The Crapified Magic of the ObamaCare Marketplace

By Lambert Strether of Corrente.

“Please, sir, I want some more.” –Charles Dickens, Oliver Twist

I confess that this second ObamaCare enrollment period is even harder to write about than the first, because watching our famously free press normalizing — as “shopping” — what is clearly an insane system is so painful and degrading to watch. Perhaps the website debacle last year — an IT disaster for which nobody with executive authority has been held accountable, not even by our fiercely oppositional Republicans — has had the paradoxical effect of setting the baseline for ObamaCare’s success so low that even the most marginal improvements induce a mutual group hug in the usual cluster of reporters, apparatchiks, and political appointees. “At least the website works” is an awfully easy story to write.

Anyhow, the stories read like coverage of holiday shopping (“shoppers” having replaced “consumers”). There are crowds, and sometimes balloons, or cookies. Venues are brightly lit. Some shoppers are intent, others confused. Some buy at once, others take the brochures home. There are greeters, floorwalkers, assistants. Random individuals are quoted by name! The “experience” is great, except when it isn’t. Occasionally, there are problems, mostly technical. “Computers!” There are very few numbers, no context, and no analysis (Bloomberg, Reuters, WaPo, New York Times, Contra Costa Times, and many others.) It’s as if the entire press corps took Obama’s riff that buying health insurance should be like buying a flat-screen TV, and reverse engineered their stories out of it.
Never mind that ObamaCare shoppers are highly unlikely to know what they’re actually buying.

To avoid becoming bogged down in all this dull normality, I’d like to focus on three things: (1) The numbers game; (2) information technology; and (3) traps for the unwary enrollee.

(1) A General Lack of Purpose and Direction

A story almost as easy to write as “the website is working this year” is the numbers game: “How many signups will there be?” (Never mind that since health insurance is not the same as health care, we aren’t sure from the signup numbers what the concrete material benefits to enrollees are; you write the story with the numbers you have.) And that’s a very safe story to write, since not only do we not know how many will enroll for the first time, we don’t know how many will re-enroll, either. (IT issues prevent us from having these numbers, even if the vagaries of human behavior were taken into account.)

Politico has a puff piece on the “much more precise strategy” the administration is using this year, but International Business Times speaks of “malaise”:

The limited talk about the Affordable Care Act — only 44,000 mentions on Twitter at press time Saturday for “Obamacare” and less than 50 for “” — appears to fall in line with a general malaise about the law. While the number of uninsured Americans has fallen by about 10 million since last year, there as still 41 million people without coverage, and administration officials have said they are expecting a net gain of only 2 million people through during this open-enrollment period.

A net gain of two million? That’s not very much. You’d think — given the death rate — that signing up as many people as fast as possible would be Job One for the administration, but apparently not. In other words, the answer to “How many signups will there be?” is “Not nearly enough!” So what is the purpose of ObamaCare, since apparently delivering life-saving health care is not? ‘Tis a puzzlement!

(2) Mind-Bogglingly Horrible Information Technology

First, the back end is still broken. This really is mind-boggling. I’d rather write about the 2016 horse race than this, and since that makes me want to claw out  my eyeballs, you know how bad this is. For review, from 2013:

NOTE [2] Frontend vs. backend from Stack Overflow:

Generally speaking, the “front end” is the user interface, and the “back end” is the code supporting that front end (responsible for database access, business logic etc). …

Frontend is what you do that the user can see. Like designing a user interface. Backend programming is the code that the user doesn’t ‘see’. This is what works with the data behind the scenes. For example fetching/inserting/deleting/updating a database. …

So, if the WordPress back end were broken the way the ObamaCare backend is broken, you would press Submit — work with me here, I know WordPress doesn’t work ideally for everyone at all times — and rather than the bits and bytes of your comment being stored in a database, and then processed electronically and displayed as a web page, they would be appear in the backend by fax, and little elves would combine your comment’s fax with other bits of paper, typing and scissoring and gluing very rapidly, and then display that as the web page. Yes, that would be expensive, cumbersome, slow, error-prone, and basically, not the way work like this is done. And your point?

Anyhow, when Obama called in a tech dude SWAT team to fix the website in November 2013, he had them fix — for reasons nobody has ever explained — the user-facing, visible front end, but not the database-facing, invisible back-end, with the result that lots of ObamaCare’s data handling is, mind-bogglingly, still done by little elves. From the Philadelphia Inquirer:

“Everyone reports that there are still back-end issues,” says Joel Ario, a managing director at Manatt Health Care Solutions and a former Pennsylvania insurance commissioner. “That means there will be some cleaning up to do in terms of reconciling accounts and making sure payments are correct and the coverage dates are correct.”

That “cleaning up” is manual data entry.  And not only are little elves working for the insurance companies, they are working for CMS, too:

Insurance industry sources say the Centers for Medicare and Medicaid Services (CMS) had sorted through about 80 percent to 85 percent of existing accounts to make sure its records match those of insurers.

“Sorted through” is another euphemism for manual data entry. Obama’s famously data-driven campaign apparatus seems to have been powered by computers, and not by little elves. Of course, campaigns are important, unlike signature domestic initiatives that involve significant financial decisions — not to mention life and death choices — for millions of Americans, out there shopping in the flyover states. What a shame they’re not visible from the Acela!

But just because the back-end is still hosed — four five years after ObamaCare was passed, mind you — doesn’t mean the front-end isn’t, in its own very special way, hosed too. One of the shiny new features rolled out in this year’s non-crashing model of the website is “window shopping,” which permits you to compare plans without first going through an insanely cumbersome registration process that hands all your personal data to the government. CMS Administrator Marilyn Taverner, who still has a job:

“Using this tool, consumers can compare plans, covered benefits, and physician and hospital networks before the Marketplace annual open enrollment period starts on November 15,” CMS Administrator Marilyn Tavenner said. “New features will give consumers a comprehensive picture of the plans in their area so they can choose the one that’s right for them.”

First, let’s set a baseline. Let’s look at… Oh, flat screen TVs at Best Buy. What you do is, you check boxes next to the TVs you want to compare, click the Compare button, and the site builds a comparison page that looks like this:


Handy, right? I can compare the two products at a glance, because they’re side by side. So  I put on my yellow waders and went to to “browse my coverage options”, selected a couple of plans, and again clicked the Compare button. Never mind the hardly affordable prices, just look at the screen:


Are the two products (labeled “(a)” and “(b)” in the left hand column) side by side, like the flat-screen TVs? No. You click the (a) button, you get the page for product (a) (“Maine Community Health”), and when you click (b) (“Anthem Blue Cross and Blue Shield”) you get that page. So if you want to build a product matrix, you’re going to have to do it yourself, like a little elf! Even though, as Best Buy proves, a second-rate chain store can deliver what Marilyn Tavenner cannot.

But wait! There’s more! Smart shoppers know that it’s not enough just to look at the brochure; you’ve got to dig into the actual policy; so to really understand the product, you click on the “Summary of Benefits” and read a 9 page PDF file (if you have a PDF reader). And then you click on “Plan Brochure” and get taken to a whole other website! And smart shoppers also know that you can get gouged if you go to an out-of-network provider, so you will want to click through to the “Provider Directory,” which turns out to be the search page for another website. [1] That was plan (a), so, gamely, you do the same for plan (b), where the “Summary of Benefits” is ten pages long, with a different layout, in Microsoft Word (assuming I can read Word), the “Plan Brochure” is another website, with a different design, and the “Provider Directory” is another search page, except with different fields from plan (a)’s. So that’s two plans with six different interfaces and three data formats (HTML, Word, and PDF).[2] Imagine the combinatorial explosion if I wanted to compare four plans, or six! I work on computers all day. I’m a sysadmin. I can code. And I find this  intimidating. How am I supposed to cajole my little elves into adding all this incompatible and obfuscatory material to the product comparison matrix I have already asked them to manually create? Do they think I have all the time in the world?[3]

So when I read about people breezing into some brightly lit ObamaCare enrollment venue and signing up in half an hour, I think those people must be awfully trusting. These are expensive products, they can have a big impact on your life for good or ill, and nobody wants you to know how good they are.

How do you know that? How do you know that this whole “comparison shopping” scheme is bogus? The answer is right there on those two screens. Best Buy has a “reviews” section. ObamaCare does not.

(3) A Minefield With Missing or Deceptive Signage

First, remember that ObamaCare, as a neoliberal program[4], is all about the shopping. You are encouraged to shop, and to switch plans. Obama:

You only have three months to shop for plans, so it’s worth starting right away.  If you already buy insurance through the online marketplace, now is the time to take a look at some new options for next year.

The Times:

To those who already have coverage, Ms. [Emily Black Bremer, the president of the Missouri Association of Health Underwriters] offered a bit of advice: “Rates are increasing, plans are being added and discontinued, and benefits within plans are changing. Consumers who do not take an active role in evaluating their benefits and subsidies may find themselves unpleasantly surprised in 2015, or at the very least paying more than they have to.”

But there are peculiar consequences to shopping in the ObamaCare “marketplace” that don’t happen at Best Buy. One is that you can get billed for a different product than the one you bought, or even for two products when you only bought one. Why? That mind-bogglingly screwed up back-end.  Remember that CMS had little elves doing a lot of manual data entry? Politico:

The agency is not likely to be done by [November 15]; the latest best-case scenario is for the job to be finished by Dec. 15.

So people will be signing up for next year even though the little elves haven’t finished cleaning up last year’s data. What could go wrong?

The date is key because anyone currently covered who doesn’t either re-enroll or pro-actively opt out will automatically be re-enrolled in the same plan or the closest match for 2015. But with all the gaps in the system, consumers could find themselves in the wrong plan — or even enrolled in more than one plan. Nor will the health plans always know promptly if a customer dropped one plan and chose another

So ObamaCare can still screw up your billing if you just auto-renew. But it can also screw up your billing if — as the President of the United States and the President of the Missouri Association of Health Underwriters both advise you — you switch plans. Philadelphia Inquirer:

It may be the law’s second enrollment but it marks the first time will manage 7 million people renewing their policies – some of whom will change plans, carriers, or both – while enrolling about the same number of new consumers.

While people are being urged to shop, switching plans is exactly what has insurers worried. Because of back-end communication issues, insurers won’t be able to tell the difference between a customer who has auto-renewed and one who has left for another company.

A termination file will not be sent from the marketplace to an insurer when someone switches companies until after the exchange closes on Dec. 15. So an insurer will not know that it has lost a customer until the reconciliation process takes place.

For consumers who switch, that can mean getting billed for two plans, or worse, getting lost in the system.

Fortunately, or not, most shoppers consumers citizens aren’t entirely insane, and aren’t going to listen to either of our presidential insurance salespersons. Most of them will stick with “what works,” their current plan. Politico:

A majority — 68 percent — who received insurance through the exchanges said they plan to renew their policy

Phew! But wait! There’s a special minefield laid for those who renew! It’s called “The Silver Plan Baseline Effect.”  Health Care Policy and Marketplace Review:

This is all compounded by something called the baseline Silver Plan’s effect on subsidies. The second lowest cost Silver plan in any market determines what a person’s subsidy will be. Last year, that plan was probably the plan that got the biggest enrollment and also the plan with the biggest rate increase this year. So, it’s probably the plan George has….

But because George’s plan is no longer the baseline plan, even though George is on subsidy and he is supposed to be shielded from any rate increase by the taxpayer, his premium is going up unless he changes to the insurance company that now holds the honors as having the second lowest cost Silver Plan.

So, George scrambles, in the very few days between his getting his January premium invoice (likely about December 6th) and the January 1 cut-off for open enrollment on December 15, to sign-up for that lower cost plan and save his full subsidy.

So, as in any marketplace, you have choices, because life is all about choices: You can stick with your plan, and step into the minefield of rate increases from the “Silver Plan Baseline Effect,” or you can switch your plan, and step into the minefield of getting billed for the wrong plan, or billed twice, or lost in the system. That’s some catch. Of course, looking on the bright side, they can just screw up your billing no matter what you do, because billing is one of the things that the back end is supposed to be doing, but little elves are doing instead.


At this point, I will issue my ritual prophylactic disclaimer that of course some people are helped by ObamaCare; a program as big as ObamaCare is bound to do that. And for those who are compelled to comment on how great the plan they got is, I’m happy for you; I just think that every American deserves to be as happy and lucky as you.

It’s the crapification that gets me: We’ve got, on the very same continent as our own, a single payer system that covers everybody for a boatload less money — those wacky Canadians call it “Medicare” — and the best we can do in this exceptionally great country, this shining city on a hill, is normalize a program that still leaves 41 million uninsured, that has gross defects in its construction, and that is a full of traps for the unwary that will cost you bucks to some unholy number or needed treatment for a vital organ, whenever you look at it sideways or put your foot down in the wrong place. Because markets.


[1] If they gave you a fixed list of doctors, they would find it harder to swap your doctor out of your plan halfway through.

[2] The CMS developers put a thin layer of CMS-ness over existing insurance company IT.

[3] Yes. Yes, they do.

[4] The essence of neo-liberalism is transforming public social relations into transactions — ideally involving rental extraction — because markets.


“ObamaCare and Its Opportunity Costs”:

The key point to remember in all discussions of ObamaCare is that neither it, nor indeed the entire private health insurance “industry,” should exist. They are rent-seeking parasites, economic tapeworms. One does not improve a tapeworm; one removes it.

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About Lambert Strether

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


  1. ambrit

    Phyllis is on Medicare while I am not eligible yet. I do not participate in HeritageCare, nor do I toil right now, so no health policy. I’m wondering how the IRS is going to handle the ‘non-compliance’ issue. If one spouse is covered and the other is not, are their respective incomes segregated for reasons of tax penalty, or are both penalized in a ‘guilt by association’ sense? Seems like the Policyend is screwed up too.

    1. sleepy

      I wouldn’t bet on it, but logic would say that if you file jointly you both are liable for any money owed. If you file separately, the liabilities are separate.

      Again, this is obamacare, so don’t bet on logic.

        1. Ernesto Lyon

          As I understand it you are only liable for the penalty if you have a refund coming.

          If you just plan your taxes so that you don’t have a refund you should avoid the penalty.

          (Someone correct me if I’m wrong.)

          1. different clue

            What little I have read/heard is that the fine increases year by year, and after several years of boycotting Obamacare, the fine is vastly huger than any refund would cover.

              1. Forgot my NC handle

                Not at all — the Brits have universal healthcare. The enclosure Movement was about grazing livestock, if I’m not mistaken.

  2. andyb

    Given Gruber’s unwitting exposure of the fraud and deceit that were baked into the pie, it is fairly obvious that the ACA has been purposely planned to fail to either set the stage for single payer (an insidious form of totalitarian control) or to further decimate the middle class; both of which are part of the agenda of all good Marxists, or Fascists; hard to tell the difference anymore.

    1. katiebird

      I’ve only heard that he thinks American’s are stupid.
      Have we learned anything from him that we didn’t know before?

      1. scraping_by

        He’s actually flipping the narrative. If Americans were stupid, they wouldn’t need to lie. They could just present this steaming pile and say ‘It’s good for you’ and stupid people would nod and go along. Instead, they rattle off jargon and indirection, head fakes and conditionals, and let the practical social value of trust supply the missing links.

        Con artists always blame the mark.

    2. Katniss Everdeen

      Essay question of the day:

      Please explain this mind-numblingly ignorant yet often-repeated characterization:

      “……. single payer (an insidious form of totalitarian control)……..”

      Pay specific attention to the concept of “insidious totalitarianism” as it applies to Canadians, all of whom have access to quality healthcare from the moment of conception until their deaths, and are, by all measures, healthier than their American neighbors. No credit will be given unless the financial aspects of healthcare–far less total national cost of said “totalitarianism” with not a single Canadian fearing personal financial devastation as a result of serious illness–is addressed.

        1. Katniss Everdeen

          Well, it IS Sunday and that would be the “christian” way to look at it.

          But I skipped “church” today. So, for me, andyb will need to “clarify.”

      1. Forgot my NC handle

        That caught my eye, too.

        Decimation of the middle class is much more easily achieved through a profit driven system that lets the ill and infirm suffer and die, than by providing single-payer healthcare.

        andyb is apparently suffering from brain parasites.

        1. Yves Smith

          Obamacare was never about getting to single payer. It was always about promoting further rent extraction by Big Pharma and the health insurers. Andyb is wrong, but not for the reason you articulate.

          1. Forgot my NC handle

            No doubt. Rent extraction is fine for someone who has been living without shelter or cover, but who COULD pay the rent, if there were no discrimination.

            Before the ACA, one couldn’t pay the rent, even if they could afford it.

            The ACA, if nothing else, does away with pre-existing condition exclusions.

            You will get old. You will get sick. Being INELIGIBLE for coverage is unbridled capitalism, and it would leave the vast majority by the side of the road to die, if it could.

            Yves: My mention of single payer was in response to an earlier comment. I never have viewed it as a stepping stone towards anything else.

            I hope we shitcan the ACA for single-payer or government option (a real market threat to insurance company earnings, if enough people take the latter option).

    3. P James

      “single payer (an insidious form of totalitarian control)”

      Haha. You’re a sick person, you need help.

    4. flora

      It is a neoliberal program.
      “First, remember that ObamaCare, as a neoliberal program”

      Neoliberalism serves the interests of the mega-corporations and great wealth. As an ideology it disguises this subservience as something noble. Neoliberals can say to themselves that they are merely disinterested proponents of a logical economic system, TINA, rather than admit to themselves they are just suck ups to wealth. If the neoliberals said to themselves that they were unquestioningly obedient to great wealth at the expense of everyone else it would be too humiliating. Neoliberal ideology is a great excuse. No need to bring in other “-ists” as your argument does.

    5. different clue

      You are the baby that rich people steal candy from. The purpose of Obamacare was obviously to prevent Single Payer from ever emerging. The other purpose was to create a “stub” which can be more purely Heritagized once rotating power is re-assigned to the Republican officeholders.

      1. urban legend

        Yes, of course, the hundreds of thousands of people who have jobs with insurance companies in Connecticut, California, Indiana, Pennsylvania, Wisconsin, Maryland, Washington and many other states were not on the mind of any legislators when they bought this concept. But then again, since you are a progressive and they are employees of corporations that never pay any claims and only try to screw people, they deserve to lose their jobs.

        1. Yves Smith

          First, insurance companies do cancel policies of people with big-ticket ailments, systematically:

          Second, the data PROVIDED BY THE INDUSTRY shows that cancellation rates may be as high as 50% in the populations they target for cancellation:

          If the top 5% is the absolute largest population for whom rescission would make sense, the probability of having your policy cancelled given that you have filed a claim is fully 10% (0.5% rescission/5.0% of the population). If you take the LA Times estimate that $300mm was saved by abrogating 20,000 policies in California ($15,000/policy), you are somewhere in the 15% zone, depending on the convexity of the top section of population. If, as I suspect, rescission is targeted toward the truly bankrupting cases – the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier – then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette.

          Third, the industry, which WROTE THE OBAMACARE BILL, made sure to preserve this ability to cancel policies:

          Fourth, as someone who makes ONLY routine claims, I have experienced first hand how my insurer has regularly engaged in insurance fraud, including throwing out claims I sent in and hoping I forget to resubmit them. I’ve had to write New York State about fraudulent denial of claims ten times over the 20 years I had my policy and the state regularly sides with me. I am lucky enough to live in a state where I have the right of external appeal to the state regulator. Most people who have claims falsely denied are screwed.

          I now have customer service reps and supervisors routinely say that there is no reason in my policy a claim should have been denied, they’ll resubmit it to be paid. Not only won’t it be paid, I won’t get the paperwork I am supposed to receive about the resubmission.

          Fifth, no industry has a right to exist in a capitalist system. Floppy disk makers and workstation manufacturers have gone the way of the dodo bird. Video rental stores are virtually dead. You want the government to protect insurance industry predatory practices because they have become essential to industry profit margins and CEO pay. And because the industry is so powerful a lobbyist, it got them.

          Wake up and smell the coffee. Your view of the health insurance industry is 20 years out of date. The industry is rife with fraud. You should be ashamed to be working in it, which is why I assume you came here to do thought policing.

  3. sleepy

    Yesterday, it was mentioned how most people renew their auto and home policies every year. Even if you don’t, changing to a new company is so relatively simple compared to obamacare, it makes your head spin. I did that this year–just walk into a local agent’s office with your old declarations page and ask what kind of deal you can get for the same coverage. Takes 30 minutes and the whole time you are sitting across the desk from a real person who, at least in my experience, seems cheerfully willing to make a mutually acceptable deal.

    1. Pedro

      The public, particularly the RW is scared that someone might rip them off. I.E. do what they would love to do or are doing. Hence the extensive cross checking. As far as the individual mandate, why is the same RW constitutency so scared of rip offs, and then don’t want everyone to pay their share, and yes the IRS is the logical co-ordinator for the funding? The only misuse of IRS info has generally been traced to the various administrations and congress.

      How about giving everyone a Medical card? Like the Military ID, good for ID, and for medical care.

  4. Faye Carr

    I’m interested in seeing what happens at tax time when people who didn’t sign up – or signed up & couldn’t pay try to file their 1040’s. All the ‘penalty’ crap has gotta hit a fan or something, Yes?
    I have Medicare (no extras) and I like it just fine, mostly. I do pay for it, and have a co-pay of course. It’s getting slightly worse now with the ACA messing with my providers (single Dr.s not conglomerates) who are NOT happy. Seems they’re losing money by the bucketfull.
    Less patients, slow or no insurance payments, increased staff & med practice hardware and software expenses.

    Hmmmmm, exactly who is happy with ObamaCare? That’s rhetorical btw

    1. Forgot my NC handle

      As an uninsurable cancer survivor under the old system, Obamacare is, to me, a gift from heaven.

      From that standpoint, I’m VERY happy with it.

      Wanna’ walk a mile in MY shoes, Faye?

        1. urban legend

          Jeez, I wish everyone was as lucky and happy as I was when I managed to get my 24-year-old daughter with a serious health condition on our insurance when she was out of a job. But that’s not an answer to anything. You have to start somewhere, and getting to where we need to be is going to take time. Getting the structure in place was a gigantic step. Anyone who thinks single-payer had a prayer of a chance in the House or the Senate to blow away an industry employing hundreds of thousands of people in every state in the country, or even to serve as a bargaining position, is a genuine idiot. You are awfully cavalier, too, about the ten-plus millions of people who were uninsured before who now have it and are insured against at least the most devastating expenses; or perhaps most important of all, the 150-200 million who right now are insured through an employer but now, unlike before this law, have the assurance they will be able to get insurance if they lose their job. It’s all my marbles or I’m going home, I guess.

          The next step is to build public demand for a public option that can be inserted right into the exchange system. The people who need it most are those approaching but not yet eligible for Medicare who have low or no credits under the law but incomes that are still very middle class. Because of the age premium allowed (3:1 max), their costs, while affordable in a theoretical sense, are pretty steep. It would be a political no-brainer for Democrats to propose the option for people between 50 and 65 who cannot get employer-sponsored insurance to buy into Medicare. I cannot believe that simple proposal would not win millions of votes, and if there is enough public pressure we could force it into law.

          Some states are going to try to adopt their own single-payer systems, and they could morph into regional systems with populations as large as those of the biggest European countries; that means that, unlike, for example, the State of Vermont by itself, they could be large enough to have the necessary economies of a huge pool of insureds.

          There are many constructive things to do to make the law be closer to But continuing to whine about single-payer — a system that, by the way, does not exist in every European country — and then joining the right wing in cherry-picking the kinds of problems that any massive system is going to encounter when it is introduced, is utterly useless.

          1. Lambert Strether Post author

            So, your concept is to spend 100% of your energy defending what is as a way to get to what we both — apparently — believe should be? Weird investment of time, if you ask me.

            I hear “but we love single payer” a lot from career “progressive” types that suppressed single payer when they could have supported it, and won’t lift a finger to move the ball forward even when given the chance. Your comment falls into that category.

            “Whining” about single payer is the tell; total up the deaths, and then come back to me about whining.

      1. Faye Carr

        I am walking (well, I can’t walk exactly) in your shoes. When I did have employer based insurance (sporadicly – which is another insurance issue nobody talks about) it never covered the condition that led to leg braces and walking sticks.Medicare now only covers the maintenance of my condition.

        If I lived in a country with socialized medicine, they would fix it. Might have prevented it in the first place.
        No matter our personal stories…

        It’s STILL insurance NOT care

    1. ambrit

      That’s the one thing ‘they’ should hand out for free; Bennies. Takes the edge off the free floating anxiety this big old cluster f— induces.

      1. Johann Sebastian Schminson

        You can buy your way into many. Perhaps JCC is able to pay his way in. If not, he should start saving. No one wants you here, if you don’t want to be here, JCC. Nothing is holding you back.

      2. scraping_by

        I was going to say something rude about cleaning toilets (which is untrue – the vast majority of Americans aren’t afraid of an honest job) but then I thought of a parent with a child with a chronic/life-threatening condition. If they could get the sick loved one into health care from day one, there are many who’d move to a single-payer country and take whatever there was on offer with no delay and few regrets.

        But from what I understand, there are citizenship requirements in nearly all of them, both for the system and for getting a job. Still…

  5. Kokuanani

    Articles like this [and the related comments] make me want to root for the success of the Republicans’ “repeal Obamacare” campaign.

      1. quixote

        (I know I’m being hopelessly juvenile, but I’m starting to think my subconscious is smarter than I am because it’s been reading that acronym as p-p-ca-ca right from the start.)

        To your main point, I doubt there’ll ever be a repeal. When the old Mittbot was campaigning on that point, I understand the insurance companies told him, “That’s all well and good, but make sure those nice new payouts to us keep coming.”

    1. different clue

      The Rs “repeal Obamacare” campaign was never anything but a hoax and a con to fool their trusting voters with. The Rs plan to purify it to its Heritage Plan roots and the Catfood Democrats plan to help them. The Rs may call that “repeal”, as in: ” we’ve changed Obamacare to Heritagecare. No more Obamacare. There. See?
      We repealed it.” Will their loyal voters accept that logic?

      1. timotheus

        What about the Supremes re-review of it? That could upend the ACA at least in part–according to the commentaries anyway.

        1. different clue

          I predict that the Roberts Court, led by Roberts himself if no one else will lead it, will uphold the meaning of “state” as being “government” in the classical sense. The Roberts court will hold that “state” MEANS “federal government” within the meaning of THIS law.

          Does anyone really think that Roberts would permit any erosion of the Revenue Streams to Big Pharma after he worked so hard to uphold those Revenue Streams to begin with?

      2. Johann Sebastian Schminson

        They readily accept the illogical, so accepting the logical shouldn’t be too difficult (as long as them liberals ain’t involved).

  6. beene

    The best part of the system is it may not pay anything. Recent national news story tells of a insured person who was unconscious was taken to wrong hospital; meaning basically that she was not insured and would be responsible for the entire hospital bill.

    1. OIFVet

      That’s the trap that awaits millions who purchased policies based on the cost of premiums rather than on the size of the plan doctor and hospital networks. As Lambert points out, figuring out the plans’ networks is as cumbersome as any other aspect of this “shopping experience”, but it helps to keep in mind that HMOs= small networks and PPOs= larger networks. But of course there is a catch there also: not all PPO networks are created equal. BCBS of Illinois, for example, has a “traditional” PPO network and a “Blue Choice” PPO network. Nowhere on its website is the difference explained, and one needs to do seriously time-consuming doctor and hospital search to figure out that the “Blue Choice” PPO is in fact a glorified HMO with a restrictive network, while the “traditional” PPO includes virtually every doctor and hospital in Illinois. I spent literally 70 hours last year trying to figure out the best plan to purchase for my mom, and most of the information needed was not on the Obamacare site. Great “shopping experience” indeed. In the end I reached one main conclusion: trying to save money on premiums is guaranteed to cost far more in the event of a serious medical, as there is no limit on out-of-network costs. My advise is to purchase the cheapest plan that has a large PPO network, and place money aside for the out-of-pocket maximum. Cheapest being very much relative of course: the premiums will be quite a bit larger than those of HMO and “non-traditional PPO” plans. It’s the extortion cost one must pay to be sure that they know what their maximum exposure will be. In a system built for the express purpose of obfuscation and maximum profit taking, knowing the real maximum amount one must fork over is about as good as it gets. The lady in Madison was unconscious, but even if she had been conscious would she be able to figure out whether every single member of the surgical team is in her plan’s network?

        1. OIFVet

          Don’t get me wrong, this could be a sound approach for younger people in good health who are willing to roll the dice. For a woman in her early 60s with a modest income and savings (like my mom), paying a premium for that large PPO network is all about risk management. Risk management, not health management. This is how perverse this monster is. At least she is in position to afford to pay premium. Many are not. My dad rolled the dice when he wanted to start his small business and lost: developed Type 2 diabetes while “saving money” by going uninsured. He had been healthy so it seemed like it wasn’t a large risk. Of course, after he got the Type 2 he became uninsurable and had to face bad choices: do I pay large hospital, doctor, and medication costs to manage my condition, or do I pay my mortgage? Do I pay both by incurring credit card debt or borrowing against my home equity? He made his “choices” and is now dead. This is an outcome that would not have happened under the “inhumane” single payer system he had in communist BG. This is what infuriates me the most about Obamacare: it gives people the illusion that they have coverage, only for them to discover that they may not be covered after all. Too many people do and will face the same “choices” that my dad did. I have a single payer coverage through the VA, and it is great regardless of all the propaganda smears against the VA care. They do very well given their underfunding and large patient population with chronic conditions. I want this quality care that I get to be available to everyone so that no one has to say goodbye to a loved one like I did. Having crappy insurance-like product is most definitely different from having access to any care, much less quality care.

      1. Forgot my NC handle

        My Oncologist was in, now he’s out. Nice guy, but I’m willing to bet his practice declines substantially.

      2. urban legend

        Emergency care is different. The law prevents insurers from denying coverage for emergency care even if the hospital is outside the network.

    2. Synoia

      How did the unconscious person sign a contract, or when after treatment was she competent to sign a contract, and at the time of signing was she under duress (fail to see how she could not have been)?

  7. ella

    A bit off topic but many physicians in my locale will not accept Medicare. Instead they only accept Medicare Advantage and only from a limited list of insurers. How long before Medicare is eliminated in favor of Medicare Advantage? And will Medicare Advantage be only available on an exchange in the future? Obviously, the republican administration that created Medicare Advantage, a system that benefits insurers and is more expensive to administer than Medicare will continue to push for the privatization of Medicare. This will be a great loss to all including the physicians because once Medicare is privatized, the insurers will cover less and less. Thus, the physicians who earn more now with the Medicare Advantage plans will earn less in the future. But why look ahead, when you can make more now? GADS!

    1. ambrit

      Simple solution. Revoke the license to practice medicine of anyone who refuses to accept Medicare. (How’s that for intrusive regulations! [Er, something about “public purpose” seems to have escaped most peoples’ attention.]

    2. different clue

      Privatized Medicare is also the long-range goal of Obama himself and his Obamacare. Obamacare is intended the toilet down which Medicare will be flushed.

      1. Oregoncharles

        I’m not convinced ANYONE involved is thinking that far ahead, or, really, ahead at all. Witness the infamous “rollout” – which was also botched in very blue Oregon with a very blue governor (re-elected, unfortunately – I’d almost rather have a Republican) who was an avid supporter of Obamacare and an opponent of the single-payer bill here – which was actually pretty close.
        I guess we try again next year. There’s a demonstration planned at the Capitol Feb. 11th, 11 to 1, if you happen to be in Oregon.

    3. trinity river

      In my area, doctors who do not want to accept medicare (most of them) say they do accept Medicare, but limit new patients to a certain # a week so that the wait to get in is months, not weeks. And the Rs said they were against rationing and single payer would ration care. Opps.

  8. Brooklin Bridge

    I note this comment by a longtime supporter of Obama and ACA on Jonathen Turley’s blog (an interesting post in and of itself):

    A majority of Americans give good reviews for insurance they recently acquired through government exchanges within the past year, a new poll shows.

    With the second round of Obamacare enrollment set to begin on Saturday, 71 percent said their coverage through the exchanges was good or excellent, according to a Gallup poll released Friday. Another 19 percent said the coverage was fair, while 9 percent rated it poorly.

    The pollster notes that these marks are comparable to all who have health insurance. However, those newly insured through the exchanges are more satisfied with the cost of health care — with 75 percent saying so — versus 61 percent of all insured respondents who said they were satisfied with the cost of health care.

    A majority — 68 percent — who received insurance through the exchanges said they plan to renew their policy, while an additional 7 percent said they will look for a new policy, but through the exchanges.

    Read more: Very interesting new poll………..

    I don’t place much faith in these types of polls because money; because I suspect that if you wave enough of it around and you are sufficiently powerful, the pollsters fall within a sphere of influence that somehow affects the questions asked, the choice of people asked, and the analysis of the results. Still, I would be curious if anyone has any take on why the above information would be particularly suspicious or skewed.

    1. sleepy

      One concern about this poll was raised the other day:

      How many of those who were satsified have actually used their policies and filed claims?

      1. Pedro

        How many of those who who have “lost” their wonderful old, pre ACA coverage really ever had to use it?
        I would rather question the regulation requiering universal emergency services for people who don’t feel they have to pay for it, and are employed. Is it a sense of entitlement for living ?

        1. different clue

          And for those willing marks who willingly buy Obamacare and think they have bought coverage for “it”, how much “it” is really covered?

          If you are one of those marks who believes in Obamacare, let us see how true is your belief after you experience some of its “downsides”.

          1. Forgot my NC handle

            I have survived due to “Obamacare,” and have not been declined ANY coverage — even though I have many physicians treating me, hospital stays, and straight-up regular healthcare visits to my doc.

            Yes — I guess I’m a “mark.”

            You should hang your goddamned head in shame.

            1. different clue

              Well! Aren’t you the lucky lad! We’ll see over the next 10-15 years how many other people enjoy your good luck and good coverage. In 10-15 years we will know whether I should hang my goddamned head in shame.
              Till then, I will take my chances on the analysis of intelligent people like Yves Smith, Lambert, and others who post here; rather than taking one lucky person’s special case as being a counter-analysis worthy of consideration.

              Meetcha in 15 years.

              1. Johann Sebastian Schminson

                Yes! I’m lucky! Lucky there’s the ACA!

                You asked for down sides, I’ve used my coverage, extensively, and there have been no “down sides.”

                That’s my report. First hand, and in no need of bolstering by referring to opinios of those who haven’t used the system, no matter how influential those folks might be. Weak.

                You might get cancer, tomorrow (that’s how it happened to me — one day very, very strong and healthy, the next, dying). Then, you’d be the lucky one. 15 years is a long time. If you do end up in a chemo chair, may you have ACA coverage, or better, and may you be haunted, incessantly and with ever greater power, by your own comment as you move through the “cure.”

                1. different clue

                  Currently I have big-group-plan coverage from my employER, a mighty midwestern fortress of academic medicine. So do all my co-workers. We already have the coverage you were lucky enough to get with Obamacare. We live in fear that our coverage will eventually be cancelled, voucherised, and/or otherwise crapified down to Obamacare levels.

                  So your wish for me is one of the stupidest things I have read on these threads, given that I already have more than Obamacare could ever hope to offer me. And the Obamacare conspirators are planning to destroy it and take it away from us all.

                  For now I will continue to take the serious analysis of intelligent people over the breathless anecdote of one lucky obamapologist. We’ll know in 15 years.

  9. trish

    God, this stuff almost as much eye-gouging face-and-hair-ripping fun to read as it is to write about. Reading the details (of which you have labored to provide us) is much like an assault. (though thank you, truly, for this assault.)

    I hate shopping. When I must do it for whatever reason, I rather quickly reach a point of brain-numbing headache and utter fatigue. I am sapped- indeed at a point of ultra- sappage, virtually brain-dead. And I feel an almost anxious desire to just grab what I need and flee the shopping paradise.

    So the experience for the “shoppers” here (coupled with anxiety and reassurance by “our famously free press normalizing” it all) perhaps similar?
    Fatigue and malaise and numbing = docile & complacent & compliant… acceptance of the best their gonna get….sapped of all will to fight the tapeworm, perhaps, a feature not a bug?

    1. pretzelattack

      they couldnt cancel my policy last year, maybe because of the back end problems, who knows. the insurance co advised me not to pay the premiums, so that they could cancel it for nonpayment.

        1. Lambert Strether Post author

          Actually, the law is written so that the IRS can’t garnish your wages for ObamaCare penalties.

          Made for mass tax resistance, which shows the kayfabe nature of Republican politics on this.

          1. ambrit

            Off the top of my pointy little head; what about things like the Earned Income Tax Credit? I remember this little item helped out in the good old bad old days.
            I wouldn’t be surprised to see that garnishment provision get the ax as some part of a Tax Overhaul Bipartisan Commission bill.
            (I’ve become so cynical I doubt my own sanity.)

          2. flora

            Wonder if failure to pay the fine/tax/penalty would show up on one’s credit score, leading to higher cost for goods/services that looks at credit scores when setting individual rates? Stuff like auto/home insurance for example.

  10. quixote

    While people are being urged to shop, switching plans is exactly what has insurers worried. Because of back-end communication issues, insurers won’t be able to tell the difference between a customer who has auto-renewed and one who has left for another company.


    No, really. Whuuuuuut? /*boggle*/ /*BOGGLE*/

    They must be counting on so few sign-ups that the backroom elves can keep up with their little scissors and jars of rubber cement. /*I know I’m repeating myself, but … bogggggle.*/

  11. pretzelattack

    i’m to the point of hoping the republicans will save us from the democrats on this. this is hurting people.

    1. Forgot my NC handle

      With what? This plan, again? The Republicans don’t save anyone but themselves and business interests. The OLD way was killing people.

      1. OIFVet

        “The Republicans don’t save anyone but themselves and business interests.”

        And that makes the Democrat party different because…? Let me ask you something else too. Will someone who can barely afford the premiums and living expenses go see a doctor regularly given the astronomical out of pocket costs? Obamacare will kill people too. It will save some, just like the pre-Obamacare plans did, but it will nonetheless kill people jut as surely as being uninsured. The difference being, Obamacare will first forse you to fork over money to the “business interests” whose lobbyist wrote the law.

        1. Johann Sebastian Schminson

          The Democrats might also be driven by money, but if you are arguing that there is no diff between the two, just look back to 1980, when the “crapification” began.

          At the very least, at least the Dems have a few liberals among them. The Republicans are abject mental/moral/governance “conservative” retards, to a person.

          Make no mistake: The Republicans moving off the right side of the political map drew the Dems to the right. Not a good thing.

          1. OIFVet

            The Dems considered the Reagan “revolution” and reached the wrong conclusion. Since then they have continued to reach the wrong conclusions time and again. Even after this last midterm debacle, where the Blue Dogs got whacked while the progressives survived, the conclusion they drew is that they need to move more to the right. How about they move to he far to the left and force the Reps to send back their wackos to the mental asylums where they belong? Hell, we will even pay for their care with the newly instituted single payer system.

            1. Johann Sebastian Schminson

              They (the Dems) are weak and ineffectual. I’m of the mind that it might be easier to change the party than it would be for a new party to get traction.

              There have been some good — or at least acceptable — third-party alternatives, but they never get traction.

              Oh, what I would give for a reset button.

              1. different clue

                Some, like Kucinich and the soon-to-retire Dingell are weak and ineffectual. Others, like Pelosi and such are Vichy Democrat co-collaborators.

  12. Banger

    The fault for all this lies in two places. First, the MSM refused to present the facts to the American public–flat out refused except in a few places where there was some mention that there is a world outside of the borders of the USA and that, perhaps (if legends can be believed) something called science and logic exists or existed. The politicians are coming close to being pure and absolute criminals but we’d never know from the Fourth Estate and that makes them far worse than the politicians and crooked insurance executives. Our anger for this mess should be primarily directed towards the misdirection and propaganda that makes up most of the content of the print and TV media outlets.

    But, secondarily, we should blame the public for wanting to believe these lies because to not believe them would demand that we face the fact that we have an illegitimate and criminal government and that might require us to well, do something other than entertain ourselves to death.

    1. Jackrabbit

      Wowsers + tortured ‘blame-the-victim’ logic.

      The public craves being lied to as a sanctuary from the lies they tell themselves?

      H O P

  13. dejavuagain

    You guys just have to wait until you turn 65 and navigate Medicare, which has had years to figure things out.

    Remember, Medicare Part B still charges you for just 80% coverage, and that will cost you between $42.00 a month to $230.80 a month, and then you have to go get Medicare Supplement Plan from AARP or someone else for another $180 a month. Then, you still have your mandatory prescription plan between $12.10 and 69.30 a month and then another donut hole plan. Oh yes, you AARP plan will have a big deducitible, and if you do not get the Supplement Plan, you are not covered on your trips to your apartment in the South of France (but, do not worry, the French will still take care of you). So, when my wife can get a very nice Affordable Care Act plan in Manhattan for $600 a month with the same deductible, that is not so bad. And, then I had to fight this past week to get a common drug covered.
    Get over it. I know a lot of people personally who have benefited immensely. I have good friend cancer survivor who is 63 and lives in Manahttan and has a great ACA plan with a subsidy. She would be SOL without ACA. I have another friend who thought he was smart and did not sign up. Last month he ripped his bicep. At 60, not so great. But, he will still get an ACA plan and have it repaired. Without ACA, he would be SOL. I too wanted a single payer plan – ACA is a step along that path, and so much better.

    Oh yes, when covered by a corporate plan, there were huge deductibles, and all sorts of tier 3 non-convered plans and screwing doctors and insureds – and yearly increases. I had premier NY bank plan, and still could not go to my preferred orthopedist at Hospital for Special Surgery. I had to sue them to get stuff covered that was clearly covered.
    So, just look at the other half-empty glasses, and let’s get behind the half-full ACA.
    But, I do thank you for pointing out the poor design of the ACA website – this is important. [In the meantime, Adobe’s CC downloads are taking days (two days to download Premiere), yesterday I discovered an activation bug in Microsoft’s 365 for Mac after four hours on the support line, and Bank of American rejected a properly endorsed tax refund check and the check has been in limbo for week somewhere – three hours wasted on that. That is just one week of screw-ups incuding people not turning out to vote and Cuomo being reelected.

    1. marym

      Before the ACA lots of people had decent or better health insurance. That wasn’t a reason to “get behind” the system then, and it’s not a reason now.

      The flaws you reference in the privatized aspect of Medicare (supplements, Medicare Advantage, and drug plans) are the same flaws that exist in ACA private insurance, the result of systems built to enrich insurance and drug companies rather than to provide access to healthcare.

        1. marym

          Fortunately no. As the author said in the conclusion to this post, people were helped by the ACA and everyone should be happy about that. Now what about the tens of millions who are still uninsured and underinsured, still victims of the many flaws of the insurance system that weren’t addressed by Obamacare?

          1. Johann Sebastian Schminson

            Remembered my handle. Gotta’ love the drugs.

            Anywho . . .

            More people are covered now, than under the old system. That ain’t perfect, but it’s certainly better.

            If Americans want an equitable share of the pie, they should stop voting to have their already über-thin slice taken away, just to prove that ‘better’ wasn’t quite good enough.

            1. marym

              This is the essence of neoliberalism. Do something that helps some people while ensuring that the long range effect (upward transfer of wealth, privatization of the commons, socialization of losses, empowerment of the rentiers) is terrible and increasingly difficult to reverse.

              In arguments about the ACA for the last 5 years, most opponents on the left are willing to acknowledge that some people are better off as a result, though the numbers aren’t clear yet. However, defenders seem reluctant to acknowledge that the cost of these benefits is a move in the wrong direction. It’s a big problem to know how we can achieve anything, on any issue, unless people who claim to want to benefit the 99% see the difference between neoliberal programs that empower the 1% while some benefits trickle down, and progressive programs which protect and expand the commons on behalf of the 99%.

              Blaming the victims for not clapping loud enough seems to be a feature now as well, though probably more a feature of red team/blue team theater than intrinsic to the neoliberal agenda, but as long as it persists, it’s difficult to see how we change direction.

              1. Johann Sebastian Schminson

                I’m not supporting the ACA in it’s entirety (in fact, it’s terrible law). Nonetheless, it is FAR better than our former “free market” system.

                And the essence of “conservatism” is to do nothing. For anyone. Ever. Let them die in the gutter.

                A trifling difference, I know . . .

                1. marym

                  If we find ourselves in a position where only a few incremental steps forward are possible (whether more was possible in 2009-2010 is another discussion), then we need to find ways to take those steps without also taking 10 steps in the opposite direction.

                2. Lambert Strether Post author

                  Sure, so 41 million can do in the gutter, the ones who aren’t covered. I’m happy for your good luck, and staggered by your unwillingness to advocate for those whose luck is not as good as yours.

    2. OIFVet

      No, we will not “get over it”. Your anecdotes are nice and all, but they do not apply to Obamacare “customers” as a whole. Most of the plans are crap, particularly for those on the lower income range, and even those who can sort the crap from the lesser crap may not be able to afford the lesser crap and high out of pocket costs. Speaking of which, maximum out of pocket is misleading advertising: given narrow networks many on the “cheap” crap plans will face medical bankruptcies in the event of a serious medical event. You want me to “get over” that? Not bloody likely.

      1. Pedro

        Who is underwriting those crappy plans? Who is supposed to watch the watchers that monitor the underwriters of those crappy plans?

        After way too many years of BS about government, i.e. US you and I, being the problem not the solution, we are fighting being hired help on the yachts of the Uber-Wealthy job creators.
        The blessed ST Ronnie was subsidized by the MIC and CA realtors who made a fortune when a monkey with darts could have made a fortune in California real estate. Reagan was a great communicator who had face recognition courtesy of the propaganda machine of the US Army.

        1. OIFVet

          Here is an idea: how about we do away with the underwrites and their “watchers” altogether? Sure, blame the voters if you want. But do we have any real choice at the polls? I submit that choosing between the evil and the slightly less evil wings of the Corporatist Party is not a real choice.

          1. Johann Sebastian Schminson

            True, they are both evil, but I wouldn’t tempt fate by choosing the more evil of the two.

    3. Katniss Everdeen

      Yeah, guys, just stick out your chin, and GRIN…….

      The sun’ll come out
      Bet your bottom dollar
      That tomorrow
      There’ll be sun!

      Just thinkin’ about
      Clears away the cobwebs,
      And the sorrow
      ‘Til there’s none!

      When I’m stuck in a day
      That’s gray,
      And lonely,
      I just stick out my chin
      And Grin,
      And Say,

      The sun’ll come out
      So ya gotta hang on
      ‘Til tomorrow
      Come what may
      Tomorrow! Tomorrow!
      I love ya Tomorrow!
      You’re only
      A day
      A way

      So ya gotta hang on
      ‘Til tomorrow
      Come what may
      Tomorrow! Tomorrow!
      I love ya Tomorrow!
      You’re only
      A day
      A way !

    4. Jgordon

      Nice to see that you live in Manhattan and don’t consider $600 to be a big deal. By the way, your whole post reads a good argument for bringing back the guillotine and breaking out the pitchforks to someone lower down on the socioeconomic luck ladder.

    5. roadrider

      I too wanted a single payer plan – ACA is a step along that path, and so much better.

      That’s a ridiculous assertion. Heritage Care the ACA was specifically designed to head off demands for a single-payer program. Obama rigged the “reform” process so that single-payer could not be considered and then sold out the public option in a sleazy backroom deal. How does any of that square with the ACA being a “step along [the] path” to a single payer system? What the ACA really does is further cement the philosophy of privatized public services for the enrichment of profiteers irrespective of the harm caused to the public. Medicare Advantage is an exemplar of this philosophy rather than an indictment of Medicare as you claim and the ACA is simply a larger scale example of the privatization scheme. And the prescription drug issues you howl about are mainly a result of prohibiting Medicare from using its bargaining advantage with pharmaceutical manufacturers – an enormous subsidy to that industry at the expense of the public thanks to the corporatist rather than an inherent flaw in Medicare.

      Those of us who advocate Medicare for all are referring to HR-676 which addresses the issues you have brought up (co-insurance, poor drug coverage, co-pays, etc.) rather an expansion of the current system.

      Concern trolling over anecdotal examples of people who have lucked out and benefited from the ACA is silly and an ultimately worthless argument. Just as many or more counterexamples could easily be produced.

    6. Lambert Strether Post author

      Did you read the conclusion? “And for those who are compelled to comment on how great the plan they got is, I’m happy for you; I just think that every American deserves to be as happy and lucky as you.”

      ObamaCare is a “step along the road to single payer” only in the sense that ObamaCare should be abolished and replaced with single payer. ObamaCare, in its legislative design and history, was always designed to prevent single payer; that’s what the Heritage plan that morphed into RomneyCare that morphed into ObamaCare was all about.

      1. dejavuagain

        Lambert. I read your exculpatory sentence, but that don’t hunt. This was just your way to attack emotionally without providing details.
        So, people are unhappy. Who says everyone should be happy. A lot of people were unhappy before. There was ample evidence that people who were screaming about Obamacare a year ago never attempted to see what was available. All of the repug horror stories of a year ago were taken apart. if you recall. So, I wonder why the horror stories this year will be any more supported by the facts.

        Well, why can you not provide with reasonable detail of a single person who is totally screwed by an Obamacare policy. When you do this, include the pertinent provisions of their prior policy, whether it was subsidized by an employer, the cost of their current Obamacare plan, the alternative the person could have obtained, and the coverage denied under the Obamacare plan which would have been covered by the prior plan.

        As to single payer, Medicare is single payer, and it is not all wine and roses either. Is that what you are recommending – and the insurance companies and drug companies and providers all have their dirty hands in Medicare. One thing though here in NYC – the providers are accepting Medicare for they need the business, and the low reimbursement rates are forcing them to be a little more efficient. And, many providers are having to accept ACA plans – for the same reason, and with the same result.

        So, what is your personal health insurance history? What were you paying before. What are you paying now. Do you have pre-existing conditions? Did your pre-ACA insurance cover any doctor you wanted anywhere at 100% with no deductible. I just wish people who are so critical will provide the nuts and bolts of their own personal coverage.

        The health care system in the US is broken. It is too expensive and inefficient. But, Obama did not create the broken system and Obamacare does not make it worse. Even with single payer, it would still be broken and expensive, just the expense would be shared by all, and then the single payer would have to grapple with all of the overcharges and fraud that Medicare tries to do sometimes. And, if single payer had gone into effect in Obama’s first term, do you really think that the government could absorb that administratively given the history with Obamacare??? Get real.

        1. quixote

          Um, you live on PlanetUSA. I understand everything is different there and not what it seems. In the developed countries on my planet, health care costs half as much per person and *covers everybody* with better health outcomes. (Longer life spans, lower infant mortality, fewer hospitalizations and illnesses in old age, and so on.) On PlanetUSA that may make single payer equally “broken and expensive,” but, really, another world is possible. As soon as we get faster-than-light communication worked out, we’ll try to let you know about it.

          1. Lambert Strether Post author

            Actually, faster than light communication is not needed; politics is. Ceaseless repetition in support of a sane policy is part of that. That’s not the same as JSS’s ceaseless repetiton of “I’ve got mine.”

          1. dejavuagain

            So, Lambert, what do you do for health insurance and how does it compare today to three years ago?
            Are all your specialists covered?
            Is your plan subsidized by an employer? Do you know how big the subsidy is?
            Do you feel comfortable with a plan that kicks you off when it has to start paying?
            Do you feel it is proper for the government to require men to pay the same as women?
            Do you feel comfortable with a plan with lifetime limits?
            As far as administration, it was the people who bring you Medicare that oversaw Obamacare web 1.0.

            1. jrs

              Geez, if anyone wasn’t buying healthcare do you really think they’d tell you? And admit a crime with tax penalties?

            2. Yves Smith

              Let me just say I know enough about Lambert’s situation to tell you he is no hypocrite on this issue, and you can go to hell for suggesting that he is one.

              I have a terrific and cheap legacy plan (an indemnity plan) that I have had for 23 years. I can see any doctor anywhere in the world. No joke. I have had claims from the UK, Thailand, and Australia reimbursed. I know all of its features and they are very simple. The fact that I have such a simple plan and that plans like mine were once common (indeed, back in the day I got it, my plan was considered to be crappy) is proof the ripoff called Obamacare is government sponsored rent extraction.

              Every 24 months or so they get stupid (by design) about some aspect of paying my claims, but that is bog standard across all insurers. And because I’ve been with them for 23 years, they can’t play the card they play to get policies rescinded, the “fraud” out (that you had some past ailment, including trivial ones, you didn’t tell them about).

            3. Lambert Strether Post author

              Adding, on “the people who bring you Medicare that oversaw Obamacare web 1.0,” what a debater’s point, and not a very good debater’s point, either.

              The “people who bring you Medicare” are able to do that because Medicare, even infested with neo-liberal programs as it currently is, is still simple, rugged, and proven — a single payer system — unlike ObamaCare, which is complex, fragile, and not proven. ObamaCare has the fundamental requirement of keeping the multi-payer health insurance industry at the heart of the health care business, and that’s the source of the complexity. There is plenty to say about the program management skills of CMS and HHS, but the fundamental problem came from the requirements of the project.

    7. dejavuagain

      What I always find in the criticism of Obamacare are anecdotes about other people. Sure, there were other plans out there which dealt with the routine, but were cancellable and had lifetime limits and did not deal with pre-existing conditions. So, a lot of people tooks risks and then moaned when they were screwed by their insurance companies. And, many of the anecdotes come from people who have not done the simple math of adding their yearly premiums to the deductibles and co-pays. So, when looking at a plan, one good comparison is to compare plan to plan by assuming the worst, not the best. But, most people do not do that. Sure, there are crappy plans with large deductibles, but those have low monthly premiums. So, I was pointing out that Medicare suffers from many of these same issues and is not free.

      So, people with the pre-ACA plans that were so great were just lucky the did not end up with a medical disaster which screwed them over despite the so-called good coverage from normal care. I had a near-gold-plated policy and still got screwed over.
      So, I would just like to see one of those great pre-ACA plans, and I could poke huge holes in the exceptions and limitations that could truly limit the coverage of these plans in the event of a major medical issue.
      So, show me a pre-ACA plan not subsidized by an employer and then tell me: was there a life time max, were pre-existing conditions covered, what was the deductible and co-pay, and could the insurer cancel the policy or refuse to renew for any reason such as if the insured got cancer etc.

      1. OIFVet

        Sure bud, people are too stupid to “shop” the exchange “properly”. Could it be though that this complexity is there for a reason? Surely, as such huge self-proclaimed advocate for single payer, you realize the advantage of a simple to use health insurance? Yet here you are flogging the exceedingly marginal “improvements provided by Dear Leader’s insurance reform plan. So no more lifetime caps and preexisting conditions, but millions more “customers taken to the financial woodshed by being forced to buy a defective product. Great. And FWIW, I challenge you to provide one example of Yves and Lambert using anecdotes in their reporting of this fiasco. You, otoh, did just that, the good O-bot that you are.

      2. marym

        None of the flaws of the predatory private insurance system pre-ACA and non-ACA, including its inroads in Medicare and Medicaid, justify further entrenching that system and further empowering and enriching the predators, while concurrently leaving tens of millions of people still uninsured or underinsured.

      3. flora

        so, before the ACA, health insurance was frustratingly complex, unreliable, abusive of customers and too expensive for a lot of people. So a lot of people didn’t buy it.
        now, after the ACA, health insurance is frustratingly complex, unreliable, abusive of customers and too expensive for a lot of people. But now if they don’t buy it they’ll get fined, er, taxed.
        What a Deal!

          1. Lambert Strether Post author

            Some did, as any idiot knows, and you seem to find it necessary to repeat; the conclusion says as much. What amazes me, or not, is that you aren’t ceaselessly repeating “Everybody should have coverage like mine!” Wouldn’t that be just as useful, and helpful to others?

      4. Yves Smith

        Sorry, you clearly don’t read the comments section carefully. Most of the complaints about Obamacare here are from people who used it or are trying to use it. For instance, we had a series of posts by Michael Olenick, who analyzed all the 132 plans or so he was eligible for and wrote up his findings. Olenick decided based PRIMARILY on the ACA to move to France (his wife is a citizen and his main consulting gig was with a French university, so he twisted their arm a little to make him full time).

    8. cwalsh

      Yeeah duude,
      Get over it!
      Thanks fer bringin back old memories of hearing that refrain after Bush v Gore.
      An oldie, but goodie …

  14. PaulHarveyOswald

    Thanks for staying on the ACA beat Lambert. I was on the site for comparison shopping yesterday and within five minutes I had at least a dozen tabs open. And I was only checking into switching within the same carrier. The “side by side” comparison is anything but. After a half hour of frustration with no results I punted.

  15. Uncle Bob

    re; “backend programming” as a nurse put it to me at my last appt., “their (Feds) computer data base and our (Valley Medical Center) computer data base could not respond to one another.
    Even though I sent my forms in 10/1/2013′ the first day of the initial enrollment, I did not receive my new card until 9/2014. I printed the PDFs forms off the website because that’s the only part of the website that worked. By 12/2013, revelations that mailed-in forms had been misplaced/lost/uncounted.
    During this time, I was unsuccessful contacting my local health care provider, Valley Medical Center, even though I still had my medical #. The automated telephone answering system did not recognize my number.
    Talking to a real person after a 30-45 minute wait, yielded scripted responses.
    Now that I am back in the system, the “backend” functions are atrocious. I cannot cancel/reschedule an appointment over the automated system. Instead, the Dr.’s office calls me informing me I missed my appt. and I apologize and tell them about the automated system, and get scripted answers.
    Very frustrating and the silly, ridiculous part of this is, is that I am in Santa Clara County, the home of Google, Cisco, Intel, Oracle, Apple; yet the County’s Automated Health Care system is all messed up

  16. PaulArt

    My wife and I together will make about $8000 total in 2015. I applied yesterday at the site and i was told that my income is too low for any tax subsidies and was presented with a lowest cost plan of $640 per month. So, no subsidy at all. Thinking there must be some mistake I called customer service and was helped by a very nice lady who was very patient and worked really hard to try plugging in every last piece of information and yet she too came up with the same plan choice at the end. She had absolutely no clue why I was being denied any subsidy. My explanation borders along the following thesis: In July of this year I applied and got Obamacare with a subsidy. We kept it for a month and then dumped it because we could not afford it. Maybe that’s why we are being penalized? I am now going to re-apply to Medicaid (Indiana) to see if maybe we qualify in 2015. We did not qualify in 2014 because I had just quit my job then to move into a full-time PhD Teaching Fellowship and my total income for 2014 from the previous job came to around $50,000. This is another very weird and strange phenomenon in this country. You are applying for Medicaid because you no longer have any decent income but the amount you made up till that time will always be considered like as if you still have that $50,000 with you. How f**king insane is that? So I am hoping that in 2015 they cannot consider the $50,000 I made in 2014. I am a Teaching Fellow on a 3/4 fellowship with only the Spring portion left for 2015. Keeping my fingers crossed. I would still support any GOPer who wants to repeal Medicare and Medicaid. There is nothing like shared pain to generate public momentum. Dump all the old foggies on Medicare into the private market with vouchers like the Ryan plan. That would be brilliant. We will get Medicare for all within a year.

    1. bob

      As soon as single payer was taken off the table, this should have been the response from anyone “concerned” about heathcare.

      Dump it all. Medicare, medicaid, subsidies etc.

      A lot of old farts don’t even know that they’re on medicare. “That’s for poor people, I have my own insurance.” If you are over the age to qualify for medicare, and have “private” insurance, the private insurance bills medicare for you without your knowledge of consent. Lots of debate and balance sheet games for fortune 500 companies around this at the time of “obamacare”. Large employers with lots of retirees got a huge “subsidy”. A true subsidy, not a 3rd party subsidy voucher.

      The whole mess is gold plated duct tape and bailing wire.

    2. different clue

      Actually, no. No American would ever have Medicare ever again.

      The bed you make for old fogies is the bed you lie in when you become old and fogie.

      1. PaulArt

        The people who regularly vote in the GOPers in every mid-term election are mostly the old fogies who preach austerity and free markets for everyone else while basking in the comfort of their Social Security and Medicare. You don’t have a clue about why the GOPers will not touch Social Security or Medicare do you? In every Presidential election since 2000 the GOPers have been accusing the Democrats of dismantling Medicare. Why do you think the GOPers who hate Government would want to protect Medicare? Its because they know that the people who vote for them regularly in the midterms are the old fogies on those Church pews. This is why I say that if you take their security away, medical and financial security, see how quickly they will come to our side. Old people in the USA are the WORST spoilt brats anywhere in the world. The first slice of the baby boom generation was and is the worst. National debt and government spending resonates with this ignoramus class because they worry that if we run out of money then the first programs to go will be Medicare and Social Security. All that hoopla about our children inheriting debt is pure twaddle.

        1. Lambert Strether Post author

          “Old fogies…” Always nice to see somebody using sophisticated analytical tools. And last I checked, the average Social Security payment was what? $1,200? Not a lot of basking going on there.

          So, with “Old people in the USA are the WORST spoilt brats anywhere in the world,” thank you for sharing your hate and pure ignorance!

        2. different clue

          If SS and MCare were ever cut or cancelled “for the old people of today”, do you think they wouldn’t be equally cut or cancelled for the “future old people of tomorrow?” Do you think that?
          Really? Can you say why?
          Have you considered the alternate possibility that the Republcan Catfood Democrats wouldn’t quietly negotiate a deal with “the old people of today” to leave THEIR SS and MCare in place in return for voting for lawmakers who will cut or cancel OUR SS and MCare tomorrow? Doesn’t that seem more likely to you?
          Survival is a privilege, not a right. And life is a gift, not a reward.
          Those who are too stupid to live have no right to exist. And don’t deserve to survive. And you, PaulArt, sound like one of those people. I only hope you don’t take down the rest of us in your crusade to cut/repeal SS/MCare to “convert the old people” to Single Payerism.

  17. Alan

    It’s just healthcare IT. Now just think of this: doctors and nurses are struggling with the same software problems while trying to take care of you, in the hospital and their offices. It wasn’t designed to be user friendly. It was designed to collect data on you.
    This is what the government has done to your healthcare: get in the way.

    1. Lambert Strether Post author

      Wrong. The data collected is insurance billing data. It’s not the government “getting in the way”; it’s the government reinforcing the power of rentiers (in this case, the health insurance industry) to collect fees.

      1. Alan

        But govt initiating it all nonetheless listen I’m a moderate not a conservative free market for everything guy. But it wasn’t big pharma that gave govt the authority to do this. Was the other way around
        Remember Hillarys attempt in the 90s with the task force went immediately to the wrong people.
        Blame the greedy lobbyists and pharmacy. I hate this system. But it’s our govt that mandated it.
        And as long as we are on to accountability, let’s go one step further back, to ourselves. We get the govt we deserve, not the other way around.

        1. OIFVet

          What does “moderate” mean, exactly? Not free market everything kinda guy doesn’t say much of anything. Does it mean you like single payer? But if so, the single payer in question is the government, the one that “gets in the way”. Hate to ask, but did you happen to be one of the fine folks yelling “Keep your government hands off my Medicare” several years ago?

          1. Alan

            Well no; I was secretly hoping it would survive long enough to get it’s benefits, but it we can’t afford it, and an intelligent and ethical discussion were done to scale back, I would have to support it. That’s what I mean by moderate.
            Also, by saying moderate, I also mean I just don’t know the best approach, it’s too complicated. But one way to approach it might have been to first ask medical personnel, then managers who could make it happen, then IT people with some background in healthcare. Not pharma first.
            People seem enamored by the single payer idea; but remember the US is not Canada. They will not sit back and say “oh well” when their heart angiogram is put off for 6 weeks. It will force us to face the reality that resources are limited, however. A more moderate approach, one where our govt failed us, was when Bush bowed to pharma and failed to make drugs meet price guidelines for medicare. There were many examples of this. That’s what this website is all about. But I believe there is a place for capitalism; under the regulatory thumb of a government with the needs of it’s citizens in mind.
            For a single payer example, look at the VA. No one much talks about that example any more. Could it be done much better? I’m sure it could. But my gut feeling is…I don’t trust the govt is smart enough to figure it out. Nothing I’ve seen in the last 6 years has made me feel any differently.

            1. OIFVet

              Oh, please do tell me about the VA single payer system. You have piqued my curiosity. As to the rest, I admit you got me all confused and I could not understand exactly what are advocating. Scaled back Medicare, but one where the government regulatory role is expanded? If so, what is the purpose of having the additional government bureaucracy to oversee a scaled back Medicare? I admit I am hardly a management genius, but that makes very little sense to me; matter of fact it sounds suspiciously like communism to me…

  18. Linda Amick

    Try as I might I could not sign up for ACA Healthcare. Doing that would BE my sickness. Better to live clean, grow food without herbicides and pesticides and die of natural causes with dignity.

    1. Forgot my NC handle

      You could cut all of your future expenses by dying today.

      If expense is your discriminator, you would accept your own logic and do the right thing.

  19. different clue

    Another reason for all this complexity should be considered. It could be designed as a time-suck/ energy-suck designed to consume the effort and attention of millions of people so thoroughly that they become too pre-occupied, diverted, and worn out to do any reformist or revolutionist thinking or acting.

    A good book on this subject is Brainwashing; From Pavlov To Powers by Edward S. Hunter. It was written literally and strictly “about” communists and communism, but parts of it are applicable to the Corporate Soviet Fascism of today.

  20. Forgot my NC handle

    “Obamacare” is a Republican program. Not “neocon” or “neoliberal.” Republican.

      1. Johann Sebastian Schminson

        It is a plan brought into existence, from it’s very first iteration, by conservative Republicans. As current law, the Republicans amended it some god-awfully great number of times before voting it down.

        The Dems went along (as they always do*), but this baby daddy is the Heritage Foundation, and it was finished and polished to a fine and shiny turd by Republicans.

        *The Democratic Party base needs to clean house. Political blood in the aisles of Congress would do a lot to hold the survivors’ feet to the fire.

        1. Lambert Strether Post author

          False. The sequence is Heritage->RomneyCare->ObamaCare. ObamaCare as we know it was crafted by Liz Fowler, a VP on secondment from Wellpoint to Max Baucus, Democrat, as his chief of staff.

  21. Forgot my NC handle

    Lots of folks in here claiming they’d rather die or suffer with disease than to enroll in the ACA.

    I can only hope y’all never get what you claim to welcome onto yourselves. Not to worry if you do, though — most folks don’t question the previous ignorant, hubristic statements made by people currently in agony and scared to the point of distraction.

    I’ll live with a pain in the ass, as long as it’s not colon-rectal cancer.

    1. Splashoil

      Which O’care plan in any State will cover your Colon Rectal Cancer? The Congessional plan not available to us plebes does not qualify as an answer.

      1. Johann Sebastian Schminson

        I’ve never had C/R cancer.

        You show me an exchange that doesn’t offer a plan that covers cancer.

        1. Johann Sebastian Schminson

          Apparently you are up to date on all of the state ACA offerings. So, as an expert, please post-up some information on a state or federal exchange that doesn’t offer coverage for cancer treatment.

        2. different clue

          ( And remember, if it isn’t 100% of all costs it isn’t coverage. If it doesn’t cover the out-of-network specialists who can actually solve your cancer, it isn’t coverage. Let’s remember that when we submit examples of how ” this or that is covered! yay!”

          1. Johann Sebastian Schminson

            You seem to be unable to comprehend that I’m talking about real experience — not chance, or potential. You think I haven’t seen specialists? You think I haven’t gotten horribly expensive medicines at a fraction of their “free market” prices?

            Dude: I have been to the mountain, and come back to have you tell me what’s what.

            If you’re lucky, you will never know how wrong you are.

            BTW: Which exchanges were you referring to, above (or is your comment baseless)?

          2. Lambert Strether Post author

            Dromaius had at least one post here in the early days on just that. IIRC, some cancer patients (children?) needed to keep going with doctors who weren’t in network, or worse, doctors across several networks; too lazy to find the link right now.

  22. Forgot my NC handle

    No doubt the ACA is the worst government-managed “healthcare” system on the planet (consider the source). Nonetheless, it’s far better than our old system: healthcare subject to naked capitalism.

  23. Forgot my NC handle

    If the Republicans present Obama a Bill overturning the ACA, he should sign it.

    In fact, Obama should tell the Republicans he’ll sign ANY and ALL Bills they sent to him.

    Let’s all learn, once and for all time, exactly what unbridled conservative government will bring us.

    It’ll make Dickensian London look like a spa weekend at the Ritz Carlton.

    1. OIFVet

      Republicans=bad. We get it. Now, please explain to me the goodness you see in the corporatist democrats, such as Max Bauchus and Kent Conrad and Obama and Rahm Emanuel who, despite having 60 senate votes, did not EVER consider single payer? What makes democrat giveaways to the parasites from the insurance industry any less deplorable than the republican giveaways to the same? What makes Obama’s deal with Big Pharma, reached in the “smoky backroom”, any less deplorable than Bush’s deal with it that prohibited medicare from using its leverage to negotiate better drug prices? And whatever happened to Dear Leader’s promise not to make deals in the “smokey backroom” in the first place?

      1. Johann Sebastian Schminson

        I see nothing necessarily good about the Dems, other than being slightly less bad than the Republicans, and on many fronts.

        I’m surprised, OIF, that you seem to suddenly see the world in stark black or white.

        The short and skinny: I view it as the difference between Bernie Sanders and James Inhofe (and for the same reason Sanders caucuses with the Dems).

        1. OIFVet

          Don’t get me wrong Johann, I can still see all sorts of gray shades. I just refuse to bargain Obama-style: assume a center-right position, move to the right to get it passed, and proclaim the result a “progressive” policy. Sure, Sanders is a good guy. But what has he accomplished by caucusing with the Dems? I listen to him every friday on Thom Hartmann, and while he says the right things about policy issues he simply refuses to be the guy who points out that the great liberal Dear Leader and his party have no clothes. That will never get us the real left party and real left policies that we need. There are other good people in the Dem party, but the power there rests with the Third Way corporatist and these good people are little more than progressive hood ornaments: they make the party look better but add no functionality to it whatsoever. So, I prefer to start from the far, far left and not settle for anything less than FDR-type left-like policies. That, to me, is the real lesser evil.

          1. Johann Sebastian Schminson

            Okay. Maybe I see the Dems as having a little variety in their ranks (not in leadership positions), as opposed to the Republican lock-step, baseless, irrational homogeneity.

            I’ll take 1mm forward (or even stasis), over 1 mile backwards. Or a small chance over no chance.

      2. Johann Sebastian Schminson

        BTW, OIF: Read your comment again. If you see no difference between the two parties, why would you even care if Obama signed all of their theocratic, science-denying, gay-hating, poor-hating, race-driven, xenophobic, political desires?

        I wish he’d do it, and then we could revisit this comment thread in hindsight and from within the “conservative” utopia.

        1. OIFVet

          IOW, identity politics have triumphed. Look, the dems are far better for minorities, be they sexual , racial, or ethnic, then the xenophobes in the R party. I have never argued otherwise and I never will. But when it comes to the economic polices, do you see the difference between the two? I see it: the R’s are too cheap to spring for KY jelly while bending us over, while the Dems are nice enough to pay for the lube. Considerate corporatists, these dems. In the end though, we are still being bent over. Sorry for the analogy but it is quite accurate, IMO. Economic policies affect us all, regardless of race or sexual orientation. So while I am happy that gays can now marry like every hetero person, what is the use if the dems economic policies will beggar them just as surely as the R’s would?

    2. flora

      See Wendel Potter’s latest blog posting.
      “…Even though there is still chatter about repealing Obamacare, GOP leaders and insurance company executives understand that isn’t likely to happen. And they really don’t want it to. Insurance firms and their shareholders actually love the billions of dollars in new revenue they’re getting as a result of the law’s requirement that most of us buy coverage from private insurers…..”

    3. Lambert Strether Post author

      This isn’t a game, you know; there are more lives at stake than your own. I don’t advocate repeal exactly because it would cause the suffering you describe; I advocate replacement.

  24. Pepsi

    This scares me so much. Why are these people allowed in power and who are they trying to fool with this absurd fake system?

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