Will delays pose a big problem for Obamacare?

“What, me worry?” could pretty much characterize how Obamacare supporters are reacting to the news that the administration is delaying or modifying the implementation of some of its requirements.  Like Alfred E. Neuman, they are expressing a public confidence that there is no reason to worry, everything is fine, the announced delays aren’t really that important, and Obamacare will be up and running and ready to start enrolling people on October 1.  No worries.

“The sky is falling” could pretty much characterize how Obamacare opponents are reacting to the same news.  Every decision that the administration makes to delay any part of the law’s implementation is used by opponents to argue that the whole thing is falling apart and the only solution is to repeal the entire law.  The sad reality is that Obamacare supporters and critics are worlds apart in their reaction to the delays, just as they have been on just about everything having to do with this law.

So what is really going on with the delays? 

The administration postponed for one year a requirement that larger employers (those with 50 or more full-time employees) provide their employees with health insurance or pay a fine.  The White House characterized the delay as being responsive to businesses concerns by giving them an additional 12 months to comply with the requirement but insisted that, “We are full steam ahead for the Marketplaces [health exchanges] opening on October 1.”

Whether you think delaying the employer mandate was a good idea or not, and no matter what you may think it bodes for the rest of the law being ready on October 1, the fact is that the delay will have a very small impact on how many people will get coverage under Obamacare.

Timothy Jost writes in the Health Affairs blog that, “As a practical matter, most employers subject to the mandate already offer insurance.  The mandate only covers employers with more than 50 full-time or full-time-equivalent employees.  Ninety-eight percent of employers with more than 200 employees offer health insurance, as do 94 percent of employers with 50 to 199 employees.  The vast majority offer insurance that is both affordable and adequate, as those terms are defined in the ACA.  All of the reasons employers now have for offering coverage to their employees — significant tax subsidies, recruitment and retention of employees, and increased productivity and decreased absenteeism when employees are healthy — will continue to exist without the mandate penalty.”

In addition to the employer mandate delay, the Washington Post’s Sarah Kill writes about “three Obamacare delays you haven’t heard about relating to verification of consumers’ claims that they do not have health insurance coverage, scaling back federal oversight of what people say they earn, and requiring state Medicaid programs to send out electronic notices on benefits and subsidies to beneficiaries and applicants. Kliff writes that the “upshot of this delay is that you could see some people who shouldn’t qualify for tax subsidies, because of their employer-sponsored insurance, getting them anyway. This wouldn’t be unprecedented: During the initial roll out of Medicare Part D, some seniors who should not have received low-income subsidies got them anyway.”

And, finally, the administration announced that smokers will get a one-year reprieve from an ACA provision that allows insurers to charge smokers more than non-smokers because of a “computer system glitch.”   The result, the report continues, is that “older smokers are more likely to benefit from the glitch, experts say. But depending on how insurers respond to it, it’s also possible that younger smokers could wind up facing higher penalties than they otherwise would have.”

Each of these delays — and there likely will be more — do not fundamentally affect the big changes that Obamacare will bring later this year and next; the health exchanges (marketplaces), community-rated health plans, tax credit subsidies, individual insurance requirements, prohibiting annual and lifetime limits on coverage, requiring insurers to accept all applicants without regard to their health status (pre-existing conditions) and limiting how much more they can charge them, all of these appear to be on track to be implemented on time.

So, an accurate, non-political, non-partisan, non-ideological take-away from the Obamacare delays announced to date is that most people who were expected to  benefit from the Affordable Care Act will still benefit, including the uninsured and under-insured and people with pre-existing conditions.  The administration is putting off the requirements that are less important, so they can focus on, and devote the limited resources that Congress has given them, to ensure that the changes that are most critical to expanding coverage—the exchanges, the subsidies, the Medicaid expansion, the consumer protections against insurance practices that limit coverage—are implemented on time, and effectively. This may or may not be good politics on the administration’s part, but triaging the requirements was probably their only practical recourse.

Are there delays that would pose a big problem for Obamacare?  Yes, any delay relating to the following would be a big reason to worry:

  • If the federal exchanges and state exchanges and information hubs are not open for business on October 1 and ready to enroll people on 1/1/14
  • If navigators and call centers are not ready to assist consumers
  • If the treasury department isn’t ready to administer the subsidies

The administration insists all of the above will be ready, but no one can be sure until they actually are up and running.

Then, of course, there is the one big delay that already is in effect, one that is outside of the administration’s control, which is the Supreme Court ruling that the Medicaid expansion is optional. The refusal by some states to delay or reject the Medicaid expansion will result in 2/3 of low-income persons who were supposed to get Medicaid under Obamacare being left out in 2014, according to an Associated Press analysis.  Now that is something to worry about!

So the sky isn’t falling on Obamacare, no matter how the critics try to parlay the decisions to delay some parts into an admission that the whole law is unworkable and should be repealed.  Yet I wouldn’t exactly say that there is no reason to worry, either, since it is apparent that the administration is struggling to get the big pieces implemented on time and as effectively as possible, given the funding limits imposed by Congress, conservative state resistance/non-cooperation, and the unrelenting efforts by critics to do everything possible to make it fail.

Bob Doherty is senior vice-president, governmental affairs and public policy, American College of Physicians and blogs at The ACP Advocate Blog.

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  • Ron Smith

    Icing on a mud pie. The ACA is, to use a current cliche, a train wreck. As you recall the problem with Chicken Little wasn’t that the sky wasn’t falling…it was that no one was listening when it did.

    Ron Smith, MD
    www (dot) ronsmithmd (dot) com

  • GT

    The wheels are falling off Obamacare, one by one, and yet the porters and lackeys are crying “Nothing to see here! Move along! Everything’s just fine!”

    Methinks Bob Doherty is the Baghdad Bob of Obamacare.

    • SarahJ89

      But it’s pretty clear several of the wheels have been deliberately removed. In my state the agenda has been to do whatever is possible to prevent success. How the heck does that benefit me as a taxpaying patient???

      • artful

        Is that as a state or federal taxpayer? Where do you think the subsidy money comes from? If your state accepts Medicaid increases do you think your taxes stay the same when healthcare is 20% of GPD and going up?

      • querywoman

        Do you have health insurance now? If your income is up to about 200% of the poverty level and you are not poor enough for Medicaid, I suspect you will be paying more if you buy a new health care policy.

      • EE Smith

        That’s one of the problems with the Feds trying to direct what is constitutionally a State issue.

        If individual states wanted universal healthcare, they were always free to bring it in – as Massachusetts did. But if they don’t want to, the Constitution has a lot of protections for individual states against Federal meddling.

        If you want your state to provide universal healthcare, you should lobby your state legislature for that.

      • EE Smith

        And I will add, the things that the Federal government has delayed/postponed, are solely the Feds’ problem.

  • buzzkillerjsmith

    It is funny that people are spinning this one way or other when the experiment will be done soon. And there is no way to significantly increase the supply of health care providers in the next few months, so even if we knew what would happen we would not be able to do much about.

    • https://www.facebook.com/arobert6 Alice Robertson

      Well.well….such pessimism needs addressed:) They could expedite the care panels and so severely limit their budget and offer ACO/HMO like bonuses to the panel …..and on top of that look at all those harvested organs they could get to help others. Now…now…Buzz Dear….have some more faith in your government and their vision for all those worker bees:)

    • morebuzzkills

      What I find even funnier is that this piece has only 10 comments (including mine). I seem to recall that a piece a while back about women shaving their pubic hair had many more comments. Makes you wonder who is reading this blog…or at least who is commenting on it.

      • querywoman

        Look buzz boy, I don’t know who you are, but I assume you were probably conceived the normal, natural way, and not merged in a petri dish. Lots of people are interested in sex! As a doctor, you should know that! Human attractiveness is a much more important issue than trivia about how to pay for health care!

      • buzzkillerjsmith

        Uh, I commented on the previous piece.

        • morebuzzkills

          Oh come on buzzkiller, your comments are almost always meritorious or funny. I’m not condemning comments on the pubic hair post…just stating an observation. However, my barometer of number of comments on an article is quickly evaporating with querywoman. She’s even responding to her own comments on this thread! Would that be called responding to internal [internet] stimuli in psychiatry?

          • querywoman

            Hee!

  • Anthony D

    If you can use Google and do some basic research you will find out for
    yourself just how bad it is and come January 01 just how much worse it
    is going to get.

    But to get you started, a 2700 page bill backed by 13,000 pages – and
    climbing – cannot be good. Add in the IRS who is going to be handling
    the enforcement of Obamacare….what could possibly go wrong!

  • Anthony D

    So, Obama creates the ObozoCare problem, then for purely political
    reasons delays it for the purpose of securing votes for his party. Even
    if you like Obama, this should make you stop and think, not just blindly
    drive on.

  • Anthony D

    You’re 20 something, poor, have kids but want no health insurance for them?

    Then the government swoops in and gives you:

    Free food (paid by the working citizen)

    Free money.

    Free healthcare.

    Free or super cheap housing costs.

    Free phones.

    Free public transportation.

    Free school meals.

    Free higher education

    Free, free, free. Time to enroll in “Why am I bothering to work to support all these Leeches”

    • querywoman

      Yeah, when I worked in welfare I saw this. Nevertheless, it’s mostly people with children who get ALL the good stuff. The rest of us, forget it!
      I don’t know the answers.

      • querywoman

        In theory, the government provides resources like training to help welfare mothers get off the dole. Some take advantage of the programs; some don’t!
        People without kids can sometimes get free education, a picayune amount of food assistance when their income goes low enough, and sometimes wait out long housing lists! A lot of them don’t know about the free cell phone or subsidized landline programs.
        But most government works programs are about school! It’s been criticized, rightfully so, as training for nonexistent jobs.

        But wow! In January 2014, and hopefully before them, there will be plenty of insurance jobs added!
        I hope what I have under Medicare stays relatively stable, and doesn’t get befuddled more along with these new wacky insurance setups!

        • SarahJ89

          Here’s what happens in my state with these “training” programs (note: I’m a retired welfare worker): They open with great PR fanfare.

          Within months they are quietly eviscerated. The first thing to go is higher education. What you end up with is short-term, basically useless on-the-job training that only benefits employers.

          I live in a state heavily dependent upon tourism. So what did our much-vaunted “training to get them off welfare” program provide–once they cut out the meaningful college pathways, of course? A six-week OJT in “hospitality”–waitressing.

          So the entire county got subsidized for the tourist season. The large hotels got free labour. The very poor living in our chronically high unemployment county got a season of dead-end employment. Come October everyone was as unemployed and as unemployable as ever.

          And the women who refused to be content with this shell game, the ones who demonstrated in protest when their nursing programs were cut in mid-stream, what happened to them? They were denigrated by one and all as “free loaders” who “want something for nothing.”

          The welfare program is a cash cow for the middle class and provides a nice subset of whipping boys to make the rest of us feel superior. I’ve been on both sides of the desk.

          • querywoman

            Around here, they train people mostly to be child care workers, teacher’s aides, low level computer something or other, etc. Seems like there is a 4th common category.
            The US economy goes in 30 years cycles. LBJ had a booming economy, and so did Bill Clinton.
            When Clinton was in office, a lot of welfare recipients got jobs. They have since lost them.

          • querywoman

            Beauty school or barber school is the 4th category. One can make a living at that, but won’t get rich, and usually has not insurance.

      • PoliticallyIncorrectMD

        How about waiting to have children until one can afford to care for them?

        • querywoman

          I never got to have children. Nevertheless, all of us were helpless children once, and birth control is a new entity.
          So is longevity, such as living past 30 years old and not losing several kids as babies or children.
          The United States is a land of plenty. We’ve got resources all over the place, but a distribution problem.
          And the real poor, the zero income types, are so used to having stuff paid for them, that when they get a real job or other income with real money, they don’t think they should have to spend those dollars for things like food, rent, and utilities.
          I get Soc Sec. Whoever you are, if you have a private office, you pay your utilities the exact same way I do: you put a little money back and save it for your utilities.
          Most doctors aren’t so moneyed that they can’t blow all their money, and many of them do just that!

  • azmd

    I personally have no dog in the Obamacare hunt. If anything, I benefit because the patient population I serve will be more broadly covered by Medicaid. However, I deplore the ACA on two counts.

    In the first place, it introduces even more layers of bureaucracy to a healthcare system which is already so bureaucratized that most of us spend more time each day massaging charts and doing paperwork than we do actually caring for patients.

    What our country needed, but was not ready for, was a single-payer system. So in the second place, I deplore the expenditure of huge political capital that went into pushing the ACA compromise through, when it could have been better spent pushing through meaningful jobs programs.

    • querywoman

      Do you limit Medicaid patients to a percent of your practice? I do believe most doctors lose money on Medicaid patients, but not on Medicare.

      • azmd

        I am a government employee at a public hospital. When I get a Medicaid patient, my social worker and I celebrate, because the alternative is generally for the patient to have no insurance at all.

        Of course, my own compensation is not affected one way or the other, since I am on salary, but it makes it much easier to arrange ancillary services if Medicaid is in place. And the vast majority of my patients are in dire need of those services, since they are chronically mentally ill.

        If I were in private practice I would absolutely lose money on Medicaid patients. Also on Medicare patients.

        • querywoman

          I saw somewhere else that you were a government doc.
          Do your patients have to wait hours for an appointment?
          In theory, it would be really nice if the lower income folks no longer had to wait for care at medical schools and public hospitals and could just get an appointment with a private doc.
          I do not see that happening in the next five years!
          Yes, money from other sources chips in for your current salary. So, Medicaid patients are often best served in setups like yours, and you will still need patients.
          Many are accustomed to going to med schools and public hospitals, and will just stay there.

    • buzzkillerjsmith

      I read an article by Ofri on Slate that said docs spend 40% of their day on the computer and 12% with pts. Perhaps physiology should be replaced with a typing course.

      • azmd

        I am sorry to have to say that these days, the most useful part of my expensive and time-consuming education is the typing course that I took in my freshman year of public high school. Sad, but true.

  • Tiredoc

    Hahahahaha!!!

    I just today tried to get a Medicaid patient of mine a gastroenterology consult for a 5 point hemoglobin drop in 3 months. The only gastroenterologist in town who still accepts Medicaid’s earliest appointment is December. What good is insurance without providers?

    Besides, all of rearranging of deck chairs on the HMS Obamanic won’t change the fact that there isn’t the money for it. When Canada passed its healthcare takeover, they included a hefty sales tax to cover the tab. There were supposed to be two bills, remember? Obamacare and the carbon tax.

    • querywoman

      Are you close enough to a medical school? That’s who would do ‘em where I live.
      Maybe your county would buy your patient a bus pass to a medical school! That’s what they used to do in Texas – get ‘em a pass to John Sealy in Galveston.

      • Tiredoc

        We have a medical school in our town, but no gastroenterology fellows. Like most medical schools, they don’t compare in efficiency to a private practice and it’s a time-consuming pain to get a referral actually through.

        The cachement area for my city is about 600,000 people. Poor people. The only Medicaid PCPs left are the county health clinics, with patients up to their eyeballs. And we’re in a state that hasn’t signed up for the Medicaid expansion.

        And, our state rules don’t allow doctors who don’t take Medicaid to write prescriptions for Medicaid patients, so patients can only go to Medicaid docs unless they want to pay cash for their doctor visit and cash for their meds. Unlike Medicare opt-outs, there’s no safety valve at all.

        It’s a nightmare.

        • querywoman

          Yuck! The new Affordable Care Act won’t change that a bid.
          In my area, we have several large medical complexes with all kinds of specialists attached.
          The church hospitals probably have programs to get charity cases in with their specialists in their clinics.
          In your case, a bus pass to a more fully staffed medical school actually sounds like a better solution!

          • Tiredoc

            I already do that for cardiac surgeries, spine surgeries, odd orthopedic cases and that was fine. But gastroenterology? I send more referrals to GI than any other specialty. If the whole state is this way, then I’m fighting every other doc in the whole state for slots for my patients.

          • querywoman

            Well, maybe you need to be quit being a magnet for tummy patients!

        • querywoman

          If you could find some kind of specialist to see her on some charity program, would you comfortable writing up the suggested meds?
          Medicaid has always limited the poor.
          In my area, most of the private Medicaid docs are awful, except for the ones who accept only a small percentage of Medicaid docs. The private Medicaid docs with heavy Medicaid practices find additional ways to make money off these unfortunate souls.
          The public clinics are usually the best place for the Medicaid patients.

          • Tiredoc

            We do have a charity clinic that is well staffed with all kinds of specialists that work for free, but doesn’t take Medicaid. I will see if they’ll take Medicaid patients for cash. I usually write all of my patients’ medications anyway. One doctor, one medication list, one pharmacy works wonders for compliance.

          • querywoman

            Could you cook up for a reason to send your patient to the ER that serves the med school? Then have the patient tell the docs there about her problem. Even though they may not have a gastroE, perhaps they have an internist who specializes in it.
            Locally, if the ER writes “next appointment available,” it takes months to get a patient in with a specialist at the county hospital. What the ER needs to write is, “See as soon as possible.”
            Tiredoc, whoever you are, you do care about your patient.
            A charity buying a bus ticket to a bigger med school might help, but there would probably be a wait there too.
            You may not be comfy prescribing chemo or a Conrad Murray cocktail, but maybe someone else will find the right drug within your scope.

          • Tiredoc

            Thanks for the support and advice. The patient has moderate to severe COPD and cirrhosis. I’ll call up our local liver academician and try to convince him to take her on on the basis of possible esophageal varices.

            I don’t give chemotherapy in my clinic because I won’t do buy and bill. The same issue prevents me from prescribing the new RA injectables and MS drugs. Everything else is just one more PA and good communication with the other treating docs and the patient.

            As for the Conrad Murray cocktail, if someone paid me $100K/month to watch them sleep, I think I’d invest in a Texas cath and an astronaut undergarment. I sure wouldn’t leave them unattended and anesthetized.

          • querywoman

            Anesthesia is one of the most dangerous things you guys do! No one does it alone in a hospital where the doc or nurse anesthesia person knows a whole team of people and equipment are close at hand.

        • guest

          You better get out of dodge. That sounds hideous.

    • SarahJ89

      Um, we could stop invading small countries. That would free up a ton of money.

      • Tiredoc

        Defense budget for 2013 $525 billion. Average ACA projected subsidy $5250. If 100 million households sign up, ACA cost for the year exceeds the entire budget for DOD. The projected revenue for cap&trade was 500 billion dollars/year.

        • querywoman

          This kind of economics I just don’t understand!

        • Alejandrina N

          Your country only has 100 million households, and many of them already have insurance.

          • Tiredoc

            Many households have more than one insurance. This includes households with one adult and children. And there is no reason to presume that any insurance policy extant now will exist next year.

    • EE Smith

      If we passed a “carbon tax”, it would end up either being revenue-neutral or actually costing us money, since we’d then have to compensate low-income and middle-class families who’d be most hurt by it. That was Australia’s experience with it.

      • Tiredoc

        I’m not advocating a carbon tax. I’m just saying that the Democrat’s carbon tax was intended to pay for the planned cost overrun for the ACA. For the record, I think both of the bills were odious.

        ACA is going to be an order of magnitude more expensive than anyone is predicting. The political class believes they will have time to see which was the cost winds are blowing. They probably won’t. It’s entirely likely that by this time next year, the only people that will have the same insurance that they do now are those on Medicaid or traditional Medicare.

        In the end, it isn’t going to be about politics, or ideas, or principles. It’s going to be about money.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    I would suggest that Mr. Jost who writes for Health Affairs takes a job with Walmart or McDonalds and lets us know how “affordable and adequate” the health insurance “offered” by his new employer really is.

    • https://www.facebook.com/arobert6 Alice Robertson

      The health exchanges are crappy too, even the cheapo Metallic plan that comes with a 90% discount (taxpayer subsidized) but huge deductible and terrible payment plan is unaffordable.

      The government has made a mess of Medicaid and Medicare and to expect the Obama administration, or the AMA, or AARP bed partners or the liberal healthwonks to offer something better is downright delusional.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        I really don’t get the entire exchange thing, but that’s a different subject.
        As to liberal solutions, we sort of had one which says that we should abolish all these hare brained “equal but separate” insurance schemes… Unfortunately our elected “representative” in chief decided to embrace a Heritage Foundation plan that he campaigned against… Go figure…

        • https://www.facebook.com/arobert6 Alice Robertson

          That was curious but I am not convinced he embraced it. I am all for the free market but at times the AMA and AARP, etc. don’t feel like a “free market” just as legislators leaving office richer than they went in feels too much like legal inside trading. It just feels like a hijacked game of Monopoly where the rule booklet keeps getting changed depending on the player and right now it seems the only ones who won are the bureaucrats with the mostly government paid for healthcare plans that are really just marvelous. Like a judge they need to recuse themselves or try living in one of their own buildings for awhile:)

          • Trina

            My mother managed the kitchen at a boy’s home, and she required everyone working in food services there to eat in the mess with the boys. Her point was that you can’t feed the boys something — some kind of awful slop — that you yourself wouldn’t eat.

            The politicians and government bureaucrats who cooked up Obamacare should be forced to eat their own cooking too!

        • querywoman

          Didn’t the young Barack and Michelle work for insurance companies?

      • querywoman

        Thanks, Alice. I just took my first real look at a new Metal plan. Horrid! I still think that they are not mandatory, and that the lower to middle classes won’t buy them.
        The uninsured upper middle class will

      • querywoman

        Well, isn’t it being farmed out to private insurance companies, new and old? This is a Republican way of handling things, voucher it out!
        Does anyone trust private insurance companies?

    • Trina

      Well it really shouldn’t be an employer’s role to provide health insurance for his or her employees anyway. Individual citizens should be out on the market selecting and buying their own health insurance, just as they do with home and auto insurance. And some sort of subsidies should be provided for the poor, so that they can do the same.

      De-couple health insurance from employment completely.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        I completely agree that employers have no business managing people’s health or health insurance for many reasons, not least of all being that said employers do not provide either affordable or adequate insurance to their low wage employees.

  • querywoman

    My first attempt to enroll in Medicare D failed. Then I got enrolled. The drug insurance provided failed to take premiums out of my SS check for about 5 months. Then the SSA docked my check for about 5 premiums, though their own policy says they can’t do that for more than 3 premiums at at a time.
    I had a problem with my Medicare D plan last year. Got a silly answer. Just had the same problem with my meds this year. I got what I think is the real answer a few weeks ago.
    Why bother to complain? The Medicare D program is an administrative nightmare! Complaining might make it worse.
    So when the new supposedly universal health insurance plan kicks in for all next year, well, I dare not speculate on the administrative snafus. I predict it will take 10 years to smooth them out.

    • querywoman

      Okay, I looked up her plan online, AARP Medicare Secure Horizons HMO online. Of course, the provider directory is available online, but I only saw a Spanish link. I read Spanish.
      So the first cr@pstomer service rep couldn’t look it up without my friends subscriber. In the time it takes me to type this, I could be typing a letter to the state insurance board about my failure to get info on the phone.
      Is it worth it? The insurance company is probably lucky to have any employees!
      Then I wanted to know how often the PCP could be changed. I could not find that online.
      So I called the enrollment info phone. Of course, the rep wanted to know who I was, etc., so she could sell me the plan. I made up a pseudonym then I got sick of being drilled. I told her I just wanted to know how often the PCP could be changed.
      It could be changed at anytime, and goes into effect the next month.

      • southerndoc1

        You do understand that all the insurance plans you’re complaining about are run by non-governmental, generally for-profit corporations?

        • querywoman

          Yes, of course! The Republicans love to stimulate the economy by giving jobs to private companies since government employees are so incompetent.
          I have seen many incompetent public employees, but private insurance employees are dumb and dumber! And dumber!
          After talking to the insurance company goons, I called Medicare to see when she could transfer out of her Medicare HMO. Okay, so I shouted in the the Medicare phone intro to navigate the voice recognition system, and somehow I got a real person.
          The Medicare rep wanted to know her SSN to see if she was eligible for special programs. My friend didn’t want to say it in a public place; a lot of older people are very particular about that.
          I told the Medicare rep that she is not, that she is too high income.
          So the M-care rep said open enrollment is November 16-January 31.
          It was much easier to talk to M-Care than the private insurance.
          So, I don’t even have to look into a crystal ball to see what will happen come January 2014.
          Private insurance companies will sprog like female rabbits. They will half-train employees. The new insurance company phone reps will promise callers the moon, stuff ‘em full of misinformation, then fail to enter the enrollment info properly in the computer and/or do the right paperwork. Then the new allegedly insured person will be shocked when her or she has no insurance!
          It might be better to hire some ex-cons for these new insurance jobs than chronic welfare recipients. Some ex-cons can plan and scheme and think!
          Whoopee! Fun! Fun! Fun!

  • querywoman

    Today I called a friend’s Medicare HMO for her to see if one of my doctors was on her plan. The first insurance cr@pstomer service person told me she just had to have my friend’s subscriber number and verbal permission to access the provider list because of HIPAA laws.
    Ha! I got her name and may write that up for the state insurance board. My friend was sitting right across from me and would have given verbal permission, but I didn’t want her to.
    I called right back and got another rep and said, “Oh, my friend has your insurance plan and it works so well for her that I wanted to see if one of my docs is on the list.” She referred me to the website, but I pressed, “Can’t you just look up this one doc for me?”
    She asked for the subscriber number, which I did give her but did not put my friend on the phone. The doctor was on it.
    I never heard of an insurance company not being able to access a plan provider list with just the group number!
    It will get worse, folks! Imagine all the new cr@pstomer service personnel to whom the new Affordable Care Act will give jobs.
    Oh yeah, let’s get those people off their rumps and give ‘em jobs!
    The circle of life, indeed!

  • guest

    My biggest concern is that these plans are competitive with other existing plans and don’t add on more bureaucracy. I sure hope they don’t make it like medicare and that PCP’s sign on as providers( again unlike PCP with medicare).

    • querywoman

      Duh? It will add layer after layer of bureaucracy. The Medicare drug plan is still an administrative wasteland. The Affordable Care Act is adding a much larger group, if people buy into it.
      Never fear! Perhaps the federal government will go out of business in mid-October when it hits the debt ceiling.
      We’ve heard that before.

  • artful

    You missed the BIG ONE Bob: with 30 to 45 million new Medicaid patients and 4 million new “boomer” Medicare ones each year, which include physicians and nurses retiring; where do we get the required providers?
    Canadians must be getting ready to tell American Healthcare jokes!

    • querywoman

      I think the providers are already there. A lot of the lower and middle income people use public or sliding scale clinics. They also go to places like urgent care centers and get a lot of $4 meds.
      If they didn’t, our life expectancy wouldn’t be so high.
      We shall see!

  • Dorothygreen

    Physicians need to help get the US to a health care system like Switzerland. That would at least cut costs up front and stop the continued fragmentation of services:doctors for direct pay, concierge services, refusal to accept Medicaid because it wouldn’t exist and most of the inequities inherent in our health care hodgepodge.

    No country has absolute equal health care for its population and none are perfect. But Switzerland’s model is basic insurance coverage mandatory for all and subsidizes insurance not direct care. Insurance subsidies are not embedded in the exchange – they are provided separately by the government, making it very easy without the need for all the navigators and such.

    Prices for basic insurance, physicians services, hospitals, pharma, equipment, and lab (and probably any other players are negotiated with the government. This is key to lowering costs. This is part of all health care systems. Lack of it in the US (except for Medicare and VA) is what will continue to keep the US from having a bona fide health care system and costs double Switzerland’s which is the highest of all OECD countries.

    The difference in Switzerland insurance companies can sell supplemental insurance – access to top docs, private rooms, adult dental etc. This puts money into the system and incentives to improve. And, if folks don’t use their insurance – the premiums are reduced.

    Physicians need to help Congress do what Dr. Koop did with our smoking addiction – was highest in the world, now one of lowest – for our eating culture. Health care in Switzerland would be overwhelmed it they had degree of malnutrition due to low nutrient, high caloric food reflected in both an obesity rate of 34%, high and increasing rate of diabetes II, and other chronic preventable diseases caused by our SAD (standard American diet).

    We need to create a new type of a VAT – RISK Tax. Calculate it from the sugar (including refined grains), fat and sodium in all processed food – sold anywhere. We have the grams and mg as nutrition facts to work from. It can be done. It is not government control or interference in our lives. Having access to safe, affordable, high nutrient food is as important as having access to affordable basic health care services.

    • buzzkillerjsmith

      Docs are fleas on the elephant of the medical-industrial complex. We are hammered by drug companies, drug and device companies, the feds, and hospitals at every turn. Of course the American people are also hammered.
      Our ability to change things is a myth. Look to a large number of organized citizens.
      I make no comment on the merit of the Swiss system.

    • querywoman

      Yeah, Switzerland is also much smaller.
      All these insurance companies and the new ones coming….what’s a good term? I called it a, “wasteland,” elsewhere.
      That’s not a good term.
      Disordered frenzy?

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