Journalism in the Public Interest

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.

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Nov. 25, 2013, 11:34 p.m.

Just - because I am a vet - an observation:  They who apply the principles of battlefront military medicine - triage, and then directly off to the appropriate treatment/specialist - shall win.

By “they”, I obviously mean hospitals/groups of doctors/practices…by “win”, I obviously mean “haul in the most loot”.

Applying “Hurry up and wait.” - which the nation’s medical system seems to be overly fond of today - is what REMF doctors do and doesn’t work when the supply of patients is not/no longer artificially constrained but the supply of physicians is/remains artificially constrained.


Nov. 28, 2013, 2:27 p.m.

steve, in several states you are not required to have car insurance.  this is easily discovered by googling.


Nov. 29, 2013, 8:23 a.m.

@“betty”, who emoted steve, in several states you are not required to have car insurance.  this is easily discovered by googling.

lolll…your attempt at conveying a patronizing tone is hilarious in light of reality, “betty”.  In those states where you can get away with not carrying insurance you still have to be able to prove your financial ability to cover liability costs.

Your statements to date insist that - without driver’s insurance - you cannot pay for the death of a pet lizard that you crush as you spin out in someone’s yard.

In fact, all of your comments combined suggest that you do not wish to be financially responsible for yourself…rather like those who bought deregulation from the Republicans and neoliberals and, when they consequentially caused the mortgage-backed securities pyramid scam, then expected to be bailed out.

(lollll…and after they were bailed out, turned right around and criticized the bail-out of the auto sector as that industry - and all of America and, indeed, the world - suffered because of their actions.)


Nov. 29, 2013, 10:04 a.m.

steve, first of all, i neither emoted nor was being patronizing.  sorry you feel that way.

second, at least in one of the 50 united states of america, you do not have to prove anything to opt out of car insurance.  you just pay a yearly fee. i know that because that is the law of my state.  i double checked it on my state’s DMV website just to be sure.

third, if you go back and read my posts, i clearly stated that i paid off a $6,000 hospital bill in installments, and that i always pay my own medical costs, which are very few and very far between.

fourth, i have stated that i am not receiving any form of government handout—neither food stamps, HUD, medicaid, help with heating bills, etc.

fifth, regarding whether or not to sign up my son for medicaid, i stated that i was debating it.  as i mentioned above, i’m not receiving any assistance and i’m not wild about the idea of receiving assistance.

sixth, back to car insurance:  if i don’t want to pay for car insurance, i simply don’t drive.  not the case with the ACA. 

and that’s the way it is.
—walter cronkite


Nov. 29, 2013, 10:10 a.m.

one more thing, steve.  i never said i don’t have car insurance.  you somehow inferred that all on your own.

when you assume, you make an “ass” out of “u” and “me”
—oscar wilde


Nov. 30, 2013, 12:56 p.m.

@betty: still not patronizing, I see.

Carrying insurance would be wise, given that if involved in an accident, the uninsured motorist remains personally liable even if you have paid their $500 fee.

Although I hope that you’ll forgive me for my initial and ongoing doubts that you have automobile/driver’s insurance given that your earlier

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

seems to be equally applicable as

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


Nov. 30, 2013, 1:01 p.m.

That was educational, by the way…I’m always reluctant to drive through Virginia because of the way their police officers enforce speed limits…i.e., out-of-state drivers seem to be more…visible…to them.

Now that I know that they have legally uninsured motorists driving all over the place…lollll…yeah, I think I’ll avoid the place.


Nov. 30, 2013, 2:51 p.m.

Insurance does not need to run criminally.  It is just that the moral hazard involved when those selling insurance can take advantage of the insured means that unregulated insurance business quickly is dominated by those with the greatest criminal intent.  Insurance, as practiced in the US, is both a gambling opportunity, with all the fixing of the results that that offers, with a protection racket.  Now for instance, if you don’t have auto insurance you are subject to police action, which paying a monthly fee protects you from.  It is the same across the board.  So called medical insurance, has more to do with the realistic fear that you will suffer maltreatment, refusal of treatment or discriminatory care, if you don’t have the card.  A protection racket of massive proportions.  Universal care, as is practiced around the world, takes the criminal opportunity out of the picture.  When we get to the payout end of “insurance” we confront fraud of various sorts.  “Oh, you didn’t state that you had hay fever on our form, so, in spite of giving us a small fortune in premiums, we have no obligation to pay for your care.”  This is the confidence crime aspect of the thing.  In cooperation with corrupt government and corrupt mass media, every effort is made to convince folks that they can trust that their insurance will be fair with them.  With no reasonable expectation of that, unless one has powerful attorneys to ensure your rights (moot since those with that sort of wealth have no need for scams like health insurance) this defines the insurance industry as a massive confidence crime.  All of this is made possible by our system of legal bribery masquerading as democracy which ensures that we have an all crime all the time society.

Plutocracy destroys.



Dec. 1, 2013, 10:25 a.m.

herb…. what can i say?  reading your wisdom evokes feelings of being safe and secure inside a warm house with a fire blazing and a huge pot of stew on the stove, while the blizzard howls outside…..

i breathe a sigh of contentment.

steve…. may the force be with you.


Dec. 1, 2013, 2:51 p.m.

How wonderfully seasonal:  Somebody rejecting reality in favor of living in a snow globe.

Herb Ruhs, MD

Dec. 1, 2013, 4:29 p.m.

Dear Betty,

It is not my wisdom that you are responding to, but the wisdom of the ages that is within you. Don’t think that you don’t know everything important already, hidden perhaps under a great pile of authoritarian bull sh_t that gets crammed into our heads by this sick culture.  Sometimes an experience, or reading something, or meeting someone, and suddenly this natural inner wisdom asserts itself and it feels great.  I have had, in this life, a wide enough background and experience to have been able to touch this inner wisdom that we share with some apparent ease, but don’t be fooled. You don’t need anyone to point you in the right direction.  You already know. The trick is not to rejoice at someone else’s wisdom, but to let one’s own wisdom find a voice and rejoice in that. 

What we have been schooled to call Civilization is really a vast catastrophe underway that threatens everything on Earth at once. It is failing, and with any luck we may survive its passing. It is an exhilarating time to be alive. 

Fear, of all sorts, clouds our vision, as the architects of this reign of terror that we call civilization specifically intended.  On the one hand we have the rule of love and the other the rule of fear inside us and projected outward in the chronicle of daily events.  To have seen, as I have been privileged to witness, so much raw courage is to be immunized to the cant about flawed human nature.  Turns out that we humans are just fine the way we are, no fix needed. It is our birthright to feel positive about our species.  It is our tragic burden to be continually afflicted by a death worshiping culture of fear.  Culture is a mere invention imposed on fully formed humans that has the capacity to destroy our spirits.  We need a new one, fast.

Rebecca Solnit in her book Paradise Built In Hell, describes how this unflawed human nature blossoms and thrives in conditions of disaster.  If you read that book in the way I do, you come to realize that when, for whatever reason, the rule of fear is suspended, as it is post disaster, and people are free to cooperate in a loving way, human nature is revealed to be wholly good and effective.  This is not being pollyannaish.  It really is true.  Granted there are always some individuals who are so scared by fear that they do not handle disaster well, but the important point is that a loving community brought together by disaster is quite capable of dealing with such problems compassionately and definitively.

So, as spiritual adepts are continually telling us, the door to abundance and a loving peace stands open in front of us.  If we take the door as mere individuals it matters not at all, but if we take the door as community we will be reborn as life loving people, able to deal with all the scary stuff with aplomb. The authoritarians hate this since axiomatic in their thinking is the idea that we are flawed and need to be told by authority how to behave.  They are soooo wrong it is silly, but being wrong and coercing us to believe them is how they manage to enslave us, so believing in flawed human nature is essential to their sick thinking.  Ignore them if you can.  Leave them if you can’t ignore them.  And as a last resort fight them compassionately.  They especially hate that as violence is their lifeblood, their reason for being.

Hence all the confusion.  The authoritarians build social structures fit for the flawed and try to shoehorn unflawed people into them as servants and slaves.  No wonder the last few thousand years have been so tragic.  And no wonder the ACA is such a mess. It was designed by malcontents for people who do not exist.



Dec. 1, 2013, 5:34 p.m.

Someone needs to define who the “authoritarians” are…

Are they religious authority figures?  Corporate?  Political?  Authorities by virtue of wealth possessed or power wielded?  Medical, because they play with life and death?  Military, because they can dispense - or withhold - death?  Educational, because they are authorities within their own fields?  Libertarians, for they seek to destroy all other authoritarians in order to rule via wealth-applied-as-power?

If some are to be ignored or destroyed, then why only some?  What makes some authoritarians acceptable, while others are not?

(P.S.  Impress me by avoiding using any variations of “anarchy”.)

Herb Ruhs, MD

Dec. 1, 2013, 6:10 p.m.

Dear IBS,

I am sorry to hear of your allergy to a perfectly good word.  The propagandaverse can do that to you.  My condolences.

Authoritarianism is most importantly a point of view.  Where I might see a beautifully functioning, highly integrated situation, the authoritarian is likely to see only the bad word.  To some degree it is a developmental problem.  There is a stage of development that is very rule oriented, regardless of the dominant regime of thought.  One of the torments of the liberal parent is to have their small child insist on concrete rules.  It lasts for many years, and at one point both our girls were still under its influence.  One day they informed me that I could not be a doctor because only girls, like their mother physician, could be doctors.  Authoritarians, bless their hearts (where they have one, but that is a different discussion), seem stuck in this phase, always looking for the rule that makes a confusing world make more sense to a small person of limited experience and development.  A curiously entertaining way to address this is to consider human history to be a glorified version of the relationships of siblings.  The dominant, dominator culture has evolved the trick of arresting the development of the humans it wishes to exploit.  Under this view, the great flowering of post WWII US is that folks returned from war with the confidence of actual adults and created an alternative working class culture that felt entitled to upward mobility and advanced education.  It was the wonder of the world in its heady days of triumph in the fifties and sixties.  The key thing is that people with a capacity of critical judgment, an advanced state of mental development, are relatively immune to mass propaganda because they have become used to thinking things through for themselves.  This phenomena was also seen in Europe in the wake of widespread literacy and resulted in the Protestant Reformation.  Old Martin Luther may look like a far gone authoritarian from our time perspective, but for his time he was a freethinker.  Authoritarians abjure critical judgement out of habit, anti-authoritarian thinkers use it.

Authoritarianism is the condition that causes compelling discomfort in individuals witnessing disobedience to socially identified authorities. 



Dec. 1, 2013, 6:47 p.m.

lolll…I didn’t think that you’d like the exclusion of anarchy.  As to your

Authoritarians, bless their hearts (where they have one, but that is a different discussion), seem stuck in this phase, always looking for the rule that makes a confusing world make more sense to a small person of limited experience and development.

At this point, it might be wise to define anarchy in order to differentiate anarchy from the artificially one-sided rule construct the right and libertarians seek:

a state of disorder due to absence or nonrecognition of authority

I find that it is the right and the libertarians who want to destroy any rule which prevents their predation upon the people - yet they still want to continue and even strengthen those rules which are designed to restrain and limit - to control - the people; that is, they desire only rules which prevent the people from defending themselves or even preying upon them.

Further and contradictorily, they themselves provide the justification for the creation and existence of rules through their own misbehavior.

If you really do want anarchy, then you must first eliminate all who think that they are entitled to prey upon others…I would note that those who think that they are entitled to prey upon others usually seek positions from which they can wield power…that is, such usually become authoritarians.

Herb Ruhs, MD

Dec. 1, 2013, 7:34 p.m.

That’s the spirit.  Down with them.  Bad people…who were we talking about?  People who refer to themselves as anarchist, which unfortunately does not share much with the word anarchy as one would think.  Personally…and massively irritatingly, I reject all ideologies as mental symptoms of various primitive fears such as of abandonment, exclusion and the like.  People exhibiting excessive influence in their lives of tightly held ideologies are analogous to persons whose lives are made difficult by substances.  Now if you asked me who I choose as friends it would be the self identified Anarchist, or being against kings.  The first notable anti-king people in our historical legacy were the Romans who, to a person resisted rule by kings and who’s history is set in the overthrow of the original dynastic rulers.  For their day the early Romans were very politically advanced, and they, much like USers today, continued to believe in the democratic delusion for centuries.  Long centuries after Rome became an Imperial entity with an Emperor, the armies marched under the name of the Senate.  Most recently were the Pane influenced American colonial subjects who ran the Kings judges from their New England towns.  Being against the institution of monarchy and aristocracy is a broad stroke.  On the other hand the opposite of Anarchist, the Monarchist, still exist!  I have met a few.  Return of the King.  All this makes sense to me as a physician familiar with the problems of those with unfortunate mental adaptations.  Trauma, often hidden from memory, is the embedded foreign body from which the pus of fidelity to ideology emanates.  When the foreign body of infantile existential panic is removed from the mental functioning of the mind, even that sort of deep trauma can heal and the person that emerges can be very strong and without enslavement to ideology I find myself interested not in what the various ideologies have to say but, rather, what reformed ideologues are saying.  Sort of like saying, if you want to understand alcoholics without becoming one, ask recovering alcoholics.

Six ideologues in a lifeboat have only one idea.



Dec. 3, 2013, 6:15 p.m.

Herb wrote, “Dear IBS”.  LOLLLLLLLLLLLLLLLLLLLLLLLLLL.  Love it. Leave it to a doctor, I’ll tell you….

Question authority.
—70’s mantra

Herb Ruhs, MD

Dec. 3, 2013, 6:23 p.m.

Hierarchy and authority are intertwined.  There is a natural hierarchy expressed spontaneously.  What is the issue is artificial hierarchy based on coercion.  Riane Eisler does the best job of differentiating this in the Chalice and the Blade.  Natural authority is secure, invites questioning, is not coercive and redistributes according to circumstance.  It is what we all want, except the sociopaths, bless their absent hearts.


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