ObamaCare’s Relentless Creation of Second-Class Citizens (3)

By lambert strether of Corrente.

And we go to Happyville, instead of to Pain City. –Thomas Pynchon, Gravity’s Rainbow

As ObamaCare inches painfully closer to its October 1 launch date, we’re getting more and more detail on how the exchanges (or “marketplaces”) will actually work. By design, ObamaCare doesn’t treat health care as a right, and does not give all citizens equal access to health insurance, let alone to health care. By design, ObamaCare preserves private health insurance as a rental extraction mechanism, along with its complex and bug-prone system of eligibility determination by past (and projected) income, age, existing insurance coverage, jurisdiction, family structure, and market segment. I’ve heard it said in software engineering that complexity is the enemy of quality and, I would speculate, the same goes for social engineering too. In any system as baroque and Kafaesque as ObamaCare, some citizens will get lucky, and go to HappyVille; others, unlucky, will go to Pain City. The lucky are first-class citizens; and the unlucky, second class. In two earlier posts, I gave examples of the whimsical and arbitrary distinctions that ObamaCare makes between citizens who should be treated equally; in this post, I’d like to give two more.

First, ObamaCare will use consumer reporting agency data to verify your identity during the eligibility determination process.* Reuters explains, today:

The potential for problems will begin as soon as would-be buyers log onto their state exchange. They’ll enter their name, birth date, address and other identifying information. Then comes the first IT handoff: Is this person who she says she is? To check that, credit bureau Experian will check the answers against its voluminous external databases, which include information from utility companies and banks on people’s spending and other history, and generate questions. The customer will be asked which of several addresses he previously lived at, for example, whether his car has one of several proffered license plate numbers, and what color his old Volvo was. It’s similar to the system that verifies identity for accessing personal Social Security information. [No, it isn’t at all similar.**]

Hmm. Never mind that this is the first time we’ve heard that the exchanges are going to ask for the color of my old Volvo; or that there are no such questions in the Enroll UX 2014 prototype. And never mind that healthcare.gov says this:

You’ll provide some basic information to get started, like your name, address, and email address….

Nothing there about license plate numbers or the color of my old Volvo, eh?

The real issue is that credit bureau data is dirty, and the credit bureaus make it very difficult to fix, as we’ve shown. How corrupt is the data? CBS:

A new government study to be released tomorrow indicates as many as 40 million Americans have a mistake on their credit report. Twenty million have significant mistakes. And our own investigation of the credit reporting industry shows that those mistakes can be nearly impossible to get removed from your record.

The bottom line here is that ObamaCare has created yet another way to treat some citizens as first class, and other citizens as second class, and on an entirely random basis (!). As I read Reuters, the first hurdle — the very first thing — you’ve got to do to get into an exchange is prove your identity by responding a series of challenges generated off your Experian data. If your Experian data is clean, and you get the responses right, you go straight to Happyville in the first-class carriage! (To the extent that being forced to purchase a defective product — health insurance — is going to Happyville, of course.) But if your Experian data is dirty, you can’t get into the exchange at all!*** So you don’t pass the hurdle, can’t get into the system, can’t fix your Experian data, and … Is there even an appeals process for people who can’t set up their ObamaCare account to begin with? Pain City even if there is, and in the slow coach. 

How many people will end up in Pain City because of dirty Experian data? I’m not sure there’s a better answer than “Could be a lot.” We do know that  10% of all Americans have been subject to identity theft, so if Experian thinks you’re John Doe2, who has a yellow Dodge Dart, instead of who you are, John Doe1, with  a red Volvo, you’re in trouble. More subtly, the Experian challenge/response is to identify you, not by an identifier unique to you, like (in theory) your SSN or a retinal scan, but by the sum of your answers to the questions Experian generates from your data. So, in the exchange’s mind, you equal not “457-55-5462” (your SNN) but {“car color: red” + “car brand: Volvo” + “LIC: GO NC!” + “address: 123 Main Street, Anytown USA”} (challenges with responses). The problem here — and I am speculating — is that not all these fields will be equally maintained. For example, Experian might be more likely to keep addresses clean and current because most of its clients want to send out bulk mailings frequently. Not so car color. The thing is, when you’re trying to prove you are who you are to ObamaCare, you could get car brand, license plate, and address all right, and then stumble on the car color — maybe you repainted it? — and have your identity rejected. You know captchas, and how everybody hates them? Because they feel random? With Experian’s Q&A system, ObamaCare’s exchanges will have the mother of all captchas.

Second, ObamaCare puts those who live on rental extraction above those who pay those rents. Here’s an example from a press release that The National Association of Health Underwriters sends out when one of its members passes a continuing education course in the PPACA:

[Agent Smith] completed this 10-hour course to receive the most up-to-date information on the key technical components of PPACA and is prepared to counsel his/her clients on upcoming required healthcare changes and new options for health plans.

“By taking this course, [Agent Smith] has joined an elite group who is uniquely qualified to assist clients in complying with the new law,” said NAHU CEO Janet Trautwein. “He understands how the market is likely to change over the next few years, and is in the perfect position to advise employers and individuals in planning for the future.”

Underwriter [Agent Smith], now a member of an “elite group” (a fine example of the workings of credentialism and meritocray) is surely on the road to Happyville! Here are the course topics:

  • Implementing healthcare reform—overview and politics
  • Grandfathered plans and the small-business tax credit
  • Medicare Part D and non-discrimination rules
  • Patient protection and changes to consumer-directed health plans
  • Medical loss ratio requirements and tax implications
  • W-2 reporting, summary of benefits, waiting periods, essential benefits and community rating
  • Individual mandate, pre-existing conditions and rating reform
  • Health insurance exchanges for individuals and small employers
  • Employer pay or play
  • Self-insured plans

But consider. The entire “continuing education” course covers topics that wouldn’t even exist with a single payer system (which, I might add, is a proven solution, and not a medical experiment performed on the American people without their informed consent). Imagine if the Democrats had abolished the filibuster in 2009 and passed Medicare for All. Given them a year to implement it. After (2013 – 2010) three years of working with a proven system that covers everybody, here’s what that “continuing education” course would look like:

  • Implementing healthcare reform—overview and politics
  • Grandfathered plans and the small-business tax credit
  • Medicare Part D and non-discrimination rules
  • Patient protection and changes to consumer-directed health plans
  • Medical loss ratio requirements and tax implications
  • W-2 reporting, summary of benefits, waiting periods, essential benefits and community rating
  • Individual mandate, pre-existing conditions and rating reform
  • Health insurance exchanges for individuals and small employers
  • Employer pay or play
  • Self-insured plans

From that perspective, the NAHU “continuing education” course looks a lot more like propaganda designed to send people like me, who pay rents, to Pain City. More importantly, the fees the course generates — $495 a pop for PPACA certification, no doubt deductible as a professional expense — represent in little the opportunity cost of the political class’s choice of ObamaCare over single payer, the road not taken; with single payer, the NAHU doesn’t — kaching! — collect the $495, and the agent doesn’t pay it. Which is good, since the transaction, like health insurance itself, brings no value to health care transactions. In a single payer system, the $495 might go to the delivery of care!

Does anybody really believe that Underwriter [Agent Smith] is going to surrender their membership in an “elite group” just for a system like single payer Medicare for All that would save the country $400 billion a year, at least, and relieve an immense amount of human suffering? It won’t be easy. OK, then, how about the “creative class” that’s building the websites and doing the training and the marketing? How about the non-profits who are getting funding from the Enroll America campaign organization for turning themselves into insurance salesmen?

Once the ObamaCare rental stream is established, everybody that’s drinking from it now will want to keep on doing that, even if total program benefit nets out to the public as zero or even negative.  The real — and only — problem with single payer Medicare for All is that everybody benefits. Rentiers hate that shit, because there’s nothing in it for them.

NOTE * I did scoop the world by actually reading ObamaCare’s form and noticing the integration of consumer reporting agencies into the eligibility determination process. I assumed — at least according to current reporting, wrongly — that ObamaCare would use consumer reporting agencies for financial data to be used in income determination. It just never occured to me that ObamaCare would use credit agency data for identity verification, exactly because the data is so bad. 

NOTE ** Social Security determines your eligibility from documents, not from easily corrupted electronic data. So Social Security and Experian are operating from completely different baselines.

NOTE *** Suppose Experian thinks my old Volvo is red, when in fact it’s green. What’s the rational course of action? Well, I can’t fix Experian’s data, so the best thing to do is to order my credit report and say whatever it says when Experian challenges me; “red,” for example. That does replicate Experian’s bad data into the ObamaCare system (assuming the challenges and responses are stored) but what’s the alternative? Although, the ObamaCare data is supplied under penalty of perjury, so maybe that’s a bad idea. Finally, do note that “a current credit report” is not on the list of basic information healthcare.gov tells you to have ready, although it only takes two weeks to get one. I’m assuming, of course, that Experian will generate questions only data that is available to consumers, which not all credit reporting data is.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. CB

    Yes, it is the very same system “that verifies identity for accessing personal Social Security information,” and I have the letter from SS Administration to prove it: “Thank you for using Social Security’s online services….

    “Social Security may use an identity verification service provided by Experian to help verify your identity and protect your privacy when you register to do business with us online….” Please try to contain your guffaws at the “protect your privacy” bit. I’m pretty sure whoever composed the letter doesn’t believe it, either.

    1. Lambert Strether Post author

      But in the Social Security system, you gain entry with documents that are (at least theoretically) under your control, like (correct me, readers) a birth certificate, a passport, a driver’s license. Experian’s “Identity Captcha” is a supplemental system.

      But under ObamaCare’s, you gain entry with data that is not under your control, because the credit bureaus make it expensive to correct “your” data, and reviewing it more than once costs you. And here, Experian’s “Identity Captcha” is the primary system.

  2. Big Dave

    Ordering your credit report and regurgitating that info won’t help. Credit reports ARE only about financial data, The color of your car or your pet’s name won’t be on it.

    Screwed again.

    1. Lambert Strether Post author

      I guess, in case of denial, the thing to do is randomly make selections until one set of ’em clicks. Could be time-consuming, except for a bot. Hey, is there an app for that?

    2. Banger

      All that stuff is in some database somewhere and many databases are now virtually linked–state gov’t databases are now linked with each other in various ways. The move is towards centralized data–it isn’t just “NSA” its the All Data System on the Permanent Record called the Internet both the one we know and the gov’t and corporate “secret” one that is available if you have credentials. I’m amazed at the sophistication of this virtual Department of Information–it really is one of the wonders of the world.

  3. Code Name D

    I have to wonder what happens after you get in? Credit reports will not magicly stop making mistakes once you secure an account through an exchange. So what happens with mistakes made after the fact?

    Right now, you don’t find out about these mistakes untill you apply for a lone. You may find out about these mistakes when you actualy need health care or go to file your taxes. Or worse, you may be held criminaly liable for some one else’s mistakes.

  4. margarets

    Help a Canadian out. I can’t for the life of me understand what Obamacare is or how it works. It’s not really universal health care is it? People aren’t just automatically covered by the system. And the system doesn’t automatically cover the bulk of their costs.


    And why aren’t American’s rioting in the streets, DEMANDING some form of (true) universal health care?

    1. NotTimothyGeithner

      There are many issues. As far as rioting in the street goes, there isn’t a particularly good Tahir Square here, and I should mention Canadian healthcare came when the central government of Canada was much weaker vis a vis the Provinces, themselves. British Columbia passed the first universal healthcare system in Canada. People began to move or admire the system putting pressure on the other provinces to follow suit, and it became the order of the day. This is impossible to replicate in the U.S. among the states. They are too weak and cash-strapped to do this.

      Getting back to the American problem, people pretty much the President’s age and older are extremely conservative, most are run of the mill fascists even if they don’t recognize it. Two, Americans have been under the boot of propaganda and a general dumbening and stress addition of society for so long they are making the best decisions they can. When you compare Obama to any member of the neo-Confederate Party, he seems so smart and cool. Remember, our vaunted neighbor to the North did elect Harper’s party. In the end, these are the people making decisions across the board.

      Within Obama’s base, are African-Americans who have really taken it over the years, white guilt types who want to solve inequality the easiest way without actually doing anything, and three, people who don’t want to admit how obvious Obama’s general awfulness was to recognize or how had they been more assertive with their views Obama might have been a better President. In the end, many Obama supporters don’t want to admit the real problem was they shirked their responsibilities as citizens of a republic by simply demanding more. Instead they chose the easiest path which was to trust dear leader and denounce anyone who criticized Obama as a racist, unicorn chaser, secret Republican, nutty libertarian, and so forth. For many of these people to get upset, they have to recognize how wrong they were, and they need to wonder why didn’t recognize what people who supported candidates* who weren’t Hillary and Obama did. If they do this, they have to recognize they relegated themselves to subject status not citizens.

      *I’m not including Republicans they are just deranged neo-Confederates who can’t win against positive messages of sound candidates.

      1. Lambert Strether Post author

        There’s no rioting in the streets because TINA. Until there is.

        * * *

        On another note, it’s interesting that the conventional wisdom on the now worldwide protests seems to be congealing around the idea that it’s a “revolution of rising expectations” fuelled by “the middle class” (gack).

        The corollary would be that there’s no protest here because there are no rising expectations. So, mission accomplished!

        (Not saying I agree but it’s fun to play with the idea.)

        1. NotTimothyGeithner

          I tend to agree with the idea. The social contract is being broken, and people tend to revolt against stark declines not gradual ones. The 1775/1776 conflict on the East Coast was set off by policies which paled to the policies of 1768 which didn’t lead to a revolt. There is an argument to be made the standard of living rose between 1768 and 1775 at least for non-slaves. France was a much worse place in 1783 than 1789. They were revolting against a return to old policies. Even the Russian Revolution was closer to a revolt against autocrats acquiring power that had been ceded post 1907ish which is why the Czar wasn’t killed right away. He wasn’t the enemy until the Bolsheviks wanted to grab power themselves.

          I read an article or book about this around 2000, so I don’t remember what it was anymore without going through my parents attic. More examples were provided, but the basic premise is revolts occur after periods of improvement. Even the Civil Rights and anti-Colonial movements didn’t occur against the most barbaric regimes but against “more enlightened” governments. The Civil Rights movement has its genesis in African-Americans who had enjoyed war times wages both from World War I and II, the Great Depression was a set back, but they didn’t want to go back to the way things were and wanted to recapture the spirit.

          Even this Egyptian case was set off by a rapid rise in food prices two years ago, and now its arguably been set off by the same inflation and the expectation that the government is running out of money which matters to a country which imports food.

          I also tend to think the idea of the middle class causing the rebellion is a by-product of the American pundocracy trying to understand how people would be upset by an economy where the Dow Jones is near 15K! Many of the young people do expect to be middle class and are now angry. In the U.S. shame and partisan mindlessness have been used to keep people from getting upset.

          1. Jamie

            “…the basic premise is revolts occur after periods of improvement”

            Sounds like David Hackett Fischer’s “The Great Wave”, an excellent book. He tied political improvement to improved food supplies. His argument (apologies for drastic simplification) is that the starving are too weak and preoccupied to organize a revolt, but on the bounce, when things improve a little, all their pent up rage is released. He identified four “great waves” of revolutionary ferver that correlate pretty well with extreme shifts in the price of staple foods where the price drops severely after a period of extreme high prices due to scarcity, and a short while after the price drops, revolution happens. It’s not clear how or whether this would apply to an improvement from a base of adequacy.

            1. hunkerdown

              I don’t think we can recognize food adequacy in the US. Food security is still pretty weak below the poverty line, and even where abundant it is by and large a simulacrum of food.

              I wonder if there is a time correlation between social unrest among the lower classes and attacks on government food-security programs, particularly whether one leads the other reliably.

        2. OIFVet

          The pundits have obviously not spent any time in Bulgaria. The article in WaPo in particular was laughable. The middle class there is vocal but exceedingly small. And I suppose it was these “rising expectations” that led to net population loss of 1.8 million over the past 23 years, thanks to massive immigration, lower life expectancy, and the lowest birth rate in the EU. Thank you, Washington Consensus. Of all the articles I’ve read in the western media, The Guardian comes the closest to the truth: “Bulgarians are protesting against far-reaching and systematic corruption and the “capture” of the state by rent-seeking oligarchic networks” (http://www.guardian.co.uk/commentisfree/2013/jun/25/turkey-brazil-bulgaria-protest?CMP=twt_gu). I suppose its true that once expectations hit rock-bottom they have no place to go but up, but that is a very perverse way to achieve “rising” expectations.

    2. anon y'mouse

      shorter answer: most people are too busy keeping body & soul together and putting food on the family table to go out rioting in the streets.

      longer accompaniment to that answer:

      they have had poor health coverage with increasing costs offered by employers. every year, the costs seem to go up and the benefits go down. this reinforces the idea that, when it comes to health coverage, you take what you can get (passive acceptance, like all other employment matters–urine tests, background checks, ever-increasing credential requirements, outsourcing, insourcing, fired for smoking, fired for not wearing makeup, fired for wearing too much makeup, whatever). need anyone point out that jobs other than bag-filler are scarce?

      rioting in the streets = time off of paid work, and with most lacking even 6 months of salary cushion in savings who can afford that? who will pay the rent and buy Mac & Cheese for little tommy and susy? rioting in the streets also = potential for abuse, death or arrest by the militarized police. even the least-serious of those three could result in firing/becoming unemployable in the future due to the above-referenced background checks. not to mention being branded as a “commie” by everyone at work for feeling “entitled” (I hear that term so often everywhere I go, and the thought that always comes is “yes, all human beings SHOULD feel entitled to basic rights and dignity, shouldn’t they? umwhatswrongwithme…”). americans, by and large have drunk the ayn rand/bootstrap coolaid and think that you’re a whining baby if you believe that you “deserve” something.

      related to the above, any social program in this country is deemed as “my hard work is carrying YOUR lazy as$!”, which is especially effective when you bring classism, racism and sexism lurking under the surface of nearly everyone you meet out and insinuate that they will have to pay for it. paying for schools = giving valuable education to knuckleheaded minorities who don’t “deserve” (read: can’t use it due to some congenital/cultural deformity, and are too lazy/entitled to work HARD for it, won’t do anything once they are given it except do drugs and parent fatherless children, etc.) social security = paying to support someone else’s stupidity in failing to arrange for their retirement, aka “you’re not MY grandma!” and giving money to the “entitled” baby boomers who have ruined it for all of us who were born after them. even the medical programs we do have = giving expensive services to people who committed some past “sin” and are paying for it in the karmic-bodily retribution sense, including but not limited to doing drugs in the past, having sex in the past, just having poor brain chemistry (still superstitiously not viewed as an illness, but a personal choice or failing somehow), having bad habits like smoking, etc.

      no one wants to pay for the program, and no one wants to see an increase in their taxes. rightly, I think, many view the taxes they DO pay as misspent (although we disagree about what qualifies as “misspent”–see above). arguments about better care, money saved, and social justice don’t seem to fly with anyone in a culture like this. they have been terrified with MSM think-tankery into believing that everyone with a socialized system is on a waitlist where they die of some preventable illness.

      and, when all of the above fails, just utter “commie” a few hundred times after reading some Ebenezer Scrooge.

    3. washunate

      Great questions. I would echo those above and a little bit more.

      On what it is, PPACA is federal government protection of the administrative salaries of hospital franchises and drug dealers (and to a certain extent health insurers, but they are more just there to hide the bulk of the waste from the public since insurance companies do ultimately spend most of their premiums).

      On why not riot, in addition to the above about how people are stressed out, there is an important distributional component. On the very impoverished end, Medicaid does mitigate some of the most egregious cases. It’s a terrible system that basically renders someone permanently destitute with little choice over their care, but it does at least provide care. On the high end, employer provided coverage and Medicare work well.

      It’s just the ‘middle’ that is getting squeezed. Until major employers and Medicare start impacting more affluent Baby Boomers – or until educated liberals decide to stop keeping their mouths shut – I don’t see how there could be widespread social unrest. Lots of Americans benefit from the system.

      Understanding that last sentence is really important to understanding American political economy in the early 3rd Millennium.

    4. Yancey Ward

      The short answer is that Obamacare is what Democrats could pass while not having to raise a ton of taxes to pay for out of government coffers. Sure, Democrats could have passed Strether’s “Medicare for All”, but that would have required a big new tax on a lot of people. Right there was the true political problem.

      1. Kokuanani

        If the Democrats had bothered to spend a little time EDUCATING the public about “what you pay now [for health care, e.g., in terms of what you’re paying in inflated prices to cover the uninsured]” vs. “what you’d pay under a single payer system,” they could have shown how cost-beneficial [and benefit-beneficial] such a system was.

        But NO, Obama had to sell out to the pharmaceutical companies & insurance companies and push a system helping them and only them. And the Dems, being as stupid as they are, were too afraid to let him “fail” and were perfectly happy to let this Obamacare beast get established and better able to resist true reform.

      2. washunate

        Please tell me that’s satire?

        1. Generally, taxes are not a constraint on spending. See bailouts, financial and spying, warrentless and drugs, war on and anything else the government spends huge amounts of money on.

        2. Specifically with healthcare, the USFG alone directs something on the order of $1 trillion into the healthcare industry (primarily Medicare, Medicaid, VA/Tricare, and tax deductability of employer paid coverage). Without ANY net new expenditures at all we could offer basic universal healthcare to all Americans.

    5. jake chase

      I don’t even understand what an exchange is, or why a person would want to get into one.

      1. Ken

        “A health insurance marketplace, previously known as health insurance exchange, is a set of government-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies.”

        You don’t get in one–you go to one to compare standardized health insurance plans and buy into one there. If you meet the requirements part of your costs are subsidized.

    6. Waking Up

      While the CURRENT Canadian health care system is far and away better than that in the United States, I wouldn’t necessarily expect it to remain that way in the future. Why? Because of the direction Canada is going…


      From the above article:

      “With oil and gas now accounting for approximately a quarter of its export revenue, Canada has lost its famous politeness. Since the Conservative Party won a majority in Parliament in 2011, the federal government has eviscerated conservationists, indigenous nations, European commissioners, and just about anyone opposing unfettered oil production as unpatriotic radicals. It has muzzled climate change scientists, killed funding for environmental science of every stripe, and in a recent pair of unprecedented omnibus bills, systematically dismantled the country’s most significant long-cherished environmental laws.”


      “Harper is aggressively pushing an economic gamble on oil, the world’s most volatile resource, and promising a new national wealth based on untapped riches far from where most Canadians live that will fill their pocketbooks, and those of their children, for generations. With nearly three-quarters of Canadians supporting oil sands development in a recent poll, Harper seems to be selling them on the idea.”

      So, if 3/4 of Canadians support oil sands development, it would appear that Canadians could also be “sold” a bill of goods on health care systems in the future.

      1. margarets

        I think that’s a stretch. The true impacts of the Tar Sands are remote from most Canadians’ lives. Health care is immediate, and previous efforts to privatize it even a little have failed.

      2. Nathanael

        Harper’s Tories are utterly evil in every way, but they can’t get a majority of the votes. Harper managed to finagle a majority of Parliament through the luck of gerrymandering.

        The real question is when the next federal election is in Canada, because then Harper is *out*.

    7. Bobito

      Americans don’t riot in the streets for several reasons:

      1. Many (a big majority?) think theirs is the best, freest country in the world, and that despite its problems, no place is better.

      2. There are no streets in which to riot. Or, rather, there are too many streets, and folks get around by car, and are not accustomed to even being in the street. Put in more technical terms: population density is not that high, even in urban areas (NYC is not typical).

      3. The cops are aggressive, belligerent, and dangerous, and everyone knows that, and is afraid of them.

  5. Samuel Conner

    Perhaps we will arrive at Single Payer (or, even better IMO, an NHS-style system) through a “starve the beast” approach to our current health-care system. Make it so complex and disagreeable that an consensus emerges to abolish it.

    1. drb48

      That has been my hope as well. Unfortunately, the only “consensus” that seems to matter is the consensus of the elites and VSPs. If a consensus emerges among them to abolish the current system the likely result – and the one they seem to be advocating – is one where health care is only available to those that can afford to pay – whatever the cost. Prior to the passage of the ACA, a consensus already existed among the general public for replacing the existing system with either single-payer medicare-for-all type system or one with a “public option”. Despite that, the only option deemed “politically viable” was the one we got. Similar to universal background checks on gun sales, where overwhelming public support failed to translate into legislation. Ergo, a public consensus doesn’t seem to matter.

      1. Cynthia

        Since it looks like we won’t be able to level the playing field for all Americans by having Medicare-For-All, then we should at least level the playing field for all Americans by eliminating employer-based health insurance plans, including plans that cover government workers at all levels of government, and plans that cover career politicians, many of which are covered for life!

        It’s welfare for the rich as its worst for a multimillionaire plutocrat like Dick Cheney–who, by the way, is a war criminal in the eyes if the Hague — to be handed a million-dollar winning lottery ticket for a heart transplant, that’s paid in full by the the US taxpayers. Dick Cheney has got more than enough money to pay for his own health insurance. In fact, he’s got more than enough money to pay for all of his healthcare, including his million-dollar heart transplant, out of his own personal bank account.

        Another advantage to getting rid of employer-based health insurance is that it will enable workers to move and seek employment elsewhere, or make it easier for them to strike out alone on their own as entrepreneur without having to worry about losing their health insurance. I can’t think of a better way to support entrepreneurship, besides having Medicare-For-all, than to let employer-based health insurance go the way of the dinosaurs!

        1. jonboinAR

          I tend as well to think that eliminating employer-based health care will help if only to make the system somewhat less baroque and liable to manipulation by rent-seekers, middlemen, and providers who use obfuscation to avoid competition. IOW, I think one way to improve things, to reduce waste and skimming off of resources is to increase, by a lot, transparency. I THINK that eliminating employer-based health care is a step in that direction.

  6. washunate

    “More importantly, the fees the course generates — $495 a pop for PPACA certification, no doubt deductible as a professional expense — represent in little the opportunity cost of the political class’s choice of ObamaCare”

    This kind of waste is what is so disgusting in our system, activity that generates no output. And then creates a double whammy, where the system becomes impenetrably complex to people without the time to peel back the layers.

    And then when you try and summarize something so it is understandable in lay terms, the Complexity Police warble that you don’t understand what you’re talking about and you’re missing this and that really important technical detail.

  7. Yancey Ward

    On a more general, philosophical level- health care isn’t and can’t be a right. In Great Britain for example, the NHS doesn’t confer a right to health care– it confers a right to a discrete set of goods and services provided by the NHS.

    1. Lambert Strether Post author

      That’s like saying there’s no right to free speech because there are court decisions that protect it.

      C’mon. The bundle of services is the operational definition of what it means to have the right.

      1. Yancey Ward


        It does not entitle one to the health care one might need. It only entitles one to the health care the government might supply. Thus, it is not a right to health care. There is a huge difference.

        1. Code Name D

          Typical libertarian apologetics that attempts to make a distinction where none exist. When we say health care is a right, we are specifically referring to access to practical healthcare services.

          We make this assertion based on the argument that denying care to one who needs it is amoral, especially when you take into accounts the reason why care is refused; racism, classism, homophobia, social status, and especially the ability to pay. It is amoral to deny care to some one who needs it for any reason. Hence we say that access to healthcare is a basic human right.

  8. Peter Pan

    When I moved to Washington state I had to have my car inspected by the State Patrol. I drove through a warehouse shed with sodium or mercury vapor lights for the inspection. The Patrol Officer asked, “What color is this car?” I said, “teal” (a shade of green). When I received my registration my car color was blue. After I paid off the loan for my car the registration proclaims that the bank still has a lien on the car even though I have a title to the car. WTF?

    I sincerely hope that Experian doesn’t pose any difficult questions for me regarding my car. If they do, it’s pain city for me.

  9. Kokuanani

    ***So you don’t pass the hurdle, can’t get into the system, can’t fix your Experian data, and … Is there even an appeals process for people who can’t set up their ObamaCare account to begin with? ***

    Ah, at last we see those “death panels” Palin was talking about.

    1. charles sereno

      Ground control to Major NC,
      Can you hear me Major NC?
      Can you hear me…?

      Yes I can, yes I can, ground control

      Whew! I was worried for a minute.

  10. Code Name D

    When I had my taxes prepared, the tax compney told me they were planing on launching a service to asist people in filling out their healthcare applications.

    Givin how much truble my folks had with their Medicare plan, they may be on to something here.

    1. Lambert Strether Post author

      Yep. Same thing happened to me at H&R Block (who also, in a really big surprise, donated to Enroll America after Sibelius hit them up).

      So, $50 to $100 bucks a pop and year-round work, too, not just in tax season. H&R Block must love it.


      1. washunate

        FYI, thought you might like the fun tidbit that H&R Block is based in Kansas City (MO). The Kansas suburbs are the largest metro area in Kansas, the state where Sebelius was governor prior to joining the Obama Administration, and her alma mater, the University of Kansas, is only about a 45 minute drive from H&R Block’s office. It would be quite shocking indeed if there wasn’t some lingering support for her eager to be hit up for a future lucrative favor.

        She’s also a good example of Obama’s progressive game plan. Earlier in her career Sebelius had been active in blocking a Blue Cross/Blue Shield merger and supporting reproductive rights. Now with Obama as a boss, she’s courting companies for Enroll America and overruling FDA scientists on emergency contraception…Boehner strikes again!


    2. Bobito

      I’ll make a comparison. I live in Spain. I file my taxes online using a digital certificate provided to me for free by the government. The government gives me (online) a draft of my tax declaration, including all the data that has been reported to them. I make the modifications I see fit, like adding in income from stock sales and so forth, and I press a button. Spain has a lot of problemas administratively, but this is one thing that works astronomically better than its US counterpart.

      In the US I can pick from a buffet of providers who I must pay if I wish to file online. Online fillable forms is a far cry from online filing. I live abroad, and can’t use most of the available programs anyway because they don’t cover my tax situation. It’s ridiculously complicated and not very functional. But it does justify a tax preparation industry that otherwise would have less reason to exist. Ordinary people with uncomplicated tax issues are so overwhelmed by the complicated tax code and the complicated filing process, that they pay for preparation services which a better designed system would render unnecessary. Such a system generates an artificial and ultimately unproductive economy (a less charitable voice might call it parasitic) related to tax preparation that no one likes except those who make their living from it. Unfortunately those who make their living from it have much more influence in the political process than do the rest of us. That’s what democracy means, operationally, in the current moment.

  11. Eureka Springs

    So a government who spies on every citizen, their every email, phone call, web browsing, etc., needs ‘help’ from a corporation in a most basic step of verifying identity a citizen?

    How much does Equifax get paid by uncle scam for every query?

    Once again…. this is sooo not about health or care.

    1. Ms G

      I don’t know how much Experian is getting paid per query by the ObamaCare “Matrix” but the Consumer Financial Protection Bureau (CFPB) is apparently collecting data on everybody’s credit card transactions an paying a bunch of vendors very big bucks to do it.

      What part of “Consumer Protection” would include spying on everyone’s credit card transactions?!

      CFPB may be a Trojan Horse, like ObamaCare, a program for centralizing life and money data on as many Americans as possible but masquerading as a “public purpose” government scheme.

      Hey Lizzie Warren — know anything about this particular activity of CFPB?


  12. Eureka Springs

    Oh and of course i’ve been called “perfect and “utopian” again today by the obots for sharing a link to this post while insisting upon single payer. It’s great when the so-called left goes beyond Rove in expressing contempt for perfection or utopia (their words, not mine).

    Thank you Yves and Lambert.

  13. ScottS

    Jack Lint: It’s not my fault that Buttle’s heart condition didn’t appear on Tuttle’s file!

    Lime: Computers are my forte!

    Guard: Don’t fight it son. Confess quickly! If you hold out too long you could jeopardize your credit rating.

    Did Terry Gilliam know how right he would be?

  14. Linden

    I’m self-employed and thus have to purchase health insurance on the open market. I just received notice from my insurer, Aetna, that because of Obamacare they are dumping me and all other self-insured people in California as of December, and I’ll have to make other arrangements, lest I be found uninsured on the Day of Reckoning. What kind of policy I’m going to find and how much it’s going to cost are unknowns to me at this point.

  15. vions

    The argument is not quite right: (1) The GOP controlled congress is the one that does not allow single class universal healthcare. (2) Under the circumstances, a live second class citizen with healthcare is better than a dead second class citizen without one.

    Thus blaming two class system on Obama is kind of off the target. We will have single class universal if the GOP continues to fall off the horizon at current pace.

      1. Vions

        Please explain this a bit more. Healthcare insurance system generally dictates how healthcare is provided. For example, all but one advanced nation (guess which one) has universal healthcare system, which is a kind of healthcare insurance system that covers all citizens against illness.

        1. NotTimothyGeithner

          Its simple:

          -Healthcare is healthcare. These would be things along the lines of seeing the doctor when you are sick and receiving the appropriate treatment.

          -Health insurance is an agreement of some sort to pay a certain amount of money on likely a monthly basis for coverage at a later date. The various contracts might range from great to poor and from simple to complex. The basic problem is you might be paying for “health insurance” including “preventive medicine” but when you get sick you might find out that “preventive medicine” amounts to a doctor telling you that you might want to take an aspirin for that bad heart.

          Yes, this is a big deal. Not to mention, the healthcare industry is an effectively monopolized for-profit industry in this country which means every practical healthcare option can act in collusion to set prices and bilk you for every dime you have while not treating you, even if you have insurance. Being upset about insurance missed the point about the healthcare industry largely existing as a wealth extraction operation.

    1. Lambert Strether Post author

      No. Another case of Democratic blame-shifting. If the Democrats had been serious about passing true health care reform, they would have abolished the filibuster in 2009 when the Democrats controlled the House and the Senate, had a huge mandate for “hope and change,” and the Republicans under Bush had lost “the mandate of heaven” owning to Bush’s performance. (The same goes for an adequate stimulus package.) Whatever plan the Democrats had in 2009, health care policy that would deliver universal health care clearly wasn’t at the top of the priority list.

      1. NotTimothyGeithner

        “they would have abolished the filibuster in 2009 ”

        Don’t they actually reauthorize the filibuster every two years? The only reason the filibuster exists was to hold the Solid South in the Democratic camp.

        Since the Constitution explicitly mentions a solution for a tie in the Senate, it would seem the Founders didn’t intend for any requirement above 50% which would be what the Supreme Court ruled in 1892.

        1. Lambert Strether Post author

          As the link explains, the Senate sets its own rules at the beginning of each session, and by majority vote. The link gives other ways to abolish the filibuster during the session. All this is well-known inside the Beltway, with major stories in the Post covering the Senate rules in great detail when the Republicans were thinking of doing this under the Bush administration (the “nuclear option”). In other words, when Obots make the argument that we can’t do anything because of the filibuster, they’re lying and worse, playing on people’s ignorance.

      2. Bobito

        The filibuster is not the problem here. It may even be a useful mechanism for protecting minority interests against abusive governance by the majority.

        The problem here is that the entire political process is dominated by large commercial/corporate interests and that the will of the people, so to speak, is not well represented in legislative bodies.

  16. sierra7

    “Step One” towards Single Payer Health Care in the US:
    Dismantle the National Security State.
    “Step Two”…find our own Tahir Square…

  17. Ms G

    There is no sign so far — at least in the few concrete *facts* that have been scarcely reported — that ObamaCare’s second class citizens will have or receive any health care, i.e., that they will be any less dead than without ObamaCare. They are, however, being forced to buy health care *insurance, which has nothing to do with delivering health care but everything to do with creating a vast stream of rents to private insurers and the secondary cottage industries (“ACA training courses” (!) and publicly-funded private IT Jobs Forever). In short, from the citizen’s (or “consumer’s”) perspective, ObamaCare is being revealed as a very expensive, defective product (the so-called “ACA Exchange Marketplace Products”) which those least able to afford it are being forced to buy.

    I would love to be proved wrong.

    1. Code Name D

      I don’t buy it.

      First, Obama modeled his healthcare plan after Mitt Romney’s plan from the very get-go. Single payer and more progressive ideas were excluded from the debate.

      Second, the GOP opposed Obama-care and had to be brow-beaten into voting for it. Once they turned on their own plan, Obama would have had the perfect excuse to try for a more progressive policy. Who knows, the GOP might have even gone for a single payer.

      Third, Obama was actually very vocal about embracing republican style free-market solutions, and rejecting progressive ideas as being unworkable. There were other lies such as ACA only being “the first step” for a broader reform agenda, and to justify the narrow insurance focus of the ACA. But further dialog on healthcare reform is nonexistence, let alone any follow up bills. ACA is it, and will likely be all the reform we get for possible another 50 years.

      1. Ms G

        Obama’s enchantment with “market solutions” is entwined in his DNA. He was never any kind of “progressive” in any sense of that word, except in NeoLiberal double-speak.

        He’s Third Way’s Agent Number One at the moment (and for the past 5 years) and he’s sure delivering. Hamilton Institute and Pete Peterson toast his aggressive destruction of our country every night clinking flutes of Crystal.

      2. vions

        Some time after I posted the comment to defend ObamaCare, which I felt was a compromise with GOP’s strong opposition to single payer plan, I realized that one question remains: why Obama dropped the single payer fight so readily.

        I voted Hillary in the primary because I knew what she was about, and where she stood in the healthcare debate. Once she lost the primary there was still hope that Obama would carry the torch. When I heard that he removed the single payer plan from the table, there was a sense of being betrayed.

        I once posted something similar to Ms G’s comment that Obama behaved like a closet Republican, at least in the Healthcare debate. Nobody but he knew exactly what he was thinking. I hope future historian can find out the truth for the public.

  18. chicagogal

    I couldn’t even get my free annual credit report from Experian because I answered their control question correctly and they refused to accept the answer. So how would I be able to answer their control question if forced to enroll in an Obamacare Exchange if I don’t have their correct answer to use?

    Kind of a chicken/egg conundrum.

    Considering the GOP is against Obamacare, why did the SCOTUS uphold Obama’s right to fine people if they chose to be uninsured?

  19. Laura G.

    Ugh…those questions form the credit reporting agency are terrible. I remember them asking me who financed my car, which had been paid off 6 years prior. And, of course, I couldn’t remember.

  20. Laura G.

    Ugh…those questions form the credit reporting agency are terrible. I remember them asking me who financed my car, which had been paid off 6 years prior. And, of course, I couldn’t remember.

  21. Laura G.

    Ugh…those questions form the credit reporting agency are terrible. I remember them asking me who financed my car, which had been paid off 6 years prior. And, of course, I couldn’t remember.

  22. Chris Herz

    So, screw the system. Do not buy their stupid insurance, do not pay the fine.
    This is what I shall do.

Comments are closed.