Trump sold old lie of health insurance across state lines

Trump just said in New Hampshire that he's going to unleash competition on U.S. healthcare after he repeals Obamacare, specifically by allowing Americans to buy health insurance across state lines. 

Trump said the insurance companies are making a killing on Obamacare. The fact is, insurance companies are taking about 3 cents of every healthcare dollar in profit. 

The problem is that U.S. medical care is too damn expensive. Insurance companies chip away at the edges and screw us in the process, through recission, yes, but they aren't the real problem. 

Buying a cracker-jack health policy from a rinky-dink insurance provider in Rhode Island isn't going to do a thing for the cost of your care at home; it's only going to hit you when you actually need it that your insurance policy doesn't cover s**t.

On Jonathan Gruber's comments 'bashing' Obamacare

Further to Jonathan Gruber's comments from 2013 on YouTube, 

which have talk radio, Fox and Republicans publicly all aflutter. So check this out:

http://www.washingtonpost.com/blogs/post-politics/wp/2014/11/11/obamacare-consultant-under-fire-for-stupidity-of-the-american-voter-comment/

"Healthy people pay, sick people get money," is the way all health insurance works, I'm afraid. It's the way insurance works, period: "Unsunken ships pay; sunken ships get money;" "Undamaged homes pay; damaged homes get money;" "Safe drivers pay; unsafe drivers get money," and so on.

Nevertheless the insurance companies through rescission have tried, illegally, to mitigate the economics of health insurance, retroactively; but PHSA, HIPPA and Obamacare have restricted that underhanded business practice.

No, Obamacare isn't "something for nothing." It's not "free healthcare." More people have to pay in by buying private insurance, or having their employer pay part of their insurance cost, but the economics are sound, there is no other way. The other side of the ledger, (which any accountant should acknowledge), is that having more people insured will lower health spending overall. That's what the CBO has said consistently. 

In the U.S. we're spending nearly 20 percent of GDP on health care, and that's not sustainable. It's also not competitive. Check this out from the World Bank,health expenditure, total (% of GDP):

Australia -- 9.1 percent

Canada -- 10.9 percent

France -- 11.1 percent

Germany -- 11.3 percent

Great Britain -- 9.4 percent

Japan -- 10.1 percent

... and so on.

Next, take a deep breath and check this out: "Revisions to CBO's Projections of Federal Health Care Spending" from July 2014. Upshot: The U.S. economy, at least the federal government'share of it, is projected to spend less  on health care in the long term, which is exactly what we liberal-progressives wanted, to bend the cost curve:

CBO now projects that, if current laws remained generally unchanged, net federal spending for the government’s major health care programs in 2039 would equal 8.0 percent of gross domestic product (GDP)—1.6 percentage points, or about 15 percent, less than the 9.6 percent the agency projected in 2010 (see the figure below). That revision stems in large part from the observed slowdown in health care spending in recent years, but it also includes the effects of other factors; some of those factors reduced projected spending, and others increased it.

The programs included in the calculations are Medicare, Medicaid, the Children’s Health Insurance Program, and subsidies for insurance purchased through exchanges. 

But how can that be, my conservative interlocutor will ask? How can the government be spending more on [Obamacare] subsidies yet projected to spend less, overall?  

The answer, (not to get too wonky), if you read between the lines of the CBO's revised estimate, is that growth in healthcare spending, including on Medicare, has been slowing down faster than anybody projected. 

Indeed, noted conservative Forbes, "The current numbers represent the slowest rate of growth since the government began tracking the data in 1960."

And why is that? Apparently nobody knows yet. But for four years running, the rate of spending on health care in America has slowed... just coincidentally under President Obama, under an Obamacare regime. 

Harvard economist David Cutler argued in the Washington Post a few days ago that, in fact, we do indeed have Obamacare to thank for it.

Probably it's still premature to say for sure, but the signs are good. Yet one more reason not to "repeal and replace" Obamacare when it's doing what it was designed to do -- covering about 7 million more Americans in its first full year; and lowering -- or at least not increasing -- healthcare costs for four years running.

UPDATE (11.15.2014): Here's kind of a fair and balanced analysis of what Jonathan Gruber said (on multiple occasions, unfortunately), from none other than CNN: "Obamacare: Voters, are you stupid?"

DC Johnston: End insurance co-payments

Here's another one from David Cay Johnston, this time on the outrageous inefficiency of U.S. hospitals:

American hospitals spend a huge and growing share of their revenue on overhead, a study published today in Health Affairs shows. Getting those costs down should be a national priority.

U.S. hospitals on average spend 25.3 cents out of each dollar of revenue on overhead, with for-profit hospitals spending 27 percent and nonprofits a bit below the average.

By contrast, the Netherlands and England, which have the next highest overhead costs, spend 19.8 percent and 15.5 percent, respectively. Both are moving toward market-based financial models, so, as with the U.S., overhead costs are likely to rise.

[...] The new study helps explain why for every $1 the 33 other countries with advanced economies spend per person on universal health care, the United States spends $2.64 — and yet more than one-fifth of Americans have no or poor health insurance.  A significant reason the U.S. health care system is so expensive and inefficient turns out to be those annoying co-pays. 

Here's one suggestion: eliminate co-pays. Here's why:

In economics “rational” is a term of art. It means groups of people consistently making choices that maximize their benefits and minimize their costs. 

By this definition, the promotion of co-pays by employers and insurers fails the rationality test. Why? Because co-pays discourage people, especially those with meager incomes, from seeing doctors and obtaining medications. That reduces immediate spending on doctor visits and drugs but not total costs over the longer term. Instead, when people who are squeezed financially do not pick up their medications, thus avoiding the co-pay, they later will need more intensive and costly care, which drives up total costs for health care as well as increasing human misery and shortening lives.

When co-pays discourage getting drugs and visiting doctors, which results in more costly medical problems later, the system is irrational. When those payments eat up as much as or even more than they bring in, the system is more so.

Here is a suggestion: Get rid of co-pays. Instead let’s just add a prominent line on paycheck stubs that reads, “Your health care is paid separately, and it cost X dollars this pay period.” That would help make the American economy more efficient and more humane.

Time to end co-pays

By David Cay Johnston

September 8, 2014 | Aljazeera

URL: http://america.aljazeera.com/opinions/2014/9/health-care-costscopaysoverhead.html

Study: Healthcare prices 'irrational'

Here's yet more evidence to prove what I've been saying all along: healthcare does not, and cannot, operate like a business.  "The charging system and payment system are irrational," i.e. not based on any known criteria, concluded a recent study:

One California hospital charged $10 for a blood cholesterol test, while another hospital that ran the same test charged $10,169 — over 1,000 times more.

For another common blood test called a basic metabolic panel, the average hospital charge was $371, but prices ranged from a low of $35 to a high of $7,303, more than 200 times more.

[...] Earlier studies by [Dr. Renee] Hsia [the study's leading author] identified variations in listed charges for labor and deliveries and for appendectomies in California, with labor and delivery charges varying eight to 11-fold between hospitals, and charges for a routine appendectomy ranging from $1,500 to $182,955.

So what does the healthcare industry have to say for itself?

Officials with the California Hospital Association dismissed the report as irrelevant, saying that the vast majority of patients pay discounted rates that have been negotiated by their insurance plans.

"Charges are meaningless data — virtually no one pays charges," said Jan Emerson-Shea, the association's vice president for external affairs.

That's right, my free market-loving, Tea Partying friends: prices are meaningless.  That's the way it was before Obamacare, and that's the way it is now.

But if the hospitals aren't the problem, then private health insurance must be. What's the answer? Make private health insurance unnecessary, (or an added luxury for those who want it), by introducing a single-payer insurance system, aka "Medicare for everybody."  

Medicare already negotiates the best prices on health care and prescription drugs, better prices than you or I can get, or our insurance providers. That's why this year the Obama Administration was the first ever to publicize the prices that Medicare pays for all kinds of health services, in the vain, (let's say misguided) hope that it would spur health "consumers" to ask tough questions of their providers and insurers and *shop around.

(*Just to illustrate the absurdity of "shopping" for healthcare, let's take the above-mentioned example of an appendectomy that could cost anywhere from $1,500 to $183,000. Nobody in the world researches prices on an appendectomy when they are healthy and able to choose where they get medical care; it is almost always an emergency procedure performed amid searing abdominal pain and the life-threatening risk of organ rupture. Anyway, the local EMT decides what hospital to go to, not the patient!)  

Wide Range Of Hospital Charges For Blood Tests Called 'Irrational'

By Roni Caryn Rabin 

August 15, 2014 | NPR

URL: http://n.pr/1pRcvKP

VA scandal is an indictment of US health care, not Big Government

Bravo, Mr. Wapshott!  Conservatives too often employ a version of the following syllogism: John is bad; John is a government employee; thus all government employees are bad.  

Here's a good 'graph:

Cannot those employed on salaries by private companies, particularly employees of corporate behemoths who operate near-monopolies, also ration their customers and say they have been put them on waitlists that do not exist? Can employees of commercial firms not also be corrupt and lazy? Does the free market not employ salaried workers? This muddled thinking is simply partisanship posing as intellectual rigor.

Intellectual rigor mortis, yes, but intellectual rigor among conservatives? Heck, no!  

Waitlists, Charles Krauthammer laments?  Gee, I called my primary care physician in January; he said the earliest he could see me was April.  Rationing, he says?  Gee, what do you call preferred providers networks, approved lists of procedures, payment ceilings, and the whole list of restrictions that private insurance companies put on our health care to cut costs and increase their profits?Private health insurance is all about rationing, because that's the only way they make money!

VA scandal is no mark against big government

By Nicholas Wapshott

June 3, 2014 | Reuters

For some, the veterans hospitals scandal is a human tragedy pure and simple. Those who loyally served their nation in uniform, putting their lives on the line, were shunned when they sought medical help.

For others, however, the troubles at the Department of Veterans Affairs have provided what one pundit called “A gift from God.”

For those commentators, the scandal confirmed their worst fears. The logic runs like this: The VA provides a government-run health service; the failures of the VA are a disgrace; ipso facto, all government-run health systems are a disgrace; proving that all government-run bodies are a disgrace. So all government should be sharply reduced — if not abandoned altogether.

The VA troubles, however, prove no such thing. The poor treatment of veterans has nothing to do with funding and everything to do with administrative incompetence combined with craven deceit.

Anyone who has been kept waiting inordinately by a doctor or hospital, or who has had their treatment or prescription drugs denied by their health insurance company, knows that. Anyone kept hanging on the line for an ill-named “customer service representative” and told by an automaton, “Your call is important to us,” knows that private companies treat customers with equal disdain.

The difference is that in the VA scandal, democratic accountability eventually — it took far too long, we know — kicked in. The top man resigned and top managers who presided over the incompetence and subterfuge were fired. It is a further scandal that it took President Barack Obama himself to push the wrongdoers into admitting responsibility. But at least the problem was ultimately addressed.

When can you remember a chief executive officer of an aberrant cable TV company or phone or utility company or even a health insurance company — fill in your favorite offender here — falling on their sword for keeping their customers waiting?

This is the full quote from the “Gift from God” analyst, former neurosurgeon Ben Carson: “What’s happening with the veterans is a gift from God to show us what happens when you take layers and layers of bureaucracy and place them between the patients and the healthcare provider.”

Perhaps, as a brain surgeon, Carson is given special treatment when he visits the doctor. But the rest of us endure “layers and layers of bureaucracy” whenever we try to access the healthcare we have so expensively bought.

One reason American healthcare is two-and-a-half times more expensive than in comparable countries is because of the “layers and layers” of insurance sales agents, ID checkers, referral faxers, hospital debt collectors from insurance companies and all the other expensive bureaucrats with no medical knowledge who are employed to administer and police the system. Add to that routine over-charging by doctors and Americans seeking healthcare are being ruthlessly abused and exploited by a commercial scheme that offers them little real choice.

Why do even the smartest free-market dogmatists, who like to paint the world in black and white, fail to see the flaws in commercial companies? Here is the dean of conservative commentators, Charles Krauthammer: “If there’s ever been evidence that a government-run system of healthcare is a disaster, it’s here,” he said. “It’s rationing, it’s waitlists, and corruption and laziness — as you get when people are salaried, rather than working in the free market.”

Cannot those employed on salaries by private companies, particularly employees of corporate behemoths who operate near-monopolies, also ration their customers and say they have been put them on waitlists that do not exist? Can employees of commercial firms not also be corrupt and lazy? Does the free market not employ salaried workers? This muddled thinking is simply partisanship posing as intellectual rigor.

The public-private divide is a red herring that used to distract the left from clear thinking. For a century or more, socialists and communists believed that the world’s problems would be solved if only the “commanding heights” of an economy and the “means of production” were brought into state ownership. Many otherwise smart people fell for an ideology that failed to fulfil its promise the second it was put into practice.

State socialism is now as extinct as the broad-faced potoroo and few except die-hard ideologues dare suggest the government should run everything. Yet the government, tempered by democracy, still has an important role to play when the private sector is found wanting.

It is not merely in treating veterans — whose profound mental and physical wounds can often be so expensive to treat that private insurance companies cannot offer an affordable rate. In many Western European countries taxpayer-funded health systems keep down the skyrocketing costs of treating their ageing populations, just as here in the United States the Social Security system provides an equitable, and relatively inexpensive, way of providing a decent standard of living for retirees.

Other essential services, too, are best administered by the state. Such as the armed services and the police. Schooling, too, is too important to the nation to be left solely to the private sector. State education too often fails, but it is not because taxpayers fund it — it is because the money is spent unwisely.

The question is not whether to have the government provide services the private sector cannot supply. It is a matter of where to draw the line between public and private.

U.S. health coverage is too categorical

Here's a clear example of "American exceptionalism," albeit not the kind we should be proud of:

In other advanced industrial democracies, especially in Europe, health insurance, pensions and even certain amounts of income support for working-age adults are considered rights, to which everyone is entitled by virtue of their membership in society and their shared vulnerability to life’s vicissitudes.

 In the U.S., where health care is not considered a right, many do believe in "Work or Starve," as well as, apparently, "Work or Be Sick." What's even more bizarre in the U.S., Lane believes, are the exceptions we make to that:

This helps explain the oddest aspect of the nature of U.S. health insurance: It’s categorical. In the United States, people get coverage based not on membership in society but on membership in a discernible segment of society: elderly, disabled, military, employee, union member, child living below the poverty line and so on.

Everyone else — from relatively well-to-do self-employed consultants to dishwashers at small restaurants, for whom even tax-subsidized insurance is unaffordable — falls into the category of “other.” They make do with no insurance or with whatever is available on the dicey market for individual coverage.

Because health insurance works best with a broad risk pool, and because “everyone” is the broadest possible risk pool, the categorical U.S. system is plagued by obvious yet intractable inefficiencies and inequities.

Sadly, many Americans still believe that it's perfectly OK for an able-bodied but poor adult to go without health coverage.  Them's the breaks!

The U.S. insurance model doesn’t work

By Charles Lane

February 11, 2014 | Washington Post

URL: http://wapo.st/1faXlrP

'Liberal' media lies: Obamacare will cost 2 million jobs

So did the CBO really mean to forecast that 2 million people would lose their jobs because of Obamacare? No. But that's how the mainstream media -- including the "liberal" axis at the New York Times and Washington Post reported it.

As Weinstein clarifies, here's what the CBO actually said:

CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor—given the new taxes and other incentives they will face and the financial benefits some will receive.

Is that just wonkish liberal-progressive spin?  Is that just "figures lie, and liars figure?"  No again:

When workers no longer have to rely on full-time employers to get affordable health care, they suddenly have the freedom to not work full-time. That could mean people stuck in crappy hourly jobs 40 hours a week at, say, the local big-box store. Or creatives jammed in underpaying urban admin assistant jobs. Indeed, the CBO adds:

Because the largest declines in labor supply will probably occur among lower-wage workers… the impact on the overall economy will be proportionally smaller than the reduction in hours worked.

Weinstein sums it up [emphasis mine]:

The problem here is truly philosophical. It is ideological. It is rooted in the two Americas' distressingly divergent answers to a simple question: What is a job for?

For pundits and pointy-headed analysts, it's to keep The Economy and Growth flowing. That is its good. That is its end. Workers are the means. For most workers (the vast majority of whom aren't leaving their families and schlepping through megastorms to cubicles or factories for the love), the job is the means to a different, individualized end: the ability to buy one's own way, to keep loved ones fed and happy and healthy, to stave off poverty.

So what the CBO said today, in essence, was that if this Obamacare thing works out, people won't need to work full-time jobs just to keep health care benefits. They may actually be able to spend more time with those families. They may be able to freelance, to split hours between two parents rather than having one stay-at-home parent and one full-time earner. They may be able to take a chance on that novel or Etsy shop, instead of staying at the office until death.

That's not what conservatives hear, though, because that's not what conservatives care about. Their concern for people is subverted by their concern for commercial output, or economic abstractions that appear to impact commercial output.

People are real. They are not economic abstractions. And health care (and Medicare and food stamps, for that matter) is not single-sided accounting, with all costs and liabilities and no assets or benefits.  Health insurance that is not tied to employment facilitates Americans' labor mobility, unleashes their creativity and risk-taking, simply because they don't have to make one of the most important decisions in life -- where to work -- based solely on where they can get decent health insurance.  

Nope, Obamacare Won't Kill Two Million Full-Time Jobs

By Adam Weinstein

February 5, 2014 | Gawker

URL: http://gawker.com/nope-obamacare-wont-kill-2-million-full-time-jobs-1515973539

UPDATE (02.082014): Check out Matt Taibbi's somewhat nuanced take on the media flap over the CBO report: "Latest Health Care Flap Shows Media at its Most Boring."

Moore: We deserve better than Obamacare

Never let it be said that Michael Moore is a Democratic hack. He speaks his mind.

Of course, for some conservatives, Moore's call for single-payer feeds right into their conspiracy theory that Obamacare was always meant to fail, thereby somehow (I still don't get the how) opening the door for single-payer medical insurance for all Americans who want it.

The Obamacare We Deserve

By Michael Moore

December 31, 2013 | New York Times

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.

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.

I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics “expose” the fact that President Obama endorsed a single-payer system before 2004, they’re actually telling the truth.

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney’s car. And we knew it.

By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they’ll use some of that to try to privatize Medicare.

For many people, the “affordable” part of the Affordable Care Act risks being a cruel joke. The cheapest plan available to a 60-year-old couple making $65,000 a year in Hartford, Conn., will cost $11,800 in annual premiums. And their deductible will be $12,600. If both become seriously ill, they might have to pay almost $25,000 in a single year. (Pre-Obamacare, they could have bought insurance that was cheaper but much worse, potentially with unlimited out-of-pocket costs.)

And yet — I would be remiss if I didn’t say this — Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter’s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won’t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month.

Let’s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care.

Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year — money that would be going to hospitals and treatment.

In blue states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients’ health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)

All eyes are on Vermont’s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That’s why corporate money will soon flood into Vermont to crush it. The legislators who’ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.

So let’s get started. Obamacare can’t be fixed by its namesake. It’s up to us to make it happen.

GOP's alternative: Un-Affordable Care Act?

I hesitate to post this because of the author's conclusion: give single-payer (aka "Medicare for all") a second look.

Don't get me wrong, I prefer single-payer. But as I said recently, many Obamacare critics illogically believe the conspiracy theory that Obama has intended all along for the Affordable Care Act to fail, ushering in "socialized medicine" to save the day.    

Even single-payer is not socialized medicine; it's socialized payment for medicine. There are plenty of private doctors and hospitals today that make a fine living off Medicare patients, and nobody accuses them of communist sympathies.

Affordable Care Act ... as compared to what?

By Caroline Poplin

November 14, 2013 | McClatchy-Tribune News Service

Republicans can hardly believe their good luck. The Obama administration has once again snatched defeat from the jaws of victory. After successfully holding off Republican efforts to destroy Obamacare by shutting down the government and threatening default, the administration badly bungled the rollout of the crown jewel of health reform: the insurance exchanges. (No surprise to those of us who wrestle with computers daily.) Somehow administration leaders also failed to anticipate the predictable response of insurance companies to a perfect opportunity to raise premiums wholesale, while blaming someone else.

Nevertheless, we need to keep in mind that even as they gleefully tear into the ACA, Republicans have not offered an alternative.

On reflection, however, this is no surprise. Republicans don't see a problem with health care in America. Insurers can sell what they chose to whom they chose; people can select policies they like and can afford, or save their money for other things. This is how markets work. The only change Republicans would make is deregulation, so insurers and good prospects can find one another more easily across state lines.

As Ronald Reagan said: "Government is not the solution to the problem, government (in this case, the ACA) is the problem."

For conservatives, health insurance and health care are ordinary commodities to be traded in the marketplace, just like automobile insurance and automobiles.

But health care is not just another item in the shopping cart. As the African-American spiritual observed, "If living were something that money could buy, the rich would live and the poor would die."

And that is where we are in the 21st century. Health care is a matter of life and death. Our medicine is highly effective. Today, we can cure, or treat, diseases that were once fatal - heart attacks, many cancers, even HIV. That is, if you have the money. Today rich Americans live, on average, five years longer than poor citizens.

Nor is health insurance an ordinary insurance product.

Illness today is not evenly distributed across the population. Some 10 percent of people are responsible for 60 percent of health-care costs in the United States. Because most illness continues for many years after diagnosis, these people are easy to identify: patients with multiple sclerosis, congestive heart failure, lymphoma.

No one wants to pay for the sick people - not the insurance companies (particularly if they cannot recover their costs by charging the sick higher premiums), and not healthy customers. We hear this now, as single men and older people complain that to comply with the ACA, they have to pay for maternity benefits that they will never use.

A free market with lots of choices among multiple insurers, risk pools, policies with all sorts of benefits and price structures, allows insurers and healthy individuals to avoid the sick. The less affluent healthy can gamble on inexpensive policies with spotty coverage (useless to the chronically ill): since most people are healthy most of the time, few of them will ever need to test their insurance. (Or they can join large groups of other healthy people working for large employers who provide insurance.) Insurers can charge sick people thousands of dollars a month to cover the cost of their claims, and then some.

The result? The people who need health care the most have the most difficulty getting insurance that covers it. Doesn't this defeat the whole purpose of the exercise?

That, however, is the Republican alternative to the ACA. And remember, even before the ACA, things were not stable, but deteriorating: as health costs rose, premiums, co-pays and deductibles were going up, employers were cutting back. Without the ACA, those trends will continue.

The ACA was an effort to preserve a private health insurance market, using regulation to achieve a better result. As we see, this is very complicated.

There is a third option. If everyone is in the same, large, pool, everything medically necessary is covered, insurers are paid merely to process claims, and premiums are scaled to income, there is enough money to cover everyone at reasonable cost without elaborate, expensive, error-prone computer programs and geniuses to run them. People will be able to choose their doctors and hospitals. (And the rich can always buy more if they want.)

A crazy, wild-eyed socialist nightmare? No, this is Medicare, a familiar, popular, competently-run public insurance system that everyone's parents or grandparents rely on. Person-for-person, disease-for-disease, Medicare is the cheapest, most efficient health insurance program in the country. (There is virtue in simplicity.) Medicare already controls health care costs better than private insurers, and with a few tweaks, could do much more, forcing prices down to the level citizens of every other advanced democracy pay, with no sacrifice in quality.

Given the alternatives, maybe Medicare-for-all deserves a second look.

Don't blame ACA for 'cancelled' health plans

Some medical insurance companies have already been fined for sending out misleading cancellation notices to their customers that don't even mention cheaper options available through new ACA exchanges. 

This was always the weakest aspect of Obamacare: depending on private health insurers to play nice.  They don't. They won't. Especially under ACA, consumers must remain savvy, well-informed and stick up for their rights.  

Meanwhile, health insurance companies keep adjusting their earnings numbers for 2013 upward -- largely thanks to Obamacare. So don't cry for them -- or cry "socialism!"  Please.

Anyhow, some customers have complained -- or more often, others have repeated complaints they heard from FOX or talk radio -- that they were satisfied with their individual insurance plan that was cancelled because their insurer declined to upgrade their plan to comply with Obamacare, or else insurers raised the price to comply. 

Two responses here. First, individual health insurance policies typically last one year anyway, and then insurers raise prices and change conditions when offering renewal -- this was the way long before Obamacare. The HHH's grandfathering rule for Obamacare stipulated that, to be grandfathered, plans couldn't be changed after March 23, 2010, and prices could only rise with the medical rate of inflation. Pretty strict, admittedly.

So Obama should not have promised you could keep your current plan if you liked it -- because insurers have never let you keep your plan the way it was if you liked it. Insurers always raise prices and/or decrease coverage. 

Over the past few decades, insurance costs have gone up while coverage has gone down. That was the trend before Obamacare.  That was what Republicans such as John Boehner and Mitch McConnell preferred.

Now in 2013, and projected again in 2014, the rate of medical inflation is going down, a heartening reverse of a long-term trend. 

Second, it's impossible to say for certain in every case, but I would bet that most of those people have not had a catastrophic event or even an ambulance ride under their current plan. Obamacare requires insurers to cover them in almost every instance to avoid medical bankruptcy, the #1 cause of personal bankruptcy in the U.S.  

And let's face it: currently, if you're an individual consumer, the primary reason for having health insurance is to avoid unpayable, unexpected medical bills that could ruin you. It really is insurance in the same sense as earthquake or life insurance: it only saves you in the worst-case scenario; the rest of the time it seems like a nuisance.

I predict that when all the dust settles and the website starts working, most consumers will realize they're getting a better deal.

Insurance cancelled? Don't blame Obama or the ACA, blame America's insurance companies

By Juan Williams

November 5, 2013 | FoxNews

Liar! Pinocchio! Deceiver!

With all the charges flying against President Obama in the on-going effort to stop ObamaCare it’s time for a reality check.

Having failed to kill the Affordable Care Act in Congress by shutting down the government the opposition is currently taking delight in charging the president will lying to the public when he said anyone who likes their current healthcare plan will be able to keep it under the new law.

It turns out that some people in the individual care market – about 5 percent of the overall insurance market -- are having their insurance policies cancelled. 

It is estimated that half of those folks will get better coverage for a lower price. Some people will even get subsidies to help them pay the lower price.

But some people losing their current policies [and being offered better coverage] are going to have to pay a higher price. Taking crocodile tears to a new level, ObamaCare opponents are now rushing to their defense and calling the president a liar.

These critics include Republican politicians who did not vote for ObamaCare; these are Republican governors who refuse to set up exchanges to reach their own citizens; these are people oppose expanding Medicaid to help poor people getting better health care; these are people who have never put any proposal on the table as an alternative fix for the nation’s costly health care system that leaves tens of millions with inadequate medical coverage and tens of millions more totally uninsured. 

The fact is if you are one of the estimated 2 million Americans whose health insurance plans may have been cancelled this month, you should not be blaming President Obama or the Affordable Care Act. 

You should be blaming your insurance company because they have not been providing you with coverage that meets the minimum basic standards for health care.

Let me put it more bluntly: your insurance companies have been taking advantage of you and the Affordable Care Act puts in place consumer protection and tells them to stop abusing people.

The government did not “force” insurance companies to cancel their own substandard policies. The insurance companies chose to do that rather than do what is right and bring the policies up to code. 

This would be like saying the government “forces” chemical companies to dispose of toxic waste safely rather than dumping it in the river. 

Or the government “forces” people to drive with intact windshields and working brake lights.

How dare they “force” drivers to pay money to get those things fixed if they are broken?

One of the most popular and important provisions of the Affordable Care Act is setting basic minimum standards of medical insurance coverage. Here are some of those standards:

- Your insurance company is no longer allowed to cancel your policy if you get sick

- Your insurance company cannot deny you coverage or charge you more if you have a pre-existing health condition

- Your insurance company must allow you to keep your children on your plan until they turn 26 years old or get a job that provides health insurance.

- Your insurance company cannot impose lifetime caps on your health coverage.

- And perhaps most relevant to current discussion about insurance companies canceling substandard policies, your insurance company must cover what are called “essential health benefits.”

What are “essential health benefits?”

They are clearly defined on HealthCare.gov:

“Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.”

That’s right.

If you are rushed to the hospital in an ambulance, the ACA says your insurance company has to pay for the ambulance ride. 

If your son or daughter has a bout with depression or suffers from panic attacks, the ACA says your insurance company needs to pay for their medicine and treatment from a mental health professional.

People should be angry that their insurance companies were not paying for these humane, common sense benefits all along. 

It baffles me that people are directing their anger at the ACA which rights these terrible wrongs.

The Hartford Courant newspaper reports that the CEO of Aetna insurance made $36 million last year plus several millions more in stock options. 

They also report that the CEO of Cigna cleared a cool $12.5 Million plus stock options. 

The American health insurance industry is one of the most profitable in the history of the world. Before the ACA, they made money by finding any excuse, any loophole to deny coverage to the sickest and most vulnerable people in our society.

Rather than being vindictive and canceling policies under the pretext of ObamaCare, the insurance companies should be thanking their lucky stars that they do not have to contend with a public option or a single payer system. That is what the law allows in every other modern industrialized democracy.

GOP governors leave 8 million uninsured

We shouldn't be surprised.  The GOP despises poor people, especially if they're black.

Also check out this interactive map that displays the full ruthlessness of Republican states.

Millions of Poor Are Left Uncovered by Health Law

By Sabrina Tavernise and Robert Gebeloff

October 2, 2013 | New York Times

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.

[...]

The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.

“The irony is that these states that are rejecting Medicaid expansion — many of them Southern — are the very places where the concentration of poverty and lack of health insurance are the most acute,” said Dr. H. Jack Geiger, a founder of the community health center model. “It is their populations that have the highest burden of illness and costs to the entire health care system.”

The disproportionate impact on poor blacks introduces the prickly issue of race into the already politically charged atmosphere around the health care law. Race was rarely, if ever, mentioned in the state-level debates about the Medicaid expansion. But the issue courses just below the surface, civil rights leaders say, pointing to the pattern of exclusion.

Every state in the Deep South, with the exception of Arkansas, has rejected the expansion. Opponents of the expansion say they are against it on exclusively economic grounds, and that the demographics of the South — with its large share of poor blacks — make it easy to say race is an issue when it is not.

[...]

Sanders: Single-payer cure for ailing America

This is just to edumacate you Tea Partiers what real liberals want, and it's not Obamacare. From the start, Obamacare was a concession to private insurance companies and Big Pharma -- Republicans' idea of free markets. Single-payer was never on the table. 

Funnily enough, Republicans liked Obamacare when the Heritage Foundation, Newt Gingrich and Mitt Romney proposed it. Yet it became damned socialism and worth shutting down our government and destroying the full faith and credit of the United States after a black Democrat signed it into law.

A single-payer system, like Medicare, is the cure for America's ailing healthcare

By Bernie Sanders

September 30, 2013 | Guardian

I start my approach to healthcare from two very basic premises. First, healthcare must be recognized as a right, not a privilege. Every man, woman and child in our country should be able to access the healthcare they need regardless of their income. Second, we must create a national healthcare system that provides quality healthcare for all in the most cost-effective way possible.

Tragically, the United States is failing in both areas.

It is unconscionable that in one of the most advanced nations in the world, there are nearly 50 million people who lack health insurance and millions more who have burdensome co-payments and deductibles. In fact, some 45,000 Americans die each year because they do not get to a doctor when they should. In terms of life expectancy, infant mortality and otherhealth outcomes, the United States lags behind almost every other advanced country.

Despite this unimpressive record, the US spends almost twice as much per person on healthcare as any other nation. As a result of an incredibly wasteful, bureaucratic, profit-making and complicated system, the US spends 17% of its gross domestic product – approximately $2.7tn annually– on healthcare. While insurance companies, drug companies, private hospitals and medical equipment suppliers make huge profits, Americans spend more and get less for their healthcare dollars.

What should the US be doing to improve this abysmal situation?

President Obama's Affordable Care Act is a start. It prevents insurance companies from denying patients coverage for pre-existing conditions, allows people up to age 26 to stay on their parents' insurance, sets minimum standards for what insurance must cover and helps lower-income Americans afford health insurance. When the marketplace exchanges open for enrollment on Tuesday, many Americans will find the premiums will be lower than the ones they're paying now. Others will find the coverage is much more comprehensive than their current plans.

Most importantly, another 20 million Americans will receive health insurance. This is a modest step forward. But if we are serious about providing quality care for all, much more needs to be done.

The only long-term solution to America's healthcare crisis is a single-payer national healthcare program.

The good news is that, in fact, a large-scale single-payer system already exists in the United States and its enrollees love it. It is called Medicare. Open to all Americans over 65 years of age, the program has been a resounding success since its introduction 48 years ago. Medicare should be expanded to cover all Americans.

Such a single-payer system would address one of the major deficiencies in the current system: the huge amount of moneywasted on billing and administration. Hospitals and independent medical practices routinely employ more billing specialists than doctors – and that's not the end of it. Patients and their families spend an enormous amount of time and effort arguing with insurance companies and bill collectors over what is covered and what they owe. Drug companies and hospitals spend billions advertising their products and services.

Creating a simple system with one payer, covering all Americans, would result in an enormous reduction in administrative expenses. We would be spending our money on healthcare and disease prevention, not on paper-pushing and debt collection.

Further, a single-payer system will expand employment opportunities and lift a financial weight off of businesses encumbered by employee health expenses. Many Americans remain at their current jobs because of the decent health insurance provided by their employer. Without the worry of losing benefits, those Americans will be free to explore other, more productive opportunities as they desire. For business owners, lifting the burden of employee healthcare expenditures will free them to invest in growing their businesses.

Congressman Jim McDermott and I have introduced the American Health Security Act. Our bill will provide every American with healthcare coverage and services through a state-administered, single-payer program, including dental and mental health coverage and low-cost prescription drugs. It would require the government to develop national policies and guidelines, as well as minimum national criteria, while giving each state the flexibility to adapt the program as needed. It would also completely overhaul the health coverage system, creating a single federal payer of state-administered health plans.

The American people understand that our current healthcare system is not working. But the time is long overdue for them to understand that there is something fundamentally wrong when the US remains the only country in the industrialized world that does not guarantee healthcare to all its people.

Healthcare is a right and we must ensure provision of that right for Americans. A single-payer system will be good for the average American, good for businesses, good for workers and good for our overall economy.