Re: Beta ACA Rollout

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I don't think "beta" was politically workable. I've been thinking about this a lot. Maybe I'm spoiled or brain-damaged by excessively "agile" experience, but having a project this big with a hard deadline (set by statute?) and a non-negotiable set of requirements and having no possibility to beta test/soft launch/dogfood is just terrifying. I don't even know how to write software like that.


Posted by: Yawnoc | Link to this comment | 10-26-13 7:22 PM
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It turns out that "death panel" referred to the website hosting panel software.


Posted by: fake accent | Link to this comment | 10-26-13 8:12 PM
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Couldn't they have released to people born in January for the first month of release, or something, though? This approach doesn't seem tremendously politically workable either.


Posted by: conflated | Link to this comment | 10-27-13 3:14 AM
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And regardless of political workability, word the system's ineffectiveness apparently didn't reach the people who might have been able to make such decisions.


Posted by: Minivet | Link to this comment | 10-27-13 5:58 AM
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+of


Posted by: Minivet | Link to this comment | 10-27-13 6:16 AM
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Word, to your higher level federal bureaucrat.


Posted by: Opinionated Vanilla Software Consultant | Link to this comment | 10-27-13 6:27 AM
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Roll-out, not version 5.0.
With my laptop on, my face lit by the glow.
Gov'ment on shutdown, Cruz says, "Die."
Did you stop?
No -- Obama's the guy.
Kept on coding to the next stop.
I busted a bug and I'm heading to the next block.


Posted by: Opinionated Vanilla Software Consultant | Link to this comment | 10-27-13 6:45 AM
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4: I'm not sure that is actually true. Or if it is, it is because Obama told them earlier not tell him. And either of those would have been fine with me. Given the political realities if you cared about ACA you probably would have done the same. It is a point of continual annoyance to me that the political fuckcunts from pseudo-wonk hell can't seem to find their way to acknowledging what was going on politically in the weeks leading up to the launch. Like the NYTimes article which legitimately described the bad test results but did not get around to mentioning the shutdown in its analysis of the politics.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 6:51 AM
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And I assume people are aware of this chart from MA rollout (not completely apples-to-apples but still). Twelve-month period.
After one month: 123
After two months: 2,289
Final: 36,167

Also, will link again to the Rude Pundit calmly reviewing the Medicare Part D rollout.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:15 AM
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And I have also been thinking a lot (too much) about this, And I am with Yawnoc in 1. Soft launches and delays are the way of the world of large IT projects (not to mention gov ones that *never* go into production, but we covered that earlier). In this case, a soft launch that made sense (in some other political world) might have been to do a few states early. Or maybe more politically workable, have opened it up first to brokers, community health centers and the like before the general public.

Could it have been better? Sure, probably. But sometimes continuing on across the Big Muddy is in fact the right choice.

And the dire warnings about apocalypse if everything is not perfect by Thanksgiving are also way overstated. And Joan Walsh has been totally right about this.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:27 AM
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Remember also that the scope of the project increased massively beyond original expectations (and after the completely hard date had been set) because of the willingness of GOP governor's to self sabotage and refuse to set up exchanges.


Posted by: Sifu Tweety | Link to this comment | 10-27-13 7:29 AM
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And for the soft bigotry of low comedy, you have Clay Shirky babbling away about how Narwhal was a tougher thing to do until Harper showed up to correct him:

@harper
What's happening today? Is @cshirky still trying to convince the internet that narwhal and hc.gov were similar sized?

@cshirky
No @harper, i'm just trying to convince people that your testing regime was better, and that that is the Obama administration's fault.

@harper
@cshirky sure. But use a real example. Narwhal is nowhere near hc.gov.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:32 AM
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11: Right, per our earlier thread. Scope creep does happens a lot in big corporate IT projects as well, but they all get delayed (and I many by many months if not years) as a result.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:34 AM
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This all part of "Why We Can't Have Nice Things*", and government IT procurement and practices do contribute their share. But one of the two parties sabotaging federal government (aside from the kill or incarcerate "bad" people function) at every step of the way is far higher on the list.

*Or more accurately why only x% of us can.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:37 AM
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Republicans get judged on ability to win elections.

Democrats get judged on ability to govern well, fix Republican screw-ups, *and* win elections.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:38 AM
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clay shirky is a damned idiot, also. Somebody should backdoor his Microsoft Messenger client and take webcam shots of him drooling on himself.


Posted by: Sifu Tweety | Link to this comment | 10-27-13 7:40 AM
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16: I actually did like some of his earliest stuff, and thought he had some good ways of describing changes in the world that were wrapped up with the coming of the broadly-accessible internet. But clearly there is some kind of Pundit Peter Principle at work, as all he seems to do anymore is trip over his own cock.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:43 AM
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...laydeez


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:43 AM
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I'm only familiar with Shirky as one of the principal boosters of Mooc Mania. I assumed he was some sort of education huckster.

So he's an all purpose tech huckster instead?


Posted by: AcademicLurker | Link to this comment | 10-27-13 7:49 AM
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I gotta think beta testing would have been more "politically workable" than what actually happened. The rollout itself wouldn't have been very different - the software still would have had the same bugs - but the word "beta" is as much a tool for expectations management as it is for the release process. If it had gone beta, you would have had a few days of late night talk show hosts making "beta" jokes, but that's a lot better than having them make "Obamacare is a total clusterfuck" jokes.

At the same time, it should be recognized that some sort of beta testing for large software projects - weather you call it a beta, or pilot testing, or phased rollout, or soft launch - is not actually an optional part of the software delivery process. Especially a this scale, that shit is required.

One of the reasons Narwall was successful is that they tested the shit out of it in mock election scenarios beforehand. I don't get the impression that anything like that was done here.


Posted by: Spike | Link to this comment | 10-27-13 8:57 AM
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What I meant by "politically workable" is that declaring a beta test ex ante would open you up to all kinds of bad faith political attacks, e.g., that you are irresponsibly subjecting real people to Bad Stuff or that you are cherry-picking your favorite people to get early access to Good Stuff. From a weaselly politician's perspective, it's better to just launch the broken thing and shrug and say, "Software has bugs."


Posted by: Yawnoc | Link to this comment | 10-27-13 9:16 AM
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17: the essay that put me over the top was the one where he thoughtfully mansplained to his female students why they would never be all awesome and successful like him.


Posted by: Sifu Tweety | Link to this comment | 10-27-13 9:18 AM
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19: Shirky is an all-purpose huckster. Most famous, recently, for Here Comes Everybody about how Wikipedia is teh awesome.


Posted by: Yawnoc | Link to this comment | 10-27-13 9:20 AM
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At this point, ACA should be able to shrug off bad faith political attacks - there have been so many. I think self inflicted wounds, like this one, are a lot more damaging to its reputation.

The weaselly politicians apparently didn't recognize that ahead of time, though. Its pretty clear that no one high up, on either side, saw this coming.


Posted by: Spike | Link to this comment | 10-27-13 9:26 AM
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At this point, ACA should be able to shrug off bad faith political attacks - there have been so many. I think self inflicted wounds, like this one, are a lot more damaging to its reputation.

Part of me thinks that if they really can get it working by Thanksgiving (and, hopefully, working well by some time in December) that this will be reasonably close to a best case scenario. I'm not at all sure that they can do that, however.

The shutdown really did blunt criticisms of healthcare.gov, and it's hard for me to imagine any outcome that didn't involve some very public failures and it may be better to have the failures be widespread (if they can be fixed in a timely manner), because it should get everyone on the same page (that is, it provides a lot of motivation to fix the problems and removes the line of attack that problems were somehow targeted or deliberate).

I don't even know how to write software like that.

I have no idea how to do it in practice. In theory a couple of things would be obvious -- first and foremost that calendar time is by far the least replaceable resource and that the goal should have been to start as early as possible with a core group -- have them identify the most difficult problems, and come up with some functional solution for the bottlenecks and then bring more people in to start working from there.

But, in practice I'm sure that sort of advice is completely obvious or useless or both.


Posted by: NickS | Link to this comment | 10-27-13 9:50 AM
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Shirky is an all-purpose huckster. Most famous, recently, for Here Comes Everybody about how Wikipedia is teh awesome.

I found Here Comes Everybody interesting and was glad that I read it, even though I disagreed with big chunks of it -- it acknowledged more complexity than some of his shorter pieces do, and it was an interesting book to argue with.


Posted by: NickS | Link to this comment | 10-27-13 9:51 AM
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10: In this case, a soft launch that made sense (in some other political world) might have been to do a few states early. Or maybe more politically workable, have opened it up first to brokers, community health centers and the like before the general public.

Didn't Oregon do just that? Yes. And a recent update on how things are going at present.

"When Google launched Gmail, you had to be invited," spokeswoman Amy Fauver told me a while back. "That was their beta launch. That was their way to identify bugs. Our benefit is that our initial users will be community partners who will be trained on the system."

Nonetheless it's not clear how the federally-run exchange(s) could have done something like that. As it is, some red state or other passed a law (or tried to, forget it they succeeded) deliberately hamstringing the 'community partners' in the state who were supposed to help people sign up.


Posted by: parsimon | Link to this comment | 10-27-13 10:40 AM
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The HHS promise that healthcare.gov will be fixed by Thanksgiving is, by the way, a bit of a pisser for those who are intending to drop their current coverage which rolls over Jan. 1. (Some with current coverage have plans rolling over April 1, so less of a problem there.)

Fixed by Thanksgiving means a two-week window, until Dec. 15th, to get your application + approval + enrollment + payment cleared up in order to avoid a lapse in coverage come Jan. 1.

Man am I glad my state created its own exchange.


Posted by: parsimon | Link to this comment | 10-27-13 10:46 AM
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God I wish there were some good old communist utopians to balance out the techno utopians.


Posted by: k-sky | Link to this comment | 10-27-13 10:47 AM
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You know, I originally thought having all the states implement their own exchanges was a stupid idea, and that having a single, national exchange was better. And, in a certain sense, I still do, on a theoretical level.

But on a practical level, its king of nice that all the states that cared about doing a good job of ensuring a high-quality implementation have been able to do so, unencumbered the the saboteurs in the red states. And all the fire-eaters stuck with the national system are basically getting the quality of implementation they deserve.


Posted by: Spike | Link to this comment | 10-27-13 11:10 AM
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By the by, regarding those intending to drop current coverage which rolls over January 1: I had a long discussion with my health insurance broker a couple of months ago about these matters, and he disclosed that *when you sign up for a health insurance plan, you're not actually agreeing to a full year -- annual -- contract*.

That is, I had thought that every year when I re-up in December for the coming year, at a given monthly premium rate, I was locked into that plan for the entire upcoming year. Broker says no: you can drop the plan partway through the year.

Anyone know for sure whether this is true? Minivet? I don't recall whether we discussed this before.

If it is so, those planning to dump their current plans in favor of an exchange-mediated plan needn't worry quite so much about a lapse in coverage for January, maybe February, if healthcare.gov is still fucked up into December.


Posted by: parsimon | Link to this comment | 10-27-13 11:16 AM
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Fixed by Thanksgiving means a two-week window, until Dec. 15th, to get your application + approval + enrollment + payment cleared up in order to avoid a lapse in coverage come Jan. 1.

You know, you don't have to go through the freaking website. Talk to your broker, for God's sake.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 11:40 AM
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32 without reading 31.last.

It's just that that particular trope annoys the hell out of me because it is part of the full court press from the Fox News liar types. Sure, their exact plan may be gone, but they can get almost always get new coverage through whatever channel they did for this past year.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 11:42 AM
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29: Classically, all the communist utopians were also techno utopians.


Posted by: rob helpy-chalk | Link to this comment | 10-27-13 11:55 AM
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I just about lost my mind when all-purpose mark Ron Fournier, late of the Associated Press, said in all due Seriousness that the healthcare.gov rollout problems were the equivalent of Katrina or possibly the Iraq invasion. We are ruled by the deeply stupid.


Posted by: snarkout | Link to this comment | 10-27-13 11:57 AM
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And all the fire-eaters stuck with the national system are basically getting the quality of implementation they deserve.

I don't like the "you get what you deserve" impulse about this kind of thing -- it's not like everyone who lives in those states personally signed up for agitating for bad things.


Posted by: redfoxtailshrub | Link to this comment | 10-27-13 12:08 PM
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What rfts said, although I'm delighted by the idea of Enlightened Topless Kentucky sneering at those flyover yokels in New Jersey.


Posted by: snarkout | Link to this comment | 10-27-13 12:11 PM
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And then also, there are what, 10 million people in these shitty states that are being left entirely out in the cold because they're too poor for subsidies? That makes me so incredibly angry.


Posted by: heebie-geebie | Link to this comment | 10-27-13 12:11 PM
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Not really connected with the ACA rollout, though.


Posted by: heebie-geebie | Link to this comment | 10-27-13 12:12 PM
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35: Bilmon went to a fairly similar place in replying to people who thought a lot of pinkboy wonk coverage was missing the point.

You're slipping into the same partisan refusal to face reality that undid the GOP during Iraq occupation.

Can't get to my favorite tweet on this topic which was from JGreenDC (Justin Green, apparently an editor at the Washington Examiner)--his tweets are now "protected." Something along the lines of "If this gets fixed it will be in large part due to the honesty of liberal pundits." Beyond delusional*.

*I am probably being overly harsh, because in the broader scheme of things the fact that "progressives" are generally less committed to fucking the outright BS chicken does serve as a bit of a corrective. But in this instance, I'm going with delusional.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 12:15 PM
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33: It's just that that particular trope annoys the hell out of me because it is part of the full court press from the Fox News liar types.

I'm .. not really understanding this. What particular trope?

Sure, their exact plan may be gone, but they can get almost always get new coverage through whatever channel they did for this past year.

My broker is a bit of an ass, and as of two months ago said that he might not be in a position to mediate (broker!) an exchange plan for me or anyone else. He's basically captive to the non-exchange environment. Your "almost always" is glib.

I'm not freaking out, realize. I'd just like to assess my options myself, as I imagine many other people would. I'm sure as hell not declaring that the ACA is a trainwreck, if that's what you think.


Posted by: parsimon | Link to this comment | 10-27-13 12:15 PM
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38: The bad parts of the ACA decision approach the VRA decision for shittiness and lack of constitutional grounding.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 12:16 PM
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34: We can only imagine what Stafford Beer would have done with Twitter.


Posted by: dalriata | Link to this comment | 10-27-13 12:23 PM
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34: We can only imagine what Stafford Beer would have done with Twitter.


Posted by: dalriata | Link to this comment | 10-27-13 12:23 PM
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41: The trope is to have someone who currently gets insurance on the open market to talk about how much worse it is now. Generally i is not true.

Also, the site is already working much better--my family has used it, and many others have as well.

41.mid: I am not saying you are doing what they are doing. I realize that "my almost always" is a bit glib, but I will note that many of the complaints of the weaknesses of the ACA are that it leaves paths open for asshole broker, employers (colleges among the worst), and governors to screw various constituencies. That is not good, but it is also a balance of harms situation.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 12:23 PM
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He probably would double-post.


Posted by: dalriata | Link to this comment | 10-27-13 12:24 PM
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Is there something wrong with the Maryland exchange?


Posted by: CharleyCarp | Link to this comment | 10-27-13 12:29 PM
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46: Also Strunk. With his penchant for omitting words and repeating key points.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 12:29 PM
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47: In 28, she does say, Man am I glad my state created its own exchange.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 12:30 PM
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38: And then also, there are what, 10 million people in these shitty states that are being left entirely out in the cold because they're too poor for subsidies?

I have to wonder whether there will be any fallout in those states once their people realize what's been done to them by their governors. The theory is that people in those states falling into this Medicaid gap will notice that it's not so in other states, but I'm afraid I'm doubtful that they will. People at that income level are used to being shit on.

Are there any organizations in those red states launching public awareness campaigns on this? Stupid question, in a way: I know there are. They're state by state. I think We are Ohio played a role in Kasich's decision to expand Medicaid in that state.


Posted by: parsimon | Link to this comment | 10-27-13 12:32 PM
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Everybody Hates Tom Corbett (informally organized) played a big role in Pennsylvania.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 12:33 PM
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50 -- We're probably going to have a measure on the ballot in 2014. Lots of blue folk in red states ought to be doing the same, if they can.

49 -- I guess 41-last confused me. Nevermind.


Posted by: CharleyCarp | Link to this comment | 10-27-13 12:35 PM
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How well did the call centre work, and who's responsible for that?


Posted by: Alex | Link to this comment | 10-27-13 12:36 PM
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The trope is to have someone who currently gets insurance on the open market to talk about how much worse it is now. Generally i is not true.

Kevin Drum also wrote a good post on that today.


Posted by: NickS | Link to this comment | 10-27-13 12:38 PM
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50 And our governor supported expansion, but couldn't get the lege to go for it. Just as our state auditor tried twice to get authority to set up an exchange.


Posted by: CharleyCarp | Link to this comment | 10-27-13 12:39 PM
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53: Not sure. And this one of the annoying parts of the coverage to me. Very little on the call centre (Ezra had a memorable tweet where he decried the lack of hold music) and other channels. (Although I do know that some 3rd parties are doing fine, but then stymied at the last step when they need to use the website. But I'd assume they could quickly finish when the final steps work better.)


Posted by: JP Stormcrow | Link to this comment | 10-27-13 12:40 PM
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45.3: I will note that many of the complaints of the weaknesses of the ACA are that it leaves paths open for asshole broker, employers (colleges among the worst), and governors to screw various constituencies. That is not good, but it is also a balance of harms situation.

JP, I think you should stop digging. The private insurance industry is indeed searching for ways to keep citizens ignorant. As are (some) brokers -- whose incomes are tied to the price of the policies they sell to consumers -- as are employers and governors.

It's okay to acknowledge that. I have no idea what you mean about a balance of harms.


Posted by: parsimon | Link to this comment | 10-27-13 12:41 PM
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47: Is there something wrong with the Maryland exchange?

I haven't even tried it yet. I've never been an early adopter! I'll give them another week or so -- I just assume that roll-outs will be buggy, so I wait a bit. I'm not concerned for myself, though. My comments upthread are about people in the federal exchange(s). And I am keeping my eye on the calendar.


Posted by: parsimon | Link to this comment | 10-27-13 12:44 PM
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I think JP's mostly reacting to stupid media coverage, which he is apparently consuming in vast quantities for some reason.


Posted by: teofilo | Link to this comment | 10-27-13 12:54 PM
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I'm of the mind that a) Democrats do need to take ownership of this fuckup, and ease off on the defensiveness and backbiting. And b) in the grand scheme of things, its not all that bad of a fuckup. So the website has a shitty user experience right now... there will be workarounds, it will get better. No, it won't be flawless by Thanksgiving, but things will improve over time.

Also, c) The government contracting and development process is clearly terrible, and that is a much broader problem that needs to be addressed.


Posted by: Spike | Link to this comment | 10-27-13 12:57 PM
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a) Democrats do need to take ownership of this fuckup, and ease off on the defensiveness and backbiting.

No. Squabble to death. Fuck everyone.


Posted by: heebie-geebie | Link to this comment | 10-27-13 1:04 PM
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I'm on team heebie!


Posted by: Sifu Tweety | Link to this comment | 10-27-13 1:06 PM
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60:No, it won't be flawless by Thanksgiving

Ezra explained why this is an actuarial problem, and why time is important to the success of the system. Down toward the bottom of the post.

The slower the signups because the young and/or healthy can't be bothered with the hassles the more the actuarial numbers suck, the more premiums and copays rise to make the insurance companies profitable, the more the experience sucks, spiral.


Posted by: bob mcmanus | Link to this comment | 10-27-13 1:06 PM
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But the degree of hassle and expense doesn't really matter, does it?

This is mandatory, enforced by law and the IRS, and everybody must sign on, no matter how much it degrades your life or is a PITA or is a complete fuckup when you get to the hospital or receive your bills.

It will then matter in the voting booth, but whatever happens in 2014 or 2016, we can blame racism and sexism.


Posted by: bob mcmanus | Link to this comment | 10-27-13 1:12 PM
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Rusty approaches part of what I think will happen, and what was intended all along by the neoliberal assholes.

Tom's Avalanche Theory- once an avalanche is started there is no controlling it

Some of the probable unintended consequences (?) of Obamacare are started to play out.

The convergence of 1) a mediocre economy, 2) a weak labor major and the 3) health reform avalanche are causing a sea change in the relationship between employers and employees.

Current higher deductibles and higher co-pays will eventually lead to much higher deductibles and co-pays and employers dumping employees into exchanges. HSAs will likely become more popular.

This risk** and financial shift will weigh heavy on the working middle class.

So what if Obamacare flops? Is repealed? The avalanche has started and cannot be stopped.

**Jacob Hacker on risk shift.

But I try to keep silent, because nobody will listen to criticism of the greatest Democratic success Evah, and just watch it happen. Watching variables like life-expectancy, infant mortality, Gini numbers and and what goes to the 1% or top 10%.

Brad DeLong this kind of thing


Posted by: bob mcmanus | Link to this comment | 10-27-13 1:27 PM
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If at first you don't succeed, try, try again.


Posted by: Moby Hick | Link to this comment | 10-27-13 1:36 PM
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I really wish it were noted more often that while some younger people may have to pay more now for health insurance than they had, they will also pay less in later years than they had. That's the point, and the idea.


Posted by: parsimon | Link to this comment | 10-27-13 1:55 PM
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The slower the signups because the young and/or healthy can't be bothered with the hassles the more the actuarial numbers suck

On the other hand, the young and healthy are more likely to be spending time in front of a computer anyway, and more likely to be able to figure out things like "clear out your cookies" to make the thing work.


Posted by: | Link to this comment | 10-27-13 2:04 PM
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59: I think JP's mostly reacting to stupid media coverage, which he is apparently consuming in vast quantities for some reason.

I blame twitter.

Actually this phase of coverage was just so annoyingly predictable (here's me predicting it a week or two ago). And it really is such a botched up mess of a bill that I hate "defending" it. But it is also one of those courses of action where once you've engaged you've got to be all in. So watch this space.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 4:55 PM
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63: Holy shit, the rarely sighted bob mcmanus-Ezra Klein Pinkboy Bedwetter's Alliance! We'll never get the yellow out of the sheets at this rate.

Yes, among the political challenges this bill will possibly face is the possibility of adverse demographics. However, 1) current websiteproblems will have little or no effect on demographics, and 2) it would have to go massively, massively wrong to overcome the ratchet/normalization effect (which Ezra is too young and surrounded by rarefied idiots in DC to understand).


Posted by: JP Stormcrow | Link to this comment | 10-27-13 5:00 PM
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57.1: JP, I think you should stop digging.

I don;t think I am digging, but if that is the imagery we are using, I've got Mike Mulligan's steam shovel going on this one. I can be here all week. Try the veal.

57.2.last: I have no idea what you mean about a balance of harms.

In the overall scheme, I am sure there will be some people who are marginally harmed or inconvenienced in the short term, but they are more than offset by those who were quite materially harmed by the previous policies. And further members of the first group are on average better-positioned in life than those in the second. So that is what I mean by "balance of harms."


Posted by: JP Stormcrow | Link to this comment | 10-27-13 5:06 PM
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I've got Mike Mulligan's steam shovel going on this one. I can be here all week. Try the veal.

Coming soon, in Mike Mulligan and His Steam Shovel 2: Hello, Catskills!


Posted by: Sifu Tweety | Link to this comment | 10-27-13 5:14 PM
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Since coming to the Catskills, Mike Mulligan's steam shovel is all in on fracking.


Posted by: Von Wafer | Link to this comment | 10-27-13 5:19 PM
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For instance my one kid could really have benefited from an earlier well-functioning system since he had to decide whether to continue an existing COBRA (very good--~gold level--but rather pricey) by October 25th. Now, since we have a dangerous, hurtful buffoon as governor (thanks to privileged, racist goobers like many of my co-workers) we are in the Fed exchange, and going into this my son was certainly not naive enough to think he would have the greatest information to base his decision on (he also has other complications pertaining to his tax status and probable income). In the event, he stayed on the COBRA and may be dropping on the order of $100/month. But, you know, he could have had that relief in 2013 under a different schedule for the ACA, it really is somewhat unfortunate timing (in part due to the stupidly tight COBRA declaration deadline).

I have no idea what relevance that has to anything.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 5:20 PM
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It does not really go into the IT stuff in any detail, but this is an OK paper comparing the Medicare Part D and ACA rollouts (from June of this year). They do talk about "data" issues a fair bit.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 5:35 PM
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An interesting article about one part of the online rollout that has been surprisingly effective so far, and which is part of the reason the states have been able to do better.


Posted by: Minivet | Link to this comment | 10-27-13 5:45 PM
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So, wait, Minivet (or Kermit or other knowledgeable folks)--*can* people sign up whenever? If things start working, can JP's son drop COBRA in January and only pay the extra $100 for a month or so?

This is of interest to me, too: I'm currently on the federal pre-existing condition plan, which ends with 2013, so I will be signing up for the exchanges. But hopefully, I will actually get a job with benefits in December or January. When that happens, I imagine I'll be better off switching to the employer's coverage--that's possible, right? Or am I locked-in to a year of whatever I bought on the exchange? (I spent a solid 30 seconds trying to google this, without success.)


Posted by: x.trapnel | Link to this comment | 10-27-13 6:41 PM
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This might be super-obvious, but since I've never had a job with health insurance, aside from when I was on NYU's PhD student plan, I'm not sure how these things work.


Posted by: x.trapnel | Link to this comment | 10-27-13 6:42 PM
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77,78: doesn't California have its own (apparently pretty good) exchange? I wouldn't think the issues with the federal site would affect you.


Posted by: Sifu Tweety | Link to this comment | 10-27-13 6:44 PM
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Oh, I see the question. Starting a job is (almost?) always a qualifying event for changing health insurance.


Posted by: Sifu Tweety | Link to this comment | 10-27-13 6:45 PM
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... except I don't actually know if it works that way with the exchanges. Super helpful, Sifu. Good effort.


Posted by: Sifu Tweety | Link to this comment | 10-27-13 6:45 PM
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Right, this has nothing to do with the exchange's problems. (As far as I know, yeah, CA's is fine.) It's just a matter of--ideally, I won't need individual coverage, because I'll be getting a gold-plated plan with a personal chef and a pet wallaby in January. But it would be insane to plan on that to the extent of not signing up for something on the exchange, especially if you need to sign up by X date in order to get coverage by January 1. However, in that case, it would be nice if I can just cancel that coverage in February, if things do turn out well. I assume that's true, and you can. Can you do the reverse, and sign up on the exchanges in January in order to be covered by February or March?


Posted by: x.trapnel | Link to this comment | 10-27-13 6:47 PM
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You have failed me, Sifu. Failed me!


Posted by: x.trapnel | Link to this comment | 10-27-13 6:48 PM
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82: You can sign up through March. To get coverage in January you need to sign up by December 15.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 6:50 PM
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Oh. So I'm confused--can't your son drop COBRA in mid-December, then?


Posted by: x.trapnel | Link to this comment | 10-27-13 6:54 PM
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Sifu actually was helpful, in that the "qualifying event" keyword led to lots of search results, including this one.this one.

Thanks, Sifu!


Posted by: x.trapnel | Link to this comment | 10-27-13 6:56 PM
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I'm still ashamed.


Posted by: Sifu Tweety | Link to this comment | 10-27-13 6:58 PM
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Actually probably. I must admit, not used to thinking this way...

His COBRA is a good plan, so he may still want to keep... but, right gives him some time to really research the others.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:03 PM
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Yeah, under the old regime, I switched from individually bought insurance to employer insurance without a problem, but I think I could have canceled the individual insurance at any time anyway. I also got a refund of the month I had prepaid for the individual coverage since I wasn't sure when the employer coverage would start and ended up "double" covered (not actually double with the retroactive cancellation + refund).* I would hope that all of this will be possible in the new system.

*I even got a refund of months of car insurance later on since I forgot to cancel my old plan immediately, so I think there's a rule about refunds when someone is double-covered in different states for certain types of insurances.


Posted by: fake accent | Link to this comment | 10-27-13 7:05 PM
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The more I think about it, sure he can. He does not need a "qualifying event." Thanks, Sifu.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:06 PM
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with a personal chef and a pet wallaby

Bay Area employers have finally gone too far.


Posted by: essear | Link to this comment | 10-27-13 7:08 PM
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He should go on Hannity and be all butthurt about it, and then get fact-checked.

These rats aren't going to fuck themselves.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:08 PM
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To Australia, apparently.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:09 PM
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Like Ted Cruz's gold-plated Goldman-Sachs coverage via his wife.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:09 PM
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I think I might be double insured right now. I'm messing it up for everybody else!


Posted by: Sifu Tweety | Link to this comment | 10-27-13 7:12 PM
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You're relatively young and healthy--sign up a zillion times and make it work.


Posted by: JP Stormcrow | Link to this comment | 10-27-13 7:16 PM
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||

I just realized that every time I've seen a car ad with the "professional driver, closed course" disclaimer, I had parsed it as meaning that the course was a closed loop, not that it was closed as in it was closed to other traffic.

|>


Posted by: Sifu Tweety | Link to this comment | 10-27-13 7:38 PM
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If the employer doesn't oblige, you could always buy a wallaby.


Posted by: Kreskin | Link to this comment | 10-27-13 8:07 PM
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||

FUCK baseball is nervewracking

|>


Posted by: Sifu Tweety | Link to this comment | 10-27-13 8:32 PM
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Regular baseball is mostly dull.


Posted by: Moby Hick | Link to this comment | 10-27-13 8:33 PM
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||

HOLY SHIT

|>


Posted by: Sifu Tweety | Link to this comment | 10-27-13 8:52 PM
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101 gets it exactly right.


Posted by: Kreskin | Link to this comment | 10-27-13 8:52 PM
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What the hell. I still can't parse how that happened.


Posted by: Sifu Tweety | Link to this comment | 10-27-13 9:02 PM
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Looks like your questions is answered, trapnel, but congratulations!


Posted by: Minivet | Link to this comment | 10-27-13 9:25 PM
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76: Heh. Apparently there was an outage at Terremark yesterday that affected the data hub (among lots of other hosted apps of course). I should probably stay off Twitter this week.


Posted by: JP Stormcrow | Link to this comment | 10-28-13 5:13 AM
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NYTimes with a nod to the bedwetter's brigade: "Health Site's Woes Could Dissuade Vital Enrollee: the Young and Healthy."

Last para: "At this point, I'm just printing it out and sending it in," he said, referring to one of the offline options for signing up. "I'll probably have it done by the end of the month."

Death spiral!


Posted by: JP Stormcrow | Link to this comment | 10-28-13 6:28 AM
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Well, this is bad: HealthCare.gov data center fails, hobbling state and federal insurance exchanges.

Seems like they botched an update, and brought down the whole damn system. These things happen, and kinks in the deployment process of a new system are to be expected, but it just goes to show how immature this thing is. It probably doesn't help that the sysadmins have likely been working 80 hour weeks for a couple months now.

Also, apparently they don't have hot backups of this thing.

Surprising that it would affect the state level exchanges as well, but I guess those are using the central system for verification and whatnot.


Posted by: Spike | Link to this comment | 10-28-13 6:42 AM
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107: More bullshit. It was the Verizon Terremark datacenter I mention in 105 that went down, which I am sure runs more than the health care.gov datahub (I will admit that I don't absolutely know this). The failure was a system-level network failure that was caused by a Terremark system/network upgrade (not the datahub siftware--but it could have been part of increasing throughput or capacity or somesuch). The state exchanges were affected because that is the part that shares data that the state exchanges need to determine eligibility and subsidy levels.

But everybody keep fucking that chicken.


Posted by: JP Stormcrow | Link to this comment | 10-28-13 7:07 AM
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Wow, data hub going down just after HHS was touting it. Still, that seems more short-term an issue.

107.last: Tax information, veteran status, Medicare status... lots of information needing to be checked that only the federal government has.


Posted by: Minivet | Link to this comment | 10-28-13 7:08 AM
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ACA = America Cloaca Act.


Posted by: Moby Hick | Link to this comment | 10-28-13 7:09 AM
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Which reminds me.

60: I'm of the mind that a) Democrats do need to take ownership of this fuckup, and ease off on the defensiveness and backbiting

Thanks. As if the Dems are not owning the fuckup which is fact mostly theirs. See 15.


Posted by: JP Stormcrow | Link to this comment | 10-28-13 7:10 AM
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I hate everybody.


Posted by: JP Stormcrow | Link to this comment | 10-28-13 7:10 AM
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Even Dom DeLuise?


Posted by: Sifu Tweety | Link to this comment | 10-28-13 7:11 AM
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113 to 108.last.


Posted by: Moby Hick | Link to this comment | 10-28-13 7:12 AM
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113: He's dead, you insensitive motherfucker.


Posted by: JP Stormcrow | Link to this comment | 10-28-13 7:13 AM
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I will admit that it does have that "you can't win for losing" aspect to it. Like Steelers kicker who had been perfect this year missing two near-gimme FGs in a 3-point loss to a bad team.


Posted by: JP Stormcrow | Link to this comment | 10-28-13 7:22 AM
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109 before seeing 108.


Posted by: Minivet | Link to this comment | 10-28-13 8:00 AM
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The failure was a system-level network failure that was caused by a Terremark system/network upgrade

This seems to be the case, although I am concerned by the lack of redundant data centers.


Posted by: Spike | Link to this comment | 10-28-13 8:45 AM
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I'm concerned too, Spike. There should be a concerned face emoticon.


Posted by: Von Wafer | Link to this comment | 10-28-13 9:27 AM
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My concerned face: let me show you it.


Posted by: Von Wafer | Link to this comment | 10-28-13 9:29 AM
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I just learned that a very good friend of mine has a piece forthcoming in Modern Love (which I have never read, but which I know is a fan favorite here in the Mineshaft).


Posted by: Von Wafer | Link to this comment | 10-28-13 9:33 AM
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Sure. Your "good friend."


Posted by: Robert Halford | Link to this comment | 10-28-13 9:34 AM
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Plus we all know already that it will be about the volatile mixture of attraction and repulsion you feel for Josh. The piece writes itself.


Posted by: Robert Halford | Link to this comment | 10-28-13 9:35 AM
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"I thought the kinks were finally getting worked out and the biking was helping his self-esteem, but then came The Limp."


Posted by: JP Stormcrow | Link to this comment | 10-28-13 9:45 AM
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So, I have an ACA question, if any of you informed types are still checking this thread: My (new, cardiologist) doctor claims that because of Obamacare*, he is not allowed to do more than one procedure (=test) per appointment, and I am not allowed to schedule more than one appointment per day.

This is REALLY DUMB. Is it real? What the fuck. Why on earth is there a rule that I have to take 4 separate half-days off (and pay 4 copays) to do a series of tests that could easily be accomplished in a single 2-hour visit? That's it, I'm joining the tea party.

*he actually phrased it as "new federal guidelines" but whatever.


Posted by: E. Messily | Link to this comment | 10-28-13 11:38 AM
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My uninformed opinion is that he's full of shit.


Posted by: SP | Link to this comment | 10-28-13 11:42 AM
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My guess is that your cardiologist has decided that anything that doesn't maximize his income isn't "allowed." If you do two related procedures on the same day, the feds might be tempted to say those were two parts of a grander procedure and not allow you to bill as much as if you do them separately.


Posted by: Moby Hick | Link to this comment | 10-28-13 11:44 AM
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125: Never heard of anything like this. Probably bullshit.


Posted by: Minivet | Link to this comment | 10-28-13 11:45 AM
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Huh. I'm not really sure if I am more or less angry now than I was before. It's directed elsewhere now though. I'll call the office and ask for some citations.


Posted by: E. Messily | Link to this comment | 10-28-13 11:48 AM
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Does anything on this sheet sound like what he was talking about.


Posted by: Moby Hick | Link to this comment | 10-28-13 11:57 AM
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Anyway, the feds certainly cut what they pay for a lot of stuff in cardiology.


Posted by: Moby Hick | Link to this comment | 10-28-13 12:02 PM
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I'm on the phone with someone now (well, on hold). SHE says it's an office policy related to insurance, and then basically stonewalled me when I tried to find out more. So now I'm waiting for her supervisor, I guess.

I can't tell what I think is happening, exactly, but I don't like it.


Posted by: E. Messily | Link to this comment | 10-28-13 12:03 PM
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Sounds like bullshit to me, Messily. Every change doctors make will be blamed on Obamacare for the next few years, until people start to catch on.


Posted by: togolosh | Link to this comment | 10-28-13 12:04 PM
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Okay now they're admitting that the issue is related to money, not some weird statute or something. I still don't totally believe it but apparently insurance will not pay for more than one procedure per visit. "Because some of the codes we use for billing are very similar to each other".

Now they're trying to reschedule some of the things (I was set up for 7 separate appointments over the next month and a half which is STUPID crazy. I might be able to get it down to 4 or 5).

Have I mentioned that I hate doctors?


Posted by: E. Messily | Link to this comment | 10-28-13 12:19 PM
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Good fucking grief.


Posted by: heebie-geebie | Link to this comment | 10-28-13 12:33 PM
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That's 7 cardiologist appointments*. Which is on top of the 1 immunology, 2 gastroenterology, 2 back/spine/pain, and 1 primary care. All between now and the middle of December.

I am basically ready to give up and convert to Scientology at this point.

*Nothing got rescheduled. Whoever I got transferred to at the appointment desk couldn't figure out how to make it work and I got sick of sitting around staring at the interpreter on the screen. Back to work!


Posted by: E. Messily | Link to this comment | 10-28-13 12:44 PM
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Converting to Christian Science should save just as much time at the doctor with fewer annoying celebrity coreligionists.


Posted by: LizardBreath | Link to this comment | 10-28-13 12:58 PM
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For more than 5 appointments, it's probably cheaper to buy your own cardiologist.

(But seriously, they should at least be able to schedule multiple appointments on the same day.)


Posted by: torrey pine | Link to this comment | 10-28-13 1:02 PM
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The only positive aspect of the whole situation right now is that I am under strict orders to eat lots of salt. "Eat those Chinese noodles for lunch! but NOT the low-sodium kind. The salty kind. Do that every day".

He seriously said that to me.

Here's the latest thing that is wrong with me: Neurally Mediated Syncope.


Posted by: E. Messily | Link to this comment | 10-28-13 1:09 PM
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I still don't totally believe it but apparently insurance will not pay for more than one procedure per visit. "Because some of the codes we use for billing are very similar to each other".

Christ. This I can believe, though.


Posted by: Minivet | Link to this comment | 10-28-13 1:19 PM
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Neurally Mediated Syncope.

If your cardiologist is telling you that you're syncopated, does that mean you have ragtime in your blood?


Posted by: LizardBreath | Link to this comment | 10-28-13 1:32 PM
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I am under strict orders to eat lots of salt. "Eat those Chinese noodles for lunch! but NOT the low-sodium kind. The salty kind. Do that every day".

I will admit, that is advice I would never expect to hear from a medical professional.


Posted by: NickS | Link to this comment | 10-28-13 1:35 PM
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"Because some of the codes we use for billing are very similar to each other we don't want to set off the fraud alarms again."


Posted by: Spike | Link to this comment | 10-28-13 1:44 PM
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we don't want to set off the... alarms again.

This reminds me that I haven't put the smoke alarms back up since the last time I made dinner.


Posted by: LizardBreath | Link to this comment | 10-28-13 2:01 PM
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Your blog commenting: It may just have saved a life today.


Posted by: Robert Halford | Link to this comment | 10-28-13 2:04 PM
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"This year alone, smoke detectors have alerted over three million people that they're cooking steak."


Posted by: JP Stormcrow | Link to this comment | 10-28-13 2:09 PM
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If I make toast and the smoke detector goes off, I know I need to shake the crumbs out of the toaster.


Posted by: Moby Hick | Link to this comment | 10-28-13 2:14 PM
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shake the crumbs out of the toaster pry the batteries out of the smoke detector remove the oxygen from the atmosphere.


Posted by: torrey pine | Link to this comment | 10-28-13 2:41 PM
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Messily at 134: I still don't totally believe it but apparently insurance will not pay for more than one procedure per visit. "Because some of the codes we use for billing are very similar to each other".

This thread is decayed by now, but if that's (supposedly) the case, it's about either the insurance company or the doctor's office. The cardiologist's office may be amateurs at billing codes. I'd frankly press them on it: how are you billing these procedures? Are you billing them as necessary because of a distinct and new state of affairs with my health? Or as a continuation of my existing condition(s)?

For example: I have hyponatremia: chronic low sodium. From what we can tell, it's due to a medication I take and have taken for over 20 years, not due to some other issue. Some meds do that. When I saw my doctor a month or so ago, she added a sodium level test to my usual medication level test when writing up the order to the blood lab, and specifically wrote on the order "hyponatremia", remarking that this indicates a specific billing code, i.e. that this sodium level test is an ongoing, not a new thing.

Does that make sense? You should be able to have multiple tests/procedures in a single visit, all as part of the investigation of a single state of affairs, health-wise. My sense from my doctor is that billing codes will differ in that case: the procedures aren't exploring a new situation.

Anyway it's absurd that you should have to have separate and distinct appointments. Maybe the billing people at the office just don't know what they're doing, or maybe it's a scam.


Posted by: parsimon | Link to this comment | 10-28-13 6:20 PM
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Messily's situation really highlights just how bullshit the entire fee-for-service model of medicine is. Ugh.


Posted by: x.trapnel | Link to this comment | 10-28-13 7:32 PM
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150 is right. It isn't a scam, by current legal definitions. It's revenue optimization. And fuck-headery, if that's a distinction you can make in late capitalism.


Posted by: Moby Hick | Link to this comment | 10-28-13 7:49 PM
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I mean, it might be a scam. Doctors have certainly scammed insurers. But the odds are that it is legal.


Posted by: Moby Hick | Link to this comment | 10-28-13 7:51 PM
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"Because of Obamacare, I am no longer allowed to treat you. Well, I can, but thanks to our nanny-state overlords I can now only make a profit of $230 per hour treating you, so fuck off."


Posted by: Cryptic ned | Link to this comment | 10-28-13 8:44 PM
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Yahoo National Headline

Obama administration knew millions wouldn't be able to keep insurance

I read comments. Some are Teabaggers some are sane but heartbreaking

Obama lied. He serves the bankers, the ones who will take your home. Obama is brilliant, and unspeakably evil.

Pelosi? Remember the bankruptcy bill? Non-dischargable student loans?

Kleptocracy wasn't gonna give you something nice.


Posted by: bob mcmanus | Link to this comment | 10-28-13 8:58 PM
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Did you read that article? They can keep their plans except that can't keep their plans because the plans weren't getting worse. That's got nothing to do with the government forcing you to shift insurance and everything to do with the wall of bullshit attack on Obamacare.


Posted by: Moby Hick | Link to this comment | 10-28-13 9:04 PM
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Obama is brilliant, comparatively.


Posted by: Moby Hick | Link to this comment | 10-28-13 9:05 PM
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Somebody work out who should be more insulted by that.


Posted by: Moby Hick | Link to this comment | 10-28-13 9:07 PM
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"Is there any bullshit so disingenuous that bob wouldn't take it for a ride?" Tom acknowledged rhetorically.


Posted by: JP Stormcrow | Link to this comment | 10-28-13 9:37 PM
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Bob is basically the blog's smoke detector/paranoid car alarm. "Are we on fire? No, just making toast..."


Posted by: Alex | Link to this comment | 10-29-13 3:46 AM
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But one say we will actually be on fire. Then we'll learn.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 3:50 AM
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day


Posted by: JP Stormcrow | Link to this comment | 10-29-13 3:50 AM
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Speaking of which, I will attempt to take the batteries out by pointing out that bob's sometimes partner in liberal butthurt, bmaz, is saying his previous wonderful independent market health insurance is going up by $650-700/2x. I'd like to see exactly how that works.

However, more than the website stuff, I do think there is some real danger here in general, and in particular I think it would have been better to give existing policies a year grace (maybe some bare minimum standards to root out the real junk ones like the $50/month ones). And yes, I know actuarial death spiral yada yada, but there are already some behind-the-scenes to adjust for that and could have been more heavy-handed/subsidized the 1st year. (But of course another avenue of attack for Repubs--I look forward to hearings on the risk pools as it is.)


Posted by: JP Stormcrow | Link to this comment | 10-29-13 4:04 AM
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162: And the late "discovery" of this and out-of-context coverage by MSM like NBC (what bob linked via Yahoo) and CBS, "@CBSNews confirms 2M+ people losing coverage bc of OCare" is as crappy as one would expect.

2m is in fact a lot of people--especially because it contains butthurt UMC like bmaz; the 40M uninsured is a much smaller number because generally losers anyway.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 4:18 AM
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163.2.last: Also not a great advertising demographic.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 4:21 AM
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I wonder what the baseline for that 2M number is. How many people get their plan switched on them in an average year, or otherwise get jacked around by their insurance companies for spurious reasons? 2M a year sounds low, for that.


Posted by: Spike | Link to this comment | 10-29-13 5:28 AM
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The total number of independent plans seems to be only about 14M (I think that is plans, so people covered is higher), and I don't think that 2M is necessarily a full count, but a minimum based on states that have reported the number. So hard to say.

The new found love for the prior workings of the independent health insurance market does warm the heart, however.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 5:48 AM
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The health insurance industry shit cute puppies and rainbows before Obama wrecked it.


Posted by: Moby Hick | Link to this comment | 10-29-13 6:02 AM
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And this article* on California seems to imply that there may be a state-level choice involved (at least for this year).

All these cancellations were prompted by a requirement from Covered California, the state's new insurance exchange. The state didn't want to give insurance companies the opportunity to hold on to the healthiest patients for up to a year, keeping them out of the larger risk pool that will influence future rates. Peter Lee, executive director of Covered California, said the state and insurers agreed that clearing the decks by Jan. 1 was best for consumers in the long run despite the initial disruption. Lee has heard the complaints -- even from his sister-in-law, who recently groused about her 50% rate increase.
This article from Kaiser Health News (who have done a very good job on covering the ACA) is a good summary. But the "Obama lied to white people" is going to be strong with this one.

*Headlined by the now famous Orange Countian with $98/month insurance going to $238/month but make too much for subsidies.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 6:06 AM
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Pelosi? Remember the bankruptcy bill? Non-dischargable student loans?

Also, the fuck? What did Obama have to do with non-dischargable student loans? That was before he was even in the Senate. He was in the Senate for the bankruptcy bill, but he voted against it. So did Pelosi.


Posted by: Moby Hick | Link to this comment | 10-29-13 6:10 AM
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It is clear that I am becoming over-involved in the coverage of this, but it is just so infuriating that we cannot have any kind of a "normal" debate over what is in fact some pretty thorny public policy issues. The first part of Greg Sargent's Morning Plum covers this well.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 6:13 AM
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169: "Ah, but the strawberries that's... that's where I had them. They laughed at me and made jokes but I proved beyond the shadow of a doubt and with... geometric logic... that a duplicate key to the wardroom icebox DID exist ..."


Posted by: JP Stormcrow | Link to this comment | 10-29-13 6:19 AM
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Our open enrollment started this week and we were told that our premiums and copays will increase by 0%. I wanted a decrease! Thanks, Obamacare! (They did fuck us last year so I think there was some slack in the system, and our director is a big Obama booster so conspiracy minded people might think he put out the directive to keep people happy about their insurance this year.)


Posted by: SP | Link to this comment | 10-29-13 6:23 AM
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Obama caused my toenail fungus to become onychomycosis.


Posted by: Moby Hick | Link to this comment | 10-29-13 6:30 AM
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One of the articles in 168 had a stat that 9% was probably going to be the average increase this year in the independent market (might have just been CA) without the exchanges opening. (And of course, several parts of the ACA that were already implemented probably influenced that amount both for good and bad.) As discussed before, all part of the ACA becoming THE framework for health insurance in the country and being grandfathered in on many of the aspects of that system. And fairly enough, except we can't talk about it in a sane way because of current political situation.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 6:31 AM
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Obama made me tired and headache-y and not wanting to go into work today after my 6:30-8:30 conference call.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 6:32 AM
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I'm thinking of taking a picture of my toenail and putting it up on the wikipedia page for onychomycosis. Mine looks way worse than that, because of the subungual hematoma from running.


Posted by: Moby Hick | Link to this comment | 10-29-13 6:39 AM
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BTW, that 0% made me wonder about stickiness of benefits, in that it's kind of the inverse of stickiness of wages. In wages people would like a performance increase or minimally a COLA but see worst case as no change, a nominal wage cut is a sign to head for the exits so there's plenty of evidence that nominal wages are rarely cut (Krugman had a chart last year of wage changes with a big spike at 0% rather than a distribution extending into negative territory.) On benefit contributions, it's the opposite, people expect a minor increase every year, sometimes get screwed with a big increase in employee cost, and consider the best case no change; A cut in employee costs is unfathomable and employers almost never do it. Is there a similar mentality between the two? Someone activate the DeLong signal.


Posted by: SP | Link to this comment | 10-29-13 6:43 AM
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176: I just had the nail on my one big toe come of, but I think it was due to repeating whacking and stubbing and whatnot. Happened to me once before back in my teens; the malformed sub-nail that is now the new nail is fairly gross-looking as well.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 6:43 AM
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I have health insurance. I should just go get it fixed.


Posted by: Moby Hick | Link to this comment | 10-29-13 6:46 AM
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off


Posted by: JP Stormcrow | Link to this comment | 10-29-13 6:47 AM
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Someone activate the DeLong signal.

David Graeber is the most insightful and accurate writer on financial topics active today.


Posted by: Moby Hick | Link to this comment | 10-29-13 6:48 AM
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Does Graeber read our comment threads?


Posted by: SP | Link to this comment | 10-29-13 6:50 AM
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177: The psychology of all of that is somewhat fascinating, and I think may have been exploited better in the ACA case. I recall at my workplace when we went from employer-only contribution to shared (mid-90s I believe), the 1st year it came out to $0 employee contribution. Everyone of course knew that was going to be the last of that (I think it's about 50-50 now), but seemed relatively content that they at least got a year "reprieve."


Posted by: JP Stormcrow | Link to this comment | 10-29-13 6:53 AM
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182: I was jokingly suggesting that saying something nice about Graeber would motivate DeLong to rebut if he were reading the comments. /standpipe>


Posted by: Moby Hick | Link to this comment | 10-29-13 6:55 AM
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From 170:They will also no longer be part of a system in which the young and healthy are offered cheap insurance premiums because their sick neighbors are priced out or denied coverage. That, after all, is the whole point of reform.

and, yes, government spending that is to some degree (though the extent is not yet clear) redistributive.

You are right it is impossible to have a sane discussion on this because at least for me "redistributive" does not mean fucking over young people trying to get started while carrying huge student loans. YMMV.

"Redistributive" means fucking guillotines lining Wall Street.

But Democrats just sorta flap their hands in the air and says well 90% marginal rates on fucking billionaires would be nice but Republicans are meanies so let's turn our kids into debt slaves and footstools for the plutocracy. Don't let the perfect be the enemy of the horrible.


Posted by: bob mcmanus | Link to this comment | 10-29-13 7:10 AM
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It's not even close to fucking over young people. Rates are allowed to be set by age so that young people pay less than old people and there is a subsidy for those who have lower incomes. The redistributive nature of Obamacare is exactly what everybody who is opposed to it worries about.


Posted by: Moby Hick | Link to this comment | 10-29-13 7:13 AM
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Let's all pull more uncited, false claims from Sean Hannity's colon and post them around the internet.


Posted by: Moby Hick | Link to this comment | 10-29-13 7:16 AM
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186: is exactly what everybody who is opposed to it worries about.

"Everybody" is not right. There is a substantial opposition who would like something more like single-payer. But certainly mostly true for those currently hyperventilating.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 7:18 AM
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Sean Hannity's colon doesn't care about single-payer.


Posted by: Moby Hick | Link to this comment | 10-29-13 7:20 AM
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Rates are allowed to be set by age so that young people pay less than old people

But rates aren't allowed to be set by age not to an actuarily fair extent. Isn't the maximum permissible age-premium spread something like 3x?

Everything I've read about the ACA indicates that the young and healthy are in fact subsidizing to some extent the older and sick. Yes, there is a subsidy for those who have lower incomes. That's a separate point.


Posted by: urple | Link to this comment | 10-29-13 7:23 AM
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189: Right, per 188.last Hannity's Colon is a good stand in for most of the current opposition.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 7:24 AM
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Not that it's necessarily wrong for the young and healthy to subsidize the old and sick. But it's wrong to deny it's happening. Like bob, I'd prefer the subsidy be borne by the ponies.


Posted by: urple | Link to this comment | 10-29-13 7:28 AM
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The brony tax. The NSA can certainly identify them.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 7:32 AM
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190: The healthy are "subsidizing" the sick. That's sort of the whole point of insurance. The limit is 3x and this is a relatively small distortion compared equalizing rates by gender or Medicare. And more than offset by subsidies plus the face that the youngest cohort who is paying the most increased rate consists entirely of people who can now stay on their parents' insurance because of Obamacare. See here, for example.


Posted by: Moby Hick | Link to this comment | 10-29-13 7:37 AM
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s/b "the limit for premium difference by age"


Posted by: Moby Hick | Link to this comment | 10-29-13 7:37 AM
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But it's wrong to deny it's happening.

I don't think it's wrong to deny that it's a trivial issue puffed-up mostly by people who don't want Obamacare to work for other reasons.


Posted by: Moby Hick | Link to this comment | 10-29-13 7:39 AM
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I don't think it's wrong to deny that it's a trivial issue puffed-up mostly by people who don't want Obamacare to work for other reasons.

Megan McArdle has been sounding this alarm for a while now.


Posted by: urple | Link to this comment | 10-29-13 7:50 AM
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That's kind of my point.


Posted by: Moby Hick | Link to this comment | 10-29-13 7:53 AM
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176, 178 Frostbite would make your toenail pics nice and colorful. Mine turned every color of the rainbow before it came off. Also, getting frostbite is painless. The thawing process on the other hand, fucking hell.


Posted by: teraz kurwa my | Link to this comment | 10-29-13 7:57 AM
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Does this mean that we are definitely going to have a death spiral? Of course I can't say that; I'm not psychic. There are various steps that the administration might take, legal or quasi-legal, to try to get the insurers to keep selling cheap policies even as their costs rise. And as I pointed out a while back, the young may buy simply because this is now the law of the land, even if it's difficult, and even if we delay the individual mandate.
But, of course, there was no way to be 100 percent certain that invading Iraq would turn out badly; smart critics of that policy argued (correctly) that invading Iraq ran unacceptably high risks. The goal was a great one: Free Iraq from a dictator who was a destabilizing geopolitical force and help the Iraqi people to establish a prosperous and functional democracy. But the downside risk of embroiling the U.S. in an unwinnable war that would kill a lot of Iraqis and destabilize the region even further was horrifying, and all too likely. Looking at the aftermath, I sure wish I'd listened -- and even more that our leaders had.
Which reminds me of something that I've been wanting to say. I admire the way that fearless liberals have come out to criticize the rollout of the exchanges -- much more quickly and completely than supporters of the Iraq War managed, I'm afraid. (Though of course, in fairness, the malfunctioning exchanges are right here where everyone can see them, not thousands of miles away.) But as with Iraq, I fear that the bitterness of the debate in the run-up is making the administration and many of its supporters discount too deeply the valid criticism coming from the opposition. It is true that I, and many others who are talking about the problems with these exchanges, opposed the health-care law; my preference is not for a delay but for completely getting rid of this law, and starting over with something that works better. (More on that later.)
But I'm also an American who wants our insurance market to work. My first preference is for Obamacare to go away, making room for a more market-oriented solution. Failing that, of course I want Obamacare to work as its designers envisioned, rather than destroying the market for individual insurance and costing the federal government boatloads of money that it doesn't have. It's just that I don't think this is the most likely outcome, and frankly, it's looking less likely with every ham-fisted management decision that endangers the long-term health of the system and gains only some evanescent political advantage.
In this, I expect I feel much the same way as patriotic critics of the war who wanted the troops brought home ASAP because they thought that our efforts in Iraq were doomed -- but, failing that, would rather have seen their opponents proven right, their country prevail, and peace and prosperity come to Iraq.

Posted by: urple | Link to this comment | 10-29-13 8:00 AM
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Yes. I read it. I'd take it seriously if there were any more market-oriented solution to cover more people than are currently covered that was proposed by any critic of Obamacare who has control over anything besides the content of a news website. Despite lifting the basics of the plan from a Republican, there was not a single attempt by Republicans to engage or compromise at all when Obamacare was past. It's been three years and there was literally nothing from the other side as far as legislation or a concrete proposal.


Posted by: Moby Hick | Link to this comment | 10-29-13 8:10 AM
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Yeah, it's funny that the free-market people see rising costs as inevitable. Something that couldn't possibly change as a consequence of publishing the fees of the greediest hospitals, or getting the AMA to start discussing how many MDs there should be.


Posted by: lw | Link to this comment | 10-29-13 8:15 AM
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Is this when we suggest hitting her with a 2x4, like the "patriotic critics of the war"?


Posted by: SP | Link to this comment | 10-29-13 8:17 AM
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I'm particularly annoyed by McMegan's analogy because it implies that a status quo where tens of millions are without coverage is somehow comparable to not starting a war.


Posted by: Moby Hick | Link to this comment | 10-29-13 8:18 AM
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I bet the hundreds of thousands of Iraqis who were killed didn't have health insurance either. The war reduced the number of uninsured, just like Obamacare!


Posted by: SP | Link to this comment | 10-29-13 8:22 AM
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I'm not saying that the treatment of McMegan in the Halfordismo reeducation camps is a positive feature of Halfordismo. I would never go that far. It was all done more in sorrow than in anger, but sometimes firm measures are necessary.


Posted by: Robert Halford | Link to this comment | 10-29-13 8:27 AM
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204: You have to think that analogy was chosen to annoy rather than to convince.


Posted by: LizardBreath | Link to this comment | 10-29-13 8:30 AM
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207: It's really somewhat interesting how many of the asshat brigade of gone for some kind of Iraq analogy. It's just sp utterly inappropriate, but I guess it may be the one Republican fiasco they are willing to admit was a fiasco.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 8:47 AM
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I hope I did not create an impression that I was quoting McArdle approvingly.


Posted by: urple | Link to this comment | 10-29-13 8:47 AM
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Does this lawsuit claiming that due to a wording problem, Federal exchange participants shouldn't get any subsidies, actually have any merit?


Posted by: SP | Link to this comment | 10-29-13 8:48 AM
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I shouldn't try to comment while in a very small meeting reviewing Employee Engagement Survey results.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 8:49 AM
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209: You didn't. I hope I didn't convey the impression that I was annoyed with you. Except for the nitrogen thing. That was bad.


Posted by: Moby Hick | Link to this comment | 10-29-13 8:50 AM
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Does this lawsuit claiming that due to a wording problem, Federal exchange participants shouldn't get any subsidies, actually have any merit?

That's for Anthony Kennedy to decide.


Posted by: Cryptic ned | Link to this comment | 10-29-13 8:51 AM
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But rates aren't allowed to be set by age not to an actuarily fair extent. Isn't the maximum permissible age-premium spread something like 3x?
Everything I've read about the ACA indicates that the young and healthy are in fact subsidizing to some extent the older and sick. Yes, there is a subsidy for those who have lower incomes. That's a separate point.

That's what I assumed, but recent wonk-discussion of this indicates that in the current market, the average 64-year-old's premium (holding benefits, number of covered people, etc. constant) is in fact about three times the average 21-year-old's. If this is the case, then it's the healthy young subsidizing the sick young, and the healthy old subsidizing the sick old. I'm not clear, though, if the unregulated actuarial band would be higher if they didn't exclude of people with preexisting conditions.


Posted by: Minivet | Link to this comment | 10-29-13 10:58 AM
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The WaPo Business section article the following bit is from is a classic "view from nowhere" account of anger against Obama in Tea Party Congressional districts because the economy sucks there and only tangentially touches on the ACA ("At the source of the shutdown, the economy falters -- and anger at Barack Obama runs high").

But their construction of this part at the end just boggles the mind:

He needs shoulder surgery but can't afford insurance. And because of a quirk in the health-care law, and the fact that Georgia declined to expand Medicaid coverage for low-income people like him, Rizer can't qualify for a subsidy to buy coverage on his own.
When he visited the federal health insurance exchange Web site, he found the cheapest policy available to him cost $200 a month -- one quarter of his current salary. "Obama," he said, "he thinks that he's helping things, but he ain't."
Ah those, quirky quirks in the law, how do they happen? So bad of Obama to force John Roberts get rid of the mandatory Medicaid extension and Georgia to decline to implement it. Bad black man! Bad!


Posted by: JP Stormcrow | Link to this comment | 10-29-13 12:49 PM
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Confidential to CCarp. Could you please send me an email at this name at gmail? Thanks.


Posted by: Moby Hick | Link to this comment | 10-29-13 12:54 PM
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215: The boyfriend read me that story over breakfast. Did you see the bit about the guy who clearly wasn't politically motivated because he liked Bill Clinton well enough?


Posted by: ydnew | Link to this comment | 10-29-13 1:01 PM
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Further from the article in 215 in case it was too subtle:

The epicenter of that economic distress lies in the Deep South. Four of the congressional districts are in North Georgia. A dozen others are close by in Alabama, Tennessee, Florida, and North and South Carolina.


Posted by: JP Stormcrow | Link to this comment | 10-29-13 2:17 PM
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Hey, JP, I've got another one for your blood pressure.


Posted by: snarkout | Link to this comment | 10-29-13 2:19 PM
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200: But, of course, there was no way to be 100 percent certain that invading Iraq would turn out badly; smart critics of that policy argued (correctly) that invading Iraq ran unacceptably high risks is ripe from McMegan given that she wrote a chin-stroker in 2009 or 2010 about how she doesn't feel the need to apologize for her support of the war given that she was reasoning correctly from what she knew a priori, unlike those filthy hippies.


Posted by: snarkout | Link to this comment | 10-29-13 2:22 PM
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Not directly ACA, but I think that the "debt limit veto" thing from the shutdown was to set up these votes.

The vote Tuesday was a symbolic "resolution to disapprove" of the debt limit hike. It was mandated by the deal thanks to a last-minute provision inserted by Senate Minority Leader Mitch McConnell (R-KY). The motion failed 45-54 because all Democrats opposed it. Even if it passed Congress, it wouldn't have stopped the debt limit hike because President Obama could veto the measure. The purpose was to give these senators the chance to say they disapprove of a deal they voted for.
Winning!


Posted by: JP Stormcrow | Link to this comment | 10-29-13 2:25 PM
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219: I've seen something similar on CNN. Complex legislation plus lazy reporting guarantees that sort of crap will be the going on for quite a while. Maybe I should be writing angry letters to the media instead of yelling at the TV, but I doubt it will make any difference.


Posted by: togolosh | Link to this comment | 10-29-13 2:50 PM
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From the piece linked in 219:

I don't know why Deborah's insurance company wanted to sell her a policy for $484 a month

That's what I find most curious, and frustrating. I'll go ahead and assume that Deborah's insurance company offered her a plan that little resembled her current $293 one (not a mere bronze level plan, for example), and the offer was for a non-exchange plan.

Why would they do that? I haven't managed to become clear on whether insurance companies writ large are in favor of the ACA -- as netting them a significant rise in the number of enrollees -- or would prefer to work against it. Quoting people whose current (non-exchange) plans are being phased out rates for alternative non-exchange plans which are a step above their current plans clearly works against the ACA: people are going to freak out at such rate quotes, and many of them are really unfamiliar with shopping the individual market. Many of them don't realize that they're being given a non-exchange rate; that they can shop for exchange-mediated rates; that the latter are usually cheaper than the former. I'd bet that Deborah there thinks that the $484/month policy offering was the only choice she had.

So why would insurance companies do this? Sure, they can con some suckers into ponying up $484, but is that where the money is in the long run? Wouldn't long-term insurance company interests lie with the ACA, with exchange plans?


Posted by: parsimon | Link to this comment | 10-29-13 6:00 PM
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bob at 185: You are right it is impossible to have a sane discussion on this because at least for me "redistributive" does not mean fucking over young people trying to get started while carrying huge student loans.

I don't know what bob means about the non-dischargeability of student loans, which doesn't have anything to do with paying for health insurance, but there is a point about the availability of insurance subsidies for those paying off student loans.

From what I understand, if you're paying large sums toward student loans, that just doesn't matter toward calculation of any subsidy you might be able to receive. That's sort of a problem.

Erm, subsidy calculation is based on adjusted gross income. You can't deduct your student loan payments from your gross income (though you can deduct your interest). Actually: what can you deduct from your gross income? Mortgage payments? Car payments? Childcare? None of those, I don't think.


Posted by: parsimon | Link to this comment | 10-29-13 6:49 PM
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Following Clay Johnson on Twitter live tweeting the hearing--more follies with Joe Barton bringing up commented out code.


Posted by: JP Stormcrow | Link to this comment | 10-30-13 7:00 AM
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A couple more of these and then I'll be done: An NYT Time article (not worth linking) about how maybe, maybe not website problems will impact young people signing up. They have an exemplar who has had issues. Then last sentence: "At this point, I'm just printing it out and sending it in, I'll probably have it done by the end of the month."

Death spiral!


Posted by: JP Stormcrow | Link to this comment | 10-30-13 7:13 AM
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Speaking of the NYT, Peter Baker seems to be their go-to guy when they need a "some say" article. And I know reporters don't choose their own headlines, but his latest was headed thus: "Where the Buck Stops, Some See a Bystander." Jeez guys, write the article if you think it is important, but how about "Republicans Attack Obama as being a 'Bystander'" or something that conveys the actual political context of the article. The view from nowhere is more dangerous to our future than Al-Qaeda, pit bulls, and sharks combined.


Posted by: JP Stormcrow | Link to this comment | 10-30-13 7:26 AM
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219: Hey, JP, I've got another one for your blood pressure.

It's too bad that they these stupid "exemplar" stories are so stupid because per comments 163-170 there is actually a pretty good discussion to be had that gets right to the heart of the key choices in healthcare as represented by the ACA. Who pays and gets what in return? Our recent thread was an example of some of that.


Posted by: JP Stormcrow | Link to this comment | 10-30-13 9:46 AM
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Why would they do that? I haven't managed to become clear on whether insurance companies writ large are in favor of the ACA -- as netting them a significant rise in the number of enrollees -- or would prefer to work against it. Quoting people whose current (non-exchange) plans are being phased out rates for alternative non-exchange plans which are a step above their current plans clearly works against the ACA: people are going to freak out at such rate quotes, and many of them are really unfamiliar with shopping the individual market.

I think they do have some legal obligation to provide information on similar available plans when they decline to renew one. I don't know if these letters are deliberate or obtuse, though.


Posted by: Minivet | Link to this comment | 10-30-13 10:10 AM
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229: There has been some discussion that they are consistently "up-sizing" what they offer to those whose current plans expire even when they have cheaper plans available. Which they certainly did in the past (and is a constant "feature" of the communications I get from every insurance company about every kind of insurance I currently have).


Posted by: JP Stormcrow | Link to this comment | 10-30-13 10:15 AM
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Where the Buck Stops, Some See a Bystander.

God, I really, really hate New York Times headlines.

"In Furious Mood, Middle-Class Scot Mulls a Subeditor Slaying".


Posted by: ajay | Link to this comment | 10-30-13 10:17 AM
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They've got to be deliberate. The legal language regarding similar available plans is pretty vague, from what I understand, in that it doesn't require that exchange-mediated comparable plans be pointed out. All the legal language does is require that the citizen consumer be offered something: anything that can, with plausible deniability, be viewed as "similar".

Notice, by the way, to those who are exercised over this "millions and millions of cancellations are being issued!" business. It's more accurate to describe these notices not as cancellations but as notice of phase-out. Your previous plan is being phased out, or modified. This happens all the time. I advise refusing to use this "cancelled" language in favor of "phased out".


Posted by: parsimon | Link to this comment | 10-30-13 10:27 AM
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The view from nowhere is more dangerous to our future than Al-Qaeda, pit bulls, and sharks combined.

DARN RIGHT.


Posted by: OPINIONATED OVERSIMPLIFIED THOMAS NAGEL | Link to this comment | 10-30-13 10:27 AM
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232 to 229.


Posted by: parsimon | Link to this comment | 10-30-13 10:27 AM
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230: JP, where has there been that discussion of "up-sizing"? Other than here.


Posted by: parsimon | Link to this comment | 10-30-13 10:30 AM
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235: I think Brian Beutler might have had something on it.


Posted by: JP Stormcrow | Link to this comment | 10-30-13 10:32 AM
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'kay. I've been a little disappointed with Sarah Kliff's wonkblog stuff on this.


Posted by: parsimon | Link to this comment | 10-30-13 10:35 AM
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232: I advise refusing to use this "cancelled" language in favor of "phased out".

The people using "cancelled" know full well what they are doing. RW operatives, media and politicians for political advantage; MSM for page clicks and tune-ins. The words are chosen for instrumentality.


Posted by: JP Stormcrow | Link to this comment | 10-30-13 10:35 AM
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235: http://prospect.org/article/time-investigate-those-insurance-company-letters
Paul Waldman via Kevin Drum


Posted by: peep | Link to this comment | 10-30-13 10:37 AM
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231: God, I really, really hate New York Times headlines.


Especially because during the Spring "scandal" season they would have gladly run with: "Where the Buck Stops, Some See a Calculating Manipulator."


Posted by: JP Stormcrow | Link to this comment | 10-30-13 10:38 AM
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There has been some discussion that they are consistently "up-sizing" what they offer to those whose current plans expire even when they have cheaper plans available. Which they certainly did in the past (and is a constant "feature" of the communications I get from every insurance company about every kind of insurance I currently have).

I can imagine this, but it seems counterproductive in this case since it's likely to make many people despair and/or look elsewhere, whereas they could get a lot more continuous business by saying "...but if you go to your exchange you could get this same plan for as low as $X depending on your income". That's only for Exchange participants, of course; in CA the big individual insurers have left the Exchange to the small-group players.


Posted by: Minivet | Link to this comment | 10-30-13 10:38 AM
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I don't think all members of the media know full well what they're doing. Diane Rehm accepts the "cancelled" language, and she doesn't really have an agenda. She just (probably) is unfamiliar with the individual insurance market, and doesn't know that policies change -- are phased out! -- *all the time*. She and others who drift gently along on the tide of nice and safe insurance coverage managed by people other than themselves just don't understand that "cancelled" is inaccurate. Therefore we should insist on "phased out".

Now, there are other leftish commentators who have no excuse for not knowing the difference.


Posted by: parsimon | Link to this comment | 10-30-13 10:45 AM
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242 to 238.


Posted by: parsimon | Link to this comment | 10-30-13 10:46 AM
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I'm not sure about the terminology of cancellation vs. phase-out. If someone works year-to-year on 12-month contracts, and the employer declines to renew the contract, technically they haven't been fired but it doesn't feel very different.


Posted by: Minivet | Link to this comment | 10-30-13 10:47 AM
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239: Thanks, peep.


Posted by: parsimon | Link to this comment | 10-30-13 10:47 AM
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Agree with Minivet in 244, but my point in 238 is that if Diane Rehm is expert in anything it is how to pitch a story in a way to get attention. It's not ideological and she may not have a political agenda per se--but her words are not generally accidental. Media people are experts at being media people.


Posted by: JP Stormcrow | Link to this comment | 10-30-13 10:50 AM
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244: I call analogy ban, minivet. Insurance companies aren't declining to engage in any contract whatsoever with the consumer. On the employment front, if someone is offered a *different* employment contract changing the terms, then unless those terms are egregiously disgusting and unfair, that someone hasn't been fired. Just offered a new contract. That happens all the time.


Posted by: parsimon | Link to this comment | 10-30-13 10:56 AM
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Diane Rehm accepts the "cancelled" language, and she doesn't really have an agenda.

She wants listeners. That's her agenda. Just because you like her -- or Ezra Klein -- doesn't mean that they're not selling a product.


Posted by: Von Wafer | Link to this comment | 10-30-13 11:04 AM
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No, I can't think of a single reason to read to the end of the thread before posting a comment. Why do you ask?


Posted by: Von Wafer | Link to this comment | 10-30-13 11:05 AM
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The chart at this link (UM poll on satisfaction with their current health insurance) is relevant to the discussion (Excellent or very good/good/fair or poor)

Medicare 54/29/17
Medicaid 65/19/16
Employer 51/31/18
Private 43/12/45

The 45% fair or poor in the private world illustrates the crap and deception out there, but the 43% excellent or very good number is higher than I would expect and is where a lot of the current heat is coming from (it is not that much lower than with the other forms of coverage).


Posted by: JP Stormcrow | Link to this comment | 10-30-13 11:06 AM
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"That means that no matter how we reform health care, we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you'll be able to keep your health care plan, period. No one will take it away, no matter what." ...Obama

1) The official and administration sources, and those who rely on official information, are spinning like dervishes. The current conversation is about exactly how big and how evil was Obama's lie to the American people. IOW, they cannot be trusted.

2) As we have seen with the changes in what requirements are "grandfathered" and the delay of the employer mandate, apparently the administration has been given huge latitude in implementation and is willing and able to change much of the ACA at whim and will. So what they say today may be "inoperative" in Ron Zieglers word, tomorrow.

3) I recommend gathering the anecdata, the comment threads are very active and passionate. People care about their healthcare. People may be misinformed or biased or whatever, but that is in itself, the reception and public understanding, much more important than one wonk bullshitting another policy wonk.


Posted by: bob mcmanus | Link to this comment | 10-30-13 11:14 AM
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And bob isn't Ted Cruz because 1 out of 5 political comments positively refer to the Spartacists.


Posted by: Moby Hick | Link to this comment | 10-30-13 11:21 AM
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252: The leftist argument that compromise, moderation, incrementalism, parliamentarianism

is guaranteed to eventually lose to the fascists

is as old as Blanqui. As old as socialism.

The liberal's counter that radicals are objectively reactionary is just as old. And very boring.


Posted by: bob mcmanus | Link to this comment | 10-30-13 11:29 AM
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250: the 43% excellent or very good number is higher than I would expect and is where a lot of the current heat is coming from

That's where the exemplars, as well as the media and political opinionators, are coming from. There's no way to tell if the coverage so loved actually is excellent. It's good to remember how many people have no idea how or how well their coverage works, because they've never had a serious medical situation; or how many think their half-assed coverage is great because they've never known anything different. I also wonder how much of that 43% is resoundingly UMC, and can easily afford an individual policy that actually is very good.

That's a poll of customer satisfaction, and customers are trained to accept and appreciate what they think is normal. We're all fundamentally conservative, small-c, in this way.


Posted by: parsimon | Link to this comment | 10-30-13 11:36 AM
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248: I am not liking Ezra Klein so much these days, so I'd rather not be lumped in with his unreserved admirers.


Posted by: parsimon | Link to this comment | 10-30-13 11:40 AM
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Sibellius

"No one indicated it could possibly go this wrong," she said, but added that private contractors who helped build the site did cite "risks" in undertaking such a massive project online.

Awww, bullshit. File this under "They are not idiots"

1) Every IT person I have read says that this huge project needed more resources and testing.
2) Obamacare IT people were not idiots
3) Therefore way long ago they knew the website would be a fail
4) Therefore they wanted it to be a fail

Now we need to ask why they wanted the initial rollout to be an early failure.

Well, given six months to a year of bad signups, the risk pool will suck, and insurance rates and premiums will be much higher than if the rollout had been a success. Now when the young and healthy sign on, and they must sign on, profits and payouts to providers will be better. Could it be?

Same when the employer mandate goes into effect. The longer they can plausibly delay, and the delay has been years already, the higher premiums and costs, the better health corps make out.


Posted by: bob mcmanus | Link to this comment | 10-30-13 11:42 AM
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Sibelius (I ment to change the above, one 'l')

"Insurance companies cancel individual policies year in and year out. They are a one-year contract with individuals. They are not lifetime plans."

242: Sibelius uses "cancelled"


Posted by: bob mcmanus | Link to this comment | 10-30-13 11:47 AM
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bob, you're being hysterical.


Posted by: parsimon | Link to this comment | 10-30-13 11:49 AM
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Have you considered going to hang with the reactionaries? They're much better at conspiracy theories and your game needs some help.


Posted by: Moby Hick | Link to this comment | 10-30-13 11:50 AM
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259:I keep telling you, I would prefer they didn't exist.

Somebody somewhere made the point, that oh two years ago, how many older very experienced unemployed IT people, programmers, and website designers were out there to be hired for a song. Thousands, tens of thousands.

Now you can say Obama didn't want this to be a Manhattan project because he is a neoliberal who would privatize everything, but that is again just saying...Obama and Sibelius are idiots.

Lefty intellectuals really get off on calling their bosses stupid. Don't make it so.


Posted by: bob mcmanus | Link to this comment | 10-30-13 12:00 PM
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255: you, time and again, expressed your admiration for his politics and for the twinkle in his eye. You're welcome to recant. That's up to you. Because this is all very, very serious.


Posted by: Von Wafer | Link to this comment | 10-30-13 12:17 PM
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And speaking of serious, why are people engaging with bob? He's a right-wing troll, through and through. Whether he's paid or not for his work is beyond my ability to fathom.


Posted by: Von Wafer | Link to this comment | 10-30-13 12:18 PM
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He's a right-wing troll, through and through. Whether he's paid or not for his work is beyond my ability to fathom.

I ain't the one deluded and/or dishonest, but we determined that long ago. I just posted too very Marxian comments over at CT. I am way to your left, and I think y'all know it.

It is interesting why the center-right folk insist that all their enemies must by definition be to their right. I think they embarrass themselves in their complicity with neoliberalism, and are ashamed.


Posted by: bob mcmanus | Link to this comment | 10-30-13 12:26 PM
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I am terribly ashamed, bob, almost all the time, actually, but not for that reason, no.


Posted by: Von Wafer | Link to this comment | 10-30-13 12:30 PM
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261: Time and again? Expressed admiration? For his politics? Not exactly. I've said that he's often sober and clear, and that I consider wonkblog to be a benefit to public discussion. He's done some really good work outside the wonkblog aegis. I've said those things contra wild-eyed claims that he's a bane to our very existence. Ezra's kind of cute, that's true, but I've also been pissed off with his approach now and again. Lately, certainly.


Posted by: parsimon | Link to this comment | 10-30-13 12:40 PM
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When Richard Nixon Met Karl Polanyi ...Corey Robin, in oh a history of American interpretations of Britain's Speenhamland system, should go a little ways to hinting on why the ACA is a horrible right wing plan.

Means-tested transfer payments are always a bad second best.

Why Means Testing Benefits Is Not Efficient or Fair ...Guardian, Jan 13, quoted by Krug recently

It isn't as if this shit was anything new. People have just forgotten what liberalism is really about.


Posted by: bob mcmanus | Link to this comment | 10-30-13 12:40 PM
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265: I've said that he's often sober and clear

Don't forget "articulate"!


Posted by: JP Stormcrow | Link to this comment | 10-30-13 12:43 PM
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I think Ezra Klein is one of the best things to happen to journalism in a long time, largely because he's so hard working, and he is a net force for good in the world.* That said "better than the WaPo was before him" is a very low bar to clear and I often find the positions taken on his website infuriating.

*Unlike too-many-eggs-stuffed-into-the-Van-Heusen-shirt Yglesias, who is just straight up loathsome.


Posted by: Robert Halford | Link to this comment | 10-30-13 12:44 PM
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I'm a little bit ashamed of how much time I spend arguing on the internet. I'm working on how to argue faster.


Posted by: Moby Hick | Link to this comment | 10-30-13 12:49 PM
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obamas-keeping-your-coverage-lie-goes-well-beyond-the-individual-market ...Jon Walker at FDL. I am not alone, sniff, unless any who sees problems in Obama and the ACA are Tea Party Wingnuts.

Answer: Why was the employer mandate delayed a year?

"If you have really great employer provided insurance the Affordable Care Act was purposely designed to make sure you wouldn't be able to keep it."


Posted by: bob mcmanus | Link to this comment | 10-30-13 12:52 PM
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added that private contractors who helped build the site did cite "risks" in undertaking such a massive project online

This is a problem? But I was told that being a "risk taker" was a good thing, to be rewarded by lavish tax breaks and praise on CNBC!


Posted by: Spike | Link to this comment | 10-30-13 7:28 PM
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