Market Participation, aka Shopping, as a Toll of Neoliberalism: Obamacare as Case Study

Corey Robin, appalled by the complexity and difficulty of selecting Obamacare policies, made a fundamentally important point about neoliberalism:

Aside from the numbers, what I’m always struck by in these discussions is just how complicated Obamacare is. Even if we accept all the premises of its defenders, the number of steps, details, caveats, and qualifications that are required to defend it, is in itself a massive political problem. As we’re now seeing….

In the neoliberal utopia, all of us are forced to spend an inordinate amount of time keeping track of each and every facet of our economic lives. That, in fact, is the openly declared goal: once we are made more cognizant of our money, where it comes from and where it goes, neoliberals believe we’ll be more responsible in spending and investing it. Of course, rich people have accountants, lawyers, personal assistants, and others to do this for them, so the argument doesn’t apply to them, but that’s another story for another day.

The dream is that we’d all have our gazillion individual accounts—one for retirement, one for sickness, one for unemployment, one for the kids, and so on, each connected to our employment, so that we understand that everything good in life depends upon our boss (and not the government)—and every day we’d check in to see how they’re doing, what needs attending to, what can be better invested elsewhere. It’s as if, in the neoliberal dream, we’re all retirees in Boca, with nothing better to do than to check in with our broker, except of course that we’re not. Indeed, if Republicans (and some Democrats) had their way, we’d never retire at all.

In real (or at least our preferred) life, we do have other, better things to do. We have books to read, children to raise, friends to meet, loved ones to care for, amusements to enjoy, drinks to drink, walks to take, webs to surf, couches to lie on, games to play, movies to see, protests to make, movements to build, marches to march, and more. Most days, we don’t have time to do any of that. We’re working way too many hours for too little pay, and in the remaining few hours (minutes) we have, after the kids are asleep, the dishes are washed, and the laundry is done, we have to haggle with insurance companies about doctor’s bills, deal with school officials needing forms signed, and more…

One more account to keep track of, one more bell to answer. Why would anyone want to live like that? I sure as hell don’t know, but I think that’s the goal of the neoliberals: not just so that we’re more responsible with our money, but also so that we’re more consumed by it: so that we don’t have time for anything else. Especially anything, like politics, that would upset the social order as it is.

I suspect the neoliberals’ beliefs are somewhat different: that markets are so inherently wonderful at solving problems that they can take over a lot of the problems and issues that were formerly fought over in the political arena. And people like shopping, right?

Well, I’m one of those people who hates shopping and regards it as a tax on my time, even in settings where effort has been made to make it pleasurable. When the stores are well organized and the wares are narrowly focused and attractive (as an example, I’m thinking of a small store that sells attractive occasion and greeting cards), it’s a tolerable exercise. By contrast, who enjoys buying financial products? Even in the best of circumstances, you are making a bet on your future in some way (what do I think the markets will do? How much of this risk should I insure). Unless you have nerves of steel or a crystal ball, it’s hard to suppress the feeling of anxiety that events can play out in a way that will prove your choice to have been a lousy one.

And Obamacare is proving to be a very costly shopping experience, if you think your time has any value. And this isn’t a matter of website glitches, although those make matters worse. Consider this account from reader ScottW:

Recently moved to Mass. and got health insurance for family of 4 with low deductible–$1,299/mo. I have to reapply by March 31, 2014 (not sure why), so started an application trying to see if I qualify for a subsidy (a worse plan now costs at least $1,550). Halfway through the application, it indicated I was in prison. I called the woman at HealthConnector and she said that error comes up with lots of people, but don’t give up. Parenthetically, made me wonder how all of that NSA data they are collecting on us all is going to shakedown in the future.

Yesterday, got back at it and I am still in prison, but was able to override it by stating I was not. Got stuck, hit the back button, got out of that message and continued. The application asks a dizzying array of questions, many aimed at predicting how much money we will be making. Since I have children ages 23/21 who are still tax dependents, it makes the process even more complex. Well, after giving them all of our most personal of data, the message at the end said they would get back to me and let me know if I qualified. Still have not been even able to determine if my current plan is part of the subsidized market.

Now this is in Mass. where they have apparently been doing this exchange for many years. I have 93 plans to choose from, with costs ranging from $1100 to over $2,500, and even within the bronze/silver/gold categories, the plan costs in each category vary by more than $500/mo. or more. And who knows what you get on the backside should you ever have the audacity to get sick.

I am a retired-lawyer, yet I find this process incomprehensible. It is a scam being perpetrated on people who believe if you have insurance, you have healthcare. Of course, no one knows until they get sick what costs they will get stuck with. And if you get sick out of network, you are doomed…

We could not have designed a more idiotic health care system had we set our mind to it.

Mind you, ScottW has a graduate degree, is in a field where he deals on a daily basis with complex documents, and he can barely manage the process of making a decision. How are people who have less savvy supposed to contend with this?

And even though the worst of the problems have allegedly been remedies (Health and Human Services claims the error rate in information submitted to insurers, known in the trade as 834s, is down to 0.38%, but given that a Reuters article still mentions human intervention, I’m not sure this outcome is based solely on website operations, or whether this is website plus some contractor intervention).

dt.common.streams.StreamServer.clsFor instance, reader AS in Florida sent this transcript of his efforts to get help via online chat after he encountered the “yellow screen of death,” which is message in a bold yellow rectangle, at the end of personal data submission on the site, that some “verification” systems aren’t working.

Here is his transcript. Notice that the “help” decided to disappear at the end:

[2:40:37 pm]: Thanks for contacting Health Insurance Marketplace Live Chat. Please wait while we connect you to someone who can help.
[2:40:40 pm]: Please be patient while we’re helping other people.
[2:41:18 pm]: Please be patient while we’re helping other people.
[2:41:23 pm]: Welcome! You’re now connected to Health Insurance Marketplace Live Chat.

Thanks for contacting us. My name is M******. To protect your privacy, please don’t provide any personal information, like Social Security Number, or any other sensitive medical or personal information.
[2:41:34 pm]: Francine
Third day in a row, the “yellow screen of death”, the verification system unavailable message. It “promised”, you “expected”, to resolve the problem within 24 hours.
[2:41:36 pm]: M******
Welcome to the Health Insurance Marketplace Live Chat, my name is M******, how may I assist you?
[2:42:05 pm]: Francine
I got a phone number yesterday, which we could call to try to resolve this. Can I have it again?
[2:43:43 pm]: Francine
We’re stuck, we’ve put in about 100 hours on this, how can we possibly get health care if this continues?
[2:43:45 pm]: M******
We are available to help you 24 hours a day, 7 days a week. You can reach us toll free at 1-800-318-2596. Hearing impaired callers using TTY technology can reach us at 1-855-889-4325. In addition to English and Spanish, we can provide assistance in a number of languages through an interpretation service. We are closed on Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day.
[2:44:55 pm]: Francine
So, this is the number you think we should call? Please, be very specific, this is a specific problem that may need special help. Please acknowledge the nature of our problem.
[2:46:41 pm]: M******
Thank you. One moment please while I look that up.
[2:47:45 pm]: M******
We are available to help you 24 hours a day, 7 days a week. You can reach us toll free at 1-800-318-2596. Hearing impaired callers using TTY technology can reach us at 1-855-889-4325. In addition to English and Spanish, we can provide assistance in a number of languages through an interpretation service. We are closed on Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day.
[2:49:26 pm]: M******
Do you have any other questions that I can help you with?
[2:51:42 pm]: M******
Francine, are you still there?
[2:52:27 pm]: Francine
You didn’t answer my question. Would you summarize the problem I’m having, for me, so that I’m sure we’re on the same page.
[2:54:21 pm]: M******
Ma’am you never stated your problem.
[2:55:40 pm]: Francine
OK, so here was the first thing I sent you, “Third day in a row, the “yellow screen of death”, the verification system unavailable message. It “promised”, you “expected”, to resolve the problem within 24 hours. ” The person who helped me yesterday, chatted with me about this particular problem.
[2:56:10 pm]: M******
That is not stating your problem, what is your question?
[2:56:25 pm]: Francine
If you want to, pass me to someone who can help with this problem.
[2:59:18 pm]: M******
Are you still there?
[2:59:29 pm]: Francine
OK, the problem is that the verification system is unavailable.
[3:00:24 pm]: M******
Have you tried verifying yourself electronically?
[3:00:41 pm]: Francine
What do you mean by that?
[3:01:49 pm]: M******
After you submitted your application did you verify yourself?
[3:02:04 pm]: Francine
How would I verify myself?
[3:02:40 pm]: M******
How do you know the system is unavailable if you haven’t verified yourself?
[3:03:01 pm]: Francine
Please, put another person on with me.
[3:04:22 pm]: M******
Thank you for contacting Health Insurance Marketplace Live Chat. We are here to help you 24 hours a day, 7 days a week.
[3:04:39 pm]: ‘M******’ has left the chat session.
[3:04:41 pm]: Your chat session is over. Thanks for contacting us, and we hope we’ve answered your questions. Have a great day.
[3:04:41 pm]: 12/12/2013

I got a chipper message from him the day after this session took place:

….now it looks like our problem won’t recur.

We called the phone number we were given, and after 20 minutes or so we were able to chat with someone really helpful. She was able to help us (and guessed that the problem was related to naturalization status, and maybe a missing middle name on the form) and suddenly things went through without the “yellow screen”. So maybe the verification tool had been up and available at least to some extent, in spite of the message.

The point here is that even if the sort of problem that AS has, of website hiccups and problematic front line responses, become less common, the problem that ScottW described, of complexity and difficulty of making good choices, is not going away. And that problem is even worse if you have can’t predict your income all that accurately. But it seems we are all required to accept these rising incursions on our time as the price of progress of sorts, when this is just another face of devolution.

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  1. Tom

    I’d like to add a comment regarding predicting next year’s income. I’m been self-employed for 16 years and my income fluctuates up or down from around $65k a year — which is just over the subsidy limit for two. In completing my ACA application, I entered that I’d be earning over the subsidy limit in 2014 since the industry in which I work is seemingly doing better (I say seemingly because it’s the auto industry, whose sales seem to be propped up in part due to an increase in subprime car loans, which are being bundled, securitized and sold to investors. What could go wrong?) Anyway, in addition to shopping the plans on the ACA exchange, I also looked at plans outside the exchange, because the premiums were better.
    But here’s the rub: If my income next year takes a dive unexpectedly (which has happened – 2009 anybody?) and I end up earning below the subsidy limit, I won’t be reimbursed with the subsidy that I am now eligible for unless I bought a plan through the exchange.
    So here’s my choice: buy a plan outside the exchange and pay lower premiums or buy a more expensive plan through the exchange, even though I don’t think I’ll qualify for a subsidy, and hope my income falls below the subsidy level. Nice, huh? Just one more bit of prognostication to perform. Just predict the world economy, the domestic economy and the health of the volatile industry upon which I rely for my income. How hard can it be?

    1. Banger

      Interesting dilemma–you have to hope that your income drops to benefit. This creates all kinds of strange vibration inside your subconscious I would think.

      I knew a cardiologist who decided to simply drop out of the medical model for herself–she still saw patients but she herself has refused check-ups or tests relying on her spiritual faith to heal herself should she get sick. I haven’t talked to her for years since I moved away (she was my cardiologist) but she’s still alive.

    2. Jim Haygood

      A subsidy system that does not require prognostication would be easy to do — simply base it on last year’s income.

      Preferably, build in 3 to 6 months of slack, so that buyers could select a plan year running from (say) April 2014 to April 2015, using their final calendar 2013 income, as documented in W-2s and 1099s received in Jan. 2014.

      But of course, all federal programs seem to have an agenda of opacity and complexity built in, which ‘creates jobs’ for navigators, lawyers, tax specialists, insurance marketers, government employees, consumer advocates, ombudsmen, and advocacy organizations: the whole useless administrative superstructure that’s required to keep customers confused and in the dark.

    3. Nathanael

      Took me 20 hours on the phone (roughly) to figure out the rules in New York. And New York is *simple* compared to most places because:
      (1) New York has pure community rating — no age, tobacco, anything — same premiums for everyone in a given county
      (2) New York accepted all the Medicaid expansions plus more
      (3) The off-exchange plans cost pretty much exactly what the on-exchange plans do — to the dollar

      Result is that everything is very strictly based on your 2014 Adjusted Gross Income. If you can predict it.

      One huge problem is that New York doesn’t provide “window shopping” on its exchange. This is the main reason it took 20 hours. First I had to look up what health insurers were offering plans in my county, then I had to *phone* each of them and get them to give me a list of option over the phone. EXCHANGE FAIL. TOTAL FAIL.

      Once I got the information, as Tom pointed out, the “expected” is the worst problem with the scheme. The idiots in Congress don’t seem to be able to imagine that people on the individual market might have wildly variable incomes. When, in fact, most people on the individual market have wildly variable incomes. Apparently nobody in Congress has ever run a small business.

      Variable income creates a complete nightmare if you get a silver plan, because there’s a TRAP related to the “cost-sharing reductions” which I’ve described before and which I contacted a New York Times reporter about — your deductible can get “restarted” midyear.

      If you avoid the silver plans, which are a TRAP, then the next problem (for me) was to figure out how to get the tax credit only when I file my taxes in 2015 — because if it’s mailed to the health insurer in advance, then you have to keep notifying them every time your expected income changes, andthen the whole thing is a big mess. New York makes it extremely unclear how to do this, but I eventually figured it out by talking on the phone.

      Anyway, Yves is right: the unnecessary and obnoxious “shopping” process is just mean. Most people don’t have the bull-headedness I do and will not actually go through the whole process of extracting the information necessary to make a good decision. I suspect this is actually the intention: the goal is to get people to make poor decisions, to pull the unwary into traps where they get very bad insurance and pay a lot. The Silver Plan Trap is one which people are being *encouraged* to fall into, and it’s going to hit a lot of people in a very very nasty way.

      1. NotTimothyGeithner

        The only over-arching goal for ACA was to appease the Democratic base and the population at large while not hurting donations. There was a sub-goal of providing a captive market for insurers.

        ACA was written by competing industries along the guidelines which would appease the narrative of serious politics (it has proceed by serious) from Versailles on the Potomac.

        Any changes without altering the for-profit model of healthcare or raising taxes were doomed to failure as health delivery was a patchwork system. Two, Washington is dominated by lazy and greedy people who no longer have to dwell in local communities. They are never held to account.

        1. Crazy Horse

          I worked in Vancouver BC, Canada for two years in 2008-2010 as a US citizen with a work permit.

          The conversation with the company administrative secretary went something like this: “Have you signed up for your Care Card yet?” “No, do I need to take a day off from work to go to the government offices and fill out an application?” “No, just fill out this form with a copy of your passport and work permit . You are in a civilized country now— we don’t allow people to go without access to health care.”

          I never spent more than ten minutes in a doctor or hospital waiting room during the five times I used the system, and never paid a penny of co-pay, deductible, or $50 dollar aspirin like I’ve since been privileged to receive from a US hospital.

      2. Nathanael

        FWIW, the Medicaid expansion is excellent and removed a huge number of really obnoxious things from Medicaid.

        Medicaid — in the states which expanded it — is now *strictly* based on your expected Adjusted Gross Income, which is a *huge* improvement over the weird “Are you REALLY poor enough? Are you sure your family isn’t giving you money? Are you sure you aren’t hiding a girlfriend/boyfriend who could pay for this?” crap which they used to put people through.

        1. Nathanael

          To put it another way, which links back into the topic of Yves’s post,

          MEDICAID GOT SIMPLER. There’s actually LESS paperwork and NO shopping. In the states which agreed to the expansion, it’s very simple: if your AGI is below XXX (which varies based on your filing status), you get Medicaid, no further questions asked.

          As such, I think the Medicaid expansion is really pure improvement.

          1. different clue

            Well then, expect the Republicans and the Catfood Democrats to pass laws Ryanizing and Voucherising it into the Exchanges as soon as they get the next Republican/Catfood Democrat President ready to sign it.

        2. scraping_by

          The obnoxious things in Medicaid weren’t there in the beginning. They were the accretion of many years of treating every applicant as a criminal. Poor-bashing rhetoric and divide and conquer whispers get put into regulations just as surely as passed legislation.

          Can we predict the future? Will it look a lot like the past? And is everyone in ‘the marketplace’ going to have the same fate?

  2. AbyNormal

    filing govt papers and finding out i’m a prisoner = 10 yrs off my life
    online healthcare chat = double the experiment meds
    shopping 96 plans = ‘they’ succeeded, im dead

    Power wants us numbered and not named, carded and not just remembering our name, address, telephone number, purpose, social security number PIN, and so forth. Power has good reason. As long as we have papers, we cohere; we don’t shift like a character or personality or desire. We’re available to be managed.
    Michael Pye, Taking Lives

    1. Bluntobj

      You are not taking this far enough. Once Power has organized, made life too complex for the “low information voter,” the demand from them will be for Power to take control and organize life for you, the consumer.

      They know best, really.

  3. Dan Kervick

    I think Robin has put his finger on a giant problem about contemporary life, and whichever political party manages to put together a viable program around simplifying our lives and giving us more time will be able to build a lot of political capital around that program.

    The neoliberal ethos is all about “choices”. But the more choices we have, the more time that we have to expend in deliberating about and exercising those choices. Also, the more market choices we are faced with, the larger the barrage of marketing pitches we are smothered in.

    Neoliberalism seems to have brought with it the rise of the personal finance magazine and industry, and a social ideal according to which every household is a hedge fund and every householder a hard-driving hedge fund manager. Instead of a job that is secure and a retirement plan you don’t have to worry about, we now have lives of permanent employment flux requiring endless “networking” – a word that has been around for a while but is a newish neoliberal era term – and the risk-fraught management of a volatile “portfolio” in place of the erstwhile security.

    1. fresno dan

      “By contrast, who enjoys buying financial products? Even in the best of circumstances, you are making a bet on your future in some way (what do I think the markets will do? How much of this risk should I insure).”

      Years ago in Maryland, after Katrina, Maryland required that home insurers inform homeowners that their homeowners policies did not cover flooding in the event of hurricanes. Now I had thought that if the policy stated that it covered damage due to natural disasters, it would not draw a distinction between wind versus water damage during a hurricane… (obviously, I’m not too bright)
      Apparently, this little quirk of insurance was a surprise to Trent Lott as well.

      Charles Hugh Smith had a column once about all the little word games with regard to insurance, and how at one point in the future, the financial peril people will be in when they discover that the words in their policies don’t mean what they think it means…
      Kind of like believing the market is always rational, its kind of amazing that people would than believe that the insurance company WOULD write the insurance policy to cover as many claims as possible (if they are profit maximizing, they are going to try and cover as little as possible). And written in legalese to make it APPEAR that you are covered when you ARE NOT, so as to sell you the policy to begin with…

      1. McMike

        Yup. Folks are starting to discover that what they thought was insurance, is in fact not-insurance.

        It’s the opposite of insurance, whereby you try and collect after a loss, and they refuse to pay. But then just for fun they kick you while you are down, by raising your rates and ruining your credit rating too.

        It is theft on the installment plan. Now, with ACA mandate, the theft escalated to extortion.

  4. Moneta

    One more account to keep track of, one more bell to answer. Why would anyone want to live like that?
    Well a lot of these decision making people are rules-based. Everything in their life is compartmentalized.

    I keep on recommending that people to just build up 1¸single account because it is much easier to manage and the fees are smaller but most are so intent on minimizing taxes and getting all the little subsidies that they refuse to listen.

    The rich got rich got rich because of big paydays, not because of these accounts. Here in Canada, many of these special accounts were creating so the rich could find a few places to shelter their money from taxes. These accounts are not really great for the middle class.

  5. Banger

    Slavery has a way of sneaking up on us–it’s tentacles are might indeed! The question of too many choices has been dealth with in social science and it results in confusion and inefficiency not satisfaction.

    I always wondered why at the end of every newscast in the USA there was a comment about the stock market being up or down it was sort of like a concluding prayer to our collective God (Mr. Market). Now this Market dude is infecting everything–we all have to spend inordinate amounts of time dealing with money issues and market choices. Some of us just don’t like shopping and don’t like money–money is just something I have to have in order to keep the power on and the bill collectors from harassing me. I don’t want my life to be dominated by process and means–I want to live not be stuck in markets.

    1. jrs

      I wouldn’t generalize to too many choices are always bad. There are bad choices and good choices. I’d like to for instance know if my food is GMO. That’s wanting a choice. Now it might be better if there were no GMO foods at all, but our corporate state simply will not err in that direction: it will err in the direction of everyone packed to the gills with GMOS. I’d rather have a choice then.

  6. JTFaraday

    I don’t think neoliberals like financial complexity in consumer financial products primarily because they want to suck up all your time–20th century work arrangements did a pretty good job doing that already– or because they think markets and shopping are wonderful and the solution to all problems.

    I think they like financial complexity because it makes it easy for them to rip people off, and the more complex it is, the larger the pool of potential marks.

    I remember during the great mortgage ripoff, at one point there was this article in the Washington Post by some journalist or some other member of the broadly literate and not unconnected creative class, professing their surprise that the banks had the temerity to blatantly defraud people like him who had some capacity to understand, at least in hindsight, what had happened to them and might talk about it publicly.

    But of course they did just that, and nothing to speak of has happened to them as a result.

    So, this is another setup like that. Obamacare is basically a fraud pool in which it is hoped that most people will never figure out where and how they were conned.

    1. Banger

      Cool, like the way you think. I think, indeed, the ACA was a deliberate fraud from the beginning–which is why he dealt with it right away at the height of his popularity as the Great “Black” Hope. He had already defrauded the pathetically naive American “left” during the election why not lock up profits for the medical industry and put off real reform indefinitely.

      1. JTFaraday

        To put a finer point on it, I am saying that Obama & Co. didn’t just lock up insurance company “profits” and head off government reform, they locked up a pool of marks to be conned by the complexity of the products for sale.

        The great mortgage ripoff was facilitated by complex mortgages, including variable (ie., rising) rate mortgages that made the house look affordable when it really wasn’t.

        What else are we supposed to think when people post these stories about how reasonable the sticker price on their policy seems– only they haven’t read the fine print yet?

        1. just_kate

          Awhile back someone predicted it would be fallout from Obamacare that might spark the big change event in the US. There will be quite a number of people who did what they were told and will discover that they will get nothing in return for their premium payments or not anything close to what they expected and need – what they believe the program promises. I agreed then it was a good possibility and as I read more and more analysis and experiences on this site alone I think that person was right on. The fraud is baked in as you say and will affect way more vulnerable people than the mortgage crisis has.

          1. NotTimothyGeithner

            “There will be quite a number of people who did what they were told and will discover that they will get nothing in return”

            Broken promises cause revolts, not crummy government.

            1. Nathanael

              Having investigated the details carefully (I always always read the fine print), I’ve found three of the major loopholes being used to give people less-than-they-thought-they-were-paying-for.
              (1) Silver plan trap (which I’ve described repeatedly)
              (2) Statement of Benefits and Coverage doesn’t explain whether a family plan actually has individual deductibles. Some do, many don’t. Result is that many family plans effectively have 2x the deductible advertised, assuming only one person gets sick…
              (3) Out of network coverage is basically being eliminated entirely, apart from emergency room coverage, which must be treated as in-network. If out-of-network coverage exists (apart from emergency room coverage) it is subject to “balance billing”, which because of fraudulent hospital billing practices makes it worthless.

            2. fajensen

              Nah. I am very cynical about that “revolt” part. Most people are authoritarians, they will follow their chosen leader in spite of all the leaders obvious lies, hypocrisy and fraud – getting ripped off time and time again, yet always make up some excuse for why that happened and carry right on!

              In Denmark we had a so-called “conservative” government, who bloated government expenditure, by about 1/3 during its 10 years of misrule … while blowing a huge credit bubble.

              Now we have a “socialist” government which is more neo-liberal than the previous lot of “right-wing” parties would ever have gotten away with …. aand yet:

              The voters still vote in the same way, while explaining why their chosen political party “was forced” to behave exactly opposite as their political programme, the election campaigns, their specious promises and common decency said they would.

              Anyway, now I understand why that is:

              Authoritarians *like* complex schemes studded with booby-traps and loopholes to catch the unprepared (who has not bothered with a degree in contract law before buying f.ex. insurance or opening a bank accoutn); They enforce discipline, punishment of inferior people “who do not follow The Rules” and the opportunity to gloat smugly when others meet a sticky end!

              We can thus expect much, much more of the same!

          2. Fair Economist

            Obamacare insurance delivers what it promises: basic preventative care is free; treatment of significant conditions can be expensive but the vast majority can find a way to scrounge up a few thousand dollars over a few years. Any insurance is a big help just from protecting you from medical extortion, where most providers will charge you about 3 times a fair fee if you’re uninsured.

            The big change is that you can get real insurance not through your work. That was never possible before. Retiring early, extended sabbaticals, and starting a small business now become options for a lot more people than before. It’s an enormous weight off our shoulders in my family: both I and my husband have pre-existing conditions that would make insurance nearly impossible to get, and I wake up grateful every morning he’s no longer shackled to his job for another 17 years.

            1. NotTimothyGeithner

              “basic preventative care is free;”

              “Preventative” is the key word. One might describe “preventative” as merely diagnosis of long term problems and not care designed to address those long term problems at an early stage.

            2. Nathanael

              “The big change is that you can get real insurance not through your work. That was never possible before. ”

              This is true. The big problem is that the new policies still contain lots of opportunities to mislead and defraud people so that you pay a lot more than you’re supposed it.

              It’s possible to end up paying 12 times the supposed “out of pocket limit” if you make the mistake of getting a silver plan when you have a variable income.

            3. NotTimothyGeithner

              “Obamacare insurance delivers what it promises:”

              ACA delivers what it promises, but does ACA deliver what the Democrats promised? What the President said and what people think they heard are two different issues. Legions of Democratic supporters are going to find out the next time they get sick that they have a co-pay or are below their limit.

              Like cars, we as consumers buy based on personal recommendations. The issue in this case is what were the Obots and OFA really saying to people.

              I know a former state rep who ran an ad with a Boss Hawg look-a-like declaring the candidate conservative principles of government (utterly meaningless), but what people heard was the rich white woman is a conservative. Surprise, surprise, turnout among African-Americans, the Democratic base, abandoned her. She was focused on appeasing the Country Club crowd and never grasped what she was telling her base because she was focused on a weaselly phrase, not what she was saying.

              If a trusted friend and Obot says ACA is going to change healthcare, what will people expect? What is said here or in the legislation isn’t as important as the word of a neighbor. That neighbor is Obama for all intents and purposes. This is why legislation has to work or work well enough because the people carrying out the messaging don’t understand it especially if the people responsible don’t.

              1. Fair Economist

                Who said anything about no copay or deductibles? The promise was always that insurance would be affordable.

                1. just_kate

                  No disrespect but people who have not participated in the system previously and/or people who have never actually had to use their insurance are not all familiar with deductibles and co-pays. And even so, forgetting those things, balance billing is flipping minefield.

                  But GOOD news, according to Wonkbook “Insurers will spend more than $500 million to get people to sign up for Obamacare”

                  I wonder who pays for that…

                2. NotTimothyGeithner

                  The issue is perception. Its not what the President says but what his cultists say in private. Is the local Democrat who sat in lines for in the inaugural telling people the same thing as the President?

                  People who haven’t had insurance but have successfully bought it, are going to be shocked by sticker prices on co-pays or what is and isn’t “preventative care.”

                  Whether or not the President said it, his henchman have been saying some wacky things to people who don’t know that much. As confusing as ACA is to this audience which self-selective, people who rely on Wolf Blitzer or one of the network twits are in for a rude surprise.

                3. scraping_by

                  The copay and the deductibles make the insurance unaffordable for the majority. Hell, even the copay alone would be a strain on most budgets.

                  If it only pays for catastrophic bills, it’s not affordable. It’s an expense without real payback.

                  If it doesn’t take care of the finances of health care, it’s an insurance policy, but it’s not insurance.

                  One would have to do a lot of redefinition of common words to get ‘affordable insurance’ anywhere near true.

                4. fajensen

                  “Affordable” is a relative term to begin with and one could ask “affordable to Who”?. Obama may well have been promising “affordable to the insurers”.

                  Besides, Obama has his own interpretation of every word in the dictionary and it is probably enshrined in some secret National Security law so anyone who leaks it gets a free trip to the local re-education facility.

        2. fresno dan

          I think your exactly right.
          When the second in charge at the DoJ says they don’t prosecute banks cause its just too complicated – he lets the cat out of the bag.

    2. Dan Kervick

      Neoliberals aren’t just the people who are in lines of work that allow them to rip people off. They include all sorts of people who supported the political tendencies of the last four decades because they believe in the efficacy of markets, competition and private enterprise. Market fundamentalism was a genuine ideological phenomenon – and still is.

          1. Klassy!

            Oh, I’ve been reading that book. It is funny, but I read it years ago and it didn’t really resonate with me. I decided to try it again and now it is like “how did I miss all this stuff?”. I knew that there were market boosters everywhere but I did not understand the extent to which the market was portrayed as the very essence of democracy itself. I like Frank’s term “market populism”. It is strange how tending to your retirement accounts was presented as subverting the order.

            1. Klassy!

              And by ‘miss all this stuff” I pretty much mean the 90’s. Maybe it took Obamacare and the endless chatter about that cure all “transparency” for me to put it all together.

        1. Banger

          My own definition is that markets odder the best mechanism of establishing value. This is true because we live in a multicultural society wherein moral values are not agreed on–so, to avoid religious wars we establish markets.

          Personally I believe this POV is a mistake–human values stop becoming human values when they become items with cash-value. When love is bought it is no longer love–market fundamentalism is, in the long run, destructive to human society–but, sadly, most people don’t see that.

      1. JTFaraday

        I’m not saying such an ideology does not exist. I am saying Obamacare is much more specific than that.

        But with regard to that ideology, I would also say that those who crafted Obamacare are clearly not opposed to the deployment of government power. Rather, they merely want to control the government themselves.

        You write at a site that also hosts Michael Hudson, maybe you should go read what he has to say about how corporations conduct themselves with respect to third world governments.

        With respect to this, one can focus on their actions or one can focus on the rhetoric they use in order to cloak their actions. I prefer to focus on their actions.

        I guess it can be disconcerting to think that your government supports and promotes financial fraud, but I’m afraid your government does support and promote financial fraud.

        1. Jill

          I agree. The IRS will be enforcing this program. I think ACA is also a goldmine of data for the govt. and private entities. The amount of data collected has little to do with shopping for a plan.

          It is also correct that neo-liberals think shopping in health care makes sense. When was the last time you saw price comparisons for hospital bills, doctor’s offices, etc.? Make certain to tell the ambulance driver where to take you when your unconscious on the street!

          Health care is not a shopping activity. It is something we may all need at one time as human beings. As such, a government functioning for the welfare of its citizens would provide single payer, universal health care. They would not demand the mandatory purchase of shoddy health insurance plans, enforced by the full faith and credit of USG through the IRS.

          1. NotTimothyGeithner

            If healthcare was a shopping activity, then it means the seekers of government “service” aren’t responsible for bad outcomes but still warrant devotion.

          2. JTFaraday

            So, they may present that as “shopping,” ie., “price comparison,” blah blah, but they surely do know that this is an opportunity to take your wallet while you’re unconscious or otherwise too sick to help yourself.

            The only time you can really do that is with preventive care, and it sounds like Obamacare covers that. Which to me, just sounds all wrong for “house insurance.” It may make sense in Medicaid.

            So, why should we accept and promulgate their framework?

            I also firmly believe that the government connected perpetrators of financial fraud effectively changed the subject from their own activities to national austerity in an attempt to deflect attention from their actions, which needed and still need serious remediation.

            As well intended as all this ideological trench fighting with libertarians/ libertardians may be, it is also fully part of this orchestrated barrage of distraction.

            I also don’t think you can win this fight, not any time soon, because it is too loaded up with long standing cultural hatreds.

            Now that that Obamacare fraud pool is here, I think we need to go back to calling things by their proper names, and connect them to the history of fraud that preceded it.

    3. Nathanael

      “I think they like financial complexity because it makes it easy for them to rip people off, and the more complex it is, the larger the pool of potential marks. ”

      Correct. By the way, if you have a variable income and there is any chance whatsoever of your income dropping below the “cost sharing reduction” level, don’t get a silver plan. They’re a TRAP where your deductible may get “reset” multiple times per year and you may end up paying multiple times the theoretical “out of pocket limit”.

  7. Eleanor

    I absolutely agree with the article and comments. I have known a few people who enjoy personal managing personal investments. One ended in prison, interestingly enough. I have known no one who enjoys shopping for health insurance. Both are complex, boring (for most people) and threatening. People don’t make prudent decisions in these areas, because they never know enough. (Didn’t Keynes have a lot to say about the limits of knowledge?) Instead, they are scammed.

    The free market works in some situations. I love our local farmers market, though it has rules and thus is not entirely free. The merchants and their products have to be local. They can’t say they are organic unless they have been certified. There is a market master and doubtless many rules I am not aware of. In addition, there are there are the laws regulating agriculture and the FDA, though I put less trust in them these days. I’m willing to put some work into shopping at the market, because it’s fun and because I am reasonably sure I can make a decision among green peppers.

    Health insurance policies and mutual funds are a far different experience.

  8. vlade

    If I was an alien who’s not affected by this, it would be rather amusing.
    The choice crowd who say “all should have a price and we should decide” forget that a choice has a cost too. Thus, it’s entirely rational to require to have _less_ choice. One way to do that is to pay taxes and elect a gov’t to do the choices for you (and if you don’t like them, elect a different gov’t). It’s exactly the same reason why we are not all single agents grouping at times but have companies that remove quite a few of the transactional costs that come with negotiating every choice possible.

    So the choice club is ignoring a choice that has been already made, and is rather forcibily pushing people to do stuff their way..

  9. McMike

    The worst part is the sense that all that paperwork is about setting up traps and smokescreens.

    Walk into my parlor, said the spider to the fly…

    1. Nathanael

      Well, it is. There’s a big trap in the silver plans. The “cost sharing reductions” created a loophole which makes silver plans *much worse* than other plans if you have a variable income. This is being concealed from people who don’t ask about it.

      And you may have noticed that people are being gently pushed towards silver plans.

  10. TimR

    My personal shopping choice wrt health insurance probably boils down to whether I should sign up for Medicaid or not. I’m probably eligible, just never looked into it. I wonder if low income earners don’t sign up for Medicaid, will they be hit with the penalty fee?

    1. Splashoil

      Well if you are over 55, it’s just pay as you go. A tab is started and you can build on that. Monthly premiums, all costs, in addition to any services actually performed. The clawback is called Medicaid Estate Recovery Program or MERP. You can’t use your savings to buy an Exchange plan to try to save your home for your kids. Plan accordingly.

    2. Cynthia

      Medicaid is for free if you qualify. Apply for it, you have nothing to lose. And there’s not a penalty if you don’t apply for Medicaid. There’s only a penalty if you make too much money to qualify for Medicaid and fail to buy a private insurance policy through the exchanges.

      1. Splashoil

        After your 55th birthday, Medicaid is not “free.” It is a lien against your families assets.
        You can thank Bill Clinton and Al Gore for that action. It dates back to a partisan tie vote in 1993 which VP Gore broke to pass the change (and the tab) to the old folks too poor to avoid Medicaid.
        I certainly do wish I was wrong. It is not “free.”

    3. Nathanael

      If you’re under 55, *and* you’re in a state which expanded Medicaid, definitely sign up. It’s become an extremely good deal, which is actually a major change.

      There are no more asset limits, you can receive gifts, they don’t check your house for hidden girlfriends, etc.

      They used to do ALL of that.

      If you’re in a state which didn’t expand Medicaid, FORGET IT — they still do all that crap.

      If you’re over 55, there’s some weird crap where the government can steal all your money, but it only applies if you get “home health care” or have to go into a nursing home. So you have to watch it if you’re over 55 — you would need to get a separate long-term-care policy to avoid that.

      1. Splashoil

        All States are required to recover all Medicaid costs from those over 55. Period. This dates back to 1993 when Democrats passed it on a partisan vote (VP Al Gore broke a tie to make this change pass. Costs to be recovered include monthly premiums for usually privately “managed care” and all other costs. Medicaid Estate Recovery Program (MERP) can be researched by State to pull up the ugly details….

        1. Nathanael

          Not actually true. I’ve researched it. There’s a specific restricted list of services which can cause “recovery”. It varies slightly by state, but for every state I’ve checked:

          Ordinary outpatient visits to doctors are not included.
          Inpatient hospital visits where you are not considered “institutionalized” are not included.
          Drugs are not included.

          However, if you need nursing or are institutionalized, you’re screwed, they take all your money.

          1. Nathanael

            Doing a little more research, it looks like some states (Washington State) do attempt to recover all money they paid out after 55.

            But New York, Wisconsin, and Texas (for example) do not.

        2. NotTimothyGeithner

          “VP Al Gore broke a tie to make this change pass”

          What about the filibuster? (Snark) I know the filibuster is a useful means for the Democrats to have their cake and eat it too and protect Jim Crow.

      2. Cynthia

        No doubt that ObamaCare has made Medicaid a much better deal. Too bad that those of us in the middle class aren’t eligible for it. I still would prefer Medicare-for-All simply because it doesn’t require any money or political input from states.

        1. Alexa


          Did you notice that there is a Medicaid Estate Recovery Program (MERP)–referred to by Splashoil?

          For Medicaid beneficiaries age 55 and up, the program amounts to a “glorified loan.”

          Anyone considering enrolling in Medicaid (age 55 and up) should check into the fine details of the MERP in their state, IMO.

          I have seen conflicting material on this program. Has anyone seen anything definitive regarding the “mandatory” aspect of enrolling in Medicaid?

      3. Alexa


        Are you aware of the Federal Poverty Guidelines for annual incomes (100-133%) for 2013?


        Only $11,490-$15,282.

        It seems to me that it would be rather unlikely that individuals with this “gross annual income” could afford to buy long-term care plans.

        In some states and localities, they are relatively expensive–even for lower to middle class individuals.

        And as Splashoil indicates–many, if not most states, have greatly expanded the services/procedures that are included in MERP.

        OTOH, you are right–it does vary from state to state.)

        I would say that this would be a program “of last resort” for anyone age 55 and up.

        I cannot imagine why the progressive community has not yet organized to defeat this toxic policy. It seems not to strike much of a chord in some progressive quarters.

        Anyhoo, the Medicaid program basically amounts to a “loan” for this cohort.

        Some deal!

  11. Cynthia

    Keep in mind, the more money spent on and other administrative costs, from overpaid executives to too many layers of management, the less money there’ll be for actual healthcare. Isn’t sadly ironic that the primary reason we need healthcare reform is to reduce administrative costs, but these costs are greatly increased under ObamaCare?

  12. rps

    People sharing their frustrations about Obamacare website dis-functionality are not seeing the Big picture. Rather, it’s complaining about how the inoperable maze was designed and thus, cloaking the premise of Obamacare. Healthcare for citizens is NOT the function of Obamacare -which is nothing more than horsesh-t health insurance product choices. Simply, the function of Obamacare is the mandatory public subsidization of Insolvent private insurance corporations…and they all are…AIG anyone? In otherwords, this is a boondoggle for Warren Buffet’s Berkshire Hathaway, Humana, Advocate, BC/BS, America’s Health Insurance Plans (AHIP), pharmaceuticals, medical device corps, nursing homes, etc. All these for-profit entities have one salient point in common, and that is gorging at the overflowing government cash spigot for them.

    If Obamacare was truly about creating a public healthcare system -all they’d have to do is umbrella the existing government healthcare systems such as medicare, medicaid and VA along with the rest of us. These public systems do work and have worked for a long time. They mostly malfunction when budgets are cut or outsourced to ‘save money’ -a Reagan falsehood to force outsourcing to private entities whose agenda is not for the public good but profit over people.

    1. Nathanael

      The Medicaid expansion is actually a very, very good part of Obamacare. I have looked at it carefully. It’s a huge improvement — in the states which accepted it.

      Medicaid was previously loaded with “humiliate the poor” provisions, and almost all of them just got ripped out entirely by the new law. It’s much more like Medicare now.

      1. rps

        I navigated the medicaid, SSI and DHS (dept. of human services) paperwork and such for a relative who has a lifelong chronic illness. Medicaid offered providers and services that HMO or PPO insurance companies restricted access to. The standard run of the mill health insurance corps determine the hospitals and caregivers. However, medicaid is a healthier choice since it includes cutting edge research hospitals/universities. For profit health insurance restricts the customers choices; whereas, medicaid encompasses state university hospitals that are also the research centers funded by tax dollars, grants, etc… The downside of Medicaid dependent on the state you live in such as Illinois, has determined dental care and corrective eye vision as unnecessary luxuries and not covered. Makes you dream of those state reps experiencing a Marathon Man dentistry moment, ‘is it safe?’

      2. Alexa

        The primary improvement that I am aware of is that “eligibility” has been expanded in approximately one half of the states–IOW, the Medicaid Program will now ensnare many more people who have slightly higher incomes.

        All the better for the States’ MERP’s!

        What other “improvements” are you referring to, please?

        (Not saying there are none–just haven’t heard about them, except the one that I just referenced).


  13. nmtdoc

    Here’s a good one. I’m on the site in NM. If you make 20k a year you have some really great policy options, almost all of which have 6k deductibles and 50% co-pays for all services except prevention screening. Anyone making 20k a year in Santa Fe is barely able to pay rent, utilities, and eat. A 6k deductible with a 50% co-pay is the equivalent of no health insurance. Interestingly, the the providers are getting a nice $300 each month from the government for offering these little policy gems. What a fraud.

    1. MDBill

      “Interestingly, the the providers are getting a nice $300 each month from the government for offering these little policy gems.”

      Not altogether surprising given that the providers wrote the underlying legislation.

    2. Klassy!

      I’ve been helping someone with a similar income because the navigator was useless– told him at first that he was not eligible for subsidies which was not true. There have been a lot of glitches in their enrollment, but they did correct that error. The subsidies and limits on out of pocket expenses can make it quite affordable, but I still say this contraption is a dog. It is a recipe for resentment– the somewhat more well off don’t get squat. Why should they not resent it? They are the only “stakeholders” (employing the language of the neoliberals) that had to take one for the team.

      1. Nathanael

        “the somewhat more well off don’t get squat”

        The experience is going to be different in different states. In New York, ALL premiums went WAY down. A standard HMO plan was $1200/month before. Now, a platinum plan, unsubidized, is about $600/month. This is a very real change for even the very well-off.

        New York already had community rating and guaranteed issue.

        In a number of other states, which didn’t have that, people with “pre-existing conditions” couldn’t get health insurance at ANY price, or were quoted prices far above $1200/month. So in those states, the well-off who had “pre-exisiting conditions” will find the new situation to be an improvement.

        It’s still a mess, of course, but I have to be fair: there are some real improvements in it. The Medicaid expansion is probably the best part.

        1. Klassy!

          Yes, I did not say that there weren’t some improvements. But, I would be seriously annoyed if I was one of those people that had a plan that was not compliant with ACA (before the reversed course with cancellations), but was a good choice for me and had a bunch of people telling me “well, your insurance was a junk plan, and everyone has to sacrifice for the common good.”

        2. archer

          Not true. I know someone salaried, in her 50s, non-smoker. She is seeing her insurance costs go up massively (and she’s financially very savvy and has done her homework). She figures the lowest cost option for her is to buy a policy and use a health savings account, and even then, the minimum cost for her (single person) will be $12,000 a year.

  14. Ed S.

    Local Bay Area NPR call-in show this AM featured two “experts” about ACA. Latest horror story is the so-called “kid glitch” (what a cute name for a horrific problem).

    Here’s the issue (as described by a caller and corroborated by the “experts”):
    Father employed and receives “affordable” insurance through employer (affordable defined as under 9.5% of household gross income). Don’t know if spouse is covered. His 2 children are not covered (he mentioned that the addition of the children to the plan was “astronomical” increase in cost.

    So no subsidy for father (because he receives coverage) – but no subsidy for children, either. The father needs to go to the “market” and purchase insurance for each child. So even the family is at 139% of poverty, he still needs to purchase coverage for each of his children and pay the full market price (or pay the penalty). But it’s only a glitch, eh?

    Gotta wonder why the R’s ever wanted to repeal this monster – from a purely political perspective (and that’s EITHER party cares about) – it’s the gift that keeps on giving.

    1. Nathanael

      Well, Obama promised that there would be no individual mandate….

      …yeah. And there shouldn’t be one.

      1. NotTimothyGeithner

        This wasn’t a mere promise. This was the one promise where he differed from Hillary. Obama and crew chose to oppose the mandate because the mandate would be unpopular because Americans hate the word mandate, so its particularly disingenuous when Obots complain about ACA not being popular.

    2. Nathanael

      Anyway, the economically effective “solution” is to get divorced and have the wife buy a subsidized family plan on the exchange.


    3. NotTimothyGeithner

      “Gotta wonder why the R’s ever wanted to repeal this monster – ”

      Distance. Telling people under a certain age that ACA is a Republican “alternative” to the Hillary-care fiasco could hurt the GOP with gullible young people, so the GOP is getting out ahead of it. 14 years after Hillary-care, the GOP Congressman are largely different than the 93 class.

      Obama will never tolerate the repeal of his ticket to glory (in his mind) regardless of what happens because Obama like W. before him is driven by his utter surety in his divine right to govern.

  15. susan the other

    “Market participation, aka shopping, is a toll of neoliberalism…” Well, there’s nothing liberal about ACA – it is a government susbsidized give away to a giant, totally incompetent, immoral and greedy industry. So if the neoliberals take this subsidy as a given, market participation is just a forced march that does not benefit the greater population. If we had choices we would make them. And the US would be a smooth running place. The only good choice is to leave the country.

  16. Foy

    I hate the complexity of daily life, it’s got to the ridiculous stage now. Business makes things overly complex in all fields especially in the realms of finance, utilities and telecommunications (even basic banking and credit card services…ever tried to read the terms and conditions of anything these days?!) because they know that a large percentage of customers don’t have the knowledge, expertise, and time to investigate things thoroughly which gives them the opportunity to gouge more eg a surprise late fee. or loss of interest penalty. And don’t start me tax complexity…

    And it’s all done through the concept of ‘giving the customer more choice’. But choice allows obfuscation. Even electricity bills are ridiculously complex here in Australia and hard to reconcile when there is a problem, and call centre staff are script driven and cannot resolve them leading to hours and hours wasted chasing a problem down like Francine encountered.

    Life seems all admin now. It’s definitely a feature not a bug. I keep picturing the guy in the 1960s getting home at 5:30pm each night to his family, sitting in the chair after dinner reading his magazine/book and maybe smoking his pipe, all relaxed until popping off to bed (or maybe that was just in the movies). I don’t see much of that going on any more. Everyone is chasing their tails doing admin.

    1. Banger

      I like the old Leary exhortation: “turn on, tune in, drop out.” I think we need to do that in a somewhat different way than Leary meant it. The system is designed to be klugey and stressful as features not bugs. I suggest pursuing alternatives.

  17. craazyman

    Shopping leaves me in a state of stunned bewilderment and I can’t even function. Even the wine store is a form of trauma. How do you choose? There are so many bottles, so many labels, so many prices. Will $80 buy a better bottle than $5?

    My conclusion is “no”. This isn’t a function of maximizing marginal utility it’s a function of minimizing marginal futility. If I spend $80 for a red wine from California it won’t get me any drunker than a $5 bottle. If I go buy clothes it won’t matter because I already have clothes. Same with shoes. Same with everything. Who really needs anything? Not very many people. Why would somebody have a theory that thinks because choice is good more choice is best? Because they’re insane.

    Marginal futility minimization is where we’re heading. That means no shopping, no buying, no spending money. It means working, but only if you have to, then crashing in front of Youtube and drinking cheap wine. As long as Youtube works and grapes are growing, who cares. Also we’ll need pizza (and coffee) and salad ingredients. But that’s as complicated as it has to be. If it gets more complicated than that, you might as well just die. It’s cheaper, if you discount the present value of the required marginal futility.

  18. different clue

    This post reminds me of parts of a book I read decades ago. The book is called Brainwashing: From Pavlov to Powers and it is by Edward S. Hunter. It is literally about
    the high-intensity individual brainwashing methods used by Communist authorities against individual captives or groups of captives under their control. Some of it was also about the low-intensity brainwashing methods applied to society-loads of millions of people at a time to keep them anxious, de-energised, time-deprived, etc. The experience your post describes closely matches some of the methods of mass control described by Edward S. Hunter . . . the carefully engineered theft of time, the carefully engineered repeated frustrations, the careful inculcation of anxiety, etc.
    It makes me wonder if the “inner and upper governments” have decided that communist brainwashing methods can be redesigned and re-applied to a neo-liberalist market-tyranny regime.

    1. craazyman

      who’s doing the brainwashing? If I think it’s who they say it is, they’re the ones who’s brains are so washed and rinsed they might as well be laundry in a basket..

  19. different clue

    If one reads the book, one will see parallels between some of the methods used by communist rulers then and neo-liberal marketist rulers now. Who is doing the low-intensity
    society-scale brainwashing? Whoever designed the time-sucking compexity of forced-shopping on the exchanges, for example. Whoever created these exchanges as time-traps
    and time roach-motels. In this and many other situations.

  20. Code Name D

    A quart can’t hold a gallon. If it holds a quart, it’s doing the best that it can. But neo-liberalism argues that a quart can hold a gallon if it manages its pints correctly.

    The wealthy are not wealthy simply because they have more money, it’s because it’s assumed that they smartly managed their pints in the past. And like wise it’s argued that the poor are poor not because they don’t have any money, but because they fail to manage their pints correctly.

    But this isn’t just an explanation for poverty, it’s the explanation they have why markets don’t work. It’s not because their notions free markets are wrong, but rather because consumers consistently make bad choices.

    The whole point of the ACA markets is to make it easier for consumers to make “the right” choices, AKA manage their pints correctly, and to start making the markets work for them by bringing down prices and improving care options.

    I don’t think Obama set out to make the exchanged complicated. In fact given the way he talks about the exchanges, he doesn’t think they are complicated. The complexity arose when he tried to accommodate all of the interests and ideologies involved, many of which are contradictory and nonsensical. But it’s not complicated because consumers have some times been described with omnipotent powers. Its “as if” consumers have a telepathic link to every other consumer in the market and can make complex evaluations on an intuitive level.

    Apparently right next to the part where God wrote the law onto are harts you will also find a perpetual stock-ticker.

  21. scraping_by

    The one aspect of ACA I’ve always thought would be creating an entire new specialy for lawyers. There are already Social Security lawyers, tax lawyers, and workman’s comp lawyers. among many others.

    As an aside, if you’re injured on the job it’s part of the law to get a workman’s comp lawyer to deal with the company. Your local labor unions are forbidden to recommend honest ones, but luckily there’s lots of lawbreakers.

    With requirements that range from arbitrary to absurd, it falls to lawyers to sort out individual cases. And not for cheap, I should think.

    The one thing mainstream economists get right is that legal fees are ‘friction costs’, having no productive return.

  22. RanDomino
    Dmitri Orlov in 2009: Boondoggles to the rescue!
    “The combined weight of all these boondoggles is slowly but surely pushing us all down. If it pushes us down far enough, then economic collapse, when it arrives, will be like falling out of a ground-floor window. We just have to help this process along, or at least not interfere with it. So if somebody comes to you and says, “I want to make a boondoggle that runs on hydrogen” — by all means encourage him! It’s not as good as a boondoggle that burns money directly, but it’s a step in the right direction.”

  23. redleg

    I’ll say it again in the land of the free
    Use your freedom of choice
    Freedom of choice

    Freedom of choice
    Is what you got
    Freedom of choice!


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