Basic Assessment and the ACA

This is a good time to remind ourselves that the plural of anecdote is not data.

congress-healthcareIt has to be understood that trotting out negative examples of the ACA is no more proof of the law being a bad than are trotting out positive examples proof that it is a good law.

It is going to be possible to find people whose premiums are going up, just as it is going to be possible to find examples of people who are now overjoyed that they can get insurance.  This is a good time to remind ourselves that the plural of anecdote is not data.

First, in terms of assessing the law, we all have to remember that the vast majority of Americans will not be directly effected because they already have health insurance through their employers.

Second, this means that the focus has to be on how the law impacts the previously uninsured and also the way it affects persons who get their insurance individually (e.g, the self-employed, small business owners, etc.).

One of the ways that we are going to have to assess the law’s impacts is going to be linked to the exchanges and the degree to which they do, or do not, provide cheaper insurance to those who use the service (and yes, the degree to which the technical side of the process actually functions is also important).

In looking into this situation, however, we have to remember a few things:

1.  Individual insurance rates have been steadily going up before the ACA passed.  Therefore, the degree to which current rate increases are ACA related are questionable.  Some clearly are (for example), but others are part of a clear long-term trend.  Also, that private insurance companies are more than happy to blame the law for price increases should not be a shock.  They currently have a great excuse for the changes, and obviously they are going to take it.

2.  The focus on private insurance is just, as I have noted on many occasions, the deepening of the pre-ACA system.  There is no public option unless one is poor or over 65.  The disparity between what an individual had to pay for family coverage if one had a good job versus what a self-employed person pays is not a new phenomenon.

3.  The true place to focus in evaluating the policy is on the exchanges, which are supposed to create more market pressure (in a limited form) on the system by allowing insurers to directly compete for the business of those who do no have employer-based insurance.  Part of the problem currently is that in many states there aren’t that many options.  As the piece linked above noted, Blue Cross/Blue Shield controls 88% of Alabama’s health insurance market.

4.  The fact that many Republican-controlled states refused to set up their own exchanges is, therefore, really more ideological cutting off one’s nose to spite one’s face than it is a sound policy decision (especially since the exchanges have the most market-linked elements of the entire policy package).

5.  Some areas for long-term testing of the law’s efficacy include:

a.  How many people sign up for insurance who previous had none.

b.  How many people opt to pay the tax penalty.

c.  How many people were able to get a cheaper rates once they shopped the exchanges?

d.  Will the inclusion of many more young, healthy persons on the rolls of private insurance push price down?

e.  Will the lack of strictures against pre-existing conditions force prices up?

f.  If prices continue to rise (which is likely), is the slope of the trend higher, lower, or roughly the same in comparison to the pre-ACA trend?

g. There is also the issue of the way in which premiums, taxes, etc. go up to pay for things like the expansion of Medicare.

In the short term, technical problems with the website (which are real) nor uplifting stories about the newly insured (which are real) nor depressing tales of rate increases (which are real) can tell us much of anything about the general efficacy of the law.

FILED UNDER: Health Care, US Politics
Steven L. Taylor
About Steven L. Taylor
Steven L. Taylor is a Professor of Political Science and a College of Arts and Sciences Dean. His main areas of expertise include parties, elections, and the institutional design of democracies. His most recent book is the co-authored A Different Democracy: American Government in a 31-Country Perspective. He earned his Ph.D. from the University of Texas and his BA from the University of California, Irvine. He has been blogging since 2003 (originally at the now defunct Poliblog). Follow Steven on Twitter

Comments

  1. Mikey says:

    The range of stories coming out about the ACA provides a golden opportunity for anyone who wants to confirm their biases for or against the law. Hell, I could do both: I have a friend whose husband is a psychiatrist in private practice, so they buy insurance on the individual market. Their premium is increasing 63% next year. I have another friend who is a single mother, working and going to college, whose employer does not provide insurance. She and her daughter will be insured for the first time in a long time. Obviously, which story I choose to tell depends on whether or not I favor the law.

    My opinion, FWIW, is that we still have a long way to go with this. It’s quite apparent the IT part of it was horribly bungled, but that’s fixable.

    The people who are really going to get screwed are those living in states that have not chosen to expand Medicaid, and who earn too much to qualify for it but too little to qualify for a subsidy. They will be responsible for 100% of the premium, which even on the exchanges can be pretty hefty.

    It’s too bad we couldn’t have opted for a Germany-style universal multi-payer system, but thanks to GOP FUD we barely got the kludge we ended up with. Hopefully this is just the first step to a much better future.

  2. Crusty Dem says:

    Anything mentioning media coverage of ACA rollout/pricing is incomplete without this fact check of the lies told on Fox:

    http://www.salon.com/2013/10/18/inside_the_fox_news_lie_machine_i_fact_checked_sean_hannity_on_obamacare/?ncid=edlinkusaolp00000008

  3. C. Clavin says:

    I have yet to see the end of civilization, as was predicted.

  4. Jenos Idanian #13 says:

    First, in terms of assessing the law, we all have to remember that the vast majority of Americans will not be directly effected because they already have health insurance through their employers.

    I’m going to challenge that base assumption. A lot of people have found that the plans they had before, and were content with, aren’t available any more because they don’t meet the minimum standards of the ACA. Their premiums are going up significantly to pay for coverage they don’t want and don’t think they need.

  5. @Jenos Idanian #13: I am going to have to challenge your lack of an argument and, especially, your lack of data.

    You are just making a vague assertion.

  6. David M says:

    @Jenos Idanian #13:

    You missed the important part:

    First, in terms of assessing the law, we all have to remember that the vast majority of Americans will not be directly effected because they already have health insurance through their employers.

    Your point may have made sense for the individual market (although I think it’s quite overblown), but not to employer provided insurance.

  7. legion says:

    @Crusty Dem: Came here to post exactly that. Prof Taylor’s basic starting point is fine, but as more and more of the cases against the ACA’s effectiveness turn out to be the product of people too stupid/lazy to check what the law actually provides them (instead of just relying on what hack like Hannity tell them it does) or just plain old bald faced liars (like the numerous businessmen who are unaffected by ACA, but are making layoff decisions & just _blaming_ the ACA), the weight of evidence has been a steady drum-beat in favor.

  8. rudderpedals says:

    The figures for individual coverage don’t make sense if the unless the comparison is an ACA compliant policy and the bogus policies for ex the $5K lifetime max typically offered on the individual market as “temporary” coverage

  9. Jenos Idanian #13 says:

    @Steven L. Taylor: I actually had a specific example in mind: a Kos diarist who had his existing policy discontinued, and the replacement almost doubled his premiums.

    Also, Obama’s extra-legal move to push back the employer mandate (there is no provision in the law for that action) while upholding the individual mandate will have the effect of pushing at least some employers into not bothering to offer coverage, throwing their workers into the exchanges. Nothing quite like literally captive consumers…

  10. anjin-san says:

    I don’t think we can expect the right to do anything but grab onto anything that supports their pre-existing bias against Obamacare, and ignore the rest. This behavior is one of the hallmarks of the modern conservative movement.

    It will be interesting to see how Democrats process valid information about real world problems with Obamacare. Certainly the web rollout seems to have serious issues. We need to take a look at what went wrong there and perhaps fire a few people.

  11. anjin-san says:

    @ Jenos Idanian #13

    Ah, so Kos is BS, except when they say something you like 🙂

  12. @Jenos Idanian #13: And thus you prove you miss the entire point of the post.

  13. C. Clavin says:

    Shorter Jenos….
    ObamacareGHAZI!!!!!!!

  14. al-Ameda says:

    It is indeed a rorschach test. People see in the ACA Exchanges what they want to see.

    People who were ideologically opposed to ACA and the exchanges when the bill was passed remain so today, and most have no idea how the exchanges are supposed to work. In my family alone, all but one person believes that ACA requires all individuals to purchase health insurance through the exchange, they also believe that their employer is going to cancel employee coverages and send them to an exchange.

    Ironically, when ACA passed, here in California state officials immediately contacted people from the Romney team who had been involved in setting-up exchanges and the insurance mandate and utilized their knowledge and abilities in setting up exchanges in CA. We’re pretty far along out here because we did not spend 3 years obstructing, avoiding and interfering with implementation of ACA, as many Republican officials did.

    I also find is “interesting” that those same Republican officials who obstructed and declined to implement ACA Exchanges are now using their own dilatory tactics and resistance as evidence that ACA does not work.

  15. Dave Schuler says:

    I agree that it’s premature to make any judgements about the PPACA, Steven. We’ll have more information in due course.

    I think there’s one factor you’ve omitted: opportunity costs. Win, lose, or draw the PPACA is healthcare reform for some period of time, probably no less than ten years. Since rising healthcare costs are absolutely killing the budgets of state and local governments, not just the federal government, the need to slow that rise is clear. I think they must rise no faster than income (since in general terms income is a limiting factor on revenue) but, obviously, that’s a bone of some contention.

    If the PPACA is successful in controlling costs, good. If it’s not, it will have delayed a very important aspect of healthcare reform until it’s run its course.

  16. @Dave Schuler: A fair point.

  17. Rafer Janders says:

    @Steven L. Taylor:

    I am going to have to challenge your lack of an argument and, especially, your lack of data.You are just making a vague assertion.

    But he said a lot of people have found that! How is that not data? How is that a vague assertion???

  18. michael reynolds says:

    Well, I’ll throw another anecdote on the fire. It looks like my premiums will go drop by 400-700 per month. That’s 5,000 to 8400 per year. (It depends, because I’m comparing apples and oranges to some extent, co-pays etc don’t match perfectly.)

    So, I had zero problem with the Covered CA site and as soon as I can figure out the details at my end (there’s my corporation, blah blah blah, so boring) I’ll jump over to Obamacare. Maybe I’ll donate the first year’s savings to Obama’s PAC.

  19. al-Ameda says:

    @michael reynolds:

    So, I had zero problem with the Covered CA site and as soon as I can figure out the details at my end (there’s my corporation, blah blah blah, so boring) I’ll jump over to Obamacare. Maybe I’ll donate the first year’s savings to Obama’s PAC.

    As I indicated above, here in CA, state officials consulted members of the Romney team with respect to their experience in setting up exchanges, and went about doing it – we didn’t obstruct the hell out of the ACA and delay implementation.

    By the way, anecdotally, 3 friends have checked out the exchange for coverage and 2 of them have favorable price quotes – basically, they’re taking on higher deductibles yet they will still save money.

  20. David M says:

    @Jenos Idanian #13:

    Not only is a single example not that useful, that diary was worthless. The person did not check the exchange for other plans. Somehow that step keeps getting missed in the rate shock examples.

  21. Jenos Idanian #13 says:

    @anjin-san: Ah, so Kos is BS, except when they say something you like 🙂

    Go have someone explain the concept of “admission against interest.” Ask them to use small words.

  22. C. Clavin says:

    Surely Jenos is commenting from one of his/her beloved parks.

  23. Ed in NJ says:

    @David M:

    In many cases, it’s purposely ignored to make a dishonest claim.

    As I predicted months ago, we are going to be inundated with purely anecdotal evidence, unfortunately, for the next many months. That’s just how reporting works these days. Hopefully, when Nate Silver opens his new 538 in January, we’ll see some of the data Steven hopes for reported in ways we can understand.

    As for how PPACA intends to control costs, I highly recommend the posts Richard Mayhew has been doing at Balloon Juice for the past several months. As an insurance industry insider, he’s really been able to explain how things like decreasing MD incentive plans, risk assessment and management, provider consolidation, and payment models, just to name a few, are either features or intended consequences of reform design to drive down costs. Whether it works remains to be seen, but a couple of partisans sitting on Hannity’s stage aren’t going to be the ones determining that.

  24. anjin-San says:

    Sounds like the post you are so excited about this more of an admission of ignorance then a admission against interest. Well I am sure there will be other cherries for you to pick…

  25. Tyrell says:

    How this plays out over the next year is anyone’s guess. Fixing the computer system could take longer than a few weeks. I haven’t talked to anyone who has applied. There are many questions that people have and these are all various depending on their individual needs and circumstances. No program is perfect. All programs need to be tuned, tweaked, and adjusted.
    I just hope that their toll free number connects you to a real person, not a long menu, and that the wait is a minute or two instead of the all day waits on the IRS phone lines.
    Looking at some of the premium rates and the various deductibles/co-payments, there are still going to be a lot of people who can’t afford this. What will be done about that? Will they have some sort of tax penalty. ?

  26. Richard says:

    “First, in terms of assessing the law, we all have to remember that the vast majority of Americans will not be directly effected because they already have health insurance through their employers.”

    Incorrect. The “revenue neutral” aspect of the ACA has already been debunked. The subsidies being doled out to those under a generous multiple of the poverty line are being funded by higher taxes on investments, income, and medical devices.

    In terms of broader policy implications, I’d be in favour of single payer, which at least will have benefits that accrue evenly to *everyone*. At least with that, everyone is getting the same benefit. As it is currently written, the ACA is a giveaway to the Democrats’ constituents while socking everyone else for the money. I cannot get behind that, or more generally, any kind of benefit/transfer payment that is not equal for all citizens. One can think of social security in the same way. Currently, it’s a forced saving net for all, with some degree of redistribution happening behind the scenes. If it becomes means tested, I bet you will see a huge revolt from those who will pay in and not get anything out.

  27. dazedandconfused says:

    Steve, Taylor,

    I agree with your point, but must point out that the plural of anecdote IS not data.

    I hate that saying…. 😉

  28. Spartacus says:

    @Jenos Idanian #13:

    while upholding the individual mandate will have the effect of pushing at least some employers into not bothering to offer coverage, throwing their workers into the exchanges.

    I thought everyone across the political spectrum was in favor of de-linking health coverage from a person’s job so how is it a bad thing if those people who were getting insurance through their jobs now start getting it through the exchanges?

  29. Spartacus says:

    @Richard:

    I cannot get behind that, or more generally, any kind of benefit/transfer payment that is not equal for all citizens.

    Are you also opposed to free public education for those families that have more children than you do?

  30. David M says:

    @Richard:

    I’d be in favour of single payer, which at least will have benefits that accrue evenly to *everyone*. At least with that, everyone is getting the same benefit. As it is currently written, the ACA is a giveaway to the Democrats’ constituents while socking everyone else for the money. I cannot get behind that, or more generally, any kind of benefit/transfer payment that is not equal for all citizens.

    I’m not sure you have the “Democrats’ constituency” part of the equation correct, especially as the ACA is a better deal for people when they are older. Also, single payer doesn’t really fix the problem of everyone getting the same benefit, as it will be a much better deal for people that don’t make very much money, same as the ACA. Even if that was a valid concern, it seems extremely minor and not really a reason to prefer the prior status quo (doing nothing) over Obamacare, as it’s a lot easier to get to single payer by reforming the ACA rather than repealing it.

  31. Ben says:

    @Jenos Idanian #13:

    The most pathetic thing about you trying to use that diary as evidence of some sort, is that you obviously didn’t look through the comment thread, where the diarist stated that this was an individually purchased plan and he admitted that he hadn’t actually gone through and looked on the exchanges yet to see if he could get a lower priced plan through some other provider. So the funny thing is that this private insurer dropped a super-low coverage, super-high deductible plan, replaced it with a better plan at twice the cost, blamed it on the PPACA, and the diarist couldn’t be arsed to go look at the exchanges, which is the really the only part of the PPACA is truly is free market.

  32. Tyrell says:

    @Spartacus: You bring up a good point. And let me say this about the public school system: too much top heavy bureaucracy and decision making from the top, from politicians, and from university people who have little real experience teaching and working with 30 students in a classroom that is short on desks, supplies, computers, and restroom space. No, the real power should be with the teachers and principals: those who are with the student every day. Too many comparisons with other countries look only at test scores, not discipline and professional treatment of our educators. In our state, teachers make a little more than unskilled labor. And are treated no better, probably worse.
    I just had those thoughts zip through my mind when I read your comment.
    ” In 1814 we took a little trip – along with Colonel Jackson down the mighty Mississipp’ ” (Johnny Horton)

  33. @dazedandconfused: I understand where you are coming from, but anecdotes are stories people tell, often with a lack of clear understanding of what is being told. Moreover, they are notsystematically collected. Even if you hear a lot of stories about how great Obamacare is or a bunch saying how awful it is, you do not have much in the way or useful data. You jus have a bunch of anecdotes.

  34. humanoid.panda says:

    @Tyrell: If someone can’t find an insurance program on the exchange that’s less than 9.5% of his/her income, they are exempt from penalty.

  35. Scott O says:

    @Jenos Idanian #13: There are certainly some people who will be worse off under Obamacare and Tirge Caps seems to be one. There are minimum requirements for health insurance plans now and the plan he had didn’t meet them. He will be forced to buy more insurance than he wanted or pay the fine. The law also has a .9% Medicare tax increase on income over $250k so folks in that bracket will be worse off. Any new law or regulation can have winners and losers. When environmental regulations prohibited dumping waste products in the river factory owners and possibly their employees were worse off. The question is whether or not the overall population benefits.

  36. Jc says:

    You hear these people complaining of having to pay more for minimum insurance, which has to make you wonder what lousy coverage were they buying before? If my employer offered a bronze plan I would not touch it, yet for some people that must be too much coverage…? The only people that can complain would be wealthy people willing to go with HD plans as they have the disposable income to cover that chance of a medical emergency.

  37. Neil Hudelson says:

    @michael reynolds:

    Donate it to a swing district dem rep who could use the cover. Obama is done with elections.

  38. Grumpy Realist says:

    I still would prefer something like a NHS for those who want it, let Teh Free Market cough up whatever it wants (including pre-existing condition and rescission stuff) for those who don’t. Get rid of Medicare. Mandatory NHS for children until they’re adult, after which they make their decision whether to stay on it, or get off it and take their chances.

    Oh, and if you want to drop NHS and go without a parachute, fine. If you want to go on NHS you have to demonstrate your health is as least as good as the average NHS patient of your sex and age,
    Oh, and no regulation of non NHS health insurance of any kind. If the results aren’t what you like, you can always bring a lawsuit, right?

  39. KM says:

    Was out of state a few days ago, decided to meet up with some old friends and got a great chance to see this in action. One of the girls was complaining her crappy plan was discontinued and her rates were getting jacked up by some 43%. We spent some 20 minutes trying to explain to her that the plan she had was crap, the new one had much better coverage, etc but to no avail. She loudly and rudely stated her opinions and challenged anyone at the table to “defend that piece of ^@&#&’ if we could. We didn’t – the old lady a table away did!! She came over, told my friend to keep it down, and pointed out that she herself had the crappy plan and was glad it was gone. After all, it seems you needed a cancer rider since there was like no coverage – leading to a major Oh Crap from my friend for whom cancer is a family scourge. Seems she didn’t really understand what her policy did and didn’t cover…..

    I would speculate that everyone bitching about their plans going away is like my friend. They had cut-rate coverage and were fortunate enough to never discover what it lacked. They don’t research on the finer points- they assume they’re “covered” regardless because they have “insurance!!”. They see only the dollar signs on the price tag, not what the dollar signs are getting them. Cheap insurance is great until you realize you were wasting your money on a defective product with little benefit when you really need it. Otherwise, its just money down the drain.

  40. Bob @ Youngstown says:

    @Grumpy Realist:

    something like a NHS

    I assume that you are referring to National Health Service?

  41. Bob @ Youngstown says:

    @KM: My sentiments exactly!!

    I believe that one of the (many) resons for health care costs out of control is that we consumers are not making wise and considered decisions, not just about our direct health care costs, but also insurance used to pay for health care.
    Blame it on wh ever you wish (lawyer and marketeers who make it extremely difficult to compare plans and the hidden “gotchas”, to employers who decide for their employees what is appropriate, to the average guy who is too lazy to investigate himself).

    If the only good to come of Obamacare is that their might be one marketplace that applies the same standards so that reasonable comparisons can be made, that alone will be a step forward.

  42. Jenos Idanian #13 says:

    So, the theory behind the PPACA is that since enough Americans can’t be trusted to make certain decisions in their own best interests, then the government has not only the right, but the duty to step in and deprive everyone of their rights to make those choices — or, at the very least, limit their choices to those the government deems appropriate and punish those who fail to make a government-approved choice.

    Which is what a lot of us said was the basic philosophy behind ObamaCare. And gun control laws. And anti-pornography laws. And drug laws. And the Defense of Marriage Act.

    Please, government, protect us from ourselves! Don’t let us make our own choices! Make our decisions for us!

  43. anjin-san says:

    @ Jenos

    Sorry dude, you don’t have the “right” to forgo health insurance, be a deadbeat, then pass your costs on to society when, inevitably, you have health issues.

    As for “limited choices” my personal experience at the CA site was that it offered a wide variety of choices – more in fact, than I currently have as a contractor who is carrying his own individual health care policy. The selection looked like it was as robust as any I have had when offered insurance through an employer.

    Please provide some data (if you don’t know what “data” is, you can look it up) that supports the claim that Obamacare is presenting people with fewer options than they had previously. Or, you can simply keep throwing up fact free screeds.

  44. Jenos Idanian #13 says:

    @anjin-san: Here’s one option they had previously: no health insurance, choosing the risks. Or another: an MSA that you could access to buy things that didn’t need a prescription. Or another: a catastrophic only coverage plan that doesn’t cover routine stuff, like the minimum for auto insurance.

    And I’ve had this argument too many times before: if “you might adversely affect other people” is the standard, then keep all the drug laws, outlaw tobacco and alcohol, and ban sex between men. All of which could potentially affect me adversely either physically, financially, or both.

  45. anjin-san says:

    Here’s one option they had previously: no health insurance, choosing the risks

    So they can choose to be deadbeats, go to the ER, and I get to help pick up the tab. So much for “the party of personal responsibility” – but then we have seen how a deadbeat mentality seems to have appeal on the right.

  46. anjin-san says:

    And I’ve had this argument too many times before

    And not once have you brought facts or data (or reason, for that matter) to the table.

  47. KM says:

    @Jenos:Or another: a catastrophic only coverage plan that doesn’t cover routine stuff, like the minimum for auto insurance.

    And what is the point of that, pray tell? You do understand what “routine” means right? “Catastrophic”? You might be shocked at how your definitions and the insurance company’s differs. My friend certainly was (see above). She believed cancer would fall under it as it didn’t fall under “routine”. If cancer (or diabetes or MS or hundred other long-term illness) aren’t “routine” and aren’t “catastrophic”, then what are they?

    I’ll tell you what they are – peripherals. And a chance to charge even more to stupid people who don’t understand they are being cheated in the first place.

    I put it to you again, what is the point of paying money monthly for a service that doesn’t take care of your needs? I mean, other then allowing you to be fleeced….

  48. KM says:

    As cold as it is, perhaps now is the time to reconsider mandatory hospital treatment. The prevailing thought amongst the anti crowd is deadbeat-is-good and the safety net will be there for them. I propose a new Modest Proposal – give them what they want. Temporarily revoke the law for a brief period (6 months maybe) and let them see what happens. Those without insurance by their own recognizance (or anti-ACA leanings) should be perfectly fine with this as they feel they can deal with emergencies on a blow-by-blow basis.

    The ONLY reason idiots are comfortable with complaining about making individuals responsible for their own healthcare is because there is a socialist net in place to catch them. Let them walk the wire without it – see how brave they are. The rest of us will have what we need by dint of employer or ACA insurance. Once the law is reinstated, we compare the statistical data obtained and see how opinions have changed.

    As I said, cold. What do you think of this Swiftian solution?

  49. Bob @ Youngstown says:

    @Jenos Idanian #13:

    Please, government, protect us from ourselves! Don’t let us make our own choices! Make our decisions for us!

    And for goodness sake, make sure that hospitals are not required to provide services when we fall out of our cribs but don’t have the ability to pay for services.

  50. David M says:

    @Jenos Idanian #13:

    Here’s one option they had previously: no health insurance, choosing the risks

    They still have this option, but there is now a penalty for being in the group that passes along their health care costs to the rest of society.

    Or another: an MSA that you could access to buy things that didn’t need a prescription.

    There are still HSA plans.

    Or another: a catastrophic only coverage plan that doesn’t cover routine stuff, like the minimum for auto insurance.

    There are still plans with large deductibles.

  51. Jenos Idanian #13 says:

    @David M: Still a coercive choice — “you can make a wrong choice if you really want to, but we’ll punish you for it, so why not just go along with us?”

    Just own it, people. You can dress it up in all the fancy rationales you like, but you are still demanding the right to control others’ choices for your own selfish interests. That’s the core of your position.

  52. KM says:

    @Jenos:Still a coercive choice — “you can make a wrong choice if you really want to, but we’ll punish you for it, so why not just go along with us?”

    “I don’t feel like doing something I really should even though it’s inevitable I will need to use some form of medical services in my lifetime and I claim to support personal responsibility and hate “takers”. I’ve decided to place the burden on others intentionally – I’m not a “taker” (that’s “those people”) but instead try to frame my selfish decision in patriotic terms to try and shame my opponents as I have none. I call it punishment to be held accountable for my deadbeat ways because we all know nyah nyah nyah you’re not the boss of me, you can’t make me!!””

    There, FIFY. Own it.

    After all, you can dress it up in all the fancy rationales you like, but you are still demanding the right to pass off personal responsibility (a former conservative staple) and be a burden on hard-working people who actually pay for their insurance for your own selfish interests. That’s the core of your position.

  53. Pharoah Narim says:

    @Jenos Idanian #13: Shorter Jenos: I support insurance companies’ right to offer sham coverage plans–FREEDUM!

  54. Pharoah Narim says:

    @KM: I can completely related as I was trapped by one of these employer crap plans before. It was cheap….. until I had several urgent care and emergency room visits and came away owing THOUSANDS! Bu-but but…I GOT INSURANCE! The devil is in the details… Sham plans are nothing but money grabs. Why the hell was Principal Financial offering health insurance? Worked out about as well as the time I ordered Frog Legs at a mexican resturaunt….

  55. grumpy realist says:

    @Jenos Idanian #13: Wrong choices should be punished and not bailed out–otherwise how do people learn to take responsibility for themselves? Allowing people to not have insurance, then mooch off emergency rooms at hospitals (and then sticking the rest of us with the bill) is an obvious free rider problem. What are you going to do about that?

    So take your pick: either get rid of the emergency room health care system for anyone who walks in, or have a health care tax.

  56. al-Ameda says:

    @Jenos Idanian #13:

    Just own it, people. You can dress it up in all the fancy rationales you like, but you are still demanding the right to control others’ choices for your own selfish interests. That’s the core of your position.

    I’m tired of owning the right of the uninsured people to use the emergency room and other expensive services that I eventually pay for through my premium rates.

    Am I being coercive in trying to get the uninsured to become insured? No, I’m “incentivizing” them.

    Why do conservatives now believe that the 30 to 40 million uninsured have the right to pass the costs of their treatment on to me and all other insured people? I thought conservatives were against the “free lunch”?

  57. David M says:

    @Jenos Idanian #13:

    You’re making even less sense than usual now. I can’t even try and guess what your point is, aside from incoherent rage that more people can get health care now.

  58. wr says:

    @Grumpy Realist: “If you want to go on NHS you have to demonstrate your health is as least as good as the average NHS patient of your sex and age,”

    So if you’ve got some kind of cancer or genetic disease or are just in crappy health, it’s sorry, kid, FOAD? I guess that’s one way to keep costs down, but I don’t see how it’s much different from the current policy of insurance companies.

  59. anjin-san says:

    @ Jenos

    You can dress it up in all the fancy rationales you like, but you are still demanding the right to control others’ choices for your own selfish interests.

    I see your point. My health care premium is due in about a week. I’ve made my choice – you have to pay it. Make the check out to Kaiser for $582.00. I don’t want to hear about any of your selfish problems, just pay up.

    This should not be a problem, it’s consistent with your position that we are not responsible for our own health care costs and that passing them on is kosher.

  60. bill says:

    hey just got here, can i still keep my plan and doctor?! LOL…… i just hope that poor girl that obama used as a prop has sufficient healthcare and doesn’t need to deal with the disastrous “sign up system” in place, and hope it covers nearly being bored to death.

  61. anjin-san says:

    @ bill

    hey just got here

    And shockingly, you have nothing to contribute. At least Jenos is good at annoying people – he has a skill – you can’t even say that.

  62. bill says:

    @anjin-san: don’t just take my word for it, oh great contributor of….what?

    http://news.yahoo.com/builders-obamas-health-website-saw-red-flags-070429400.html

    remember, the t-party crowd gave them an out- (to delay it a year) but they insisted its ready!

  63. anjin-san says:

    @ bill

    Try to keep up. No one is disputing that there were serious problems with the web rollout. No me, not other Democratic commenters on OTB, not Obama.

    The teas don’t want to delay to take the time to get it right. They want to delay and destroy.

    Based on what I know, there should be some heads on a platter over the website launch. So we have a bad web launch. That does not mean that Obamacare is fundamentally flawed, and it does not change the fact that Republicans in government, for the most part, have done everything humanly possible to sabotage Obamacare.

    And before you burn too much daylight crowing about this, I will remind you about the train wreck that was the Romney for President IT effort. You remember, Mitt Romney, the guy we were assured was the brilliant manager/executive?

  64. al-Ameda says:

    @bill:

    hey just got here, can i still keep my plan and doctor?! LOL…… i just hope that poor girl that obama used as a prop has sufficient healthcare and doesn’t need to deal with the disastrous “sign up system” in place, and hope it covers nearly being bored to death.

    Has anyone who has health insurance through an employer’s coverage been forced to go to an exchange to purchase an insurance policy? That is not a requirement of ACA.

    Why do conservatives continue to imply that that is the case?

  65. bill says:

    @anjin-san: fair, i won’t pile on about the roll out as i’m somewhat empathetic….seriously. mitt wasn’t running some twitter campaign to lure the young/dumb college kids in to vote for him. like him or not he’s a very savvy biz guy- something DC needs ever so often.

    @al-Ameda: i alluded to no such thing- just throwing out that good old lie/promise from yesteryear. some of us keep track.