HealthCare.gov what is wrong? - Page 2

[Reverend Jim]

Conversely, male-specific benefits was 0.

So prostate examinations and treatment for various disorders of same (enlargement, cancer, etc) apply equally to both sexes?

[deceptikon]

So prostate emaninations and treatment for various disorders of same (enlargement, cancer, etc) apply equally to both sexes?

Right now you've got cervical cancer screenings at no cost, for example, but prostate cancer is statistically more pervasive and fatal by orders of magnitude yet screenings aren't covered at all last I checked. Where's the logic there?

I have no problem with things like covered screenings, but isn't it more rational to focus on high risk conditions in general rather than saying what amounts to "women get a free pass, men gotta pay"?

[Reverend Jim]

My point was that there are conditions that are exclusive to both sexes. Aside from prostate problems, I imagine you rarely see women being treated for erectile disfunction. The insurance $$ all go into the pot for both sexes. Some goes for women's problems and some for men's and some goes for both. And has been said here and elsewhere, reproduction involves both sexes even if the more labor intensive (hilarious pun intended) parts belong to the women.

[Agilemind]

Almost always? More like always, unless science has invented artificial sperm.

I don't consider sperm donors obligated to the care for any children produced from their sperm (since after donation they don't have a say in how it is used). Although there are strong arguments both ways.

Right now you've got cervical cancer screenings at no cost, for example, but prostate cancer is statistically more pervasive and fatal by orders of magnitude yet screenings aren't covered at all last I checked.

1) I find it very hard to believe prostate checks aren't covered, since the latest research I read suggests many of the prostate surgeries in the USA are unnecessary - the cancer would have gone away by itself - because of the prevelence of screening. However, it might depend on the screening method. Generally PSA testing is a less reliable test so it is less likely to be covered than physical exam.

2) prostate & breast are far more comparable diseases with respect to incidence, prognosis and screening, where as testicular cancer is more similar to cervical cancer but testicles are much easier to examine & screen oneself than the cervix.

However, in general I agree. I don't think anyone should have to pay for best-practice medical care.

[mike_2000_17]

Insurance is based on the fact that the majority of insured persons won't use the majority of services they are insured for

That's one component of it. The other component of insurance is bargaining power. Technically, you could create a one-man insurance company, which would essentially amount to stuffing money under your mattress (figuratively), for the rainy days. But when you do get unlucky and need that money to pay for some medical care, you'll have to go around shopping for the best deal from one hospital to the next. The problem with that is that you have no bargaining power because you are a single individual and you are in a desparate state. In other words, they will be able to charge you almost anything they want, and indeed, they do.

Arguably, the single most important role that the insurer plays is to act as a force to be rekon with at the negociation tables (its force comes from its number of members), and is thus able to negociate much more advantageous prices for the care being delivered. By far the insurer with the most bargaining power in the US is Medicare, and this is why its far more efficient and low-cost than any competing private insurance company.

Last I checked, there were well over 100 benefits unique to women (that men are required to subsidize, recall). Conversely, male-specific benefits was 0. This is hardly fair, and I question half the population being forced to pay for things they couldn't possibly use (ever!).

It's not like we can ignore biological differences between men and women. As far as I'm concerned, making sure my neighbors are healthy and well is not conditional on their gender or on any special medical afflication they might have.

And also, as Agilemind pointed out (which you said you misunderstood for some weird reason), the care that women need in relation to their specific role in reproduction is as much in the interest of men as it is in the interest of women. Men's reproductive role is far simpler and lower maintenance, that's just reality, there's nothing sexist or "preferrential treatment" about it.

Oh, and also, women cost less to the healthcare system than men, due to their tendencies to visit the doctor more often, and thus, getting more preventive care and/or early diagnosis. So, if "counting the pennies" is the game you want to play, I don't think that men turn out the winners.

Finally, "fairness", in my opinion, is not a matter of balancing each other's tabs, down to the pennies. Fairness is not the product of an accountant's balanced checkbook. Fairness is about everyone functioning under the same morally-desirable principle, such as "pay according to your means, receive according to your needs". Things get unfair whenever either one of those sides are violated (people with lots of means that evade their responsibilities / don't pay their taxes, or people who receive more than they really need).

[deceptikon]

And also, as Agilemind pointed out (which you said you misunderstood for some weird reason)

I understand Agilemind perfectly. My difficulty was in phrasing my response. Did I make that unclear?

[Reverend Jim]

many of the prostate surgeries in the USA are unnecessary - the cancer would have gone away by itself

The reason is not that prostate cancer "goes away". The reason is that in many cases the cancer is so slow growing that the sufferer would usually die of other causes before the cancer becomes a problem. In many cases, treatment causes more problems than it solves, impotence and incontinence, for example.

[Agilemind]

That's one component of it. The other component of insurance is bargaining power.

Bargaining power is the basis of Unions and other associations and is not the primary purpose/goal of insurance. In reality due to the size of most insurance companies they have huge bargaining power as well but they are generally ill-suited to wield this power for their members because of their un-democratic structure.

[vmanes]

Not explaining why the thing has turned into such a huge blunder (getting back to the original topic of the website), but here's a perspective on the issue I found floating the interwebz

March 21st 2010 to October 1 2013 is 3 years, 6 months, 10 days.

December 7, 1941 to May 8, 1945 is 3 years, 5 months, 1 day.

What this means is that in the time we were attacked at Pearl Harbor to the day Germany surrendered is not enough time for this federal government to build a working webpage.

Mobilization of millions, building tens of thousands of tanks, planes, jeeps, subs, cruisers, destroyers, torpedoes, millions upon millions of guns, bombs, ammo, etc. Turning the tide in North Africa, Invading Italy, D-Day, Battle of the Bulge, Race to Berlin - all while we were also fighting the Japanese in the Pacific!!

And they can't build a webpage.

I've seen a memo from CGI to their govenrment handlers with tables of the issues and timelines - they allegedly didn't even start end to end testing till two weeks before rollout. Not a wise schedule, IMO.

[Agilemind]

You can't compare to WWII.
1) much of the victory was due to the other countries involved who had already been fighting for sometime.
2) all countries could see the war coming and had been preparing for many years prior to the beginning of the war.
3) most countries involved enacted special powers laws to give the gov't more power to force people to do things to get stuff done.

Part of the problem is government procurement systems are ill suited for technology. They generally require getting giving the contract to the lowest bidder and for large projects they require dividing it up among multiple companies. The point of these requirements is to prevent wasting tax dollars and preventing a single company having a monopoly which could lead to corruption.

But when this is applied to the technology sector it usually means the different parts don't work together properly causing huge amounts of bugs, and inadequate testing. Along with the general tendency of shoddy work and cost & time overruns which is seen in other gov't procurements.

[Ancient Dragon]

The point of these requirements is to prevent wasting tax dollars

Like the $500.00 hammers? Or like reroofing a bunch of buildings one day and tearing them down the next day?

[Reverend Jim]

The $500 hammer thing I can understand for two reasons

1. it's a way of giving yet more money to private companies in return for generous campaign donations
2. it's a way of hiding expenses for "off book" operations

AD - you are obviously opposed to the ACA. Can you explain to me how Republicans can claim to be pro-life and yet are willing to

1. defund SNAP
2. keep millions of Americans from receiving affordable, basic health care
3. loosen gun laws so that even more people die

And lest I forget, many Republicans would deny contraception (which would prevent unwanted pregnancies) to many. I guess pro-life means only from conception until birth. After that you are on your own.

[Ancient Dragon]

Can you explain to me how Republicans

Nope, I'm not Republican, although I have voted Republican presidents just as I have voted for Democratic presidents.

defund SNAP

Yes, because it doesn't work due to too many people abusing the system, I've seen it with my own eyes when I was a recent WalMart cashier for 5 years.

keep millions of Americans from receiving affordable, basic health care

What makes you think they already receive health care? Just walk into any emergency room in USA and you will see people who have no health care insurance.

loosen gun laws so that even more people die

No one wants to do that. Republicans are agains gun control, not deregulation. I favor some regulation such as banning assult weapons not because such regulations will magically remove them from the hands of criminals but because it gives law enforcement ammunition to arrest people who have them.

AD - you are obviously opposed to the ACA.

I'm not opposed to the idea of ACA, from what I've heard it is just a bad law. One father said of TV just this morning that it will cost him at least another $500.00 per month. Insurance companies have cancelled the policies of several million Americans, leaving them with no insurance at all. I don't know how anyone can say that is an improvement.

[mazharul41]

Yes, i am a professional engineer with IT related.

[Reverend Jim]

Yes, because it doesn't work due to too many people abusing the system

Republicans want to defund SNAP but they aren't proposing anything to take its place to help the people that need it. In effect they will cut off everyone in order to prevent abuses. I notice they increased agricultural subsidies. I guess there are no corporations abusing the system. I give as much credence to their claims of SNAP abuse as I do to their claims of voter fraud (the reality is essentially non-existent as opposed to their claims of "rampant")

What makes you think they already receive health care?

Reread my post. I didn't say they already received health care. I asked why they wanted to keep millions of Americans from receiving affordable health care.

One father said of TV just this morning that it will cost him at least another $500.00 per month

I see Sean Hannity had three married couples on to talk about how the ACA was going to hurt them. One couple claimed how it would hurt their construction business. They would have to restrict the hours of employees to keep them as part time because of the increased costs. They have only four employees and under the ACA, their only requirement is to make employees aware of the ACA website. There is no cost to do that so they are either lying or ignorant.

The second couple was paying $1100 a month for a policy under which one child was not covered because of a pre-existing condition. To get her covered as well would have increased their premium to $1900 per month. Under the ACA their insurance would be around $640 per month including both children.

The third couple said that Blue Cross was replacing their policy with a new one which included coverage for benefits like maternity, pediatric care, etc. that they did not need (their kids are grown). The new plan was around $10,000 per year. They said the ACA plan would be 50 to 75 percent more (as related by the Blue Cross agent). In actuality the ACA plan would cost the around $3700 per year.

I have to ask, if Obamacare is as bad as the Republicans say it is, why do they have to make up so many lies in order to discredit it? Surely the truth would suffice.

[Agilemind]

Yes, because it doesn't work due to too many people abusing the system, I've seen it with my own eyes when I was a recent WalMart cashier for 5 years.

Hang on one second.
1) Why would anyone abuse SNAP? - everyone I know who has had to got to food banks to get food because they couldn't afford it was ashamed/embarassed to do so, I'm guessing needing SNAP would be the same.
2) How would you being a WalMart cashier beable to tell if the people were abusing it or not? I doubt people bring their whole family or their tax returns to the checkout lane.
3) Even if this imaginary abuse is going on, and lets take it to ridiculous extremes: lets say everyone in the USA is on SNAP (aka having their food subsidized, like say when farmers & agricultural companies get federal subsidies). Why is that a bad thing? Surely having nobody struggle to feed themselves or their family could only be seen as a good thing. And its not like SNAP is can be spend on drugs or jewlery or other unnecessary luxuries.

Food is not a luxury item, regardless of what FOX/the GOP say.

[Ancient Dragon]

Why would anyone abuse SNAP

To buy booze, street drugs, and other things that are not covered under SNAP.

How would you being a WalMart cashier beable to tell if the people were abusing it or not

Because there is a list of items that people can get. If it's not on the list, then it can't be bought with SNAP (or WIC).

Even if this imaginary abuse is going o

Nothing "imaginary" about it.

Why is that a bad thing?

It's not a bad thing -- the bad thing is the abuse of the system, not that people can get free food.

And its not like SNAP is can be spend on drugs or jewlery or other unnecessary luxuries.

In theory, yes. In practice, maybe or maybe not.

[Ancient Dragon]

Here is a cute video I just found about ACA.

I have to ask, if Obamacare is as bad as the Republicans say it is, why do they have to make up so many lies in order to discredit it? Surely the truth would suffice.

I think everyone is just scared of unknown future. It might just be less expensive not to get any insurance and pay the small penalty tax. The USSC said the penalty is a "tax".

[Agilemind]

To buy booze, street drugs, and other things that are not covered under SNAP.

That would be corruption in the system. The presence of corruption is not an argument to eliminate a program it is an argument to find a way to prevent corruption.

And frankly some level of corruption will be present in any system which involves humans. The question should be how to optimize the program to keep corruption to a minimum without the cost of controling corruption becoming more expensive than the corruption.

[Reverend Jim]

You stated

To buy booze, street drugs, and other things that are not covered under SNAP.

and

Because there is a list of items that people can get. If it's not on the list, then it can't be bought with SNAP (or WIC).

So you first state that they are using SNAP to buy items that are not covered under SNAP, then you state that they can't buy items that are not on the list.

I think everyone is just scared of unknown future.

It would help if those opposed to it would give valid reasons instead of just making shit up. It's one thing for the public to speculate in a vacuum, but they aren't. The public is being flooded with lies from Republicans and the media who should be giving truthful information. I'll ask again - if the ACA is so awful (worse than slavery if you believe the rhetoric) then why is it necessary for the opponents to spread lies?

It might just be less expensive not to get any insurance and pay the small penalty tax.

How is it less expensive to have no insurance? It's only less expensive if you never need medical care. The number one cause of bankruptcy in the US is medical expenses. Let's say you have equity in a house and you get into a bad accident, or have a heart attack or stroke requiring extended care, possibly surgery. Kiss your equity goodbye. If you have no assets and you get cancer, how are you going to pay for the treatments with no insurance?

[Ancient Dragon]

The public is being flooded with lies from Republicans

You mean the lie that people who like their present insurance won't have to change it???

So you first state that they are using SNAP to buy items that are not covered under SNAP

Seems like a conflict, but isn't. Suppose I have a bunch of tickets to get free food then trade them to someone for drugs. Or suppose I have a good friend who is a cashier and gets him to give me unauthorized stuff for those tickets.

[Ancient Dragon]

How is it less expensive to have no insurance?

The penalty tax is soo low that it's not worth getting the insurance for some people. Here are the rules.

1. Year one: 1% of income or $95.00
2. Year two: 2% of income or $325.00
3. Year three and beyone: 2.5% of income or $695.00

Compare that with a $10,000+ policy.

how are you going to pay for the treatments with no insurance?

I agree with you that paying the penalty instead of buying insurance is a huge risk.

[mike_2000_17]

You mean the lie that people who like their present insurance won't have to change it???

The only people who would have to change their policy are those whose insurance policy is so terrible (not enough coverage, too much deductibles) that it doesn't meet the minimum standards set by the ACA. These people would be required to upgrade to a better plan since that crappy plan would disappear. And, a very important part of this is that if they cannot afford to increased price for the better plan, the state will subsidize it. Then, there are only a very tiny percentage of people who would actually end up having to pay more, and only those who can afford it. I have heard that the actual percentage of people affected in this way is less than 1 percent of the population. Even the right-wing media has trouble finding cherry-picked examples of people in that situation. Like this example of the disgruntled woman who complained she was forced to upgrade her plan, but then retracted that complaint when she was informed that the new plan would not cost too much more (after subsidies) and cover her far better (due to the minimal requirements / mandates).

Oh, and by the way, they just (today) anounced a provision to the law to say that if you want to keep your sub-standard coverage (i.e., not upgrade to a policy that meets the minimum requirements), you can do so. I doubt many people will choose that option once they actually get informed about the options that the ACA offers them.

Compare that with a $10,000+ policy.

A $10,000+ policy is not what the ACA requires. There are much more modest plans as well. And if you can't afford to pay for it in full, you get different levels of subsidies. I don't know how the exact calculation is made, but the point is, for those with very limited capacity to pay, the cost of the policy will range from 0 to a few thousands per year. So, the penalty tax is actually not very far from the minimal costs of basic subsidized healthcare plans. People would have to be really stupid to decide not to get an ACA plan and instead pay a yearly penalty (and be left with no insurance). And, of course, you cannot legislate on stupidity.

defund SNAP

The only real problem with SNAP is the fact that it such a program is needed in a "developed" country like the US. Most people on SNAP work full-time jobs, and still can't afford to feed their family. (I said most, not all, since there is abuse and partial employment) This is not surprising when the minimum-wage is so low that it cannot possibly be enough. The SNAP program is not welfare for the direct recipients, it's welfare for the companies that employ them at ridiculously low salaries. It's like the government is paying part of the salary that companies would rather keep for themselves, to serve their bottom line. Make minimum-wage a living wage, and much of the need for programs like SNAP will disappear.

[Reverend Jim]

How is it less expensive to have no insurance?

If you are going to respond then please respond to the comment in context. My point was that having no insurance is only cheaper if you don't get sick or injured (as you point out later on). The same thing for fire insurance on your house. It's only cheaper to have no insurance until your house burns down. Then you are pretty much screwed.

You mean the lie that people who like their present insurance won't have to change it?

I agree. That was a lie. But when you compare lies on both sides then that one is pretty tame. Especially since there was no way to know that the insurance companies would respond by cancelling policies. Obama also said that you could keep your doctor. Obviously that is not true if your doctor refuses to treat you or if he (or she) dies. That's not any where near the scale of "government death panels".

I saw a news item today that said someone was offering a free application similar to LOIC (low orbit ion cannon) to anyone who wanted to launch a DOS attack on the ACA websites. Like Republican controlled states that wanted to make it illegal for your family doctor to even make you aware of the ACA, this just reeks of desperation. Again - if the ACA is so bad then just present people with the facts and let them decide. Instead, the Republican response has been to keep the public stupid and scared.

[jwenting]

Lowest bidder.

if only... The contract was granted to "the correct party" which was a company headed by an old college friend (of the correct skin colour of course) of Michelle Obama, which just happened to be a large campaign contributor to the Obama campaign.
A company with an international record of failed websites just like healthcare.gov.

[jwenting]

Especially since there was no way to know that the insurance companies would respond by cancelling policies.

right... There was no way to know insurance companies were going to cancel policies if they were forced to do so because those policies were not in line with the ACA diktats...

If you're providing coverage beyond what ACA allows, at a price above what ACA allows, and now you're told by the ACA that you have to lower the price but aren't allowed to reduce the coverage, you as a company have but one option: cancel the policy.
The alternative would be to offer the policy below cost, which would hurt your business.
What kinda does surprise me is that not more insurance companies offered customers ACA compliant policies in exchange for their previous policies as a company policy (when a similar change happened here insurance companies did just that).
Maybe many of them left the health insurance industry, I don't know, but that could well be the reason.

[Reverend Jim]

There was no way to know insurance companies were going to cancel policies if they were forced to do so because those policies were not in line with the ACA diktats

Policies that were in effect when the ACA was enacted were grandfathered in. At that point the insurance companies were informed as to what would be required for any new policies. Knowing this, the insurance companies created new policies, after the passing of the ACA, with the full knowledge that these policies would be invalid once the ACA came into effect.

If you're providing coverage beyond what ACA allows, at a price above what ACA allows, and now you're told by the ACA that you have to lower the price but aren't allowed to reduce the coverage, you as a company have but one option: cancel the policy.

The ACA does not force insurance companies to lower their prices. What it DOES do is provide a way for people to get the same or better coverage at a cheaper price. And what, exactly, do you mean by coverage beyond what ACA allows? The ACA certainly does not tell any company that their policies provide too much coverage.

[mike_2000_17]

If you're providing coverage beyond what ACA allows, at a price above what ACA allows, and now you're told by the ACA that you have to lower the price but aren't allowed to reduce the coverage, you as a company have but one option: cancel the policy.

I'm afraid your understanding of the ACA is literally completely the opposite of what it is in reality. In a nutshell, the ACA sets a minimum bar for the insurance policies, but only on what the policies provide, not how much they cost, that is completely up to the insurance company (which is why the insurance companies absolutely love the ACA). Then, it requires everyone to get insurance (the "mandate") at least reaching that minimum bar, but if they can't afford even that insurance, the government will provide the necessary financial assistance to be able to afford the minimum insurance policy. Then, it gets rid of "pre-existing conditions" as an excuse that insurance companies have used for decades to either refuse to insure someone, or retro-actively cancel their policy the day they need it (get sick). There are a few other goodies, but that's the main parts of it.

Many progressives (including me) would criticize the ACA for being too much of a hand-out to the insurance companies (the mandate + government assistance is a big pay-out for the insurance companies), and the fact that there is no price control or competition. Allowing everyone to buy into Medicare if they so wish would introduce real competition in this market and would drive prices down significantly, but that option was taken off the table in haste by Obama because it did not please his main campaign donors (Wall Street and private insurance companies).

But one thing is for sure: ACA does not put a cap on what is "allowed" in insurance policies, and it does not dictate prices for the policies. Whoever told you that is either grossly misinformed or deliberately trying to deceive you.

[JeffGrigg]

Here's a pretty good summary of how the project looked to its leaders before it went live: analysis by McKinsey & Co Looks like a mismanaged and largely doomed project to me.

[JeffGrigg]

Obamacare Consultants Warned of Website Failure in March

See slide 5 of this presentation.