Probably didn’t see that coming if you didn’t read it at the end of my last post, eh?

Well, I’m not under any illusion that the ACA is going to do anything its creators, supporters, and apologists ever talked about or promised.  But I do believe it’s got a chance of dramatically shifting Americans back to better health via some of the most dramatic Unintended Consequences in modern economic history.

Unintended Consequences is an actual and pretty self-explanatory economic term.  Like unemployment rising among the  most vulnerable people when the minimum wage is raised, for example.  It wasn’t intended, its degree isn’t necessarily predictable, but it isn’t really a mystery once they show up.  Normally, however, they’re only some fraction of the benefit of the new policy, law, regulation, or what have you.  This whole Obamacare thing is looking to be all about Unintended Consequences.

I’m going to get to how this is going to make for a better, healthier life for you fellow Fat Heads out there, and even more so for those who aren’t, but first I’m going to have to torture you with a quick primer on insurance.  Because even if you have health coverage right now, it’s important to understand that you probably still don’t really have insurance.

What do I mean by that? Let’s consider what true insurance is. It consists of:

1) Some large, definable risk (my house could burn down) within

2) a group of people (50,000 homeowners) that can’t/don’t want to assume the sole financial risk of same, which

3) will occur with some reasonably predictable frequency (100 houses per year in x market)

4) at a reasonably predictable cost to make whole ($175,000 per house)

[3) and 4) are what Actuaries do, and they're generally incredibly good at it and make great money, kids, so stay in school and study that math!]

So we pretty much know how many times this is going to happen and how much it’s going to cost to rebuild all of those houses — $17,500,000.

The thing nobody knows is — which 175 people out of that 50,000 homeowner group is it going to happen to?  So since none of those 50,000 want to be on the hook to rebuild their $175,000 house (remember, they still have to pay off the mortgage even if the house is nothing but ashes), they all chip in (via premiums) $350 to cover the rebuilding costs, maybe another $120 for admin and overhead, another $20 or so as profit, and there you go — you sleep easy in your $175,000 house in exchange for a $490 annual premium.

How is what most Americans who do have a health insurance policy not really insurance? Here’s a couple of the most blatant distortions from what real insurance is…

Does your homeowner’s insurance cover having your lawn mowed and windows washed?  Of course not.  Those expenses don’t comprise a risk to your financial well-being,  and we know exactly who it’s going to happen to — because it’s pretty much everyone.  If people did have that coverage, it’d be expensive as hell because 1) the cost of administering all of those small transactions would drive the overhead — and your premium — up way over the value of those routine expenses; and 2) with a low deductible or say a $2 co-pay, people would use the services way more often.  But how many people are aghast at the idea of “insurance” not paying for those one or two routine doctor visits a year, or not covering the one or two bottles of pink stuff for little Johnny’s ear infections.  Even though we all know it’s going to happen — to everyone.

[That type of true medical insurance -- no-frills, high deductible plan where you cover all of the regular stuff -- makes for a very affordable premium and is what Tom had -- until the ACA made it illegal.]

Or this — think this phone call ever takes place?:

“Acme Home and Auto, may I help you?”

“Yeah, um, I want to buy an insurance policy on my house.”

“OK, sir, do you know about what your house would cost to replace?”

“About $175,000 I think.”

“Good.  About how many square feet is your house?”

“Well, right now it’s zero.”

“Excuse me, how could you have a $175,000 house with no livable space?”

“Well, it burned down last night.  Say, I’d also like a really low deductible, OK?”

Of course that’s insane.  But it’s not called insane in the health insurance debate — there it’s called a “pre-existing condition.”  We should have a dialogue in this country about how to help uninsured people who already have medical conditions, but to think it belongs in the insurance market is no less insane than the above conversation.

OK, that’s real insurance, but for the rest of this I’ll be using the term to refer to the current stuff many of us have, mostly through employers.

 

…Now, let’s see how the ACA is going to help us all start getting healthier.  One of the main ways is this — odds are pretty good that by the end of next year, you’re not going to have insurance.  I don’t mean you personally.  That would be a major setback.  I mean you and probably 50-70 million of your closest friends.  Company-provided health care will be exiting the scene in rapid and dramatic fashion, and good riddance.

It’s a major setback if it happens to a few or even a few thousands of folks, because now they’re out there naked in the market where everyone else is able to pay for all of those expensive doctors visits and specialists and prescriptions.

But when 50 million people find themselves looking for health care with only their own resources, you don’t have a disaster — you’ve just created a monstrous consumer-driven market overnight.  Fifty million people who yesterday would’ve gone to the drug store (the closest one), given the nice person behind the counter their insurance card and $15 copay, and then gone home without a thought.  Now they’ll be saying things like:

“How much does this cost?”

“It’s $10 cheaper if I drive six blocks to your competitor — can you match that?”

Magic.

Another thing that’s coming to light if you’ve followed this at all is that the Obamacare policies, besides having major increases in both premiums and deductibles (out of pocket expenses before you get a dollar covered by insurance will probably range from $4,000 for the most expensive policies up to over $12,000 for the “cheap” ones) have made drastic cutbacks in the formularies.  That’s the approved drugs that they’ll pay for or count towards deductibles.  They have to have at least one drug from each class, and that’s pretty much what you’re going to have.

Many people are going to find that even if they have insurance, they drugs that have worked for them aren’t on the list, so they’ll be out of pocket. So even more important than that conversation at the pharmacy counter, more people will be asking their doctors things like:

“Isn’t there a generic for this?”

“Why’s it so expensive?”

“Why do you want me to take a drug for the rest of my life?”

“Shouldn’t I be looking at changing my diet and habits BEFORE trying drugs, instead of the other way around?”

Or even,

“It’s costing me $120 for this visit, not counting the hour I just sat in your waiting room.  I’d like a little more than 8 minutes and a prescription.  How about you explain why you’re making these recommendations.”

Another way this reshuffles the current incentives in our system in a major way is this:

I think most Fat Heads will agree that part of America’s problem is that the commodity, Frankenfoods are just plain cheaper calories than eating good food even before all of the subsidies and price distortions that work in their favor.  So, eating crap that has disastrous long term health effects is cheaper in the short run.  Then people get cheap drugs to treat the chronic conditions they develop as a result.  First we buy you the sugar, then we buy you the insulin.  Perfect.

If people suddenly find themselves actually footing the bill for their own poor lifestyle and diet decisions, I believe it will trigger a paradigm shift in how they view their food.  Perhaps even a paradigm shift in how they view the people who have been telling them what to eat for the last couple of decades.

These things don’t have to be voted on, or spelled out for the many people who won’t be that focused.  But they’ll be listening to the people who do care, and are focused, because now it matters to them, and their positive actions will yield positive results.

It’s all about that “Wisdom of Crowds” effect that Tom is lecturing on (which his how you got stuck reading this!).

OK, you’ve suffered enough.  Tom should be back next week.  I may put up a couple of corollaries to this line of thought over the weekend, like how the continuing collapse could trigger a sudden outburst of fiscal sanity, and how to decide whether or not you should be trying to get insurance, or just wait until your house burns down and then let Obama buy you a new one.

See you in the comments!

The Older Brother

 

 

 

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50 Responses to “The Older Brother makes a case for Obamacare”
  1. Darren says:

    Hey older brother, good to hear from you! I liked your farm report, very nice use of the wasted fruits and veggies by the way.

    Lots of thoughts in here so I’m going to intersperse my comments — The Older Brother

    You know, reading this blog post I actually find myself agreeing with you. From an outsider’s perspective, a big part of the issues with ACA in my view is in trying to keep a bastardized “Market” system, which also is being forced to act like a socialized system as well. That is not doing anyone any favors.

    I am also glad that you think something should be done for people who have pre-existing conditions that do not fit the for profit insurance model. These people are indeed not burned down houses…..they are sick people who need help.

    And unlike a burned down house that can be rebuilt for a onetime fee, sometimes sick people need ongoing care and costs (sometimes for the rest of their lives).

    So that is the real problem for a free market healthcare system…….what do we do with these free-loading liabilities eh?

    I think your country should probably just pick a lane and go to a fully socialized medical system instead.

    We’ve had a bastardized system in this country for decades. As much as Republican protest Obama “taking over 18% of the economy,” it was over half socialized already, between Medicare and Medicaid spending, insurance mandates, protected medical and pharmaceutical cartels, etc.

    People with limited means and pre-existing conditions where provided medical services through charitable acts long before government inserted itself, and can be effectively dealt with after it falls apart. When everyone gets a free pass, the real free-loaders overload the system, tax the ability to help to truly needy, and fuel resentment among those coerced by the government into subsidizing them.

    So yes, I’m sure we’ll have to agree to disagree as I want to take this opportunity Obama has blessed us with to try to swerve suddenly and sharply back into the free market lane.

    It works to varying degrees of success in most of the other first world counties that have gone that way. Better health outcomes, cheaper per capita, etc.

    Some supporting references:

    http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html

    http://www.americashealthrankings.org/Rankings/InternationalComparisons

    http://www.nytimes.com/2013/06/16/business/what-sweden-can-tell-us-about-obamacare.html

    Yes of course there are problems with all systems, and yes sometimes there are wait lists, and for sure no system is perfect. And you can also be sure that taxes are definitely higher to pay for this stuff. But I still think on balance it is a much more efficient, and cost effective way to go for a country.

    The bottom line is: The USA spends way more on healthcare under the private insurance model and still has inferior health outcomes for the majority of its people.

    Europe’s economy of soft socialism is sclerotic and declining. The Aussies seem to be doing quite well and do have government provided health care, but my read is they’re doing so damned many other things right that it just doesn’t matter yet.

    If you’re a regular Fat Head, please consider that all of those “America Spends More, Has Worse Outcomes!” studies are the equivalent of Ancel Keyes’ Seven Counties Study “proving” that eating saturated fat causes heart disease. They’re cherry-picked data, they ignore massively important “confounding variables,” and are written by people with either financial or philosophical (or hey, let’s not forget — it could be both!) vested interests, along with some by the occasional well-meaning useful idiot.

    The short answer is that we Americans enjoy driving and shooting each other more than any other nation in the world. Although that ends up driving health care costs, it’s not health care system issue. Likewise, we also enjoy an inordinate number of very young, uneducated, and unwed mothers; which is another proxy for poor (and expensive) health outcomes that is not a health care problem. Factor those out, and we’re back towards the front of the pack.

    Thank you, BTW, for not throwing in the usual “highest infant mortality rate” chestnut. That is a despicable lie presented as a statistic that never fails to make my blood boil.

    We do, as a nation, spend an extraordinary amount of our health care dollars in the country on the very beginning and end of life, where countries with socialized systems have made conscious choices not to support. I think that is a proper item for consideration, but think it should be considered by the individual, not the government.

    I know I am not going to change your mind (or many of the people who read this) but the “Free Market” is not the only way to deal with all problems. Government involvement does not always have to end in a train wreck. Lots of other places are doing it quite successfully.

    You also can spare us the American exceptionalist arguments like “It can’t work here” etc. The USA is a “can do” country. If a bunch of wimpy non-Americans can do it, so can you if you try.

    I’m not sure “it can’t work” would be an argument someone advocating American exceptionalism would make, it seems rather it would go with the “if anyone can, we can” thought you make. But I have to stipulate I’m not much of an authority on American exceptionalism.

    I think the real America is exceptional, but the real America isn’t defined by some set of geographic points, or some group of people currently in or out of power. The real exceptional America, America at its very best, is an idea. I think there’s thousand of real Americans around the world I’d like to see here, and there’s millions of people born and raised here who aren’t. If your cat has a litter in your oven, that doesn’t make them muffins. I don’t think those folks who reaalt want to come make in America want to come for the free health care.

    I know and understand that this sort of a view offends your personal ideology, however not everyone in your country shares your ideology.

    Cheers!

    I’m not offended by people who disagree with me, especially in a thoughtful way such as this. Arguing and having to defend your position is the essence of the free exchange of ideas.

    I’m also hip to the idea that not everyone here shares my ideas. If even half did, we wouldn’t be having this conversation!!

    Cheers back at you.

    The Older Brother

    • Darren says:

      I’m going to insert my responses into the original text again on Darren’s points here — The Older Brother

      I only have a couple of thoughts to add to this useful and interesting debate.

      1. You said “we also enjoy an inordinate number of very young, uneducated, and unwed mothers; which is another proxy for poor (and expensive) health outcomes that is not a health care problem. “”

      I agree with you here. The USA does indeed have the highest teen pregnancy rate in the world.

      http://www.ncbi.nlm.nih.gov/pubmed/11804433

      However I am going to disagree with you here as well. Actually, this IS a huge health care problem. Unfettered access to contraception (and the education to use it) and access to the full suite of family planning would help to curb a large number of unwanted births and unplanned pregnancies. This kind of healthcare is fundamental to a young woman’s health, and wellness for her and her children’s whole lives.

      This actually underscores my point about saving your country money with additional healthcare funding. In the case of the kids who would otherwise be born into single mother poverty, that savings is not just in healthcare either. Every country in the developed world would be better off with fewer of these “million dollar babies” clogging up our jails, court systems, and welfare offices.

      Maybe I didn’t say it clearly enough, so I’ll try it again. This is a huge health care problem, but it’s not a problem caused by the design of our health care system. It’s a societal problem that manifests itself in our health care system. We’re not spending too much on procedures, we’ve got a behavior issue that leads to too many procedures being needed.

      It’s not caused because we don’t let government run our hospitals, it’s because young, uneducated unmarried women have more distressed pregnancies, more premature and low birth weight babies, and more babies born with health issues. That drives costs up dramatically, because in this country, unlike the rest of the world, we do everything possible to save a viable baby. Of course, they’re already 100% in the part of our system that’s completely socialized, as nearly two-thirds of babies are being born directly onto the medicaid roles.

      And please, EVERYONE in America has unfettered access to birth control, if they have the slightest motivation to avoid pregnancy, which they don’t. “Mistakes” always have, and always will happen, of course. However, we have an entire underclass of people who simply don’t care, and an overclass who encourage that irresponsibility, because there are zero disincentives to having a baby they have no means or intention of supporting and nurturing. Because that’s government’s job now.

      Assuming these poor, lovestruck folks truly wanted, but had to somehow foot the entire bill for their birth control, at what point did we degenerate to the level that single women have no problem screwing someone who can’t chip in on the exorbitant $10-$20 a month for birth control pills? If someone can’t swing that, could we agree that perhaps they should be out looking a job instead of love?

      2. We drive a lot in Canada too and we also spend way too much at the beginning and end of life as well. (Incidentally I have never heard or seen of one case in Canada where some government bureaucrat decides when to pull the plug on grandma either). In fact with the exception of the shooting each other (you got me there), our cultures, way of life, and so on, are very similar. Not too sure why then you need to spend almost twice as much per person as we do on health care. Why is that?

      They don’t pull the plug on granny. They don’t have to. That’s the thing about the effective but totally misleading term “Death Panels” in our debate down here. There will be no plug to pull, because the procedure to put the plug into granny in the first place won’t be on the approved list.

      So, they should’ve been named the “It’s Not That We Intend For You To Die, But We Simply Decided That The Treatment You Need Isn’t Worth Spending The Money On Since You’re Pretty Old And We Want To Collect Your Estate Taxes Anyway, So There’s Nothing We Can Do, Well We Mean There’s Nothing We’ll Approve Payment For That Could Be Done But It’s Not Like We’re Going To Come Into Your Room And Put Cyanide In Your IV For Crying Out Loud, Unless You’re A Republican, But Not All Republicans Only The Conservative Kind” panels. That just doesn’t really roll off the tongue quite the same way, though.

      3. Let’s assume for the sake of argument that you are correct, and that all the international health outcome statistics are cooked, and the USA is not at the back of the pack in terms of outcomes but right up there with the rest of the developed countries.
      Your country is still spending way more than everyone else to accomplish the same goals. Way more in terms of dollars per person, and way more in terms of the percentage of your total GDP.

      Not very efficient if you ask me.

      Well now we’re just having an argument about math. The point I ways making when I say we’re not out of line when you factor that in can be summarized with this example:

      1000 Canadians’ spending (done via government taxation and allocation) on general health care: $5,000,000. Spending on gunshot treatment – $0. Zero deaths.

      1000 American spending (via self-pay, insurance, gov’t programs, etc) on general health care: $5,000,000.
      Spending on gunshot treatment – $200,000. 1 death

      So now, our crappy system just spent 40% more on health care and had a much higher mortality rate. That’s how it’s done.

      (I may have inadvertently clipped some of the end of your comment off — if so, please let me know)

      Cheers!

      • Darren says:

        Umm okay.

        I think I will leave the teen pregnancy thing on the table. There are a number of other social, financial, and moral issues at play there (you might call them confounding variables) and It just hijacks the issue of overspending on healthcare. Let’s stay focused shall we?

        Ah, “Death Panels” I must say I also have heard the term bandied about sometimes when I make the mistake of watching Fox news. And actually, yes there are finite limits to even our medical resources here in Canada. Our system will usually not pay for experimental or extremely rare treatments until there is good data to support doing so. Pretty sure most private health insurance plans have similar lists of stuff they will not pay for, so the difference is?????

        Additionally it is true in rare cases, if a panel of doctors agree that there is no hope of someone recovering from a vegetative state, then a legislative panel can overrule a family’s wishes to keep someone on life support. This issue was recently decided by our own Supreme Court about an Ontario man. And yes in these very rare circumstances there can be a decision to withdraw life support. I would point out a number of things about that. The panel of DOCTORS (who have no financial incentive either way) was convinced there is no hope of recovery, The family fights that decision for three or more years, then finally the Consent and Capacity Board, a body with the power to make the final decision when doctors and families disagree on keeping a patient alive with continued treatment or pulling the plug makes a call.

        So Sara Palin is right. In 0.001% of the cases in our system, our medial system does finally have the ability to say, “we are not paying for this anymore”. Nobody would stop the family from paying for it out of pocket however. Keep in mind our medical system has been around for more than forty years and this was the big test case so obviously this is a daily occurrence.

        This is so silly to me however as an argument against socialized medical care. How many people in the US could afford to keep a loved one in a vegetative state for 3 years in the first place? So yes, in the most extreme cases, even our system has a limit. Are you saying that a private insurance company wouldn’t have a limit?

        And if you’re a rich Canadian, you still have to option to pay for it yourself anyway.

        So, the difference between our systems is the guns eh?
        Okay let’s do some math. You said:

        “1000 American spending (via self-pay, insurance, gov’t programs, etc) on general health care: $5,000,000.
        Spending on gunshot treatment – $200,000. 1 death
        So now, our crappy system just spent 40% more on health care and had a much higher mortality rate. That’s how it’s done.”

        $200,000/$5,000,000 = 4% unless I am mistaken.

        Where is the other 36% coming from?

        I realize you just made an error in calculation (I personally am a whore to Excel myself ;) )

        But I think you’re grasping at straws here.

        I continue to contend that your system is more expensive.

        P.S. There is a solution to the shooting each other problem too, but I am not gonna go there. :)


        Of course you;re right on the math error, and it wasn’t supposed to illustrate just the cost of gun violence.

        My point was once you add the additional costs here for trauma emergency care, beginning and end of life treatment, et al, those are the costs — which socialized systems don’t incur — that make the difference in our spending and health outcomes, not the fact that our delivery system still retains some vestigial portion in the market.

        It’s also the government portion of our system — Medicare/Medicaid — not private insurance, that is spending wildy on end of life care.

        Again, a la observational studies that say we should take statins, or fat causes heart disease, the more you look at the actual data, the less there is to see.

        I’m also not arguing for the existing insurance industry. It’s terrible. But like pus and scabs, it’s not the actual problem, it’s just the body’s (market’s) reaction to injury. It’s pretty gross, but you’re still better off without it. I want the current insurance market to collapse along with Obamacare.

        If people were making end-of-life decisions with their own assets, you would get much more of a focus on quality of life without the government or a panel of doctors arrogating those decisions to themselves.

        Cheers

      • Nads says:

        Approved list sounds more like something that we see on US tv when they are discussing private health insurance. In the Australian health and hospital system (I work in it) everything is done, and more, without actual discussion of what is covered and what isn,t, because everything is covered. If anything, I think too much treatment and therapy is given, and it’s not sustainable for years to come when more and more get sick.

  2. Max says:

    It kind of stuns me that this discussion goes on in the U.S. at all, it’s the wrong discussion. To my knowledge, in every other Western country (and many non-Western countries) people pay taxes and in return get free (or mostly free) vital health care. For example; cancer treatment, emergency care, childbirth and a range of other necessities. It’s never perfect, though there’s usually an option to get health insurance in addition (without the price-gouging and problems inherent in American health insurance). Without nationalised medicine dozens of people I have met would literally be bankrupt and dead.
    I am astonished that 300 million Americans aren’t protesting for what the rest of the world thinks is a no-brainer. Maybe clowns have distracted you from seeing the elephant in the room.


    Can we at least agree on this? — if you’re paying taxes for it, it’s not really free.

    The common idea of not being able to imagine how people would get some good or service without the government figuring it out for them isn’t evidence of a failure of the marketplace, only a failure of the imagination. I’m not claiming to have the imagination to figure it out — that is the “fatal conceit” of the central planner.

    I do think that in an entire country of 5 million kiwis with a more homogenous culture, government-run anything can be less destructive. If everyone in a group agrees they want something, and everyone agrees to pay the same price, there’s not much conflict. They’ll also tend to feel personally vested and keep an eye on things.

    When Tom and I were growing up, our folks sent us to the public schools in little Bettendorf, IA because they were simply better than the parochial school. It was a small, young community, with most of the residents sharing the same values — like wanting quality schools for their kids. Everyone was in, everyone cared, and everyone was paying.

    Here in America, with a diverse, aging population of 330 million, with over half not paying anything in taxes (and a good portion of them getting “refunds” anyway), that’s never going to happen. Obamacare wasn’t sold with the promise that everyone was going to pay, it sold as being “free.” You could keep your doctor — period. Your premiums were going to drop by $2,500 a year. everyone would be covered.

    Big lies beget big consequences.

    Cheers!

    • Austin Pitts says:

      Woot for small towns in Iowa! Grew up about an hour north of Bettendorf in Bellevue.


      Go Bulldogs!

      The Older Brother

    • Laird Popkin says:

      I certainly agree that it’s weird that in the US nobody is talking about adopting the system that works everywhere else, far more effectively and efficiently than our system.

      That being said, your last paragraph is wrong.

      First, “over half not paying anything in taxes” is incorrect. Yes, 47% of the population doesn’t make enough to pay federal income taxes, which is a little bit more than usual due to the Bush depression reducing incomes of a few million people below the minimum income, and due to the Republicans raising the minimum (which they were proud of at the time). The large majority of people who don’t pay income tax are children, retired adults, and the “working poor” who work full time but are paid so badly they don’t even make the minimum for paying income tax. And keep in mind that income tax is not all taxes paid- it is only one tax, which collects 40% of the tax revenue. The other 60% are things like sales tax, gas tax, etc., which are paid by everyone, and in fact are paid disproportionately by the poor and middle class, because they spend more of their money on taxed purchases, gas. If you count all taxes paid, in fact, the taxes paid by the poor and middle class are a higher percentage of their income than is paid by the rich, because unearned income is taxed at half the rate of earned income, the inheritance tax has been cut, the top marginal tax rate has been cut, social security is capped, and corporate taxes paid in the US are much lower than in any other wealthy country, all of which really benefit the extremely wealthy, forcing the rest of us to pay higher taxes to compensate for their tax breaks.

      Secondly, Obamacare wasn’t sold as “free”, it was sold as everyone paying for insurance so that uninsured people weren’t either left to die or covered by inflating what everyone else pays. Remember, ever since Nixon, Hospitals’ ERs are required by law to provide stabilization to anyone who needs it, and if they are uninsured and can’t pay, the rest of us pay for it because the hospitals inflate their charges to those who can pay to cover the rest. If everyone is insured, then we can pay the lower, actual costs.

      Health care costs this year are up less than 3% over last year. That’s much, much better than the 4-7% annual increase we’ve been seeing for decades.


      Yes, I should have said “slightly under half.” My bad. But you don’t get to count the kiddies — the number is based on “households,” not population, so the three-year-old doesn’t get counted in the non-contributing column unless he’s already moved out of the house.

      And, I don’t how some people just can’t seem to grasp this, but Bush has been out of office for 5 years now, and he was only in office for about the first 6 months of the collapse. Every dumbass thing Bush and his folks did to “fix” it once it started has been doubled down on by Obama, except for the ones he blew up exponentially. I suppose if things finally get back on track by 2025 or so, it will be known as “the Obama Recovery.”

      Sorry, but I am completely tired of the whole “boo, hoo, taxes are regressive on the poor” crap. It’s one of the biggest con jobs since the social service industry came up with the incredible “every dollar we spend saves seven dollars later!” load. Everybody whines, but no one seems to want to trade tax bills with those greedy, under-taxed rich turds, do they? I mean, if you’re paying 15% total on an income $50,000, you really want to trade tax bills with a millionaire who’s only paying 8% of their income in taxes? I’m sure she’d be happy to pay your $7,500 tab, but are you really insisting that you’re better off only paying that 8% whack of $80,000? Hey, do it on principle.

      BTW, what about FOOD? I mean, everyone needs to eat, for crying out loud. How can you stand the idea that a poor person HAS TO PAY THE SAME PRICE FOR A BOX OF TWINKIES AS DONALD TRUMP?!?! Talk about freaking regressive.

      Most of your other statement regarding taxes are factually incorrect, and I’m not sure how we’re being forced to pay for all of those alleged tax breaks for the rich, since close to half aren’t participating.

      I would refer you to all of Obama’s lies, now even occasionally covered by the press, concerning how much cheaper premiums were going to be, how much money it would save, how you could keep your health plan (period!), your doctor (period!), etc., etc. in regards to convincing the average American that their bill would either go down or disappear. In other words, free.

      Finally, your illusion that the current situation — where all hospitals are forced to provide services to indigent people and somehow recover that cost — will be improved by instead providing these same indigent people with a piece of paper that says they have insurance (at no cost to them), then adding tens of thousands of government workers, tens of thousands of new regulations, and then forcing all of those costs back through the now government-run health insurance industry is going to be a big money-saver to the rest of us is mind-boggling. Please provide examples of where this worked.

      Cheers!

  3. You make some sense. I’ve had similar thoughts myself.

    Another benefit of Obamacare is that more people are opening their eyes to the reality that it’s a mistake to turn over your healthcare and 18% of the economy to politicians and bureaucrats, most of whom couldn’t even run a hot dog stand.

    -Steve

    To quote Tom — “Bingo!”

    The Older Brother

  4. Nads says:

    Wow, that’s all so complicated what is happening to your health insurance. I sure don’t understand it. In Australia we don’t have much incentive to be healthy. Free health care, plus optional private health insurance if you need no waiting and a glass of wine in hospital.

    Hope it all works out over there.


    I think it may start un-complicating itself fairly rapidly now. Other than health care, you folks down under seem to be becoming more and more what we used to be told America was supposed to be about. I’m getting a bit jealous.

    Cheers!

  5. Kelly B says:

    Wow – thanks! You’ve just cheered me up from a bad mood brought on by listening to the fall of civilization on talk radio for the past 2 months. I should have been able to think through the unintended consequences, but I didn’t or couldn’t. If it works out like that, it really might end up being a good thing. Freaky!

    Also, a much delayed thanks for 2 things: your post on concierge medicine (I’m investigating a switch), and your son’s recipe for pizza crust. It’s awesome!

    Flattered you liked them. The Oldest Son’s pizza recipe has especially been a continuing hit.

    Concierge medicine routinely gets dismissed as “health care for the rich,” but it’s really health care for people who care about their health. I liked Craig’s analogy with parochial schools — they’re populated mostly with middle-class folks who feel it’s important enough to prioritize their finances in a way to make it happen.

    The Older Brother

  6. Steve says:

    It sounds great, but I’m not convinced that your mechanism of action is completely plausible. I’m not sure I can hang with the Naughton brothers on political or economic topics but I’ll give it a shot.

    Business like to save money too. There are wasteful businesses and efficient businesses just like families. Although the ship moves more slowly, they are ultimately bound to the same principles as individuals. Businesses have been unable to influence the market in a meaningful way. Having them dump the problem off on the employees won’t solve it.

    Healthcare is a two headed monster. First of all they have gotten away with convincing folks they are what are keeping them alive. Combine this with the fact that there is such a huge pool of money there. This gas-and-fire combination has formed corrupt and at times blatantly unconstitutional public-private partnerships. When the dread PPP enters the picture, you get regulation and favorable treatment that keeps the theory of capitalism from taking effect.

    The insurance mess is a symptom of the real issue that the medical system is a huge corrupt mess. Unfortunately I see Obamacare as simply “rearranging the deck chairs” and not something that is going to change the face of clinical healthcare.

    The potentially saving grace in this thing is that employers are largely going to run away from providing health insurance and just pay the fines (there’s no rational alternative for them) while on the flip side — and contra all of wet dreams of the Pivan and Cloward savants who figured this was finally going to get Americans demand socializing everything — the Obama administration has made it unequivocally clear just how incompetent a government run system would be here.

    There won’t be any public-private partnership — no one will be able to play.

    The best possible alternative is that the whole things collapse, which makes it back into a de facto free market where everyone is a consumer again, and the dumbasses in Washington will be forced into allowing a true insurance market to develop.

    Notice this does not require them to make actual, rational decisions. They’re incapable of that. In this scenario, which I think may be the most likely, they just get drug along by reality, and once the market starts to heal, they can do what they do best — run around to the front and pretend it was their idea.

    Cheers

  7. Kristin says:

    After the comments to your post that was simply on composting you are a brave man to put this up…or one who loves a good argument. Not sure corporate health care is going to tank very soon though it may wind up phasing out. This is because for us corporate workers, that health care is part of our compensation package. The company just drops that and they have given a big pay cut. Such a dramatic action would not come without consequences. If next year my corporate health insurance is cancelled I’ll come back cap in hand.

    What concerns me the most about ACA is that it is another heavily funded government program to go along with the FDA and the USDA who have both demonstrated that they work at cross purposes to the health of the populace. These agencies have put policies in place to ensure the population becomes increasingly chronically ill. And now they plan to pay for those illnesses? Damned decent of them but I foresee a train wreck. I sure hope the Wisdom of Crowds does begin to kick in. It is a small minority of my acquaintance that has given up sugar, grains and processed foods. Most of them either eat crappy or they think they are eating well with their kitchen stuffed full of low fat foods and seed oils. After a couple years of my weight being stable and never being ill most still think I’m killing myself.

    I’m probably being pretty negative about this whole thing but the government is going to continue to push their failed healthy eating recommendations and lots of people are going to continue to listen and to get sicker. Only now I get to pay for them as well as my good food. I’m holding back a final judgment, though. This will be a big change and it will shaking that apple tree pretty hard with all sorts of stuff falling out. Perhaps it will sort itself out into something more sane over the next few years.

    I know my fancy corporate ‘insurance’ functions for me more like real insurance. I may have well care coverage but I don’t consider it a perk to go argue with my doctor once a year about cholesterol and mammograms.

    The bigger corporations will hold out longer, and will be getting “incentives” from the government for awhile, but I believe way sooner rather than later, and mostly all at once, they’ll start dropping it. I expect many will offer increases in wage rates to offset a portion of the net loss of compensation, but they immediately regain certainty over their costs.

    Of course the government will continue to push the failed programs, but it doesn’t have any money, so as people have to start taking responsibility for their own heath decisions instead of having the bad consequences subsidized, they’ll start making better decisions. That’s the thing about the Wisdom of Crowds effect. It doesn’t mean people have to actually be smarter, or pay more attention.

    Cheers

    • Lori says:

      I agree with Kristin–I don’t think company health insurance will go away soon. Major medical was regulated out of existence in Colorado over ten years ago, and even the small, privately owned companies I’ve worked for since then have offered health insurance. Even though the rates have gone way up, they’re much cheaper than going out and buying your own.

      Having a high deductible plan, I assure you it motivates you to check prices and think about whether you really need medical care. I’m glad I’m not paying for some parents to run their kids to the doctor with every sniffle since it’s only a $10 copay (for them).


      I haven’t met a business owner who hasn’t said it’s inevitable. Big business will gut it out for awhile, and Obama will keep giving pushing exemptions for them, but it’s too much of an unknown (plus people are getting pissed seeing all of the Big Boys not have to play by the same rules). Uncertainty is the thing business hates the most. The $2,000 penalty per employee (over the first 50) is cheaper, and you can put it in a spreadsheet and know some moron is not going to think of something else to add to the required coverages and jack the next premium up another 15%.

      Having insurance tied to employment was the first major wrong turn in our long road to destroying the health care market, and it needs to have a stake pounded through its heart. Unfortunately for the progressives, they thought that would push people to a government controlled system, but it’s pushing them away in droves. That’s especially true among the young folks who are starting to become politically aware, and aware that the plan is to stiff them with a gazillion dollar tab after us baby boomers have dined and dashed on them.

      Your high deductible plan is the way to go, but the ACA loads the coverage requirements up so much, and then mandates coverage for pre-existing conditions so you end up with the worst of both worlds — higher premiums AND high deductibles.

      The Older Brother

      • Elle says:

        It’s gonna go away. Even for small businesses. We’ve got three full-time employees where I work. The CEO is covered by her husband’s insurance. The initial ACA-compatible plan our insurance company recommended dropped our dental, raised our deductible a few thousand, and raised the rates close by about 40%. After talking with the insurance company we got a plan that’s only ACA compliant because no one in our company has kids. We can keep our dental coverage and the rate is only raised 25%.

        The only reason the health plan is being kept is because our boss is a tenderheart and is willing to pay more so we don’t have to struggle to find health insurance on our own. But who knows what 2015 is going to bring in regards to this.


        Small businesses are the “canary in the coal mine” in our economy. I’ve been hearing from small, medium, and large business owners since it passed (so we could “find out what was in the bill”) that this was the endgame.

        It will be wrenching, but it’s needed for people to start taking responsibility for their own health again.. Change always is, and that’s why politicians won’t do it on purpose.

        I wish you the best of luck.

        The Older Brother

        • Lori says:

          Small businesses generally don’t offer good benefits anyway. I’m surprised a three-person business offers any benefits at all. At the large firm where I work, November was actually premium-free because employees had kept their claims down. Except for that, our insurance didn’t change at all.

          • Elle says:

            So I shouldn’t be upset by the awful changes to our plan, because most small business don’t offer health insurance? I’m kind of in a position right now where I can either take the hit personally (by the business not offering health insurance) or the business can take the hit (paying for significantly increased premiums) in our smaller-than-we’d-like profit margins. This situation pisses me off more than you can believe.

            And I’m glad you didn’t have to pay any premiums in November. Our plan was normal then too. It’s what happens on Jan 1st that’s the kick in the ass.

            Please, correct me if I’ve misunderstood your counterpoint.


            You should be extremely upset, along with the 6 million people who’ve already lost the insurance coverage they’d contracted for, and the 50 million who will be losing theirs over the next year, and all of the people who are figuring out that they’ll have to pay thousands in premiums and $4-12,000 out of pocket before they get a dime of coverage.

            I can absolutely believe how pissed off you and millions of other people are, and it’s only going to get worse. At which point, the only option is radical change. Obama has shown everyone who can see what the radical government-run option looks like. The free market is the other radical option.

            The Older Brother

  8. Chuck says:

    “If people suddenly find themselves actually footing the bill for their own poor lifestyle and diet decisions, I believe it will trigger a paradigm shift in how they view their food. Perhaps even a paradigm shift in how they view the people who have been telling them what to eat for the last couple of decades.”

    I think it is going to take a lot to undo the current beliefs of most people. My coworkers see the weight falling off of me after going low-carb. Many just can’t wrap their head around the idea, even though they see how well it works. I tell them to watch the movie, some have, but they don’t seem to get it. I had to laugh at one of them one day, she said she brought in some healthy snacks that day (she has been desperate to lose weight for a while). She then pulled out a Little Debbie Oatmeal Cream Pie (about 3″ diameter), and a Quaker Oats granola bar. The cream pie had about 50g of carbs and the granola bar had 30 some grams of carbs. I told her you might as well eat a candy bar. She said the doctor had told her that you can’t give up carbs and that you have to go by the nutritional info on the package, and you can stop when you get to 100% for the day. I asked – “Did you even watch the movie Fat Head?” She said she did. One of the guys always has candy at work, that day he had the bite sized Snickers. I read the nutritional info and told the lady with the “healthy” snacks, that she could have had five pieces of his candy and still had less carbs. I could see the light bulb go off in her head, but she still hasn’t got it. That is the kind of thinking we are up against.

    Most of my coworkers that are interested in losing weight and being healthier are female. The thought of giving up or severely restricting bread and grain products just scares the heck out of them and they dismiss the idea without even giving it a try. I don’t push or preach, but if they ask I tell them.


    One possible effect I could envision if insurance was allowed to move back to a free-market basis would be premium adjustments based on some relevant combination of A1C, triglyceride:HDL ratio, and maybe a couple of other inflammation/health markers. Kind of like they do now for smoking.

    Motivated people would then listen to their bodies if it didn’t jibe with what their Big Pharma sponsored doc said, and people who didn’t care woould be paying enough to offset the cost.

    Cheers

    • susan says:

      I fear that rather than the sensible markers you’ve proposed, the premium adjustments would be based on things like BMI, total cholesterol level, and how regularly you refill your statin prescription and report for the official guideline-mandated health screening procedures.


      That’s the point — if we’ve shoved the government out of the way, and restored insurance to its actual function, and it’s the insurance companies’ money on the line, they’re not going to care about “official” guidelines. They’re only going to care about what helps their bottom line.

      If you’re writing high deductible health insurance policies, you want people to behave in such a way that it reduces your exposure to things like diabetes, heart disease, cancer, etc. They’re not going to listen to the government — they’re going to listen to their actuaries.

      Under the ACA, insurance companies are fined if they don’t spend a minimum percentage of their total premiums on health claims. Let’s say it’s 80% and you’re an insurance company executive with a nice stock option deal. Do you want people to eat low-carb, healthy fat foods and maybe drop your claims by 20%. Hell no — you just got a 20% cut in pay, dude! You want people to eat hearthhealthywholegrains, avoid arterycloggingsaturatedfat, and take their statins like good little nazis. Then, when claims go up by $50 million, you can raise premiums $60 million, and maybe buy that new corporate jet.

      The power of a free market is no company has to wait for the government to pull its head out of its a** to try something its competition isn’t doing yet, and you only need to find one company that meets your needs. If it works, they kick butt for awhile while everyone else has to change to compete.

      Cheers

      • Walter Bushell says:

        I like that you got the RomBma Health care is a Fascist system no communist or Communistic. OTOH, the low fat, high carb diet is so entrenched that the suggestion is almost hypnotic in intensity, the though stopping, the slogans, the appeal to authority etcetera are very like the practices of the bad cults. Most of the insurance company execs are AFAIK firm believers in the dogma[1].

        Most people, you have to have noticed are walking around in what appears to be a hypnotic or somnolent state. If some authority was to tell them to kill all the blue eyed people they’d just do it. Well after some time and careful propaganda, for which we have very good models.

        The real problem is to recognize when we are in such a state and we are here because we managed to get ourselves free of the Government-Military-Industrial-Agricultural propaganda machine, to some degree. And hey, a high carb diet is likely to keep people in a dependent state. Hey, you or many people on such a diet have to eat every two hours and it doesn’t work. I remember losing jobs because I could not stay awake at my desk or even in meetings. Of course, they were accountants at a bank, so I suppose that could happen to anyone.

        OK, best to stop here before I start ranting. >;0

        [1] My karma ran over my dogma. Now my dogma’s dead and my karma is out of alignment.


        Man, I was hoping they’d start with brown eyed people first.

        Cheers

    • Kristin says:

      That would be fine with me as long as they used relevant information, such as the aforementioned TG/HDL or numbers of small dense LDL or some other marker of actual systemic inflammation. But they’ll do total cholesterol and total LDL I would predict. It is what my doctor bashes me with.


      Your doctor is too busy to pay attention, thinks he knows everything anyway, gets his information from pharmaceutical companies who buy him dinners and invite him to “conferences” in exotic locations. Plus being completely wrong doesn’t cost him anything — it helps drive repeat business.

      An insurance company operating in a free market with its own profits on the line will lose money if they weight premiums on criteria that aren’t actuarially sound.

      If they’re being guaranteed a profit, but it’s limited to a percentage of their total premiums, as is the case under Obamacare, insurance companies’ most profitable option is to have lots of people with chronic conditions with ongoing expenses.

      Cheers

    • Angelyne says:

      You seem to have lots of confidence in the free-market system, a system that brought about Big Pharma, Big Agri, Big CAFO, Big Food, ect. Yes, one could argue they are not true example of free-market because of subsidies, but even the absence of subsidies wouldn’t change the bottom-line. The free-market system is not designed to help people, it’s designed to make use of people for the benefit of a few.


      I doubt we can reconcile our conflict of visions, but Big Pharma, Big Ag, Big Food, et al, never could’ve evolved into their current form without government.

      Monsanto couldn’t persecute farmers whose fields get contaminated with GMO seed for theft of patented technology without the government. They got the government to see it their way and write the regs for them.

      The USDA decided that Big Food didn’t need to disclose that Pink Slime is treated with ammonia, and once it started to leak out, all of the food chains stopped buying it. Who would still buy that stuff? Well, the USDA of course — for the school lunch program.

      The free market system is absolutely designed to help people. The enforced right to say “no,” the ability to own your own labor and property without having someone else direct your actions, the ability to have contracts enforced under laws that apply equally, are the free market. Everything that makes the Bigs you mention (and admit aren’t free market, which perplexes me) evil and scary is the result of their ability to use the power of government to compel transactions, destroy competition, etc.

      Big Government is what makes Big Business possible, the free market is their common enemy, and the nearly universal tendency for people to conflate “business” with “the market” helps keep them both them metastasizing as the freedom recedes.

      Cheers

  9. Jessi Hance says:

    I’m not going to weigh in anti- or pro-Obamacare here. But I question this “magic” you think will happen as a result of people doing comparative shopping for their healthcare.

    The reason? It is extremely difficult, and sometimes impossible, to find out how much treatments, tests, etc. are going to cost you! I know this because I used to have insurance. It had a very high deductible, as has been more and more common. So I had to pay for just about everything out of pocket, in effect. I always refused visits, tests, treatments until I could find out at least an estimate of the cost. The providers would have me call somebody who would research for a few days, then get back to me. Sometimes the answer was “we just don’t know”!! You wait for the bill. You even pay the bill, and think you’re done. And then you get more bills for other itemized parts of your treatment or tests that you didn’t even know about.

    I fervently hope this situation changes. I hope Obamacare can make a difference in this respect. But I don’t think it will change without a real fight. Certainly not like “magic.”


    Oh no, the only difference Obamacare could make in this area is that it would get much worse. The collapse of Obamacare, however, which is progressing nicely, will radically alter it.

    I’ve been through the same thing you’re talking about — you ask how much some routine service you’re there for is going to cost, and they look at you like you’ve got a couple of extra heads and are speaking some non-terrestrial language. That’s because we’re just nuisances to them — their current systems are incapable of answering the question because 99% of the time the people they deal with are not their customers. The insurance companies are.

    But come the implosion of our grand experiment in Community Organizer-run health care, there are going to be millions of people who have to walk into the doctors office with their checkbook. And the first thing almost every one of them is going to ask is — “how much is this going to cost?”

    And then, after the medical providers’ staff have seen a few dozen or hundred patients turn around and walk out the door, they’ll suddenly start figuring out how much they can charge, and how much of a discount they’ll give you if you pay them right there.

    Up until that happens, they have no reason to be able to answer your question. As soon as it does happen, they’ll have no choice but to be able to answer your question. And then they will. As if by magic.

    Cheers

    • Carole W says:

      As someone who’s seen and talked to several doctors not covered by our insurance (and many others’ insurances), I can say The Older Brother seems to be correct here. The office staff know exactly how much things will cost, and gladly and without delay provide a range of costs depending on what the doctor might decide to test for or do for treatment. They also typically give a discount for cash pay…and, as a bonus, seem to treat people like individual people instead of acting like everyone should be exactly the same, and they take time to actually listen. Shocker. Of course, it does cost more than a $25 copay, but when none of the $25 copay docs can figure out how to help you, it’s worth paying more anyway.


      Exactly. You are now their customer, and being treated like one. With the traditional insurance model defining the market, the insurance company or government program is the customer.

      The Older Brother

  10. Dave, RN says:

    I’ve thought of this as well.

    Unfortunately, you are going on the premise that people will use common sense and change their diet and get healthy.

    No. They won’t.

    As an RN I see it all them time. An example would be those that still smoke through their stomachs. Get the picture?

    And I don’t think that it will drive down the cost of insurance either. The entire industry know that we must buy their product. Prices will increase. They already are. And lets face it, if my insurance goes away or is unaffordable, I will pay the little fee, er, I mean tax, and then get insurance should I need it. Because they cannot turn me down for my newly acquired pre-existing condition. Wow! I already love Obamacare!


    Since we have to either buy it as approved by Obama or go without, that works well for the industry at the moment, especially now that they’ve been given guarantees that they’ll get their profits. But this time, when the average American gets that letter in the mail from their insurance company or HR department, they know exactly who caused all of it.

    You are correct — if you don’t have a significant net worth or high income, there’s no reason to sign up for an Obamacare policy. They are severely limited in coverage, very expensive, and have higher deductibles than people are prepared to handle. Especially if you’re young, and even more especially if you still have a negative net worth due to student loans.

    As you allude to, if you get cancer or get hit by a bus, sign up afterwards (like I mentioned, wait until your house burns down, then have Obama build you a new one), and then declare bankruptcy if you’re still stuck with a big balance.

    If your income is fairly predictable, you should spend just a few minutes figuring out what your income tax will be for 2014, then make sure you’re not going to get a refund (aim for maybe having to send in a hundred bucks when you do your taxes). The IRS can only collect the “fee” by withholding it from a refund due.

    My point is that so many people are going to figure this out that the “death spiral” of only the sick signing up while everyone else opts out is almost a forgone conclusion.

    As for folks who smoke through their stomachs — not to be cruel, but our current health care system is what’s delaying natural selection from doing its job. That won’t last long. Common sense optional.

    Cheers

    • Walter Bushell says:

      Some pity a lot of people got where they are from believing the government advice. Weren’t we all there? I’m sure I have metabolic problems from following the government — big business approach. Ah, Snackwells, low fat, I ate several packs glaum, glaum, glaum, before I realized they did not satisfy after going through a whole pack, I was just as hungry as before, and Coke a Cola is certainly a low fat food. (Not really, excess carbs get stored as fat. I mean what else could they possibly be stored as?)

      I remember looking at a package of brown rice and thinking there’s no there there and still eating it for years. The suggestion is so strong, so repeated and ubiquitous and everywhere so authoritative.

      The wonder is that anyone breaks free. We start off as children with no defense at all and our parents and society is so much wiser than us that we have to take it in without question and when we get to school we are drinking from a firehose and have to absorb without background. Kids from darkest suburbia (Even in the 50s and 60s and I don’t think the situation has improved) can get through college with no life experience and one of my teacher friends tell me that kids in Manhattan from like what most of the country would consider rich families don’t know anything. In the ghettos they at least know how to play the dozens, I suppose.


      People, especially the younger folks, are starting to assume the government is lying. So I think we’re reaching a tipping point. Keep your fingers crossed.

      The Older Brother

    • Ed says:

      “If your income is fairly predictable, you should spend just a few minutes figuring out what your income tax will be for 2014, then make sure you’re not going to get a refund (aim for maybe having to send in a hundred bucks when you do your taxes). The IRS can only collect the “fee” by withholding it from a refund due.”

      True as of now, but if people actually start doing it his royal highness will just issue a proclamation(executive order) changing it. He has already demonstrated repeatedly that law or the Constitution mean nothing compared to his will. Our corrupt elected officials keep allowing him to do it. I doubt that a week goes by that Obama doesn’t commit an impeachable offense.

      Just read an article in Forbes about his latest illegal order. He now wants the insurance companies to cover those who don’t pay anyway, at their own expense. What are we talking about now? 5-8 million people? Right. That’s really going to happen.

      I have believed from day one that this whole program was deliberately designed to fail. Then they will come back and say “well, we tried reform and it didn’t work” then they will start to implement a single payor(Government) system.


      I think most folks will agree though that it failed WAY beyond their wildest dreams. Again, the beauty of this disaster is that people are actually being harmed in measurable ways in real time, and it’s blatantly obvious who is causing that pain.

      After the whole “keep your doctor –period!” fiasco, people are revoking the free pass to lie at will that Obama has enjoyed for the last five or more years. If he tries to decree a new tax collection strategy at this point, I can’t imagine anything less than massive tax non-compliance. If a couple of million people decide that they get to interpret the Constitution any way they want to, also, and refuse to send their returns in, it’s game over. I don’t think even Obama’s echo chamber and the main stream steno pool couldn’t figure that out.

      In the interest of staying fair and balanced, however, I hasten to point out that there wasn’t anything in the Constitution or Bill of Rights that prevented Bush, or Clinton before him, etc. from doing whatever the hell they wanted. It’s not a team thing, it’s simple acceleration.

      Cheers

  11. Darren says:

    Might want to check your spam filter. I wrote a long post quite a while ago and its nowhere to be found.

    FYI


    It’s still in the queue. Just taking care of some of the shorter ones so I can do it justice!

    The Older Brother

  12. Pierson says:

    So Jerry, would it be accurate to say that this plan will ‘help’ us to become more healthy, in much the same way that streets overflowing with critters and raw sewage helped us to become more sanitary?


    Only in the sense that once we were able to identify the critters and raw sewage as the source of our health problems , instead of “vapors” and “bad humors,” and we were then able to address them more efficiently.

    Much like people are receiving letters cancelling the insurance policies they were promised they would get to keep — PERIOD! — and realizing that the problem wasn’t their greedy bosses or the god-forsaken insurance companies, but the government that is decreeing what they have to buy.

    Of course, critters and raw sewage aren’t nearly as bad for you.

    Cheers!

  13. Mike says:

    You and I and Tom can probably afford the high deductible health insurance plans – but they are not going to work well for the lower income folks. Obama care is a major plan to bring health care to the lower income folks.

    Our biggest problem has always been the for-profit nature of our insurance and health care, and Obama care does not adequately address that cause. While Obama care is not perfect, it is a start, and it is going to evolve into a single payer system.

    Now about the raise of the minimum wage – you must be ok with people who work not making a living wage (or your are in denial about it). The facts are that many of those low paid workers make ends meet with government assistance. So how do you feel about “your money” (your tax payments) going to subsidize Walmart and mMcDonalds (if they would pay a living wage, we would not need to subsidize them). Are you OK with that? (Or would you be OK if those folks starved to death?).

    What about all the red state governors turning down medicaid expansion money? That is going to leave many people without medical care. They are probably working in restaurants preparing and serving your food – when they get sick. Are you OK with that?

    And don’t ignore the fact that your red state governors are turning “your money” away – you paid taxes to Washington, and Washington wants to return it to you for medicaid expansion. But like-minded people (like-minded like you) will do anything that they can to cause government to not succeed.

    Stick to the topic, loved your farm report – but your politics suck.


    Good grief. ALL of the Obamacare plan are high deductible. Unlike Tom’s plan that the ACA led his previous provider to drop, however, they also have high premiums. Did you see Tom’s earlier post? So Obamacare screws people with high premium, low deductible policies out of their coverage, and screws people with high deductible, low premium policies out of their coverage, then dictates everyone buy high deductible, high premium policies with almost no prescription coverage. You know, to help out the lower income folks. Seriously?

    I’m pretty sure the whole “single payer” play isn’t going to pan out. Not after 6 million people got letters yanking their coverage out from under them, then being told it’s for their own good, then directed to a HALF BILLION dollar website with no working parts and zero security, designed by people working for the smartest president in the history of the galaxy. That was just the first round of suckers. Next comes all of the small businesses in the middle of the year, and then the rest of the big guys who aren’t on the list of special interests whose exemptions last longer. Probably around 50 million plus folks right before the next election.

    The average American, who probably couldn’t name one of their senators, two Supreme Court Justices, and the Speaker of the House to save their own kids’ lives, is now paying very close attention. Because they just got a $5-$10,000 kick in ass, and a letter telling them who did it. So you’re thinking all of those folks are going to insist that the same morons who just destroyed any chance they had of avoiding financial devastation in the event of a major health issue take over the whole deal, huh? Because better that than some evil bastard actually make a profit by providing people with a valuable service at a reasonable price.

    I used to worry that people might just snooze through the whole single-payer scheme until it was all over, but Obama completely blew past even my low opinion of the government’s capacity. If he’d achieved just simple incompetence, he probably could’ve pulled it off.

    Ok, I’ll bite on the minimum wage thing. Are you in denial about the fact that waving a magic wand over someone doesn’t actually make the value of their labor some number that meets with your approval? That jobs don’t have some intrinsic requirement that generates value equal to whatever the current “living wage” has been inflated to? That in fact, if every job had to pay a living wage, then lots of jobs where people can get some experience would disappear.

    I assume you’ll provide your phone number so we can check with you for updates on the current definition of “living wage.” Obviously, McDonalds and Walmart don’t have a clue about the labor market. Which is why no one wants to work for them and they don’t have any customers.

    It’s too bad you don’t much faith in poor folks. I’m pretty sure that they’ll find a way to keep from starving to death if their government assistance dries up. They always have. Maybe they could call for help with their Obama phones?

    The governors (both red and blue) who took the bait on the medicaid deal will be swirling the drain in a few years. Of course, here in Illinois EVERYTHING will be swirling the drain in a few years, anyway, so it’s kind of moot.

    Here’s a suggestion for you though, to show I’m not a heartless SOB and am willing to try to help. How about you and Obama and Governor Quinn and everyone else who’s always whining about a “living wage” stop being such pussies? If it helps employment and drives jobs, let’s all put on our Big Boy pants and raise the minimum wage to $500 an hour!

    Hell, everyone working full time would be a MILLIONAIRE. I know, we’re supposed to hate millionaires, but I bet you’d get over it. Plus even if people only worked 20 hours a week because their greedy bastard boss didn’t want to pay health care, it wouldn’t matter because they’d still be making $10,000 a week!! Now that’s a freaking minimum wage.

    I know selfish pricks who don’t understand economics like me always try to weasel out of it by saying that “if you raise the minimum wage, people will lose jobs,” right? But who cares? If you’ve worked a couple of months, you’d get like $5,000 a week for unemployment! Plus, even if people did lose their jobs when they were making $500 an hour, it would be all right because they’re MILLIONAIRES, and we hate millionaires, so who cares if those turds lost their jobs, am I right?!

    C’mon, I’ve just bid $500 an hour. If you’re not willing to man up and join me, it’s your politics that suck.

    Cheers

    • Bret says:

      Mike has threatened to leave this blog before over Tom’s politics. His arrogance reminds me a lot of Obama’s. I told Tom he had better just shut the whole blog down if Mike is not going to read it anymore. At any rate, he is obviously still here, reading and commenting on the politics he so vehemently disapproves of.

      On a separate note, I find your opinions on the ACA fascinating (and to be clear, I am talking to the Older Brother, not Mike). Libertarians have by and large been so fiercely against this program that it is actually refreshing to see a different perspective. I had not heard the prediction that employer-provided health care would go extinct. That would certainly be a huge step in the right direction.

      With that said, I am not nearly as optimistic as you are that single payer will not transpire. By electing and then reelecting the Community Organizer, as you aptly called him, the American people as a whole have exhausted any confidence I had in their ability to comprehend the fairly straightforward, not especially difficult subject of economics. I am sad to say I can fully see the religiously anti-capitalist, in-love-with-their-own-ideas-in-spite-of-the-facts-and-simple-reality liberals (see above) convincing a big enough chunk of America to swallow the line, “The free market had its chance…this is proof that we need single payer.” Of course those of us who are in fact economically erudite (Jesus, I sure sound arrogant, but it’s the truth) know that an industry in which 60% of the money is spent by government is anything BUT free market. But other folks don’t seem to…they whine a lot, in an utterly embarrassing display of economic ignorance, about the profit motive (again, see above).

      Certainly I hope that your predictions come true. But I would be lying if I said I was optimistic.


      I don’t mind Mike’s tone. I know that sometimes I can inadvertently come across sounding more snarky than I really intend. The rest of the time, of course, I’m doing it on purpose. A little rough and tumble keeps it interesting. It’s just the idiots who think they’re making some kind of statement with just straight invective and no point that we tire of quickly.

      The point I’m trying to emphasize is that this doesn’t require the average American to stop worrying more about their job and their kids and then steeping themselves in libertarian philosophy. All they have to do is react to pain and disincentives. It’s the socialists who think we can just educate people into doing the right thing. Over half of Americans now consider Obama a liar, and that’s bound directly to the idea of government running health care.

      I’m about as hopeful as I’ve been. The odds are certainly way better than hoping the Republicans will do something right.

      The Older Brother

      • Bret says:

        Well, those are good points. Even though I am still a bit skeptical, your optimism is truly inspiring. Keeping my fingers crossed.

    • Walter Bushell says:

      Obarom health care is *not* single payer. Each insurance company has their own staff of claim deniers and doctors have to fill out different forms for each and deal with different breauarcracies and policies. And the insurance companies have no long term interests as people will move or be moved between them.

      Just wonderful.

      Merry Feast of the Undefeated Sun to all. Those in the Southern Hemisphere happy whatever seasonal holiday you have, for you it’s neigh unto summer.


      It’s not, but I think it’s pretty well a given that the plan was for it to be a bridge to single-payer. Obama just hadn’t planned on the bridge collapsing catastrophically before it was completed.

      Cheers

    • lurkerman says:

      MIkey,

      It is not the government’s job to provide any form of healthcare, period.

      If you truly cared about the poor, you would create private organizations to help them, and donate your time and money to charities completely. But you do not; instead you demand that other people do it for you so that you can feel good.

      In short, you are a bully who cares about nothing more than forcing other to do what you say. But you are a weak bully.

    • Pierson says:

      ^This, all the way. Granted, money would eventually become useless because of the ridiculous amounts of inflation needed to actually raise minimum wage indefinitely, but who cares? Hell, post WWI Germany did just fine, so why not?


      Yes, other than destroying their economy, aggrieving its citizens, and directly planting the seeds for the rise of Hitler and World War II, it worked out pretty good. I mean, we got the VW Beetle out of the deal.

      What could possibly go wrong?

      Cheers!

  14. Nate says:

    Give Mike a little credit, Jerry. Your politics – or rather, your economics – do suck. It sucks to be the one to tell people that healthcare is a commodity that must be produced in order to be consumed, and that providing more of it to more people costs more money. It sucks to be the one to have to explain that a finite payroll can hire X number of employees at $7.50 per hour, and only X/2 employees at $15 per hour.

    It’s what Bill Whittle calls “The Hammer of Reality”: http://tinyurl.com/lq5q3r8

    Incidentally, Bill also gives a pretty good explanation of why we suck: http://tinyurl.com/74vnacb

    Yeah, I guess when you look at it that way, I really do suck. Nice links, BTW.

    Cheers!

  15. lurkerman says:

    So an anti-left version of the Dunning-Kruger Effect?


    Not sure if you’re referring to me or the left. But I suppose it could go either way, no?

    Hmmm, would my recognizing that possibility lower the odds that I’m susceptible?

    Cheers

  16. lurkerman says:

    Excuse me, I meant the Cloward-Piven strategy. The Dunning-Krueger effect is what happens to the left inside their echo chamber.


    Oh ho! Yes, I believe I referenced Cloward Piven in one of my comments. I thought maybe you felt that I was wrong on my analysis, but not smart enough to know that I could be overrating my ability, which, as I said, has to be recognized as a possibility!

    The Older Brother

    • lurkerman says:

      Is it Cloward-Piven or Cloward Piven? I never can get it right.

      To Hyphenate or not hyphenate…that is the question.


      Seems most of the Google results were hyphenated, as in the Cloward-Piven strategy. So far, it’s working out like hearthealthywholegrains.

      Cheers

  17. Marla says:

    What I never see discussed is the big lie about health care costs. I have had a high deductible health insurance plan by which I had to pay all bills up until I spent $10,000. annually. I also have a chronic health condition, so I use a fair amount of doctor and lab time. My insurance company would always “reprice” the charges that the doctors/labs would invoice, and I would pay the repriced amount. For example, a routine lab test was billed at $1874.00. It was repriced at $151.95; the amount that I paid. There was no other payment made by anyone to the lab. Thyroid labs: $400. repriced to $26.51.
    I had a surgery that was billed in the $30,000. range; I paid in the high $7,000s total for surgeon, assistant, anesthesiologist, hospital, nurses, meds, etc.
    The surgeon grossed $1200. for the surgery and follow-up.
    My point is that the propaganda machine has been working overtime with regards to the cost of healthcare. The overall, total costs published that our country spends is based on this bogus, false billed amount that has probably come about for tax purposes ( loss write-offs). An amount that no one actually pays, unless they are ignorant and uninsured.

    • Cameron Baum says:

      Philip DeFranco on YouTube had a segment on it, because he had a bill, baulked at it, then did research. The charges change from state to state.

      I feel that the crux to all this is drug patents. Once statins run out, and they are, then something will come along to replace it. Which it has. An is eye watering i. Price, needs to be injected,needs steroids, one other pill and paracetemol to work.

      Imagine all the people out of pocket questioning THAT. And once people realise the true rip-off nature of drugs, then the Big Pharma gravy train will get derailed. Once it happens, they can’t con people again.

      I also see the population of the world sharply declining in twenty years. Because the baby boomers are now becoming pensioners. This means that they will be more dependent, and the system will not handle them. Mass death is inevitable. Everyone dies, so


      Demographics are indeed destiny.

      Cheers

      • Cameron Baum says:

        Something that people forget when talking population figures. In the end, it is wise to avoid insurance, if I’m right. But I’m in the UK, so not clued up about these things….

        And sorry for the mangled message, replied on my phone. Always great to cause confusion…


        I figured. Edited it the best I could, but couldn’t decipher a couple…

        The Older Brother

  18. James H. says:

    There are complaints that discovering the actual cost of a medical procedure is difficult. I guarantee that when Obamacare does collapse, if a free market does actually take over the costs will be far, far easier to find. Hell, the costs would probably be listed much like a restaurant’s menu posted at the front door.

    Of course, the advocates of the “free” medical care offered by socialized medicine are not smart enough to recognize the benefits of capitalism and their numbers increase every year.


    True story –

    In the late 80′s, after the government ended AT&T’s monopoly (good) and a federal judge decided how many companies to break it up into (stupid), I had an engineer who’d been with the company for decades come into our Manpower office. The Baby Bells were giving very nice early retirement packages out, and Manpower was just getting into higher-level, technical staffing.

    He was very sharp, and unlike many engineers I’ve met, was also very savvy about finance and operations. At one point, he said “the company has no idea what it cost to make a phone.”

    I was initially thunderstruck, but he explained that up until they lost their monopoly, the company’s profits were completely regulated — their rates were approved by the government, to guarantee a certain profit margin above their costs. (Utility providers also operated under that model.) Given that, not only would the cost and effort of gathering financial information in a way that would allow them to determine their unit cost been a pointless exercise, it could’ve been used against them when they were asking for rate increases. All of the incentives pointed towards raising costs as much as could be justified to a handful of regulators.

    Once people were given permission by our government to walk into Radio Shack and buy a phone for 20 bucks, the entire system exploded in favor of us consumers who’d been “protected” for the last eight decades. Goodbye, government decreed services; hello faxes, internet, cell phones, etc.

    The Older Brother

  19. Angelyne says:

    I don’t have a dog in this fight, being Canadian and all, but it seems to me that the previous “disease care” system was broken. and left millions of people with no health care. But, from my limited knowledge of the matter, there are serious drawbacks with Obamacare.

    What are the alternatives ? Status quo doesn’t seem to be much of a solution, except for the people who are happy with it. Has anyone come up with a decent alternative that would work?


    There is a long history of the demise of what used to be a free market health care system in America and the morphing of a true insurance concept into a (generally) employment-based, third party administered, pre-paid medical model.

    It started in the late 30′s, and took a major leap as a result of post WWII wage controls (tying “free” health insurance to employment as an alternative to wage increases). The introduction of Medicaid inserted the government into what had previously been charity care provided as part of most hospitals’ mission, and Medicare turned everyone over 65 into government welfare recipients.

    This is of particular importance as the entire baby boom generation, and its tremendous demographic momentum, ages into the system with historically low savings and an attitude of absolute entitlement.

    So the status quo has been slogging towards this point for decades. The fact that the ACA pulled so much of this trajectory into such a compressed time frame — literally jumping almost all of the rest of the way to a government run system over several months — has made the effects traceable to their causes, for a change.

    The alternative would be people making their own decisions in a marketplace with health care providers and insurers competing without government picking winners and losers. Obama has made that at least a viable alternative.

    Cheers

  20. Elenor says:

    Hey Older Bro’,

    Lovely coupla blog entries! However, you wrote somewhere above:
    “people to start taking responsibility for their own health again…”

    I say: not gonna happen. You’ve got the economics of it right, but not the medicine! People, generally, are (seemingly, I could just be way way jaundiced — do I need insurance for that?) just not SMART enough to manage their own health care! I just had a chat with an 87-yr-old SMART engineer (still working as a consultant!), who is having a problem with swelling in his legs. I was telling him a bit about statins and diet and and and … you know, proselytizing … and he didn’t even know if one of the many pills he’s taking even IS a statin! I have a “medical” background (was medical affairs director for an ambulance corps) and enjoy learning more… but that vast majority of SMART people can’t figure out how to manage (or even understand!) their own medical situations. If their doctor gives them advice (with a price), on what possible basis can they decide whether or not to TAKE that advice? TO spend that money of their own?

    I think it’s going to be a slow and horrific version of an absolute blood bath!

    I didn’t HAVE any insurance to lose — and my cheapest version of CommieCare will cost me $11k a year (premiums and deductible), which means it would not have paid one *red* dime toward my kidney stone diagnosis last year. (Diagnosis only, NOT treatment: the $8k it cost for a night in the ER, an MRI, and (thankfully!) strong pain meds — with a scrip for ‘take-at-home’ strong pain meds!). Couldn’t afford the diagnosis OR any follow-on treatment! Suffered, took pain meds, till I passed the damned thing a week later!

    Yes, of course, I’m going to pay the penalty — with the added “‘bama-benefit” that, as a small biz owner, I don’t pay 1% of what I *paid myself* out of the company, but I have to pay a penalty on the 1% of my meager salary (bad economy, eh?) PLUS the 1% of ALL the profit my small manufacturing co. made, whether or not I could pull that money out of the company without destroying it (couldn’t, obviously!). (Imagine that, a small AMERICAN manufacturing company — ever seen one? {eye roll})

    Would you expect your average ghetto dweller with four kids with five different fathers to have ANY chance in hell of figuring out how to work the medical system — whether or NOT she can get a list of the prices of the most likely care options she/they will need? (And if I WERE a doctor? I’d be finding a new field!)


    Under the current system, your engineer friend never had any reason to ask the questions he would before even building a tree house. It didn’t matter. You go to the doctor, they tell give you a prescription, and you take the meds. It was all “free” anyway, so why worry? After 40 or 50 years of that “working” for him, change doesn’t come easy. I think a 27 or 37 year old’s worldview will change more readily — they’re still vested.

    Once people are paying for their non-catastrophic health care, they will naturally start asking all kinds of questions, and even uninterested people will enjoy the benefit, just like everything else in the market. Subjecting everyone to the marketplace will also drive those prices down, with providers being aware that the people walking in the door are now price sensitive; but will also actually pay for the services, instead of waiting for a payment to loop through the insurance system for a few months while the insurance company collects interest, or getting 15 cents on the dollar from the government systems.

    With millions being added to the Medicaid/welfare rolls, nothing will change in that system, but there’s nothing we can do about that until the rest of the system collapses, which Obama is speeding along with the help of both Democrats and Republicans. Gotta love that bipartisan feeling.

    The Older Brother

    I’m counting on this being FAST and horrific

  21. Kirk says:

    Thank you for this post. It’s the first one I’ve seen where a person opposed to the ACA predicts how it will fail during 2014. Many on the right have expressed their displeasure, but nobody I have read has explained how it will collapse. If I’m reading correctly, the prediction is that most businesses will revoke company-provided insurance. This is not just a few mom-and-pop businesses; the prediction is 50 to 70 million workers currently covered by company insurance will have that insurance dropped.

    If that happens, yes, there would be Unintended Consequences.

    I am curious if you have read others who have made specific predictions like this one, preferably with a timeframe. Examples could include X percentage more doctors refusing to accept insurance, or Y number of doctors taking early retirement (above current levels). Any measurable number would meet the criteria. Anecdotes are fun to read but numbers tell the hard and true story.

    If so, I would appreciate the links to those predictions.

    As for my personal perspective, I have no opinion, other than that I’m glad that some politicians finally got around to attempting to address runaway health costs. If ACA fails, it fails, and something else will be attempted. I can’t just listen to Republican politicians shout at me that the ACA is a failure. I need to see what numbers will demonstrate the proof.

    By the way, I’m retired from a corporate job. My corporation implemented high deductibles many years ago. Family plan, about 400/month, 2500 deductible, 8400 out-of-pocket maximum. Using healthcare.gov and the salary I used to earn, if I bought via the exchange my insurance costs would be 1400 a month (the deductible and max are not that different). Ouch. That would be a $12,000 yearly hit. And the corporation would have to pay the $2,000 penalty. So that would be a huge hit to employee retention. One of the reasons people stayed there was the medical plan.


    Here’s a prediction from Obama (from government analysis published in the Federal Register — in 2010!)…

    “The Departments’ mid-range estimate is that 66 percent of small employer plans and 45 percent of large employer plans will relinquish their grandfather status by the end of 2013,” wrote the administration on page 34,552 of the Register. All in all, more than half of employer-sponsored plans will lose their “grandfather status” and become illegal. According to the Congressional Budget Office, 156 million Americans—more than half the population—was covered by employer-sponsored insurance in 2013.

    Another 25 million people, according to the CBO, have “nongroup and other” forms of insurance; that is to say, they participate in the market for individually-purchased insurance. In this market, the administration projected that “40 to 67 percent” of individually-purchased plans would lose their Obamacare-sanctioned “grandfather status” and become illegal, solely due to the fact that there is a high turnover of participants and insurance arrangements in this market.

    …so, the intention of the law was to force everyone off their current plans — which Obama lied about repeatedly and intentionally, and which the media remained stone cold silent about, dismissing anyone who pointed it out. The 2013 date became 2014 when Obama unilaterally decided to not enforce the law on corporations for a year.

    As for other predictions, that’s the thing about Unintended Consequences — libertarians/Austrian Economics types know that beyond general economic tendencies, the more certain and precise a projection is, the more likely it will be wrong. There’s already reports of 40% or more of physicians stating that they will refuse to accept patients under ACA plans (with just over 20% saying they will), and insurers in California are reporting a 70% refusal rate by physicians. There’s also many hospitals, many of the ones with recognized, world-class programs, that have either opted out or have maybe one insurer that has contracted with them. The number of doctors that are signing up is so constricted that people who have, say, a GP and a Pediatrician that they like, or need speclialists for things like cancer, diabetic care, etc. find that no plan available lets them retain the same tream

    Republicans would be stupid to do anything other than stand aside and let the Democrats drown. For one thing, if they even lift a finger to help Obamacare be 1% less of a disaster, they will be given 100% of the blame from that moment forward by Obama and the press. So, you can probably count on them doing it pretty soon.

    Republicans talked over and over during the last two election cycles of things that would improve health care — like eliminating state-based cartels by allowing people to buy across state lines, tort reform, etc. So Obama kept saying that the Republicans didn’t have any solutions to offer. So the media kept reporting that the Republicans didn’t have any solutions to offer.

    At this point, only hard decisions will work, which is an other reason Republicans would be stupid to get involved. That’s moot anyway, as neither side of our bipartisan ruling class is capable of a hard decision.

    Cheers

  22. Kirk says:

    Yes, but “The Departments’ mid-range estimate is that 66 percent of small employer plans and 45 percent of large employer plans will relinquish their grandfather status by the end of 2013,” does not necessarily mean that millions of people previously covered by company insurance will be wandering the land uninsured. It means the insurance coverage will be modified to meet ACA minimum requirements. If that modification results in premiums so high that people choose to go without, or, alternatively, if the companies choose not to offer insurance, then yes, that’s an ACA failure. But change by itself is not a failure. Businesses have been changing their medical coverage for decades.

    Same applies to the 25 million people in the “nongroup and other” market. Many had poor coverage. I ran across a blog post by a guy who isn’t political. He had 6-month crap insurance because he was 40 with a pre-existing condition of apnea. He was thrilled to get decent insurance under the ACA, considered the price reasonable, and was encouraging his readers to do the same. I tell this anecdote only to refute the assumption than any change from current insurance must by definition be unwelcome.

    Thank you for taking time to reply. I assume you read other political sources than I do (I stick to The American Conservative and DailyKos) so if you come across anybody on the right who articulates what ACA failure looks like in measurable quantities, I’d appreciate if you’d append the link as a comment.


    The ACA compliant policies are pretty much universally higher premium and/or higher deductible than legacy policies people had. There’s no economic mystery to this. By mandating all kinds of new coverages for everyone, regardless of what they’d prefer to insure for, and then making it a requirement that the policies be issued regardless of pre-existing conditions, there’s no way they wouldn’t be more expensive for most people.

    People with pre-existing conditions naturally find the premiums much more affordable than what they’d had available before. As I hoped to illustrate in my post, they aren’t getting insurance, they’re getting welfare. They’re being allowed to buy a policy after their house has burnt down. It’s all of the other people who are footing the bill, and now many of them are going to be making rational decisions about why they shouldn’t decline coverage until their house has smoke pouring out of the upper story windows.

    Cheers

  23. Walter Bushell says:

    Blime mate! How did the Republicans let a tax increase of that magnitude slip by them? Oh, well it may be revenue neutral, except for the amount the sick care insurance industry siphons off.

    The penalty of no insurance is a straight tax, however.


    The Dems pushed the whole thing through without a single GOP vote while they had 60 votes in the Senate — that lasted about 15 minutes. As to being revenue neutral, one of the big selling points was that it would cost less than $1 trillion over the first decade. That started skyrocketing upward as soon as it was passed.

    The tax “penalty,” for anyone even only slightly motivated, can be completely avoided by making sure they don’t have their federal income taxes withheld in such a way that they have a refund due. That’s the only collection mechanism the IRS has at its disposal.

    Cheers

    • Walter Bushell says:

      They *will* find a way around the no refund due loophole.


      If people start getting harassed or having their wages garnished over the “penalty” when that is clearly not not only a mechanism defined in the law, but stated that it can only be collected via refund reduction, I think we could pretty well count on a true insurrection.

      Besides, our politicians are absolutely not in the business of making people actually pay for the stuff they get.

      The Older Brother

  24. CFB says:

    A few comments on this since I can intertwine the movie with the health care issue. Just saw the movie Fat Head yesterday and it really resonated with me. Probably because I went through the same sort of thought and independent research process and came to the same conclusions.

    Six years ago I suffered a serious set of injuries while working on my house…was stuccoing it and the scaffolding was improperly installed and shifted, dumping me off, then part of it fell on me. Prior to the accident I’d been trying to drop ~15lbs doing what the doctor told me. Eating lots of grains and juice, avoiding fats and meats and so forth and working out like crazy. But I kept gaining a few pounds every year. Made me nuts.

    After I got hurt I couldn’t walk well for about six months and for around 3 years being on my feet more than an hour a day was very painful. I was in pain and depressed. I quickly gained another 25 pounds and then kept packing it on until I was about 70lbs over what would be a good weight for me.

    My blood sugar and blood pressure kept increasing and my doctor put me on ‘prediabetes’ and ‘prehypertension’ meds. I complained that they made me feel tired and sluggish all the time. He said I’d adapt to it. But I never did. I ended up sitting in a chair in the corner of the livingroom getting fatter and sicker. I probably had an expected life span of about 5 years if I remained on the same trajectory.

    A somewhat fortunate accident then occurred. My doctor gave me a new blood pressure medication and I thought it was to replace the one I was taking but he had intended for me to take both. As soon as I dropped the old med, my metabolism took off and I had energy. I dropped almost ten pounds quite quickly but still had pain issues. So I worked harder to deal with those and kept moving, and while I did that I researched foods. It made no sense to me that I’d dropped all the white sugar and flour items, cut my calories, juiced my brains out, and loaded up on whole grains and vegetables and still struggled to lose weight, felt tired and depressed all the time, etc.

    Once I came to the same conclusion as you did, that fat and meat weren’t the enemies and almost everything I was told to eat wasn’t that good for me, I changed to a ~1700 calorie per day diet of meat, eggs, greens, berries and mostly avoided things that grow underground.

    As I kept working to manage my pain, keep moving and eat differently, I got results. I ended up losing almost 100lbs, my blood sugar and blood pressure dropped, and my lipid panels improved so significantly that my LDL was only one point above the safe minimum level. I put a couple of pounds back on because I thought I could hear the wind blowing through me at times, but I’m still within a very good weight range and have had no problems maintaining it for over 2 years.

    So aside from inadvertently and independently confirming your dietary discoveries, I also discovered that in some cases, the ‘preventative’ medicines cause way more problems than they may solve. I later found high quality, long term studies that showed that people on the medications I was on enjoyed no longer life spans or fewer health problems than a control group with the same issues that didn’t take the medications. So they spun the blood sugar and blood pressure knobs but didn’t actually improve health. Since then I’ve seen other studies on statins that produced the same results. Lots of side effects, no improvements on lifespan or heart events.

    Lastly, I ran across the insurance problem. While I was overweight and had my ‘pre’ conditions, I found that my health care provider had reported me into a central database of pre-existing conditions as having diabetes and high blood pressure, even though my test results didn’t even meet the minimum criteria of the AHA and ADA for pre-hypertension and pre-diabetes. As it turns out, getting a health care provider to remove these things is pretty much impossible. You have to get a bunch of doctors to admit they made a mistake, then get the hospital and insurance company to agree with that. There is no benefit to doing that for the doctors or insurance company, and it puts them in a bad position for a law suit. So they stick to their guns and if you want it changed, you have to line up some lawyers and spend a lot of money.

    Good news is I was covered on my wife’s group policy. Bad news is the marriage was no good and I hated every day of it. But I knew because of the pre-existing conditions I never actually had and despite current excellent health, I wouldn’t be able to get any sort of health insurance without a job and the associated group policy. As a stay at home dad for 12 years and in my 50′s and with a young son, the odds of getting a job in the technology field I’d previously been in and making enough money to overcome the costs of day care and doing all the things I do every day to take care of my properties was pretty low. So I stayed in the marriage because my options were limited.

    But that did eventually come to an end, and of course every insurance company declined to cover me when I tried to get individual health care. I did manage to get on the phone with someone at the same insurance company I’d had under my ex-wifes plan, and after going through the test results they agreed to cover me under a very high deductible plan with almost no coverage except for extreme disasters at a cost of >$500 a month. Way more than I could afford. Similar policies from people who refused to cover me would have been closer to $200-250. And it had so many pieces of fine print, I’m pretty sure they’d have found a loophole to deny paying on anything of significance that ever happened to me.

    Enter the ACA. And yes, we’d have been better off just extending Medicare to everyone and cutting out the insurance companies, but they seem to like their huge downtown buildings and expensive furniture and our politicians would rather do the right thing for the people shoving money into their pockets than their constituencies. Its a system with plenty of warts, made worse by half the politicians and people in the country fighting it tooth and nail instead of supporting it, then complaining when it inevitably as problems associated with a lack of support came about.

    The good news is that my state implemented their own exchange, it worked beautifully, I had a boatload of choices from the same companies that earlier refused me, and I ended up with a far better policy for far less money. It doesn’t have a high deductible ($500). It covers almost everything I’d ever need @87% after that. It costs $120/mo after subsidies. I couldn’t be refused for conditions I never really had and no longer was close to having. So I’m no longer having to choose between things like food or heat vs making my insurance payment.

    Health care isn’t like homeowners insurance. You can take plenty of precautions against your home burning down and the odds of it being crashed into by an airplane are pretty low. You can’t take quite as many precautions against getting cancer, having an uninsured motorist crash into your car and crushing you or a drunk driver jumping the curb and running you over. People get injured and sick all the time, even healthy people who eat well and live cautiously.

    Health care is like roads and a free public education for everyone. We contribute as a society for the greater good of the society. I know a lot of people who have never owned a car but pay for the highway system. I paid into public education for almost 30 years before having a child.

    The real problem with the comparison is that if my neighbors house burns down, the guy who rebuilds it isn’t going to charge me twice as much for doing work on my house, yet that’s what happens when someone goes to the hospital or a doctor and doesn’t pay. We bear the costs one way or the other, and the costs of fixing a person after they’re broken is a lot higher than the preventative care.

    We like being able to make a choice, but lets be real…most people aren’t that excited about the consequences that go with those choices. I’m 99% sure that a person without means who chooses no insurance or a high deductible policy that gets in a car accident or develops cancer won’t choose treatment options that fit their wallet, they’re going to go to the emergency room, get care, and dump the bill on everyone else.

    I know this is a ways back, but used to be that a majority of people ‘chose’ not to wear seatbelts until the insurance companies forced it as a law. Some states rebelled and didn’t require seatbelts, and the insurers just raised the rates in those states, and people sure didn’t like that, so on went the seat belts and down went the rates of serious injuries in car accidents. Morale of the story: sometimes someone has to tell people to do what’s right for them, even though it grates on a lot of people.

    There *is* a reason why you’re required to have auto coverage on your car and homeowners insurance on your home. Because a fair number of people would choose the stupid option of little or no coverage, the inevitable would happen, and they wouldn’t or couldn’t stand behind the consequences of that choice.

    So yep, the ACA is a dumbass compromise system that lots of diverse people came to agree on that incorporates the current system of insurers. Its a bad system, it’ll have warts and lots of unintended consequences. Maybe on the next go round we’ll do the same thing that most other countries have done and just extend medicare to everyone and go to a single payer system that gives basic necessary coverage and is paid out of the tax pool just like every other basic service like roads, education, etc.


    Whew! Well, I’ll keep this short as we probably won’t agree anyway (plus I think I finally found someone who can use up more of the internet than me). Without elaborating, here’s points where we disagree:

    I’m a libertarian. I don’t think roads and schools should be free, either. People got around and kids got educated way before government jumped in and convinced everyone that it couldn’t be done without them. And way better.

    Do you really think that Medicare and Medicaid don’t have huge downtown buildings and expensive furniture?

    Keep in mind that when we talk about the insurance industry, we’re talking about a creature that has been evolving in reaction to over 60 years of government interference and meddling. It’s not evil because it’s in the free market — it’s evil because it isn’t.

    I realize your health probably isn’t accurately reflected in the standards the insurance industry uses. Again, those standards are dictated to them, or more accurately, they’re dictating them to themselves via their ownership of the regulatory agencies. This helps prevent competition.

    Given the standards in place, your house has smoke wisping from the upper story windows, a large tree leaning dangerously across the roof and making groaning noises, and a pit bull with foam at the mouth barking in the garage. You are not being insured. You are being subsidized. I’m not saying you shouldn’t do it — you should. But it’s not insurance.

    One hears constantly of people not leaving a job because of insurance concerns, but yours is the first (but I’m certain not incredibly rare) instance I’ve heard of not leaving a marriage to not leave insurance behind. I’m sorry, but I found that a bit amusing, mainly for the refreshing honesty of it! It’s too late now, but didn’t you have a COBRA option for 18 months?

    Finally, congratulations on your greatly improved health. I’m serious when I say that one of the main benefits of the Obamacare fiasco is that people will be forced to follow the path you did and start asking what they need to do to get better instead of just getting another prescription for each successive symptom or side effect.

    Cheers!

  25. pam says:

    my problem w/ health insurance is

    it covers too much & not enough.

    too much of the little stuff
    not enough for the big stuff

    so what does one do with health insurance now if not covered by an employer?
    i have recently heard of “health share” from Sarah the Healthy Home Economist.
    sounds interesting. i may check it out.

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