"Do or Do not. There is no try."

“Hey, Obamacare Complainers”: You Hypocrites, Regular Insurance Has Tons of Glitches Everyday

The nation’s new health-insurance exchanges, the online marketplaces for medical coverage that are an integral part of Obamacare, opened for business last week. Immediately the trouble began. Web pages went blank. Attempts to enroll in coverage were delayed, or altogether stymied, as sites crashed. Critics of the law pounced. “Too many unanswered questions and too many unsolved problems,” said U.S. Sen. Orrin Hatch, Republican of Utah.

Yet there’s another way to see these growing pains: as evidence not of change but of continuity for consumers of health insurance in America. With each misstep, government officials are simply catching up to the  record of headache-inducing frustrations produced by the longstanding private medical insurance system.

Whether you’re one of the 50 percent or so of Americans who already have private health insurance (mostly through an employer, as I do) or one of those who may now turn to the exchanges to buy coverage, the bureaucracy is often maddening. Sure, the Affordable Care Act may seem opaque and unwieldy, but make no mistake: Employer-provided healthcare—which offers plans by the very same companies now on the exchanges—is equally Byzantine. No wonder that only 22 percent of American consumers reported themselves as satisfied with the health care system in a 2012 survey from the Deloitte Center for Health Solutions.

A few weeks ago I had an all-too-typical experience. My insurance company, Anthem Blue Cross, sent me a letter saying, “It has come to our attention that we have been paying for certain . . . drugs that are not covered under your existing benefit plan.” Going forward, the letter added, my doctor would need to prescribe something different or I’d have to start paying for these particular medications myself.

And when would this kick in? According to one part of the letter, January 1, 2014. According to a different part of the letter, right away.

It concluded with the sentence I’ve come to dread most: “If you have any questions or concerns, please call the customer service number on your ID card.”

Bravely, I did. Forty-five minutes later, I had yet to talk to an actual human being. Finally, at the 50-minute mark, a customer-service representative showed up on the line. She was cheerful and peppy. I was not.

The Anthem representative was unable to clarify anything in the letter and asked if she could put me on hold while she did a little research. I said OK, but I made a special plea: to call me back if we somehow got disconnected. Just a week before, on another Anthem call—concerning a paid claim that Anthem said was unpaid—I’d gotten cut off after an hour or so on the phone. She assured me that she’d call me back, if need be.

Ten minutes later, the representative returned to tell me that the answer to when Anthem would stop covering my prescriptions was neither January 1 nor immediately. It was December 1.

Where did this new date suddenly come from? She couldn’t explain. I asked to speak to her supervisor directly. She countered with a classic chess move: I was put on hold for another 15 minutes. Then: “Thank you for calling Anthem Blue Cross. Good-bye.” The line went dead. Checkmate.

Despite my plea and the representative’s promise, no one from the company called me back. I have yet to find the stomach to phone Anthem again.

Sure, the implementation of the Affordable Care Act is hitting some bumps, especially in its early days. But before critics falsely brand these as the inevitable consequence of a “government takeover” of our healthcare system, let’s remember that when it comes to medical coverage, bureaucratic snafus are hardly the province of Obamacare alone.


By: Randye Hoder, Contributor, Time Magazine, October 9, 2013

October 12, 2013 Posted by | Affordable Care Act | , , , , , , , , | Leave a comment

“Ideology Meets Idiocy”: The GOP’s Obamacare Youth Hoax

It’s rare for a political party to trumpet a position that unintentionally reveals its myopia, incoherence and expediency. Yet such is the trifecta with the Republican campaign to call attention to Obamacare’s young “victims.”

Republicans are obsessed with the supposed injustice being done to some healthy young people who will effectively subsidize their sicker elders when Obamacare’s individual mandate takes effect.

The crusaders are nothing if not convinced of the righteousness of their cause. “The whole scheme is enlisting young adults to overpay, so other people can have subsidies,” Dean Clancy, a vice president at FreedomWorks, told my Post colleague Sarah Kliff. “That unfairness reminded us of the military draft.”

Conservatives are therefore urging young Americans to resist. “I’m burning my Obamacare draft card,” runs one theatrical riff from a group called Young Americans for Liberty, “because I’m too busy paying student loans to pay for somebody else’s health insurance.” Republican policy advisors have urged the party to make such child abuse a big part of their anti-Obamacare message.

Sounds like a sexy argument, except for one thing. Republicans seem to have forgotten where most people aged 19 to 34 get health coverage: from their employer. And at virtually every company, young people pay the same premiums as employees who are much older than they are and who get more expensively sick than they do. In other words, the evil cross-subsidy Obamacare’s foes are storming the barricades to roll back already exists, at vastly larger scale, in corporate America.

These youngsters are already in chains! They’ve been put there by the private sector! And, inexplicably, young employees have entered this servitude of their own volition. (To extend the GOP’s draft analogy, it turns out there’s a voluntary army of health care masochists from sea to shining sea.)

How could injustice on this scale escape the GOP’s searing moral scrutiny?

After all, the president is only hoping that about 2.7 million young people will purchase coverage in the new exchanges. But 20 million Americans between the ages of 19 and 34 get coverage from their employer right now, according to an analysis by the Kaiser Family Foundation.

If you’re keeping score, that makes employer-based health care’s cross-subsidy about eight times more evil than Obamacare’s.

How does it work? Compare a typical, strapping young employee of 28 to her broken- down 58-year-old colleague. These two employees have very different annual health expenses. Yet under the nefarious plot known as “group health insurance,” they basically pay the same premiums. It turns out every big company in America is essentially a socialized health care republic, in which the young subsidize the old, and the healthy subsidize the sick — all of whom pay the same premiums for the same plans.

Similar dynamics explain why, in the federal health-care plan, spry 42-year-olds like Marco Rubio and Ted Cruz subsidize 79-year-old geezers like Chuck Grassley and Orrin Hatch.

Maybe that’s why Cruz always seems so angry.

Of course, most people in civilized nations know and accept that this is how insurance works. But Republicans nowadays aren’t like most people in civilized nations. They think Obamacare is a form of injustice akin to slavery. Which makes employer-provided health care slavery on steroids. Where’s the outrage? If conservatives were consistent and principled, they would devote far more time and effort to liberating 20 million young Americans from the socialism baked into employer-based insurance and look past the Obamacare exchanges as a puny sideshow.

But, alas, conservatives are not consistent and principled, save for their consistent determination to hurt the president politically.

It would be better if all those smart GOP thinkers devoted their talent and energy to the question of how they would expand coverage to the 50 million uninsured — but to raise that question is to enter the policy cul de sac in all its delicious irony.

Because the answer to that question is RomneyObamacare, the only sound way (as Republicans rightly taught us) that a country can move toward universal coverage using private health plans. The GOP could offer a tweaked version with slightly fewer regulations. Or structure it to offer universal catastrophic coverage to save money. But if Republicans were serious, they’d offer the same basic reform architecture.

So Republicans choose not to be serious. And it shows.

In the end, the GOP’s Obamacare youth hoax shows how silly a party can look when a political focus on one corner of a policy leads it to latch on to “insights” that utterly miss the big picture. It’s a reminder, if we needed another, of how close the connection can be between ideology and idiocy.


By: Matt Miller, Opinion Writer, The Washington Post, August 21, 2013

August 22, 2013 Posted by | Affordable Care Act, Politics | , , , , , , , | 1 Comment

“GOP Opposition Is More About The Man”: The Obamacare Idea Conservatives Should Be Cheering But Aren’t

Obamacare hate is a full-time occupation on the right. But a story from Monday’s New York Times is a reminder that some pieces of the law should have conservatives celebrating, for the same reason they are leaving liberals like me a little queasy.

The story is about Obamacare’s “Cadillac Tax,” which isn’t really a tax so much as a convoluted attempt to undo an existing tax break. To simplify things a bit, the government today doesn’t treat employer health insurance as taxable income. That makes a dollar of insurance worth more than a dollar of wages, giving both employers and employees incentive to load up on insurance.

Most economists think that contributes to rising health care costs, since people with more insurance tend to spend more on medical care. The Cadillac tax would limit the value of the tax break, effectively reducing that incentive and, in theory, reducing health care costs for everybody over the long run. (The mechanism is complicated; read here if you want an explanation of how it works.)

In an ideal world, insurers and employers would respond to the Cadillac tax by finding more efficient ways to pay for care, so that workers would end up with the same access to and quality of medicine. They’d just pay a little less for it. One way to accomplish this would be to switch employees over to a smartly managed care insurance plan—think Kaiser Permanente, where the physicians and nurses coordinate with each other, focusing on the most effective treatments and long-term health of the patient.

In the real world, alas, employers frequently find it easier just to shift costs over to their employees. They change their plan benefits, so that workers pay more for each prescription, hospital visit, and the like. The Times story, by Reed Abelson, suggests employers are doing just that.

It’s difficult to pinpoint how much the Cadillac Tax is responsible for these shifts, given that employers were looking for ways to shift costs long before Obamacare came long. The tax doesn’t start to phase in until 2018. And the Congressional Budget Office, in its most recent revision of projections on Obamacare, said that it now expects fewer plans to hit the tax threshold when it first takes effect. Still, employers are certainly talking about the tax. (I’ve heard the same chatter.) If employers are reducing their coverage in response, then—as Matthew Yglesias notes—it’s working precisely as the economists predicted it would.

That doesn’t mean the change is popular. People don’t like to hear that they’ll have to pay more the next time they go to the doctor. Unions are particularly wary of the change, since many of their members fought hard for the generous financial protection that the Cadillac Tax will curb. But the real danger is for the chronically ill, who run up huge medical bills year after year—and for whom higher out-of-pocket expenses can be a real hardship. The Times article focuses on one such person—a woman with cystic fibrosis who said she had to drop out of school and take a second job, in order to pay the bills from her higher deductibles.

Liberals who support or at least tolerate the Cadillac Tax do so because the economists have convinced us it might truly reduce costs in the long run. We also know that other parts of Obamacare, like tax credits for purchasing insurance and guarantees of coverage for people with pre-existing conditions, will help the sick and the poor far more than the Cadillac tax will hurt them.Conservatives can’t stand this kind of spending and regulation, of course. But they should have no such hostility to the Cadillac tax.

On the contrary, writers like James Capretta and Robert Moffit have long called for reducing or eliminating the tax breaks for employer sponsored insurance. They subscribe to the same economic logic that compelled Obamacare’s architects to include the provision in the first place—that, without the favorable tax treatment, employers and insurers will be more thrifty. The only difference is that conservatives think the tax incentives are even more central to the cost issue than liberals do. And, unlike liberals, conservatives don’t seem particularly troubled by the implications for the chronically ill. Either that, or conservatives do a remarkably good job of disguising their anxiety.

The Cadillac Tax will not work as quickly or smoothly as conservatives would prefer. And that’s fair grounds for criticism. But surely the concept deserves a kind word or two somewhere on the right—unless, perhaps, opposition to Obamacare is less about what’s in the law and more about who signed it.


By: Jonathan Cohn, The New Republic, May 28, 2013

May 31, 2013 Posted by | Affordable Care Act | , , , , , , , | 1 Comment

“Eight Months Until The End Of Job Lock”: A Reminder About One Of The Best Things Obamacare Does

For years, even before Barack Obama was elected, one of the many complaints liberals (mostly) had about the current employer-based health insurance system was “job lock”—if you have insurance at your job, particularly if you or someone in your family has health issues, then you’re going to be hesitant to leave that job. You won’t start your own business, or join somebody else’s struggling startup (unless they provide insurance), and this constrains people’s opportunities and dampens the country’s entrepreneurial spirit.

That this occurs is intuitively obvious—you probably know someone who has experienced it, or have experienced it yourself. And today there’s an article in that pro-Democrat hippie rag The Wall Street Journal entitled “Will Health-Care Law Beget Entrepreneurs?” Amid the worrying about the implementation of Obamacare in January, and the quite reasonable concern that the news could be filled with stories of confusion, missteps, and dirtbags like that Papa John’s guy cutting employees’ hours rather than give them insurance, to avoid the horror of increasing the cost of a pizza by a dime,11This is important: when you hear a story about an employer who cut his employees’ hours so he wouldn’t have to abide by the law, what you’re reading about is a jerk who doesn’t want to offer his employees insurance, not some inevitable consequence of the law. That’s a choice he makes. And don’t forget too that the employer mandate only applies to companies with 50 or more employers, and 96 percent of them already offer health insurance, even without a mandate. it’s a reminder that there will probably be lots of stories like this one in the news too, stories about people whose lives have been changed for the better by the fact that Americans will have something they’ve never had before: health security.

So what kind of effect could the elimination of job lock have on the economy? That’s tough to say. The study referred to in the WSJ article finds that people are much more likely to start a business if they get their health insurance from their spouse’s job than if they get it from their own job; in the former case you’d still have insurance if you started a business, while in the latter case you’d lose it. In addition, and this is particularly interesting, even though you might think of 65-year-olds as looking forward to days of golf and eating dinner at 4 p.m., a large number of people seem to start businesses pretty much the minute they become eligible for Medicare. While it’s hard to get insurance in the current private market if you’re 44, it’s basically impossible if you’re 64.

So it seems that the fact that after January, job lock will be history means that more businesses will be started. How many more? Well, we don’t know yet, and it could depend in part on how affordable the insurance you can get through the exchanges is compared to what people are getting from their employers. And it will be hard to measure precisely how much more economic activity is generated by businesses that wouldn’t have otherwise been started. Obviously, some will succeed and more will fail.

Nevertheless, beyond additions to GDP, there’s something psychological that shouldn’t be discounted, touchy-feely though it might be. The end of job lock means the end of a certain kind of fear that all of us under the age of 65 live with to one degree or another. It’s the fear that leaving a job, voluntarily or otherwise, could become an utter financial calamity if we or one of our loved ones has a health problem. Even if you wish reform hadn’t been grafted on to the existing employer-based system (I’ll raise my hand on that one), ending that fear is huge; it’s one of the best things Obamacare does. Even if it’s difficult to communicate on a bumper sticker.

By: Paul Waldman, Contributing Editor, The American Prospect, May 9, 2013

May 10, 2013 Posted by | Affordable Care Act | , , , , , , , | Leave a comment

No Credibility Or Integrity: What McKinsey & Company Has To Hide

An outfit called McKinsey & Company released a report this week making all kinds of discouraging claims about the Affordable Care Act. According to the study, nearly a third of American businesses will stop offering health coverage to their employees as a result of the new reform law. Several news outlets pounced on the release of the report, as did many Republicans.

The White House’s Nancy-Ann DeParle, in a rather understated response, urged caution.

A central goal of the Affordable Care Act is to reduce the cost of providing health insurance and make it easier for employers to offer coverage to their workers. We have implemented the law at every step of the way to minimize disruption and maximize affordability for businesses, workers, and families. And we agree with experts who project that employers will continue to offer high quality benefits to their workers under the new law. This one discordant study should be taken with a grain of salt.

That’s putting it mildly.

McKinsey claims to have done a survey of 1,300 employers. How was it conducted? We don’t know and McKinsey hasn’t said. What were the questions? We don’t know and McKinsey hasn’t said. How were the employers chosen? We don’t know and McKinsey hasn’t said. What were the statistical breakdowns among businesses of different sizes? We don’t know and McKinsey hasn’t said.

Who funded the study? We don’t know and McKinsey hasn’t said.

Kate Pickert noticed a small tidbit in the report: McKinsey acknowledged having “educated” those participating in the survey. And what, pray tell, did the company say to respondents that might have affected the results? You guessed it: we don’t know and McKinsey hasn’t said.

Politico added today that it “asked really nicely” to at least see the questionnaire McKinsey used to conduct the employers survey, but the company refused.

Raise your hand if you think the McKinsey & Company report has some credibility problems.

But here’s the angle to keep an eye on. How soon will Republican talking points simply incorporate this highly dubious claim into all arguments about health care policy? That’s usually how this game works — sketchy outfit tells the GOP what it wants to hear; Dems point out how baseless the claim is, and the media presents the information in a he-said-she-said format, leaving the public to think “both sides” have merit.

Keep this in mind the next time you hear a Republican claim on television, “We recently learned that a third of American businesses will stop ensuring their workers.” It won’t be true, but that won’t matter.

By: Steve Benen, Contributing Writer, Washongton Monthly-Political Animal, June 9, 2011

June 10, 2011 Posted by | Affordable Care Act, Businesses, Conservatives, Democrats, GOP, Government, Health Care, Health Care Costs, Health Reform, Ideologues, Ideology, Politics, Public, Republicans, Right Wing, Under Insured, Uninsured | , , , , | Leave a comment


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