ObamaCare’s Neoliberal Intellectual Foundations Continue to Crumble

By Lambert Strether of Corrente.

ObamaCare is, of course, a neoliberal “market-based” “solution.” ObamaCare’s intellectual foundations were expressed most clearly in layperson’s language by none other than the greatest orator of our time, Obama, himself (2013):

If you don’t have health insurance, then starting on October 1st, private plans will actually compete for your business, and you’ll be able to comparison-shop online.There will be a marketplace online, just like you’d buy a flat-screen TV or plane tickets or anything else you’re doing online, and you’ll be able to buy an insurance package that fits your budget and is right for you.

Let’s leave aside the possibility that private plans are phishing for your business, by exploiting informational asymmetries, rather than “competing” for it. Obama gives an operational definition of a functioning market that assumes two things: (1) That health insurance, as a product, is like flat-screen TVs, and (2) as when buying flat-screen TVs, people will comparison shop for health insurance, and that will drive health insurers to compete to satisfy them. As it turns out, scholars have been studying both assumptions, and both assumptions are false. “The dog won’t eat the dog food,” as marketers say. This will be a short post; we’ve already seen that the first assumption is false — only 20%-ers who have their insurance purchased for them by an institution could be so foolish as to make it — and a new study shows that the second assumption is false, as well.

ObamaCare’s Product Is Not Like a Flat-Screen TV

Here’s the key assumptoin that Obama (and most economists) make about heatlth insurance: That it’s a commodity, like flat screen TVs, or airline tickets, and that therefore, there exists a “a product that suits your budget and is right for you” because markets. Unfortunately, experience backed up by studies has shown that this is not true. From ObamaCare is a Bad Deal (for Many). From Mark Pauly, Adam Leive, Scott Harrington, all of the Wharton School, NBER Working Paper No. 21565 (quoted at NC in October 2015):

This paper estimates the change in net (of subsidy) financial burden (“the price of responsibility”) and in welfare that would be experienced by a large nationally representative sample of the “non-poor” uninsured if they were to purchase Silver or Bronze plans on the ACA exchanges. The sample is the set of full-year uninsured persons represented in the Current Population Survey for the pre-ACA period with incomes above 138 percent of the federal poverty level. The estimated change in financial burden compares out-of-pocket payments by income stratum in the pre-ACA period with the sum of premiums (net of subsidy) and expected cost sharing (net of subsidy) for benchmark Silver and Bronze plans, under various assumptions about the extent of increased spending associated with obtaining coverage. In addition to changes in the financial burden, our welfare estimates incorporate the value of additional care consumed and the change in risk premiums for changes in exposure to out-of-pocket payments associated with coverage, under various assumptions about risk aversion. We find that the average financial burden will increase for all income levels once insured. Subsidy-eligible persons with incomes below 250 percent of the poverty threshold likely experience welfare improvements that offset the higher financial burden, depending on assumptions about risk aversion and the value of additional consumption of medical care. However, even under the most optimistic assumptions, close to half of the formerly uninsured (especially those with higher incomes) experience both higher financial burden and lower estimated welfare; indicating a positive “price of responsibility” for complying with the individual mandate. The percentage of the sample with estimated welfare increases is close to matching observed take-up rates by the previously uninsured in the exchanges.

So, for approximately half the “formerly uninsured,” ObamaCare is a losing proposition; I don’t know what an analogy for flat-screen TVs is; maybe having to send the manufacturer money every time you turn it on, in addition to the money you paid to buy it? That’s most definitely not a “package that fits your budget and is right for you,” unless you’re a masochist or a phool. Second, the portion of those eligible that does the math probably won’t buy the product if they’re rational actors (and Obamaare needs to double its penetration of the eligible to avoid a death spiral). That again is not like the market for flat-screen TVs; the magic of the ObamaCare marketplace has not operated to produce a product at every price point (or a substitute).[1] Bad marketplace! Bad! Bad!

Health Care “Consumers” Tend not to Comparison Shop

We turn now to a second NBER study that places even more dynamite at ObamaCare’s foundations. From Zarek C. Brot-Goldberg, Amitabh Chandra, Benjamin R. Handel, and Jonathan T. Kolstad, of Berkelely and Harvard, “What Does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics” NBER Working Paper No. 21632 (PDF), the abstract:

Measuring consumer responsiveness to medical care prices is a central issue in health economics and a key ingredient in the optimal design and regulation of health insurance markets. We study consumer responsiveness to medical care prices, leveraging a natural experiment that occurred at a large self-insured firm which required all of its employees to switch from an insurance plan that provided free health care to a non-linear, high deductible plan[2]. The switch caused a spending reduction between 11.79%-13.80% of total firm-wide health spending. We decompose this spending reduction into the components of (i) consumer price shopping (ii) quantity reductions and (iii) quantity substitutions, finding that spending reductions are entirely due to outright reductions in quantity. We find no evidence of consumers learning to price shop after two years in high-deductible coverage. Consumers reduce quantities across the spectrum of health care services, including potentially valuable care (e.g. preventive services) and potentially wasteful care (e.g. imaging services). We then leverage the unique data environment to study how consumers respond to the complex structure of the high-deductible contract. We find that consumers respond heavily to spot prices at the time of care, and reduce their spending by 42% when under the deductible, conditional on their true expected end-of-year shadow price and their prior year end-of-year marginal price. In the first-year post plan change, 90% of all spending reductions occur in months that consumers began under the deductible, with 49% of all reductions coming for the ex ante sickest half of consumers under the deductible, despite the fact that these consumers have quite low shadow prices. There is no evidence of learning to respond to the true shadow price in the second year post-switch.

So, empirically, these “consumers” just don’t act the way that good neoliberal Obama says they should; they do not comparison shop. That alone is enough to undermine the intellectual basis of ObamaCare. If there’s no comparison shopping going on, there’s no competitive pressure for health insurers to improve their product (assuming good faith, which I don’t).

(We can leave aside the issue of motivation, but to speculate, I’ve found that when I talk to people about health care and health insurance; they’re very defensive and proprietary about whatever random solution they’ve been able to cobble together; and if you’d been sold an exploding flat-screen TV, and had somehow been able to use duct tape and a well-timed fist to the housing to get it work, most of the time, wouldn’t you be rather unwilling to go back to the same store and buy another? So there is evidence of “learning”; the lesson learned is once you’ve got something that seems to works, don’t on any account change it, and we “bear those ills we have,” rather “than fly to others that we know not of.”)

Moreover, the population studied has more ability to comparison shop than ObamaCare’s. From page 4 of the study:

Employees at the firm [in the study] are relatively high income (median income $125,000-$150,000), an important fact to keep in mind when interpreting our analysis

The top income for a family of four eligible for ObamaCare is around $95K (and not eligible for subsidy). Do people think this ObamaCare-eligible population has more ability to comparison shop, compared to a population with a $125K median income for individuals, or less ability? To put this more tendentiously, if a population that can afford accountants or at least financial planners doesn’t comparison shop, how likely is it that a population that cannot afford those personal services will do so?

Even worse, the population studied reduces costs, not by comparison shopping, but by self-denial of care. From page 6 of the study:

In our setting consumers were provided a comprehensive price shopping tool that allowed them to search for doctors providing particular services by price as well as other features (e.g. location).

So, just like the ObamaCare “marketplace online” front end (at least after they got it working). And what happened?

We find no evidence of price shopping in the first year post switch. The effect is near zero and looks similar for the t-1 — t0 year pair (moving from pre- to post-change) as it does for earlier year pairs from t4 to t1. Second, we find no evidence of an increase in price shopping in the second year post-switch; consumers are not learning to shop based on price. Third, we find that essentially all spending reductions between t1 and t0 are achieved through outright quantity reductions whereby consumers receive less medical care. From t1 to t0 consumers reduce service quantities by 17.9%. Fourth, there is limited evidence that consumers substitute across types of procedures (substitution leads to a 2.2% spending reduction from t1 — t0). Finally, fifth, we find that these quantity reductions persist in the second-year post switch, as the increase in quantities between t0 and t1 is only 0.7%, much lower than the pre-period trend in quantity growth. These results occur in the context of consistent (and low) provider price changes over the whole sample period.

Now, it could be that the study population is reducing items like cosmetic surgery and not items like dental care (assuming they’ve got dental); the Healthcare Economist summary of this study says no. In fact, says the study, some of the foregone services were “likely of high value in terms of health and potential to avoid future costs.” And it could be that the lower-income ObamaCare-eligible are smarter shoppers (dubious: Shopping is a tax on time a lot of working people can’t pay). That said, it looks like ObamaCare has replaced a system where insurance companies deny people needed care with a system where people deny themselves needed care; which is genius, in a way. However, if any doctors or medical personnel continue to support ObamaCare politically, they should consider closely whether they’re violating the principle of non-maleficence — “First, do no harm” — and halt their support, if so. Bad marketplace! Bad, bad!


Shopping for health insurance under ObamaCare is nothing at all like shopping for a flat-screen TV. First, there’s a sizeable population who, if they are rational actors, just won’t buy health insurance at all; the ObamaCare “marketplace” is not capable of adjusting prices to get such “consumers” to enter the market. Second, people don’t comparison shop; they reduce needed care. (To flog the flat-screen TV metaphor even further, if the screen is so defective it’s painful to watch, people don’t reduce the pain by comparison shopping for a better TV; they reduce the pain by watching less, and keep the TV they have.)

So, with ObamaCare, and thanks to the dogmas of neoliberalism, we have a “marketplace” that repels “consumers” from entering it, and repels people from shopping if they do enter. Perhaps there’s a better solution out there?


[1] It may be that the ever-increasing mandate penalties will force enough people into the marketplace to make ObamaCare actuarially stable; needless to say, we don’t see Federal agents forcing people into Best Buy to buy TVs, although the social pressure of Black Friday comes close.

[2] Again, much like ObamaCare plans, which are increasingly high-deductible.

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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. brian t

    The author seems to have forgotten that the kludge called “Obamacare” is not the single payer solution that this Obama wanted. What you have is what was able to get past a Congress after intense lobbying by HMOs and insurers. I see little evidence of ideology in the result, “neoliberal” or otherwise. It does nothing to address the insane-and-rising cost of healthcare, because the vested interests are OK with that.

    1. OIFVet

      Every time there is an 0bamacare post, the 0bot on $pam dissemination duty gets the first comment in, and it is always the same nonsense about how 0bama was hamstrung by the eevil Congress and HMOs. Too bad I can’t remember if the last time it was “brian t” who $pammed the thread, all of you 0bots are so alike and therefore equally forgettable.

      1. voxhumana

        Indeed! brian t elides the revealing fact that Obamacare was passed without a single Republican vote, which suggest to me that the Democrats could have passed any bill they wanted… and so they did! This is the bill that Obama and the Democrats (sounds like a bad band name… oh wait… it is!) wanted.

    2. Yves Smith

      Let me clue you in: the readers here are way WAY too clued in to buy your Big Lie.

      1. Obama was never in favor of single payer, ever. Wash your mouth out for even suggesting that

      2. He had health care lobbyists draft the legislation

      3. He used the “public option” as a bright shiny toy. He was so uncommitted to it he didn’t even trade it away. He gave it up as a free concession. A basic principle in negotiating is you NEVER make a free concession. The fact that he just threw it away is proof he never meant it as anything more than a talking point

      I hope you are paid to dispense this blather. I really feel sorry for you if you actually believe it. Obama is a neoliberal who campaigned as a leftist but has governed as a right-winger. His apologists have regularly used the meanie Republicans as excuses for his selllouts, when Obama gets what he wants when he wants it, and there’s no evidence that his center-right results are at all at odds with what he intended to achieve.

      1. Linc

        I won’t pretend to be as smart as you and I was doing okay with your comments until the following. “Obama is a neoliberal who campaigned as a leftist but has governed as a right-winger.” You’re kidding? I won’t ask for an example because I am sure there are a few issues you can name and discuss. That being said, Obama is no where near the middle, never mind the right. If anything, I would say Obama is an inexperience professor trying to teach Economics at Wharton….he can’t. The problem is Obama is too narcissitc to even think about listening. He has constantly picked situations because it is what he believes and that includes the simple things such as inviting the Harvard professor who was arrested early on in his presidency for a beer to the WH to giving how many millions to Solyndra. He can’t be wrong!

        As far as Obamacare. To me it is a simple issue. Health Care does not equal Health Insurance. The sad part is we have spent billions in what will eventually end up as quasi single payer system with 4 large insurance companies sharing the administrative function. Let’s just get there and quit kidding one another.

        1. Yves Smith

          Huh? Obama has proven to be an extremely skilled political infighter when he wants something done. And as to him being center-right, all you have to do is look at his staff, most important his economics team.

          He’s got a history of being a fake leftist going back to his days in Chicago. Obama, Michelle, and Valerie Jarrett were the black faces that legitimated the plan by the Pritzkers and local finance interests to gentrify near South Chicago and push the black community 3 miles further south while giving them nothing. See here for details:


          And he’s never been a real prof. This constitutional law talk is a crock. No one can remember him teaching any courses (he appears to have taught a couple but made no impression). This was a resume-burnishing post and he did the bare minimum.

      2. Hayek's Heelbiter

        Beg to slightly differ regarding Obama and single payer (if the transcripts of his campaign rally speech in Jersey City before he was nominated hadn’t been scrubbed from the Internet, I’d have the exact wording).

        After he had had told the story of sitting with his dying mother on her death bed, surrounded by paperwork, trying to sort out the restrictions of her employer-based insurance policy and there wasn’t a dry eye in the gymnasium, everyone THOUGHT he said, “When I am President, I will fight tooth and nail for single payer for every single American.”

        And the gymnasium absolutely erupted in applause.

        Apparently, he said something very CLOSE to that, but when the sentence is carefully parsed, did not mean that all.

        Nevertheless, as a former Obot who worked tirelessly to get him elected on almost the sole basis of the genuine emotion he exhibited when he told this awful story and how he promised to rectify the situation in the future, I felt the dagger of betrayal when the first thing he said during the health care debate was, “I’m taking single payer of the table.”

        1. Lambert Strether Post author

          I hate to say this, but a lot of us at Corrente did try to keep track in 2008, and I can’t remember any reporting on this at the time, and we were also strongly for single payer, which we also kept track of. Not to say that we couldn’t have missed something, but a link to something contemporaneous would be helpful.

          1. Michael Hudson

            I know that I’ve said this on NC before, but Yves is absolutely right — and THEN some. When Dennis Kucinich tried to introduce EVEN A DISCUSSION of single payer in Congress, the Democratic Party leadership blocked him from even bringing it up. Pelosi et al. were absolutely committed to the Republican neoliberal policy.
            This led us to discuss whether the only way to get progressive health care policy was to start a new party, now that the Democrats have become the Wall Street wing of the Republican Party’s natural resource monopolists.

            1. WorldBLee

              The only thing I would disagree with there is that the Democrats “have become with Wall Street wing” since they’ve been the Wall Street wing for a long time now… Otherwise, spot on.

          2. Hayek's Heelbiter

            If you could locate a transcript, I would dearly love to read what he ACTUALLY said.

            Cameras and recording devices were strictly forbidden, and this was in the days before everyone had cellphones that could record anything.

          3. meeps

            I don’t know the date of this speech (the upload predates the 2010 debacle), but Obama stated, “I happen to be a proponent of single payer health care…”

            That said, we got hosed. Each of us must now decide whether to roll over and take the corn, or, to demand single payer and the re-regulation of industry (the pharmaceutical industry and others that affect health tangentially).

              1. meeps

                I’ve not been able to resolve the technical reason behind my missing links. You’ll find the 53 second clip on youtube channel 6y2o12la titled: Obama on single payer health insurance.

      3. Oregoncharles

        To be precise: he CLAIMED to want single payer when he was campaigning FOR THE SENATE, a few years before he ran for President. In fact, he promised, on camera, that if the Dems controlled both Congress and the Presidency, we’d get single-payer. Guess what? When those conditions were met, in spades, we got Heritage-Fund Care, instead, as a result of his machinations – described in other posts, including Yves’.

        Note I didn’t say he WANTED single-payer, so I’m filling in detail, not disagreeing. In fact, I’m pointing out that he’s a flaming liar.

    3. Paul P

      “the single payer solution that this Obama wanted”

      Obama kept single payer off the table from the start. He would have had to decide to fight the industry and take the fight to the country. Medicare for All is a simple idea. He could have done a 50 state whistle stop tour. He could have saturated any Congressional district opposing Medicare for All with the same message. That wasn’t his plan.

      I attended one of his community meetings on health care, held around the country prior to him adopting Romney Care as his proposal. One of the organizers of the meeting starts off by complaining to the group about not just telling Obama we want single payer.

      1. cwaltz

        One of the first things Obama did was make the GOP party point men on health care(Olympia Snowe anyone?)

        And it was Nancy Pelosi who called it impractical and took it off the table, heck she even went so far as to have some of the activists committed to being heard arrested for being disruptive. She then promptly gave a minority Blue Dog group the opportunity to co opt the debate to grandstand on abortion.

        It’s positively revisionism to blame the health care mess on GOP. It was Democrats who screwed it up from start to finish.

    4. Myron Perlman

      “Obama wanted’? Single payer was ruled out from the beginning. Advocates for that position were not permitted to be part of the discussion. Who knows what Obama wanted? Look at his actions on this and other issues to make a better judgment. My take is that it was a presidency of symbolism not substance when it came to policies.

    5. Lambert Strether Post author

      Not to pile on or anything, but I think a review of the bidding is in order:

      I suggest the real constraints came from three sources, as indicated by their behavior from 2009, when battle for health reform was joined: (1) The Democratic nomenklatura, which censored single payer stories and banned single payer advocates from its sites, and refused even to cover single payer advances in Congress, while simultaneously running a “bait and switch” operation with the so-called “public option,” thereby sucking all the oxygen away from single payer;1 (2) Democratic office holders like Max Baucus, the putative author of ObamaCare — Liz Fowler, a Wellpoint VP, was the actual author — who refused to include single payer advocates in hearings and had protesters arrested and charged; (3) and Obama himself, who set the tone for the entire Democratic food chain by openly mocking single payer advocates (“got the little single payer advocates up here”), and whose White House operation blocked email from single payer advocates, and went so far as to suppress a single payer advocate’s question from the White House live blog of a “Forum on Health Care.” (Granted, the forums were all kayfabe, but even so.) As Jane Hamsher wrote, summing of the debacle: “The problems in the current health care debate became apparent early on, when single payer advocates were excluded [note, again, lack of agency] from participation.”

      In short, if single payer was “politically infeasible” — the catchphrase of that time — that’s because Democrats set out to make it so, and succeeded.

      Brian, could you ask your boss to send us smarter trolls?

      1. nigelk

        I appreciate that such takedowns are always link-filled and impeccably sourced, and though combativeness in the comments is not the prevailing tone of this website (happily), damn if I don’t pump my fist when I read a troll getting cut down thusly.

        Fake leftist trolls are the worst.

    6. GlobalMisanthrope

      Maybe you’re not an incredibly lame troll. Maybe you’re just a poor beginner who unwittingly wandered onto the Varsity field. But if you “see little evidence of ideology in the result,” you may want to look up the definitions of “evidence,” “ideology” and “result.”

    7. pretzelattack

      he didn’t want single payer; he took it off the table while still assuring his supporters it was his preferred option.

    8. ds

      Who the hell is still shilling for Obummer t this point. This isn’t 2008; it’s not even 2010. Get with the program.
      Yeah, I guess him being (half) black really gets some people creaming/ejaculating, but if Obummer proved anything, the non-Caucasian=Jesus PC crap we’ve been fed since 1965 is complete bunk.

      As for this article, why so squeamish? I mean, yeah, this market mess is too difficult to navigate for those not working in the industry, or have lots of time, but the real problem is IT’S A MARKET SCAM JOB. Advocate for health care, not insurance; use price controls, plan care. At this point, N. Korea is offering better average care for cheaper for the non-insured.

  2. James Levy

    Educated elites with a modicum of leisure always love to play these games. It took them decades and the most draconian policies imaginable to break the habit of workers early in the industrial revolution of trading off pay for leisure time. The basic notion of every capitalist scold throughout the ages has been that this is irrational laziness, even if your job is a physically exhausting and soul-crushing exercise–you must work more, or you are a bad person who should be punished.

    Now, it’s the “let’s turn everything into a market” game. Don’t want to play? Screw you–we’ll make it mandatory, and, of course, punitive. This goes way beyond Obamacare into every facet of our lives. Public utilities? Hell no–give them “choice”! Community schools? No way–can’t have the races and the classes and the ability levels mixing in such a promiscuous manner–let’s go charter “academies”, or vouchers. It’s a normative takeover under the guise of “rational” “scientific” “efficiency”.

    1. ilporcupine

      So true. Ask them about their golf game. It is only YOUR leisure time at issue, not theirs. Don’t you wish you could count as “work” blathering your stream of conciousness on CNBC day after day?

  3. ambrit

    I remember that one of the ‘talking points’ in favour of Heritage Foundation Care (HFC) was that “pre-existing” conditions were not to be allowed to deny anyone coverage. Using that logic, it can be asserted that ‘Poverty’, absolute or relative, a pre-existing condition if there ever was one, denies ‘patients’ useful medical care. The system as administered is internally contradictory. Taken one step farther, the HFC can be defined as a “Faith Based Service Provider.” This would be an insult to actual traditional Faith based providers. Most “real” FBPs are governed, at least in theory, by ideologies that counsel ‘compassion’ when dealing with the less fortunate. As has been demonstrated, the HFC program counsels exploitation when dealing with the less fortunate. A case in point; this week a local religious charity opened a ‘Free Clinic’ in our town of 45,000 or so souls. The local paper put this on the front page. Buried in the body of the article was the mention that this clinic was fully booked up for the first, and probably second month. All this before public mention of it’s existence. There’s your ‘Marketplace’ in action. As I discovered when I looked into signing up for the Mississippi Medicaid program for myself, a family cannot have over 2,500 USD in ‘assets.’ There is an ongoing dispute as to whether or not an automobile classifies as an item counted toward this limit. Thus, those in our state who do qualify for Medicaid are poor indeed.

    1. Carolinian

      Using that logic, it can be asserted that ‘Poverty’, absolute or relative, a pre-existing condition if there ever was one

      Great point. In the US we have a health care system that saves people’s lives while–in many cases–taking away their means of living it. The Hippocratic Oath should be modified to read: first do no harm to Capitalism.

  4. thatworddoesnotmeanthat

    Obama is a 1060s style communist;==perhaps one could call him a “NeoCommunist” Obamacare is anything but “Neoliberal” –it is redistributionist in its very nature. This is why it is crumbling. It is an absurd notion as is this article, but that is to be expected as you cannot seem to get over this adolescent attachment to Marxism.

      1. nigelk

        William of Normandy, a notorious leftist prior to his hard pivot to militarism after the 1066 election

        1. Ulysses

          “Election!” That’s a good name for it. Hustings, Hastings, I mean, only one letter separates them!

      2. Ulysses

        Yes, it is an intriguing suggestion. Does commenter thatworddoesnotmeanthat care to elaborate? Were the architects of RomneyCare (and it’s national extension Obamacare) attempting to recreate a golden age, of 11th century free peasants– happily enjoying the abundant commons of medical care, in the carefree forests and dales, before they slipped under the Norman Yoke of feudal exploitation?

        Or, is the reference to some non-Western communist society that flourished in the mid-11th century? Perhaps thatworddoesnotmeanthat has studied early communist cultures in South Asia, America, or Africa that distributed healthcare in a way that eerily foreshadows what Romneycare did in Massachusetts?

    1. James Levy

      The record is irrefutable–the ACA was written by the insurance companies with a wink and a nod to Big Pharma and the HMOs. Unless you are going to seriously entertain the notion that these are “communist” institutions, or give a rats ass about anything but making money, you can’t really believe what you wrote. You are just angry about something and projecting your fears onto this travesty.

  5. Disturbed Voter

    The subsidies of Obamacare, if you qualify for them, requires the IRS to get intimately involved with your checkbook. Just like middle class folks want recipients of SNAP to be regulated with every food and drink purchase … matching what the bourgeoisie thinks matches their own moral rectitude.

    I prefer not to make the IRS my intimate partner … helping me to define what is an asset and what is income to the last penny.

  6. Wade Riddick

    The idea behind high deductibles is that you’ll force consumers to economize. It’s kind of like telling science, “Hey. This patient needs ten pills to live? Let’s give him eight and see what happens.”

    Medical treatment is a science issue. A treatment’s either effective or it’s not. You can negotiate the cost – *with the supplier* – but you can’t bully a disease or injury into behaving the way you want. You certainly can’t bully the sick person and they’re in no position to negotiate with the supplier. They have none of the necessary experience or health. That’s exactly the wrong time to try to educate someone about their “options.”

    But then that’s the whole point. The medical market is intentionally littered with opacity. There is nothing transparent about insurance, much less drugs or surgeries. Medicine is increasingly dominated by complex bureaucratic cartels for exactly that reason – so you *won’t* find out how things work. They don’t want you comparison shopping for drugs, surgeries, therapists. Everything about the modern medical system is precisely about robbing “customers” of human agency.

    The whole idea of shopping for health insurance itself is absurd. It requires you figuring out exactly how sick you’ll be in the next year and then inventing a time machine to travel back so you can pick the Pareto optimal policy with exactly the best deductible – which really won’t matter because then they’ll find a way to make sure your E.R. wasn’t in network nor your anesthesiologist and the only drug to keep you alive won’t be “covered” and then you’ll wish it was only an Arnold Schwarzenegger skin-wearing android sent to kill you ’cause that would be way easier.

    They’re removing choice left and right and destroying scientific information through lobbying. The people responsible for creating diseases aren’t being held responsible for them but the victims suffering from them are.

    When multiple sclerosis organizations are run by drug companies selling $50K+ a year drugs, do you think they want those customers finding out that deworming society is what created the risk for M.S. in the first place?

    As Martin Shkreli put it, he has the perfect “price inelastic” product. Patients are a captive market that’s easy to exploit. Either they get what they need or they die. You can charge what you want.

    Do you think lazy executives looking to bump up next quarter’s earnings are going to invest heavily over the long haul in scientific models of effective disease prevention and treatment or are they simply going to squeeze people a little more and a little more?

    Let’s not forget why politicians love the sickcare complex. The more an industry turns into a cartel, the easier it is to raise both economic and political rents from it. Let’s be honest here and call a spade a spade. Politicians like this system because it easily feeds campaign dollars into the system. It may not be efficient for treating patients, but it’s quite efficient for extracting political re

    1. Crazy Horse

      Comparison shop for medical care in the USA? You’ve got to be kidding.

      Case in point. My doctor recommended a cardiovascular “stress test” for diagnosis of heartburn symptoms to make sure that it wasn’t cardiovascular in nature. I traveled to a regional heart specialist center for the test, but based upon previous experience refused to undergo the test until they put the bill for the procedure in writing including my deductible cost. The intake administrator acted shocked by such a request, and it took 30 minutes of increasingly strongly worded demands on my part before they finally produced a verbal quotation – which I recorded for future use if they decided to bill $12,000 for 10 minutes on a treadmill.

      The world’s most expensive health care extortion system at work.

      1. Jim Haygood

        NBER: ‘There is no evidence of learning.’

        As Barry O. likes to joke, mimicking George W. Bush’s drawl, “Is our consumers learning? Ha ha ha!”

  7. Winston

    It’s nearly impossible to “comparison shop” if you’re part of an HMO these days. The only choice one really has is to select their PCP. After that the PCP pretty much forces you to see docs and get tests within the hospital system – presumably for “coordinated care”. And this for nearly $1000/mo for a single person not receiving much in the way of “healthcare”. That which can’t continue, won’t….

  8. Jim in SC

    One of the things that distinguishes the US from other countries is our high level of tax compliance. I’m concerned that these Obamacare penalties will lead to diminished compliance, both because people resent the penalties, and because it is such an intellectually frustrating exercise to try and estimate future income.

  9. allan

    More like a flat screen TV, rented from Samsung, that functions like one of those old British hotel radiators that you have to feed with pence $60 copays every 10 minutes in order for Time Warner not to interrupt the streaming.
    And then you get balance billing from Disney for the content.

  10. Chromex

    My experience is that there IS no “competition” in any product field that involves actuarial calculations. I get a subsidy and I am 63. There were about 50 plans offered in my area. A few were OVERpriced, yes, but the vast majority offered very similar premium prices, and identical elephantine deductibles, which means that except for aspects of the annual physical, it will “cover” ( assuming cover means pay for) jack. “Coverage” is not care, it is nothing to brag about. I am “covered” for expenses beyond my deductible as a form of catastrophic insurance but the plan will never pay for anything else and actuarially, it is easy to calculate a premium that guarantees that companies will make lotsa money while paying out less. Needless to say the “product” is outrageously overpriced for what it covers and puts people like me _- close to medicare but limited income and owns own house free and clear in a far far worse position than before the law. ( eg medicaid asset recovery if I dare to state a lower income etc etc). So I’m “covered” , so what. I have far less actual care. And that , it appears to me , is deliberate.
    Even if it were “competitive” there is not much point in comparison shopping for flat screen tvs.. for a flat screen tv with X features made by brand “A” the price difference for a tv with the same features ( and longevitiy) of brand “B: will in the vast majority of online offerings, be so close as to not be worth the effort. This is even more true with insurance.
    Like most politicians, Obama wanted to “do something” and a have a bill he could hold up in front of Everybody and say “see this is mine”. My experience with such legislators/administrators is that they have a lot of hubris and grees for the bill to pass and do not subject potential downsides to any critical analysis so that advisers get the message “construct something that will pass” .The fact that he was dumb enough not to see this coming suggests that his “ideology” was driven by his advisers- who are definitely neocons IMO not neoliberals unless the term “liberal” is used in its classic economic sense.
    And while we are on the subject, “Health care” is not really subject to “market” principles. Start with the fact that most people in this country have less than 1K savings, which means that they cannot cover the ginormous deductibles most “silver” plans offer or the premiums of better plans. Then add in the fact that these people cannot predict how much care will be needed in a given year or what the final cost of that care will be. What’s the “market ” for that? Under these two facts mandatory “insurance”with high deductibles and narrow networks simply functions as a wealth transfer from strapped lower-middle and middle class adults to Insurance company shareholders and CEOs.
    Even assuming that Obama “wanted” single payer- an assumption that has been ably refuted in this string already, had he given “what can get passed” a moment’s critical analysis, he might have realized that he- with his insistence on change for change’s sake- was making it worse for so many Americans. I for one , could care less that pre-existing conditions are now “covered” if I can’t actually use the coverage- pre existing survives, its now called high deducitlbes and narrow networks.

  11. macman2

    Actually, as Winston Churchill famously noted, “Americans manage do the right thing after they have exhausted all of the wrong choices firs”t. So it is that had we gone right to single payer without this “market based” attempt, we would have heard howls of capitalistic remorse, etc.

    So I am glad that Obamacare was attempted and that it is failing predictably. It is pretty clear to even the free marketers that high deductibles only impoverish Americans, that “skin in the game” does not make people better shoppers for the highly technical world of medicine, that price transparency is essentially worthless if nobody is comparison shopping while they are bleeding out from every orifice, etc.

    Medicare for All is arguably catching on. Bernie Sanders poll numbers have not taken a dive with this promise and the sputtering Obamacare is only putting more fuel to this fire. Hillary’s tax scare attempt will turn flat on its face. People know bad value when they see it, and the current market based health reform is failing into the predictable death spiral. View Bernie’s ascendency as evidence that the American people think health care is a right and it is time to fund it that way.

    1. marym

      Is the argument here that it was necessary for millions of people to suffer from lack of access to affordable healthcare, and tens of thousands to die, to teach us a lesson, because designing, advocating for, and rapidly deploying a simple, effective single payer system that would bring both immediate and long-term benefits that would silence even its would-be detractors is impossible even to imagine? This is why Democratic Party and Obama cheerleaders have no credibility anymore.


      Also, while it’s great that Sanders is bringing attention to this topic, it’s not surprising that people are responding favorably People have been polling in favor of a Medicare-type single payer program for decades.


      1. James Levy

        Americans have not and will not “do the right thing” on this issue because the entrenched interests that are making money off of the current atrocity that passes for a healthcare system are too strong to displace. Europe got single payer after WWII because the only institution in society left with access to money was the State, so doctors and hospitals after the war were going to sign on for socialized medicine because societies at large were destitute. Whatever the government will pay is better than grandpa’s watch (if some conquering army hadn’t stolen it) or a chicken (ditto). Until this situation comes into being here in the USA we’re not going to see single payer tax-based healthcare.

        1. Ulysses

          Your argument would make sense if Canada, which, like the U.S., never suffered the same WWII devastation as Europe, hadn’t managed to build a national single-payer health system.

  12. sleepy

    And let’s not forget the medicaid clawback provisions for those between 55-65. If you apply for Obamacare, and your income level is below a certain threshhold, you are not eligible for subsidies. You are placed into medicaid.

    However, for those in that 55-65 age bracket, there is an estate clawback provision that effectively acts as a lien on your estate: once you die your assets will be seized by the state to satisfy all medicaid provided healthcare expenses.

    Prior to Obamacare, in order to qualify for medicaid, not only was there an income requirement, but your assets also had to be below a certain, very low, amount. With Obamacare however, the asset requirement is waived for those in that age bracket.

    What happens? Many who now are eligible for medicaid via Obamacare will now own a house as their primary asset of any significance. But once enrolled, that house will be sold on the insured’s death to pay medicaid. I would assume that in states that have privatized medicaid, these sums will also include all premiums paid by medicaid on the insured’s behalf—even if no claims are ever filed.

    If that’s not bad enough, under Obamacare to satisfy the law, the consumer is forced into this by the mandate. There is no choice. Beyond that, if the insured had an income level a few dollars higher, he/she would be eligible for subsidies which, of course, need not be paid back on the insured’s death.

    Clawback provisions, though with many exceptions particularly for those under age 55 have always been required under medicaid, but now medicaid enrollment will be required by law with actual assets available.

    Medicaid is essentially a reverse mortgage.

    1. sleepy

      In terms of the assets issue, my comment is applicable to those states that have adopted the expanded medicaid features of Obamacare. As mentioned by a poster in Mississippi, states that have not, still have the old rules on having virtually no assets in order to qualify.

    2. ilporcupine

      I have seen this stated here on many occasions, over the course of the OCare debate. While the law seems to give authorization to clawback, in my state it only seems to have been used for nursing home and other long term care. I can state from my experience, I was never queried about assets, and was qualified only on income. I just lost the person with whom I have shared my life for 30 years, and her assets, went to her daughter without any claim from the state. Hers was an expensive battle with cancer, and did rack up a pile of charges. ( In my state, Medicaid is paying a private insurer to cover Medicaid patients). I have been reading here for a long time, rarely posting, I tend to agree mostly with the view here, but this seems to be widely different between states. I have no issue with Yves or Lambert on this, they have done yeoman work trying to get to the bottom of these issues. Just felt I needed to weigh in for the sake of completeness. Yves and Lambert you have my email if you want to discuss my experience, it is all to fresh a wound to discuss in this public forum.

  13. Rob Lewis

    No argument that Obamacare has some serious problems. But placing ALL the blame on the President seems excessive. Even if he had come out strongly for single payer, there are more than enough DINOs in Congress in thrall to Health Care, Inc. to have prevented its passage. And the Republicans would have dialed up their anti-reform propaganda to new levels of hysteria (Remember the anti-Hillarycare saturation media campaign? I’ll bet Obama does.)

    1. sleepy

      When Obama was inaugurated he had more political capital in his pocket than any president in recent memory. The repubs were on the ropes.

      Sure, the repubs could have gone all out in opposition, but as another poster mentioned Obama could have gone all out as well and blitzed the country. And in the first few months of his presidency, my bet would have been on him more than on the repubs.

      Of course he did nothing. And to say he did nothing because of fear of the repubs at that point is silly. He empowered the repubs. He didn’t even pretend.

    2. HotFlash

      Even if he had come out strongly for single payer…

      Oh, but he didn’t! If pigs had wings, perhaps they could fly? He could have, he didn’t even pretend (like he did with closing Gitmo). Oh, concerned about his legacy? No problem, $peaking fees from insurance companies, pharmacos, $eat on bds of directors, his future will be golden!

      Hello. “Leaders”, elected or otherwise, sell out locals to corps = banana republic.

      Have a banana.

      1. fb

        “All health insurance plans purchased through Covered California must cover certain services called essential health benefits. These include doctor visits, hospital stays, emergency care, maternity care, pediatric care, prescriptions, medical tests and mental health care. Health insurance plans also must cover preventative care services like mammograms and colonoscopies. Health insurance companies cannot charge copayments, coinsurance or deductibles for such services.”

        1. Yves Smith

          By taking that out of context, you’ve considerably overstated what Covered California covers.

          Just as in the rest of the US, the “metal levels” have the same meaning. For instance:

          Bronze: On average, your health plan pays 60 percent of your medical expenses, and you pay 40 percent.

          This is the language from their “Essential Health Benefits” section:

          Essential Health Benefits

          All health insurance plans now share some common characteristics. The Affordable Care Act requires that all health insurance plans offered in the individual and small-group markets must provide a comprehensive package of items and services, known as essential health benefits.

          These benefits fit into the following 10 categories:

          Ambulatory patient services.
          Emergency services.
          Maternity and newborn care.
          Mental health and substance use disorder services, including behavioral health treatment.
          Prescription drugs. For more information about prescription drug benefits, visit the page Prescription Drugs.
          Rehabilitative and habilitative services and devices.
          Laboratory services.
          Preventive and wellness services and chronic disease management. For more information about preventive services with no cost sharing, click here.
          Pediatric services, including dental and vision care. Dental insurance for children will be included in the price of all health plans purchased in the exchange for 2015.
          The requirement for insurance plans to offer essential health benefits is just one of many changes in health coverage that began in 2014.

          So this is just ACA boilerplate. I do recall reading that Covered CA does require some services be provided irrespective of the deductibles (beyond the ACA-mandated preventive care items like mammograms, which separately are a bad test), but after 10 minutes of poking around the Covered CA site and other Googling, I can’t find any evidence of what those other services might be. I thought it was at least a doctor visit or two, but I can’t even find that.

          And 75% of Covered CA plans have narrow networks, compared to 41% for the US as a whole, which among other things means you might not be able to get a specialist you need:


          The site and web service are also terrible, see the long horror stories at Yelp:


          And see this from Kaiser News:

          Most Insurance Exchanges Just Got Bigger. Covered California Is Getting Smaller.


    3. RUKidding

      Obama NEVER tried one iota to go for Single Payer. Nada, Zip, Nothing.

      Ergo, I place ALL the blame on Obama. IF he had tried even a teeny tiny bit, I could perhaps place some blame elsewhere. But factual reality refutes that.

      I also do recall the POTUS taking Dennis Kucinich up in Air Force One, and when they landed, suddenly Kucinich had changed his mind and was (reluctantly in my viewpoint) giving an thumbs up on ObamaCare. Kucinich was the longest hold out advocating for Single Payer. Obama basically took him to school and forced him in some way to STFU and say Obamacare was the best.

      Baloney. Obama sold us all to BigInsurance, BigPharma, BigHospital, BigMedDevice, and I’m sure he was handsomely rewarded.

      This one, imo, is all on Obama. It was what he wanted, and it’s what he now touts as being this very great thing, which it’s not.

    4. so

      No amount of dem. or repb. BS will ever persuade me to participate in national politics again.
      obamas handling of the ongoing financial and health care crisis finished it for me.
      It’s so clear to me where were at. The corruption is sickining. EVERY DAY the stories. I keep thinking….”all the kings horses and all the kings men couldn’t put Humpty back together again.” Read The Archdruid Report for some insight. Everybody wakes up sooner or later.
      In this life or the next

  14. tegnost

    Yes, definitely better to give up without a fight. Have you noticed that in spite of what is essentially a media blackout Bernie is likely leading in the polls? As to your opening statement “No argument that Obamacare has some serious problems” you admit to ACA shortcomings, maybe you would like to offer up some of what you see as good aspects of the ACA? Further, “there are more than enough DINOs in Congress in thrall to Health Care, Inc. to have prevented its passage. ” there was and is a DINO in the oval office “in thrall to Health Care, Inc.” who made no other option impossible. So much for the vaunted “free market” The ACA was designed and implemented as socialism for the 20% (h/t Lambert and others who have noted the upper class and their minions occupy the top quintile) whose medical care was getting too expensive, and whose medical (device, pharma patents, and insurance co.) investments were not being supported by demand, so the ACA created demand for them. Medicare for all, and get rid of the clawbacks, I personally would rather chromex’s heirs get his assets rather than Blackstone, thank you.

    1. tegnost

      I notice that Crude Earl is tempting $30 and copper is at $1.96/lb, looks like some demand problems there, as well. Maybe we should mandate that everyone must purchase gasoline even if they don’t have a car, and mandate that pennies will once again be made of copper? ka-ching!

      1. Ulysses

        You jest, but in many late medieval and early modern Italian city-states there were ruthlessly enforced minimum consumption levels for salt. Prior to refrigeration salt was more of a food preservation necessity, but the huge consumption taxes placed on salt made them a fiscal necessity as well. Our word salary derives from the fact that so many government officials were paid from the revenues collected through salt taxes.

        The much-hated gabelle in pre-Revolutionary France was a salt tax!


      2. Lord Koos

        No, a better solution would be forcing everyone to go in debt to own a large SUV… hybrids don’t qualify.

    2. Rob Lewis

      I doubt you’re really interested in a discussion, but here are a few very good things about Obamacare:
      1. Elimination of pre-existing conditions as a reason for being refused coverage
      2. Requirement that insurers spend at least 80% of their revenue actually paying benefits
      3. Preventive care must be free
      4. Expansion of Medicaid (where permitted by states) brings coverage to millions of previously uninsured
      5. Standardization of plans makes is possible (if not easy) to compare them

      And this is my opinion, but I don’t think it would have been possible to get Medicare for All through Congress, even with Democrats nominally in control, for the reasons already stated.

      Anyway, my whole point is that Obama doesn’t deserve ALL the blame. Are you arguing that the public and Congress were ready and willing to enact single-payer, and Obama somehow prevented it?

      1. Katiebird

        1. Pre-existing condition with the caveat that you must live in an area served by a medical establishment that specializes in your possibly rare illness.

        2. 80% Yay! It’s almost like Christmas! …. Cold comfort to those who must cough up $10,000 or more before getting any benefit from trom their policy at all.

        3. Preventative care must be free. OK. So the $10,000 get’s them a colonoscopy and a glucose meter.

        4. Expanded Medicaid … In the states where it happened, anyone over 55 years old subject to an undisclosed clawback of benefits from estates. Wow.

        5. I cannot imagine how you come up with the comparison justification. People have to sign up for plans without final commitments of which doctors or hospitals are included. And even then they are subject to change!

        “Democrats nominally in control” … This is a pure deception. They had overwhelming majorities and wildly popular President. Do you seriously think that if faced with Obama’s shaking finger and an enticing promise, that any Democrat would have defied him during those first 100 days. I laugh at the thought. He could ave gotten Expanded Medicare for All passed in those first 100 days with one hand tied behind his back.

      2. bob

        Are you arguing that any single one of your bullet points is true?

        For instance #1- covered? Covered by what? You can be covered and still not be able to afford the deductibles, or even the premiums.

        The rest is talking point BS, tiny little grain of some sort of truth wrapped in ponies.

      3. tegnost

        Thanks for responding. Yes it’s good that pre-existing conditions no longer can be refused coverage,but one still needs to be able to afford coverage, so not being refused is not the same as receiving care, no? Your second point also has some merit as it appears intended to contain profiteering, but as one can see from martin shrkeli there’s nothing stopping the greater healthcare marketplace from increasing costs, so the 80% becomes ambiguously beneficial. I did not know preventative care is free, but if that means as implied by another comment colonoscopies and other rather invasive procedures that might be seen as a cash cow with once again ambiguous benefits to consumers, really they are actually insureds, not consumers, as the prices are beyond peoples ability to pay, only insurers can ably do that, so the consumer is consuming insurance not care, I’m arguing for a gov’t insurance and appreciate your opinion that it couldn’t have been pulled off, as I think you are aware that my opinion is that they not only didn’t try, indeed the executive branch stood between private sector healthcare industries and reform in the same way it stood between the banksters and those pitchfork wielding crazy people. Whatever your feelings about all that saving the economy stuff, it was largely and in many aspects a giveaway to people who were on the brink of disaster, a little more give and take would have been appropriate and the hope and change mandate provided the executive with considerable clout. Also, the medicaid expansion is a wolf in sheep’s clothing as the clawback is regressive and punishes low income people as well as some probably good sized portion of people who will find themselves unceremoniously dumped into medicaid when their insurance and other medical bills drive them into financial distress. Lastly, the standardization of plans was in fact useful for me to figure out i couldn’t afford it without taking to much time. I’ll dilute my criticism of the president to be more inclusively the executive branch and their collective agenda, but basically the O man is the CEO so gets to be the hero, or the goat…

  15. Adrienne Adams

    As Chromex notes, Obamacare “coverage” is high-deductible catastrophic, so all day-to-day “care” is paid for out of pocket. But just try finding out how much a procedure costs… I needed an MRI on my knee, and it took three phone calls to find out how much I would be paying for the procedure. First you need to know the exact billing code for the procedure, which means you need to find the person in the doctor’s office who is anointed in the mystical realm of billing codes; then you need to call the insurance company customer service rep, who is initially mystified that you are actually trying to find out how much something costs; then you (hopefully) transferred to someone in the billing department (who has never spoken to an actual patient before); and finally, if you are lucky, in two or three weeks you will revive a letter from another anointed person giving the actual out of pocket cost of the procedure—which will probably be different after the fact as “adjustments” are made between provider and insurer.

    If we had to buy anything else in this fashion, we’d all be naked, starving, and out-of-doors.

  16. ProNewerDeal

    I recall seeing a stat that the median adult net worth of USians was only US$37K, whereas in Canada it is US$80K. I wondered if the primary reason for the huge difference, is the presence of Canada-style MedicareForAll in Canada. It appears the US health system bankrupts you rapidly as in literal medical bankruptcy as per indivduals’ examples in the “Sicko” documentary”‘ or bankrupts you slowly, as in these crapified ACA policies that charge ~$12K/yr before paying for anything besides the annual physical exam even within your “narrow network”.

    Yves, are you aware of any economist study which estimates the differential in financial net worth between barbaric USA & civilized Canada?

    1. sleepy

      Apparently what the masters of Canada can’t extract through healthcare debt, they do it through astronomically high real estate prices, exceeding our bubble high of 2007. Though there are signs of deflation, tiny 2 bedroom bungalows in Winnipeg–depressed Canadian flyover country–go for $300K. The same dump in Minneapolis is yours for $175K. And that’s comparing economically challenged Winnipeg with relatively prosperous Minneapolis.

      Yes, not paying $1200/month in health insurance premiums can go to that overpriced Canadian mortgage, but that’s sort of my point.

      And to ward off some comments–I am in no way stating that Canada’s national health program causes high housing costs.

    2. Crazy Horse

      And the median net worth in Australia and Italy, among other countries is well over 100k. Makes you wonder about American Exceptionalism.

      1. ProNewerDeal

        America is exceptionally wack & Crapified (c) Yves, as far as life for the 99%ers probably in the lowest quintile within the OECD, even when including the don’t-really-belong members like Mexico & Turkey. Meanwhile Murica, from everyday people to the elites, drink Murican Exceptionalist Kool-aid on how Murica is Always The Best, no need to ever learn from any other nations on anything.

  17. ProNewerDeal

    I wonder if the “net present value” of money/time/stress cost of emigrating to a civilized nation like Canada for those USians fortunate enough to have a chance of doing so, is likely to be much less than the equivalent money/time/stress cost of living an entire life in the US & having to deal with the US Sickcare Mafia.

  18. hemeantwell

    Lambert said:

    I’ve found that when I talk to people about health care and health insurance; they’re very defensive and proprietary about whatever random solution they’ve been able to cobble together

    In my limited conversations I’ve noticed that, too. I’ve been left wondering if it is hard to for them to give a clear answer since they’ve had to engage in guessy speculation about what they, and their families, might come down with, and they end up having to imagine awful stuff and then discount the possibility of it occurring, so too bad for little Susie if awful occurs. Trudy Lieberman has given emphasis to the absurdity of asking people to bet on their health, and I’m guessing it’s not just a matter of feeling embarrassed about weak actuarial skills.

    1. Shilo

      Talking about how you coped with Obamacare gives a clear insight into your personal finances, something a lot of people are hesitant to discuss.

      When I was young I was taught never to ask a rancher how many head of cattle he ran, because it’s no different that saying, “Hey, How much money are you worth?”

  19. jonf

    So where do we go from here? Help the republicans repeal it? Fix it? Frankly I don’t know. We don’t have a congress to fix or replace it -even if Sanders wins. I think it helps some people, mostly those on Medicaid. So repealing it doesn’t make sense unless it can be replaced. Even saying this is a marketplace is an outright lie. These bastards are just stealing from us all. Rock and a hard place. Sanders is the only hope and that at times seems vanishingly small.

  20. nihil obstet

    When Obama took office, The United States National Health Care Act, HR 676, for a single-payer system of expanded Medicare for All, was in the House of Representatives. If I remember correctly, it had over 100 Democratic Congresspeople co-sponsoring it. Part of the Obama administration’s efforts on its own health insurance bill were aimed at getting the bill withdrawn.

    1. afreeman

      Thanks for that reminder. Reading the recent book, American President (from Teddy to Bill) helps one’s recall considerably—telling contrasts between Presidents who knew how to pass legislation and the flukes (if assassination can be called a fluke, i.e. Devil’s Chessboard) that brought them our way against those who didn’t. For instance, LBJ compared with JFK, who had enough legislative service to learn a thing or two if he were interested, that is.

      Too bad the book’s so damn thick—well written and lively though it may be. Voters not likely to read it. Should though.

  21. Malcolm MacLeod, MD

    Lots of arguing and different thoughts, but one primary fact remains. Obama was a bald-faced
    lier from the get-go, and has remained true to that principle. He hasn’t really tried hard to
    question that. The amount of damage done to this nation during his tenure amounts to that
    amount perpetrated by a traitor. Just being bad was “W”; this is actually far worse.

  22. tongorad

    If the intellectual foundations are crumbling, should we expect to see a more decent and humane alternative anytime soon? It seems to me that neoliberalism is just getting stronger.
    What evidence is there that America’s primary/foundational dogma (“because markets”) has been subjected to the slightest whiff of popular dissent? Bernie Sanders? Ha!
    I ponder not out of snark, but despair.

  23. Oregoncharles

    “outright quantity reductions whereby consumers receive less medical care.”

    Nasty question: did their overall health improve? More medicine is not necessarily better, as I discovered when I had frozen shoulder. It can easily make you worse.

    1. Rhondda

      Yes, exactly. It’s a system and as such it can and usually does eat you up and spit you out, preferably after extracting all your funds and assets. Every single one of my mom’s (77 yrs old) health issues that have required hospitalization over the last five years have been the result of “care” she’s received from a doctor or nurse. She’d have some small complaint, some twitch in “her numbers” — that a doctor or nurse insisted required some sort of intervention. Evidence-based guidelines, don’t ya know. Next thing you know…blood sugar’s whacked or blood pressure mega high or the reverse –life-threateningly low. Always some “unintended consequence.”

      Just like in the study Lambert deconstructs: the HIC (Health Insurance Con) extracts about $10k from me for “coverage” — but I can’t use it because there’s a $14k or so deductible. Of course, that’s assuming all the stars align or all the ka-ching doctors wandering the hospital looking to “consult” on unconscious or dying Medicaid patients are in Aruba. Yes, I could go get an AWV — an annual wellness visit or some shit like that. But seriously, when have you EVER been to the doctor that they didn’t find a little sum-sum…a number too high or low…a puzzling lab results. “Let’s make another appointment for next Thursday.” And you’d better show and be quiet and deferential or you’re “non-compliant.” The smallest thing will put you in the system and they will suck and suck and suck you dry. Not to mention time wasted in a waiting room where you’ll catch some damn MRSA or something.

      It’s a racket. To treat it like purchasing a TV or a new laptop isn’t whack-o they-don’t-get-it incompetence…they’re not stupid. It’s evil.

      I’ve met a few well-intentioned doctors and nurses. A very few. But even they worked in the system and didn’t question.

      I am serious when I say I am just figuring to die. The system killed my dad. It killed my step-dad. (Medical errors.) It’s nearly killed my mom a couple times. Me, I’m not going there. I’ll get a bone set or that sorta thing but no pharma, nothing invasive…and very little else.

  24. equote

    Market (definition) An actual or nominal place where forces of demand and supply operate, and where buyers and sellers interact (directly or through intermediaries) to trade goods, services, or contracts or instruments, for money or barter.
    Markets include mechanisms or means for (1) determining price of the traded item, (2) communicating the price information, (3) facilitating deals and transactions, and (4) effecting distribution. The market for a particular item is made up of existing and potential customers who need it and have the ability and willingness to pay for it. (From: http://www.businessdictionary.com/definition/market.html)

    Does health care meet the definition, particularly regarding a customer’s ability to pay?

    Do health care consumers often forgo the treatment recommended by providers (particularly if life of disability is threatened)?

    note: Yves said in another post — “What we have that looks like inflation (2015) … (for instance, continuing increases in health care costs) is looting in actual or perceived “must have” services . . .”

  25. Merf56

    I will apologize in advance for the tone but I am angry. Potentially losing my son, our home and our entire retirement savings will do that to a person…
    Our son has severe dyslexia and a sky high IQ. He also has chronic kidney issues for which he is hospitalized several times a year each and every year. It is taking him quite a few years to get through college because of these two situations and thus fell off our insurance at 26 though he is still in college doing a double major in microbiology and neuroscience. Through Obamacare he stayed on our excellent insurance an extra three years from 23 to 26 thank heavens.
    Before ACA when he tried to get his own policy that would cover him fully for his kidney issues he was turned down by ALL companies for anything related to kidneys in any way. Even so far as excluding some slight extra specific kidney function testing done in bloodwork. It was nuts.
    Just for your erudition last year’s total bills for kidney issues were $638, 854. Do you think a colleges student has that kind of money? Really? We would have had to cash in our retirement savings and sell our house to pay for a couple of years of that. So would most of the American middle class. We are fiscally responsible college educated people living in a fairly modest home albeit in suburban metro area considered on the slightly more pricey side ( not like NYC of LA or course).
    Through the ACA he was able to get a good policy for himself( that we pay for of course as he is still in college this year finishing up) that covers his massive bills with an affordable deductable for us.
    I dislike most of the people in both parties and think they are all shills for business interests and Obama has been a massive failure in my book for most things. But the ACA literally saved my son’s life AND saved us from being totally penniless in to retirement or destitute within a few years. Our house we bought in 2007 is still worth 200,000 +less than we paid for it despite my skilled husband having rebuilt the damn thing from top to bottom so in forced selling we would lose the paper equity we put down. I am still waiting for the rebound in real estate with bated breath…..
    NC features pieces from themselves others constantly… which salivate over tearing down and wanting to sweep away the ACA. For all its blatant giveaways to the insurance/pharma oligarchs and other evils, scrapping it would literally kill/financially ruin us and my son. KILL. NOT ‘just hurt a little’. KILL. So THINK a little before you open your your damn snotty self righteous mouths. Real easy to be cavalier with other peoples’ literal survival. ‘Something’ is far better than the brutal ‘nothing’ we had for some of us real live middle class people out there……
    I don’t know if I will even vote for a presidential selection or other national office this year because of the dearth of people who give a damn about the citizenry who are running. Sanders talks a good game but the piranhas in Washington will never allow him to make more than a window dressing change in the meager steps already taken to improve healthcare access.
    Work instead please for changes to the ACA which will make a real positive difference in peoples’ lives and bring down the multinational healthcare cabal who runs the show. It is what I talk about when I show up to my US Representative’s office each month and to my two Senators staffers when I do the same to their regional offices. If every single person would do this like I do each every month we would have single payer health care with every single person inside this country fully cared for. I wouldn’t have to lay awake and worry each and every night about what if someone on their smug high horse gets rid of the ACA and we run out of money and then….. my son dies…..

  26. bill3

    NC really has the richest comment section on the web. I love you guys.

    Should be a weekly best of round up.

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