brainiac conspiracy

Tinkering at the Margins

Sure, it's great that people with pre-existing conditions can now get health insurance. And poor people can now obtain quality coverage for reasonable sums of money. But the bigger, most overarching problem afflicting our system of health-care delivery is the fact that we are all paying way too much money for health care in America. The Goldberg Act doesn't remedy that. It just shifts the costs around.

---Baron V

Letting Go Of Goldberg

I've suspected for awhile that once Barack Obama leaves Washington in 2017 that Team Republican will quickly lose interest in the Affordable Care Act as a political issue. Their bankrollers in the pharmaceutical and insurance industries will tell them it's only gonna happen over their dead bodies, and if the law turns out to work effectively (still unknown if we are talking about cost controls), they will actually take credit for it, just like they've taken credit for working across the aisle with Clinton in the '90s; notwithstanding, you know, the I-word. It's really ironic that their party symbol is an elephant---an animal that, allegorically, never forgets---when these guys don't remember what they said 10 minutes ago.

---Baron V

Not Coming Back

I blogged about this a long time ago (you'll have to go fishing for it, sorry), but I've always suspected the employer mandate provision of the Goldberg Act that's been postponed until next year would end being postponed again and postponed again, and finally postponed forever. In and of itself, it's not necessarily a bad thing, because (1) some employers will still continue to offer coverage to enjoy the tax benefits, and (2) once people see for themselves how much their health care costs when they pay full freight on the individual exchange, it just might lead them to start demanding federal price controls---a necessary precursor to, yep, single payer. We can at least hope!

---Baron V

Goldberg Redux

I suppose there's a good reason why we should have a health-care system that's predicated on transferring billions of dollars from patients to enterprises that don't provide any actual health care, i.e., insurance companies, but I can think of one right now. Sure, the Goldberg Act makes this system a bit more equitable---and more affordable, if you're poor---but the fact that they've had to tinker with it so many times over the past four years seems indicative to me of the inefficiencies that are deliberately engineered into our needlessly complex and confusing system of heath-care delivery, and the Goldberg Act doesn't really solve this problem. It simply shifts the costs around.

---Baron V

Hard to Figure

I caught a little bit of this fracas on the TV last night---I switched the channel after two minutes; I can't stand shouting matches---and I wondered what the hell Chris or his producers were thinking when they invited that lying grifter onto their show in the first place. It's like Bill Nye "debating" the guy from the Jesus Museum over climate change when there's no debate to be had. Bottom line, grifters gonna grift. That's why we have Fox, and that's really where they belong.

---Baron V

Glass Half Full

Elaborating on the previous post, sure, there are plenty of people who have benefited from the Goldberg Act. I'm one of them! (Pro bloggers who come across this post, e-mail me and I'll provide all details.) On the other hand, the only reason why I'm one of the "winners" under O-care is because I've made less money every year for the last five years in a row, so I qualify for a generous subsidy. I'm grateful for it---as a man over 50 with two preexisting conditions---but all things being equal, I'd like to be working and making a lot more money again. Maybe someone would consider proposing a federal jobs program or a guaranteed annual income? We need them both!

---Baron V

They Own It

There's absolutely nothing that can be said or done to mitigate the fact that for a sizable segment of the populace, Team Democrat will forever be known as the party of feminazis and appeasers and welfare moochers and death panels. There is nothing---nothing---to be gained by running away from this. Better to embrace it, defend it, promise voters lots of free stuff, and dare the opposition to propose something better. You want to win elections, don't run scared. The zanies sure aren't.

---Baron V

What Ever Were They Thinking

I guess there was a compelling reason why we spent so much political capital, and mortgaged away control of the House of Representatives for the next ten years, so we could get a landmark federal health-care law passed. But the fact that they are still farting around with the mandates after four fucking years suggests---to me, anyway---that the law wasn't thought carefully through. There have always been workable alternatives, though!

---Baron V

Everything That is Wrong With Our Health-Care System

In one easy paragraph:

"The Affordable Care Act is great," said Dr. Patience White, a rheumatologist and vice president for public health policy and advocacy at the Arthritis Foundation. "Insurance companies now have to take people with chronic illness. But they have investors and can't lose money. That's the way American healthcare is."

Boom.

As opposed to, like, a health-care system that doesn't view sick people as profit centers to be mined but as patients to be treated. Maybe we should consider trying it sometime.

---Baron V

There's Been an Easier Way All Along

Wouldn't it have made a lot more sense to write a law where everyone with a Social Security number---and their dependent children---were automatically enrolled in health care instead of relying on 300 million individuals to spend countless hours comparison-shopping private insurance plans on the Interwebs and trying to figure out what kind of coverage they need? Health care is a complex and difficult issue, so it should surprise no one whatsoever if some people grow weary of trying to make sense of it all and simply say, fuck this shit, I'll pay the fine. If only we had discussed the better option.

---Baron V

No One Could Have Possibly Predicted

That Team Democrat would be blamed for every glitch in America's health-care system:

[T]here are deluded, angry, lying and sometimes totally justified constituents out there who are going to publicly confront Democrats for quite some time and these Democrats are going to have to have a strategy for dealing with it. They certainly can't demean or contradict these voters. So, what do they do? It's not a simple problem. And I don't have the answer.

I do. It's called "Medicare For All." Maybe the next time we have a Democrat in the White House and big majorities in both houses of Congress, we'd consider enacting it into law. It would certainly be preferable to constantly having to defend a piece of legislation that's easy to demagogue, difficult to understand, and which arbitrarily picks winners and losers based on age and income. Sure, it will, over time, make our terrible, overpriced health-care system slightly less terrible and less overpriced, but Team Democrat had to know that once they'd waded into the morass, they would be blamed for everything real or imagined that's been affected by the Goldberg Act. (Not to say they did know ahead of time; incompetence is always a possibility!) Besides being smarter policy, Medicare For All is smarter politics too since it puts the Republicans on the defensive by having to explain why we shouldn't be allowed to enjoy the same level of health care that our parents and grandparents do. At least we could discuss it!

---Baron V

Not Asking For Much

It's depressing that only 16 Senators would be willing to sign a letter asking the President not to propose future cuts to social-welfare programs. I mean, that's a little-ball policy proposal when what we need to be debating is how much we should increase/expand those programs instead of simply holding the line. Come to think of it, you'd think Team Democrat would consider using this as an issue against its opponents since, you know, that's where all this "entitlement reform" bullshit comes from, instead of trying to co-opt bad policy that voters despise. Just trying to be helpful.

---Baron V

World's Greatest Health-Care System

Not counting, like, all the other health-care systems:

Last fall, my mother asked me to come and see their general practitioner in Paris so we could plan ahead for my father. My mom got an appointment for the next morning and we walked to the office, five minutes from my parents’ apartment. We waited for a half-hour on a comfortable couch, chuckling over the very French selection of magazines on the coffee table (Elle and Vogue) and admiring the lush garden view. The waiting room was quiet. I realized what was missing: There was no billing department.

We spoke with the doctor for about 45 minutes. My mom wanted to know what would happen when my dad was no longer able to walk. “Oh,” said the doctor, speaking in English. “I prescribe a wheelchair and it’s delivered to your house. Shall I do it now?”

When I asked the price, she looked surprised. No charge. She asked if we wanted someone to come to the house every day and it was my turn to look surprised. What would they do? For example, someone could come and give my dad a massage to alleviate his neck pain. Again, no charge.

At the end of the appointment, my mom pulled out her French insurance card. Total cost of the visit? 18 euros.

When my dad began to get worse, the home visits started. Nurses came three times a day to give him insulin and check his blood. The doctor made house calls several times a week until my father died on December 1.

The final days were harrowing. The grief was overwhelming. Not speaking French did make everything more difficult. But one good thing was that French healthcare was not just first rate---it was humane. We didn’t have to worry about navigating a complicated maze of insurance and co-payments and doing battle with billing departments.

Other than the fact that our health-care system is overpopulated by unproductive middlemen who provide no health care despite extracting billions of dollars out of the system, is there any reason why we can't manage to do what the cheese-eating surrender monkeys have done? Just wondering.

---Baron V

They've Had Four Years to Get it Right

And they're still farting around with the Goldberg Act.

Snark aside, one suspects that the small-business mandate will be delayed again a year from now, and that the President's successor will get to decide how to implement it in 2017---if it ever gets implemented at all. But even if they don't delay it again, the fact that they feel as though they still need to tinker with the health-care law, at this late stage in the game, would tend to suggest that they really didn't think this thing through very carefully when they were crafting the legislation. There has always been, and always will be, a much simpler, more cost-effective alternative.

---Baron V

Rob Peter, Pay Paul, Etc.

Sure, the Goldberg Act is going to make our terrible, overpriced health-care system less terrible and more affordable for a good many people. Hey, it worked for me! But we should also remember that to accomplish this, it effects a massive wealth transfer from taxpayers to a bunch of corporate middlemen who don't actually provide any health care whatsoever but who simply extract rents. We could save billions each year if we cut out the middlemen, no?

---Baron V

Good Ideas Should be Contagious

I've always kinda wondered how the big pharmacy chains could ever justify selling tobacco products in their stores. (Same goes for liquor, come to think of it.) Sure, it makes money for them, but so would selling guns and ammo. I guess it comes down to the kind of message they want to send to their customers: "Buy smokes, go home, get sick, and give us more money for meds." Personally, if I ran the show, tobacco and booze would only be available at state-chartered "package stores" like they have in the Midwest. Yeah, it would make these products less accessible, but that's precisely the point.

---Baron V

Still Overlooking the Obvious

Elaborating on a post from earlier today, to be fair when we say the Goldberg Act will result in the "loss" of 2 million jobs, it doesn't necessarily mean that 2 million people will be handed their pink slips. Some people will choose to work fewer hours to qualify for a subsidy, and some older workers may simply retire earlier now that they know they can't be denied private insurance coverage. But as with any market-based system, there will be some losers---people in the upper-middle income brackets who will pay higher premiums, part-time workers whose employers will drop their coverage and force them onto the exchanges, and a few asshole job creators who will take advantage of the law to drop employee coverage altogether. But whether the financial burden is being borne by businesses, individuals or taxpayers, the law still doesn't address the most urgent and obvious problem: We are all paying too much money for a health-care system that mercilessly gouges us because it can. Fix that problem, and the Goldberg Act, by and large, becomes unnecessary.

---Baron V

Tweeting Gets Results, Sometimes

Amazing what a little online bitching can achieve, isn't it?

What couldn't be be accomplished in over six hours of waiting on the phone to speak to an Anthem customer-service rep, I managed to get done in ten minutes on Twitter. Are the Interwebs awesome, or what? In a way, it didn't much matter since in the interim I'd already contacted my bank and instructed them to stop any future payments that these awful people might try to drain out of my checking account. But either way, glad to see my experience was not unique!

---Baron V

Still Too Damn Expensive

A neighbor of mine suffered a health scare recently---heart attack symptoms that turned out to be a false alarm---and had to spend the night in a local hospital undergoing observation. When he received an itemized bill from the facility the next week, he almost suffered a real heart attack when he read the total: $14,500, of which his so-so insurance picked up two thirds and left him to handle the rest. It's kind-of the problem-in-microcosm with our insanely managed health-case system. Namely, everyone in the pipeline charges exorbitant prices, basically because they can. It's also the reason why the jury is going to be out on the Goldberg Act for some time into the future because it relies on the same "market forces" that created this problem to somehow correct themselves. Maybe they will and maybe they won't, but bottom line, you want to control health-care costs, you control health-care costs.

---Baron V

Welcome to My World

Make yourself comfortable!

[I]nterviews with doctors, hospital executives, pharmacists and newly insured people around the country suggest that the biggest challenge so far has been verifying coverage. A surge of enrollments in late December, just before the deadline for coverage to take effect, created backlogs at many state and federal exchanges and insurance companies in processing applications. As a result, many of those who enrolled have yet to receive an insurance card, policy number or bill.

Many are also having trouble reaching exchanges and insurance companies to confirm their enrollment or pay their first month’s premium. Doctors’ offices and pharmacies, too, are spending hours on the phone trying to verify patients’ coverage, sometimes to no avail.

“The system wasn’t really built to handle this kind of glut of new patients,” said Dr. Curtis Miyamoto, a radiation oncologist at Temple University Hospital who is president of the Philadelphia County Medical Society. “So it’s resulting in us having some delays in getting people verified, and therefore delays in their care.”

Here's my timeline: Applied for individual coverage December 7. Covered California requested proof of income on December 12. Documents were sent to them December 13. Officially enrolled December 21, at which time I was told that my insurer would be contacting me "soon." Insurer never contacted me, so I made my first payment online via the exchange on January 2. Received letter from insurer January 8 stating that they hadn't received my first payment; letter was dated December 18 (!). Since then, I've spent approximately three hours on hold over three successive days, waiting to talk to a Blue Shield representative, to no avail. In the meantime, of course, I had to refill a prescription, and since I don't have an insurance ID number because I haven't been sent an ID card yet, my pharmacy couldn't give me the standard co-pay price discount for my meds, even though I presented confirmation-of-payment documents, so I had to pay full freight.

It's now January 11, and still no insurance ID card. ("Nobody's gotten them," said my pharmacist.) At least I know my physician's in the network since I called her office and asked her before I plunked down for a plan. (Covered California told me she wasn't in the network for the same plan.)

Now, I'm not reciting this litany of headaches to start some pity party, I'm just saying that there are hundreds of thousands of people across the country like me who've tried to do the right thing and who have been rewarded with a nonstop string of bureaucratic snafus and fuck-ups. Yes, I'm sure things will smoothen out over time, but I'm only mentioning this because Team Democrat---you know, the party that believes that government can do big things!---is forever and henceforth going to be associated with this new regime, and that's why they really needed to make sure they Got It Right the first time. And obviously, they failed. Perhaps we'd consider simpler alternatives next time?.

---Baron V