Obamacare implosion

I am not surprised that your indigenous populations are having severe problems coping with modern civilization. I would refer you to the "10,000 Year Leap" by David Cochran. Aboriginies have not had millennia to evolve genetic adaptations to grains, dairy products and alcohol that Europeans and most Asians have. There seems to be subtle cognitiveadaptations that allow people to exist in hierchial societies.

Some American Indians continue to suffer from the same problems in the US. I vividly recall some interesting interactions with some of the students from the Apache and Hopi Indian reservations. The two peoples were very distinct in appearance as well as behavior and not entirely at peace with each other. Governor Palin's book had interesting revelations about Todd's experiences with his relatives.

All of this aside, African Americans as a group have a very unique set of physical pathologies and more importantly behavior pathologies. The behavior issues are mostly a recent development. By many metrics, Martin Luther King's dream has become a nightmare.

Daryl wrote:Spacekiwi said "Yes we dont cover as much of the advanced stuff as the Americans do due to population size, but for that which we dont cover, people often head over to australia which has the population base to support it, which has an average lifespan of 82, despite having treated the aboriginal population worse than the US treated black people.

So we spend a lot less on healthcare per person than the US does, and have it done by an inefficient government body, yet still have healthcare good enough to have an average life expectancy around 3 to 4 years longer than the US. So our socialised medicine systems are cheaper than the capitalistic US system, yet according to the WHO, Australia has a better performing healthcare, and NZ an almost equal performing healthcare system, despite NZ and Australia spending around half as much as the US as a percentage of GDP."

Fully agree with the information and sentiment expressed. I unfortunately have to add that our own indigenous population of Aboriginal and Torres Strait Islanders only makes up 2% of our population, yet their overall life expectancy is so bad that if we only count the non indigenous population our life expectancy ranking goes from 3 to 5 (fluctuating by year and reporter) up to a clear world leader. Why? Some is similar to what Namelessfly says, they are targeted by fast food and alcohol companies, some is generationally entrenched poverty, and some is genetic in that overall they have a greater chance of suffering type 2 diabetes and alcoholism (we Europeans had done our culling of those tendencies over the past few hundred years). Our national shame, but not easy to fix quickly.

We have some restrictions on free funding of the most expensive treatments, plus our free basic cover makes you wait for surgery on non fatal problems. We do have an efficient second tier that many are in, costs my wife and I $250 a month for us both to have top treatment.
As to euthanasia my paternal grandfather had pneumonia at 96 that was not aggressively treated, and more recently my father in law was let slip away with palliative care.
From the published literature I believe that given enough money we can access similar expensive cutting edge treatment as is available for some in the US.

biochem wrote:Canada is what most Americans have personal experience with since it is our next door neighbor. So when you read news stories etc referring to socialized medicine in 9out of 10, it is the Canadian system being referred to. So when thinking of the US perspective it tends to be the US system vs Canada, not the US vs Australia or the US vs Sweden.

The Canadian system has notoriously long waiting lists for just about everything except primary care. Every Canadian person that I personally know has been put on a waiting list for something at some point. If you are in reasonably good health and don't need complex or timely treatment it works OK eventually. If you need complex, expensive treatment delivered in a timely fashion... start praying. People meeting that description routinely die on waiting lists. The rich pay out of pocket for timely treatment in the USA.

That´s pretty much just making a mountain out of a molehill.

Waiting lists are as much of a tool as anything else, they´re there so that healthcare doesn´t have to have MUCH more capacity in total than is normally needed.

It´s very easy to make it sound oh so very ominous and sinister, but in reality, most of it isn´t.

Sweden is a bit infamous for waiting lists, but if i take a look at my immediate surroundings?

When i needed surgery after an emergency visit to the hospital, got it in about 2 weeks, and the doctor at the emergency was prepared to do it then and there if i wanted him to, but he recommended that i take other treatment first as otherwise the surgery might not do all that much good. And the one eventually doing it was one of the best you can find literally anywhere, with that specific operation.
Amusingly, with my regular doc and 3 students there to learn how to do the same procedure.

Dad, less than 1 week, but that was acute as followup to the emergency surgery done right away after a nasty fall. Complicated stuff that in USA would likely have cost insanely much as it required repeated surgery several times over more than a year before it was done.

Mom, on the list for a few months, but was also NOT acute.


So, beware what you are told.

PeterZ wrote:Part of what makes Americans so different from the rest of the world is a different national/cultural tradition. Most of the world developed from the idea that the state was sovereign and the state granted privileges to its subjects. The nature of the state has changed from absolute monarchs to elected parliaments. Yet sovereignty or the ultimate authority has always resided in the state.

The US tradition is different. Sovereignty or the absolute authority resides in the individual citizen. We the people lend that authority to agents that act on our behalf. The amount and nature of the authority lent is defined by our Constitution.

The question of socialism is approached and viewed differently depending on which tradition your PoV has been shaped by. To the American PoV socialism or asserting public ownership of certain enterprises and activities means giving up more authority/sovereignty to our agents in government. To most of the world with that other tradition, socialism secures a greater share of privilege from the sovereign state.

I am sure that many will disagree with my quick analysis. Yet, if one understands the American prism described reflects the PoV of a great many Americans both liberal and conservative, any discussions will be more productive.

You keep telling yourself that.

But i would suggest you read up a bit on history. You seem to have missed rather big chunks of it.

Still no cogent response?

Still no cogent response?

OK I'll take a stab at some of it.

And hopefully, this will eventually happen because of "Obamacare". Think about what would have happened if someone didn´t push something through?

Then it would just be business as usual ever after until bankruptcy.
Because many(most?) politicians in USA have been perfectly aware that the system as is, just wont work if it stays the same, but the inertia and the special interests that are making big money from it, doesn´t want any change.

If Obama hadn´t pushed it, then it would just have gotten worse until someone else had the courage to try, or if really unlucky, was forced to deal with it.

Even the original plan, before a lot of morons(politicians) from both parties meddled with it to satisfy their lobbyists, would likely have been a fair deal better.

But the important part is that something is done about it.

OK Before Obamacare about 15% of the population was uninsured. The rest were covered by:

1. The poor were covered by Medicaid (about 20% of the population). Obamacare has expanded Medicaid enrollment. There was some increase in funding to compensate, whether it is enough to cover the new enrollees, only time will tell. It is entirely possible (and given the track record of the rollout to date, even likely) that the additional funding will be insufficient leading to less $ per person being available. So whether Obamacare is good or bad for this group is still unresolved.

2. The elderly are covered by Medicare. The middle and upper class elderly supplement this by private Medigap policies. Medicare funding is being reduced to fund Obamacare. So a net negative for this group to date (and the elderly vote!)

3. The majority of the middle class (about 55% of the population) is covered by group private insurance provided by their employers or unions. Insurance companies are passing the added burden of Obamacare onto this group as well, so policy costs are going up and benefits are going down. So a net negative for this group to date (and this group votes too!)

4. People who are not covered by the above include self employed, people who retired early (Medicare starts at 65), people who work in lower middle class jobs (the not quite poor who make too much to qualify for medicaid) etc. This is about 20% of the population. The biggest losers under the old system were individuals with chronic health conditions (complicated diabetes, autoimmune disorders, etc) who were uninsurable.

About a quarter of those individuals not covered by the above purchased private insurance (about 5% of the total population). The most popular policies are catastrophic policies which only cover very high medical expenses because it is cheaper to pay for small emergencies out of pocket than it is to buy insurance that covers them. To date this group has been huge losers!!! Even if they can get the websites to work their premiums have skyrocketed.

Of the 15% of the population who was uninsured:

a) The young uninsured are now eligible to stay on their parents' policies until age 26. Net winners. (A popular policy and one likely to be kept even if Obamacare is repealed)

b) The uninsurable are now eligible for policies. Net winners especially those eligible for subsidized policies.

c) The not quite poor are now eligible for subsidized policies. Except for those who have chronic health conditions, they haven't attempted to navigate the lousy website in large numbers. If the website gets fixed they may choose to apply for insurance coverage or they may not since the fine for not having insurance is less than the cost of even the subsidized insurance. So whether Obamacare is good or bad (still uninsured but now need to stretch the budget to pay a fine) for this group is still unresolved.

d) Healthy young people who don't want to spend the money on insurance, aka the young invincibles, except for those added to their parents' policies they aren't interested in Obamacare. They're choosing to pay the fine instead. So a net negative for this group too.

e) Cost to the taxpayer for unnecessary ER visits. (The law requires the ER to treat anyone whether they can pay or not because it is an "emergency" Many of the uninsured use the ER room for primary care. Those who do this can't be successfully sued for payment because they have low incomes and no assets so the taxpayers get stuck for a huge ER bill for things like minor ear infections.) No reduction to date but it's early. Obamacare supporters say it will take a while for people who do this to break the habit. So whether Obamacare is good or bad is still unresolved.

f) Illegal immigrants still aren't covered and still show up in the ER at taxpayer expense. Huge financial burden for states in the southwest. No change from Obamacare.



To summarize:

Obamacare is NOT single payer like Sweden. It is a law which establishes a very complex and expensive bureaucracy adding very complex and expensive compliance burdens, that basically requires that everyone in the US buy a "quality" insurance plan from insurance companies. For the 85% of the US public who already has insurance this has been a very BAD deal. All of this bureaucracy cost and compliance costs has to be paid by someone and that someone is those with insurance & Medicare.

To date only a small handful of uninsurable have benefited. There has been very little benefit outside that group. Frankly it would have been cheaper just to write each of them a huge check!

But the important part is that something is done about it

Just doing something isn't enough. You need to do something that actually improves the situation. To date Obamacare has made things worse not better!

I agree something needs to be done about the uninsurable. But there are ways to do that that don't wreck the system for everyone else!

At this point things are so bad that the conspiracy theory (Obama deliberately designed Obamacare to destroy insurance in order to force the US into a single payer system) is actually getting listened to! While I don't subscribe the the conspiracy theory, the fact that it is is gaining traction outside the lunatic fringe is a sign of just how bad the law is.

This is a very cogent response.

Theoretically, I am one of the small minority that should benefit from Obamacare. However; I was already covered under Oregon's high risk insurance pool. It was costing me about $2,000 per month to insure myself, wife and children, but we had decent insurance. We received cancellation notices six months ago but both the national Obamacare website and the Oregon website are FUBARed.

biochem wrote:

Still no cogent response?

OK I'll take a stab at some of it.

And hopefully, this will eventually happen because of "Obamacare". Think about what would have happened if someone didn´t push something through?

Then it would just be business as usual ever after until bankruptcy.
Because many(most?) politicians in USA have been perfectly aware that the system as is, just wont work if it stays the same, but the inertia and the special interests that are making big money from it, doesn´t want any change.

If Obama hadn´t pushed it, then it would just have gotten worse until someone else had the courage to try, or if really unlucky, was forced to deal with it.

Even the original plan, before a lot of morons(politicians) from both parties meddled with it to satisfy their lobbyists, would likely have been a fair deal better.

But the important part is that something is done about it.

OK Before Obamacare about 15% of the population was uninsured. The rest were covered by:

1. The poor were covered by Medicaid (about 20% of the population). Obamacare has expanded Medicaid enrollment. There was some increase in funding to compensate, whether it is enough to cover the new enrollees, only time will tell. It is entirely possible (and given the track record of the rollout to date, even likely) that the additional funding will be insufficient leading to less $ per person being available. So whether Obamacare is good or bad for this group is still unresolved.

2. The elderly are covered by Medicare. The middle and upper class elderly supplement this by private Medigap policies. Medicare funding is being reduced to fund Obamacare. So a net negative for this group to date (and the elderly vote!)

3. The majority of the middle class (about 55% of the population) is covered by group private insurance provided by their employers or unions. Insurance companies are passing the added burden of Obamacare onto this group as well, so policy costs are going up and benefits are going down. So a net negative for this group to date (and this group votes too!)

4. People who are not covered by the above include self employed, people who retired early (Medicare starts at 65), people who work in lower middle class jobs (the not quite poor who make too much to qualify for medicaid) etc. This is about 20% of the population. The biggest losers under the old system were individuals with chronic health conditions (complicated diabetes, autoimmune disorders, etc) who were uninsurable.

About a quarter of those individuals not covered by the above purchased private insurance (about 5% of the total population). The most popular policies are catastrophic policies which only cover very high medical expenses because it is cheaper to pay for small emergencies out of pocket than it is to buy insurance that covers them. To date this group has been huge losers!!! Even if they can get the websites to work their premiums have skyrocketed.

Of the 15% of the population who was uninsured:

a) The young uninsured are now eligible to stay on their parents' policies until age 26. Net winners. (A popular policy and one likely to be kept even if Obamacare is repealed)

b) The uninsurable are now eligible for policies. Net winners especially those eligible for subsidized policies.

c) The not quite poor are now eligible for subsidized policies. Except for those who have chronic health conditions, they haven't attempted to navigate the lousy website in large numbers. If the website gets fixed they may choose to apply for insurance coverage or they may not since the fine for not having insurance is less than the cost of even the subsidized insurance. So whether Obamacare is good or bad (still uninsured but now need to stretch the budget to pay a fine) for this group is still unresolved.

d) Healthy young people who don't want to spend the money on insurance, aka the young invincibles, except for those added to their parents' policies they aren't interested in Obamacare. They're choosing to pay the fine instead. So a net negative for this group too.

e) Cost to the taxpayer for unnecessary ER visits. (The law requires the ER to treat anyone whether they can pay or not because it is an "emergency" Many of the uninsured use the ER room for primary care. Those who do this can't be successfully sued for payment because they have low incomes and no assets so the taxpayers get stuck for a huge ER bill for things like minor ear infections.) No reduction to date but it's early. Obamacare supporters say it will take a while for people who do this to break the habit. So whether Obamacare is good or bad is still unresolved.

f) Illegal immigrants still aren't covered and still show up in the ER at taxpayer expense. Huge financial burden for states in the southwest. No change from Obamacare.



To summarize:

Obamacare is NOT single payer like Sweden. It is a law which establishes a very complex and expensive bureaucracy adding very complex and expensive compliance burdens, that basically requires that everyone in the US buy a "quality" insurance plan from insurance companies. For the 85% of the US public who already has insurance this has been a very BAD deal. All of this bureaucracy cost and compliance costs has to be paid by someone and that someone is those with insurance & Medicare.

To date only a small handful of uninsurable have benefited. There has been very little benefit outside that group. Frankly it would have been cheaper just to write each of them a huge check!

But the important part is that something is done about it

Just doing something isn't enough. You need to do something that actually improves the situation. To date Obamacare has made things worse not better!

I agree something needs to be done about the uninsurable. But there are ways to do that that don't wreck the system for everyone else!

At this point things are so bad that the conspiracy theory (Obama deliberately designed Obamacare to destroy insurance in order to force the US into a single payer system) is actually getting listened to! While I don't subscribe the the conspiracy theory, the fact that it is is gaining traction outside the lunatic fringe is a sign of just how bad the law is.

Theoretically, I am one of the small minority that should benefit from Obamacare. However; I was already covered under Oregon's high risk insurance pool. It was costing me about $2,000 per month to insure myself, wife and children, but we had decent insurance. We received cancellation notices six months ago but both the national Obamacare website and the Oregon website are FUBARed.

That is one example of a way to do something about the uninsurable without wrecking the system for everybody else. Too bad that Obama didn't just implement a national high risk pool. It would have been a lot more effective and a lot cheaper!

biochem wrote:That is one example of a way to do something about the uninsurable without wrecking the system for everybody else. Too bad that Obama didn't just implement a national high risk pool. It would have been a lot more effective and a lot cheaper!

Which is why all those loonies talking about plots are getting traction.

Not like they didn't already have an national example, like say flood insurance already. I think anyway.

Or state level for say things like hurricane insurance for homes and high risk pools.

Just like we can't figure out as a nation the difference between what is "broke" and what needs "tweaking". "We need to fix it now damn it."

T2M

Are you certain that the Loonies are really wrong?

The keystone of Obamacare is the insurance exchanges. These websites should be no more difficult to develop than a retail marketing site. Obama had four years to get it done rather than a few months which is normal. How could he screw it up this badly if it was not intentional?

thinkstoomuch wrote:

biochem wrote:That is one example of a way to do something about the uninsurable without wrecking the system for everybody else. Too bad that Obama didn't just implement a national high risk pool. It would have been a lot more effective and a lot cheaper!

Which is why all those loonies talking about plots are getting traction.

Not like they didn't already have an national example, like say flood insurance already. I think anyway.

Or state level for say things like hurricane insurance for homes and high risk pools.

Just like we can't figure out as a nation the difference between what is "broke" and what needs "tweaking". "We need to fix it now damn it."

T2M

I don't think that the conspiracy theorists are right and that this disaster was on purpose because of Obama's titanic ego. Let's face it anyone over the age of 10 who truly believes that he/she can become president has a titanic ego!!! Obama's probably isn't any more titanic than the rest of them, but he does seem to have more trouble hiding it. (He should probably borrow Victor Cachat's simulation chamber and practice!)

No matter how idealistic they are individuals with egos that big don't want to have their name associated with a program that is a disaster! While I have no doubt Obama would have preferred single payer to this thing, he's not the sort to "take one for the team" and have his legacy forever tainted by disaster.

1. The entire premise that such a program would be successful nationally no matter how well designed may be incorrect. This is largely a matter of opinion, since the program is NOT well designed. And political theorists on both sides have well thought out arguments why or why not it was a good idea in the first place. Since it is opinion and not facts, Obama's ego will allow him to ignore his opponents.

2. The law was very poorly written. Even those who support the program's premise agree that the law was very poorly written. This has caused numerous difficulties in the rollout as well as has given opponents lots of ammunition for lawsuits. This one is on Obama, since it was his team that wrote the law. He's a lawyer and no lawyer especially not a lawyer with his ego would DELIBERATELY want to be associated with such poor legal work.

3. The implementation was even worse than the law! There have had to be 100s of last minutes changes, revisions, delays, exceptions etc etc. And then there was the website! The US has a lot of expertise building websites but Obama screwed up and did the crony capitalist thing instead of hiring the most competent firm in the US to design it. The is solely on him, there is no way he can blame anybody else for it (although he is trying). He looks like an incompetent idiot. There is absolutely no way his ego would have tolerated doing this on purpose.


FYI for those not in the US. Re namelessfly's reference to the federal and Oregon websites. The states have the option to set up their own insurance websites. The feds can't force them to do so, due to the separation of powers. A handful of states have set up their own (including Oregon and Massachusetts). Most have not wished to spend the money or deal with the headaches and thus their residents use the federal exchange solely.

Problems with the FEDERAL website:

1. Not working period. That one seems to be sort of solved. But for the first few weeks, the Federal website was totally non-functional.

2. The backend is not functional. People are filling out forms, getting confirmation but the website isn't sending the information to the insurance company. Lots of public service announcements to call insurance companies and confirm that they actually have you listed. Many companies are filling out the info by hand, since they aren't receiving the info from the website.

3. An entire host of minor issues with the website. For example it is signing multi-millionaires up for medicaid. There are a number of multimillionaires who have retired early to enjoy the good life. Because they are multimillionaires, they are not really eligible for medicaid, but the website was only programed to ask for income and not assets. Since their income is zero, the website assumes that they are poor and signs them up for medicaid.