For Health Care Law
The Obama administration has been publicly upbeat about the coming rollout of its health care law. But a new report from the nonpartisan Congressional Budget Office suggests that at least one set of influential observers anticipates some turbulence in the law’s first years. On several important measures of the law's success, CBO's numbers are pessimistic compared with earlier estimates: Fewer uninsured people will get coverage, insurance options will be more limited, and more employers will stop covering their workers (Sanger-Katz, 2/6).


The Hill: Obama Health Law Will Cost $1.3T, CBO Says
The Congressional Budget Office (CBO) estimated Tuesday that President Obama's signature health care law will cost about $1.3 trillion over the next 10 years. The figure represents a slight increase since August, when the nonpartisan budget office estimated that the law would cost about $1.17 trillion before 2022 (Viebeck, 2/5).

Michigan Governor Rick Snyder went all in on the Medicaid epansion. Could be the tipping point.

While the Right mashes their teeth and the Far Left gets their panties in a wad and both bash away, Obama just extended free health care to thousands of poor and near poor in Florida -

http://www.nytimes.com/2013/02/21/us...d=myyahoo&_r=0

Florida Reverses, Taking Health Law’s Medicaid Expansion

Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state’s Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama’s healthcare law to decide to put it into effect....

But you all keep up the good work, some day the great magic pony in the sky will reward you!

Booya!

Many governors are opting their states into Medicaid but not the Federal exchanges.

Originally Posted by Wonkbook

In the span of a month, some of Obamacare’s most ardent opponents have come to embrace one of the law’s most crucial programs: The Medicaid expansion.

With seven Republican governors now signed up, most recently Florida’s Rick Scott on Wednesday, Republican-led states now account for nearly one-third of those expected to take the federal government’s money to expand Medicaid up to 133 percent of the federal poverty line.

These same governors have, however, also eschewed another big Obamacare component: The exchanges. The three most recent Medicaid expansion converts—Florida’s Rick Scott, Michigan’s Rick Snyder and Ohio’s John Kasich—have all rejected the idea of setting up the marketplace, leaving it to the feds to do the work, instead (Michigan is splitting the difference and will run its market in partnership with the feds).

Why embrace one part of the health care law — a single-payer system that will stretch President Obama’s law to cover millions more Americans — while ditching the other more market-oriented aspect? It likely has to do with the big consequences for a governor who chooses not to expand Medicaid—versus the tiny reward with setting up a very complex insurance marketplace.

There’s not a lot riding on governors’ decision to build a health insurance exchange. The marketplaces certainly are important to the Affordable Care Act: They’re the online portals where millions of Americans will ultimately purchase health insurance, the key vehicle for delivering the health law’s insurance expansion.

Building a health exchange is a huge undertaking. Between connecting disparate government computer systems and creating a seamless shopping experience, industry analysts say that this process should take two or three years.

If governors cram it into 10 months, and the final product comes out subpar, they would likely take the blame. But if a governor doesn’t go through with building one, the federal government swoops in. It has promised that every state will have an insurance exchange by Oct. 1, the date that the new markets will open for enrollment.

So it seems that risk vs. reward payoff is having a big role in how this new 4T system is evolving.

Originally Posted by herbal tee

Many governors are opting their states into Medicaid but not the Federal exchanges.

So it seems that risk vs. reward payoff is having a big role in how this new 4T system is evolving.

Now, how do we add Medicare Zero to the Federal options?

Steve Brill has written the longest story ever for Time Magazine, and it is about health care. He has nailed the cause of the problem: high prices. Reform doesn't get the job done so far because of America's obsession with the free market. But health care is not a free market. You don't have a choice; you have to take what they offer. You don't get to see the prices beforehand, and even afterward you can't decipher the bill. You don't have a choice in whether you get sick, or where the doctor sends you, or what products to choose from. There is no competition, because hospitals have too much power over the market. Health care is grossly overpriced in America, and the field is booming in spite of the recession. Whether it is the drugs, the scanning equipment, the hospital's services or insurance companies, they can charge as much as they want, and they do. The only customer that has any leverage in the market is medicare, which is the most efficient system in America.

There is no internet reference yet for this article, and the only buzz on the internet now seems to be that Brill was promised the cover story for a relaunch of the New Republic, but was replaced by an Obama interview, prompting Brill to call the publisher a liar and to say he won't write for New Republic again. But this never came up on the Charlie Rose interview last night, where I heard him make these points.

If we want to handle our federal deficit, or bring down the cost of living, we'd better deal with the price of health care, and put the industry under government supervision. And we'd better do it before this 4T is over. That seems to be the bottom line.

Chalk up another correct prediction for E. Alan Meece!

Rick Scott Joins GOP Governors Accepting Medicaid Funding

Reaction was swift and strong from both sides on Wednesday to Florida Gov. Rick Scott’s reversal on Obamacare — now saying that he would expand Medicaid coverage to as many as 900,000 more people under the healthcare law.

Scott said Wednesday he would ask the Legislature to broaden the program under a bill to sunset in three years. The move allows Florida taxpayers to reap the benefit of full federal funding for the Medicaid expansion during the first three years, without a promise to continue beyond the three years.

Scott joined a number of conservative Republican governors who have ardently opposed Obamacare, but believe it would be wrong to deny their state the benefits of federal funding.

Last month Arizona's Gov. Jan Brewer, an Obamacare critic, signed on to the federal Medicaid funding plan, as did Republican Gov. John Kasich of Ohio earlier this month. Republican governors in Michigan, North Dakota, New Mexico and Nevada have also agreed to the federal plan.

http://www.newsmax.com/US/rick-scott...2/20/id/491268

Good on Govenor Chris Christie on siging on to Obamacare's Medicaid expansion. That's another 300,000 + being given single payer essentially to some of the most needy folks in the country.

http://www.nj.com/politics/index.ssf...t_details.html

Gov. Christie to announce expansion of Medicaid in budget speech, sources say

The usual mashing of teeth on the Right -

http://www.nationalreview.com/corner...eliana-johnson

No CPAC Invite for Christie Because of ‘Limited Future’ in Republican Party

and only the chirping of crickets from the Left as they just briefly pause from their bashing Obama for not getting single payer.

Birds of a feather in so many ways.

Paul Ryan; oh what can you say? He won't give up. He even says so

http://youtu.be/LT3Px11xN-0

Originally Posted by Eric the Green

Paul Ryan; oh what can you say? He won't give up. He even says so

http://youtu.be/LT3Px11xN-0

Here's my word to the GOP: Outright repeal of Obamacare isn't going to happen anytime soon (barring extremely unlikely events not until at least 2017, and even then only if all the majorities in Congress and the Presidency go their way); however, if you want to make some minor tweaks here and there that is workable. One change that will probably get enough Democratic support (and may be necessary for practical reasons anyway since the exchanges may not be ready on time) is to delay the implementations set to take place in 2014.

My suggestion to get people to stop complaining about the individual mandate is to allow anyone to waive themselves from the penalty by signing a statement to the IRS, with several points that may come back to bite you as a consequence for opting not to be covered (this would not apply to anyone exempt under the current version of the ACA for hardship or other reasons, so "choosing" to go without insurance means being able to afford it but not buying it):
1. Any medical bills incurred while choosing not to be insured will not be dischargeable in bankruptcy court (note that the same already applies to certain other debts like most student loans and child support).
2. If you don't pay your medical bills that come about from being uninsured in full within a certain amount of time (e.g. a year), the hospital or other medical institution reserves the right to garnish a (small) portion of your paycheck to cover the outstanding debt.
3. If you decide to get back "on the grid" and get health insurance later on, the company can charge you a "penalty" and deny coverage for any pre-existing conditions incurred while being uninsured for a certain amount of time.

What do you think?

Prepare to be gouged even more by the insurance industry.

Health Insurers Threaten To Increase Premiums, Even As Profits Soar

on Mar 22, 2013 at 11:41 am

Some of the nation’s largest health insurance companies are warning investors that they’ll raise insurance premiums by as much as 116 percent next year, as the coverage expansion provisions in the Affordable Care Act go into effect and millions of uninsured Americans begin purchasing coverage.

The threats of premium increases come as the industry is experiencing record profitsand are part of a well-coordinated publicity campaign to alarm Americans about the cost of coverage, while downplaying mechanisms in the law that will cushion them from rate shock. The effort comes as insurers seek more favorable regulatory changes that would, in part, allow companies to charge older people more for coverage.


United Health Group Inc., Aetna, and Blue Cross and Blue Shield are ringing the alarm, attributing the possible cost increases to general health care inflation as well as provisions in the health care law, which require insurers to offer more comprehensive coverage, particularly in the individual health care market, and limit the companies’ ability to set premiums based on beneficiaries’ health care histories, age, or sex.

Insurers, meanwhile, are already seeing impressive profits. UnitedHealth, for instance, “had a particularly strong past year, with net income of $5.1 billion, up by 11% from the previous year” and Aetna is similarly beating revenue expectations. A July 2010 report from PricewaterhouseCoopers concluded that the law’s state-based health care exchanges provide private insurers with a lucrative new market in which they stand to gain up to $200 billion in revenue by 2019.

An economist who at one time supported Obama, has now opened his eyes to Obamacare. He explains to progressive Democrats why the new proposed benefit cuts and means testing, is healthcare rationing.

Obama’s New Budget: Why He’ll Cut Social Security & Medicare

April 9, 2013 by jackrasmus

In retrospect over the past three years, and especially since November 2012 elections, the ‘grand bargain’ looks less like a bargain and more like a ‘grand collusion’ between the various parties—Teapublican, Big Corporate, Obama, and the pro-corporate wing of Democrats in Congress that have had a stranglehold on the Democratic party since the late 1980s.

This is not the Democratic Party of your grandfather that agreed to introduce Social Security in the 1930s and that proposed Medicare in the 1960s. This is the Democratic Party, and the Democratic President, that has agreed with Republicans and Corporate America to begin the repealing in stages of these very same programs—programs that are not ‘entitlements’ but are in fact ‘deferred wages’ earned by Americans over the decades that are now being ‘concession bargained’ away without any say or input. Not content with concessions from those workers still in the labor force, capitalist policymakers are intent on concessions on social wages now coming due in the form of social security and medicare benefits.


It’s not a grand bargain; it’s a charade and a ‘grand collusion’ from the very beginning from Simpson-Bowles to the present.

http://jackrasmus.com/2013/04/09/oba...care/#comments

Originally Posted by The Rani

Go India!

Why Chemotherapy That Costs $70,000 in the U.S. Costs $2,500 in India

Kinda makes one wonder about the corporate phramaceutical hold on this country, huh?

On another note: My best doctor is from India. She returned there this past fall and was sharing some of the stories about her reuniting with many of her med school friends. She said that she found herself almost being envious of how simple medicine was with her doctor friends.

Originally Posted by The Rani

I can't remember where the "is meat really bad for you" discussion was, so posting this here:

http://www.scientificamerican.com/ar...eries-bacteria

Really interesting, and maybe a tiny little step closer to understanding the symbiotic relationship we have with the many microbes that inhabit our bodies. Instead of playing in the dirt and getting sunshine, we're throwing antibiotics at anything that sniffles... and then we wonder why all these novel illnesses are popping up...

Since they were basing this on the Harvard diet-mortality study, do you know if this explains why chicken, fish, lean red meat, and processed meats ranked so differently in terms of risk? Chicken and fish ranked with the "healthy proteins," so are they lacking in l-carnitine or is there something else going on? And the risks of processed red meats was like 2-3X higher than lean red meats, so is that also about the l-carnitine or is the salt/nitrate thesis still hanging out there? How does milk and cheese and yogurt factor in?

I really don't know. I just find the recent research patterns to be pretty fascinating. Proper nutrition can have a huge positive impact on quality of life, and I think we're still trying to figure that out with regards to an increasingly industrialized agricultural system that is motivated more by costs and calories than it is by micro-nutrient balance or sustainability.

Originally Posted by Deb C

Kinda makes one wonder about the corporate phramaceutical hold on this country, huh?

On another note: My best doctor is from India. She returned there this past fall and was sharing some of the stories about her reuniting with many of her med school friends. She said that she found herself almost being envious of how simple medicine was with her doctor friends.

Oh it has much less to do with the pharmaceutical companies than it does with intellectual property law.

I found this article interesting. If much of it is true, it might explain the growing apathy/numbness of our citizens. In some respects, our culture wants to solve problems with drugs, and the pharmaceutical companies love it.

Breeding mental illness in the US

Rampant over-prescribing of drugs contributes to a system that is better at producing disorders than rectifying them.

n a recent article on the BBC News website, Professor Peter Kinderman - head of the Institute of Psychology, Health and Society at the University of Liverpool - warns that the forthcoming edition of theAmerican Psychiatric Association's Diagnostic and Statistical Manual "will lower many diagnostic thresholds and increase the number of people in the general population seen as having a mental illness".

According to Kinderman, the manual - scheduled for publication in May 2013 - constitutes a dangerous effort to pathologise emotions and other symptoms of human existence and will exacerbate the rampant over-prescribing of drugs that already occurs "despite significant side-effects and poor evidence of their effectiveness".
The practice of attributing emotional distress and other phenomena to alleged cerebral/biological abnormalities rather than to social and psychological causes, writes Kinderman, is particularly problematic: "Standard psychiatric diagnoses… do not correspond to meaningful clusters of symptoms in the real world" and can counter-productively result in "further stigma, discrimination and social exclusion" for their recipients.


Regarding the impending updates to the psychiatric manual, Kinderman notes that "[t]he new diagnosis of 'disruptive mood dysregulation disorder' will turn childhood temper tantrums into symptoms of a mental illness", while relaxed criteria for "generalised anxiety disorder" will turn "the worries of everyday life into targets for medical treatment". Normal grief will undergo conversion into "major depressive disorder". Additional cutting-edge maladies will include "internet addiction" and "sex addiction".

http://www.aljazeera.com/indepth/opi...119833454.html

Typical.
​
Lawmakers, aides may get Obamacare exemption


Congressional leaders in both parties are engaged in high-level, confidential talks about exempting lawmakers and Capitol Hill aides from the insurance exchanges they are mandated to join as part of President Barack Obama’s health care overhaul, sources in both parties said.

The talks — which involve Senate Majority Leader Harry Reid (D-Nev.), House Speaker John Boehner (R-Ohio), the Obama administration and other top lawmakers — are extraordinarily sensitive, with both sides acutely aware of the potential for political fallout from giving carve-outs from the hugely controversial law to 535 lawmakers and thousands of their aides. Discussions have stretched out for months, sources said.

Yet if Capitol Hill leaders move forward with the plan, they risk being dubbed hypocrites by their political rivals and the American public. By removing themselves from a key Obamacare component, lawmakers and aides would be held to a different standard than the people who put them in office.A source close to the talks says: “Everyone has to hold hands on this and jump, or nothing is going to get done.”

Read more: http://www.politico.com/story/2013/0...#ixzz2RTwnamgA

Originally Posted by Deb C

Prepare to be gouged even more by the insurance industry.

Health Insurers Threaten To Increase Premiums, Even As Profits Soar




Insurers, meanwhile, are already seeing impressive profits. UnitedHealth, for instance, “had a particularly strong past year, with net income of $5.1 billion, up by 11% from the previous year” and Aetna is similarly beating revenue expectations. A July 2010 report from PricewaterhouseCoopers concluded that the law’s state-based health care exchanges provide private insurers with a lucrative new market in which they stand to gain up to $200 billion in revenue by 2019.

You can always tell alarmist analysis over rate payments is horseshit when the words "subsidy" and "medical loss ratio (MLR)" are nowhere to be found in the analysis. It's like screaming "fire" but not telling anyone that the said fire is confined to the fireplace.

To most people, it is obvious that if you keep the basic private insurance model and bring more people into that model then there will be more profit for the insurance companies - it's called capitalism. It would othewise be like asking the grocer to sell more bananas to more people but not profit from it. The question is does it set up some sort of gouging of prices due to the increase in demand? The MLR was specifically added to the ACA to stop that. Whether you think the MLR is too little or too much, you should understand that any analysis of insurance costs without even mentioning the MLR is horseshit.

Furthermore, it is pretty obvious to most people if you offer better insurance to people that had none or had really shitty insurance, then the average price of the insurance is going to go up. To thing otherwise is to be upset that a hamburger costs more than eating nothing or eating shit. Most people get this. Moreover, under the ACA, the govt does help; by analogy, those who had to previously eat shit will now instead get a hamburger actually paid in whole or in part by the govt - it's called "subsidies" (look it up if need be). Again, whether you think subsidies are too little or to much, one should understand that any analysis of increased premiums that doesn't even mention subsidies is trying to feed you a different kind of shit called horseshit.

There are those with veiwpoints that will never get or accept some of the practical aspects of the ACA. These are people who will never be satisfied with anything less than "single payer" (e.g. Medicare for everyone); people who completely ignore political realities. They really don't have to worry about losing any credibility over pushing alarmist horseshit because no one takes them seriously anyway due to their ignoring politicl realities to begin with - basically, they're viewed as just noise. That's not to say that revolutions are impossible; it's just saying the odds are about as close to zero as you can get. That leaves it to others to try to actually figure out how to help people... rather than just making a lot of noise.

The bottom line of the Affordable Care Act
by Bruce Dixon


The problem is that Obamacare was written by a health insurance company lobbyist to prolong his employer's parasitic business model, not to make health care available or affordable. A third of the health care dollar goes to advertising, profits, fat executive salaries, lobbying and the paperwork occasioned by thousands of insurers who make more money denying care than providing it, instead of a single payer, like Canada, Medicare, or Social Security. As Physicians for a National Health Plan point out, Obamacare will not curb medical costs or stem the tide of bankruptcies caused by health care bills. It won't force most employers who now don't offer affordable coverage to offer it in the future, because the administration is allowing employers to write its enforcement regulations, and it will leave millions more, all poor and disproportionately people of color, uncovered altogether.


Worst of all, Obamacare's 2016 effective date reveals it as a promise the administration never intended to keep. Back in 1965, when computers with less power than today's laptops were the size of boxcars, the Johnson administration passed Medicare and put it into effect the same year. That's the real comparison between the achievement of Obamacare and the effective results of a previous generation's struggle.

Originally Posted by Deb C

The bottom line of the Affordable Care Act
by Bruce Dixon


The problem is that Obamacare was written by a health insurance company lobbyist to prolong his employer's parasitic business model, not to make health care available or affordable. A third of the health care dollar goes to advertising, profits, fat executive salaries, lobbying and the paperwork occasioned by thousands of insurers who make more money denying care than providing it, instead of a single payer, like Canada, Medicare, or Social Security. As Physicians for a National Health Plan point out, Obamacare will not curb medical costs or stem the tide of bankruptcies caused by health care bills. It won't force most employers who now don't offer affordable coverage to offer it in the future, because the administration is allowing employers to write its enforcement regulations, and it will leave millions more, all poor and disproportionately people of color, uncovered altogether.


Worst of all, Obamacare's 2016 effective date reveals it as a promise the administration never intended to keep. Back in 1965, when computers with less power than today's laptops were the size of boxcars, the Johnson administration passed Medicare and put it into effect the same year. That's the real comparison between the achievement of Obamacare and the effective results of a previous generation's struggle.

That's a lot of unsupported conjecture there. Do you care to back up any of it with, you know, FACTS???

Let's just take the -

A third of the health care dollar goes to advertising, profits, fat executive salaries, lobbying and the paperwork

Let's see, 1/3 is 33%, right? Now the ACA requires a Medical Lost Ratio (MLR) of 80% for individual plans and 85% for group plans. That means for each premium dollar only 20% and 15% respectively can go to the insurance companies' "advertising, profits, fat executive salaries, lobbying and the paperwork." And when the insurers go over that amount, then there are mandatory rebates given to premium payers such as the $1.1 billion in rebates returned to 12.8 million individuals by August 1, 2012.


Now the MLR for individual plans is more than 1/3 less than what you stated and for the larger category of group plans it’s less than ½ as big. Your source says "health dollar" so I guess the difference is going to primary care providers' "advertising, profits, fat salaries, lobbying and paperwork." That raises some crticial questions.

Are you saying that insurers and care givers are equivalent and both need to reduce their "advertising, profits, fat salaries, lobbying and paperwork”? Do you think the primary care givers that do Medicare have different "advertising, profits, fat salaries, lobbying and paperwork” than those that don’t do Medicare? How much is the difference? Do you think these costs could be reduced? How? Are you saying that providers should no longer be private businesses but instead government employees, i.e. you don't just want single payer, you want to nationalize health care in toto?

If you don’t think we should force much cost reductions on health care providers, do you think it would be more honest to talk about the 15/25% for insurers rather than the 33% and imply that it is just for fat cat insurers? Or if you do think we should force cost reduction on the providers, do you think it might be more honest to state that as being part of the discussion when you bring up the 33%?

Just this one aspect of your linked unsupported conjecture seems to raise a number of questions? Some of the answers to these questions (e.g. nationalizing our entire health care system) would make even a lot of pretty liberal folks blanch. Other questions/answers would suggest your link has as much credibility as Faux News’ fair-and-balance.

Have you ever considered asking even one critical question of the alarmist horsepucky you seem compelled to continually hoist upon the rest of us without any critical analysis? Do you think doing so would undermined the message that you want to convey and it’s just best to hope no one else will question what is being presented?

Or, are you just lazy - an advocate, but a very lazy advocate?

Originally Posted by playwrite

That's a lot of unsupported conjecture there. Do you care to back up any of it with, you know, FACTS???

Let's just take the -



Let's see, 1/3 is 33%, right? Now the ACA requires a Medical Lost Ratio (MLR) of 80% for individual plans and 85% for group plans. That means for each premium dollar only 20% and 15% respectively can go to the insurance companies' "advertising, profits, fat executive salaries, lobbying and the paperwork." And when the insurers go over that amount, then there are mandatory rebates given to premium payers such as the $1.1 billion in rebates returned to 12.8 million individuals by August 1, 2012.


Now the MLR for individual plans is more than 1/3 less than what you stated and for the larger category of group plans it’s less than ½ as big. Your source says "health dollar" so I guess the difference is going to primary care providers' "advertising, profits, fat salaries, lobbying and paperwork." That raises some crticial questions.

Are you saying that insurers and care givers are equivalent and both need to reduce their "advertising, profits, fat salaries, lobbying and paperwork”? Do you think the primary care givers that do Medicare have different "advertising, profits, fat salaries, lobbying and paperwork” than those that don’t do Medicare? How much is the difference? Do you think these costs could be reduced? How? Are you saying that providers should no longer be private businesses but instead government employees, i.e. you don't just want single payer, you want to nationalize health care in toto?

If you don’t think we should force much cost reductions on health care providers, do you think it would be more honest to talk about the 15/25% for insurers rather than the 33% and imply that it is just for fat cat insurers? Or if you do think we should force cost reduction on the providers, do you think it might be more honest to state that as being part of the discussion when you bring up the 33%?

Just this one aspect of your linked unsupported conjecture seems to raise a number of questions? Some of the answers to these questions (e.g. nationalizing our entire health care system) would make even a lot of pretty liberal folks blanch. Other questions/answers would suggest your link has as much credibility as Faux News’ fair-and-balance.

Have you ever considered asking even one critical question of the alarmist horsepucky you seem compelled to continually hoist upon the rest of us without any critical analysis? Do you think doing so would undermined the message that you want to convey and it’s just best to hope no one else will question what is being presented?

Or, are you just lazy - an advocate, but a very lazy advocate?

Just keep slamming the messenger, that always does a lot of good. I wish we were all as brillient as you, then the world's problems would be solved. But no, we are just mere humans and you are the all knowing one. sigh

Perhaps you could get a job on Obama's administration as his propaganda minister. Ugh, I mean, PR person.

One sure fire way to let our government take us down the road of fascism, is to have wonderful citizens, such as yourself, making excuses for a wolf in sheep's clothing.

Insurers still in control in Obamacare

By Jonathan D. Walker, M.D.
The Journal Gazette (Fort Wayne, Ind.), April 15, 2012

America’s Health Insurance Plans is the main lobbying organization for the private health insurance industry – companies such as Anthem, WellPoint and Cigna.

If you went to their website in the years preceding enactment of the PPACA, you would have found their recommendations for health care reform. Those recommendations were based on their business model: profitability largely depends on trying to cover healthy people and avoid covering sick people. The basic structure of the PPACA almost exactly matches those recommendations.
First, the companies know that most of the population is healthy and won’t cost them much, so they wanted a mandate to force people to buy their product – that guarantees them a lot of extra income. But they also knew that most people can’t afford what they sell, so they wanted taxpayers to provide subsidies so that people could actually purchase the insurance the law required them to buy. Finally, they agreed to try to cover people regardless of their health status, but they wanted to be sure that sick people could still be unloaded onto taxpayers through government programs such as Medicare, Medicaid and state-run high-risk pools.


There are aspects of the PPACA that represent a big improvement, such as trying to stop companies from denying insurance for pre-existing conditions. Still, the basic structure of the law is very favorable to private insurance companies and not so favorable to taxpayers and patients. This is not surprising, given the amount of political influence these companies wield (for instance, a former executive from WellPoint helped write the law). In fact, back in 2009, Business Week reported that the insurance companies had “won” – that whatever shape health care reform would take, it was clear that it would be very close to what those corporations wanted.

OR

Obamacare architect leaves White House for pharmaceutical industry job

Few people embody the corporatist revolving door greasing Washington as purely as Elizabeth Fowler

By Glenn Greenwald
The Guardian (U.K.), Dec. 5, 2012

More amazingly still, when the Obama White House needed someone to oversee implementation of Obamacare after the bill passed, it chose . . . Liz Fowler. That the White House would put a former health insurance industry executive in charge of implementation of its new massive health care law was roundly condemned by good government groups as at least a violation of the "spirit" of governing ethics rules and even "gross," but those objections were, of course, brushed aside by the White House. She then became Special Assistant to the President for Healthcare and Economic Policy at the National Economic Council.

Now, as Politico's "Influence" column briefly noted on Tuesday, Fowler is once again passing through the deeply corrupting revolving door as she leaves the Obama administration to return to the loving and lucrative arms of the private health care industry: "Elizabeth Fowler is leaving the White House for a senior-level position leading 'global health policy' at Johnson & Johnson's government affairs and policy group."