[Winstonm]

We have all seen and heard it - CBS and Fox News Channel - all echoing the same story:

Quote

If you’ve followed the stories of insurance cancellations related to Obamacare, you may have heard about Dianne Barrette. She’s the 57-year-old Florida realtor who was paying $54 a month for a Blue Cross insurance plan. The plan won’t be available after December. And while FloridaBlue offered her a new plan, the company told her the premium would be $591 a month. Barrette, who makes $30,000 a year and could not pay for such a plan, was flabbergasted. Jan Crawford of CBS News made her the key source for a story about plan cancellations. An appearance on Fox News followed

In fact, if one were to rely solely on televised news, one would think that the change in insurance laws and healthcare coverage was the greatest foul-up since the Edsel. To get the actual story, one must dig into better sources and actually read about what is happening.
Here is one such story from New Republic.

Quote

The policy Barrette has today is called the Go Blue Plan 91. Its coverage of doctor visits and tests, such as MRI scans, consists of paying $50 and then letting Barrette pay the remaining balance. Drug coverage works more or less in the same way, only the plan pays $15 per prescription—which is enough to cover generics, but not many name-brands. And hospitalization? The plan pays nothing at all. As Wemple put it, "it’s a pray-that-you-don’t-really-get-sick 'plan.'" Barrette doesn't really disagree—but this plan, she says, was all she could afford. "Most everyone I talked to said they were paying thousands more to get hospital coverage," she told me, "so I took my chances with what I have now."

Quote

Given Barrette’s income, she’ll be getting a tax credit worth nearly $331 a month, according to the Kaiser Foundation’s subsidy calculator. And that tax credit works like a discount, upfront. To figure out what she’d pay, you subtract the value of the tax credit from the price of the plan.
Accounting for that discount, it looks like the cheapest plan available her would cost about $100 a month—in other words, about $50 a month more than Barrette pays now.

And for the extra bucks Barrette gets an actual healthcare policy that actually is worth having. Does being required to buy a better policy bother Barrette?

Quote

When I gave her a broad description of the plans available, she seemed interested. I noted that she’d be paying $100 or $150 extra a month for policies that still had high cost-sharing, so that she would still be a lot of money out of her own pocket.... Here was her response: "I would jump at it," she said. "With my age, things can happen. I don’t want to have bills that could make me bankrupt. I don’t want to lose my house."

And that is the rest of the story...

[Vampyr]

It is clear the the administration has had a PR failure; they should have preempted these "cancellations" by announcing that some plans would be rendered illegal, and why.

[kenrexford]

Obviously, the comparison makes no sense. The question should not be what she pays now against what she will pay later, but rather (1) what will the price be for what she will now get as opposed to what THAT plan would have cost had the law not been passed and (2) does she (and others) want the larger plan?

Assuming, however, that the new plan is best, whatever the price, it seems weird to have a comparison of price out-of-pocket against price out-of pocket when we go from one payer to two payers. I could create a great bargain for a lot of people by offering to change the price of a $20K automobile to only $15K by simply subsidizing the car, but then I would run out of money unless I took it from someone. It seems rather expensive for me to pay $331 per month to get this lady that plan.

Unless I am missing something, isn't this paying $331 per month to help this lady pay out-of-pocket twice what she paid before, to give her and me piece of mind in case she gets sick? Then don't I need to tax someone -- like her -- to get that $331?

I am not meaning to take sides here, but it seems to me that EITHER free market OR single payer works better than this present idea.

[HighLow21]

You cannot possibly wage a winning PR campaign against Fox News and the like, because they will find a way to twist anything into something bad for the other side. And most of its viewers are simpleton enough to take everything they said at face value. It's not a news organization, it's a political entertainment organization (with tremendously bad consequences for our current political dialogue).

I agree single payer would work better than Obamacare but I believe wholeheartedly that Obamacare beats the pants off what we have now. Holding people accountable for the actual (expected value of) costs of providing healthcare to them? All the while taking money from the wealthy to pay for subsidies for the less fortunate and have EVERYONE covered?

With OUR CURRENT level of income inequality?

What a brilliant idea.

-Tate

[kenberg]

Of course people with an agenda make their points. But blaming it al on Fox News really won't cut it. I don't even know what channel delivers Fox News. I have never heard most of the right wing commentators most often cited as baddies. Still, I think that this all has been handled very poorly.

The Washington Post ran a story today. http://www.washingto...b769_story.html

Ok, the Post is not perfect. But it tries, and I don't think it has an agenda to derail ObamaCare.

A sample:

Quote

Marlys Dietrick, a 60-year-old artist from San Antonio, said she had high hopes that the new law would help many of her friends who are chefs, actors or photographers get insured. But she said they have been turned off by high premiums and deductibles and would rather pay the fine.

"I am one of those Democrats who wanted it to be better than this," she said.

Her insurer, Humana, informed her that her plan was being canceled and that the rate for herself and her 21-year-old son for a plan compliant with the new law would rise from $300 to $705. On the federal Web site, she found a comparable plan for $623 a month. Because her annual income is about $80,000, she doesn't qualify for subsidies.

A cheaper alternative on the federal exchange, she said, had a premium of $490 a month — but it was an HMO plan rather than the PPO plan she currently has. "I wouldn't be able to go to the doctor I've been going to for years," she said. "That is not a deal."

And both the HMO and PPO exchange plans she examined had family deductibles of $12,700, compared with her current $7,000.

Ms. Dietrick, a Democrat, is unhappy. Perhaps her current health care plan is poor. Or perhaps not. As she indicates, she was hoping for better. The one specific that is cited, that she could do better by using an HMO, speaks to me. I do not, absolutely do not, want an HMO. She makes 80K a year, quite possibly she will choose to pay out the $705 per month, that's $9,000 a year, for the PPO with the $12,700 deductible. I probably would, if my choices were between that and the HMO for $6,000 a year, same deductible. But I would, and I bet she does, remember that Obama said that if I liked the plan I had I could keep it. Adding "Period" for emphasis. These emphatic assertions of things that are clearly false have a way of coming back to haunt you. It's clear, if you think about it, that not all plans would be acceptable. It would have been better if the President had not emphatically claimed as true something that was obviously false. Ok, he is a politicain, we have to expect such things. Unfortunately.



Now the above concerns a person who is clearly pissed, but will no doubt suck it up and cope. How about the guy with the cancellation notice in his hand who has not been able to get onto the site? Maybe the site has some good options for him, maybe it doesn't. He has not been able to access it well enough to find out. All he knows is that he has a wife and three kids, his insurance is cancelled as of january first, and the government has promised him that there is nothing to worry about. The 22nd amendment means Obama will not be seeking his vote, or the vote of Ms. Diedrick, in 2016. Probably just as well.



Me, I have Medicare. I have a supplemental plan through my employer that continues into retirement. I suppose the premiums will go up. But this plan, the ACA, was never sold as a plan designed to help me. It was sold as a plan to help those who have, or hope to have, insurance in the individual market. We shall see. Ms. Diedrick said it very well and probably spoke for many:: "I am one of those Democrats who wanted it to be better than this".

Blaming this all on Fox News is way, way too easy. Of course they pounce. But the administration has made itself a very easy target.

[Vampyr]

 kenrexford, on 2013-November-04, 13:07, said:

I am not meaning to take sides here, but it seems to me that EITHER free market OR single payer works better than this present idea.

Single payer is excellent, and I am extremely grateful that that is the sort of health coverage I have. But such a system forces choices that I don't think Americans are ready to make explicit -- eg does drug xyz provide enough years/months of good-quality life to justify the cost of providing it for our patients.

Of course there is also the option to take up private insurance, which I believe is MUCH cheaper than in the US, because they have to compete against such a good single-payer provider.

[HighLow21]

 kenberg, on 2013-November-04, 14:54, said:

Of course people with an agenda make their points. But blaming it al on Fox News really won't cut it....

I'm not blaming Fox News for everything -- they are just trying to make money, and they can't make money without a gullible audience. They are one of the main culprits, though, of the right-wing misinformation machine is very large, very scattered, and very lucrative. See Rush, Erickson... hell even the NY Post and WSJ nowadays. There are plenty of organizations making money by giving extremely biased perspectives on everything political -- some on the left, but an absolute ton on the right.

And by no means am I happy about how Obamacare has been handled thus far. I expected better on the website, I expected better on the overall management of the process, and I expected more favorable (or at least more balanced) press coverage.

The administration has made numerous flaws in this rollout, not least of which on the PR side, where it effectively lied about being able to keep the insurance you have if you like it. (It can be argued that Obama, when he said this repeatedly, was referring only to insurance that would REMAIN LEGAL after the ACA took effect -- but when you have to retroactively caveat bold statements like that, you've failed the PR quality test in my view.)

The problem here is that, it seems, all we are getting in terms of serious discussion of ACA comes in two flavors:
1. Criticism of the rollout/website/certain features of the ACA plan.
2. Anecdotal stories about individuals who are made worse off by the new system.

On (1.) -- there will be problems with the rollout, as ACA represents a massive change in a massive industry. There should have been fewer problems or less severe ones, but they ALL (or at least *mostly*) will be fixed. (It should be noted that if the GOP spent half as much time trying to constructively improve ACA as bashing it or trying to repeal it, for over 3 years now, it would be a better law. Thankfully, the Democrats are at least interested in governing rather than only obstructing and squabbling.)

On (2.) -- anecdotal evidence is interesting as it gives color to a situation, adds depth, names and faces, details. However, it's anecdotal. When a new system rolls out there will ALWAYS be winners and losers in that system. Anecdotes are a poor substitute for statistics.

What I'd like to hear more of is:
A. Unbiased information about how the plan is going so far -- people signed up, people calling/creating accounts, etc.
B. Unbiased analysis of how many people are made better off, and by how much, and how many people are made worse off, and by how much. In other words, are we as a country better off under ACA? My guess is (1) it's too early to tell for sure right now, and (2) eventually without question, yes.

But you don't hear much about A. and B. because it's hard to sell newspapers or get click-throughs with boring headlines like "An analysis of the costs and benefits of ACA."

[HighLow21]

Here's an excellent article referring to the sabotage from the right from the very start. The GOP has intentionally been doing everything to make the government-centric plan fail, because, well... they run on a campaign of "government is bad." (Except defense spending and border protection of course.)

Again -- ACA would be in much better shape of the right had cooperated, rather than sabotaged. In how many situations do half of an entity's employees have to spend so much time and energy doing the work for everybody, while having to obviate obstacles put up by the other half, who get to keep their jobs?

http://dish.andrewsu...hare=email&nb=1

[kenberg]

 HighLow21, on 2013-November-04, 16:09, said:

What I'd like to hear more of is:
A. Unbiased information about how the plan is going so far -- people signed up, people calling/creating accounts, etc.
B. Unbiased analysis of how many people are made better off, and by how much, and how many people are made worse off, and by how much. In other words, are we as a country better off under ACA? My guess is (1) it's too early to tell for sure right now, and (2) eventually without question, yes.

But you don't hear much about A. and B. because it's hard to sell newspapers or get click-throughs with boring headlines like "An analysis of the costs and benefits of ACA."

I completel;y agree with this. My only interest is in seeing this go well. I don't expevt the ACA to help me in any way at all, but if it helps people on the edge move a little farther away from the edge I am for it. I won't complain if it costs me a bit, as long as it achieves the stated aims. I would very much appreciate coverage that evaluates how it is doing and presents realistic options.

All that being said, I think this has been handled very very badly.

[HighLow21]

 kenberg, on 2013-November-04, 16:23, said:

...

All that being said, I think this has been handled very very badly.

It's been facepalmingly bad.

[HighLow21]

Here's a good article -- it claims that roughly 80% are left alone, 14% will benefit, and 6% will face a tough choice. The article claims about 3% of US residents, total, will be made worse off.

I'm not saying it's necessarily right, but it's a good data point in favor of ACA.

http://www.newyorker...t.html?mobify=0

[billw55]

 HighLow21, on 2013-November-04, 17:34, said:

Here's a good article -- it claims that roughly 80% are left alone, 14% will benefit, and 6% will face a tough choice. The article claims about 3% of US residents, total, will be made worse off.

I'm not saying it's necessarily right, but it's a good data point in favor of ACA.

Unless you are in the 3%. I suppose every change has some losers, even when the change is for the better on balance.

One of the main selling points of the ACA was getting coverage to the formerly uninsured. I would like some stats on how many such people have enrolled so far, and at what cost (to themselves, and to taxpayers). Unbiased stats are preferred, but hard to find.

[kenberg]

It's good to see numbers, even if they are estimates.
Interpreting the numbers:

80% are left alone. Let's assume that is true., Then we want to take them out of the equation. I have been saying that I expect I am one of those left alone (although I would be surprised if it had no impact on my premiums, but I am not up in arms over that). But for those of us left alone, the ACA is not good and it is not bad.,

So we need to consider the 20% who are affected. The 14% w/o insurance and the 6% who buy their own. Actually, here he argues that of the 6% of the population who but their own, half of them, 3% of the population, will be unaffected. OK, assume this to be right, then they are in with the unaffected.


So, with his estimates, he argues that 14% of the population will benefit, 3% will be harmed.


These are estimates. So the number of people who will benefit is about 4 or 5 times as large as the number who will be harmed. Well, it's something. These are estimates from an advocate of the ACA.


I note one part in the article that I thought was careless.

Quote

If the problems linger until late February, Gruber thinks we will reach DefCon 2. The law requires everyone to have health insurance by March 31, 2014, or face a penalty. Obviously, the government can't tax people for failing to buy a product that is unavailable. In that case, Gruber said, "Obama will have to delay the individual mandate."

This will not be enough, not nearly enough. Early on when the website didn't work it seemed obvious that you could not tax/fine people for not using a site that wasn't working. But that is far from the only problem. A guy with a cancellation notice for January 1 in his mailbox is worried about more than the fine.Of course maybe the site will be working fine by then. We can hope.

And there really is a difference between "is up and working" and "is trusted by consumers". Some distrust of web operations is no doubt be extreme, I certainly know some cases, but still it exists as something to be reckoned with. And in a case like this, a cautious attitude seems not totally irrational.

But all in all, the article is welcome as a place to focus a bit.

[jeffford76]

 kenberg, on 2013-November-05, 10:21, said:

But for those of us left alone, the ACA is not good and it is not bad.

Are you sure about this? For example, if more people have insurance, then more people will go to the doctor to be treated when they have a communicable disease, and I am less likely to catch one.

[blackshoe]

The one question I've not seen an answer to: will ACA reduce the use of Emergency Rooms for routine medical care? Right now, I can't usually see my VA primary care physician on a walk in basis — appointments are three months down the pike. So the VA tells me that if I need to see a doctor "soon" I should go to the Emergency Room. That's not what emergency rooms are for, and their abuse is one of the problems with the current system.

[kenberg]

 jeffford76, on 2013-November-05, 10:48, said:

Are you sure about this? For example, if more people have insurance, then more people will go to the doctor to be treated when they have a communicable disease, and I am less likely to catch one.

True. There is, or might be, some benefit to us all in social progress. I don't deny that. There are a variety of effects that I see as secondary. Perhaps important but still secondary. Maybe my own insurance rates will go up. Maybe there are fewer communicable diseases around. Maybe a lot of things. I really do not mean to dismiss these items, some perhaps need some hard thinking.

Looking at it from my own self-interest, my largest issue would be whether or not it will have any long term effect, intended or not, on freedom of choice. Will it be affected? I don't know, just as I don't kow if I will encounter fewer germs once the ACA is up and running.

I wasn't addressing any of these somewhat speculative matters. Not that they aren't important. This matter of choice takes precedence for me over rates, and I want the sick visiting the docs for their good, only incidentally, very incidentally, for mine. But all of these issues matter.

[mike777]

 Vampyr, on 2013-November-04, 15:26, said:

Single payer is excellent, and I am extremely grateful that that is the sort of health coverage I have. But such a system forces choices that I don't think Americans are ready to make explicit -- eg does drug xyz provide enough years/months of good-quality life to justify the cost of providing it for our patients.

Of course there is also the option to take up private insurance, which I believe is MUCH cheaper than in the US, because they have to compete against such a good single-payer provider.

I am glad you find single payer is excellent. Per your post it sounds like many in the UK are not satisfied and turn to private insurance to fill the holes. Do you have any idea how many look outside single payer in the UK?

Also it sounds per your post that the costs are higher not lower, you pay twice.

[kenberg]

 blackshoe, on 2013-November-05, 10:57, said:

The one question I've not seen an answer to: will ACA reduce the use of Emergency Rooms for routine medical care? Right now, I can't usually see my VA primary care physician on a walk in basis — appointments are three months down the pike. So the VA tells me that if I need to see a doctor "soon" I should go to the Emergency Room. That's not what emergency rooms are for, and their abuse is one of the problems with the current system.

Whew! This seems incredible to me. It's true that I can't see my doc on a walk-in basis unless there is a reason, but I can see him withing 24 hours on things that are far from life-threatening. I have a routine appointment with him for next Tuesday, made long ago, but from experience I believe I could call today if I needed to and reschedule it for a different day next week. Non-emergencies of course require scheduling but three months down the pike seems ridiculous.


Exactly how this will all play out is not clear to me. Medical care in this country is, or can be, quite good. But it can be a challenge to navigate it. Judgment is needed, and sometimes it requires some truculence, or at least some insistence. We might like to think that all the medical providers are careful and competent. If we are to get good care, we have to get past that comfortable illusion. Whether, with the ACA, it will be easier or harder to deal with the inevitable problems that arise in getting good treatment is not certain..

[Zelandakh]

 mike777, on 2013-November-05, 11:13, said:

Do you have any idea how many look outside single payer in the UK?

The wiki entry says fewer than 8%. It should also be noted that a little over 4% of NHS patients are actually treated privately (at no cost to the patient). In my experience it is actually rather rare for people to rely purely on private health insurance in the UK. Most of those who use private insurance do so as a top-up to NHS treatment, for example for dental work or to avoid waiting lists on major operations. It should also be mentioned that for all its faults the NHS remains incredibly popular. The idea of having an American-style model would be a nightmare for almost everyone and even suggesting it would be political suicide.

[mike777]

Zel, thank you for the information.

" should also be mentioned that for all its faults the NHS remains incredibly popular. The idea of having an American-style model would be a nightmare for almost everyone and even suggesting it would be political suicide."


It is this most important point that you make that concerns me. It sounds like there is little appetite for risk taking, a culture of accepting risk taking, failure and creative destruction in the name of stability. This leads to a culture that inhibits innovation and one that does not encourage risk taking in the name of politics and stability. As you point out when NHS remains incredibly popular, large changes would be political suicide. It is a system that defends the status quo not one that is trying to compete and overthrow it.