Beyond the Spin

Massachusetts as an example of low-income workers foregoing care because of costs.

For example, a recent report found that low-income workers with health plans that required high out-of-pocket payments in Massachusetts did not go to the emergency department for serious medical conditions because of the costs. They had 25 to 30 percent fewer visits, whereas high income workers with similar plans did not reduce their visits. A health survey from 2012 found significant increases in the number of people who did not get care because of the cost (80 million total), who had difficulty paying medical bills (75 million) and who went into bankruptcy as a result (4 million over 2 years).

Health insurance does not equate to healthcare

[QUOTE]In the US, having health insurance does not guarantee access to necessary health care. The ACA will increase the number of people who have inadequate insurance which requires high out-of-pocket costs and does not cover all necessary services. This trend towards underinsurance has been growing steadily over the past decade so that currently about one-third of employer-based health insurance and half of individual plans are high-deductible plans. It is expected that in 2014, 44 percent of major US companies will only offer high-deductible health plans.

The ACA has significantly lowered the bar for what is considered to be adequate health insurance coverage. On the new health insurance exchanges, plans are offered based on four tiers. The Platinum plans will pay for 90 percent of covered care and Bronze plans, the lowest tier, will pay for 60 percent of covered services. It is important to distinguish that these levels are only for covered services because people don't usually understand that they will have to pay for uncovered services and out-of-network services. Unfortunately, the use of out-of-network services is often involuntary and occurs without being known at the time of care, especially in emergency situations./QUOTE]

Pre-existing caveats

Insurance companies have a long history in the US of skirting regulations that interfere with profits. So, while insurers can't exclude sick people, they can avoid areas where there are sick people. For example, several of the large insurance companies are selling plans on only a small number of exchanges, preferring to sell plans mostly to businesses instead. And companies that sell plans on the exchanges are restricting their networks. They avoid hospitals that care for complicated patients and keep the number of doctors in their plans low, making it more likely that people will have to go out of network and pay more of the costs of care.

Insurers will game the system

And while companies can't charge more to people with health problems as individuals, they can charge up to three times more based on age and can charge more in geographic areas where the population has more health problems or the costs of care are higher. It is expected that if a company finds they can't make enough profit in a particular area, they can just pull their plans from that area. These are some of the most obvious ways that insurers will game the system. The largest insurance companies assisted with writing the law and then with the regulations that accompanied it, so we will see what other tactics they employ as time goes on.

http://www.aljazeera.com/indepth/opi...653308300.html

Deb, this is why it will be at least two presidential cycles, before it gets sorted out.

Also, it will take at least one Microsoft cycle to get the software sorted out. This is the Windows ME version...

Deb C, don't they have Romney-care there? Isn't Obama-care based on Romney-care?

Originally Posted by TimWalker

Deb C, don't they have Romney-care there? Isn't Obama-care based on Romney-care?

Yes, Massachusetts is where they have Romney-care. And, yes, Obama-care is based on the Romney-care model.

http://www.rawstory.com/rs/2013/10/1...for-obamacare/

The government of Texas under Republican Gov. Rick Perry quietly began to shut down its high risk insurance pool program this week and urged users to enroll in the health care programs offered to people with pre-existing conditions under the Affordable Care Act (ACA) — also known as Obamacare. Think Progress reported that the high risk pool website now directs applicants to the ACA health care exchanges and informs users that the state program will be phased out entirely by January 1, 2014.
“The state has deemed the high-risk pool obsolete,” the website now says, “as the Affordable Care Act prohibits insurance companies participating in the federal marketplace, which launched on Oct. 1, from denying coverage to Texans with pre-existing conditions. Gov. Rick Perry signed Senate Bill 1367 in June, scheduling the pool’s abolishment.”
It stated, “The pool will close Jan. 1, and the 23,000 people currently participating in the pool must sign up for coverage on the insurance exchange by Dec. 15 or find coverage elsewhere to avoid a lapse in care.”
Weeks ago, Perry called the implementation of Obamacare a “felony” and a “criminal act.”
“If this heath care law is forced upon this country, the young men and women in this audience are the ones who are really going to pay the price,” said Perry to a crowd at a fundraiser for New Jersey Republican Senatorial hopeful Steve Lonegan. “And that, I suggest to you, reaches the point of being a felony toward them and their future.”
“That is a criminal act,” Perry continued. “From my perspective, to put that type of burden on them — to mortgage their future like that. America cannot stand that.”
Lonegan lost his bid for a Senate seat to his Democratic rival, Newark’s Mayor Cory Booker


Lonegan lost his bid for a Senate seat to his Democratic rival, Newark’s Mayor Cory Booker.

From the Washington Post, a excerpt of a depressing analysis. For the full article, press on the link.

It's much too early to say anything conclusive, or even very predictive, about Obamacare. As Burke and Kamarck note, a lot of what we're seeing right now are "short-term problems" that will likely be fixed within the first year. But short-term problems can become long-term problems in states where the leadership wants to see Obamacare fail rather than be fixed.

The result may be that Obamacare doesn't do anything as simple as succeed or fail. Instead, it vastly improves the health-care systems of the states that wanted to use it to improve their health-care system while collapsing in the states where the leadership did what they could to undermine the law.

Over time, that could lead to a country with two health-care systems: One, a near-universal system based around Obamacare and centered in blue states; the other, a policy mess based around the rejection of Obamacare in the red states.

That's the catch-the assumption that a flawed system will be fixed. During a period of very divisive politics. Against powerful, strident opposition. In the meantime, will voters come to view Obamacare as a turkey?

So Obamacare becomes an excuse to gut the risk pool in Texas? And in the meanwhile, Obamacare itself will be undermined in the Red states?

Originally Posted by TimWalker

That's the catch-the assumption that a flawed system will be fixed. During a period of very divisive politics. Against powerful, strident opposition. In the meantime, will voters come to view Obamacare as a turkey?

Success in state A will be touted as proof that obstructionists in state B are the cause of failure there, not the program itself. In deep red states, that may not work, and a cry to let them escape the program will start the TP obstructionism again. The election of 2014 will make inroads, but the House will remain GOP. In fact, I doubt that 2016 will be a big enough wave election to realign the House, so the 1850s may very well continue through the end of the decade. That's simply not a viable alternative.

I'm beginning to think that the secession idea is going to gain real traction in the not too distant future, unless this issue gets resolved. Making this a state-based program was a huge mistake.

Agreed. A viable program would have to be de-coupled from the states. A Federal program that by passes the states.

Off hand I don't recall the present name for the old food stamps program. Anyway, isn't that a Federal program?

Originally Posted by Bad Dog

Back when I played poker regularly, I would come back from the boat, and my dog would say, "Daddy! You went to the stinky place again!".

Dogs are smart.

Dogs are predators. They read their prey -- and they read us.

Originally Posted by TimWalker

Off hand I don't recall the present name for the old food stamps program. Anyway, isn't that a Federal program?

Food Stamps are now SNAP, and it is a Federal program. Medicaid is a Federally mandated, but state operated program. That model is not as good, but better than Obamacare.

http://www.npr.org/2013/10/17/235739...edium=facebook

HealthCare.gov was meant to create a simple, easy way for millions of Americans to shop for subsidized health care.
Instead, in a little two more than weeks, it has become the poster child for the federal government's technical ineptitude.

A dysfunctional contracting system clearly bears some of the blame. But entrepreneurs in Silicon Valley likely would have approached the project differently from the start.
A week after the site launched, NPR spoke to Suzanne Cloud, a jazz musician based in Philadelphia. At that point, Cloud had spent hours on the site, trying to sign up for coverage. "Something went wrong, and it just went to a page with all kinds of html stuff," she said.
This week, Cloud says she gave up on the website and ended up registering by phone. The folks on the phone took all of her information — then asked if she'd like to pick out her plan online or receive information about her health care options via snail mail.

Cloud chose snail mail. "Once I signed up with the telephone, I didn't go back and try the site again," she said.
At 17 days old, HealthCare.gov has become a bit of a joke — even to folks like Cloud, who were eagerly awaiting its rollout.
So how could a roughly $400 million software project that had been in the works for years have so many problems at its launch? One bit of advice from Silicon Valley: Start small.
"It's not as if Facebook says, 'OK, here is our six-year plan for how we're going to make Facebook.com,' " says entrepreneur Ben Balter. "They build one feature at a time, and take a step back, look at how the feature is be used, before they go on to the next feature."
Balter says you build something small, you test it, and when it works for your users, then you take the next step. Right now, Balter works for GitHub.
"GitHub is a social code-sharing service," he says. "Think of it like Facebook for code. So instead of posting pictures of your kids or posting ... on Twitter what you had for lunch, you are showing what projects you're working on."
By sharing the code you are writing, lots of people can critique it, find the bugs, offer ideas and make sure it works. It's called open source, and Balter believes HealthCare.gov should have been written that way from the start.
"Why would you make that code private?" Balter asks.

But often when things don't work in government, the impulse is to duck and cover and clamp down on information.

"I think the key reason is the way projects get funded," says Michael Cockrill, who used to work in startups and is now the chief information officer for Washington state.
He says to get a software project funded in the public sector, typically you have say exactly what it is going to do, spell how much it will cost and when you will finish.
"As a result, you end up creating this culture that is all about doing what you said you were gonna do," Cockrill says.
It's a culture that is risk-adverse and terrified of public failure. You can't learn from little failures or adjust course midstream. And instead of taking big jobs, breaking them down into small tasks and testing for success at each step, a project like HealthCare.gov becomes a giant all-or-nothing gamble.

Cockrill says too often it's a gamble taxpayers loose.

"You've made all these commitments about what you are going to build. What is it going to look like upfront," Cockrill says. "And even if the market changes underneath you, and even if your customers need something different — which you know always happens — you made a commitment a big public commitment, and they've written it into budgets and law."
Cockrill and many others around the country are trying to help governments become more flexible and agile as they embark on software development projects.
"It's really hard to convince people to kind of trust you," he says. "Especially when you are saying, 'Look I don't know exactly what is going to look like — but we are going to do what matters most first.' "

Originally Posted by TimWalker

So Obamacare becomes an excuse to gut the risk pool in Texas? And in the meanwhile, Obamacare itself will be undermined in the Red states?

That's Plan B, since the effort to kill it at the federal level failed.

Originally Posted by Marx & Lennon

Food Stamps are now SNAP, and it is a Federal program. Medicaid is a Federally mandated, but state operated program. That model is not as good, but better than Obamacare.

Just about the same history, too:

http://en.wikipedia.org/wiki/Food_Stamps

The measure drew overwhelming support from House Democrats, 90 percent from urban areas, 96 percent from the suburbs, and 87 percent from rural areas. Republican lawmakers opposed the initial measure: only 12 percent of urban Republicans, 11 percent from the suburbs, and 5 percent from rural areas voted affirmatively.

http://www.cnn.com/2013/10/21/politi...html?hpt=hp_t2
Saying there was no "sugarcoating" the login difficulties, long waits, repeated failures and other problems, the President added that tech industry experts were being brought in to help workers going 24/7 to resolve the website woes.
"Nobody's madder than me about the website not working as well as it should, which means it's going to get fixed," Obama said without specifying exactly what went wrong or who was to blame.
At the same time, he argued that the health insurance available through the 2010 Affordable Care Act provided Americans previously unable to get coverage with the security of knowing that an accident or illness wouldn't bankrupt them.
Though some people are having trouble applying, those who have had the chance to enroll through HealthCare.gov are "thrilled with the result," and people can apply in ways other than the website, including though a call center and in person, Obama said.

***
A ConsumerReports.org article last week offered tips for people trying to sign up, but had the following advice for those overwhelmed by the difficulties:"If all this is too much for you to absorb, follow our previous advice: Stay away from Healthcare.gov for at least another month if you can. Hopefully that will be long enough for its software vendors to clean up the mess they've made."

Dr. Margaret Flowers

"Billions of public dollars and tremendous efforts are being spent to create new health insurance markets, advertise them, subsidize their products and actively solicit buyers for them. But the United States, as the only industrialized nation to use a market-based health care system, has already proven over the past 40 years, that this system doesn’t work. It is the most expensive, leaves the most out and leads to poor health outcomes. It means that people only receive the health care they can afford, not what they need."


The ACA is the Wrong Direction, Time for Medicare for All

Market competition does not improve health outcomes because it consists of health insurance corporations competing for profit by selling policies to those who are the healthiest and denying and restricting payment for care. And regulation of insurers doesn’t work either. Although rules in the ACA give the appearance of changing insurance company behavior, insurers are already working around them.


Defense of the ACA ignores the long history of private insurance influence and domination and is based on the hope that this time things will be different. But the ACA has not changed the fact that private insurance companies view their plans as products and have no more allegiance to human health than does Big Energy which will stop at nothing to drill, frack and blow-up the planet for profits.

http://greenshadowcabinet.us/stateme...e-medicare-all

Originally Posted by Deb C

Dr. Margaret Flowers

"Billions of public dollars and tremendous efforts are being spent to create new health insurance markets, advertise them, subsidize their products and actively solicit buyers for them. But the United States, as the only industrialized nation to use a market-based health care system, has already proven over the past 40 years, that this system doesn’t work. It is the most expensive, leaves the most out and leads to poor health outcomes. It means that people only receive the health care they can afford, not what they need."


The ACA is the Wrong Direction, Time for Medicare for All

http://greenshadowcabinet.us/stateme...e-medicare-all

My hunch is that the purpose of the ACA is to convince a majority that single payer is the solution. If so, I hope that we use a good example ( such as France) for a model. We don't need to make things worse.

Suprise! Political maneuvering is partially responsible for the ACA web fiasco:

http://www.npr.org/blogs/health/2013/10/22/239197047/how-politics-set-the-stage-for-the-obamacare-website-meltdown?sc=ipad&f=1001

Then there was the timing issue. Technically, department officials have had three and a half years since the law passed. But much of that time was spent in limbo. First there was waiting to see if the Supreme Court would overturn the law in the summer of 2012. (It didn't.) Then there was waiting to see if Mitt Romney and a Republican Senate would be elected that November to repeal it. (They weren't.)
Then it was another month waiting for states to decide if they wanted to build their own health exchanges or let the federal government do it for them.
"The administration bent over backward to accommodate the states; the administration begged states to cooperate," said Angoff.
And in the end, the administration made a major miscalculation. Officials figured that even Republican states would both create their own exchanges and expand their Medicaid program because both came with so much federal money attached.
"The thought was that ultimately money trumps everything," Angoff said. "And that no matter what the rhetoric was of some of the elected officials against the Affordable Care Act, ultimately they would take the money. And I think what surprised most people was that in this case, money didn't trump everything."

****

Note: None have us have *ever* seen a major IT project rushed out to meed an inpossible deadline before, without proper testing.

It look like the Administration really thought the SCOTUS, then the House Republicans, would kill ACA.

Then, panic set in, as they realized just how short a time they had to make the bloody thing work, while keeping the inevitable frakkups out of the headlines.

So, here we are.

Update on the Dutch System.
So far, I think that the French approach is better.

One reason for the complexity
http://www.economist.com/blogs/democ...3/10/obamacare

…" When I compare the structure of Obamacare to that of its closest foreign analogue, the Dutch system, a few possible answers leap to mind. Broadly put: it's possible to make it simpler and more transparent for consumers to purchase health insurance by regulating the insurance marketplace aggressively so that the products are more uniform."...

Originally Posted by Bad Dog

That's Plan B, since the effort to kill it at the federal level failed.

If Obamacare is killed, what will be the Plan B of the other side?

Originally Posted by TimWalker

If Obamacare is killed, what will be the Plan B of the other side?

Obamacare won't be killed. It will be allowed to pass away under the Complete Lives System.

Originally Posted by Bad Dog

Suprise! Political maneuvering is partially responsible for the ACA web fiasco:

http://www.npr.org/blogs/health/2013/10/22/239197047/how-politics-set-the-stage-for-the-obamacare-website-meltdown?sc=ipad&f=1001

Then there was the timing issue. Technically, department officials have had three and a half years since the law passed. But much of that time was spent in limbo. First there was waiting to see if the Supreme Court would overturn the law in the summer of 2012. (It didn't.) Then there was waiting to see if Mitt Romney and a Republican Senate would be elected that November to repeal it. (They weren't.)
Then it was another month waiting for states to decide if they wanted to build their own health exchanges or let the federal government do it for them.
"The administration bent over backward to accommodate the states; the administration begged states to cooperate," said Angoff.
And in the end, the administration made a major miscalculation. Officials figured that even Republican states would both create their own exchanges and expand their Medicaid program because both came with so much federal money attached.
"The thought was that ultimately money trumps everything," Angoff said. "And that no matter what the rhetoric was of some of the elected officials against the Affordable Care Act, ultimately they would take the money. And I think what surprised most people was that in this case, money didn't trump everything."

****

Note: None have us have *ever* seen a major IT project rushed out to meed an inpossible deadline before, without proper testing.

It look like the Administration really thought the SCOTUS, then the House Republicans, would kill ACA.

Then, panic set in, as they realized just how short a time they had to make the bloody thing work, while keeping the inevitable frakkups out of the headlines.

So, here we are.

$600 mill and three years. Nice excuse. Bull$hit!

Yeah, the Obamacare catastrophe will work. Sure. Keep hoping.

http://themattwalshblog.com/2013/10/...merican-lives/