Some are projecting the ACA will reach the CBO estimate of 7 million private insurance sign-ups by the end of March -

http://www.washingtonpost.com/blogs/...lion-sign-ups/

Obamacare just might net its 7 million sign-ups

- which will completely take away that narrative from the Right.

Just need to weather the smaller storm of those not getting continuous coverage on Jan 1 due to problems from the hand-off from the website to the insurers. But there's been big-time bending over backwards by both the govt and the insurers to minimize that with delaying deadlines - something the Right has tried to pick on but most will see it as Obamacare doing all it can to help people and the Right just being toadies.

Basically, there should now be a couple months of general calm but with some good news stories of people getting coverage. Then in March, the big scare about having to pay the penalty if you don't sign up. That will actually help with the sign-ups and narrow those not signing up to the obvious crackpot militia nuts - a good counter being that these are the free riders looking to be carried by the rest of us.

Then, after the election (although it will likely be played up prior by the wingnuts), we'll start getting the fear-mongering over the employer mandate. However, some of the big players will have dropped out as agree-to when they got the 1-year extension to better prepare. Also, the theme will emerge that maybe employer-based insurance is too heavily subsidized by the govt and the question of whether that's fair will enter the fray - that is going to shut up a lot of the business GOPers pretty fast.

For the election itself, I think the GOP is going to have this as a growing problem leading up to election day -




Tying the GOP House to the pre-ACA insurers will unite/energize the Left and peel off a lot of baggers from the big business GOPers. The DCCA is already running this in over 40 competitive districts.

Originally Posted by playwrite

National level depends on the 2014 elections but even with a GOP gain of the Senate and keeping the House, not much significance - if GOP gains both Houses lots of huffing and puffing but no there there; if Dems keep the Senate and pick up some seats in the House maybe a few minor fixes to the ACA with the Dems giving on some of the tax provisions in return for some sweetening the Medicaid Expansion pie for the recalcitrant states to accept and claim some sort of victory for holding out on giving the most needy in their state health coverage - that's the world we live in. Obama could fart magic ponies and it won't change a thing on this issue.

I'm not sure what you mean by that (the italicized quote). Do you mean that Congress would be unable to repeal ACA while Obama is in office, at which point, people will like it the way they like Medicaid Part D (prescription drug coverage) once the kinks from that roll out were ironed out? But wouldn't a GOP-controlled Congress (House and Senate) be able to defund it prior to 2017?

Originally Posted by playwrite

Your meatless organic magic nachos aren't going to do a thing to help a parent whose 9 year old got hit by a car, a spouse whose husband has just been diagnose with a brain tumor, or a dad who can no longer work because of a herniated disk, all of whom never smoked, drank excessively or voted for Obama

...And neither will the "health insurance" you want to make them pay some rich guy for. A doctor will help them (or, more likely, several doctors working in an infrastructure). All your "health insurance" will do is ensure that, when they are forced into penury, relatively more of the rents extracted from their lifelong-indenture will go to line the pockets of some particular politically-connected individuals. That is, as opposed to actually paying for the provision of health care.

Insurance is anathema to provision.

Originally Posted by The Wonkette

I'm not sure what you mean by that (the italicized quote). Do you mean that Congress would be unable to repeal ACA while Obama is in office, at which point, people will like it the way they like Medicaid Part D (prescription drug coverage) once the kinks from that roll out were ironed out? But wouldn't a GOP-controlled Congress (House and Senate) be able to defund it prior to 2017?

The way the funding is set up, they can't touch it without repealing it.

What I'm saying is that they can't repeal it until 2017 and that assumes that they win both Houses and the POTUS. Highly doubtful particularly by then the number of millions benefiting may be in the mid-teens and all the fear-mongering will have been shown to be what it really is.

In the meantime, if the GOP gets more power, they'll huff and puff but nothing much will happen. And if the Dems get a little more power there may be some negotiated changes around the tax provisions (other than the individual/employer mandates) and some incentives for recalcitrant states for the Medicaid Expansion - good stuff but no fundamental changes to the law.

Originally Posted by Justin '77

...And neither will the "health insurance" you want to make them pay some rich guy for. A doctor will help them (or, more likely, several doctors working in an infrastructure). All your "health insurance" will do is ensure that, when they are forced into penury, relatively more of the rents extracted from their lifelong-indenture will go to line the pockets of some particular politically-connected individuals. That is, as opposed to actually paying for the provision of health care.

Insurance is anathema to provision.

I certainly realize it has some special consideration, but health insurance is at its heart just another good/services just like any other good/service. It can be delivered through a govt program as a public good/service or, under a capitalist system, as a privately provided good/service. One way or another, it is paid for with premiums, co-pays and deductibles and/or taxes (of course MMT will tell us that the only cost as a federal govt good/service is a higher risk of inflation, but that's another story that we have already parlayed ad naseum ).

Of course, people can self-insure (i.e. set aside funds for the possibility of an accident or illness) but the vast majority of people choose not to, and a majority of them who choose not to instead buy insurance (or get it from a govt program) rather than just go without. It is what it is.

I'll leave it to you to tilt against the windmill of the peoples' choice for how they insure against the uncertainty of the need for health care. I will also leave you the windmill of public versus private; I've already made my mind up about that and supporting what I believe is the only path for real change - incremental and, for now, mostly at the state level.

Let's check back in 10 years and see who accomplished what.

This is what the GOP will be up against multiplied by several million -

http://facesofrepeal.com/page/-/Face...eal/index.html

Originally Posted by playwrite

I certainly realize it has some special consideration, but health insurance is at its heart just another good/services just like any other good/service.

Sure. And plutonium is just another metal/ice cream like any other metal/ice cream.
Except, you know, in the ways in which is isn't the same. And those ways are far more important than your dismissive non sequitor wants to admit.

Ultimately, what you keep avoiding is the fact that insurance -- by which insurance as a class, fundamentally regardless exactly what is being insured -- is a system for maintaining income in the form of subscription fees at a higher level than expenses (which include as merely one of their number expenditures on the actual provision of care). Insurance is a parasitic load on the relationship between a healthcare consumer and healthcare providers. Its existence necessarily ensures at the very least that less goods will be provided at a particular level of cost than there would have been in its absence.

Pretending that spreading the insurance-leech universally throughout the health care system is in any way good means necessarily defining 'good' as purely and totally 'good for the parasite'. There might hypothetically be an argument to be made that the parasite provides some sort of ancillary benefit to the components of the system or the system as a whole -- though the performance of the parts of the American health system which had previously been infected by it, as well as the shapes and behaviors that the system developed as it grew in tandem with the parasite very strongly suggest that such benefit (at least as regards the American system) is another self-serving myth from the parasite and its defenders.

Please, though... feel free to try to put forth an argument why the parasitic load imposed by American health insurance on the health care system and its consumers is outweighed by whatever ancillary benefits you can demonstrate that American health insurance provides. Ideally, the net-good would be at least equal to, if not better than the hundreds of examples in the real world of health care systems which both lack American health insurance and function demonstrably better (from the point of view of everyone but the parasite, naturally) than the parasite-burdened American health care system does. But whether or not you're able to make that argument, at least please show a bit of respect for anyone who might read what you write... quit trying to pretend that health insurance is a part of or in any way not-detrimental-to health care.

Originally Posted by Justin '77

Sure. And plutonium is just another metal/ice cream like any other metal/ice cream.
Except, you know, in the ways in which is isn't the same. And those ways are far more important than your dismissive non sequitor wants to admit.

Ultimately, what you keep avoiding is the fact that insurance -- by which insurance as a class, fundamentally regardless exactly what is being insured -- is a system for maintaining income in the form of subscription fees at a higher level than expenses (which include as merely one of their number expenditures on the actual provision of care). Insurance is a parasitic load on the relationship between a healthcare consumer and healthcare providers. Its existence necessarily ensures at the very least that less goods will be provided at a particular level of cost than there would have been in its absence.

Pretending that spreading the insurance-leech universally throughout the health care system is in any way good means necessarily defining 'good' as purely and totally 'good for the parasite'. There might hypothetically be an argument to be made that the parasite provides some sort of ancillary benefit to the components of the system or the system as a whole -- though the performance of the parts of the American health system which had previously been infected by it, as well as the shapes and behaviors that the system developed as it grew in tandem with the parasite very strongly suggest that such benefit (at least as regards the American system) is another self-serving myth from the parasite and its defenders.

Please, though... feel free to try to put forth an argument why the parasitic load imposed by American health insurance on the health care system and its consumers is outweighed by whatever ancillary benefits you can demonstrate that American health insurance provides. Ideally, the net-good would be at least equal to, if not better than the hundreds of examples in the real world of health care systems which both lack American health insurance and function demonstrably better (from the point of view of everyone but the parasite, naturally) than the parasite-burdened American health care system does. But whether or not you're able to make that argument, at least please show a bit of respect for anyone who might read what you write... quit trying to pretend that health insurance is a part of or in any way not-detrimental-to health care.

That sure is some magic pony horseshit you got going there. Pretty funny actually.

Just as with the Libertarian/Anarchist nirvana, the argument is that your horseshit doesn't exist in the real world.

If a society is developed enough, affluent enough, the insurance model not only emerges but is actively in demand. Whether by paying premiums or by paying taxes, people want it. In the US, 1/2 the population pays to get insurance through their employers, no one forces them to do so. Another 30% of the population are happy to be covered by Medicare, Medicaid, VA through the taxes we all pay. The other 20% are the target for Obamacare and with 7 million likely scrambling to get insurance by this April and several million more happy to get coverage under the Medicaid Expansion, there's little doubt insurance is a coveted commodity. Not understanding this fundamental is not just a sign of your sophomoric thinking but your possession of a blinding ideology that leaves one wondering how you even function in the modern world.

The problem you have is your inability to grasp that health care cannot only be highly expensive but that it is a crap shot as to whether you are going to be the one who is in serious need of it. Most people get that notion. Most people, however, are not in the position to self-insure against the odds of a serious health problem. Fortunately, however, most people are not handicapped by an idiotic ideology and can grasp the fundamental common sense of the need for collective insurance against risks and how it works, AND the vast majority act accordingly and actively seek insurance by paying premiums or by getting it from their govt with or without taxes to 'pay' for it.

Can there be profiteering in the insurance business? You betcha, just like in any other sector of the economy. However, the health insurers are one of the least profitable sectors out there; something like 155th out of 220 sectors. Moreover, the ACA now caps their expenses, including CEO salaries and shareholder dividends, to 15-20% - very few other business sectors have such imposed limitations.

Don't get me wrong; I'm not an insurer apologist. I am for single payer, and actively involved in bringing that about.

I just don't come at these real issues with magic pony sophomoric understanding of the fundamentals and I'm certainly not blinded by some idiotic ideology, at least anywhere near to the extent that yours has you by the balls to the degree that its obviously cutting off blood supply to your brain.

Originally Posted by playwrite

That sure is some magic pony horseshit you got going there. Pretty funny actually.

Just as with the Libertarian/Anarchist nirvana, the argument is that your horseshit doesn't exist in the real world.

So.... your best argument in favor of what even you (occasionally, and never honestly and forthrightly) acknowledge is a bad system is to argue that the hundreds of real, long-term-functioning, far superior alternative systems... don't actually exist?

You've got originality going for you, I guess. That's something.

"TODAY marks the beginning of health care coverage under the Affordable Care Act’s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful." Michael Moore

The Obamacare We Deserve

That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president’s enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president’s Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it.

For solutions:

http://www.nytimes.com/2014/01/01/op...erve.html?_r=0

Originally Posted by Justin '77

So.... your best argument in favor of what even you (occasionally, and never honestly and forthrightly) acknowledge is a bad system is to argue that the hundreds of real, long-term-functioning, far superior alternative systems... don't actually exist?

You've got originality going for you, I guess. That's something.

Your initial argument was that INSURANCE 'just pays rich guys' and is "anathema to provision" of health care.

As I've made clear that is just plain wrong and stupid. Your "hundreds of real, long-term functioning, far superior alternative systems" ALL PROVIDE INSURANCE either through the private sector (e.g., employer-based private insurance), the public sector (e.g. Medicare, Medicaid, VA) or some combination of both (e.g. ACA govt subsidized health exchanges)

One needs to have that fundamental understanding to move on to even the most rudimentary discussions of the different systems. It seems, with my patience help, you may have arrived to at least that point.

My position is that single payer (i.e., central govt provided) insurance is the best approach but it is not a panacea for all issues at the societal level and certainly not at the individual level. For EVERY one of your "superior alternative systems" there are reams of critiques as to their flaws depending on perspective. For example, single payer is bounded by govt expenditure limitations and therefore has built in price controls including what is eligible and what is not based on some deliberative process, e.g. death panels; for further example, organ transplants are likely not covered and even if they are, they obviously still don't put everyone at the front of the line.

These are not actually very difficult facts and tenets to grasp. The problem comes when one's blinding idiotic ideology turns them into a moron.

Now the more difficult discussion is what is "the art of the possible." That is a political and tactical discussion. Blowing magic pony farts about "far superior alternative systems" isn't really much of a tool in the toolbox in today's world; I'm not sure it ever was. When you're ready for a more adult discussion about what are real possibilities and promising tactics, let me know.

Originally Posted by Deb C

"TODAY marks the beginning of health care coverage under the Affordable Care Act’s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful." Michael Moore

The Obamacare We Deserve


For solutions:

http://www.nytimes.com/2014/01/01/op...erve.html?_r=0

Here's the key point in Moore's piece that a lot of people, such as yourself, purposely miss or gloss over -

...BUILD ON WHAT THERE IS TO GET WHAT WE DESERVE...

I put it in capitals, put it in bold, and underlined it in the hopes that for once you might catch on.

PW: when do the tax credits kick in? At time of premium payment, or at time of filing my 1040?

If the premium payments are *not* reduced at time of payment, then I am out (example for cheapest bronze plan in MO) $3600 before being re-imbursed by the US government. Also, the term "balance billing" comes into play. Anything charged above what the plan sets as the limit, the patient is on the hook for- it does not count towards the out of pocket limit.

That limit is $6340. More than $500/month. Car payment? Rent? Food?

This means, since premiums do *not* count against the out of pocket limit, that I could be out $10,000 even if I stay below the "balance billing" limit. Ouch.

I think the insurance companies are cashing in.

Let the screaming begin.

Originally Posted by playwrite

Here's the key point in Moore's piece that a lot of people, such as yourself, purposely miss or gloss on

Yeah, we know already. The big social/political hurdle was crossed with the SCOTUS ruling. Now, it will take a decade to get it right, minimum. More like two. Meantime, the insurance companies and Big Drugs cash in for as long as they can.

And all of us suffer in the interim. You can stop cheerleading, now. My great niece and nephew will eventually benefit, but I will take it in the (deleted).

Originally Posted by Bad Dog

PW: when do the tax credits kick in? At time of premium payment, or at time of filing my 1040?

If the premium payments are *not* reduced at time of payment, then I am out (example for cheapest bronze plan in MO) $3600 before being re-imbursed by the US government. Also, the term "balance billing" comes into play. Anything charged above what the plan sets as the limit, the patient is on the hook for- it does not count towards the out of pocket limit.

That limit is $6340. More than $500/month. Car payment? Rent? Food?

This means, since premiums do *not* count against the out of pocket limit, that I could be out $10,000 even if I stay below the "balance billing" limit. Ouch.

I think the insurance companies are cashing in.

Let the screaming begin.

My understanding is that the subsidy (i.e. the tax credit) can be arranged to go directly to the insurer from the get-go and it is expected that most people are going to sign up that way. This is why the "back-end" of the website 'handshaking' with the insurers' data bases is such a big deal. I would check this all out with your particular insurer; I'm pretty sure the not only have to do this but WANT to do it.

"Balance billing" has always been an issue with any private insurers including the 50% of the population that gets its insurance through their employer. It's a question of watching out who you go to for health care - in the plan is where you want to be unless you truly believe one doctor has better magic than another. People want lower health costs - that doesn't happen by magic; it happens, in part, by rewarding lower cost providers with more subscribers.

Contrary to a lot of myth-makers, insurance is expensive not because insurers are making huge profits - they are one of less profitable business models out there. Health insurance is expensive because health care is expensive. Yes, it would be great if the government paid for all the health insurance and/or the actual health care, but under our present mindset (i.e. non-MMT) it is going to be paid for by tax payers if we go that route. No free lunch in a non-MMT-believing world.

Originally Posted by Bad Dog

Yeah, we know already. The big social/political hurdle was crossed with the SCOTUS ruling. Now, it will take a decade to get it right, minimum. More like two. Meantime, the insurance companies and Big Drugs cash in for as long as they can.

And all of us suffer in the interim. You can stop cheerleading, now. My great niece and nephew will eventually benefit, but I will take it in the (deleted).

Not cheer leading; just trying to inject a little reality and facts into a dialogue where most are more interesting in talking horseshit.

Originally Posted by Bad Dog

Yeah, we know already. The big social/political hurdle was crossed with the SCOTUS ruling. Now, it will take a decade to get it right, minimum. More like two. Meantime, the insurance companies and Big Drugs cash in for as long as they can.

And all of us suffer in the interim. You can stop cheerleading, now. My great niece and nephew will eventually benefit, but I will take it in the (deleted).

Agreed. I'm assuming that PW, cheerleading Dem that he is, is merely carrying political water for his party. As a not-Dem, I'm among the disgusted who would send that party to the showers permanently, given even a small chance of success. We need a major party that is left-of-center, we don't have one today, and we'll never have one until the Dems die or change. If Hillary gets the nod in 2016, the right-of-center Democrats will lock-in there for the duration.

Originally Posted by playwrite

Not cheer leading; just trying to inject a little reality and facts into a dialogue where most are more interesting in talking horseshit.

No, you've moved the marker into horseshit territory. This is not a happy program, no matter how many people may sign-on for help. Is the ACA an improvement? It helps many, and hurts some too. I can't be happy with that. With the ongoing equivocation, it's getting worse, not better. If it crosses the line into net-worse space, I'll actively join the crowd to kill it.

Glad to know that the subsidy is applied at time of premium payment.

I'm still stuck with a bronze plan of some kind. I am trying to select the least suicidal one, as I am, for the moment, an independent business person, with no guarantee of a monthly income.

That $500+ a month cost, passed on to customers, means $15-$20 bucks a day that need to be raised. Or, for a full work day of eight hours, at least $2/hr. Employers will happily offload these costs on to the employees. I see a lot of employer benefit plans dying, real soon, now that they have the cover to do so. Salaries, of course, will not be raised, as the employers treat themselves to the full benefits of the admin cost savings. Neither will prices be lowered.

Originally Posted by Bad Dog

Neither will prices be lowered.

WHAT??!! Competition between the insurance companies WON'T lower prices??!! Well slap me and call me Susan!

Originally Posted by TnT

WHAT??!! Competition between the insurance companies WON'T lower prices??!! Well slap me and call me Susan!

Yeah, that one is right up there with "You can keep your doctor."

Originally Posted by Marx & Lennon

Agreed. I'm assuming that PW, cheerleading Dem that he is, is merely carrying political water for his party. As a not-Dem, I'm among the disgusted who would send that party to the showers permanently, given even a small chance of success. We need a major party that is left-of-center, we don't have one today, and we'll never have one until the Dems die or change. If Hillary gets the nod in 2016, the right-of-center Democrats will lock-in there for the duration.

The scenario more likely to work, is to send the Republicans to the showers permanently. If the Democrats go, the Republicans take over for some period of time, and we can't afford even the amount of power that they already have-- let alone more. If the Republicans go, then the Democrats potentially become the conservative party compared to the Greens or another Left party, and the country is more liberal overall, or at least more centrist than today's reactionism.

Hillary is not likely to serve two terms, if elected. She will probably retire. In any case, if she wins, the moderate Democrats will not be any more locked in than they already have been ever since her husband was president. The country will go more progressive in the 2020s; that is guaranteed regardless of who wins in 2016, which will not be a watershed election.

Originally Posted by Eric the Green

The scenario more likely to work, is to send the Republicans to the showers permanently. If the Democrats go, the Republicans take over for some period of time, and we can't afford even the amount of power that they already have-- let alone more. If the Republicans go, then the Democrats potentially become the conservative party compared to the Greens or another Left party, and the country is more liberal overall, or at least more centrist than today's reactionism.

Hillary is not likely to serve two terms, if elected. She will probably retire. In any case, if she wins, the moderate Democrats will not be any more locked in than they already have been ever since her husband was president. The country will go more progressive in the 2020s; that is guaranteed regardless of who wins in 2016, which will not be a watershed election.

Stalemate in not a solution. If we can't try the progressive solution, then the regressive one will win by default. Worse, the failures of that default regression will be blamed on both parties, but the GOP will manage to lay claim to any gains, no matter how minor or short-lived .. as they have for the last 40 years.

Originally Posted by Eric the Green

Hillary is not likely to serve two terms, if elected. She will probably retire.

I dunno. They said the same thing about Reagan. Just sayin...

Originally Posted by The Rani

Oops:

http://www.npr.org/blogs/health/2014...sits-in-oregon

This should not be surprising. With a few exceptions for the occassional free clinic, healthcare for the poor has been the ER ... period. Habits don't break themselves.