The Affordable Care Act is Coming Home to Roost

[John Adams]

Oh, I thought you were previously on the individual market.

 

Any word on whether your company is planning on dropping health care coverage in 2015?

 

I was sparing you my biz details because no one cares. But I have the option of individual or through the business because it's my business.

 

My two friend's companies are dropping their plans, giving their employees the exchange-equivalent-plan amount of cash, and letting them do what they want.

Edited January 5, 2014 by John Adams

[OCinBuffalo]

I was sparing you my biz details because no one cares. But I have the option of individual or through the business because it's my business.

 

My two friend's companies are dropping their plans, giving their employees the exchange-equivalent-plan amount of cash, and letting them do what they want.

So, they are essentially doing what, if I had to bet $ on this, will be the eventual outcome here:

 

They are creating their own private Health Savings Accounts.

 

In the end, HSAs for the small stuff, and catastrophic for the big...is the real solution here. Also, like gravity, the only variable is time: how much time it takes for us to "discover" this as a nation.

 

The Ds who are trying to change the subject to wealth inequality? Big mistake, because the HSA is the fastest way to create wealth that there is, and, the Feds can tax and pay into one with relative ease. If you want to redistribute wealth, that's the fastest way to do it.

 

By arguing wealth inequality, the Ds may very well end up destroying Obamacare in the process, because the Rs should, if not will, counter with HSAs.

[B-Man]

Noah Rothman at Mediaite has had more than his fill of this media malpractice

White House Insults Nation’s Intelligence by Pretending Obamacare Enrollment Goal Never Existed

 

Appearing on MSNBC on Tuesday, White House health care adviser

Phil Schiliro

asserted that the White House never had a target number of Affordable Care Act enrollees. The widely circulated figure of 7 million – a figure which has been cited and repeated regularly by the press and members of the administration, was never

their

number, Schiliro asserted.

 

“That was never our target number,” he insisted.

“That was a target that was put out by the Congressional Budget Office and has become the accepted number.”

 

He should have informed Health and Human Services Sec.

Kathleen Sebelius

of this development.

Washington Times

reporter

David Sherfinsk

i notes that Sebelius said “7 million is a realistic target” in June. She repeated this claim in an interview with NBC News in last September. “I think success looks like at least 7 million people having signed up by the end of March, 2014,” Sebelius insisted.

 

Indeed, the White House has been laying the groundwork for the dismissal of the CBO’s projected enrollment floor, at which point the ACA would be financially stable, for months.

In late November, the

Washington Post

’s

Ezra Klein

and

Sarah Kliff

, two preferred channels through which the administration funnels information about the ACA’s ever-shifting mandates and deadlines, reported that the 7 million mark was never a White House target.

 

According to Klein

, the White House has their own metric to determine the success of the ACA — the mix of enrollees ...

 

 

Rothman goes on to report that Obamacare is also on track to flunk the "mix of enrollees" test.

 

I guess the next step will be, "We were just looking for a few million ... we mean 2 million ... we mean several hundred thousand people who have a pulse and fog a mirror when they breathe." It seems we can pretty much count on the press to go along with whatever narrative shift occurs.

Read more: http://newsbusters.org/blogs/tom-blumer/2014/01/05/politico-turns-obamacares-7-million-enrollment-target-suggestion#ixzz2paNYoclh

[birdog1960]

So, they are essentially doing what, if I had to bet $ on this, will be the eventual outcome here:

 

They are creating their own private Health Savings Accounts.

 

In the end, HSAs for the small stuff, and catastrophic for the big...is the real solution here. Also, like gravity, the only variable is time: how much time it takes for us to "discover" this as a nation.

 

The Ds who are trying to change the subject to wealth inequality? Big mistake, because the HSA is the fastest way to create wealth that there is, and, the Feds can tax and pay into one with relative ease. If you want to redistribute wealth, that's the fastest way to do it.

 

By arguing wealth inequality, the Ds may very well end up destroying Obamacare in the process, because the Rs should, if not will, counter with HSAs.

$3300/year max. no doubt it's a good deal but "fastest way to create wealth"? i must be missing something. i don't think there are many dems against hsa's. even if they benefit higher earners disproportionately, they're a good idea. they, coupled with required insurance benefits for preventive care push health care consumption in the right direction. Edited January 6, 2014 by birdog1960

[OCinBuffalo]

$3300/year max. no doubt it's a good deal but "fastest way to create wealth"? i must be missing something. i don't think there are many dems against hsa's. even if they benefit higher earners disproportionately, they're a good idea. they, coupled with required insurance benefits for preventive care push health care consumption in the right direction.

We agree...sorta.

 

When I say HSA, I mean the following:

1. HSAs are run no different than 401k, which means no 3300/year max. It means up to 20% of your income, pre-tax, can be directed there. Two changes: you can add as much after-tax money as you want to an HSA, and there's no limit at all people over the age of 55. They can put their whole paycheck in if they want. And, you can't invest HSA's in "risk" funds, and you can only have 50% of your HSA in equities or commodities.

2. HSAs are transferrable to family members(and yes, partners, or whatever the hell ends up happening with gay people), or a single designated beneficiary. This means that I can transfer $ from my account to my kid's, if they are having problems. I don't necessary like the idea of a "family" HSA, because then divorce creates havoc with it. I favor every person, especially kids, gets an HSA, and that way, each kid is protected from divorce havoc. Also, the government has an easy way to fund each kid = put $ in there, rather than putting money into Medicaid. The big point: HSA are transferrable upon death.

3. Anybody, government, companies, armed services, charities, invididual people can contribute to anyone's HSA, tax-free.

 

You take 1-3, and now do you see why I say HSA's are the easiest way to create wealth? If a grandmother can bequeath her HSA(which she's been dumping her extra money into for the last 10 years) to her grandchildren, then all of them start out ahead, and responsibly ahead. It's no different than a savings bond...but you don't have to pay taxes on it's income.

 

The poorest of the poor, can put $1 in their HSA, without the need to stand in line, try to buy a house, sign up for government nonsense, or any other bureacratic activity. They can just go to the bank, and put their money in.

 

See? Literally instant wealth creation, regardless of class, and no dependence on government.

 

I'd like to see "average" people with $300k HSAs running around(earning quaterly tax-free interest), because they are 2nd generation HSA inheritors, having to think very carefully about what they spend their money on, and demanding that their vendors(whih means you) educated them fully on why this, costs this, sure, but also, very well protected in terms of unforeseen illness.

 

I DO NOT agree that the government should set minimum insurance requirements. I think doctors like yourself should be able to come up with your own "plans" for people, and if people want to subscribe, or not, that's on you/them. The whole thing should be what it always should be: between you and them.

 

So, yeah, you still need insurance, but, let it only be catastrophic, and, let the bigs fight it out across state lines. Let Walmart be the TPA for catastrophic. You wanna see the ass fall out of premiums and deductibles in across-state-line catastrophic insurance? Walmart.

 

In a few generations, the need for Medicare/Medicaid/Government involvement in health care....is obliterated.

 

Then, we will all be happier. I don't know about healthier = did you see the Oregon Medicaid Lottery data(EDIT: if not, here: http://www.nber.org/papers/w17190)? Insurance doesn't make you healthier, personal accountability does.

 

But, in having to deal with regulations as a part of my Acitivies of Daily Living, I assure you: we will ALL be happier.

Edited January 6, 2014 by OCinBuffalo

[MadBuffaloDisease]

So now 7M people wasn't the goal? We destroyed health care and are spending trillions...for, what, 4M people? Wow.

[B-Man]

Little Sisters of the Poor Case: The Administration’s Position Goes from the Absurd to the Surreal

 

The Obama administration told the Supreme Court that nuns running an elder-care facility should have to provide “free” abortion drugs through their health-insurance plan. Witness your tax dollars at work.

 

There is hope, though, that your hard-earned pay won’t be wasted on absurdities like this much longer. Religious freedom is so embedded in American law that Obamacare has suffered court orders against its mandate in 53 of 60 rulings so far.

 

Yet despite having many opportunities to promote abortion without involving people of faith, the Obama administration refuses to cut its losses. Instead it has doubled down ferociously – insisting on coercing even nuns to participate in its anti-life, anti-religious agenda.

 

In the first wave of the abortion-pill-mandate debate, President Obama promised Christian leaders that the rule would exempt religious groups. But the abortion extremists had their way and the White House “evolved” on the issue. The 2012 election year “solution” was to tell religious groups they would, in the words of Cardinal Dolan, get an extra year delay in order to “figure out how to violate [their] consciences.”

 

{snip}

 

At this point the administration’s position went from the absurd to the surreal. The government now says that the Little Sisters must still submit their form. The form still requires the Sisters to explicitly tell someone else they have “obligations” to provide abortion pills and contraception. But the government says it overlooked the fact that the Little Sisters’ plan fits into a legal loophole where, if that third party abortion-pill guy doesn’t follow his “obligations,” there’s no penalty on him.

 

In other words, the Obama administration refuses to grant an injunction that would protect the Sisters from hiring someone else to do offensive things, and its refusal is based on the theory that the government’s coerced speech probably won’t work anyway. The government admits that its offensive coerced speech might not actually achieve the government’s goals, but the Little Sisters must speak it anyway.

 

The Obama administration has fought all the way to the Supreme Court to force the Little Sisters to do something that the government insists is pointless. If it’s pointless, the federal government shouldn’t be forcing people to do it against their will in the first place. But that lesson applies to all of Obamacare, and it seems that the administration just can’t resist the temptation to coerce.

[DC Tom]

Little Sisters of the Poor Case: The Administration’s Position Goes from the Absurd to the Surreal

 

The Obama administration told the Supreme Court that nuns running an elder-care facility should have to provide “free” abortion drugs through their health-insurance plan. Witness your tax dollars at work.

 

There is hope, though, that your hard-earned pay won’t be wasted on absurdities like this much longer. Religious freedom is so embedded in American law that Obamacare has suffered court orders against its mandate in 53 of 60 rulings so far.

 

Yet despite having many opportunities to promote abortion without involving people of faith, the Obama administration refuses to cut its losses. Instead it has doubled down ferociously – insisting on coercing even nuns to participate in its anti-life, anti-religious agenda.

 

In the first wave of the abortion-pill-mandate debate, President Obama promised Christian leaders that the rule would exempt religious groups. But the abortion extremists had their way and the White House “evolved” on the issue. The 2012 election year “solution” was to tell religious groups they would, in the words of Cardinal Dolan, get an extra year delay in order to “figure out how to violate [their] consciences.”

 

{snip}

 

At this point the administration’s position went from the absurd to the surreal. The government now says that the Little Sisters must still submit their form. The form still requires the Sisters to explicitly tell someone else they have “obligations” to provide abortion pills and contraception. But the government says it overlooked the fact that the Little Sisters’ plan fits into a legal loophole where, if that third party abortion-pill guy doesn’t follow his “obligations,” there’s no penalty on him.

 

In other words, the Obama administration refuses to grant an injunction that would protect the Sisters from hiring someone else to do offensive things, and its refusal is based on the theory that the government’s coerced speech probably won’t work anyway. The government admits that its offensive coerced speech might not actually achieve the government’s goals, but the Little Sisters must speak it anyway.

 

The Obama administration has fought all the way to the Supreme Court to force the Little Sisters to do something that the government insists is pointless. If it’s pointless, the federal government shouldn’t be forcing people to do it against their will in the first place. But that lesson applies to all of Obamacare, and it seems that the administration just can’t resist the temptation to coerce.

 

Just did some digging in to this, because it seemed unlikely even for this administration (this is approaching real Nazi-propaganda level incoherence). But...yeah, that's the government's argument: the Little Sister's objection to the contraceptive mandate is invalid because a religious organization can file formal notification that they object to the contraceptive mandate, whereby the mandate is transferred to a third party who is not obligated to fulfill the mandate,

 

"Who is not obligated to fulfill the mandate?" Then where's the !@#$ing mandate?

 

Scariest thing I found while looking in to this, though: A Washington Post headline saying "Administration Tells Supreme Court to Lift Delay on Birth Control Rule." The White House tells the Supreme Court what to do now? I hope (and expect) that's just editorial stupidity.

[Nanker]

Perhaps you weren't listening Tom. The mandate means exactly what The President says it means - unless it doesn't, or he says something different on a different day.

Now stop bothering the people that are running the country. They know what's best for us, so shoo-shoo! Go AWAY!

[OCinBuffalo]

Just did some digging in to this, because it seemed unlikely even for this administration (this is approaching real Nazi-propaganda level incoherence). But...yeah, that's the government's argument: the Little Sister's objection to the contraceptive mandate is invalid because a religious organization can file formal notification that they object to the contraceptive mandate, whereby the mandate is transferred to a third party who is not obligated to fulfill the mandate,

 

"Who is not obligated to fulfill the mandate?" Then where's the !@#$ing mandate?

 

Scariest thing I found while looking in to this, though: A Washington Post headline saying "Administration Tells Supreme Court to Lift Delay on Birth Control Rule." The White House tells the Supreme Court what to do now? I hope (and expect) that's just editorial stupidity.

The worst is: now they are saying that the Sister's have a "weak case" because they don't have to break their faith to comply...they can hire an insurance company to break their faith for them. And...what's wrong with that?

 

Looks like the government's attorney needs to brush up on his Bible. I believe the Sisters may be concerned...about something involving millstones around their neck, the sea, and being thrown into it....being a "better" option for them than what the government is offering.

 

And, yeah, as far as I can tell( )? They've now changed the word "tells" to "urges". "Tells" was never accurate anyway, as the Administration wasn't telling anybody anything. Their lawyer was making an argument to the SCOTUS.

Edited January 6, 2014 by OCinBuffalo

[B-Man]

NATIONAL JOURNAL: Obamacare Can’t Fail … because the White House won’t stop watering down its definition of success.

 

 

 

 

.

[Nanker]

If it can save just one child!

Think of the children.

[Rob's House]

haha thats all you got? You think I'm idiot cause i correctly stated that some of the Obamacare principles evolved from the Heritage Plan. Note that I was responding to a guy who linked to heritage piece about administrative costs it was and topical and I referred to it as an an FYI.

 

Just to clarify, did the Heritage Foundation endorse this plan, or was it just concocted by some guy that happened to work for Heritage at some point?

[Doc]

Just to clarify, did the Heritage Foundation endorse this plan, or was it just concocted by some guy that happened to work for Heritage at some point?

Liberals blaming others for their failures? Say it isn't so!

[outsidethebox]

I don't know to much about Obama care, but I do know one good thing that came out of it is the out of pocket cap of $4300 starting this year. I wish it was in effect last year, I spent more than twice that amount last year in medical bills. I have learned how out of control the cost of health care is, The dr. office billed the insurance company over half a million dollars in charges, which in turn the insurance company said "no way!" and proceeded to reduce the cost to about half of the charge. I guess there is some contractual agreement between the hospital and the insurance co.

[birdog1960]

I don't know to much about Obama care, but I do know one good thing that came out of it is the out of pocket cap of $4300 starting this year. I wish it was in effect last year, I spent more than twice that amount last year in medical bills. I have learned how out of control the cost of health care is, The dr. office billed the insurance company over half a million dollars in charges, which in turn the insurance company said "no way!" and proceeded to reduce the cost to about half of the charge. I guess there is some contractual agreement between the hospital and the insurance co.

this is a major part of the problem: the rack price for hospitals and doctors. the only ones paying it are the uninsured and they can least afford it.

[TakeYouToTasker]

Hilarious that you believe government is the solution to inflated third party billing.

 

You'll note that before Medicare (the largest price fixing entity on the planet) we didn't have these sorts of problems.

[Doc]

this is a major part of the problem: the rack price for hospitals and doctors. the only ones paying it are the uninsured and they can least afford it.

Doctors' salaries account for 8% of health care spending.

[boyst]

 

Doctors' salaries account for 8% of health care spending.

so that makes perfect sense right? Instead of just the 1% elites Dr's are taking in 8%, that's 7% more then their other rich colleagues!

 

/liberal

[John Adams]

Like others, we have run into the billing/invoicing problem that's been well publicized. So...the first problem I've seen with the system is that the government can't figure out how to charge me.

 

That's the kind of government incompetence I was hoping for.

[Nanker]

Rest assured, you'll be getting plenty of it too.

[birdog1960]

Doctors' salaries account for 8% of health care spending.

way to misunderstand the point. the "mark up" in health care prices for the uninsured is a major reason that even wealthy folks can't afford to be self insured. if everyone paid what blue cross or medicare negotiated as their usual and customary rates, many systemic healthcare problems would seem less daunting. and 8% of a massive number is still a very big number.

[Doc]

way to misunderstand the point. the "mark up" in health care prices for the uninsured is a major reason that even wealthy folks can't afford to be self insured. if everyone paid what blue cross or medicare negotiated as their usual and customary rates, many systemic healthcare problems would seem less daunting. and 8% of a massive number is still a very big number.

As you (should) know, doctors fees are negotiable. And 92% if a massive number is a much larger number. As for markups,

[B-Large]

Hilarious that you believe government is the solution to inflated third party billing.

 

You'll note that before Medicare (the largest price fixing entity on the planet) we didn't have these sorts of problems.

 

We also couldn't do much for people either.... expensive medical innovation and cutting edge tech has drive up cost/prices, we can also treatment almost everything.

 

But yes, TPA and the "claims" process is a trainwreck... glad we doubled down on it.

[TakeYouToTasker]

 

 

We also couldn't do much for people either.... expensive medical innovation and cutting edge tech has drive up cost/prices, we can also treatment almost everything.

 

But yes, TPA and the "claims" process is a trainwreck... glad we doubled down on it.

Market forces and exponential technological growth are a remarkable thing. They drive down prices everywhere they are allowed to take hold. Medicine is not one of those places.

[4merper4mer]

Market forces and exponential technological growth are a remarkable thing. They drive down prices everywhere they are allowed to take hold. Medicine is not one of those places.

 

Glad to see that you actually learned something in Econ 102 that turned out to be correct.

[OCinBuffalo]

Market forces and exponential technological growth are a remarkable thing. They drive down prices everywhere they are allowed to take hold. Medicine is not one of those places.

Margins is the problem. Health care doesn't have any. They can't afford to take risks, and God forbid they make a profit...which would give them the capital to take risks. Look at all the that has come from hospital mergers. Yeah, so if anybody actually makes enough $ to actually benefit from technology...they get excoriated...for making the money they need to do so.

 

I've had to contort myself in all sorts of ways to try to fit what we do into this space. In other industries? No problem. The upside? We've made some kickass stuff over the years as a result, and other industries can't believe we can charge so little for what we do. We've even not closed deals...because they thought we were lying. Health care too: A large Mid-Western State's VA system CIO told me "we just don't think you can do the job for as little as you quoted".

 

But, lack of money = health care has routinely attracted sub-standard IT people, and those sub-standard IT people have burned their clients more than a few times. I've heard lots of stories. It's very hard to get people to trust you in health care. Very hard.

 

Then? You have the big guys, like Cerner, GE, McKesson, who are essentially too big to care about making better things, and they themselves either don't have the margins, or, see the risk of real innovation as too great for the return. They'd rather put their $ into big ticket hardware stuff, and forget about doing software/process work. Some of these clowns are still running DBs from the 70s. Dumb, fat, and happy to collect their maintenance fees. That's about it.

 

Thus: little changes. It's become a vicious cycle.

 

We break it, with a jackhammer. But, we are just a small firm in a sea of incompetence. And, there's only so much we can do. I've looked into VC funding and the like, but, most of those guys want us to become GE v2.0. They don't yet understand my approach. Although, there is a group, supported by the big guys, that does get it. We're working with them...but I believe it's going to be a long haul to get the kind of funding I need to make a huge difference. I may be wrong. We'll see.

Edited January 8, 2014 by OCinBuffalo