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How Low Will Health Care Enrollments Be? Here’s What to Watch For

Just a fraction of the 500,000 people expected to enroll in Obamacare via the new health exchanges have done so, according to media reports anticipating the official numbers. But there’s more to the story.

(Healthcare.gov)

This week, the U.S. Department of Health and Human Services is expected to announce the long-awaited enrollment numbers for the first month of the health insurance marketplaces. And from all reports, they’re going to be low.

The Wall Street Journal reported yesterday that the 36 states that rely on Healthcare.gov for their insurance marketplaces signed up fewer than 50,000 people in their first month of operation.

“Another way to look at the Healthcare.gov enrollments is that 50,000 enrollments over 36 states over 31 days is less than 50 enrollments per day per state,” health-care consultant Robert Laszewski wrote in an email to reporters.

The Washington Post reported this morning that the number is actually around 40,000.

That appears to be far lower than the administration’s early estimate that 500,000 people would sign up for coverage in October, the first month the marketplaces were open.

Other recent stories offer variations on that theme. Oregon has not signed up any people in its exchange. Delaware has only four. And Washington, D.C., has five. There are surely more applications in the pipeline, but these early numbers are anemic.

So how big a failure is this?

To those convinced the law will fail, it’s a disaster. The glitches that have plagued Healthcare.gov have not been solved, and the clock is ticking toward Dec. 15, the last day that consumers can sign up for insurance plans that begin on Jan. 1.

If the problems continue and only the most motivated – i.e., the sickest and oldest – sign up for coverage, insurers will be hit with big losses and will have to dramatically increase rates for 2015, the beginning of a death spiral, the critics reason.

To those convinced the law ultimately will succeed, the number means little. The problems with the website have masked demand. And the experience of Massachusetts and Medicare’s Part D prescription drug benefit demonstrate that the vast majority of people sign up closer to the deadline. In this case, the final deadline is March 31, the day the 2014 open enrollment season closes.

Four things to look out for when the numbers are announced:

Consider those being dropped by their insurers, not just those signing up.

The Congressional Budget Office has set the bar in terms of predictions — estimating that 7 million people will sign up for coverage on the exchanges in 2014 (6 million with subsidies; 1 million without). But the CBO also seems to estimate that the number of people in the “nongroup” market, which includes individual policies, will decrease by a net of 2 million next year. It’s clear now that many more people than that are being dropped by their insurance companies, which are citing provisions of the Affordable Care Act.

The administration has changed its definition of enrollees.

According to Sarah Kliff at the Washington Post, the administration’s figures will include not only those who have paid their first month’s premium payment but also those who selected a plan on the exchange, but who haven’t yet paid. It’s unclear how many in the second group ultimately will pay up. One would assume officials would have to drop them from the count if they don’t.

The age mix of enrollees matters almost as much as the total number.

The new insurance system relies on young, healthy consumers to help share the risk with older, sicker ones. That will help keep costs in check. If that doesn’t happen and the group skews older and sicker, it may mean that the premiums won’t be enough to cover medical costs. Annie Lowrey wrote in the New York Times: “Getting ‘young invincibles,’ as insurers sometimes call them, to sign up for insurance is an uphill climb. Even with the public campaigns, only about one in four 19- to 29-year-olds is even aware of the exchanges where they might buy affordable insurance, and the ignorance is especially acute among the uninsured, according to a survey this year by the Commonwealth Fund, a nonprofit research group.”

Some state exchanges have had much more success than Healthcare.gov.

Kentucky has received praise across the country for doing what the federal government has been unable to: Create a functioning website. As of Nov. 8, more than 33,000 had enrolled in Medicaid and 7,000 had enrolled in a qualified health plan, according to kynect, the state’s marketplace. Jeffrey Young at the Huffington Post writes, “Obamacare's fate in these states is just as uncertain as at the federal level, yet success there is crucial if the law is to take hold and thrive. Grass-roots, state-run success stories could inspire others to do more to help the law in the future, while failures could further undermine support for the entire endeavor.”

Curious about “age mix.” I imagine information on the ages of those who enroll should be available. But “young” does not mean “young and healthy” which is what the plans need to succeed. Just as the plans on the exchanges may be particularly attractive to older people with health issues, they will also be particularly attractive to younger people with health issues. The ACA is structured as an attempt at some social engineering through a hodgepodge of penalties and incentives but insurance plans on the exchanges remain most appealing to those with health issues. Given the low numbers expected to sign up, there is a likelihood that the people enrolling are significantly less healthy than the general population. I don’t know if information on pre-existing conditions is collected during the enrollment phase but I would think that “health mix” is more important than “age mix.”

Herb Ruhs, MD

Nov. 12, 2013, 4:16 p.m.

The Health Care System, or as I like to call it now, the Health Care Extortion system, is in a state of rapid collapse for a host of reasons, most traceable to predatory financial activities by the big players, who consistently make more and more money of the carcass of what was a fairly respectable system when I graduated med school in ‘79.  I keep asking how it is better to have more access to a system that is crashing.  People just stare at me when I say that.  No answers.

During the 1st month of Romney’s Masshealth, only 123 persons signed up. Now, nearly the whole state is signed up—at least those needing their own insurance.

Gee, Herb, maybe they just stare at you because they recognize a strawman argument when they see one.

Kentucky’s success - and whether or not Rand Paul and Mitch McConnell will be threatened with defunding by the GOP - might better be measured by how many Kentuckians who need the ACA but who don’t have/cannot afford computers and internet (or even telephone) access have been helped “manually”.

Something else I’d like to know…how many times have multiple partial sign-up attempts originated from entities like local/national GOP and “Young Republicans” offices.

Maybe I’m just a cynic.

Why is the administration and its cheerleaders mentioning the Medicaid numbers in Obamacare coverage? Medicaid increases are additional evidence of a bad economy - not the strength of a health care program. Medicaid is NOT Medicare - the senior’s health program - it’s a straight-out welfare system. I am not pounding the idea that poor people ought have coverage, only asking why the numbers are mentioned in an article about Obamacare.

Jerry Lee Mayeux

Nov. 13, 2013, 10:25 a.m.

Consider the Connection to: Environmental Conservation CTC2 [PEOPLE]
People are ignorant but NOT invincible!
http://www.twitter.com/CTC123GREEN
http://www.pbckt.com/aY.8V1o
Jerry Lee Mayeux on Facebook

The new insurance system relies on young, healthy consumers to help share the risk with older, sicker ones.

Different question:  How long is a program like this sustainable when it depends on (a) people with the crappiest incomes in the country (due to inexperience) overpaying to cover people they generally don’t care about and (b) an increasing birth-rate in a world where important people hawk their Malthusian theories and young adults are putting off starting families?

I mean, in the latter case especially, isn’t the lack of young people paying taxes exactly the reason we’re told that we need to put off retirement and survive on less as we age…?

Seems like the law would be so much better without the insurance aspects.  When you’re sick, if you don’t already have insurance, you pay a tax penalty and the government insures you.  Set the penalty to the average cost of care for the year.  Ta-da!

Hmmm

So nearly 20% of the total enrolled in healthcare insurance come from one of the least populated states in the Union. When you back that out it leaves just 33,000 for the other 49 states. That is only 675 on average per state. The numbers are already beginning to NOT add up.
Given that the government lies about virtually everything it is difficult to believe at this point that the new “initiative” is anything but a bust.

Looked at from a different perspective the “plans” offer little in real coverage to the consumer. The very best “Gold” plan is in effect a high deductible 80/20 plan. It has lengthy exemptions and restrictions. So despite being called insurance it really isn’t. One stay in the hospital of say 15 days and 90% of the families enrolled face bankruptcy. And god forbid both you and your spouse are involved in a crash together.  Now before you say but it limits out of pocket expenses! Well hold the phone those “limits” have already been delayed until at least 2015. And most likely they will never be implemented.

In short if you are facing bankruptcy with the first major hospital stay. The premiums are stretching your budget to the max before the co-pays and deductibles. And the paperwork gives you migraines, while all your private data is sold and resold many people who need insurance figure they might actually be better off without any. At the very least they know where they stand.

Our government has spent over 4 TRILLION dollars fighting wars in the middle east and they still can’t provide affordable real health insurance or feed all its poverty stricken children. Talk is cheap and actions speak louder than words. Our leaders value war over the welfare of their own people.

The Obama Care plot to have the young and healthy pay for the sick and/or old has suffered a small set back.  The larger scale plot of selling lots US Treasury Bonds and State Bonds continues to transfer the out of control social welfare entitlement costs to the young and healthy.  So the intergenerational screwing of the young goes on lead by Obama the con man they voted for; but he talks so nice.

clarence swinney

Nov. 14, 2013, 10:45 a.m.

Obama Catcher Bush Pitcher——

CBO evidence continues to show the Great Recession, Bush huge Tax Cuts,
two wars explain most of the deficits on Obama five years.  The Obama efforts to stabilize thew economy increased budget deficits only briefly and will have no effect on long range deficits.

Deficits in 2010-2012 topped one trillion. If current policies remain in place, deficits my range
between $600 billion and $900 billion reaching a low point in 2015. Reining in long range deficits
would be easier were it not for policies set during the Bush years. The tax cuts plus costs of two wars and American Taxpayer Relief Act will account for half the debt we will owe under current policies by 2019.

The Great Recession hit the budget, driving down tax revenues and swelling outlays for employment insurance, food stamps and other safety net programs.

It is estimated that the downturn has pushed up deficits by $2500 billion over the 2009-2018 period.

James M Fitzsimmons

Nov. 14, 2013, 6:34 p.m.

Seems to me like grandiosity, ideology and dishonesty doomed this program. Was it really necessary to throw out an entire system in need of reform for this? An untested grand scheme based upon partisan assertions was the best our government could do?  Was the real goal a step towards single payer and, if so, what objective facts justify such a “fundamental transformation” of what was already in place? Hard to believe that none of the opposition’s ideas such as tort reform and competitive interstate markets for insurance to name a couple were worthwhile. We have an obligation to help those who cannot help themselves but why didn’t we figure out a way to do that instead of creating this mess? Our government seems out of control.

Maybe if “the right” didn’t manage to convey the impression that their goal in attempting to delay the ACA isn’t to ensure the general welfare of the American people but lies instead in boosting the profits of the insurance and medical sectors - and their own stock dividends - by shoving five or ten thousand uninsured Americans into the cold, cold ground for every month delayed…

There are lots of ACA success stories out there. I’m one of them.  Why doesn’t anyone report those?

I live in New York and have a policy through a professional organization that is being cancelled as of 12/31, not because it doesn’t meet ACA standards, but because it is a sole proprietor policy (the other category that was supposed to be cancelled with the advent of the ACA).

Through the NYS exchange my new silver level plan through United Healthcare will cost me $639 a month, compared to the $1000 a month I currently pay also for a United plan.  My deductible will decrease from $500 to $250, all my doctors are in network as they are now, my drug co-pay remains $10 for generics, my doctor visit copays go from $40 to $30 for a specialist and all the way down to $20 for my primary care doc.  I will no longer have out of network benefits under my new plan, but I don’t see a big downside to that right now.

TK, maybe there are ACA success stories in your income bracket, but not in mine.

My payment, as a single mother with one child at home, would be $60 per month after subsidies, which I cannot reasonably afford.  My family deductible is $7,000, which I cannot reasonably afford.  The co-pay is 0% for in-network doctors, but all hospital stays must be pre-approved.

How is that health insurance?  It’s not.

Betty,

I understand that the $60 premium is a hardship, but I’m not sure I understand the rest of it.  Yes 7K is a high deductible, but if you have a 0 copay for doctor visits you’ll be able to go to the doctor without worrying about having to meet it.

well, the problem is not just the $60 premium.  it’s the need for pre-approval of MRIs and CT scans, it’s the staying within the health network, it’s the need for pre-approval for ALL hospital stays, AND it’s the $7,000 deductible, which means i don’t really have a 0% co-pay until i’ve paid $7,000.  isn’t that how deductibles work?

@betty:  Your description?  It sounds just like the shock expressed by everybody in America when their company stuck ‘em into HMOs in order to increase “shareholder value” (and fatten the CEO’s paycheck).

steve, i agree.  but i think that what makes this worse is the fact that supposedly washington was so “concerned” about those of us who could not afford insurance and so they invented the ACA. 

the fact is, we still can’t afford insurance.  and if we decide to play by the rules and obey the law, some of us will be throwing an extra $720 per year down the toilet for absolutely nothing.

example:  5 years ago i passed a kidney stone.  hospital bill:  $6000.  paid it off in installments.  under the ACA the same incident would cost me $6720 and i’d have to get pre-approval for the CT scans and xrays they performed while i was in the emergency room.

a scam, if you ask me.

Herb Ruhs, MD

Nov. 19, 2013, 3:55 p.m.

Yes.  A scam, but one of such magnificent proportions that it qualifies as a “big lie” as well.  People have been told what to think, not use critical judgement, and obligingly enough people do so as to allow the continued success of a culture that is basically all scam, all the time.  The apocryphal quote about being able to fool some of the people all the time fails to address the issue of what proportion of fools and useful idiots is necessary for Corporate Tyranny to survive in its sea of marks.

Happy hollidays,
Herb Ruhs, MD

@Betty,

I don’t know what kind of insurance you have now, but pre-approval for hospital stays, MRI, and major procedures is more the rule than the exception and has been for some time.

As far as the 7K deductible is concerned, you need to look carefully at the policy to see what is and what is not subject to the deductible, not everything is.

Which state do you live in?  Policies vary in price widely from state to state and some states are better than others and in some cases much better than others.

You also should check out under what circumstances you need pre-approval for something.  Unfortunately looking at one’s premium and deductible rarely tells the whole story.  Blame the insurance industry for that and President Obama and the whole damn Congress for being in bed with them.

You also need to look to see what your “out of pocket maximum (max)” is.

Which is defined as

Total dollar amount an insured will be required to pay for covered medical services during a specified period, such as one year. The out-of-pocket maximum may also be called the stop-loss limit or catastrophic expense limit.

I note some from the medical community being upset…I wonder if they were upset when Reagan trampled on the rights of the air traffic controllers union…or when the neoliberals and the Republicans inflicted inequitable free trade upon America, destroying jobs which included decent health insurance…

Was the medical community upset when Congress changed tax laws to favor investing/“high finance” over building/creating jobs…giving Wall Street control of both the greed and the ethics of hospital and medical supplies corporations and health insurance corporations…and then added deregulation to make separating the American people from their savings easier?

Were doctors upset when Reagan and Bush, Jr. used “voodoo economics” to incentivize those who could - particularly those who provide life-and-death services or inescapable necessities like energy - to permit their greed to run rampant?

Anybody who was alive in the 1970s knows that “the health care crisis” didn’t exist then…and they should have already asked themselves “What changed?”.

And they should ask themselves other questions, like who convinced Congress and Clinton to reduce the reimbursements for residency slots in hospitals paid by Medicare in the 1990s, thus intentionally and artificially reducing the supply of doctors today?  Or rather, what extremely limited pool of Americans benefited from that act - at the cost of the American people and our nation as a whole?

Who was it, exactly, that put their own greed ahead of the American people and the United States of America?  Why is this (Mercatus) chart reality???

http://www.mercatus.org/sites/default/files/healthcare-costs-us-oecd-chart1.jpg

If you want a bigger chart that shows how bad health care costs in America are when compared to even more countries, try this:

http://blogs.wsj.com/economics/2013/07/23/u-s-health-spending-one-of-these-things-not-like-others/

(It will take longer to get through moderation, so I put it in a separate comment.)

America is being…raped.

Herb Ruhs, MD

Nov. 19, 2013, 5:39 p.m.

“(It will take longer to get through moderation, so I put it in a separate comment.)

America is being…raped.”

Thanks for the warning.  There is no excuse for my cluelessness and gullibility.  Somehow I believed that this was not moderated—hello moderators, love you guys and gals, have a lovely set of holidays—, more delusional thinking.  Got to watch that wishful sort especially.

OK, bye everyone.

herb

steve, i have no health insurance.  in my example about the kidney stone, i stated that i paid off the hospital bill in installments. 

the premium of $60 per month and deductible of $7,000 come from the research i’ve done on healthsherpa.com (wouldn’t go to the government exchanges if you paid me….)

there are other policies available, yes, some even free after subsidies. but those also have a huge family deductible, and most tests, hospital stays—actually most EVERYTHING—requires pre-approval.

thank you for attempting to explain insurance terminology to me.  i am definitely not familiar with the lingo, having never had insurance.  while i am not sure whether simple doctor visits under my hypothetical policy would be free or not, i can tell you that i have never spent $720 a year on doctor visits.

there are plenty of sliding-scale clinics in my community, where the fee usually falls around $30 per visit.  in addition, there are two “good samaritan” clinics where doctors volunteer their time and talent, as well as a few good-hearted doctors in private practice who manage to keep their fees affordable.  i am a very healthy, middle-aged woman, and have never really had much use for doctor visits.

i am over the limit for food stamps, medicaid, HUD, etc.  i survive on my small income quite nicely by being very adept at keeping a budget.  i resent the fact that my budget might be upset by being forced to buy health insurance.  i highly doubt i will comply with the ACA mandate, nor will i pay the penalty.

i am self-employed, so i never get a tax refund.

of course it would be nice to have some sort of catastrophic policy in place, but i guess that is out of the question now.

whenever God calls me, i’m ready. 

peace.

herb, rock on.  loved what you said about lies.

steve, richard nixon is probably responsible for the start of the health care crisis.  i was only 12 in 1973 —technically, “alive in the 1970s” —therefore i had no interest in health care crises, nor the HMO act, so i am not sure if nixon is to blame or not.  :-)

come to think of it, i’m not interested in health care crises now, either, aside from the fact that the ACA is unconstitutional, anti-catholic, and a big lie, like herb says.

good night, and good news.
-ted baxter

excuse me, TK, i meant to address your comment about what type of health insurance i have, and instead i addressed steve.  i apologize.

and thank you, too, for explaining deductibles and pre-approvals.  totally agree with obama et al being in bed with insurance.  they’re in bed with a lot of other people, too.

peace.

Herb Ruhs, MD

Nov. 19, 2013, 8:28 p.m.

Thank you Ted. 

And Betty, thank you for your comment.  You represent the every person of our time, here in this place.  Fingertips clinging to survival, seeking solace in acceptance.  I had planned to work as you describe.  Free even.  Even had a good job lined up with San Francisco Public Health, for which I am well qualified, but the Feds in their maniacal wisdom sent them a letter saying that if they hired me, FOR ANYTHING, they would lose Federal Funding.  Talk about crashing and burning at the last interview!

Health issues keep me pretty house bound now so there is little I can do anymore, but during my active career I always sought to serve the underserved. 

So here I am now, stuck in a unremunerative occupation, that, by the way disqualifies me for much of anything else too, with an expensive license to maintain and no opportunity to use it.  I think some of my angels may have a twisted sense of humor.

@betty, who said:  the premium of $60 per month and deductible of $7,000 come from the research i’ve done on healthsherpa.com (wouldn’t go to the government exchanges if you paid me….)

lolll…hardly fair to criticize something that you have not and don’t intend to verify.

Misleading, if not intentionally dishonest.

herb, you’re a poet. 

very sorry to hear about your health issues, but take comfort in the fact that suffering is redemptive.  offer it up for the soul of obama.  no, wait…  obama doesn’t have a soul.  ok, offer it up for the state of disgrace our country is in.

and remember, “it is better to light one candle than to curse the darkness.”  and you’ve certainly been a light in this discussion.  thank you.

hang in there, herb.  i’ll say a prayer for you.

peace out.

oh no, wait a minute!!  can’t sign off without correcting you, steve.

healthsherpa.com actually FUNCTIONS.  the government website does NOT.  the information is the same.  you go to healthsherpa, you find out what policies are available, then you go to the particular insurance company’s website and you download a PDF of the exact details of the policy.  this is the proper way to research things, steve.

do think the policy would somehow be more “real” if i actually purchased it?  the numbers would change?  the limits of the policy would change?  what an odd claim, steve.

do you research anything before buying it?  a car?  a college education?  a house?  do you buy it without knowing EXACTLY how much it will cost you and all the terms involved?

no deceit involved here, steve.  and i resent the implication.

damn.

steve, you pissed me off.  so i read the entire policy in question.  nothing is covered until the deductible is met, like i said before.  only preventive services are free. if you want to know what they are, they are listed on healthcare.gov. 

i would never use any of these preventive services.  not even mammogram.  nope.  and that is my choice.

healthcare.gov recommends using the kaiser subsidy calculator to estimate the cost of coverage (which i had already done while doing my earlier research.) 

so i entered my info again, only this time using my adjusted gross income instead of gross income.  yes, i admit my mistake, steve.  you win one point on that one.  subsidies are based on AGI. here are my results based on last year’s taxes.

*  *  *  *  *  *  *  *  *  *  *  *  *  *  *  * 
Household income in 2014:  111% of poverty level
Maximum % of income you have to pay for the premium, if eligible for a subsidy:  2%
Health Insurance premium in 2014 (for a silver plan, before tax credit): $3,532 per year
You could receive a government tax credit subsidy of up to: $3,189 per year (which covers 90% of the overall premium)
Amount you pay for the premium: $343 per year (which equals 2% of your household income and covers 10% of the overall premium)

Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $4,500. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren’t covered.  You must choose a Silver plan to get the savings.

*  *  *  *  *  *  *  *  *  *  *  *  *  *  *  * 
so the premium cost went down by half, good.  but the out of pocket is still too high to be affordable to me. 

reading the complete details of the policy i chose didn’t change my perception of it; everything which i previously stated has to be pre-approved actually has to be pre-approved, including being admitted to the hospital after an emergency room visit.  and it all has to be considered “medically necessary.”

so thanks for the thought, obamacare.  but even with subsidies the policy is not do-able for me. 

and thanks to you, steve, for pissing me off enough to do some extra research.  hope the results meet your criteria for transparency.

ciao

p.s. abortions are not covered on this policy, unless necessary to protect the life of the mother or when pregnancy is caused by rape or incest. 

well, that’s halfway good, at least.  don’t say a word, steve.

@betty
So I’m guessing you don’t live in a state that has expanded Medicaid. The new Medicaid income threshold is 138% of the poverty level.

@betty, who said healthsherpa.com actually FUNCTIONS.  the government website does NOT.

Did you bother to ask yourself why that is? 

healthsherpa.com is attempting to make money for itself…that is, it is motivated to achieve the most functionality at the least cost…to make the most profit by spending the least possible.

CGI Federal - the company that the Bush Administration started outsourcing to and was charged with the health care website - is motivated to make money for itself.  That means not achieving the most functionality at the least cost because the government/taxpayer picks up the cost…because building a system that functioned to specification on time would end their ability to milk the government/the taxpayer of yet more money.

In other words, “Business-with-a-capital-B” is screwing America and the American people, but those who don’t like the poor…who don’t like the idea of the poor inconveniencing them…are taking this opportunity to attack anybody and everybody who defends the poor and the American people (any of whom can become poor literally instantly).  To include Obama.

And private insurance companies are likewise motivated to make the most money they can with the least expense…that is why they had the only existing legal “death panels” in America…that is why they denied health care coverage to those with “preexisting conditions”...that is why they cut people off who actually used their health care “too much”...like, at all.

http://www.slate.com/articles/business/moneybox/2013/11/cgi_group_stock_price_theontractor_behind_obamacare_s_bum_website_is_doing.html

I don’t understand why the media gives the business that is screwing America a free pass…although I suppose the fact that the media itself has become a business has something to do with it.

But if you think government is bad, turn government’s functions over to business…then you’ll see “death panels” in all aspects of American life.  “Replace the guide rail on that road?  That would cut into profits…and we don’t drive that road, anyway.”

What too many Americans refuse to recognize - sadly, too often because of their greed - is the difference between our “government”, which is charged with

We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.

and business, with is charged (thanks to Wall Street and Jack Welch) only with increasing “shareholder value”.

That means that our government will kill the citizens of other nations - either directly or through denying us access to that which we need to live - in order to achieve the goals of the Preamble to our Constitution.

That means that business - either directly or through denying us access to that which we need to live - will kill the citizens of other countries and any and all Americans if that will increase “profit”...if that will increase “shareholder value”.

If you think I exaggerate, consider again the fact that insurance corporations deny medical care to those with preexisting conditions…or look up the environmental records of GE or Koch Industries.

“The right” doesn’t really want to eliminate “government”; they want to eliminate things like the SEC, FDA, EPA, OSHA, and the other entities that prevent business from preying on the American people…the entities that inhibit “profit” and reduce “shareholder value”.

But do you hear them demanding that the organs which serve to police and control the American people be eliminated?  Do you hear them demanding an end of “the war on drugs”?  Do you hear them demanding the abolishing of their ability to pursue debts?  Do you hear them demanding an end of the laws that prevent Americans from acting against them with guns?

The base of the right…the people who shriek their hatred of anything designed to help those less fortunate than themselves…their worldview is too small…it is confined to the interior of their wallets.

Herb Ruhs, MD

Nov. 20, 2013, 2:19 p.m.

Way to bo Betty!!!  The only nit I feel compelled to pick is that what we get from the media is a carefully choreographed Corporate hagiography of monsters eating the population alive.  The Media is the Message and the message is “Go f__k yoursleves, ass—-es.”  In virtually every case that I can find in world history where plutocracies rule this is the rule.  Screw the weak to fatten their wallets (the exception I know about is Kerala, India).  It is an essential feature of plutocracies to rob the poor.  Modern scientific propaganda methods (focus groups, etc.) have added mass insanity to the mix by working tirelessly to mislead and confuse the population.  Not that this sort of mass abuse is new.  For example deliberately causing famine has been a strategy for retaining control by plutocratic elite rule forever.  Watch now as basic food prices soar and death from starvation soars along with it. 

The Universe is a kind as possible.  If we fail to learn from a situation the Universe amps up the stakes and sends us the problem back again.

My bumber sticker version of this is “Suffering is the only possible cure for stupidity.”

Sigh…a most unfortunate error…a consequence of passion, I’m afraid.

Where I said

That means that our government will kill the citizens of other nations - either directly or through denying us access to that which we need to live</i?

read

<i>That means that our government will kill the citizens of other nations - either directly or through denying them access to that which they need to live

Freudian…I worry that the Republicans will indeed attain their utopia; sometimes that fear leaks into what I write.

My bum[p]er sticker version of this is “Suffering is the only possible cure for stupidity.”

From your mouth to God’s ears…

TK,  correct, my state will not expand medicaid.

however, my son is probably eligible for medicaid as it currently stands—(he’ll be 18 next summer; will have to investigate how long he’s eligible). 

if i enrolled him in medicaid, however, my subsidy for ACA would be reduced, thus increasing my deductible.  but it’s a moot point, because unless i develop a major illness or suffer a catastrophe, i don’t have a need for a health insurance policy, and i just don’t feel good about the ACA in general.

thanks for your suggestions, TK, and i’m very glad you were able to find something to fit your needs.

steve,  healthsherpa.com is not a profit-making venture.  as far as i know it’s basically just a search engine for insurance policies.  i highly doubt the three 20-somethings who created the site are getting kickbacks from the insurance companies.  you can’t buy a policy from healthsherpa; the site merely links to insurance provider websites, where you peruse plan details.

your rants are very interesting, steve.  are you… anti-obama? anti-republican?  libertarian?  hard to tell.

herb, very interesting also.  and thanks for the compliment.  my theory is that along with or instead of food prices soaring, many nutritionally-void or toxic foods will be made readily available to the poor of the world, so that they will die of disease even while thanking their sinister benefactors for their daily bread.  codex alimentarius, herb. codex alimentarius.  it’s happening all over the world even now, especially in america.

as always in parting, we wish you peace, love, and soul.
- don cornelius :-)

Herb Ruhs, MD

Nov. 20, 2013, 6:09 p.m.

Betty said,” many nutritionally-void or toxic foods will be made readily available to the poor”

History is replete with this ploy.  My favorite were the ergotamine poisoning during the middle ages.  Much more interesting than the effects of trans-fats and hydrolyzed sugars.  The genetic engineering mass experiment underway offers another example of deliberate poisoning of the mass of the population.  No point in getting upset though.  Certainly does not help the digestion.  Personally, I have cultivated an appreciation of black humor to get through the day.

@betty, who made an unintended, I suspect, point with

unless i develop a major illness or suffer a catastrophe, i don’t have a need for a health insurance policy

@ibsteve2u Indeed.

Herb Ruhs, MD

Nov. 20, 2013, 8:05 p.m.

We have become so befuddled by marketing messaging that it is difficult to see things for what they are beyond the superficialities. The whole idea of “health insurance” is just an elaborate con based on rebranding gambling in the name of health.  After all what is the transaction?  You give a sum of money to a third party that bets that you won’t get sick while you are betting that you will.  But unlike regulated gambling (where it still exists) the house gets to right the rules of the wager and change them at any time by cancelling your so called insurance.  A bookie wouldn’t last long who settled losing bets that way.  The economists at Missouri would say that the health insurance market is an artificial one that depends on government granted monopolies.

There is another economy richly available.  Almost anything said these days by mass media “economist” is total bull and can be safely ignored, though it is hard to get the fallacious assumptions out of ones mind. I have lent out Debt: The First 5,000 Years by David Graeber to a few people who report having the scales lifted from their eyes as they view economics from an anthropological point of view.  Most of the assumptions we make these days about money and debt, profit and loss, are in error.  Deliberately in error due to the work of professional liars in robes.

steve, steve, steve…  sigh.

i don’t live my life, like herb said, “betting i will get sick.”  i do the necessary daily things which keep me healthy, i trust in God, and if something happens i deal with it. 

i should not be forced to buy something i feel i don’t need; especially at a price which upsets my budget.

if there was an option to buy catastrophic insurance under the ACA, i would seriously consider it, steve.  but as the ACA is written, that is only an option for those under 30. 

because of the forced participation issue and multiple other issues which offend my sensibilities, i have concluded that i will not partake in the ACA.

thank you very much.
-elvis

herb, you da man!! 

thank you, oh thank you, thank you, THANK YOU for writing “The genetic engineering mass experiment underway offers another example of deliberate poisoning of the mass of the population.”  YES!

my new goal is to only buy my food at the farmer’s market and stay out of grocery stores as much as possible.  it’s so empowering and comforting to speak to farmers who are committed to growing non-GMO crops and raising humanely treated, naturally-fed animals.  i hope they all have started their own personal seed banks…

i do believe in spooks, i do believe in spooks, i do, i do, i DO believe in spooks!
-the cowardly lion

and herb, i just have to say, i absolutely LOVE this line: “Deliberately in error due to the work of professional liars in robes.”

yes indeedy!!

You liked that?  I thought it was obscure.  I was aiming at the academic and judicial robes.  Feel free to pass on anything you like.  My family sometimes put things I say on Twitter.  Now it is in hiatus, but for the last couple of years we have been in a CSA from a farm we can easily walk to.  Shopping has become cloak and dagger sort of thing.  I stand there looking at the goods thinking, “Is there any packaged stuff I trust?”

another scary consequence of trusting in the Almighty American Health Care System—nothing new, but it’s particularly clear in this case:

“Court: Ohio hospital can force chemo on Amish girl”—i cannot provide the link here due to moderation protocol, but it is an online usatoday article dated oct 7, 2013.

so let me get this straight:  the supreme court (a.k.a. “professional liars in robes”) (thanks, herb) says it’s ok for a parent to do whatever it wants with a child while it’s still in utero.  but once the child comes out into the world, only doctors and courts know what is best for the child.  hmm.

and since when is chemotherapy a guaranteed success?  i know plenty of people who have had chemo and died anyway.  no medical treatment is ever guaranteed.  the poor child even BEGGED her parents to stop the treatments because they were so debilitating to her.  what if she died from the side effects of chemo?  what would the court say then?

this case is a perfect representation of how disgustingly mis-guided and hypocritical our country is.  people playing God by taking away life from some and forcing dubious “life saving” therapies on others.

only God decides who lives and who dies.  we humans think of death as something to be avoided at all costs because we simply don’t understand it.  death is not suffering.  it is the END of suffering.  it is life eternal with the Father. 

only those who have no faith fear death.  and this little girl, her parents, and the entire community they live in trust in God and have given their lives over to Him.

this is another unconstitutional, anti-religious decision.  horrible.

@betty, who spake - after having said

unless i develop a major illness or suffer a catastrophe, i don’t have a need for a health insurance policy

spake thusly

i don’t live my life, like herb said, “betting i will get sick.”

lolll….I bet you take a lot of back roads when you drive…given that state troopers who find people driving with your attitude of “I don’t need insurance!” tend to react rather…predictably.