Healthcare.gov

george
1

Am I the only one who was horrified, then amused at what a disaster it wound up to be? Was anyone else surprised when 3 kids in California put up a working site in California over a weekend and no money?

This comes at the WORST time for me as I’m planning on quitting working in the biz completely by the end of the year. I’m working it in such a way as to never get called back in, but it’s a delicate balance as people tend to rely on me rather than think for themselves. Now, I’ve got my phone ringing more than ever because I’ve worked mainly with the medical profession here and folks are absolutely scared. The ID theft and hacking into the site is already the stuff of legend.

I’m so glad I’m getting out and turning that phone off December 31. I’m unplugging my house phone for about a month and the fax machine… jesus, I still have a fax machine, two in fact. There are times when I do wonder what will come of all of this. But, if I play my cards right, I will be on a beach, somewhere in Belize, ogling Cabana Boys with a strawberry daiquiri in each hand.

2

FWIW, the 3 kids just pulled together a scraper that pulled out the cost estimates and the applicable plans from healthcare.gov. It didn’t actually do any heavy lifting, nor did it interface with the big back-end stuff—the “Apply now” buttons that it presented all pointed you to the healthcare providers’ sites, and sometimes literally just at their homepages, rather than actually applying.

Not denying that hc.gov wasn’t fucked beyond all understanding (in fact, there was an article linked off of Slashdot this morning talking about their odd database choice, likely driven by existing DoD contracts more than actual sensible requirements), but the three developers didn’t do anything remotely on the same scale.

That being said…yes, debacle, from end to end. Inevitably so. Government scale IT is never pretty, and something this broad with this many stakeholders? Titanic-sized disaster.

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3

Well, especially when you have so many things done to the software because of politics, not the actual law, or the requirements.

No bid contract? Can’t have any Republicans weigh in on who is selected, or have anyone not properly vetted to handle it.

No load testing, or insufficient testing in general. Can’t have early testing failures used as ammunition by opponents to the bill.

Having to log in and create an account on the front end. Done to prevent reporters and political opponents from skimming gross costs out and publishing them.

There are no teeth in the Fine/Tax provisions. There is no penalty for not paying the penalty, the income checks are substandard, young healthy people are staying away in droves, Obamacare is going to collapse under it’s own weight at any point now. Even if the website works.

And for all of this I pay an additional $63(x4) a year, plus another 10%, on my insurance every year. Thankfully my premiums have been going down because we manage our health costs well here, since it’s what we do and all, but they would be even lower without Obamacare. $63 a year doesn’t sound like much until you look at a school district where that adds up to a quarter of a million, out of a fixed budget. Hello teacher lay-offs.

It would have been cheaper to take the 25 million or so people that didn’t have, but needed, insurance and give them cash to pay their bills. As it is, we’re going to end up with more people without insurance after PPACA than before. And none of this should be a surprise to anyone. It’s all in the way the law was written, and it’s what people who read it have been saying for years said would happen.

Here at my office we terminated the insurance of tens of thousands of people by the end of the first year of PPACA. Insurance for small day cares, hairdressers, small businesses, etc… all terminated due to PPACA calling the coverage illegal. And I would bet those people still don’t have coverage. We now have a new product that meets the law’s requirements, that frankly sucks. It’s like car insurance that covers oil changes, but not collision damage. But people are lining up for it, because they have to have something.

4

Nice analogy. Too bad it is so accurate.

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5

The largest driver of health care costs is the way health insurance is structured. Anything that removes you from the “pain” of the exact cost means you pay more. People spend more on credit than they do cash, people buy more on an expense account, people don’t even know how much a doctors visit costs.

So of course the costs go up.

Look at a few things that aren’t insured, but are medical related, so malpractice insurance, and cost of innovation, and all that are still included in the base cost. How much was a boob job 20 years ago compared to today? Or a lip plump, or a eye widening? How much was LASIK 10 years ago.

Now, everyone (in theory) will have insurance and no one will have any idea how much this crap costs. “You might need an MRI”… my first response is how much, why, and what happens if I don’t. A lot of people just say ok, like because it’s medicine all of a sudden they can’t make a decision based on information they can ask for.

Meanwhile, people will continue to bitch about how expensive health insurance is without realizing that it’s the cost of health care +7%. You will never “control” health insurance costs. All you can do is knock more and more small players out of the market, HIPAA and PPACA both did awesome jobs at killing competition and raising rates even higher. But not one thing for making health care cheaper.

6

You want cheaper health care for the poor and indigent, bring back the county hospitals and free clinics of the decades prior to 1960ish.

Make it so there are government supported hospitals and clinics that offer care, but you have to go to that facility to get that care. And yes, if you want to have your baby for free, you are having it in a bay with 10 other women, not a private room with WiFi. Use them as teaching hospitals, and remove the laws that make it illegal to take someone who can’t pay to another hospital or facility. With the amounts of transparency and press that can be brought to bear on any issues we won’t have to deal with the same issues these facilities dealt with for ages. Then, instead of the government paying 5 million people 10 million different times for medical care, they can just pick up the entire tab for the whole facility. Boom, there goes the entire bureaucracy surrounding Medicaid.

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What are you, a job-killer?? With your plan, all the people who run Medicaid will be out of jobs and need Medicaid to survive! Man, you really want to keep the little man down…

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There was actually a decent level of medical care for the poor in the US at one point. Instead of fixing the problems with that system they scrapped the whole model because it wasn’t “fair”. At some point “Beggars can’t be choosers” really fell out of style here. Now they’ll turn us all into beggars, so we’re easier to please.

9

Private charity is always preferrable to enforced governmental altruism. Charity at the point of a gun is not charity.

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Charity at the point of a gun is so some dipshit somewhere can say they do their part without having to think about it because they pay taxes. And since they pay taxes their moral obligation is met and they can just ignore all the people they pigeonholed into various programs until someone forces them to pay attention again, at which point they start another program to prove that they still care.

11

Taxpayers are getting screwed two ways now, though, and a lot of people are waking up. Not ENOUGH people, but more than before. The irony is that I’ve never been more thankful for TriCare . . .

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12

I wonder on what basis the President of the United States can unilaterally change a law like he has been.

Now, it’s actually HHS doing it, which appears to be legal, but you’d think this would set warning bells off for some people. The ACA is whatever the hell HHS wants it to be. If Gozer becomes the next President then the whole thing could be used to force people to get RFID chips and get sterilized. (Likely to happen, no, but the damn law is just a framework to add power to the bureaucracy) You could have anything decided on this, without congressional input beyond approving the head of HHS, and thanks to Barney that only requires a majority. the individual mandate taxanalty could also be jacked up 1,000% next year.

Not all of the parts that are being changed are part of the “Up to HHS” section; “promising” not to enforce the penalties on companies that play ball doesn’t sound very progressive to me, sounds more like how the Sopranos would do health care.

Regardless of how you feel about nationalized healthcare, this thing is a mess. They meant to clean it up after the vote, but losing the majority broke everything. Since the Democrats wouldn’t hold open meetings, or negotiate a settlement on the bill they had to use the Frankenstein bill they had. The public debate on C-Span never happened, the whole thing was brokered between the president, the pharma companies, big insurance, and the democrats in congress. Not a single person actually understanding what they were messing with on the government side.

This latest “it’s ok to get bad insurance if that’s all you can find” decree from yesterday is ruining the markets, I don’t know who they are going to get to sell these policies.

13

Obamacare : The way I understand it, if you’re unhealthy, obese and need medication you pay less than a fit and healthy person (who don’t need medication or medical attention, but will pay more)?

Or am I missing something here?

14

It’s easier to say it this way:

The state of healthcare in the US is absolutely broken, at all levels. It was broken for years before Obamacare, it’ll be broken for years after Obamacare.

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I have to agree with Dak here. When I was out of work and my COBRA ran out, the best quote I could find for health insurance was $900/month. This was due to the fact that I’m overweight and have Graves’ disease. It was far, far cheaper for me to pay for my labwork and doctor’s visits out of pocket than get health insurance. The problem was finding a doctor who would take me. They didn’t care that I could pay for the visit. The moment they heard, “I don’t have insurance” they wouldn’t even return my calls.

Something needs/ed to be done. Obamacare may not be the ideal solution, but at least the problem is being looked at.

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Nabiki, you might have been better off answering the insurance question with “I’ll pay cash up front”. A massive portion of the overhead for a doctor’s office now is billing.

No one looked at it. The thing was slapped together and was supposed to be fixed in committee, but due to the loss of the democratic majority, and things like “Elections have consequences” and “We won”, combined with the total lack of transparency on the sausage making made this thing a mess.

Contraceptive mandate? Really? Why? Paying for insulin would save more in medical costs, or free antibiotics, any number of things. Except it isn’t free, you just get everyone to pay for it.

Mandating wellness be paid for, but then come up with a definition of wellness that’s even more restrictive than what most plans already covered. And at the same time reducing the maximum flex contribution and taking OTC remedies off the list of acceptable expenditures.

I’ve been complaining about the same issues with this law for over three years now, and some people I know still think it’s a good thing that 5 million people lost coverage and only 1 million signed up. Though the way they are counting the people enrolled is the next best thing to lying. Enrolled in coverage means the check is in the bank.

17

Hey, did you guys know that a disincentive to work is a good thing when Obama does it? ACA will kill 2.5 million more jobs over 10 years or so due to people getting insurance from other sources and quitting their jobs.

“Job Lock” is when you keep a job just to get the benefits. As compared to “I just want to eat and have a place to live Lock”, which is when you have to have a job for money.

Susie has to work to keep benefits for her husband and child. He works as a freelance artist, making enough money to take care of everyone comfortably, but there is concern about little Johnny’s asthma. Susie doesn’t get paid very well, but the hours are very flexible, and she gets benefits for her family. Her prior experience as a CPA helps her current employer as well, he needed an office manager, but he also needed some accounting help.

Now, Susie can shop for an individual policy and get subsidized if she quits her job. Her and her husband and child can actually get insurance cheaper with the subsidy on their own than when she worked. So she turns in her notice.

Her employer is now up the creek. Anyone in the same situation as Susie is going to take the same route. He’ll have to shell out significantly more cash for a replacement, which he can’t afford, or do the work himself, which will cut into his already shorted free time. He may decide the whole thing is too much effort, sell his client base to a competitor and fire the 10 people working there.

And this is a good thing how? Why would we rather subsidize through the government something that’s currently being paid by private industry? Do we have a surplus?

19

Paying with cash means you walk in with the cash to pay right then and there. The Amish and the Mennonites do it all the time and they get discounts upwards of 70% for hospital procedures.

I have seen cash discounts on an individual basis hit over 50%. Walk into a doctor’s office and tell them you will pay cash for a doctor’s visit and see what they say. If they won’t take it go somewhere else. Elective surgery works the same way. You need a mole removed that insurance won’t pay for you can even work out almost a layaway program to pay for it up front for less than it would cost if insurance covered it.

In my scenario “Paying with Cash” means I have money in my hand I am willing to give you in payment for services rendered. Not a check, not a debit card. I don’t know another version of paying of cash that means I won’t pay you.

Think about it. Why does Lasik and plastic surgery keep getting cheaper while Dialysis keeps getting more expensive? Because people pay out of their own pockets for two of them and don’t for the third. Once the cost of care goes beyond your out of pocket most people don’t give a crap, or even double down on services. Hey, I hit my deductible, time to get all that other stuff done! Plans have a huge increase at the end of the plan year, and it’s from people that maxed out their oop more often than not.

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There’s also consumer choice and supplier competition, especially in Lasik.

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Again, if you offer cash up front you can take that down by half. Is it perfect, hell no, but it’s better than paying $900 a month for insurance that would just take it down to a $35 copay.

Cash up front does not mean I’ll gladly pay you Tuesday for a hamburger today.

I work at a TPA (Third Party Administrator) in the self funded group insurance world. I know how a lot of the nuts and bolts of this work. I’ve seen the marketplace evolve over a couple decades now and the influence of the government on medical pricing is insane.

There are choice and competition in those markets partially because they aren’t covered by Medicare. The profit motive drives the innovations which reduce costs and charges. The incentive is almost the opposite direction for Dialysis. If Medicare pays $1,000 for this service, and will continue to pay that regardless of competition or demand for the product, then why innovate? Hell, just take the increase each year and pocket it. And then you can whine about losing money on Medicare, something I believe less and less, and then get $1,500 from Anthem, $1,750 from CIGNA, and $1,599 from Aetna. Off of a $3,000 charge. (Numbers pulled out of ass, discounts close to actual ratios.

Why the hell would I even try to compete in that market? The government determines how much I can make.