In politics often all that is needed is a little patience, and the political winds will change. In the last week we have gone from a civil war in the Republican Party that will result in its certain death to the great failure of healthcare.gov and the implosion of Barack Obama’s signature accomplishment of his presidency. It’s important to learn from what we see plainly happening in front of us, without the spin of political prognosticators, that lesson is to take a deep breath and pause.
It’s amazing how quickly, everyone, right of center can be unified by a good old fashion lefty inspired government failure. We, Republicans, Libertarians, Patriots acknowledge the limits of government action and government programs as a method to improve every ones lives. It’s in our DNA, it’s what makes us believers in limited government. Our opposition to Obamacare/The Affordable Care Act has always been partially based in the belief that a program so massive, so requiring of the heavy hand of Government in its implementation could not work. Don’t misunderstand me, building a website to enroll millions of Americans in a cost effective program to expand health insurance to many who have been left without health insurance is very doable. It’s just that Government cannot do it.
We all would be happy to support Amazon, Google or Netflix adding health insurance to their product lines. We would cheer their success. Many more would have insurance. So what’s our problem with Government doing it and why can’t they pull it off. The next few months will be illustrative. When private industry and business start failing sirens wail, customers disappear, profits evaporate AND business is required to adapt to the needs of its customers. The customer is the dog, business is the tail. The customer is king, money and authority flow from the customer to the business. Screw-up that value proposition and the business is dead. When Government screws-up a different relationship is revealed. See Government asserts itself as King, it is the dog and the citizen is the tail. Obamacare requires a mandate, a requirement to do business with it. If you don’t like the web site, tough use the phone, if not the phone the mail! You may not assert your wants, needs, or priorities, because Government has decided for you. Hundreds of thousands are being thrown off their healthcare plans, because they do not meet the Governments specifications. Initially, millions of Americans went to healthcare.gov to look, to explore, to learn. And for three weeks they have been largely unable to do that, yet the President encourages them to continue, with no regard for their wants, needs, desire for efficiency. He brings a lone Delaware enrollee to the White House and holds her out as an example of perseverance; she only spent 7 hours buying coverage (Dog to tail, just do what I want you to do). Good government empowers individuals. It makes us better citizens, better members of our communities. It does not order us around like serfs. It doesn’t bludgeon us with web sites that do not work, that are only the tip of the iceberg of failed centralized healthcare planning.
One week ago democrats ruled supreme. For the next 2 and ½ months they will be tested, their vision of a Government run healthcare system will be forced to work, not eventually, but in real time. They will have to enroll millions, issue policies, verify coverage, make Obamacare work. This is about America’s sense of wellbeing, their sense of security. Americans will need to feel in their gut that Government healthcare is working and they are better off because of it. Mess with my children’s access to medical care and you will invoke the wrath of mothers across America. Make me feel insecure about my parent’s care and I will hunt you down in November and vote for your opponent regardless of your party affiliation. War on women? Just get between a lady and her access to a physician and you’ll know which side wins when women go to war. In December, they will seek to once again expand the nation’s debt, to ask Americans to give them more money to make Obamacare work. See in Government, unlike business, when you fail you ask for more. More taxes, more laws to fix the ones that don’t work, more, more, more. That value proposition between the customer and the business has gotten reversed, it’s what governments do. When it comes to policing, and courts, and food safety you need written rules that we all must follow. Healthcare? Did democrats know what they were asking for? Earlier this year a young girl in Philadelphia needed a lung transplant to live, she was too young to be put on the transplant list. Her parents took her plight to the media to save her life. HHS secretary Sibelius refused to intervene. A judge did and she lives today. These sort of care decisions will multiple across America, did democrats know what they were asking for when they asserted themselves into everyone’s healthcare decisions? Americans do not like to be told what to do. If Obamacare is going to work, they will need to fix a broken website and create a sense of wellbeing in America that currently has a great feeling of unease and concern. When Jon Stewart is ridiculing you on the Daily Show and he calls HHS Secretary Sibelius a liar, and your target demographic is young people, YOU ARE IN TROUBLE.
We are in for a wild ride, the political winds will blow both left and right, our future and the next election cycle will hinge on the successful implementation of Obamacare. The Democrats have the ball, its early in the game. So far they are having trouble lining up correctly, let alone gaining a yard. If private industry were on the field I would bet the family farm on getting this right. However, It’s the Federal Government on the field. They are arrogant, have difficulty playing by the rules, and have a track record of ineffectiveness. I’m predicting a self-inflicted safety, if not a fumble and a touchdown by the opposition on the first possession. Obama should have kicked-off and continued to make the Republican’s play offense. Betting on Obamacare, a massive Government run program, is like taking the Soviet Union and giving the Free World points. Take a deep breath.
Mr. Cragg, one thing not to forget, as you pointed out, when government fails, it ask for more, more, more.
That means that even as Obama care fails the Democrats will keep pushing for more money and more laws. The longer that goes on, the harder it will be to either pry Obama care out of the system (which is what needs to be done), or to replace it with a private sector oriented version (which is what needs to be done), what is more likely from both sides is to attempt to “FIX” it, (which should not even be attempted).
This is why instead of the circus we saw in recent weeks, what the Republicans and their second cousins (libertarians, independents, and as you call them patriots, or to save time, TEA people), should do is focus on winning election so as to be able to legislatively remove the cancer of Obama care before it can metastasize.
Until they realize that tactics and perception are as important as our goals, the TEA people’s tactics will continue to drive the average citizen away from the GOP and the conservative movement.
Although I expect it to fall on deaf ears, I would like to point out two things.
1. Private industry (in this case CGI) wrote the software. The government provide a statement of work, but CGI wrote the code. So yeah, the government doesn’t seem to do a very good job in running things, which is why they hire contractors. But you know, contractors screw up just as much, including Apple, Microsoft, and Google. I could give you a litany of their abject failures, but hey you guys can look it up very easily.
2. A “massive Government run program” merely organizes, structures, and operates a capability in which insurance plans offered by private industry can be obtained. Other than Medicare, there is no single government program for Obamacare. In fact, many of the states are operating their own exchanges without the “assistance” of the federal government. Effectively, the government is acting as a broker (a poor one to be sure but still only a broker). I know it’s convenient to create a sound bite such as “massive program” and let’s face it, most people with their short attention spans probably even appreciate the sound bite (even if they are demonstrating their ignorance in doing so).
Regardless, those who know better, should also take it upon themselves to educate the ignorant, rather than simply trying to sway them. It sort of reminds me of the lady (or man) at a one of the town halls a year or so ago. He/she said (paraphrasing) “Keep your government hands off my Medicare” LOL. I wonder if someone ever explained who operates Medicare?
Dave, while you may be correct, the private sector does not have the benefit of a government mandate that could land you in jail at the end of the day if you don’t buy their product. While the government may be operating through the use of private sector companies, these companies are acting as agents of the government, and not for their own benefit beyond the profits from the tax dollars that they are paid.
You do know that some enterprising company would have done this long ago if, one there was a market for such a web based insurance market, and two, if the government would have allowed it. One has to ask why, and which one kept it from happening in the past from the private sector.
America has a Democratic health care plan because the Republicans don’t have any of their own to offer.
Yes, America has a free market healthcare plan that covers 85% of Americans, it the existing market, that’s the one the Right supports.
It’s the one the President said, “If you like your insurance you can keep it, Period.”
That just doesn’t appear to be the case. More, more, more, hear comes the democrat cry for single payer.
Frank,
One answer to your question of why no one has done it until now, is because 50 states regulation health insurance and considering that each state has to have the wherewithal to establish their own exchange AND that the exchange itself could only operate with the cooperation of the insurance providers, there was no incentive for the providers to cooperate in such an endeavor. Additionally, there was no real means monetize such an exchange. Now with a potential customer base of millions, there are many providers who are now interested. In short, the government created a market and the providers see opportunity in servicing the market.
In regards to mandates, I know you were using hyperbole to make point when you said “land you in jail” because we all know no such thing will happen. Regardless, let’s consider Jeff’s 85% (which as of 2009 is really approximately 81%, but let’s not quibble). That leaves 15% of 300,000,000 people (45,000,000). Now, in my opinion, that’s a rather large number. You and Jeff would also agree.
Now forget about the humanitarian aspect of that many people unable to obtain health care. Let’s just consider the economics. These 45M get sick. They get hurt. They go to the hospital who is required to treat them. Who pays? Me, you, us. We pay higher prices for health care. We pay in the form of being unable to obtain emergency care (ever gone to emergency with a broken whatever? how many hours did you have sit and wait?). Society pays, in the form of lost labor. Society (us) also pays, because what happens when people who have no health care get sick? They go to work. They go to school. They go to restaurants. They handle my food. Guess what happens to you and I? Yeah, we get sick.
Now I don’t know what the real cost is of this situation, but I’m tired of paying because other people either cannot are will not (how come cannot is a word and willnot is not?) obtain health care. Purely, from a capitalistic perspective, this makes sense and I’m a capitalist. I don’t care where you get your insurance from, but by God you are gonna have it because I should not have to pay because you don’t. Just like I resent having uninsured motorist insurance because DE is lax in policing motor vehicle insurance, I have pay more.
Federal mandates have a long history, ever since the Second Militia Act of 1792. There is a need for society to protect itself, from invaders to invasive diseases.
I am not a supporter of single payer, partially because to eliminates choice, but also because I am not convinced it would do anything to mitigate skyrocketing health care costs. I believe that government can and should create markets where there is a need but should not be a provider in that market because it both stifles innovation and it is not an inherently government function.
OK. Let’s get into the weeds. 81% – 85%? It depends, and it’s not worth quibbling about, but this is an aspect to the problem that most people haven’t seen.
Having run a health insurer, the number 1 reason people terminated coverage was? The didn’t have money to pay the premiums! That’s the biggest obstacle to keeping Americans covered.
Are we measuring the number uninsured on a specific day or over the course of a year? See people drift into and out of coverage, it’s very hard to measure. The ACA is going to make things very much worse. Under Obamacare you have 60 days to pay your premiums. So, I sign-up on 1 January and pay in advance for one month. I skip paying Feb., I still have insurance (they won’t pay my healthcare bills till I pay, but I’m covered). I have till 31 March to pay Feb. 1’s bill, and I know owe March, too. But I haven’t been sick, so I don’t pay. I lose coverage for Feb. and March, but I sign-up for a new policy on 1 April and pay a month in advance, I don’t pay May, but I’m still covered (like February). Well low and behold it’s May 31 and I’ve gamed 5 months coverage and paid for two!
So who had coverage on March 1? Who was covered on May1, when I didn’t pay was I covered? (yes if I was ill, and I subsequently paid). So who manages this??? That’s right the Government Exchanges. The Insurance Companies have escaped this part of the business, it’s expensive hard to manage and almost impossible to get correct. (As an Insurer I now need to maintain an 80% claims ratio, and I have outsourced all this expense to the Exchanges) So will it work? This is what the website will have to manage, keep records of, all on a realtime basis, so that when I show-up at the Hospital, ER, Doctor’s office you can verify my covered status.
See Cable, my cell phone, my whatever terms me when I don’t pay. They are also are only on the hook for the services they provide…not potentially a multi-million dollar claim for a Kidney Transplant, Cancer Treatment, Brain Tumor? See where this has gone. People struggling to pay bills can wait 60 days(!) to pay the health insurance, when they need to pay the cell phone tomorrow. It will be a mess and many will term coverage and reapply rather than pay back premiums. (If you study the history of employee benefits in America, it is why our healthcare is based on employment, because premiums were deducted from your paycheck and sent to the local hospital) Can this be done by the exchanges? I don’t think so, because they can’t get enrollment correct, and people will try to game the system. In THEORY, the ACA works; In reality the behavior of insured’s will mess everything up. Most Importantly, people will not be regularly paying into the program, thus requiring the monthly premium charges to go up to cover the in and out flow of coverage, those of us who pay every month will subsidize those who don’t. ACA doesn’t fix the free rider problem, it just changes it. Without the penalty of not having coverage as a stick, you will not get full participation, an ACA Fail.
WEEDS, PART II
What the ACA also has done is ramped up coverage so that it meets Government mandated minimums. On it’s face a good policy. However it has made coverage much more expensive, by adding full mental healthcare, chiropractic care, maternity coverage, full prescription drug coverage, outpatient services, doctor visits, skilled nursing care, etc. , etc. All these medical provider groups got their’s in the ACA deal. So, what’s the problem..it makes coverage more expensive and creates a one size fits all healthcare product. When you add to the price of something you make it more expensive and people will buy less of it (supply/demand stuff). So “market forces” will make healthcare less affordable, if you are one of the lucky ones who gets a subsidy, you don’t care. But if you don’t get a subsidy your healthcare cost has gone up. This is what your hearing about on the news. rising premiums in the 100% plus range. (Insurers offered a lot of policies with limits the ACA got rid of because it made them more affordable and helped with the #1 reason people didn’t buy insurance, It COST TO MUCH.
So the ACA has help make insurance more expensive, less affordable in the name of getting more people insured. Will it work? I don’t think anyone really knows, but if your premiums (85% covered) went up, you might just vote against the ACA politicians. In theory, no one will not have insurance, but those with it will pay that cost in premiums that will rise.
The exchanges do not do much more than act as an independent broker between the client and the companies they wish to do business with. Once the client makes a connection with an insurance provider the transactions are between the provider and the client and is the same as if one were to have a private insurance and did not make the monthly payments. When the health care provider checks on someone’s insurance status, the provider says yea/nay depending on whether they have paid, just as it is today, even with employer provided insurance.
As far as tracking the mandatory aspect and whether a penalty is assessed that is being accomplished by the IRS.
I don’t disagree that some premiums will rise. Some of that obviously is due to increased coverage (pre-existing conditions, et al).
I also agree that the program as it stands has faults and believe our Congress should be spending their time improving, fixing, correcting, etc. because lets face it, there has never been a piece of perfect legislation enacted.
Finally, health care costs are astronomical. ACA is not going to fix that. Congress could fix it. Industry could fix it. But we know that industry will do nothing unless forced, not when they profit from those astronomical costs. So it is left to Congress to craft legislation that addresses health care costs in a sane and reasonable manner. Remember the mythical $600 hammer? Want to know what a bandaid costs in the hospital? The range is $400 to $800.
So yeah, I agree that premiums are going to generally rise for many people (not for the ones getting subsidies). Hopefully that will be somewhat offset by a healthier workforce and population. At there will be some people paying their way (partially) for a change instead of digging into my pocket. Yeah there is no free lunch. It’s sorta like DEL DOT who has run out of money to build roads partially because fuel taxes have no risen in 17 years. There just isn’t any free lunch anymore, except maybe at the soup kitchen.
Tuxamus Maximus wants to remind Dave that those are some really nice bandages you get for that $400 to $800. Worth the price? Nah…not really but they are nice!
Good Job Dave and Delacrat.
Pediatrician and Medicare-for-All activist, Dr. Margaret Flowers describes ACA as
hmm…
“perhaps the greatest corporate scam ever”
http://www.counterpunch.org/2013/10/24/why-obamacare-will-fail-to-solve-our-health-care-crisis/
Dave, the penalty for not buying insurance under the mandate is a fine levied by the IRS, if those fines go unpaid, and they do increase every year, you do not buy insurance, then isn’t it likely at some point you will face prosecution for not paying the “TAX” that OC is said to be? If only we could ask Al Capone about not paying the IRS.
Also, Dave you answered my question of why no one has done this until now, and only then the government, when you said, ” Additionally, there was no real means monetize such an exchange.” You are correct that in our capitalist system, if there is no profit then no private company with any sense will attempt it, only good business. However now the government mandate forces people to buy more expensive insurance than they can afford or want, how? Because the government is subsidizing them. So you see, the system hasn’t been monetized, it is being propped up by tax payers. It doesn’t work, it will never work, and the very fact that it has to be subsidized and mandated prove that without a doubt.
You also make an excellent point when you point out the restriction of the states and how they restrict the ability for the people to find the best buy in insurance on their own, no government needed thank you.
Frank, I might be wrong but, with the insurance exchange, how it is designed to work is that yes, the taxpayer props it up, but buy the premiums they pay
This is not a company making widgets….it works much the same as any INSC company works, the actuarial tables…
Younger healthier people, needing health INSC but less likely to use it pay in and older less healthy people use more of the services…..like a triangle…..but the bottom MUST be broad and wide to hold up the top tier….
I was priced out of my old health plan years ago, because the younger folks could no longer enter the pool and as the pool grew smaller , the older people who used more benefits paid more premiums, until they were simply priced out of existence.
I’m don’t like a lot of things about the ACA……however, being able to carry children until 26, coverage if there is a pre- existing condition, expanded subsidies……..health care should be a basic human right as it is a basic human need
Britain established their NHS when they were broke and coming out of WW2., the least auspicious time for that country. Government OF the people, BY the people and FOR the people….
Not for profit and not for corporate America. No system run by mankind is perfect as people are not perfect, but a society that tries to right it’s wrongs and help ALL it’s people to the basic human right of healthcare is a better society.
I’m taking a wait and see approach…..and the truth will not out for a couple of years……all we can do is try to make it work and stop the infighting.
Simplistic maybe but hey, maybe the great experiment will work…imagine that!
I agree that a wait and see approach is appropriate. I know we are going to discover some really good things and some really bad things. Some of the good things about ACA Frank is that if you have a pre-existing condition, no insurance company can refuse to cover you. If you had children who were still in school or working in an occupation that provided no health insurance, they can stay under your policy until 26. Additionally, as Laffter pointed out, with younger people joining in, the pool will be larger and the cost should be able to be spread.
Some of the bad things are that some premiums will rise due to mandated expanded coverage, plus there is a cost for the subsidies.
I’m sure there will be more good and bad things as well. Still, as employment continues to rise, subsidies will be reduced as income rises. I would rather get a couple of years under our belt on this and then point out the warts that need action. Medicare Part D that Bush pushed through had to be tweaked as well.
When I moved here I bought a house, new construction, in a development. When I went through settlement, having bought new construction homes before, I knew I was acquiring an asset that was less than perfect (actually stick built homes are never perfect and never will be). So I spent the next year issuing work orders to work off the punch list of things that had to be fixed. Most were minor problems, but there were two fairly major problems. It’s like all things built by less than perfect humans – less than perfect.
I’m a project/program manager by trade. I’ve always said that every endeavor requires both perfect planning and perfect execution. Unfortunately, because we are human, we can never achieve both states. We might be able to achieve one or the other but only God could manage both and considering how the human race turned out, I’m not all that certain about His ability either.
Before getting to the secret squirrel duties House Tuxamus Maximus just wanted to take a moment to thank Dave and yes once again Laffter for their attempts to educate Mr. Knotts and some others but as HTM found out some time ago Mr. Knotts only considers his ‘liberties’ when it comes to this subject. Really nice try though and great analogies!
Frank I’d like to ouch on some misinformation that has been posted. FYI I agree Obamacare ACA is going to be as screwed up as everything else the government sticks it’s fingers in.
“If you had children who were still in school or working in an occupation that provided no health insurance, they can stay under your policy until 26.”
This was already in effect before Obamacare went into place. Both our children who are under 26 were covered by our private health insurance. One now has their own insurance through their employer, the other is still under 26 and covered by our policy.
One of the major problems I have with Obamacare after listening to a personal friend in the medical profession explained it. While they cannot refuse pre-existing conditions the insurance companies CAN legally refuse to perform certain procedures such as hip, knee replacements, kidney, heart, lung transplants based on the actuarial tables in regard to a persons age.
The government can’t even prevent or control the rampant fraud in the Medicare/Medicaid system that’s been going on for years.
sorry first sentence I meant “touch”
My health insurance did not cover my children after the age of 22. Yours is the first experience I have heard of where children over the age of 22 were covered. Of course most of the companies added that a couple of years ago in anticipation of ACA. However, that generally was not the case prior to that.
And yes insurance companies can and still will be able to deny coverage, especially in cases where a medical professional (which they are required to use) determines that a treatment is not medically necessary, in which case the appeals process kicks. No real difference under ACA.
Remember ACA primary says everyone must be insured and the insurance must meet certain standards. Otherwise there is not a great deal of change.
As far as Medicare goes, let’s get rid of it. That will stop the FWA (Fraud, Waste and Abuse). I’ve been paying Medicare taxes all these years and will never see a dime of it because I’ll never be under Medicare. So no skin off my nose. Of course my parents might not like me saying that. I bet your parents wouldn’t either.
Laffter, it is propped up by the subsidies that the government pays for those people who can’t afford the mandated level of “AFFORDABLE” insurance. Dave, surely you will agree that anywhere subsidies are present, the cost of the product goes up, farm subsidies and oil company subsidies are but just two examples. If the market is artificially inflated, along with mandated consumers for the product, there is no way cost comes down.
As for the idea of the forcing of the younger people into the “POOL”, to cover the cost of the elderly, well how has that worked out for Medicare and social security?
Frank, look up who in kent and sussex who gets subsidies and how much..
It will make u sick
And who props them up?
Let’s fed , cloth our neighbor. And care for them,…before millionaires make more millions.
Dave you’re correct it did only happen several years ago. All state employees insurance covered their children until age 26. I probably should have been a bit more specific.
Personally I don’t agree with doing way with Medicare, however I do believe in prosecuting the abusers. Sadly both my parents are deceased, I lost my dad in 1972 and my mom in 1999.
Since Laffter segued into subsidies more generally, I’ll tag off of that. I generally agree that subsidies should be need based, whether they are ACA subsidies, farm subsidies, SNAP, what have you.
Philosophically are subsidies a legitimate instrument for influencing behavior? I believe they are. I don’t subscribe to the narrative that industry or people will naturally innovate (in the case of industry) or change their behavior (in the case of people). Sure there are some people (industries are people too) who demonstrate the entrepreneurial wherewithal to go out and build the next big thing. But generally, there are insurmountable barriers to entry without some subsidization. This is true whether we are talking about industry or people.
Where would Sher Valenzuela be without the assistance she received from government? I applaud those kinds of subsidies. The ones I don’t applaud are the subsidies that provided to those who really don’t need them and just use them as a handout. Farmers who are paid not to grow on land they would never farm in the first place are just as bad as the lazy good for nothing who lives off the dole. There is a special place in hell for both of them.
But the Shers of world who are trying to make their way in this complex world by providing something of value or the mother who is desperately trying to feed her children. Yeah, I can subsidize that. There can and should be limits. However, there is a limit to what government can and should do. I have no objection to exploring those limits and discussing the value of what government can and should do.