Patterico's Pontifications


This Week In ObamaCare

Filed under: General — JD @ 6:11 pm

[guest post by JD]

Avik Roy lays out the case on how disastrous the idea of retroactive coverage is — treating out of network docs as in network, waiving formulary, etc as “suggested” by the Obama admin would be. This is not a sign of an improving system.

It was well known that the Obama admin delayed their ObamaCare regulations until after the election, which contributed to their epic failure rolling it out. The MFM is getting around to reporting it now.

Jonah Goldberg makes the depths of their mendacity readily apparent. Hint, if you like your plan, you can keep it is just the tip of the iceberg.

This is another view on how the new “suggestions” from Obama show how awful this system is leading into the 1 JAN start date.

That should suffice.



  1. Relax. Obama is off on a 17 day trip to the 50th state.

    Comment by Neo (d1c681) — 12/15/2013 @ 6:12 pm

  2. Bet the vacay selfies will be Awesome!

    Comment by elissa (0c4f80) — 12/15/2013 @ 6:14 pm

  3. This whole “pay for uncovered patients, for out-of-network, for all drugs no matter what” stuff, with the promise the government will make it good is pretty much back-door single-payer.

    And doesn’t Congress have to, you know, authorize spending?

    Comment by Kevin M (536c5d) — 12/15/2013 @ 6:33 pm

  4. And ther real question on everyone’s mind: How will CJ Roberts rationalize this?

    Comment by Kevin M (536c5d) — 12/15/2013 @ 6:35 pm

  5. I need to get an MRI of an old injury to my neck (when my face was broken I got a whiplash injury. The face repair failed and got refixed yada yada but the neck nearly got broken too… that guy had a very hard forehead and was moving fast)
    My DR can’t get it confirmed with Blue Shield this monthbecause they are punting everything to next year.
    He is saying the entire system is screwed up because the different federal agencies are still writing regulations (and then will be rewriting those regulations that fail.)
    I’ll get in for the MRI soon enough, (as soon as the get my first premium check for 2014) but my DR was of the opinion that everyone in the insurance business is tied up trying to figure out moving targets of regulations and rulings… the ” all hands on deck and how in the hell do we proceed? Curtain drops in 16 days…”

    Comment by steveg (794291) — 12/15/2013 @ 6:48 pm

  6. BY March, Obama will be claiming the ACA is a failed Republican scheme and the press will back him up.

    Comment by Kevin M (536c5d) — 12/15/2013 @ 6:53 pm

  7. if we get anything approaching a flu season

    I’m a be hard-pressed not to giggle a little bit

    especially after the propaganda slut candy crowley media made such a big deal about flu vaccine shortages when bush was in office

    it traditionally peaks in February

    hey Candy I got your shortages right here

    ok now me I’m a go wash my hands

    Comment by happyfeet (8ce051) — 12/15/2013 @ 6:55 pm

  8. We should start a pool on what day Obamacare will be repealed. Multiple people can wrongly choose “never.”

    Comment by Kevin M (536c5d) — 12/15/2013 @ 7:30 pm

  9. Kevin M:

    Honestly, I see no way Obamacare will ever be repealed.

    Every campaign from now until I am dead will be about how to either improve it or repeal it.

    Every winner of all of those campaigns will be the one who says he or she can improve it.

    So, that will be my pool choice. I hope I am wrong, but I will not be wrong.

    Comment by Ag80 (eb6ffa) — 12/15/2013 @ 9:54 pm

  10. i already got my free flu shot…

    Comment by redc1c4 (abd49e) — 12/15/2013 @ 10:45 pm

  11. So, that will be my pool choice. I hope I am wrong, but I will not be wrong.

    You will be wrong because we will run out of money before you die.

    Comment by Kevin M (536c5d) — 12/15/2013 @ 11:17 pm

  12. i already got my free flu shot…

    So did I. Any sane insurance company will pay for that rather than pay for you having the flu.

    Comment by Kevin M (536c5d) — 12/15/2013 @ 11:18 pm

  13. In August of 1989 I was in Berlin, and one of the things I did was walk the West side of the wall. Besides the world-class graffiti, the occaisonal names and dates at the top of the wall were sobering in the extreme. I’ve never seen a purer display of evil intent.

    It looked so permanent. And yet, 3 months later, the Wall had been reduced to keepsakes.

    Obamacare isn’t that much of a thing.

    Comment by Kevin M (536c5d) — 12/15/2013 @ 11:23 pm

  14. It cannot be fixed, Ag, it’s not designed that way.

    Comment by narciso (3fec35) — 12/16/2013 @ 3:33 am

  15. R.I.P. Peter O’Toole

    Comment by Icy (fc44ff) — 12/16/2013 @ 7:00 am

  16. 8. Comment by Kevin M (536c5d) — 12/15/2013 @ 7:30 pm

    We should start a pool on what day Obamacare will be repealed. Multiple people can wrongly choose “never.”

    It probably won’t be officially repealed until at least 2018, with an effective date of January 1, 2019 or later. But long before, it will be altered and superceded.

    Comment by Sammy Finkelman (9fe80b) — 12/16/2013 @ 7:24 am

  17. I dont think it will ever be repealed. Politicians of both sides of the aisle will tinker around the edges, screw things up worse, and then in yet another attempt to fix the problems they caused previously, make it worse again. Just look at their “solutions” so far. Extend enrollment to exacerbate adverse selection. Waivers for constituent groups. “suggestions” for insurances companies to engage in awful business practices that would guarantee failure. Spending money not appropriated. But repeal? Wont happen. It may collapse upon itself, but it wont be repealed. Each side will have a “plan”, which decreases liberty, and increases taxes, and costs to future generations.

    Comment by JD (5c1832) — 12/16/2013 @ 7:34 am

  18. I dont think it will ever be repealed. Politicians of both sides of the aisle

    This puts them on the same side of the aisle, IMHO.

    Comment by Kevin M (536c5d) — 12/16/2013 @ 6:26 pm


    … independent practitioners were able to get lower insurance rates through group plans, typically set up by their professional associations or chambers of commerce. That allowed them to avoid the sky-high rates in New York’s individual insurance market, historically among the most expensive in the country.

    But under the Affordable Care Act, they will be treated as individuals, responsible for their own insurance policies. For many of them, that is likely to mean they will no longer have access to a wide network of doctors and a range of plans tailored to their needs. And many of them are finding that if they want to keep their premiums from rising, they will have to accept higher deductible and co-pay costs or inferior coverage.

    “I couldn’t sleep because of it,” said Barbara Meinwald, a solo practitioner lawyer in Manhattan.

    Ms. Meinwald, 61, has been paying $10,000 a year for her insurance through the New York City Bar. A broker told her that a new temporary plan with fewer doctors would cost $5,000 more, after factoring in the cost of her medications.

    Ms. Meinwald also looked on the state’s health insurance exchange. But she said she found that those plans did not have a good choice of doctors, and that it was hard to even find out who the doctors were, and which hospitals were covered. “It’s like you’re blindfolded and you’re told that you have to buy something,” she said….

    ….many of the New York policies being canceled meet and often exceed the standards, brokers say. The rationale for disqualifying those policies, said Larry Levitt, a health policy expert at the Kaiser Family Foundation, was to prevent associations from selling insurance to healthy members who are needed to keep the new health exchanges financially viable.

    Siphoning those people, Mr. Levitt said, would leave the pool of health exchange customers “smaller and disproportionately sicker,” and would drive up rates.

    …..David Rubin, vice president of Teiget, the Entertainment Industry Group Insurance Trust, which had served as a broker for about 1,000 members of creative guilds, said a big complaint was that in New York City and much of the state, the new individual plans both on and off the exchange did not allow patients to go to doctors out of network. “All these people had these customized plans which are better than most of the things out there, and most of them are saving only a small amount of money,” Mr. Rubin said.

    Roy Lyons, managing director of Marsh U.S. Consumer, an insurance brokerage, said he had heard complaints from physicians, lawyers, pharmacists and optometrists. “At first they think it’s the bar association making the decision or the insurance company doing it,” Mr. Lyons said. “We have to explain that this is the Affordable Care Act; that’s what was put into law. Once they understand, they’re less emotional, but they’re not happy with it.”

    Among those affected are members of the Authors Guild; the Advertising Photographers of America; the Suzuki Association of the Americas, a music teachers organization; the Society of Children’s Book Writers and Illustrators; the New York City Bar Association; and the New York County Medical Society. (One group, the Freelancers Union, negotiated a one-year exemption with the state.)

    “One of the reasons to join a society is to get health insurance,” said Dr. Paul N. Orloff, president of the New York County Medical Society. Even doctors pay a lot for coverage, he said, because the days of trading medical care with colleagues are long gone. “In the old days, professional courtesy was the norm,” Dr. Orloff said.

    The medical society has not yet formally notified its solo practitioners, because their insurance plans do not expire until April. But those letters will be going out soon, officials said.

    It is not lost on many of the professionals that they are exactly the sort of people — liberal, concerned with social justice — who supported the Obama health plan in the first place. Ms. Meinwald, the lawyer, said she was a lifelong Democrat who still supported better health care for all, but had she known what was in store for her, she would have voted for Mitt Romney.

    Comment by Sammy Finkelman (9fe80b) — 12/16/2013 @ 7:51 pm

  20. It seems like pediatric dental care isn’t actually required after all. They are offered on the exchanges, but can be stand-alone policies. If stand-alone, there are no subsidies.

    … dental coverage for children is optional. People shopping on the exchanges are not required to buy it and do not receive financial support for buying it. …. More than a dozen senators and several advocacy groups representing dentists, insurers and consumers have asked the Internal Revenue Service to revisit its decision to deny subsidies to purchasers of stand-alone dental plans for children.

    Senator Debbie Stabenow (D-Mich.) said it should be included – she co-wrote the provision allowing stand-alone pediatric dental care.

    Comment by Sammy Finkelman (9fe80b) — 12/16/2013 @ 8:00 pm

  21. Ther are alo stories about some state exchanges.

    In Maryland, the person in charge for 2 years, finally resigned, after being criticized for taking a vacation:

    In Illinois, the exchange referred legal immigrants here less than 5 years to Medicaid, for which they are nit eligible.

    In Washington State, the only way now to apply, or recertify for Medicaid is through the exchange. Only about half those expected are doing so. But that’s probably raising the reported numbers for that state. (but doctors still can get paid, because people can enroll 90 days retroactively)

    In addition, there may be some confusion when people try to set a date for automatic payment from a checking account. One couple thought they had set it for December 23, but it was withdrawn on December 9, leaving them short.

    Comment by Sammy Finkelman (9fe80b) — 12/16/2013 @ 8:35 pm

  22. I honestly mean no disrespect but, Sammy is this your job or an intense hobby? It is obvious you work really hard on your posts. Inquiring minds want to know.

    Comment by Ag80 (eb6ffa) — 12/16/2013 @ 8:41 pm

  23. Speaking of this week in Obamacare, Hot Air discusses this little hand grenade as reported by the Seattle Times:

    It wasn’t the moonlight, holiday-season euphoria or family pressure that made Sophia Prins and Gary Balhorn, both 62, suddenly decide to get married.

    It was the fine print.

    As fine print is wont to do, it had buried itself in a long form — Balhorn’s application for free health insurance through the expanded state Medicaid program. As the paperwork lay on the dining-room table in Port Townsend, Prins began reading.

    She was shocked: If you’re 55 or over, Medicaid can come back after you’re dead and bill your estate for ordinary health-care expenses.

    The way Prins saw it, that meant health insurance via Medicaid is hardly “free” for Washington residents 55 or older. It’s a loan, one whose payback requirements aren’t well advertised. And it penalizes people who, despite having a low income, have managed to keep a home or some savings they hope to pass to heirs, Prins said.

    As MKH accurately terms it, it’s not just a loan but a predatory loan.

    Before the Affordable Care Act’s Medicaid expansion, there weren’t that many people in Medicaid who had much in the way of assets for seizing. But now that Medicaid enrollment requirements have been relaxed, more people with assets but low income are joining the program or being forced into it. For instance, a couple in their 50s who, say, retired early after losing jobs in the bad economy may have assets but show a very low income. Under Obamacare, if their income is low enough to qualify for Medicaid, they must enroll in Medicaid unless they want to buy totally unsubsidized coverage in the now-inflated individual market. As teh Times notes, this is no small difference:

    Lots of people have been pointing out phalanx of lies used to sell Obamacare, but one thing not often discussed is the lies start with the words that make up official title of the bill, commonly shortened into the acronym PPACA.

    It’s not about patients, it’s certainly not about protecting them or their privacy, it’s not affordable, forcing people to buy expensive but inferior insurance or onto Medicaid has nothing to do with providing them with care.

    It is definitely an Act, though. Unfortunately it’s against nature and of the type that once used to be illegal.

    Oh, by the way, John McCain’s photo-op in the Ukraine went about as expected. But slightly better than the one the Syrians staged for him.

    John McCain Went To Ukraine And Stood On Stage With A Man Accused Of Being An Anti-Semitic Neo-Nazi

    Read more:

    It was better than getting his picture taken with torturers and wanted war criminals as was the case in Syria. And you’ve got to consider the source the author of this article is using for this information about Tyahnybok, the giddily leftist UK press. But I have to agree with the author’s conclusion that McCain simply doesn’t have a clue about the complexity of the situations he keeps diving into. Which makes him about par for the course among our ruling class.

    Comment by Steve57 (e607ae) — 12/17/2013 @ 12:24 am

  24. 14. It cannot be fixed, Ag, it’s not designed that way.

    Comment by narciso (3fec35) — 12/16/2013 @ 3:33 am

    Which is true for so much of our federal government. It’s designed not to work as promised. Or at all. But that doesn’t stop the pols who create these messes that can’t work and can’t be fixed from making a career out promising to do just that.

    Just because it can’t be fixed doesn’t mean it well ever be repealed.

    Comment by Steve57 (e607ae) — 12/17/2013 @ 12:29 am

  25. 13. …It looked so permanent. And yet, 3 months later, the Wall had been reduced to keepsakes.

    Obamacare isn’t that much of a thing.

    Comment by Kevin M (536c5d) — 12/15/2013 @ 11:23 pm

    If you had asked me in 1980 when Reagan got elected which would be more likely to be consigned to the ash heap of history by the end of the decade, the Departments of Energy and Education or the Berlin Wall, I would have cheerfully said those two federal departments.

    At the end of the ’80s when the wall fell I had been disabused of that level of optimism.

    Comment by Steve57 (e607ae) — 12/17/2013 @ 12:37 am

  26. Yes, it’s right up with his other recent moves;

    the Berlin Wall was a much bigger deal, Steve;

    Comment by narciso (3fec35) — 12/17/2013 @ 6:39 am

  27. This is why Churchill said, the worst of all, except for all the others’

    Comment by narciso (3fec35) — 12/17/2013 @ 6:42 am

  28. Comment by narciso (3fec35) — 12/17/2013 @ 6:42 am

    I found that to be a very nice way of expressing some basic principles. thank you.

    Comment by MD in Philly (f9371b) — 12/17/2013 @ 7:18 am

  29. 26. …the Berlin Wall was a much bigger deal, Steve;

    Comment by narciso (3fec35) — 12/17/2013 @ 6:39 am

    Really? All it proved was that in economic terms can’t continue, won’t. That’s just the reality of the situation. I don’t know how big of deal it will turn out to be as it’s a bit soon to be writing the verdict of history.

    I imagine the bigger deal than causing the USSR to collapse will be when we cause our own. We find ourselves heading in the same direction as the Soviet Bloc. But rather from drawing a lesson from their experience, the only way Obamacare is going to end is the same way the Berlin wall did. By collapse, not repeal and a controlled, voluntary change of course.

    Not really a harsh judgement considering we find once again our Ear Leader possesses instincts and ruling style are no different from Maduro’s (and why should we expect differently since Prom Queen’s first foreign policy action was to join with Chavez and Castro and back Zelaya against the Hondurans). Hot on the heels of Maduro forcing what he calls “capitalist parasites” to open their doors so the supporters of Chavismo could loot their stores we get President Mean Girl “urging” insurance companies to provide coverage for people whether they’ve paid for it or not. Through his enforcer at HHS, the agency that regulates those companies and has the power to pick winners and losers.

    So the ever shrinking remnant of what passes for the private sector in our increasingly command and control economy has to take the hit for in this instance the problems created by Obamacare. But if I didn’t say Obamacare, but rather government policy in general, no one would know if I was talking about the US or Venezuela. This I think will turn out to be the bigger deal, as we voted for it twice.

    Comment by Steve57 (e607ae) — 12/17/2013 @ 8:19 am

  30. *This I think will turn out to be the bigger deal, as and we voted for it twice.*

    Comment by Steve57 (e607ae) — 12/17/2013 @ 8:26 am

  31. 29. The big problem with Communism wasn’t the economic level of the country – yes the economics wa sbad, but that didn’t prevent the government from staying in control. If bad economics destgroyed governments, North Korea should have been gone long ago. And they were not bankrupt.

    Comment by Sammy Finkelman (3bb3ae) — 12/17/2013 @ 12:51 pm

  32. From “Best of the web” December 17:

    (Almost) Everyone Loses

    Of course the uninsured hate ObamaCare too.

    Links to this:

    Backl to best of the web:

    Imagine a law ordering everyone to buy a bicycle, or a periodic ration of meat. Even if the prices were deeply discounted, it would still be an unmitigated burden on noncyclists or vegetarians.

    Or even a law mandating compulsory education – except that everybody had to pay for it, but if they were enough, maybe…there could be a subsidy and so on.

    Arguably the problem of the uninsurable was a market failure that justified government intervention of some sort. If ObamaCare’s architects had approached the matter intelligently, they would have conducted research to identify the extent of that precise problem and carefully targeted their response.

    It’s all wrong. They give free “preventative care” but not free “emergency care” When do you get bad outcomes? You get bad outcomes when there’s something badly wrong – and people know when that is the case – and people delay seeing a doctor.

    Unscheduled visits should be compensated more than schculed ones.

    Comment by Sammy Finkelman (3bb3ae) — 12/17/2013 @ 12:57 pm

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