Michael Olenick: Obamacare Will Lead Me Either to Get Divorced or Leave the US

Yves here. While readers may contend that Michael Olenick’s case is an outlier and anecdotes are not the same as data, the extreme secretiveness of the Obama Administration combined with deliberately misleading statistics leads one to give some weight to anecdote in the absence of better facts.

And despite the Administration’s persistent efforts to message otherwise, it’s becoming clear that significant groups of people are being made worse under Obamacare, although we don’t know how large they are in aggregate or how seriously they are hurt. We have people losing access to their primary doctor (and worse, sometimes to key specialists or facilities) due to narrow networks. We have people facing significant cost increases due to policy cancellations. And I’ve heard enough stories from people I know personally that these aren’t, as the Obamabots would like you to believe, stupid people who now have cheap plans that cover little. I’m seeing a lot of self-employed and small-employer types winding up with considerably more costly insurance and worse coverage (and they can give me chapter, book and verse as to why and how).

And Olenick’s issue of the marriage penalty is real, but the media has barely commented on it and even then not fully recognized its extent. We linked to this MSN article yesterday, The hidden marriage penalty in Obamacare:

Any married couple that earns more than 400 percent of the federal poverty level—that is $62,040—for a family of two earns too much for subsidies under Obamacare. “If you’re over 400 percent of poverty, you’re never eligible for premium” support, explains Gary Claxton, director of the Health Care Marketplace Project at the Kaiser Family Foundation.

But if that same couple lived together unmarried, they could earn up to $45,960 each—$91,920 total—and still be eligible for subsidies through the exchanges in New York state, where insurance is comparatively expensive and the state exchange was set up in such a way as to not provide lower rates for younger people….

Married people who are uninsured make up just a small fraction of the uninsured, for obvious reasons: It is easier to be insured if you have two potential pathways of getting there.Only 15.4 percent of married people were uninsured 2012, according to research from the Kaiser Family Foundation; the uninsurance rate for “single adults living together” was more than twice as high—33.4 percent.

That may be one reason the Obamacare subsides are more generous to single people and one- or two-parent families with children in the house than to couples who lack children. They were designed to help single moms and struggling middle-class families with children, not married creative-class millennials in pricey cities who have not yet settled into well-paid work, or barring that, work for a single employer.

As you’ll see in the post, the attitude implicit in this extract (“oh, those childless couples in high cost cities, who cares about them, they could just go and like in Tulsa or Atlanta or have kids and they’d be fine,” is a serious understatement of the problem. Clearly we don’t have good stats, but Olenick is in none of those categories. He has a child and he lives in Florida (and not in Miami or one of the glitzy resort communities like Naples), so he’s not the in-the-process-of-being-negatively-stereotyped creative class type.

I’d very much like any reader examples along these lines, either positive or negative, about the cost and benefits of Obamacare versus your current plan (assuming you’ve been able to find information!)

By Michael Olenick, a regular contributor on Naked Capitalism. You can follow him on Twitter at @michael_olenick

I have to confess to NC readers that my wife and I have been discussing divorce. It’s not that we’re unhappy – I’m blessed with a wonderful relationship to an amazing woman – but marriage is becoming cost prohibitive thanks to the Obamacare marriage penalty. Children do make it more likely to get a larger exemption but one doesn’t do much: people should either ditch their families or make like the religious types that have a dozen.

If I accepted the federal government’s not-so-subtle nudge to abandon my family I’d have to pay child support but an online calculator tells me the monthly cost is less than the real-life cost of healthcare with an Obamacare policy. Given the choice of supporting a child or a health insurance executive I’d prefer the kid. Of course there are noneconomic intangibles that prevent us from ditching our families; even if the federal government has abandoned the US middle class my experience is we haven’t abandoned one another.

Obama didn’t quite outright tell us to fuck ourselves but between mandatory policies that cost $800/month, that include deductibles and co-payments which can cost another $1,000/month, these policies are only affordable only for the 1%, and that crowd tends to already have good health insurance.

At the suggestion of a nakedcapitalism commenter I checked out ehealthinsurance.com, which shows the Obamacare plans that the federal system will not or cannot. Somebody at ehealthinsurance.com got the attention of CMS and received permission to display the policies for comparison shopping. I suppose they were concerned the federal exchange would make their website obsolete though, at this point, it’d probably be cheaper for the federal government to just buy the website rather than continue building their own.

Once able to compare plans I found that for my family – not some theoretical family but my very real one – there are several 2013-era plans that seem to work well. The lowest costs $276/month; doctors visits cost $40 and the maximum annual out-of-pocket cost is $12,500 per person or $25,000 per family, which is steep but fair for cheap insurance. Generic drugs cost $20 and they’re the only drugs covered. Maternity is not covered except for complications, a strange clause in that complications are by far the most expensive component of birthing a baby (click to enlarge).

Screen shot 2013-11-07 at 4.17.02 AM

For the same $276/month in the 2014 Obamacare plans there is nothing. The cheapest plan is $493.68/month and has a maximum out-of-pocket cost of $12,600 per family. Assuming more than one person in a family doesn’t suffer an extreme illness in a year the [fill in every pejorative imaginable] old policies are actually cheaper than the Obamacare policies.

If you don’t get really sick the existing plans are much better because where the cheap plan pays for lots of routine care – a half dozen doctor visits and generic meds – the more expensive Obamacare plan pays for literally nothing until the $12,600 deductible is met. Routine doctor visits, generic prescriptions, urgent care, hospitalization .. the plan seems designed to never pay a cent unless a person develops a debilitating disease. Of course the Obamacare covers more things, like mental health professionals and residential drug rehab for “free” once you hit that $12,600 level, in case the financial stress this causes drives a person to start needing sedatives.

So one plan costs $3,312/year, helps pay for basic doctor visits and generic meds, and can leave a person owing $12,500 if they get injured or sick (yes, you’ve got the joint probability of two people getting sick and incurring costs of $25,000, but if you know anything about statistics, joint probabilities of already low-odds events are super low. So while you can in theory hit the $25,000 cost level, statistically the likelihood is awfully low). In contrast the ACA plan costs $5,924.16, can result in $12,600 of medical bills, and covers nothing unless a person becomes injured or really sick. On second thought it’s really not much of a contrast, or at least not one that reflects well on the ACA.

My wife is European and my employer is based in Europe. Rather than abandoning the family – an idea that just doesn’t sit well with any of us, even if federal bureaucrats dig the idea – it might make more sense to hop the pond and abandon the bureaucrats instead. That sounds sarcastic but it’s an idea we’re actually considering: there’s better healthcare, schools, cheaper housing in most places, and depending upon where one ends up even the food is an improvement. But how many people have this as an option for dealing with Obamacare sticker shock?

Years ago I proposed setting up medial tourism on Indian reservations. Next to the casinos and resorts would be state-of-the-art hospitals, unencumbered by US laws that allow American medical businesses to conspire and rig prices. Theoretically the drug makers and equipment manufacturers could refuse to sell to the tribes at regular world pricing, rather than American price levels, but since the tribes can import their products from anywhere else, the refusal would be pointless (as in rather than reimporting US made drugs, they could buy from Europe, for instance). It’s only a matter of time until once ridiculous proposals like this are adopted then only a little more time until the US is forced to go in the direction of single-payer and address the cost of medical care.

American healthcare is a competitive disadvantage, producing steep costs and sick workers. Healthcare once consumed a far smaller share of our GDP. If we were sane, anybody outside the healthcare marketplace would demand that the costs decrease to historical norms. Just like using the best standards and tools to build healthcare.gov would have resulted in a healthy website, using the same system that works everywhere else in the world, single payer, would produce a healthier country.

I supported the ACA as a stopgap measure towards universal healthcare: Medicare for all rather than only the absolutely most expensive to treat. About twenty years ago I realized something was profoundly wrong. My already sick grandfather underwent an entirely paid for quadruple bypass, spending a long time hospitalized. At about the same time my sister had a baby, a routine birth with no anesthesia and left as soon as they could legally release her. Grandpa’s operation and stay was entirely paid for; the hospital ended up suing my sister because she could not pay the stunningly high bill. Since then things have only gotten worse.

I understand that people were going bankrupt due to healthcare costs when they became seriously ill but, with these policies, that will still happen. Now healthcare costs will not only drive both the sick and the healthy into bankruptcy as they do now, but rent extraction via overpriced insurance will lead some people like me to get divorced or abandon the US. This is progress?

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  1. Adriannzinha

    Hopefully sooner than later people will recognize the ACA for what it is: A health insurance bailout for the insurers.

    This was always about cutting corporate costs and shifting them to working folks. More employers will simply shift workers to exchanges and phase out health benefits under the false banner of ‘competitive necessity’. All the while corporate america is seeing all-time record profits.

    The end result, aside from the obvious windfall for said corporations, will be a segregated two-tier system of health care.

    The stunted derelict known as obamacare for the 99 and the sky is the limit for the 1%.

    And yes, this is progress if the entire purpose of your governmental apparatus is to serve as an upward wealth transfer spigot from working people to bankers, oligarchs, and America’s wealthy.

    1. 12312399

      given the way that the ACA/Obamacare plans, deductibles and benefits are set up, it’s not unreasonable for many people who are under 50 to 1) pay cash for health care, 2) pay the ACA penalty and 3) risk it that that won’t get into a major accident or come down with a freak illness.

      i’m sensing that ACA will turn out to have a lot of opting out by healthy young peope either cuz they have limited disposible income (even with the subsidies) or they are willing to risk having no coverage.

      practically, what America needs is a hybrid system (as 100% national health care would never pass)—-a single-payer system for preventative, basic and emergency room care, and private insurance system for all other stuff.

      1. Wendy

        Don’t be so sure that paying cash for health care is an option. A few years back, when I was waiting for a health insurance eligibility period to expire and had not opted in to COBRA under my old policy during the insurance gap, I could not even get a Dr to allow me to make an appt to be seen, without current insurance. No insurance, meant no appointment. I had to get a friend who was friends with a Dr get me an appointment.

        1. Yves Smith Post author

          I can’t believe that’s true. I have an indemnity plan (I can see any doctor I want to) and I put my visit on a credit card. I’ve never had any doctor not accept that. They prefer it. It means faster payment, and higher profits (no fighting with insurer for payment). This sounds like a miscommunication.

          I know tons of doctors in NYC who are migrating their practices off insurance as fast as they can (basically focusing on the rich, for instance, derms doing strictly cosmetic treatments, endocrinologists converting their practices to anti-aging).

          1. OpenThePodBayDoorHAL

            Shameless thread-jumping just to say ACA is designed as a terrible pool for sharing risk. They need young fit people in it for it to work. But why would a 27 year old join? Pay the penalty, then sign up in the ambulance on the way to the hospital if something bad happens.
            Oh and did anyone notice that 73% of the US population qualifies for government assistance with ACA costs? Hopefully the Wizard of Ben is standing ready with his magic printing press.
            Sad sad sad. They should have lowered the Medicare eligibility age to zero. Or forced congressmen & senators to be in the plan. Maybe that way they would have come up with something reasonable.

          2. DolleyMadison

            Same in my town – one system owns neaRly every practice and if you don’t have insurance they won’t take you even if you prepay. My son aged out of my insurance and just graduated and doesn’t yet have a job. We were able to get a family friend who is a dr. to come to the house to see him and then I went to my doctor and asked for the medicine he needed. (for me wink wink)

          3. JerryDenim

            I can vouch for Yves and her assertion about doctors in NYC actually refusing those WITH insurance. Several years ago when my wife was doing temp work one summer while finishing her Masters degree she did temporary admin work for three separate doctors and only one accepted patients with insurance. As I recall the one doctor who did accept Insurance was very picky about which insurance he did take. My current dentist has the same policy. Many NYC doctors operate their practice on a strict cash only basis. Why? Because they can. Old fashioned supply and demand, not so many great doctors, tons of people with money in NYC, and dealing with insurance companies suck. Why haggle with the misers at insurance companies which will bury you in a mound of paper and passive-aggresive procrastination when you can just name your price and get it in cash?

          4. ~salix~

            Yves, love ya, love this site and all that I’ve learned, but I must humbly disagree with you on this. You’re assuming that those of us without insurance have credit. I, for one, don’t.

            I’ve seen doctors on a cash basis, and they are quick to get you out of the office. Limited testing (under the assumption that you can’t afford the lab fees anyway), and treatment is at an arms length (I can only assume that this is a liability issue).

            I’ve seen the same GP with high-falootin’ private insurance, no insurance, and Medicaid, and I can tell you that each round of treatment has been profoundly different from the rest. CUT (cash upon treatment) was by far the worst. Cheaper in the long run, but a total waste of money overall. I had better services from the nurses in High School.

    2. Cynthia

      Obamacare is just a shell game, that will transfer wealth to the health care and insurance industries, mostly with funding derived from working middle class Americans. Obamacare does nothing to control overall health care costs, and it will increase the %GDP we spend on health care, thus endangering the US economy. What is needed is to control the exorbitant overhead costs and the exorbitant costs of medical tests and procedures, and then to implement a single payer national health service.

    3. Welch

      No this is about single payer plan. Obama knows exactly what he is doing. This is his way of driving you into a single payer plan.
      The only way to stop it is to repeal it. You can only do that if you win the Senate in 2014. The only way you will win the Senate is to back Tea Party candidates. Now you may no like the truth I just handed you. I don’t like the medication I have to take but it is necessary if I want to live. The Tea Party will never come to you. They are willing to break it in order to fix it. There you now have it, the truth.

      1. Yves Smith Post author

        You are out of your mind. This is the part of the lunatic fringe that sees Obama as a socialist (which if true would not be a bad thing), when he’s a center-right corporatist. There are people here who were active participants in the political debate re Obamacare. Single payer wasn’t even allowed into the debate on the Dem side, people who tried bringing it up were effectively censored. All that was discussed was the public option, and then only a short period of time, just to placate some folks on the left. It wasn’t even used as a serious trading chip.

        That’s aside from the fact that single payer is what we need. But what Obama wanted, and produced, was a big payoff to the health insurers and Big Pharma.

  2. charles 2

    Funny that. I left Europe for Asia precisely because I considered that the health system will be bankrupt when I need it. Maybe you should consider the move to Asia directly. FYI, my insurance cost is around 300$ A YEAR.

    1. from Mexico

      Pretty smug you are. It’s all part of your Ayn Rand philosophy, which you elaborate more fully here:


      I jumped ship too, but am not indifferent to the suffering of my fellow Americans back home. I still love my nation, though I suppose you might say it’s a love-hate relationship, kind of like that which the Rev. Martin Luther King articulated in his “Why I am opposed to the war in Vietnam” sermon.

      I must admit, though, that Obamacare is the best propaganda gift you anti-government types have been handed since the National Endowment of the Arts awarded grants for the exhibit of things like Andres Serrano’s Piss Christ or Robert Maplethorpe’s Jim and Tom, Sausalito and Self Portrit 1978.

      Piss Christ is a photograph of a crucifix immersed in the artist’s urine. Jim and Tom, Sausalito is a photographic triptych which shows two men, one urinating in the other’s mouth. Self Portrait 1978 is a photograph which shows the artist dressed in black leather with a bull whip protruding from his anus.

      While bashing icons and societal, moral, and religous conventions can be quite liberating, it nonetheless proved highly offensive to large segments of the working class, which tends to be culturally conservative, though not necessarily economically conservative.

      It’s amazing how it seems like it’s always the New Left, in the current case the Obama administration, which seems to find its home in the land of stupid. It seems to go out of its way to do things which its base finds highly offensive: morally, culturally and socially.

    2. JGordon

      Hey right on Charles2;

      I’m prepping myself to teach English in China myself (I’ve already made friends and got the city I want to go to picked out–guilin fyi!!); cost of living is way lower, cheap healthcare, and the women are absolutely gorgeous.

      So I agree with you 100%. Getting out of here like you and FromMexico did is the way to go. For those who have the option it’s definitely a good plan.

      1. Barmitt O'Bamney

        Good plan. Personally, I plan to teach ESL in Canada.

        U.S. Americans take flight – you have nothing to lose but your chains!

  3. Canadian

    I don’t live in the USA and never have, so the system is not familiar to me.

    The way I read this article, if a member of Mr Olenick’s family became seriously ill, then the cost of healthcare, before the cheapest policy started to pay out, would be premiums of 12 x $494 = $5,928 plus the deductible of $12,600.

    So if something bad happens to a member of Mr. Olenick’s family they would be $18,528 out of pocket.

    That seems like a lot to me.

    1. CaitlinO

      “So if something bad happens to a member of Mr. Olenick’s family they would be $18,528 out of pocket.

      That seems like a lot to me.”

      It’s a lot. It’s just about the value of a second house payment for many many American families. Which means it’s simply not feasible and many will have to go without insurance at all and pay the tax fine.

      If, as predicted, the next step in this danse macabre is that employers will drop their plans dumping their employees onto the exchanges, the howls of pain will be so loud even deaf DC will hear the fury.

        1. DollyMadison

          …and then heartily toast one another. I honestly think D.C. must hate us all with a blind hot fury.

  4. Clive

    I don’t normally comment on Obamacare because it’s not relevant to me in England and I don’t have anything factual to add.

    But I saw the figures in the table above. You’re kidding me, right ? Is that really — really — what you folks across the pond have to pay for coverage ?

    And, let me get this right, you, like, have to — mandated by federal statute — buy these products ?


    1. Michael Olenick

      Those are not only real figures but they’re the most positive for the ACA because that is, by far, the lowest cost insurer! We had our daughter in for a physical and noted a big sign that her doctor, like many, do not accept their insurance because they are apparently aggressive about reimbursements (read: they have a reputation as really cheap paying claims). A better branded insurer offers a policy for $726/mo., that starts to pay after $6,350 for an individual or $12,700 for a family (similar to the plan in the article but the individual deductible is lower). For the extra $300/month you get up to three doctors appointments a year for $20 before having to blow through $6K+. Go onto ehealthinsurance.com, enter my ZIP (postal) code of 33405 — which is a fairly typical US small city — and check out the different rates.

      1. Clive

        No Way !!!

        Just did a quote based on my details and played around with the options. It’s every bit as bad as you said. What was really vexing is the Faustian bargain you have to make between setting a high deductible to bring the monthly premium down but then wondering, if it came to it, where you’d get the $6,500-odd if you were unfortunate enough to have to have a hospital admission or similar.

        Picking a plan with a sensible deductible which I would normally have as a “free float” in my checking account (so I wouldn’t have to sell assets, dig into retirement savings or get into debt), I got this outrageous premium:


        And that’s just for me, no family cover.

        People must, to make ends meet, be selecting high deductible plans and just keeping their fingers crossed.

        And that’s before you get to all the other “gotcha’s” like prescriptions and clinician visits.

        So you don’t have a choice but to pay up ? But that’s like taxation. And since I doubt Aetna or Cygna would let me into their offices, let alone vote for a board member to promote my interests, I can’t see where there’s any representation. Didn’t you all fight some pesky little revolution over that sort of thing ?

        Makes me think that the great PR / messaging strategic blunder of the 18th century was not rebranding revenue collection in Massachusetts “King-George-IV-a-Care” and telling everyone it was all essential they paid up for their own good…

        1. Banger

          Indeed–it is a tax paid to private insurance companies run by people who are, essentially, criminals. I may, if all this turns out to be true, vote Republican this year.

          1. Min

            “Indeed–it is a tax paid to private insurance companies run by people who are, essentially, criminals. I may, if all this turns out to be true, vote Republican this year.”

            Why? It is because of Republicans that the ACA is so insurance industry friendly. True, they have been making a lot of noise and taking symbolic votes to repeal Obamacare, but that is because the current crappy system is better for insurers. Better to vote the Republicans out, so that the Democrats can pass a single payer system.

            1. jonboinAR

              If the current crappy system is better for insurers, and Obamacare doesn’t benefit the rest of us any, then for whom is it any good? Someone’s making out, I’m sure, but who?

              1. different clue

                Obamacare is better for the insurers. It was written for the insurers. It may well be better for employers who get to plan-dump their employees, because Obamacare was written to permit them and encourage them. So when the employers dump employees and say its because of Obamacare, they are being exactly truthful.

            2. Ed S.

              ….so that the Democrats can pass a single payer system.


              1) The Democrats had the best opportunity in 2009 to pass single payer in the last 50 years (D controlled House, Senate, and WH with a then popular new President). Single payer was never on the table — for reference read any of the 100’s of posts and comments on the “Naked Capitalism” site for example.

              2) Give me a break with the D vs. R propaganda — on the most critical issues that face the United States, there’s virtually NO difference in their positions.
              Read more at http://www.nakedcapitalism.com/2013/11/michael-olenick-obamacare-will-make-me-either-get-divorced-or-leave-the-us.html#EbzYxijMPRKgW8M2.99

            3. Ed S.

              ….so that the Democrats can pass a single payer system.


              1) The Democrats had the best opportunity in 2009 to pass single payer (or meaningful HC reform) in the last 50 years (D controlled House, Senate, and WH with a then popular new President). Single payer was never on the table — for reference read any of the 100’s of posts and comments on the “Naked Capitalism” site for example.

              2) Give me a break with the D vs. R propaganda — on the most critical issues that face the United States, there’s virtually NO difference in their positions.

            4. Banger

              The Republicans did advocate for Romneycare as an altenrative to Hilarycare. Yes, the RP opposed all efforts at reform, to be sure but they aren’t to blame as much as the other side which refused, I repeat, refused to present the case for sanity, science, reason by pointing out to the American people that our system sucks compared to other systems of which there are many from single payer to hybrids–but what they all have in common is that the work and they are cheaper because criminal (I don’t mean legal criminals but the criminally minded) elements are not allowed to dominate the HC system. Had the President presented the case for reform by noting that we pay almost twice as much for health-care as the OECD average then people would have understood the problem. Instead 90% of Americans don’t know the facts so how can they decide. As for the mainstream media they are beneath contempt for their coverage of the issue which was appallingly bad. Republican opposition was an important factor but those other two factors were more important.

                1. Daikon

                  It wasn’t only Obama’s silence. Obama systematically took covert steps to block even a puny Public Option, especially after it began to gain supporters in the Senate. Obama is both Anti-Single Payer and Anti-Public Option.

            5. different clue

              No, it is not because of Republicans. It is because of Obama, Baucus, his little insurance-lobbyist staffer who helped write the bill, and the Catfood Democrats in general.

              The Republicans voted against Catfood Democrat Obamacare.

            6. ian

              “Why? It is because of Republicans that the ACA is so insurance industry friendly”

              How do you figure that? Was it to get votes? If so, fat lot of good it did.

          2. Lambert Strether

            ObamaCare is a Republican plan (or, I should say, a legacy party plan): HeritageCare -> RomneyCare -> ObamaCare. So please consider voting for an emergent party, not a legacy party.

            1. Banger

              A week ago or so some of us had a brief discussion about whether or not to support the destruction of the system or just keep trying to “reform” it (not sure what that means anymore) so it is possible to support far-right because that is precisely their agenda–they are actually defying their corporate enablers with wanting to bring the whole thing down. The question is should we think about joining them. Normally I would say “no” now I’m not so sure.

              1. JerseyJeffersonian


                I think it debatable that the net effect of the far right agitators would be to “bring down the system”; rather, it may actually serve the interests of Corporatists quite well through further removing the State as an actor in limiting the depredations that they can work on the nation. Granted, with corporate capture of the Executive (particularly in regulatory agencies), the Legislative (via bribes, a/k/a campaign contributions), and the Judiciary (by means of packing the bench with Federalist Society idealogues), things are already not too great. But removal of even the possibility of resistance by the State on behalf of the citizens through further gutting of the State might just delight the pirate captains of laissez-faire Corporatism still more.

                No, I am not optimistic about the possibility of restoring balance to the society through a reinvigoration of the State as advocate for the interests of the citizenry; massive forces are arrayed against this possibility. But allowing oneself to be co-opted to effectuating the agenda of extremist anti-government libertarianism out of a sense of disgust with the state of affairs doesn’t seem productive. Do you see a way from that endstate to something beyond it more desirable that would have a chance in hell of actually manifesting? Realistically, you may not have a lot of hope in seeing things get a lot better, but how can actively helping to make things worse, and with little hope of escaping the morass that results be a good thing? Better to refuse consent, and to try to build local, resilient communities as a counterpoise to societal dysfunction.

              2. Nathanael

                There may possibly be a case for voting for far-right… but not for REPUBLICAN far-right. The Republican National Committee has been changing its rules in order to prevent populist influence.

                If the only third-party candidate on your ballot is from the Libertarian Party or Constitution Party or something like that, however, perhaps you should vote for him.

                But if there’s a left-wing third party, please vote for that one instead. The Green Party candidate was clearing nearly 20% of the vote in the Syracuse-area Congressional election recently. The time for emergent parties is coming, we just can’t tell which one will “catch fire”.

                If there’s no third party, write in someone. If write-ins get high enough votes, people will start paying attention and organizing third-party runs.

            2. bluntobj


              Agree with the emergent party point. BvR is about extraction.

              When you say Obamacare is an R plan, you are correct under the axiom that R = B.

          3. Jeremy Grimm

            DON’T VOTE REPUBLICAN!!!!! Ugh! Check you county and if they count write-in votes — just vote ‘no’. Register that you care enough to vote and you don’t accept or support this system. It got rid of GEN Pinochet in Chile. Can’t hurt to try it here. Better than not voting, and voting Republican — chop off you voting hand.

        2. Nathanael

          “So you don’t have a choice but to pay up ? But that’s like taxation. And since I doubt Aetna or Cygna would let me into their offices, let alone vote for a board member to promote my interests, I can’t see where there’s any representation. Didn’t you all fight some pesky little revolution over that sort of thing ?”

          Correct. We might have one of those again sometime soon.

      2. EMichael

        Course you understand that the quote you received may, or may not, be the actual rate you are charged. That you cannot know until the insurance company receives your application and processes it.

      3. SK Graham

        So I entered your zip code, and my family’s ages (45M, 35F, non-smokers, newborn F), and got $460 / month on the 2013 AETNA plan; not $276.

        And the $494 plan is a high deductible, HSA eligible plan. The goal there is to shelter a bunch of cash tax-free for use later (for an early retirement.)

        The Humana Connect Bronze 4850/6350 Plan with Children’s Dental is coming up as $500.76, and does, in fact, cover roughly comparable stuff to the $460 2013 plan. A $40 / year increase is in the vicinity of medical inflation.

        (And $6000 a year is considerably less than what me and my employer pay combined for my health insurance.)

        Are you guys significantly younger than me and my wife?

        1. Michael

          Our families ages are pretty much the same. The $276 plan is still there though, it’s the Aetna Health Network Option Value 10000. Not sure if it will work but here’s a link: https://www.ehealthinsurance.com/ehi/ifp/plan-details?planKey=3268:713&productLine=IFP

          The Humana Bronze plan doesn’t pay anything until the $12,600 deductible is met, so the plan requires $18,528 (averages to $1,544/mo) until it pays out anything. Even then it’s an HMO that has seven pediatricians — not practices, doctors — for a county with a quarter-million children. Even then there are no doctor visits until the $12,600 deductible is met. This is catastrophic insurance.

          The 2013 plan is the United HealthOne Copay Select 70 – 5000. Here’s a link: https://www.ehealthinsurance.com/ehi/ifp/plan-details?planKey=3206:100504&productLine=IFP Doctors and specialists visits include a $35 copay and there is no deductible. Generic drugs have a $15 co-pay with no deductible; others have a $500 per person deductible. There is a $5,000/family member deductible per person or $10,000 per family. There are 213 in-network pediatricians in my county.

          There is no comparison between these plans. The 2013 plan is insurance. It has some bumps and bruises but no doubt they could have been worked out via basic cost containment legislation (ex: no collusion on pricing, open price books by providers, allowing importation and reimportation of meds, requiring maternity coverage), but it works. The other is garbage: a $500/mo. raw tax to a that’s virtually guaranteed to never pay out benefits.

  5. Hayek's Heelbiter

    An incredibly dear friend is suffering from serious cancer in the U.K.

    Total cost of her chemo, radiation, supervision by one of the top oncologists there, medications and transportation to and from the hospital for treatment.

    $0.00 or converting to pounds, GBP0.00.

    She paid for it in higher taxes over her lifetime, but the NHS was there in full force when she most desperately needed it.

    Right now, a team of five or six specialists are spending an enormous number of hours trying to figure out her extremely complicated case.

    Last night, after working hours, the incredibly warm and compassionate colorectal specialist spent nearly an hour in her room discussing their findings and possible tratment protocols.

    As mystery writer Frank Hickey once remarked, “If that ever happened to me in America, I would be waiting for the alarm to ring and wake me up.”

    1. Banger

      A friend had a severe concussion and brain-damage and was treated in a way that would have been inconceivable in the U.S. unless she had been a millionaire–including home care and great rehab–and there are many stories like that out there. Americans have no clue, due to the mainstream media’s permanent lie-machine, about what is going on in other countries. Looking at how the rest of the world handles health-care for good or ill was never discussed during the HC debate by anyone other than a few on the left who were not allowed to talk and Michael Moore’s movie.

      1. BillC

        The ignorance of most Americans — even moderately traveled ones — regarding the quality of health care in advanced nations is stunning and embarrassing. I dined about a month ago in a nice restaurant in small Black Forest town and had the unpleasant experience of overhearing the entire conversation between a brash 30-something American male from the midwest who was there to make an import deal, and his hosts, apparently export manager and managing director of the beer brewery a block away.

        After running through the standard right-wing litany of how small business fares better under the US’s less pro-union, pro-regulation, and pro-social-welfare policies (to his hosts’ merely polite acknowledgement), he then capped things off with the proud boast, “America has the best health care in the world.” This fellow had spent significant time in Germany with the US Army before embarking on his business venture, so one can’t explain his ignorance by lack of exposure — just blind preconception and lack of curiosity.

        His hosts politely avoided discussing the issue further, but I really wanted to go over and ask him, “On which metrics do you base your claim?” Luckily, the gemuetlich atmosphere (and my wife’s firm grip) held me back.

        1. just_kate

          I suspect he was using his experience with the medical care he received or had access to while being in the US Army. I grew up in that same system as a Navy kid and it was the best system I’ve been a part of so far. And I speak from personal experience re: multiple employers and under almost every major insurance carrier at one time or another. To date I’ve paid out close to 80K in premiums and have never once met a deductible.

    2. Cynthia

      Those on the far right believe that ObamaCare is patterned after European healthcare. They couldn’t be more wrong. The Europeans have either cut out insurance or have made them a virtual arm of the government, regulating every aspect of what they do down to their profits. ObamaCare is purely the American way — Wall Street healthcare, turning what should be a public service into a profit center for big business. It results in the least efficient healthcare in the world and it produces terrible outcomes except for the extreme wealthiest. This is not government-run healthcare; it is corporate-run healthcare as American as apple pie — not a good thing.

    3. PaulinLondon

      You can always find anecdotes to back up any view, but as someone who has lived in Europe most of his adult life, I assure you these systems aren’t as portrayed by people seeking to implement universal health care in the US. Occasionally, in the most serious cases, the system works as described, but the vast majority of people who interact with the health care system have a somewhat different experience. There are endless delays, filthy hospitals and unavailable drugs. People who can afford it in the UK opt out and get private care. If they have even more, they travel to the US for treatment.

      Why would anyone do that if everything was so rosy here with the medical treatment?

      1. Knifecatcher

        Even anecdotes are better than sweeping, unsubstantiated declarative statements about “the vast majority of people”.

        Also, the trope about hordes of foreigners coming to the US as refugees from their horrible socialized health care systems has been pretty thoroughly debunked. Here’s a Canada focused example.


        1. PaulinLondon

          All I can say is that I’ve spent 46 of my 57 years in a system of single payor health care (mostly Canada and the UK) and it just isn’t the great deal that you all make it out to be. Too many people are making a political statement — single payor good/private bad — and that just doesn’t reflect reality.

          The US insurance system is certainly flawed, but to pine for a very dictatorial single-payor system is simply naive. My experience is that people huff and puff at every comment that goes against what they wish to be true, but reality is far more complicated.

          1. Lambert Strether

            All of which explains the wave of Canadians entering the US to take advantage of our wonderful health system. Oh, wait…

            Seriously, link-free whinging culminating with a delphic things are seldom what they seem. Pathetic.

            1. PaulinLondon

              If everyone who disagrees with you is “pathetic” then I begin to understand what’s tearing the US apart.

              The bottom line is that I’ve lived in 4 different systems and have extensive family in all 4. And I can state with no fear of meaningful slurs from idealogues that all 4 systems are deeply flawed.

              I will also add that almost 30 years have been spent in Canada, which is so far away from having health care right that it’s almost funny that Americans love it so much.

              I don’t even think you appreciate just how much of Canada’s system is supported by the US, as either a treatment safety valve or as a development platform for drugs that Canada could never fund.

              But your minds are made up and you will plunge ahead regardless. Once a true believer homes in on something anyone trying to warn them off is simply “pathetic” — and that’s from the side of the spectrum that considers itself sophisticated!

              1. Patricia

                My sister lives in Canada and she is quite happy with her health care although it’s not perfect. I have US Medicare and have more problems than she does but I am also satisfied. You’re the one demanding perfection.

                1. PaulinLondon

                  I’m well aware that probably a majority of Canadians love their healthcare system, however that’s largely because most people haven’t been really sick and most people seem to think it’s “free”. My sister loves it even though my father recently died in a way peculiar to systems where government makes the decisions.

                  Her argument was that she gave birth and didn’t have to pay and didn’t have to borrow money. That’s fine as long as everyone realizes that someone is borrowing money to pay the costs. And frankly, her experience during one of the births was so poor that it makes one wonder why someone would be a fan of such a service, but then there’s that “free” thing I guess.

                  And you should probably understand that Canadian nationalism is largely in direct comparison — both positive and negative — to the US so they “love” their healthcare because it’s so different from what Americans have.

                  The best argument for it is that it holds down overall costs, but too few people look at what that means.

                  It means doctors can’t charge as much and now there’s been a shortage of doctors for many years (wait lists).

                  It means that tests on advanced diagnostic machines are less expensive, and now there’s a shortage of advanced diagnostic machines (wait lists).

                  It means that the government with its buying power holds down the cost of medicines and now there’s little research and development in Canada and we wait for the US to develop and market the drugs.

                  These are absolutely undeniable facts. It’s still ok to be in favour of that system, but don’t be a blind cheer-leader. These are hard, expensive decisions and they are literally a matter of life and death so make them with your eyes open.

                  And far from demanding perfection, I’m a realist. If I had to rank them I’d say overall the UK is the best because it has both and NHS and a private system running side-by-side.

                  Next comes the US — it’s tops for the high-end, but that’s unaffordable for most so I drop it down.

                  Canada, aside from the fact that it somehow got tied up in the self-identity of Canadians, is a clear last.

                  The fourth one mentioned is too different from these countries to be relevant.

                  1. Waking Up

                    Over 60% of bankruptcies are due to medical bills in the United States.

                    What percentage of bankruptcies are due to medical bills in Canada?

                    1. PaulinLondon

                      I’ve never seen numbers for even specific age groups above 30%. Even that’s a serious problem — and I believe marginally the biggest cause of bankruptcy — but no where near 60%. I think the overall number is around 20%, but I haven’t taken the time to look at the numbers and test the source of those numbers. If you have and they show 60% I’d love to see them.

                      Still, the Canadian percentage would be much smaller and limited to peculiar cases, but that’s hardly an answer to the big question. After all, the Canadian system is “free”.

                      I’m more and more of the opinion that the American debate about healthcare is solely a political question and the view one holds is tied almost completely to which party one votes for. This is largely a liberal democrat site so everyone favours single payor systems. On conservative republican sites they favour private healthcare. I see no evidence that people actually spend much time thinking about exactly what’s wrong with the various systems and what they might do to try an correct for all this experience and real data.

                      Arguing that so-and-so likes their healthcare seems more a popularity contest and in that game the system that requires the collective to pay is usually going to outpace the system that requires saving and planning on the part of the individual.

                      Maybe that’s the way it should be decided, but make certain you understand the consequences of that choice when you make it.

                      At least, everyone seems to agree that ObamaCare has captured the worst of all the systems.

                    2. Yves Smith Post author


                      That 60% figure is correct, it comes out of the Harvard Bankruptcy project (IIRC, it’s 62% or 63%). So if you haven’t seen it, it says you are looking at the wrong literature.

                      And honestly you have NO IDEA how bad the healthcare system is here. Admin costs are estimated at a minimum of 18%, I’ve seen as high as 30%, and I tend to believe the latter because the former does not include all the time doctors and their staffs spend fighting with insurers to get paid. There’s a whole layer of awfulness (the admin hassles, things not covered, denial of care) that I guarantee your don’t even begin to understand.

                    3. jlji

                      Work in the pharmacy industry. Largest component of pharmaceutical companies is marketing, which warps the whole doctor as authority thing. Most drug research is funded by the government and transferred free to pharmaceutical companies.
                      It is much cheaper to prolong patent or take old drugs and dream up a new use for them.
                      Most pharmaceutical companies have fired their research staff and exclusively contract to third world labs.

                  2. Patricia

                    My sister is a landed immigrant. When she lived in the US, she could not afford health insurance. I have a Canadian uncle with complex health problems, and while not perfect, his care has been adequate.

                    Do you truly think Canadians are so stupid that they do not notice the high taxes they pay? And that they’d continue adoring a tax-heavy health-care behemoth merely to maintain an identity separate from their neighbor?

                    Re doctor shortages—that is so in both countries and easily remedied by opening the bottleneck of education in each country; and for Canada, requiring a number of years’ service. There are large numbers of intelligent capable college kids who would be delighted by the opportunity.

                    As to who determines limitations, choose your poison—insurance company or gov’t?

                    No one here believes there’s a panacea but any first-world health care system is better than what must endured by the ~200,000,000 USians who are not wealthy.

                    For those who can afford it, well, sure, it’s great, but as you say, the wealthy can jet in from anywhere to partake of it. The issue at hand is how to create the greatest social good for a large nation, not the highest quality for those who can pay.

                    You are not thinking clearly. You sound as if you are ensconced in a money bubble.

                    1. PaulinLondon

                      200,000,000 aren’t wealthy enough to have proper healthcare!!!!

                      That’s laugh-out-loud funny. All credibility is destroyed when you make up things. There is a real problem with the insurance based system, but it doesn’t involve 200 million not having proper healthcare.

                      But even if you were right and the problem was that big, then can’t you see that the collective can’t afford it any better than the individuals at those numbers. Collective responsibility for healthcare can only work when 200 million can afford it and 50 million can’t. That’s the problem with all these government programs — people don’t realize that they are unaffordable.

                      And far from living in a “money bubble” I can only say I come from a family where the bread-winner never made more than $15,000 per year. I’m sure you were much poorer, but I know all about struggling to pay bills. Some of those bills were for education to understand basic things, but then that’s simply one more thing that is becoming unaffordable.

                    2. Patricia

                      With Obamacare, most USians will not be able to afford proper health care. Obamacare is rapidly increasing what has been a long slow decline.

                      We contribute to health insurance and highly inflated medical costs. We get some kind of care out of it, but it ever shabbier and will remain often poverty-inducing. Here, decent health care is now considered a “cadillac plan”. It is not that it is impossible to deliver adequate care but we have a corrupt system.

                      We can talk again in a year, Paul, and you can tell me that I am wrong. I might be, but I doubt it.

                    3. Nathanael

                      Stop making shit up, “Paul in London”. Patricia is correct. In the US, 200 million of us cannot afford decent healthcare.

                      You’re in London. You have no idea how bad it is in the shithole known as the US.

                  3. Nathanael

                    Paul: the way your father died is undoubtedly *typical* of the way people die under the insurance company “death panels” and delay scams in the US. It’s LESS likely to happen in a government-run system.

              2. Patricia

                Moreover, from what I understand, the UK has been slowly starving and twisting NHS since Thatcher. Therefore its current malfunctions only serve to warn us about the PTB’s goals for chipping away at SS and Medicare. Get it to work awfully enough and people like Paul will think the idea itself is to blame. humbug

                1. PaulinLondon

                  This is not the forum for a comprehensive discussion, but on the 60% number, as luck would have it, that data base is one I have actually looked at. Suffice to say that I struggle to interpret it as you so confidently have. People who declare bankruptcy have debts and rarely is that debt confined to a single type. There is massive complication in trying to draw cause and effect conclusions from mere presense. At best what usually happens is that someone has too much debt and then something comes along that tips them over the edge.

                  About 25 years ago I was heavily involved in creating the first comprehensive corporate default study and I still struggle to interpret the data that comes out of that. I cannot tell you how many times I’ve sat through a presentation from some consultant who makes declarative statements about that data base that are aknost certainly wrong, but always support whatever argument they’re tring to make.

                  And I appreciate the fact that I have “NO IDEA” but in fact I was a permanent resident of the US for 23 years (living there for about half of that), my wife is American, one of my sons lives there, all of my in-laws and several of my own extended family are Americans. I suspect I know more about the American system than most of you know about the UK or Canada — and I do understand quite well the issue of adminstrative costs and know that they rarely go down when government gets involved.

                  The bottom line is that medical care is a problem everywhere because it is a black hole of expense. The only helpful approach is to compare systems and see both what works and what’s affordable. Almost all of these proposals will break countries in a generation or two as unaffordable costs slam head-on with unreasonable expectations.

                  I believe this is a genuine crisis, and not one that should be used to score political points. And I also think that whatever “solution” is arrived at should work for my grandchildren as much as for someone who votes today. Virtually all of the Western systems of medical care today will break those countries in the lifetime of readers of this site.

                  1. Nathanael

                    Except no, they won’t.

                    The single-payer systems (Canada) and the National Health Service systems (UK) are just fine the way they were originally designed and will work pretty much forever, as long as you can prevent politicians from “privatizing” them (and major attacks were already made on the NHS with success).

                    In contrast, the bodged together systems with “private insurance” are falling apart already — even in Germany and Switzerland.

          2. just_kate

            It may seem to you that we romanticize some of those other systems but unless you have a really good plan in the US and/or cash our private for profit system also has delays, filthy hospitals and unavailable drugs and the insurance carrier is the party most often dictating those conditions one way or another. I’d rather try something else and eliminate the parasitic element of that industry altogether.

          3. Waking Up

            Seems that you had a different experience than the majority of Canadians who voted Tommy Douglas (the Father of Canadian Medicare/Single Payer) as the “Greatest Canadian of All Time”.

            1. PaulinLondon

              That is certainly a fact, but largely irrelevant to the discussion. I would also note that when Tommy Douglas died in the mid 80s it passed virtually without notice — not what one would expect for a man voted the greatest Canadian only 2 decades later. The truth is, almost no one even knew who he was, and they don’t really know who he was today either. He became “great” by a serious effort by schools to support his political positions and no one votes in dopey campaigns like that more than motivated, coordinated kids.

              And I would point out than Don Cherry finished very near the top — an amusing character admittedly, but “great”?

              It has absolutely nothing to contribute to a very serious debate.

          4. JGordon

            I have VA care in Florida. I get free check ups, free tests, free meds, free specialists, and free surgeries, whatever I need, in a very timely manner.

            The one time I did have to deal with private healtch care and private insurance convinced me that I’d never want to do it again.

            So I’m not sure what you’re trying to say, but whatever it is based on my personal experience it seems a lot like you’re talking out your ass to me.

          5. jonboinAR

            What you leave out while arguing that we in the US are complaining without cause and glamorizing socialized medicine is the fact that as healthcare is in the US currently and looking to be even more so under ObamaCare, a great number of us, including myself, simply can’t afford health care, at all. I’d love to go into beautiful facilities when I need them, but I’m unwilling to expend all my life savings AND my future income in order to do so, meanwhile spending most of my discretionary income attempting to prevent any catastrophic event from entirely ruining me. My wife’s hysterectomy (sp) cost us over $30,000. That’s WITH the really crappy insurance that we were paying for at the time. Screw that! I’ll take lines and a dingier facility that I can REASONABLY AFFORD!

            Get this straight. I can’t afford American health care! Nor can most of us. ‘Nuff said.

          6. Mark P.

            I’m quite familiar with both systems since I hold both UK and US passports, and had to do healthcare-themed journalism at one point. Most recently, I had my 86-year dad in the North of England — who’s still working 5-6 days a week, running his small company — have a serious spinal operation on the NHS a couple of months ago, while my mother died of cancer in the U.S. system a couple of years ago. The basic pros and cons are —

            [1] When I used to look at U.S. studies, the projected figures pre-ACA usually showed the U.S. system breaking because of costs and numbers of uncovered people around 2020. The ACA can be understood as essentially a preemptive bailout/giveaway for the U.S. health-insurance system, written by the industry.

            [2] My father’s NHS experience was great doctors and actual surgery experience, horrendous hospital warehousing and aftercare. Recall, though, that single-payer systems as they currently exist around the world are all different — France is far better than the UK, probably the best experience in the world and where you’d want to get sick if you had the choice.

            [2] For American readers, the NHS experience has analogies with patches of the US healthcare system. For instance, in the Bay Area, one of the best hospitals as far as getting actual effective emergency healthcare and doctors is Highland in Oakland, the county emergency and trauma center.

            The downside there is you either have to go through Highland’s emergency room triage or have learned how to work the system. Also, unlike the NHS — paid for by your taxes and effectively free at point of entry — with Highland you have to not show any kind of substantial income later that they can come after you for.

            That said, the upside — and let me stress this — is that the actual emergency medical care at Highland, which is essentially free if you _can_ deal with the system, is better overall than what you’re going to get at Kaiser and Alta Bates, your likely East Bay region mainstream U.S. health-insurance alternatives.

            [4] I know doctors and nurses inside both Kaiser and Alta Bates, and it’s not primarily the caregivers’ fault. The health-insurance system creates healthcare dysfunction.

            In one instance, a friend of mine and her husband have mainstream health-insurance that costs over $3,300 a month. Between her husband’s Silicon Valley employer-paid policy and her own situation, she has access to both the Kaiser and Alta Bates systems.

            Nevertheless, she had an open lesion at an ankle for eighteen months that she had to bandage, since doctors in neither system would undertake an operation. On a business trip to Germany, however, she went to a German hospital for something else and the examining doctor saw the wound in her leg, then said, “We need to fix that.” And they did.

            Here, specifically, my friend required a slightly tricky operation with a slightly risky outcome; the U.S. health-industry saw her as a potential lawsuit if the operation went wrong. Yet it wasn’t so tricky that the German hospital didn’t go in immediately and fix it.

            Think about that. The U.S. health-insurance system doesn’t just deny care to those who can’t pay, but denies the necessary care to someone to enable them not to walk around with an open lesion in their leg — even though that person has an expensive policy.

            [5] With the U.S. system, there’s also the dominance of big pharma. When my mother died of cancer a couple of years back and was in the Kaiser system in the U.S., for pain she had to be given vicodine, which had side-effects that made her sick so she had to be given another drug — which then had side-effects that required more medication. Conversely, my father under the NHS in the U.K. received morphine post-surgery and there were no problems.

            This profitable set-up for the drug companies is possible because that industry was able to buy U.S. legislation to ban morphine for its addictive properties, thus making all these cocktails of drugs commercially viable. Note, too, that vicodine turns out to be quite addictive; my nurse acquaintances are quite disturbed by the problems they’re seeing on that front.

            [6] All the above just bears out in gruesome detail exactly what the figures tell you, for all that it’s only anecdotal data. The U.S. enjoys by far the worst care of anywhere in the northern developed West and pays twice as much.

            “The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations”

            1. bluntobj

              The thing about anecdotes is that when you have enough of them they look suspiciously like data….

          7. Nathanael

            “All I can say is that I’ve spent 46 of my 57 years in a system of single payor health care (mostly Canada and the UK) and it just isn’t the great deal that you all make it out to be.”

            Yes, actually, it is, and you’re an idiot. You’ve never spent enough time in the US to realize that the Canadian system is like *manna from heaven* in comparison.

            The MEXICAN system is better than the US “system”. The THAI system is better than the US “system”. Maybe you’ll begin to get the picture eventually?

      2. from Mexico

        What is this, my anecdotal experiences are better than your anecdotal experiences day on Naked Capitalism? And I gotta give it to you Free Market fundamentalists, when it comes to spin, you’re the best!

        But there are objective measures available.

        According to the OECD, for instance, in 2010 the US spent $8233 per capita on healthcare. That compares to $4445 for Canada and $3433 for the UK.


        Do Americans get something for all that money spent? Well, no.

        According to the World Health Organization study conducted in 2000, which employed a number of measurable performance indicators to compare quality of healtcare of 191 countries, the US ranks 38th. The UK ranks 18th, and Canada 30th.


        So America’s privatized healthcare system is terribly inefficient. When it comes to bang for the buck, it doesn’t get any worse, and by a wide margin.

        1. Mark P.

          Exactly. And when you find both From Mexico and my neocon self — as he once called me — agreeing that this is a dysfunctional and even outright evil system, it’s probably both those things.

          1. from Mexico

            Well I come from a whole line of hardheads, German Lutheran stock on my father’s side. As Eric Hoffer reminded us, “Perhaps people throw themselves into heated polemics to give content to their lives, to warm their hearts. What Luther said of hatred is true of all quarelling. There is nothing like a feud to make life seem full and interesting.”

      3. Walter

        It gets annoying hearing your arguments. I am an immigrant to the U.S. from a third world country, and as much as I love the U.S. I still got better health care service in my country of origin. A third world country provided me better services than the U.S.
        yes, hospitals were not as fancy as they are in the U.S. and yes, if I had been born a millionaire services would have been better in the U.S.
        So, if a third world country can outperform the U.S. then I can only expect Canada and Europe to do much, much, much, better. So, maybe you are a Canadian who just hates the sight of other people and prefer the social Darwinist system we have here in the U.S.
        Get a life.

        1. Nathanael

          Which country did you come from? If it welcomes immigrants and is not going to be destroyed by global warming, maybe I’ll move there.

          (Too many are going to be destroyed by global warming.)

      4. Nathanael

        ” Occasionally, in the most serious cases, the system works as described, but the vast majority of people who interact with the health care system have a somewhat different experience. There are endless delays, filthy hospitals and unavailable drugs.”

        There are endless delays in the US. Even for people with “gold-plated” insurance. There are unavailable drugs. I’ve dealt with this roughly twice a year, minimum. There are filthy hospitals.

        You have an insane, rosy vision of US healthcare which has nothing to do with reality.

        When we had a routine problem in Canada, we saw a doctor within *5 minutes*. In the US, that would have taken *TWO WEEKS*, minimum. That’s just a delay example for you.

  6. barkingtribe

    Yves, I won’t dismember the details of how we got here, but these are the results. I work for small tech company in GA. 30 people. Employer provided insurance. Grandfathered BCBS, yet rates are going up 70%. 70%. I want to say this again, 70%. We did the math. That’s over $100K to the employer annually. What the idiots did was force us to hire one additional HCE that does nothing but look out the window all day.

    1. scott


      You’re the exact demographic the ACA was designed to destroy, people like you and the self-employed entrepeneurs. There are large corporations with lobbyists to protect.

      You didn’t build that, you know.

  7. s spade

    $490 per month and it doesn’t cover anything? That isn’t insurance, it’s extortion. The probability that two people under age 65 will incur more than $12,500 in medical costs in a single year has to be less than one percent. I did not incur $12,500 in the forty-four years between ages 21 and 65, and I had three episodes of DVT as well as chronic back pain that lasted twenty years.

    1. Spring Texan

      You say “The probability that two people under age 65 will incur more than $12,500 in medical costs in a single year has to be less than one percent. I did not incur $12,500 in the forty-four years between ages 21 and 65, and I had three episodes of DVT as well as chronic back pain that lasted twenty years.”

      Well, according to the Guide to Federal Health Plans, the chances of a family of two that are “persons under 55” incurring high medical costs ($30,000 or more) is 8%. For “annuitants age 55 to 64”, it is 17% — much higher than you estimate. For a single insured person under 55, they say the chances of incurring high costs are 3%.

      In other words, for whatever reason including escalating medical costs, there is MUCH more chance of high medical bills than you think for two people under age 65, somewhere between 8-17%.

      1. Spring Texan

        Actually, if we reduced their breakpoint for “high medical costs’ — $30,000 — to yours — $12,000 — I am then sure the percentage would go up quite a bit more.

      2. Michael

        If the probability is 8% for one person then I’m pretty sure the probability for two is 8% squared, or .64%, which is low enough that the “two or more people” clauses seems to be more of a gimmick to justify higher deductibles for people with families.

        1. Yves Smith Post author

          You are correct. Most people don’t know how to calculate joint probabilities. Lordie.

          Although we still don’t have the right data. The issue is not “odds of two people incurring X” since X could come about via either one person having a bill of over $30K or two together having bills that push them over $30K (remember we are discussing that a policy has both an individual AND a family deductible).

          So what you would need is: odds in a SINGLE year that a SINGLE person under 65 incurs costs of over the relevant deductible. You square that.

        2. Nathanael

          I ran my spreadsheet, and there is an ENORMOUS marriage penalty on every single choice you make — the lowest I could get it down to was about $6000.

          Nobody on the individual market should be married, unfortunately.

  8. Banger

    I am surprised at what has emerged about Obamacare. I genuinely thought that the ACA would result in increased access for those who are health-care insecure and would be marginally better than the current system. But, I’m beginning to think it is a net-negative due to the information I’ve been reading here at NC.

    The take-away here for all of us is that maybe the RP may be worth listening to–maybe a little humble pie is in order.

    1. mk

      if the rp you are referring to is republican party, they are not in favor of single payer universal medicare for all health care, they are against anything obama is for. see the difference?

      1. Banger

        Yes I mean the Republican Party. And, of course, they do not favor single-payer or any other rational solution–but that is mainly the fault of the American mainstream media which refuses to present alternative solutions or even advocate for a round wheel over a square one. The RP just reflects the deliberately programmed ignorance of its constituents.

        My point is that we ought to be humble in listening to critiques–if they fit we should listen and not automatically dismiss each and every criticism that the RP gives to DP policies which seem to be as corrupt as the RP’s policies are mean-spirited.

        1. craazyboy

          You just need to know how to talk to Republicans. You tell them we should invade Canada to get control of the Tar Sands, which God intended to be ours anyway, then once we have control of Canada, we’ll find out they have the only health care program anyone can sign up for.

        2. hoops

          You forget that the ACA is a Republican designed plan for a “Free Market” approach to health insurance. The feckless Obama thought the RP would support this plan because it was originally written by the Heritage Foundation and Insurance company lobbyists. So what if the RP have some criticisms of the plan, their disingenuousness knows no bounds.

          It has always been a loser politically and so Obama continues his destruction of the left.

        3. Lambert Strether

          The RP is useless and delusional because it’s a legacy party. Don’t listen to them. (Even as a party they’re pathetic, to somebody who remembers how feral and focused the Republicans were in the 90s. To bad ends, mind you, but for awhile they were the Wehrmacht of political parties.)

          There are, however, honest conservative sites that have a clear point of view and don’t make shit up. I check out CCH Freedom, for example, even if I couldn’t disagree with them more on policy.

          For a lot of Republican/conservative sites, you want to handle their toxic material with a Waldo:

          So your media critique has to be strong. Of course, that goes for Democrats and career “progressives” as well; they are, after all, responsible for passing this turkey.

        4. Legendary Bigfoot

          Fallacy of composition. Obamacare IS the Republican Party plan for decades now and has all the shortcomings of Republican programs-corporate welfare, graft, blizzardy propaganda program designed to make you wilt before critically evaluating the rubber meets the road impacts. Obama being slightly better than McCain/Palin and Romney/Ryan is a trap-the programs are the same and they serve the same masters.

        5. Nathanael

          Unfortunately, Banger, the Republican Party criticisms of Obamacare have been (a) mostly wrong, and (b) not remotely consistent. They just make shit up and throw it at the wall.

          You want to listen to people outside the Republican Party. It’s actually worth listening to the Libertarians, even though they have some things very wrong, becuase at least they have a consistent and thought-out viewpoint and it’s possible to have an argument with them. It’s worth listening to Greens. It’s worth listening to all manner of Independents and Third Party types, actually.

  9. DakotabornKansan

    Alan Bavley and Diane Stafford of The Kansas City Star warn area residents that the best bargains offered by the two insurance companies in our region on the new exchange federal marketplace might not include all the hospitals, including the physicians, they are familiar with:

    “Blue Cross and Blue Shield of Kansas City, the area’s largest health insurer, is offering versions of many of its plans with just seven hospitals in their networks, rather than the 19 hospitals Blue Cross plans typically cover…

    The low-cost plans do include academic medical centers… as well as about 2,000 doctors in a multitude of specialties… But absent from the networks of these cheaper plans are the St. Luke’s Hospital system… as well as hospitals owned by HCA Midwest.

    Coventry is the only other company selling health insurance for Kansas City area residents on the federal marketplace. The St. Luke’s system is missing from its plans, but most other area hospitals are included.

    In a statement to The Star, St. Luke’s explained its reason for not participating in narrow network plans for this area: “We believe the rates currently offered for new products by (Blue Cross and Coventry) are insufficient and would ultimately result in sacrificing the quality for which St. Luke’s is known.”


    For Kansas City area residents, this is the trade-off between cheaper premiums for bronze and silver plans and the “narrow networks” (limited provider choices) these plans offer. Low premiums will come with a price. Their plan may not include the hospital or physicians required for their special medical needs. Forced to go out-of-network for care, they will pay a lot more than they bargained for when they signed up cheaper for bronze or silver plans.

    As Columbia Journalism Review’s Trudy Lieberman recently pointed out, “One point often missed in the limited coverage of the narrow network issue is that narrow networks have been tried before, when HMOs became dominant in the 1990s. Back to the future, perhaps?”

    “F***king HMO bastard piece of shit,” Helen Hunt’s characterization of HMOs in “As Good As It Gets”


    “This question is at the heart of the price/benefit calculus—how good will insurance policies be, and is the price reasonable for the coverage? Reporters in other states ought to explain how this issue is playing out in their backyards, too.” – Trudy Lieberman,


  10. middle seaman

    ACA manifests the long known and aptly demonstrated incompetence of the Obama administration. One looks at the silver and bronze plans wondering what the heck were they think when those plans were hatched. These plans are downright terrible. It appears that the designers of ACA thought that health coverage for the uninsured is the only goal of the law. They couldn’t care less if that coverage leaves the former uninsured as uncovered as before.
    One has difficulty ignoring the fact that the ACA seems designed to strengthen the health insurance companies. The talk about controlling health care cost appears to be an underhanded message while actually increasing health care cost.

    1. Cynthia

      Our President’s goal for healthcare reform is to “bend the cost curve,” an uninspiring and near meaningless goal. The US healthcare industry will exceed $3 trillion (20% of GDP) this year. Numerous studies have acknowledged that less than half of that amount is actual healthcare. In fact, most studies agree there is at least $1 trillion in waste, inefficiency and fraud – why isn’t that the target? Nothing in the ACA does anything to eliminate that waste and inefficiency. Nothing.

    2. Lambert Strether

      They are not “incompetent. They are highly competent at what they care about, which is guaranteeing rental streams to rentiers. They are also competent at reducing life expectacy which, like permanently high disemployment, is an unstated but obvious goal of our elites.

      1. Nathanael

        This makes them deeply incompetent in a larger sense. Idiots savants, if you will.

        People with shorter life expectancy are more willing to do very risky things.

        They are creating a huge group of people with nothing to lose, who are willing to take large risks, who hate them with an abiding passion for their thieving and abusive ways. What could possibly go wrong?

  11. DakotabornKansan

    Alan Bavley and Diane Stafford of The Kansas City Star warn area residents that the best bargains offered by the two insurance companies in our region on the new exchange federal marketplace might not include all the hospitals including the physicians they are familiar with:

    “Blue Cross and Blue Shield of Kansas City, the area’s largest health insurer, is offering versions of many of its plans with just seven hospitals in their networks, rather than the 19 hospitals Blue Cross plans typically cover…

    The low-cost plans do include academic medical centers… as well as about 2,000 doctors in a multitude of specialties… But absent from the networks of these cheaper plans are the St. Luke’s Hospital system… as well as hospitals owned by HCA Midwest.

    Coventry is the only other company selling health insurance for Kansas City area residents on the federal marketplace. The St. Luke’s system is missing from its plans, but most other area hospitals are included.

    In a statement to The Star, St. Luke’s explained its reason for not participating in narrow network plans for this area: “We believe the rates currently offered for new products by (Blue Cross and Coventry) are insufficient and would ultimately result in sacrificing the quality for which St. Luke’s is known.”


    For Kansas City area residents, this is the trade-off between cheaper premiums for bronze and silver plans and the “narrow networks” (limited provider choices) these plans offer. Low premiums will come with a price. Their plan may not include the hospital or physicians required for their special medical needs. Forced to go out-of-network for care, they will pay a lot more than they bargained for when they signed up cheaper for bronze or silver plans.

    As Columbia Journalism Review’s Trudy Lieberman recently pointed out, “One point often missed in the limited coverage of the narrow network issue is that narrow networks have been tried before, when HMOs became dominant in the 1990s. Back to the future, perhaps?”

    Helen Hunt’s characterization of HMOs in “As Good As It Gets,”


    “This question is at the heart of the price/benefit calculus—how good will insurance policies be, and is the price reasonable for the coverage? Reporters in other states ought to explain how this issue is playing out in their backyards, too.” – Trudy Lieberman,


  12. lakecabs

    I want to reiterate a point in your article.

    Why wouldn’t you copy esurance format?

    Why not pay them to copy site?

    My insurance came due on Oct. 15.

    I received a notice that my insurance was going up.

    I tried to get on ACA site could not.

    I have always used esurance and found a better plan for a cheaper rate.

    It is not an ACA plan.

  13. TomDority

    Healthcare should be part of our national infrastructure like, say, the highway system, electrical grid, telephone, moon landing, schools, libraries, bridges etc. and not be defunded so that private interests can extract their vig.

    As quoted below from a previous article in NC.

    “As Simon Patten, the first economics professor at the nation’s first business school (the Wharton School) explained, public infrastructure investment is a “fourth factor of production.” It takes its return not in the form of profits, but in the degree to which it lowers the economy’s cost of doing business and living. Public investment does not need to generate profits or pay high salaries, bonuses and stock options, or operate via offshore banking centers.”

  14. ambrit

    Anet the RP comment above; We may have been premature in ridiculing the Tea Party folks for waving their signs that said: “Hands off my Medicare.” One way or another, they hit the bulls eye. That, and Social Security are precisely the programs this exercise in monopolistic, no, make that oligopolistic rent extraction are designed to engulf and dissolve. If we can’t make common cause with those folks, at least we can cheer them on as they splinter the old line Republican Party. Next up, where’s the Democratic Parties Coffee Cabal?

    1. Banger

      This is all very sad–the Obama con was a stunning success. We have a broken left that is spinning in circles in its own grave a mad-right and a center that is running for the exits. And here I am thinking that maybe the Republicans have the right idea about stopping Obamacare.

      1. Gerard Pierce

        The Republicans may be right in one key area. If Obamacare is actually implemented it may be impossible to get rid of it.

        Apparently any law which cuts out the insurers could be interpreted as a “taking” inder the Fifth Amendment. This means that you can’t get rid of them without paying their anticipated profits.

        This kind of insantity should not be possible, but apparently some similar rulings have already been made by our Extreme Court.

          1. The Black Swan

            I think this is the ultimate goal. Make it impossible to get health insurance through the Federal exchange, then the insurance companies can sue the US gov for loss of profits. These new ‘trade’ agreements are going to be nightmares.

          2. Lambert Strether

            Ah. So that would explain why health insurance in 2009. Have to get the anticipated profits in place first, before the TPP locks them in place forever (see Forever, Boot Stamping on Human Face for). Check.

            Thanks for the nasty twist of thought.

          3. Nathanael

            They imagine that a law which is not respected can be enforced.

            Idiots. Haven’t they paid attention to the history of the drug war? Or, before that, Prohibition? Oh, right, I guess they haven’t….

  15. Ramon Creager

    The only way the ACA could have been considered a stepping stone to single payer would have been via the public option (RIP), or via lowering the minimum Medicare age. Both were explicitly deep-sixed. Therefore I can’t understand any arguments that the ACA is a stepping stone. To where? I don’t see the mechanism, unless it is by pissing everybody off.

    Further, the ACA seems to have gone out of its way to penalize employers and unions who already offered humane plans (so-called Cadillac plans). Apparently we all are headed to Universal Mediocrity (‘cept the beautiful ppl, of course). My employer has already downgraded my plan.

    We need to take a few steps back and contemplate our reality. How is it that our government *consistently* forces things upon us that the majority of us do not want? Wars; austerity; Wall Street bailouts; broad and universally invasive surveillance; TPP/TTIP/ACTA/SOPA/etc. etc. Like an alcoholic whose first step must be to recognize that he has a problem, we must acknowlege we no longer live in a free and representative democracy. Only then can we start winning back our rights.

    1. Yves Smith Post author

      I think one problem is the left critics of ACA and the ones involved in the debate at the time, is that once “single payer” was nixed as an option (recall that was shut out of the debate entirely), they didn’t have a fallback plan besides going with the Obama straw man “public option”. Even now, the response is “single payer”.

      A lot of countries with better health care than here have mixed public/private health insurance schemes. The Administration was going to be very loath to include any universal health care program as a budgetary item because it makes total spending look so large. That’s the reason Fannie and Freddie were made into weird public/private entities, to get them off the Federal balance sheet. It really was an accounting issue back in the Johnson administration.

      You also have the issue that it would have been really hard to take the health insurance industry out and shoot it.

      So my solution would have been to have the government take over catastrophic care and make that universal. Eliminate the FICA cap, maybe add a transaction tax to fund it. Anyone who has medical bills over X a year has them covered by the government. That also allows the Federal government to crack down on hospitals, which have gotten to be in the price gouging business.

      On the other end of the spectrum, you let some income groups just above the current Medicaid cutoff buy coverage at subsidized rates. Insurers generally don’t want them anyhow, low income people tend to be less healthy.

      You leave the insurers to sell policies for pharmacy, routine dental, and routine medical care for middle and upper income people.

      1. Jane Doe

        1. The system you describe when looking abroad is still more expensive than single payer, but at least you are looking toward a path way to (a) single payer and (b) actually bending the cost, which ACA does not do.

        2. That being said I don’t think it would have had any chance of passing because the Administration wanted the support of all stake holders, including big insurance, pharma and hospitals. Remember, that drug re-importation had bipartisan support and would have reduced drug costs, and the president killed the bill by twisting arms. After the passage of ACA, he has killed attempts to pass the bill as well.



        The people who hated it are the following:


        1. Yves Smith Post author

          Oh, agreed 100%, Obama would have needed to break china, which he’s not willing to do. But the Obama we were sold, as opposed to the one we actually got, could have done this in his first 100 days. Everyone forgets how desperate the country was. This was a historical window of opportunity that he forcibly closed.

          1. Jane Doe

            I’ve been following universal health care for a very long time.

            In the early to mid 2000s (before we had even considered a “President Obama”), the insurance companies were aware that polling data was saying that universal health care was inevitable.

            It wasn’t Wall Street that made reform possible. It was always going to happen anyway.

            The only real question for the insurance industry considering (1) it was losing its customer base to an aging population and (2) it knew universal health care was inevitable was how to manipulate the bill.

            Enter Liz Fowler and Senator Max Baucus who had written the plan for President Obama.

            In classic Orwellian twist, they redefined universal health care as universal health insurance coverage. I remember this being debated as far back as 2006 on Ezra Klein old blog.

            In short, my point is there was never a chance that Obama or anyone else was going to change anything unless he was willing to break the back of some of the stake holders. There was no other way.

            The minute he decided to have only them at the table, this debate was over. Even the candidate obama given the way he thought would have failed.

          2. Banger

            I ended up voting for Obama, reluctantly. I did not believe in him since I actually listened to him one day on the Charley Rose show after which I told others that never before had any man I’ve heard said so little so well (and I’ve been a round a lot of BS). The guy was clearly gifted. I ended up voting for him because both daughters (the sons didn’t really care that much) were so excited about him as a candidate that I would have felt like I had stepped on and crushed a kitten had I not voted for him. I was touched, in short, by the enthusiasm the young had.

            As cynical as I am, even I was shocked at his first 100 days and all that followed including ACA. These young people who supported him are, in the end, the real victims of his administration.

            1. Nathanael

              I reluctantly voted for him the first time. My vote was reluctant becuase Obama’s a goddamned treasonous fascist liar, as we found out when he voted for the “FISA Amendments Act” and lied about what was in it.

              I voted for Obama that time because McCain was joking about bombing Iran, which is not merely goddamned treasonous fascism, it’s dangerously insane — and McCain seemed to have a chance.

              In 2012, Obama and Romney were peas in a pod (Obamacare == Romneycare, done worse) so I voted for Jill Stein.

          3. EMichael

            You do understand that, even if you count Lieberman as a Democrat(which is kind of silly), that the Dems did not have a super majority in Obama’s first 100 days?

          4. Nathanael

            ” Everyone forgets how desperate the country was. This was a historical window of opportunity that he forcibly closed.”

            This is the same thing he did with Wall Street.

            Obama has done very, very bad things — and I don’t mean just evil, I mean *stupid*. We’re going to come ’round to another crash like 2008, but this time people will be *even more pissed*, and they’ll be looking for *anyone* who will promise to kill the Wall Street greedheads.

            Who knows who we’ll get — our own version of Golden Dawn, maybe? Obama made this likely. That was STUPID EVIL.

      2. Lambert Strether

        Well, if single payer advocacy is what it takes to pull the Overton Window left so the possibility of same humane policy emerges, so be it. Perhaps we all should have gone for NHS, and single payer would end up as the policy.

        Advantages of single payer from the purely rhetorical standpoint

        1) Simple to understand

        2) Simple to implement

        3) Known to work and requiring no international experience (Medicare; Canada)

        4) Polls well

        1. Jane Doe

          If you truly want to go for simple, it should be called Medicare for All

          Everyone knows what that is

          The lesson from the public option is any time you do a name change, it leads to confusion

          Never underestimate the ignorance of the public

        2. Banger

          Yet, the left, bamboozled by the slickest con game in American history (the 2008 Obama campaign) has stridently supported a Heritage Foundation program as good public policy. The more the right attacks it the more the left supports simply because the right opposes it. This is where we are, Lambert, this is what the American left is all about: utter and abject stupidity.

          Again, a mere examination of the facts would have persuaded most Americans to adopt some model, if not single payer then the German, French, Swiss or whatever model. The fact that a rational argument NEVER occurred, again, thanks to the Obama “progressives” is one of the great tragedies of our time.

      3. Bridget

        How very strange. I haven’t got a lefty bone in my body and that is pretty much exactly what I would have done. I would have also tried to phase out the employer subsidy to help subsidize the expansion of Medicaid.

      4. Banger

        As I say over and over again, the main problem in 2009 is that the “debate” was not on the level of facts, science or pragmatism. All sides in the debate agreed not to seriously criticize the American medical system in comparison to others in the developed world for the usual Washington reasons.

        When I saw this happening I saw two things–the fix was in and that the result would be a disaster. When the debates online were getting intense no one on the left mentioned any other possibility (if they were opposed to the direction Obama was taking) than single-payer because, sadly they knew next to nothing about health-care around the world. And that’s the issue here. It is almost impossible to come up with good public policy in any area because both the American people and the people who create policy are ignoramuses or Machiavellian operatives who just gauge which hustle will work best (Obama’s people).

        That’s why I would like to see a re-vivified left march under the banner of reason as well as compassion (which is nothing other than admitting the scientific fact we are deeply connected with the web of life and each other).

  16. Eureka Springs

    Left of Lucifer.

    I’m not a member of any organized religion but this is my new litmus test in a three word slogan. If your idea of acceptable, affordable, better, enemy of good health care excludes anyone, any individual, then you are not Left of Lucifer and shall forever be not only barred from receiving my vote but likely to be spat upon in public or private.

    Thank Goddess I am no longer a Democrat. Not even for dog catcher! You have to be left of Lucifer for me to consider voting for you or any party.

    Left of Lucifer looks just like this:



    United States National Health Care Act or the Expanded and Improved Medicare for All Act (Introduced in House – IH)


    (a) In General- All individuals residing in the United States (including any territory of the United States) are covered under the USNHC Program entitling them to a universal, best quality standard of care.

  17. EMIchael

    “Maternity is not covered except for complications”

    There is a reason for that.

    “The cost of having a baby can really add up at the hospital. You should make sure you are well-prepared financially for this part of pregnancy, especially if you don’t have health insurance.

    The costs of childbirth can be steep. The charge for an uncomplicated cesarean section was about $15,800 in 2008. An uncomplicated vaginal birth cost about $9,600, government data show.”


    We are way too early in the process for people to claim, either way, what is the end result for the 4% of the population that purchases health insurance thorugh the private market.

    But if we are going to do anecdotes, let’s do this one also:

    There are close to one million Medicaid expansion signups right now.


    Let me know when you guys come up with another 999,999 horror stories.

    1. RalphR

      Your stats are bogus. They mean close to nothing.

      I clicked on the California and Alaska links for the hell of it.

      This isn’t “signups” which implies people have gotten coverage. The Covered CA is total account creation. That includes Obamacare + Medicaid expansion. The state portals are supposedly better, so I don’t know if the state ones are plagued with the trouble the Feds have with account creation as in some people have had to have multiple attempts at creating an account to actually get one, which has likely led ot multiple accounts actually having been created (this is confirmed by some insurers saying they’ve gotten multiple 834s from the same person).


      1. Total almost assuredly includes double or even some higher X counting

      2. This is only account creation!!! Who are you trying to kid? You have no idea what the convesion rate is to actual completed applications. Many people will shop and like Olenick, decide to opt out in some way (which in many cases will include paying a penalty rather than leaving the US).

      You Obots are pathetic as well as dishonest. Hope you are at least well paid for your service.

        1. RalphR

          Are you stupid or merely dishonest?

          Go click through on the links. The stats you provided aren’t for expaneded Medicaid but total Obamacare account creation in CA.

          I’m not doing your work, but the burden is on you to understand what you link to and present it accurately. You aren’t.

          1. EMichael

            You should read posts that you reply to.

            I clearly stated “it was too early” to determine what is happening in the private market. Then I mentioned the number of people who have signed up for the Medicaid expansion under the ACA, and linked to a site where those numbers are accumulated.

            Now, if you want to dispute those numbers, fell free. They are readily available in many places, like:


            Humorous that a man that thinks people are going to “shop Medicaid”, or simply cannot read, calls me names.

    2. AbyNormal

      your propaganda wheels have wobbled off your coach

      from Sebelius’ testimony, part 2 (YESTERDAY)

      “Enrollment numbers *coming out next week* will show how many people signed up on the insurance exchanges during Obamacare’s first month. “We certainly will have a state breakdown,” Sebelius said. “We certainly will have a differentiation between private coverage and Medicaid coverage. We intend to give you as much information as we can validate.”

      1. Nathanael

        As of January 1, Medicaid coverage is WAY better than private coverage in New York State.

        It’s a bit of a change from previous decades.

  18. elboku

    I see his costs but not his income; so I have no idea if he can afford it. I can cite anecdotes about people left crying with HAPPINESS after finding out they finally were able to get insurance after a lifetime of none. So what does that mean? Nothing. As Carroll writes: “To be honest, I simply don’t pay attention to the stories. It’s ridiculous that so many seem to be false, but I have no doubt that some of them are true. I completely accept the notion that some individuals will immediately fare worse under the ACA than they did before.

    What’s important to me is how we see the system work at a population level. That will require data, and none will be available for some time. When it is, you can be sure that I will respond.”

    1. RalphR

      Another bogus talking point demand.

      The Administration will eventually provide data on Obamacare enrollment. If nothing else, Congress will demand it.

      However, you are never going to have good data on how many people were hurt. The Obama Administration has no interest in collectintg that. And it would be extremely hard to do that regardless, since the only route would be large-scale surveys, which are costly. The “made worse off” population falls in all sorts of categories. Here are some big ones: people who lose coverage and the plan they get in place is more costly and not demonstrably better (or as Olenick shows, worse); people who lose coverage and can’t afford Obamacare plans; people who lose access to specialists who are essential to them due to the “narrow network” problem, people who don’t lose coverage but get hit with huge increases (see stories in this thread alone).

    2. Jane Doe

      Let’s do a more meaningful analysis

      The mean income is around I believe 45 k. Let say you make a dollar more than the subsidy.

      After taxes: 35k or disposable monthly of about 3200

      Bills to be paid with that amount

      Student loans
      Utilities (phone, electric, water, heating)
      Clothing and other incidentals (if you have a job there will be small incidentals)

      This is assuming an extremely disciplined person.

      that would mean you expect all other money to go into health care even if they did have money left over, which depending on the city (say NYC) that may not be the case.

    3. CaitlinO

      The people who will be happy about this are the seriously ill, who could’t get insurance at any price before (barring state run high risk pools) and the working poor who will qualify for insurance, perhaps for the first time, under either Medicaid expansion or with partial or full subsidies.

      But if the rates and deductibles we’re seeing are really what’s going to be available on the Federal/State exchanges, then we’ll simply be substituting a new class of uninsured for the old: Those families making too much for a subsidy but who can’t possibly afford $500 to $1200 a month for a worthless policy with thousands in deductibles.

      I can’t understand why anyone of average or better health would buy a policy like the one Mr. Olenick described or the useless POS I found for my family on ehealthinsurance. Better and much much cheaper to bump up medical on your auto policy and pay the damned tax fine. There’s at least a small chance the government will spend the fine on something socially useful while there’s absolutely no chance the blood-sucking insurance execs will.

      1. Michael Olenick

        I did some follow-up research into the Humana plans: the one’s in the article. Even at those high rates they were lower than others and I was wondering why. It turns out that they’re an old-fashioned HMO. Their network, the doctors one can see, includes seven pediatricians for my county which has a population of 1.35 million people, 20.1% (273K).

        So for $700/mo., or whatever it was, you can pay $20-50 more per month to bring your child to one of seven pediatricians serving a quarter-million kids. Or you can pay per month then $60-100 and bring your kid (or yourself) to a walk-in clinic. I think I know which option those people who can afford the steep premiums will chose, and so do the health insurance sellers.

        What we really needed were affordable options for if anybody became genuinely sick; we ended up with the opposite.

    4. bluntobj

      ” I can cite anecdotes about people left crying with HAPPINESS after finding out they finally were able to get insurance after a lifetime of none.”

      Their happiness is only made possible by their ignorance.

      And such people don’t realize that their deductible is not going to be paid by .gov, and they can expect to pony up anywhere from 12,500 to 25,000 per year.

      They may have full subsidies, but as far as I have found the subsidy is only for premiums.

      The network narrowing thing is true as well. The fire districts that provide EMS in my state will now have to tangle with ACA, and if they don’t grant a 50% haircut on their transports the insurers are now reimbursing the transportee 50% directly, and the Fire district gets to pay bill collector trying to get 100% of their fee.

      I’m looking for a cash basis doctor now. I carry insurance only on my wife for the maternity stuff, although the silver plan she’ll be enrolled in after dec. 31 has a HSA version which I think we’ll switch to. Otherwise I’ll pay the 2.5% on me and my kids.

  19. Dan Lynch

    Yves asked to hear how O-care was affecting us so here is my story: I’m self employed and most years below the poverty level (though I never know what my income will be from one day to the next.) That means I don’t qualify for subsidies.

    My state is not offering extended Medicaid and even if it did I would refuse to participate because I own a primitive cabin which the state could seize to recover my Medicaid expenses. No thanks, I’d rather die with dignity than live as a slave to the state.

    Fuck O-care. Gimme Mosler-care instead.

    1. TimR

      So does that mean you’ll have to pay a fine? What becomes of the Medicaid-eligible in states that don’t expand it? Or those who refuse to go on Medicaid?

  20. BondsOfSteel

    Hmm. Michael Olenick is going to get divorced or move out of the US because he’s forced to pay for his own healthcare.

    1. Clive

      I too am “forced to pay for my own healthcare” via UK general taxation which covers the cost of the National Health Service (NHS).

      Don’t get me wrong, the NHS is far from perfect.

      However, if I think that a political party in government isn’t managing the NHS very well, I can vote them out. I have redress. There is accountability for the money I have to hand over. Flawed accountability yes. But not “zero” accountability.

      I’m wondering what redress you think Michael (and the rest of the citizens of the US) has/have ?

      I’m a non-US resident so I’m new to all these arguments. If I’m missing something here, please do correct me.

      1. BondsOfSteel

        For the record, I’m not a huge Obamacare (ACA) fan. Just trying to get the facts right so the criticism is accurate.

        >>I’m wondering what redress you think Michael (and the rest of the citizens of the US) has/have ?

        Insurance is provided through private companies. The ACA was enacted to create a better market for these plans. The recourse is to pick a different policy from a different company. (This is not possible in a very few markets since they are small.)

        Or… his recourse is to choose none, and he’ll be fined $95 US. (Or about 26 cents per day.)

        1. Lambert Strether

          The $95 is only for the first year; after that, the fines increase. You wouldn’t be calculating that figure in cents to make a rhetorical point if you knew that, unless you’re assuming that the NC commentariat is ignorant, which is unlikely.

          So do your homework before pontificating and standing in judgment of other people’s life decisions, mkay?

          1. DakotabornKansan

            Adrianna McIntyre @ The Incidental Economist points out:

            “What people forget when they talk about the ACA penalty is that $95 is the minimum penalty for those who don’t enroll in coverage; it’s actually $95 or 1% of income, whichever is greater. Everyone above the poverty line will face a penalty in excess of that minimum—and any individual earning more than $22,000 will face a penalty that’s effectively greater than the penalty Massachusetts [which was $219] enforced in the first year.


            From healthcare.gov, The penalty in 2014 and beyond:

            The penalty in 2014 is calculated one of 2 ways. You’ll pay whichever of these amounts is higher:

            • 1% of your yearly household income. The maximum penalty is the national average yearly premium for a bronze plan.

            • $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.

            The fee increases every year. In 2015 it’s 2% of income or $325 per person. In 2016 and later years it’s 2.5% of income or $695 per person. After that it is adjusted for inflation.

            If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you’re uninsured. If you’re uninsured for less than 3 months, you don’t have a make a payment.


            1. bluntobj

              It goes further than that.

              If you refuse to pay the penalty and engineer your taxes so that you will have to pay when you file, the penalty will accrue from year to year and will bear interest. It acts exactly like any other tax penalty in Chapter 68b IRC, except that you cannot be directly impacted by seizure or arrest.

              Now, there is a central question which I have not seen addressed anywhere, and requires a tax attorney to answer:

              When you make your payment on your taxes during filing, which you have engineered so you do not receive a refund, to which balance is the tax payment applied to first? Your regular tax liability, or your Obamacare tax?

          2. BondsOfSteel

            I did know it went up to $695/year (or ~ $1.90/day). An amount I still think isn’t huge. I didn’t know about the 1% of income…. that’s huge.

            Like I mentioned I’m not a ACA fan. Personally, I think it a hodgepodge of hacks that should simply be replaced with Medicare for all. OTOH, Medicare for all is going to cost a lot more than $695/year.

            1. Lambert Strether

              May not be huge to you. It’s a tank of fuel for one month to me. Just saying.

              On Medicare for All, obviously, it’s not perfect, and the end of life care stuff is horrible — hooking people up to machines that suck money out of them until they die in horrible pain. And I’m sure there’s equally horrible stuff at the beginning of life.

              But at least it solves the “placement of function” problem society wide. We have a shot at fixing the bad stuff with single payer, exactly because it’s single payer.

        2. Waking Up

          By 2016, the minimum penalty/tax will be $695 per person and up to 3-times that per family. After 2016, these amounts will increase at the rate of inflation.

          1. brian

            You can get insurance with pre existing conditions.

            Why wouldn’t i pay 695 a year until i get ill? When i am ill i can just sign up.

            Is anything stopping this?

            1. Bridget

              As far as I can tell, the only problem would be the open enrollment dates. This year, they span the six month period from October 1 to March 31. I assume that means that if you get sick on April 1, you’d be on your own until the following October. Of course, you’d have thousands of dollars in savings due to the premiums you didn’t pay to use towards paying expenses. And under a bronze plan you’d have $12,700 deductible, I believe. So unless you get really sick, with an illness demanding immediate treatment, you’d be money ahead.

            2. Barmitt O'Bamney

              The very first thing about the law that they’ll “fix” will be the penaltax. Count on that going up to punish people for preferring food to paying off the health protection rackets. We must not let Obama down! The law bears his sainted name, after all.

              The rest of the law needs fixing in the form of a flamethrower, but that will have to wait until the remedies of more punishment for the scofflaws and more juicing of blood from a stone have run their course.

            3. CaitlinO

              That’s how I’m seeing the math, too. If the fine is only equal to one or two months’ premiums and if the deductible is so high that you’re going to pay the entire medical expense out of your pocket, anyway, just swallow hard, write a check to the doctor and cut the insurance company middleman out of the picture. This will save a family that doesn’t qualify for subsidies thousands of dollars a year so long as no one falls off a mountain or has a mole go malignant.

              Of course, this kind of logic would lead to a mass refusal by middle income families of average or better health to enter the risk pool, destroying the economic benefit of Obamacare to insurers.

              What will they come up with next?

    2. Michael

      Given the healthcare history of my family and I I’m certainly not complaining about being “forced to pay for [our] own healthcare.”

      I am complaining about being forced to pay for:
      * healthcare “costs” that are grossly inflated above international norms,
      * healthcare insurance industry overhead and profits,
      * prices set by open and entirely legal collusion between healthcare executives,
      * services I neither need nor want, nor will ever need, like inpatient drug rehab,
      * cost shifting from from the lower middle to the regular middle class in a way that avoids shifting a progressive burden to the wealthy,
      * grossly overpriced bureaucracy to support things like the half-billion nonfunctional website,

      In summary I am expressing concern about being forced to pay for very expensive items that have nothing whatsoever to do with my family’s healthcare but are bundled as one big cost as if they are all hopelessly linked together.

      As for income there are basic privacy constraints, even in this day and age, though I certainly can’t afford to pay almost $2,000 extra per month for healthcare for a family of three. Putting that into perspective the average price of a house in my county is $206,500 so on a 30-year mortgage at 5% monthly P&I is $1,108.54. Healthcare costs should not be twice that of housing costs.

      1. BondsOfSteel

        I have no argument with these complaints:

        I am complaining about being forced to pay for:
        * healthcare “costs” that are grossly inflated above international norms,
        * healthcare insurance industry overhead and profits,
        * prices set by open and entirely legal collusion between healthcare executives
        * grossly overpriced bureaucracy to support things like the half-billion nonfunctional website,

        But they have nothing to do with the subsidy’s apparent marriage penalty. Single or married they are the same.

        The other two issues you mentioned are also not effected martial status… but I do disagree:

        * cost shifting from the lower middle to the regular middle class in a way that avoids shifting a progressive burden to the wealthy,

        Actually… the Obamacare taxes are progressive. The majority of the taxes to fund the ACA are higher medicare taxes on people over $250,000 and taxes on “Cadillac” insurance policies.

        The lower middle class is getting _subsidies_ for private insurance. Their cost are not being shifted to the regular middle class through private insurance premiums.


        * services I neither need nor want, nor will ever need, like inpatient drug rehab,

        This is kinda the whole point of insurance; Coverage for things you think you’ll never need. Nobody thinks they’ll become a drug addict, yet people do.

        If everyone knew if they were going to get say cancer, insuring against it wouldn’t make sense. Only the people who would get cancer would need to pay. This is like Insurance 101.

        1. Lambert Strether

          “If everyone knew if they were going to get say cancer to need heath care, insuring against it wouldn’t make sense.” Fixed it for ya.

          So, no, it makes no sense, and we have an industry that exists 100% for the purpose of rental extraction and serves no public purpose whatever, which the legacy parties have made the lynch pin of health care delivery.

          1. BondsOfSteel

            So… you’re against insurance in general?

            You must know some people will need millions and some almost none. Insurance isn’t a bad idea. (IMHO, public insurance like Social Security Disability and Medicare is better…. but it’s still insurance.)

            1. Lambert Strether

              I’m for social insurance. If we look at the evidence of how private health insurance is doing the job, it’s terrible. Kills lot of people and is very expensive. So if public purpose is the metric, private health insurance deserves to be mothballed. If private profit is the motive, it doesn’t, but then the argument is that the profit to a very few is worth the excess deaths to the many. Of course, the people who really do believe that have insurance in the form of, oh, a militarized police force….

        2. Yves Smith Post author

          Can you not get it through your head that grossly overpriced insurance is a bad product? Did you miss that his insurance will cost 2x the cost of a mortgage for a typical house in his area? This means he’s devoting undue money to a lousy ripoff product that has to come out of other household expenses or saving for emergencies, college expenses, and retirement.

          Or do you simply favor impoverishing the middle class? That seems to be your position.

          1. BondsOfSteel

            Is it grossly overpriced? It shouldn’t be. ACA as you know requires 85% of the premiums spent on healthcare.

            Yes, it’s expensive… but that’s because insurance companies must now take in people with pre-existing conditions. Plus, they aren’t allowed to drop you when you get sick, which they did a lot.

            Personally, I’m a fan of Medicare for All. But let’s not kid ourselves… it’s going to be expensive too. Better critiques of Obamacare would be:

            1) It doesn’t cover everyone.
            2) The premiums are essentially a tax and are not progressive enough.
            3) Employer and individual pools should be merged. Too much pre-existing cost is being put on the individual pools.
            4) There is not enough in ACA to bend the cost curve.
            5) The rules are too complex and add costs.

            1. Nathanael

              Administrative costs would drop massively under Medicare for All. Cutting prices by roughly 30% on day one.

              So yeah, it would be a lot cheaper. Don’t kid yourself.

              1. Lambert Strether

                If we had passed single payer in 2010, and it took a year to implement, we would have saved the country a trillion dollars by now. Pretty soon, you’re talking real money.

        3. bluntobj

          Not to mention that the premiums will increase by 12-15% per year. That’s not hyperbole, that’s an actual calculation of the premium precentage increases that are allowed for insurers under ACA.

          Not to mention that with that rate of growth ALL municipal and special purpose district health plans will quality for “Cadillac” tax within 3 years. That’s why the “Union Exemption” is being pushed so hard. Any union member that works for a government entity will see their collective bargainning leverage kicked out from under them as these costs soar and destroy public budgets.

          Not to mention that voters will be in no mood to fund tax increases, bonds, or Levy Lid lifts for any government after Obamacare extracts its pound of flesh.

        4. JTFaraday

          “cost shifting from from the lower middle to the regular middle class in a way that avoids shifting a progressive burden to the wealthy”

          As someone who finds social welfare policy culturally fascinating, I noticed this point too and immediately thought, well, the “regular middle class” should be better positioned to defend itself than the “lower middle middle class.

          The question then becomes, will this “regular middle class” attempt to punch above its weight class like proper social reformers or will it kick down like it usually does?

          I certainly think this “regular middle class” has a legitimate complaint– as do those qualifying for subsidies because their subsidies are buying the same crap– but what will the “regular middle class” decide they should do about it is the question.

          Perhaps this is similar to how surprised I am that the upper middle class laid down for a crooked finance and real estate sector despite the fact that disorder in financial markets and property law directly threatens the interests of those who actually have some assets to lose.

  21. LillithMc

    The key to any kind of health care reform is getting younger healthier people into the system. Being uninsured and using the emergency room may be possible for them, but it is expensive for tax payers. In states where they set up the exchange, some also worked for competition between the insurance systems to lower prices. We will not know until March where we are either with numbers of the needed younger people who will probably sign-up at the last minute or overall enrollment. Meanwhile we have in states like Kentucky many insured who have never had health insurance. Olenick may be in a tight place, but he is still paying double the price for health care compared to the rest of the world due to the inflated US system. Other countries regulate. We regulate costs within medicare which is why many Doctors refuse to accept medicare patients. That may be where we need to go, but without the ACA considering the disinformation being pumped out today, the health care cartel would have continued their profit-taking and ignoring millions of sick Americans. Time for change and it will be a long painful process. So is dying without access to health care or going bankrupt because of illness.

    1. Lambert Strether

      No. The key to any kind of health care reform is treating health care as a public good and funding it through taxes (ideally progressing approaching confiscatory, but that’s another story).

      So instead of asking citizens to pay for each other, you ask for the young to pay for the old; in other words, you force the government, which I grant on some other planet not ours should act for public purpose, to adopt a private actuarial model.)

      First, you’re wrong even in your own terms. It’s the healthy who pay for the unhealthy. Granted, most of the young are healthy, but youth is only a proxy for health, not health itself.

      Second, whether by accident or design, you’re reinforcing the debunked but powerful intergenerational inequity talking point propagated by billionaire sociopaths — sorry for the redundancy — like Pete Peterson to further enhance the rental extraction opportunities for their class, e.g. by privatizing retirement funding.

      Third, the moral or ethical justification for the not-yet-old paying for the no-longer-young is akin to Confucian filial piety (and indeed, I didn’t mind “paying for” my mother’s retirement as well as my own under the Reagan/O’Neill deal)/

      If so, granting filial piety as a value, (a) why should the youth support age by handing the insurance companies 30 cents on every health care dollar and (b) doesn’t that make taxation a far better mechanism?

      If we had passed single payer in 2009, and given a year’s implementation, we would have saved the country a trillion dollars. In just two years. I’d have put that toward a debt jubilee for student loans, but YMMV.

      1. LillithMc

        No one who worked for health care reform wanted the ACA. The House bill had a “public option” that would have led to “medicare for all” removed by the health care industry courtesy of Senator Baucus. There is no country with universal health care that lets the user cherry pick to either be part of or not part of the system other than the US “free to die” system that is designed for maximum profit. People can stay on their parents health care until age 26. Then they need to make some decisions. For low income 26 year olds policies can be $50/mo with subsidies. Is it more important to fund a new aircraft carrier or prevent millions from going uninsured without access to affordable health care?

        1. Waking Up

          “Is it more important to fund a new aircraft carrier or prevent millions from going uninsured without access to affordable health care?”

          Actually, your question should be, “Is it more important to fund a new aircraft carrier or subsidize the health insurance companies with taxpayer funding?”

      2. Calgacus

        No. The key to any kind of health care reform is treating health care as a public good and funding it through taxes (ideally progressing approaching confiscatory, but that’s another story).

        Yes to the first, NO, NO NO to the second. Government spending IS. NOT. FUNDED. by taxes. MMT really, really, really is true. And everybody used to understand this. The key is to treat health care as a public good and fund it by printing boatloads of money, just the same way we fund the military and the military-industrial complex.

        If we had passed single payer in 2009, and given a year’s implementation, we would have saved the country a trillion dollars.

        Yes, and if that is all we did, that “saving” would be a catastrophe that would have caused a Great Depression. One cannot neglect the major benefits to the USA of having the world’s least efficient, most wasteful and craziest health care system, as everybody here does. The only one who gets this right is James Galbraith. See his Predator State. (Based on his Keynesian devolution, soft budget constraint paper)

        Without full employment, government waste is productive and efficient and government “efficiency” creates far larger waste in the economy. The European systems are too efficient for their own good. Single payer would have saved so much money, so many resources by not directing vast quantities toward the hole-digging of the medical-industrial complex, by suddenly terminating a vast make-work enterprise that we would have had galloping deflation and depression without major new spending or tax cuts. The problem is not where the government will get the money for national health care, but the opposite, of how it can spend, and if need be, “squander” enough on health care and other things so that people can save and pay taxes – and consume enough to pay for their and others’ jobs.

        1. jonboinAR

          Wouldn’t this supposed deflation have been ameliorated quite a bit by the public having a bunch more in their pockets to spend, or would you argue that much of that would have leaked overseas?

        2. from Mexico

          Calgacus says:

          Yes to the first, NO, NO NO to the second. Government spending IS. NOT. FUNDED. by taxes. MMT really, really, really is true. And everybody used to understand this. The key is to treat health care as a public good and fund it by printing boatloads of money, just the same way we fund the military and the military-industrial complex.

          Your version of MMT is what I call Nixonian MMT, or Nixonian Keynesianism, Keynesianism being the progenitor of MMT. It is the lobotomized version of MMT, the supply-side tax-cut theology which Nixon ushered in 1970 when he declared “we’re all Keynesians now.”

          But I don’t think your rendition of MMT squares with that of L. Randall Wray. Here, for instance, is what Wray wrote in Understanding Modern Money: The Key to Full Employment and Price Stability:

          When readers first encounter this argument, they typically believe I am calling for full-tilt operation of the ‘printing presses’, to finance all the government’s spending by ‘printing money’, which is believed to be a surefire path to hyperinflation. And indeed it would be. My point is that, in reality, all government spending is ‘financed’ by ‘money creation’, but this money is accepted because there is an enforced tax liability that is, by design, burdensome. Without that onerous tax liability, the government could run the printing presses until the cows come home, but would find nothing for sale for dollars! Thus government spending can be too large (but also too small); government deficits can be excessive (but also deficient); there is a real danger that government activity could crowd out private activity; and there is a danger that government spending can cause inflation when too large, or deflation when too small.

          The key, then, is to ensure that government spending is at just the right level so that neither inflationary nor deflationary forces are induced.

          Here’s an old-guard Keynesian, John Kenneth Galbraith, explaining how Keynesianism went off the tracks:

          By the early ’60s it had become the conventional wisdom of the New Economics that, at full employment, the revenues raised by the Federal government were too large in relation to expenditures. The result was “a fiscal drag” upon output, income and employment. To lessen this drag, a horizontal reduction in taxes was deemed necessary. By now, public sophistication allowed of such action; taxes could be reduced and the deficit increased for the deliberate and exclusive purpose of increasing the budget deficit and so improving economic performance. In 1964, such a reduction, amounting to $14 billion in revenues, was enacted. It was “the most overt and dramatic expression of the new approach to economic policy.”

          Implicit in this action, however, was the need to reverse it should an excess of demand start pulling up prices. And this, as later history would amply establish, was far more difficult.

          And this is where Nixon and his tax-cut theology entered the picture. As Galbraith goes on to explain:

          The good years of economic management in the United States came to an end with the Vietnam war. Wartime spending and resulting demand put pressure on prices. The guideposts succumbed. Prices pressed upward. Spending for the war and the associated deficit are held especially responsible. In fact these were rather quickly neutralized. In the calendar year 1967, the Federal government had a deficit of $12.4 billion in the national income accounts. Income taxes were then increased by the addition of a surtax; as a principal though not exclusive consequence, the deficit was a modest $6.5 billion the following year. And in 1969, there was a surplus of $8.1 billion.

          Then enter Nixon and his tax-cut theology:

          With the ending of the surtax and other tax reduction the deficit then returned.

          The sequence of events just mentioned is of importance; in later years the economists of the Nixon Administration attributed the increasingly serious inflation to the fiscal disorder they had inherited. Through repetition the explanation acquired a wide measure of acceptance. There is an obvious convenience in attributing one’s shortcomings to one’s predecessors in office. Carried to its logical end, it would mean that no administration would have to take responsibility for economic performance until it had been in office for several years. A valuable alibi. But, in fact, the fiscal position inherited by the Nixon Administration was, as such matters are usually described, remarkably sound….


          Fiscal policy was tight in 1969. Then, as noted, with the phasing out of the surtax, other tax relief and increased expenditures, it greatly eased. The Federal deficit in the national income accounts was $11.9 billion in 1970, a large $22.2 billion in 1971. For resisting inflation, reliance was on monetary policy; this was tightened, with sharply increasing interest rates, in 1969, and kept so until the closing months of 1970. So much for the fine tuning.


          However, the effect of monetary policy on price increases and unemployment, by now predictable, was to allow the worsening of both. Unemployment, which averaged 3.5 percent of the labor force in 1969, rose to 4.9 percent in 1970 and to 5.9 percent the following year. And wholesale prices, which were 106.5 in 1969 (1967 = 100), went up to 110.4 in 1970, and 113.9 in 1971.6 Unemployment, as before, was not the alternative to inflation. There could, as before, be both. Monetary policy could suppress activity and increase unemployment, and especially in those industries — housing, and the construction industry generally, being the leading examples — which depend on borrowed money. The market power of corporations and unions meanwhile could keep prices going up as before. The modern capitalist economy could suffer inflation. And it could suffer recession. And it could, up to a painful level of unemployment, have both at the same time. However, the economists whom Mr. Nixon had brought to Washington were not men of shallow faith.


          John Kenneth Galbraith’s analysis is more nuanced than what we mostly hear these days, because he speaks of price deflation for some items and price inflation for others, all happening at the same time. We have something similar going on these days.

          1. Calgacus

            I try to present MMT as the MMT academics do, and make clear when I am presenting my own thoughts. And I’ve criticized others for not doing this – most all the non-academics at NEP in fact. The waste and efficiency statements I made above are close paraphrases of Keynes and Lerner on many occasions.
            I cited MMTer or fellow-traveler Galbraith. Wray has highly praised Galbraith’s Predator State – saying it was the best economics book of the past few years or somesuch. The argument there is based on his WHAT IS THE AMERICAN MODEL REALLY ABOUT? Soft Budgets and the Keynesian Devolution and other papers. I suspect that James Galbraith does not think his thoughts inconsistent with his father’s – who lived several years after the paper was written.
            I agree of course that The key, then, is to ensure that government spending is at just the right level so that neither inflationary nor deflationary forces are induced. The point is that right now, taxes are much too high, or spending is much too low. Deflation, depression, unemployment, low wages and stagnation are the real problems, not inflation. I do not think it is a good idea to think too much about the dangers of drowning when you are dying of thirst.

            Dean Baker is an example of a good economist, with his heart in the right place – but not always his head. He very often points out that without our broken health care system, we would be looking at endless large budget surpluses in the future. But he crazily concludes that the health care system is the big problem then – when this statement shows that our broken health care system is the thing that is keeping our economy afloat, by preventing extremely destructive and unsustainable surpluses.
            The general public would NOT have a lot more money in their pocket after a mindless Europeanization of our idiotic health care system, but a lot less – all those hole-digging health care prevention bureaucrats spend a lot of money. Something on the scale of Lambert’s jubilee would be needed, not an option. Government spending or deficits may be wise or not – but they are logically infinitely sustainable. Government taxation and surpluses are not.

      3. bluntobj

        Damn, lambert. I mean wow. I have not seen a post from you that I have never had a disagreement with, until now.

        You are 100% correct, ACA is feed the young to the old and the elite.

        1. Patricia

          How deeply broken you find the social contract! The young will at some point become old—what for them, then? And what of SS and Medicare, which is a separate program for the greatest expense, the old and disabled?

          Given the poor economic conditions for the young, there won’t be much money coming from them, even when forced into the horrible plans that cover almost nothing. Moreover, the forced extractions will be deeply skimmed by the insurance companies and the overpriced hospitals/machines/medications.

          The old really are not the problem except insofar as they are, for any society, an obligation. Does the obligation feel so heavy because you see them as the only problem about which “something” can be done, and because you believe our country has no future?

        2. Yves Smith Post author

          No, you’ve still got this wrong. Health insurance companies price discriminate a TON more than that. Lambert is correct, this is sick or special conditions v. healthy.

          Here is a long list of ways young people can be sick or otherwise costly:

          1. Type 2 diabetes. You are dead in 25 years unless you have super genes (ex the diabetes) and take meticulous care of yourself and you cost the system a ton in between. We are now seeing Type 2 diabetes in children and teenagers

          2. Hep C, which you can get from tattoos as well as IV drugs (in Oz, over 20% of the Hep C is from tattoos)

          3. Of course, CANCER!!!

          4. Car accidents

          5. Pregnancy. Young women have higher insurance costs because it is assumed they will have kids

          I’m sure I missed a few.

          By contrast, I am and continue to be a screaming bargain to my insurer even with my very cheap policy. I never had anything expensive done evah. No surgeries, no expensive ailments. One emergency room visit with a scare and that didn’t cost much. So don’t go on that all young people are cheap and all older people are a burden. It’s not that simple.

          1. bluntobj


            All of the items you list are true, and happen. In the individual, they are expensive. In the aggregate, youth are not expensive, and are the revenue source that must be maximized and consumed for the benefit of the old and elite, and yes, the sick. By the models, yes, age is a proxy for health. That reinforces the concept that the young and statistically less costly must be made to support the older and statistically more costly.

            If we were looking at a Venn diagram, “Young” would overlap “healthy” by 90%+, and “old” would overlap “unhealthy” by 90%+. That’s not just a proxy, but the reality.

            Lambert mentioned an actuarial model, and that’s what ACA is. It is organized looting to feed profits to insurers on the backs of youth, and delivering votes to the elite from the class of people most likely to vote to protect their wealth transfers.

            It’s good that you are a screamin deal for an insurer. You are thinking of your relationship with them on an individual level. I know that you’ve poked them with a sharp stick deservedly many times in the past to hold up their end of the bargain. But as a “corporate person” they have no individual relationship with anyone, and do not care beyond an actuarial table. To them you are just a probability, like all the rest of us.

            Finally, ACA disallows discrimination on the basis of health, and only allows discrimination, by way of premiums, based on age. It is true older individuals will pay more, but the youth must pay so that the older individuals can pay less, and insurers can have their profits.

            The actual practice of ACA will be to siphon revenue out of the young, and healthy, and feed it to the old, and the sick, enriching the elite along the way. That’s what I take away from Lambert’s post, anyway.

            I am skeptical that single payer will work, or produce the savings that are advertized.

            1. Yves Smith Post author

              Huh? How can you be skeptical when:

              1. Admin costs ALONE (due to the private insurance layer) conservatively measured (not including costs imposed on doctors) 10% higher (as in next highest country has admin costs of 8% v. our 18%) and including costs imposed on doctors, in the low 30%? We’d lower HC costs by 10-20% based on that ALONE. Admin costs for Medicaid I believe are under 5%, so we could do even better

              2. Our health care system costs nearly 2x as much per capita as the next most expensive country and delivers worse outcomes.

              Re discriminating young v. old, you are missing a ton of other factors. ACA is set up to make it very hard for people who don’t have internet connections at home to sign up. I guarantee that’s no accident. The Census says that’s over 25% of the population, and that skews older and poor. There are more clever devices in the legislation than you appreciate. And you aren’t even listening to the messaging: the ones the Administration wants and needs in are the “young invincibles”, that is, the young AND healthy, not the young per se.

  22. jfleni

    “It’s only a matter of time until once ridiculous proposals like this are adopted then only a little more time until the US is forced to go in the direction of single-payer and address the cost of medical care”.

    Obamacare is just naked corruption of odious insurance plutocrats by Barry’s pathetically incompetent butt-kissers.

    Further, if a European connection has such huge advantages (it really does!), why not bring the European system here to the rational and sane parts of the (former) USA — now beginning obviously to split apart? No more foolish maneuvering to satisfy “DogPatch DC” That too is only a matter of time once people think carefully about it.

    The Northeast and the industrial – agricultural Midwest comprise at least one third (120 million+)of the population of the USA,(the most productive third, check the satellite photos, Bubba, and notice where the lights are on!) and are taken to the cleaners every single hour by “DogPatch DC”; and that that third has a neighboring and friendly one-sixth in the Pacific Coast states.

    Just as Ireland and Portugal (and others) will not always bleed themselves dry for the “Euro” (Frankfurt and Berlin will screech, but to no avail), the sane parts of the USA have to take control of their own economic and political destiny. Just think! No more mad snooping Generalissimos, no more mad and obnoxious billionaires, no more bloviating by the useless nuts roosting beside the swampy mud-puddle on the Potomac, no more outsize military forces looking for trouble everywhere, and our dollars making our jobs (a huge number really) for our people! It may sound ridiculous, but it’s really only a matter of time!

    The North will rise again! Write if you get work Bubba!

    1. sleepy

      Yet it was the Northeast and the Midwest that elected Illinois senator Obama and Delaware senator Biden to office in 2008.

      1. anon y'mouse

        Obama, sellout as he was since he didn’t do what he portrayed he would, is just a symptom.

        can’t anyone SEE that? it does not matter who they put the crown on. he’s like the dummy groom standing atop the wedding cake. it’s a symbol.

        no matter who we’ve gotten in there, we’ve had the same dagnab stupidity year after year. how long has this been going on? at least my entire lifetime.

        who CARES about Obama, or any of the rest of them. they are actors in a play pretending to do things ‘for our good’, when the ‘our’ always means the rich class to which they themselves belong or will be made to belong.

        good gawds, y’all. voting R in protest, voting for someone other than Obotma. like any of this would have made a darn bit of difference in the end. the playbook would have looked a bit different, but that is all. eventually the crap gets rammed down our throats.

  23. kevinearick

    Artificial People, Artificial Intelligence & Artificial Worlds

    If the morons are stupid enough to herd people into urban prison regulation and pollute the countryside to drive up real estate prices, do you really think they have any interest in space exploration? What are those satellites doing up there?

    Do you really think that empire planes, trains and automobiles, loss leaders all, are going to get you anywhere you want to go?

    Is a municipality in the country-side adopting best urban practices really a community?

    How many grant writers does this world need?

    If the kids are so damn stupid, why is Obamacare driving up the average age of participation, increasing the risk pool? And why are healthy seniors opting out of the ponzi?

    War is stupid automaton behavior, and the vast majority is participating. Don’t be surprised when the asymmetric war comes to your door.

    The empire always pays me, with interest and penalties, at the end of each artificial cycle. What it pays me to do is up to you. Fixing elevators or designing bombs is six of one, half a dozen of the other to me; I’m good at both, but couldn’t care less about either, eliminating observers prism. If the morons declare war, you may want to avoid dc control devices all together. If you want to de-escalate, discount the empire price of real estate; it’s completely artificial.

    If you make everything you touch a little better than you found it, the empire line is held. Germany is going to prove once again that the last to lose is not the winner. It can’t fix its own elevators. Closed systems blow up when they reach the limit of diminishing returns. All systems are not closed.

    Because the State of California is stupid is no reason to take it seriously. The San Francisco Fed is the least competent part of the system, a thread on a cheap sweater, and Yellen, the scapegoat, is going to prove it. One way or the other makes no difference to labor. Print all the smart infrastructure you want.

    Do you know what really pissed off my ex-wives, bosses and co-workers? I made more than they did and gave everything away. And, surprise, surprise, always ended up with more crap than I gave away.

    You have a clutch, a bomb and propulsion. NEVER SADDLE A DEAD HORSE.

    What is zero divided by zero? What does that mean?

  24. Dromaius

    I’d very much like any reader examples along these lines, either positive or negative, about the cost and benefits of Obamacare versus your current plan (assuming you’ve been able to find information!)

    Here’s a link to my story, Yves. http://fiveper.blogspot.com/2013/11/debunking-notion-that-plans-that-were.html

    This is a direct comparison of an existing, but soon to be cancelled plan and a 2014 Obamacare-compliant plan. Our BCBS insurer provides direct comparisons between the 2 plans and I’ve included shots of the comparison table they supplied.

    While the current plan was pretty bare bones, the new plan is “bare-er and bones-ier”. The new plan is ONLY OFFERED outside of the Exchange, so much UNLIKE the Exchange plans in our state (Washington) it DOES have a robust doctor/hospital network. But you have to get pretty sick to get any payout at all from the new plan.

    Right now, as of 2014, the ONLY insurer in my state that offers a robust doctor network for individual plans is Regence Blue Shield….

    Our state had great mandates that ensured that the coverage was good. The notion that the plans we had were bad and the 2014 plans are better in terms of the safety net they supply is completely ridiculous.

    The new plan includes maternity. But if the numbers quoted in comments above are correct, an average birth costs about $9,500. Premiums and deductible for this plan are $9,000, so insurance would have to pay only $500 for a birth. And then next year the insure-co would get their $4000 without having to pay out for a pregnancy, and the insuree would have to pay out $5000 before they received any care, so it’s still a win for insurance.

  25. Matt

    ehealthinsurance.com IS NOT showing all 2014 plans. For example in my county it does not show Kaiser. Looks like the insurance companies have broken the process Michael is used to. If you don’t qualify for the subsidy then you can try going straight to the insurance provider. Another choice may be to take up an early renewal offer for an existing 2013 plan.

    Just another example of how old reality systems are broken by the changes of this very painful and costly law.

  26. Matt

    ehealthinsurance is not showing all 2014 plans for my county. One example is Kaiser. If you do not need the subsidy you can in the examples I have tried go direct to the different insurance companies.

  27. Jerome Armstrong

    @michael_olenick, the pain is just beginning. You can probably expect those rates to double over the next few years due to the ‘unintended consequences’ (lack of youth, increased numbers that drop $ insurance, lack of paying fine…). I’d suggest you do whatever it takes and feel no guilt or responsibility.

  28. Bridget

    Just did a bit of googling. It appears as though the open enrollment period tightens up after this year. One site said it will run from October 1 to December 7. So, the period of time you’d be on your own is longer than what I originally stated. But it still is something to consider.

    Another scenario for gaming Obamacare might work as follows:

    You are allowed to go without coverage for three months of every year without paying a penalty. You could consider going without coverage from September through November of each year, enroll in the cheapest plan in December, and then cancel the following September 1. That way, you’d only have to pay premiums for 9 months, and retain the option during the open enrollment period to enroll in any plan you want, if you get sick. You’d only be at risk of being without coverage for the month of September.

  29. Wells Fargo Must Die

    In my situation, it is pretty much a draw. Because I have a low taxable income, I’ll only pay $50 per month for a plan that is basically the same as what I have now. The full price is $50 higher but that does not include the 20% price increase that I would get. Basically, the plan costs $600 extra for a free doctor’s visit once per year which does not seem like a very good deal.

    When it comes to the average Joe, I don’t see any reason that a person will want to pay $50-$200 for a bare bones Bronze plan that only gets you catastrophic coverage. Better to save your money for your doctor’s visits and declare bankruptcy if you have a medical condition.

  30. Maggie

    I’m a single healthy self-employed 63yr old in California. I’ve been buying health insurance in the individual market since 1998. Before that I went without. Until 2012 my insurance never paid for anything and I never met my deductible because I never saw my primary care Dr more than 1X/year and my Dermatologist more than 3X/year.
    In 2012, I changed my Blue Shield policy to another Blue Shield policy with a deductible 2X the previous policy’s in order to bring the premium down. For the first time, the insurance co paid for the office visit to my Primary Dr, a Mammogram and a Colonoscopy because they were considered preventive care under the Obamacare provisions.
    I received my policy cancellation letter in October. Their recommended new policy has premiums 30% higher, a slightly lower deductible but then a 10% reduction (to 60%) in what they will cover once the deduction is met.
    Obamacare is out of the question. My Drs are not in the network as they are part of a large (more than 100 Drs)Medical Clinic with multiple locations throughout the county who have been unable to reach an agreement with insurance companies about reasonable payment amounts. The Obamacare network in my area is on the level of Medicaid.
    Because I’m so close to Medicare-15 months, I’ve decided to wing it until then. Hopefully, the increased stress won’t kill me.

  31. sierra7

    Really makes sense, doesn’t it?
    Health care costs could conceivably totally bankrupt the whole country…..taking down the, “….70% consumer marketplace.”
    Just goes to show how much common sense our practice of “capitalism” contributes to a better life after thousands of years of rising out of the muck!
    Health care, in a modern society, IMO, should be by definition, “Non Profit”….PERIOD.
    The phraseology of, “….shopping for healthcare,” is sheer idiocy!
    Healthcare is not a, “product”, like towels, pots and pans, etc…(you get the idea).
    Having a heart attack do you “….just go shopping for health care?”
    What are we to do:
    Euthanize all those who are “unhealthy, or deformed, crippled….at birth?”
    What kind of society are we?
    Have we become so degenerate and insensitive that we can just ignore all the inequities of health and call all those who can’t afford food, shelter, have decent jobs or cannot afford the incredible insurances for “healthcare” as just “bums” or “n’er-do-wells”?
    Either we change our attitudes as to what a decent, progressive society is or we will perish as a society.
    I truly believe this country is on the cusp of civil upheaval.
    Our present for profit “healthcare” system is dominated by the concept of being an, “industry.”
    Say what????
    Our whole country has been captured by images of the super-wealthy…their lifestyles….and everybody else are incompetent.
    Many of us know better.
    (I grew up during the Great Depression and I have non-fond memories of the life my family lived, and we werent’ really anywhere destitute like so many others)
    Too many of us have succumbed to outright righteous greed and look down on all others who disavow this view.
    Our government is totally corrupted by the thousands of slick lobbyists that descend on WDC every day and get to literally write most of the legislation that is passed by corrupted legislators, regardless of either major party.
    Those that “rule” this country are asking for it.
    They don’t really know it but they are.
    As we “debate” this horrible ACA (Non-Partisan voter here), our military and local police forces are preparing for civil disorder….make no mistake!
    The ACA waw written and delivered to passive legislators excluding any thought or debate on any alternative…Remember the public option???????
    It was written by the “industry” behemoths…..who’s executives pull down millions in “for profit” healthcare monies literally squeezed out of spent out citizens in too many cases who have succumbed to “non-planned” health care issues that in the end bankrupt them and their families.
    How crazy is that??????
    Do we really want a real revolution?
    We will get it if we continue down this path.

  32. Maggie

    Medicare is 65. At least it is now.
    SS is 66 at this time. There are those that want to change both.

  33. Jerome Armstrong

    And so it begins:
    Meanwhile, one big insurer is cutting back expectations for enrollment all over. Humana, which is offering plans in 12 state exchanges, said yesterday that it was cutting its enrollment projections in half, from 500,000 people down to 250,000. Given that the law’s supporters say the law will require both a certain amount of enrollment (about 7 million total) as well as a particular demographic mix (about 40 percent of enrollees need to be young, healthy adults) in order to function as intended, this isn’t terribly promising news.

      1. NotTimothyGeithner

        Only the Bidens and credit card company mailing addresses live in Delaware which has a screen door factory. These enrollment numbers could be a sign of success.

        There may be a Jewish deli, but that could have been in PA. I don’t remember exactly where it was. People came from all over.

    1. AbyNormal

      PLUNDER, v. To take the property of another without observing the decent and customary reticence’s of theft. To effect a change of ownership with the candid concomitance of a brass band. To wrest the wealth of A from B and leave C lamenting a vanishing opportunity.

      POLITICIAN, n. An eel in the fundamental mud upon which the superstructure of organized society is reared. When he wriggles he mistakes the agitation of his tail for the trembling of the edifice. As compared with the statesman, he suffers the disadvantage of being alive.

      devils dic.

  34. Benjamin

    For me one of the most depressing parts of this whole farce is the way the left is desperately trying to defend the ACA. I don’t mean the vichy left, the Democratic Party flag-wavers who would probably defend Obama even if he literally came to their house and shot their dog in front of them (though going by the poll numbers, even that group of diehards is fading fast). I mean those that actually have at least a modicum of principle and have a history of criticizing Obama and the Democrats, to one extent or other. The Sam Seders and the Cenk Uygurs. They keep prefacing themselves with ‘I’d much prefer single-payer, but this a step in the right direction’ and then proceed to try and paper over the cracks.

    Even more absurdly they’re usually just repeating White House talking points, like claiming the website crashed because it was so popular and getting lots of traffic (a lie).

    And then they have to start backpedaling. There’s usually a timelag of at least a week between when I learn about something like how rotted the Obamacare backend actually is from here and when I actually start seeing that reality start to filter through to even the most hardcore defenders. I wonder how long before the true realization of how much we’ve all been screwed will sink in.

    1. Dromaius

      It’s what I call “Democratic Capture”. Pass a horrifying law, contrary to what Democrats are supposed to stand for. Pass it with only Democratic support so nobody else can be blamed for it. The highly visible “Democratic” team players have to defend the horrors “for the good of the party” and because Republicans. Thus, the Democrats are completely silenced, aka captured. Republicans throw up strawmen to shoot down, which don’t help the situation at all.

      The policy is implemented. People lose in a big way with no highly visible and vocal opposition to even slow the suffering.

      Then in 10 years Democrats attempt to run against the law. And enough people have forgotten (or in this case, have DIED by the law’s sword) so that the Dems get away with it.

      Lather, rinse, repeat.

      Pure unadultered evil.

  35. JCC

    It’s killing employees with Business Employee Plans, too.

    We just got our “planning notifications” for next year today. Family plans supplied by BC/BS Tennessee will be jumping at least 60%.

    So it’s not just ACA subscribers, at least not here in California.

  36. EMichael

    You people really need to read into MLR and what it actually means in terms of these horror stories.

    The math is not hard and I would be happy to explain it, but it seems to me there is no explanation that anyone in here will accept.

    1. Nathanael

      The regulations allow the MLR to be faked.

      Insurance companies can shuffle certain types of administrative costs into “medical” costs, and ALL administrative costs at doctors’
      offices and hospitals are misclassified as “medical” costs.

  37. Nathanael

    Yep. I’m unmarried due to health insurance prices. Been with my non-spouse for 15 years now.

    This is typical.

  38. Nathanael

    “Years ago I proposed setting up medial tourism on Indian reservations. Next to the casinos and resorts would be state-of-the-art hospitals, unencumbered by US laws that allow American medical businesses to conspire and rig prices. Theoretically the drug makers and equipment manufacturers could refuse to sell to the tribes at regular world pricing, rather than American price levels, but since the tribes can import their products from anywhere else, the refusal would be pointless (as in rather than reimporting US made drugs, they could buy from Europe, for instance). It’s only a matter of time until once ridiculous proposals like this are adopted then only a little more time until the US is forced to go in the direction of single-payer and address the cost of medical care.”

    With sufficient funding, I bet we could get the Seneca Nation to go for this. They’re pretty hardcore.

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