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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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.



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. 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. 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, 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, 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, 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, 2:51 p.m.

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


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.


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.



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, 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. 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. 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, 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. 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. 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. 25, 2013, 10:20 p.m.

@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.


Nov. 22, 2013, 2:02 p.m.

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.

Herb Ruhs, MD

Nov. 22, 2013, 12:17 p.m.

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?”


Nov. 22, 2013, 10:11 a.m.

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!!


Nov. 22, 2013, 10 a.m.

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


Nov. 22, 2013, 9:50 a.m.

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.

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.


Nov. 20, 2013, 6:19 p.m.

@ibsteve2u Indeed.


Nov. 20, 2013, 6:17 p.m.

@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

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.


Nov. 20, 2013, 6 p.m.

steve, 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 :-)


Nov. 20, 2013, 5:31 p.m.

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.


Nov. 20, 2013, 2:28 p.m.

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

From your mouth to God’s ears…


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

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?


<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.

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.”


Nov. 20, 2013, 2:16 p.m.

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.


Nov. 20, 2013, 1:58 p.m.

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

Did you bother to ask yourself why that is? 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”, at all.

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.”


Nov. 19, 2013, 11:27 p.m.

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.


Nov. 19, 2013, 11:22 p.m.

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 

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


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.


Nov. 19, 2013, 9:11 p.m.

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



Nov. 19, 2013, 8:59 p.m.

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.


Nov. 19, 2013, 8:50 p.m.

@betty, who said:  the premium of $60 per month and deductible of $7,000 come from the research i’ve done on (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 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.


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

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.



Nov. 19, 2013, 8:13 p.m.

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


Nov. 19, 2013, 8 p.m.

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 (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. 


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.



Nov. 19, 2013, 4:32 p.m.

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

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

America is being…raped.


Nov. 19, 2013, 4:24 p.m.

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???


Nov. 19, 2013, 3:56 p.m.


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.

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


Nov. 19, 2013, 3:28 p.m.

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.

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