BBO Discussion Forums: surreal and more surreal - BBO Discussion Forums

As many point out...current insurance is horrible....we wait to see if Ob care better...so far just as a huge mess and many of us are hurting. The last 3.5 years since this vote I have to pay more and more for insurance and I am a southside Chicago democratic since well 1950's. or so.


As I said the worst part is we cannot keep our old insurance or our old docs. This is a huge lie of the new health care People are hurting from this crap plan.


I was in huge pain. I hope 10/30 dentist is better.

mike777, on 2013-October-25, 03:57, said:

How old are you?

Where do you live?

Over the past five years, how did your family arrange for health insurance?

What is preventing you from continuing with the health care plan that you are currently purchasing?

Are you going to be purchasing insurance via one of the exchanges set up under the Affordable Care Act?

Mike,

Pain comes in various forms. I think that Obama gets a pass on the pain from your tooth. But the other complaints are of interest.

You have not been able to continue seeing the same doctor? I have not, myself, had any problem with this, and I don't expect to have. And at my current age, now that visits to a doc are more frequent than they were twenty years ago, I am finding my insurance coverage to be a pretty good deal financially.

This latter part seems to me to be a real issue. As mentioned, my health has been good but I am not getting younger. How should we balance the twin facts that as we age we need more medical care but are less prepared to handle full time employment? Right now if someone says "Ken, times are tough. Your pension is cancelled for lack of funds, we are cutting social security in half, and someone swiped your identity and cleaned out your bank account" I could still, probably, find decent employment. Ten years from now maybe not.

The general approach of what the ACA is attempting seems right to me. Buy we always fall back on Yogi Berra "In theory, theory and practice should be the same. In practice, they aren't". Otherwise put, good intentions are not enough.

What the Affordable Care Act does is - horror of horrors - grant personal choice in coverage/cost of health insurance. In the case of Mike777, I am certain that his complaint is that status quo is no longer available to him. His insurance company will provide a policy that allows him to continue as he has - just not for the same cost as before because all policies have to cover certain contingencies.

Whether that is a good or bad thing is the debate.

It is odd that one does not hear the free market proponents complaining about the government subsidies (in the form of medicaid and food stamps) that are provided to sustain profitability and a low-cost workforce to the gargantuan fast food industry:

Source

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It always seems (at least, to me) that to many on the right side of politics that socialism is deemed a good thing when the recipient of the public largess is a business category while it is painted as the "end of America as we know it" when the same social programs help the poor and needy.

How HealthCare.gov Was Supposed to Work and How It Didn’t by Larry Buchanan, Haeyoun Park and Alcicia Parlapiano

Summarizes problems for key use cases (apply, verify identity, compare plans, pick a plan and confirm enrollment).

I saw a coomment somewhere this morning that there is complete areement on who is to blame for this. Someone else.

kenberg, on 2013-October-26, 09:14, said:

They said it?.

kenberg, on 2013-October-26, 09:14, said:

To blame for what?

ArtK78, on 2013-October-26, 13:04, said:

everything

onoway, on 2013-October-26, 13:47, said:

Exactly.

Added: I did not have any serious intent with my comment "Someone else". There was a discussion about the hearings, where I gather all of the software people explained that the part of the system that they were responsible for worked perfectly. In short, someone else is responsible.


My experience with software is similar, but at a much less dramatic and public level. Most software works well, until you have to integrate it with other software. I was recently remotely logged into a system at the U. The files have gone under many revisions and migrations, none under my control. I wanted to take a file on googledocs that I would reach from home, convert it into a pdf, download it to me personal files at the U, move it into this complex file system, and then, from home, link it to something using html. I almost succeeded. Sure, and I almost won the lottery. I finally did what I wanted to do, but I drove in to do it. (I had other things to do as well.) I think I now understand what I needed to do from home, so maybe next time, if I remember.

They all have my sympathy, but it's a screw-up.

barmar, on 2013-October-23, 10:12, said:

I do mean it (and I'm not knocking corporations particularly) based on many years of experience in business, including some doing contract work for the US government. And I can say definitely that I have changed my opinion from the opinion I had when I was starting out.

It's not necessarily the case that providing better service to customers results in more profit in the short term, and quarterly reports drive stock prices. When the founders of a company leave or die off, I've seen a tendency for long-term planning to slip. The incentives for managers tie in closely with short-term results.

To me, it makes more sense to talk about the incentives of the folks running corporations and of those running government agencies than it does to talk about the incentives of the organizations they run. Alan Greenspan was surprised to find that the long-term health of a corporation was not the greatest incentive for the managers running it. I'm not sure what world he was living in, but it wasn't the real one. I don't mean to denigrate all corporate managers -- there are some really fine people everywhere I've been. But they do not have it easy, mostly because of the pressure of short-term thinking.

I found no discernible difference in the overall competence of folks running corporations and of those running government agencies -- and that was contrary to my expectations. Because the managers in government do not face the same sorts of quarterly pressures, their incentives are different. A number of times I've tried to imagine why a clearly talented person would settle for a government salary (and I admit that I could never do that), but some folks seem not so interested in financial rewards. In my experience, many talented folks in the government actually do have a strong commitment to providing good service. They tend to outweigh the slugs (of which there are many in both the government and in corporations).

The negative incentives are different too. When a corporation provides bad service, they hire "customer service representatives" to field the calls of irate customers. When the US government provides bad service, congress throws a televised tantrum.

Well, part of the reason one would wish to manage in the public sector (and take the lower wages there given) is that they have good union jobs with good union pensions, and are quite willing to make less now to ensure their future. Well, until private enterprise, with their short-term thinking goal of "don't give anyone but us anything we can't take away", started pushing the government to do the same thing they've done [edit: to their workers], so they don't look bad...

Yes, there are bad things about unions as well - especially ones as large and connected as the public sector unions. But there were very good reasons for them, and if 20 years ago, it looked like they were more trouble than help, all the good things they fought for are being taken away now, and the "leeches" aren't there any more [edit: to protect those good things]. Odd how that works.

Well, it is all about blame.

Ken could probably chime in on this topic, with his math background.

It is somewhat human nature to look for only a single cause of anything. Why? Well on the news, you only have 90 seconds, so forget finding anything out there.

But the real world is virtually always a system of complex interactions of many factors. Really messy. Do we want to assign a percentage blame to the pilot, the engineer of the control system, the copilot who did not notice the problem, the weather and conditions, the time of day, etc. No. We ask for just ONE reason. So the NTSB will take months to do all the work to figure out what went wrong after a "disaster", but the news media has finished the story, long before the results are in.

Take physics. It is all taught about idealized systems. Friction free, and all sorts of simplifying assumptions. Why? Because the math is tractable - solvable in many cases analytically. Resorting to computer modelling to take into account the real world is hard, and there is no glory in it. (Well maybe if you decoded the human genome cheaper and faster than the government could, but that is a bit of an aberration.)

Population growth models. In calculus, everybody learns the model in which the change in the population is proportional to the existing population. The solution is the well known exponential growth. What the book does not bother to tell you is that exponential growth is completely a myth. It is fundamentally impossible.

Pogo pretty much had it right. "We have met the enemy, and he is us."

Slow breaking story. There are an estimated 19 million people who last year purchased their own health insurance. Bloomberg News has already identified nearly 1,000,000 cancellations of those policies. In a story today, there was an estimate that 80% of such policies will be cancelled. That would be nearly 16 million people, about 5% of the population. Most of those are likely not to be pleased, because they chose a policy in keeping with their perceived needs and ability to pay.

Who is to blame? The President, Pelosi, Mary Landrieu - who all promised that people could keep their existing policies and doctors? The voters who voted the turkeys into office? Or is it a system that is too complex to fathom because government spending is done in numbers to large to fathom by any but a few people? Is it a taxation policy that is geared to gouging the minority in what clearly garners the votes of a majority - aka gaming the system.

Suppose that taxes were flat, so that every politician's pet program could be priced in dollars per voter - yes, that scales the spending down to what everybody can comprehend - basic principle of numeracy. A 165 billion dollar program. That is just a big number like all the others - until you divide it by the population or the number of voters. 165 billion / 330 million people = $500.

Let's round the $17 trillion debt down to 16.5 trillion. Whoa $50,000 per person. How the heck did we get here?

Who is to blame for that kind of lunacy?

If you have a single answer - carry on.

8 ever, 9 never.

I certainly did not agree to put myself 50 grand in debt. I don't think anyone else did either.

Our system of government is broken. Time, I think, to scrap it and start over.

FM75, on 2013-October-29, 18:30, said:

The NTSB looks for the cause - not a cause. The cause can be a combination of events. It is the sound byte news media that strives to reduce cause to its simplest form - pilot error - when in fact it was a series of events that led to pilot error.

I am one of those 19 million who had a policy which I am letting lapse? Why? Because it was a $10K deductible piece of garbage Blue Cross policy that the complany more than doubled the price on - I can now get a much more affordable and lower deductible policy from a company that didn't even operate in my state previously.

I also take issue with misrepresentation of facts: the president had an "if" in front of his statement that everyone seems to conveniently leave out.

What I seem to be hearing is a great deal of clamor from those who benefited from the previous exclusions of the poor and the uninsurable - those who had a policy that was artificially low-priced based on the ability of insurance companies to reduce risk by legal bigotry.

If we can stop the finger-pointing and misinformation, the best thing that will come out of the ACA is just how incredible screwed up is the U.S. healthcare system - and perhaps the clamor will eventually lead to a single payer system.

FM mentions physics, math, and simplifying assumptions. Just a word or two: If we analyze the path aof a golf ball we might, at first, assume that the earth is flat, the gravitational feild is constant, and that there is no air resistance. If we want improved results, we can continue assuming that the earth is flat and the gravitational field is constant, but we have to get real about the air resistance. No air, no slice. The world will always be too complicated to include all aspects of it in analysis, we have to know which things matter and which, to a very great extent, do not.


Now about this latest flap with people losing their insurance. The administration may have a point that they are losing crappy insurance and the ACA will help them get better insurance. Yes, maybe, but it's getting messy. Most people, definitely including myself, don't always read the fine print. I want to use some software package and I click "Yes, I have read and understood the terms of service". I hope no one is keeping score on how often I lie about this. I trust some software, so I click "yes I agree" and I don't trust other software and for those products I would be very reluctant to agree even if i read every word of the terms and conditions.

A Post article this morning described some of what is happening: http://www.washingto...ry.html?hpid=z2

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Ok, but don't expect this to play well. I have insurance, I have Medicare, no one is cancelling my insurance (as far as I know) and if the rates go up a bit I can handle it. So I am not the one most directly affected here. As I understand it, the ACA is mostly designed for those in "the less stable individual market". If those are the people who are now getting upset, this may not go well.It sounds a lot like saying "Yeah, we conned you a bit, but we have your best interests at heart, quit griping". I am not so sure this will work.

There is going to be an outcry that ACA has caused people with prior insurance to pay more. I have a very good insurance policy that went up this year more than any previous year (I have had the same policy for 15 years). The out of pocket maximum has also been creeping up -- again including this year. However, going it has gone up every year, and some previous years, there was a higher percentage increase than this year. The copay for office visits have gone up four times during the life of this policy (this year only for seeing specialist). The prescription copay went up each of the last three years, including this one, but it was crazy low (five dollars) a few years ago. It is 14 now, so one of the generics I pick up is just 4 at a local pharmacy so I don't even use it there.

Should I blame ACA for any of these increases? Even the ones 5, 8, 10, 12 years ago? I am certain some people will claim all their increase premiums this year are due to the ACA. I am not going to say that. What I hope is the ever escalating prices will stabilize for others (I will lose this insurance in a few years as I switch to medicare and a supplement). That at least, is one potential benefit, time will tell if it happens. But when you hear "my premiums went up due to ACA", at least in my case, I can not say the increase was or was not related to the ACA but the historical trends suggest probably not or not so much.

For premium increases, I agree we need to be cautious about where to lay the blame. But I think these cancellations are a real political threat.

Suppose I get a notice from my insurance company telling me that since the coverage I have does not meet ACA requirements, it is being cancelled. I learn that the ACA will help me get better insurance and I go to the website. It doesn't work. I ask around and find that the government really thinks that maybe they can get the website up and working properly, or at least pretty much so, by the end of November. Huh? My insurance will be cancelled at the end of December and the government thinks that maybe they can get the website operating by the end of November? That's cutting it a bit close.

I am sure many Tea Party Republicans still do not understand the massive public backlash against them. Democrats claim to be brighter. If so, now would be a good time to demonstrate this.

It is really time for everyone to just sit back, take a deep breath, and relax a bit. The ACA website will be fixed before too long, and I am sure that a work-around will be established to handle particular hardship cases such as the case of someone with a pending cancellation.

Despite what most Tea Partyers would have you believe, Obamacare is not evil. It is intended to solve some of the more serious problems in America's health care system, and it is long past time that these problems were addressed. The web site issues are merely technical issues which will be dealt with.

The sky is not falling. But if the Tea Partyers want to go running to the bunkers as if the world is coming to an end, go for it.

Art is correct.

The real concern has always been can we get enough people under 35, healthy or rich to pay for us old or poor or sick.

Clearly those of us who are old, sick or poor will be patient to get our benefits. I expect tens and tens of millions of us will sign up and enrollment will soar. 50+ million of us are on food stamps and over 21 million of us are on disability. These are just some of the people who really need help.