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U.S. President Barack Obama delivers remarks alongside Human Services Secretary Kathleen Sebelius (R) and other Americans the White House says will benefit from the opening of health insurance marketplaces under the Affordable Care Act, in the Rose Garden
The health care exchanges—federal and state—are now functioning and not sucking up all the oxygen around the implementation of Obamacare. Finally, the "good news" news stories are finally being told, like this one in The New York Times.
Since his chronic leukemia was diagnosed in 2010, Ray Acosta has paid dearly for health insurance: more than $800 a month in premiums, plus steep co-payments for the drug that helps keep him alive.

Mr. Acosta, 57, owns a small moving company in Sierra Vista, Ariz., which he said had barely made it through the recession. He was thinking about dropping his coverage, but the insurance company beat him to it, informing him recently that it would cancel his policy at year’s end.

He sought advice from an insurance agent who had used his moving company. She connected him with an application counselor at a community health center, who found — to Mr. Acosta’s astonishment — that he qualified for Medicaid under the new health care law, the Affordable Care Act, which gives states the option of expanding the program to include more low-income adults.

“I’m kind of in a disbelieving fog,” Mr. Acosta said last week, two days after completing an application. “I’m just hoping, keeping my fingers crossed, that this might really help me out.” [...] “After being gouged all these years, trying to make ends meet, to all of the sudden get this?” he said. “I’m really blown away.” [...]

That's the kind of story that makes Republicans quake in their shoes. For more of them, go below the fold.

The good news keeps coming.

Claire He grew up worrying about her parents’ health. Her mother, who is a waitress, and her father, who is a cook, work long days at a Chinese restaurant in Battle Creek, Mich., where they settled after immigrating from China 14 years ago. Health insurance has always been a luxury they could not afford. [...]

This Thanksgiving, she and her family sat down to explore their options in the new insurance marketplace. After about 45 minutes online, they selected a midlevel, or silver, plan that would cost the family about $30 a month, after tax-credit subsidies based on income.

“We were shocked,” Ms. He said. “I actually called a few places to verify that.” [...]

At 61 years old, Bruce Kleinschmidt, a lawyer who is mostly retired, has no illusions about whether he needs health insurance. He has a chronic sinus condition that has required three operations, including one last year, and has had a few serious accidents over the years, including a fall that required back surgery. Doctors also recently diagnosed a heart condition. [...]

“I have been declined before,” he said.

The coverage available through the state high-risk pools for people like him, Mr. Kleinschmidt said, typically have “extraordinarily high premiums with really high deductibles.” On the state’s new online exchange, he was able to select a plan from a well-known insurer that came with a deductible of only $1,000.

“It’s a godsend,” he said. [...]

Tasha Huebner, 45, had long wanted to leave Chicago, but one of the biggest roadblocks was the fear of losing her health insurance. Ms. Huebner learned that she had breast cancer five years ago and, given her costly medical history, knew the chances of a new insurer accepting her were slim.

So when she finally sold her house and moved to Silverton, Ore., this year, she did so knowing that the new health care law would soon make it much easier for people like her to get coverage. Under the law, insurers cannot turn away people with existing medical conditions, nor charge them more for coverage. [...]

So she turned to the new exchange after it opened on Oct. 1. Oregon’s online marketplace has not worked properly, but Ms. Huebner figured out that a midlevel plan would cost her about $300 a month — within her budget. If she qualifies for subsidies — which is uncertain, given her unpredictable income —her bill may drop to about $150, she said. She applied through the mail and is awaiting approval.

Ms. Huebner said she is in good health and is training for two half-marathons. But she needs annual mammograms and checkups with an oncologist, and she lives with the knowledge that her cancer could return.

“I’m young,” she said. “The chances are that it will come back.”

For that reason, she said, being able to afford health insurance is “just a huge, huge relief.”

That's precisely what Republicans have been fighting against so desperately for the past four years; people's lives being made fundamentally better. People realizing that government can be a direct force for good in their personal lives. It's every Republican's nightmare, and it's going to play out in every state until next November.

Originally posted to Joan McCarter on Mon Dec 09, 2013 at 02:52 PM PST.

Also republished by Daily Kos.

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  •  Tip Jar (289+ / 0-)
    Recommended by:
    implicate order, ontheleftcoast, vivadissent, ericlewis0, itskevin, TXdem, CwV, Miss Jones, fiercefilms, fugwb, oxfdblue, tuesdayschilde, pvasileff, maggiemae, jsfox, hannah, theKgirls, OrangeMike, whenwego, Gowrie Gal, ekgrulez1, Sylv, SuetheRedWA, radarlady, karmsy, WinSmith, Laurel in CA, CitizenJoe, ratador, rmonroe, Cassandra Waites, this just in, Glen The Plumber, blueyedace2, We Won, raincrow, ferg, Ojibwa, Its the Supreme Court Stupid, dewtx, Trix, albo, praying manatheist, Pluto, a2nite, elwior, HappyinNM, librarisingnsf, jnhobbs, Ian S, Involuntary Exile, smileycreek, Raggedy Ann, don mikulecky, Polly Syllabic, Clive all hat no horse Rodeo, Aureas2, Lujane, MKSinSA, Sherri in TX, 1BQ, niteskolar, katrinka, BlueOak, Habitat Vic, hardart, gloriana, TheGreatLeapForward, fumie, grollen, leftykook, marykk, Tonedevil, jck, jedennis, MrJayTee, mconvente, skohayes, maybeeso in michigan, whaddaya, AJ in Camden, rsmpdx, misterwade, badscience, Dartagnan, rasbobbo, SaraBeth, rhonan, onionjim, Steven D, sawgrass727, NYmom, The BigotBasher, Buckeye54, Brian82, Themistoclea, slowbutsure, Darwinian Detrius, Witgren, HugoDog, virginwoolf, rlharry, global citizen, Rumarhazzit, eru, peachcreek, hotdamn, kharma, weck, Brainwrap, SherwoodB, Jim R, 2thanks, majcmb1, jaf49, gundyj, IndieGuy, Blue Bell Bookworm, Assaf, wader, GeorgeXVIII, buddabelly, checkerspot, Persiflage, Dodgerdog1, kleinburger, Mokurai, Capt Crunch, jrand, micsimov, sngmama, Blazehawkins, MBramble, Grandma Susie, pileta, eeff, zipn, toom, bbctooman, louisev, Dobber, Seneca Doane, nirbama, Texknight, JL, Em, dakinishir, wdrath, Smoh, exNYinTX, Jason Hackman, jdmorg, wilderness voice, antooo, bythesea, SoCalJayhawk, TrueBlueMajority, Ice Blue, puckmtl, FiredUpInCA, 207wickedgood, puakev, davehouck, ichibon, Linda1961, Orinoco, marina, BadKitties, IllanoyGal, allensl, Dewstino, Tailspinterry, hooktool, thomask, JNSD, BlackSheep1, Dvalkure, srelar, cordgrass, kkkkate, tommyfocus2003, TheMeansAreTheEnd, Powered Grace, MyMy, TomP, anyname, StellaRay, hulibow, flumptytail, Siri, annan, OIL GUY, LABobsterofAnaheim, parker parrot, Chitown Kev, sethtriggs, BlueDragon, maggid, imicon, Pilotshark, tinfoilhat, MRA NY, smoothnmellow, TexasLefty, richardvjohnson, Pinto Pony, newinfluence, Hill Jill, AsianAfricanAmerican, gramofsam1, asm121, aunt blabby, bleedingheartliberal218, wonderful world, cactusgal, cocinero, Gottlieb, EastcoastChick, Matilda, Libby Shaw, grrr, johnosahon, kj in missouri, beemerr, AllDemsOnBoard, Jakeston, Hayate Yagami, Front Toward Enemy, ratcityreprobate, slakn1, Rick B, SaintC, 3rock, Most Awesome Nana, GrannyOPhilly, MI Sooner, Mr MadAsHell, Lawrence, Byblis, dandy lion, steamed rice, bibble, greenbird, leonard145b, ConservativeBrainTrust, RadGal70, assyrian64, duhban, NormAl1792, Mostel26, Bud Fields, Spirit of Life, LMS44, Catkin, TofG, Eric Nelson, JayBat, amsterdam, tweeternik, kefauver, gmats, S F Hippie, FindingMyVoice, Mistral Wind, Creosote, eddieb061345, post rational, CoyoteMarti, rbird, Jeff Y, bobwilk, Late Boomer, yoduuuh do or do not, Triangulate, Alice Olson, Bear, Dead, schad500, alice kleeman, humanmancalvin, The Nose, DarthMeow504, chickeee, cececville, CoolOnion, sciguy, Lilredhead, Calamity Jean, mikejay611

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Mon Dec 09, 2013 at 02:52:18 PM PST

  •  Small typo in your diary... (80+ / 0-)
    That's precisely what Republicans have been fighting against so desperately for the past four FORTY years; people's lives being made fundamentally better. People realizing that government can be a direct force for good in their personal lives. It's every Republican's nightmare, and it's going to play out in every state until next November.
    This current fight against health care was only the latest salvo. The "Gingrich Revolution" of '95 was their revolt against health care. The "Reagan Revolution" was their revolt against, well, everything. Hell, one of Ronnie's (im)famous quotes, "The scariest words in English -- I'm from the government and I'm here to help" has been the rallying cry for the TEA Party and every other conservative group for 30 years.

    Maybe, just maybe, when people see that Obamacare isn't killing them they'll get a clue and stop voting for these GOP assholes.

    There are lies, damn lies, and statistics but they all pale in comparison to conservative talking points.

    by ontheleftcoast on Mon Dec 09, 2013 at 03:04:55 PM PST

  •  Republican "leaders" can get away with their (24+ / 0-)

    crap BECAUSE their followers want to be obedient and be considered virtuous. They're good and generous people. That's why they get taken advantage of.
    It is not kind to blame them for being naive. Moreover, there is no way their leaders can be reformed. Their egos thrive on causing distress. I don't think we should expect Republicans to be distressed. They'll think of some other way to inflict damage, if we let them.
    No more bi-partisanship.!!!

    Obamacare at your fingertips: 1-800-318-2596; TTY: 1-855-889-4325

    by hannah on Mon Dec 09, 2013 at 03:15:48 PM PST

  •  More stories like this... (38+ / 0-)

    and we grow our base!

    I want to live in a world where George Zimmerman offered Trayvon Martin a ride home to get him out of the rain that night. -Bishop G. Brewer

    by the dogs sockpuppet on Mon Dec 09, 2013 at 03:17:55 PM PST

  •  Someone I know posted on FB about some of the (64+ / 0-)

    RW propaganda she had heard. When she got her policy, it was a silver for 70 a month with a 30 a month dental.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White -6.00, -5.18

    by zenbassoon on Mon Dec 09, 2013 at 03:20:15 PM PST

  •  This news does my heart good, thanks. nt (14+ / 0-)

    It's here they got the range/ and the machinery for change/ and it's here they got the spiritual thirst. --Leonard Cohen

    by karmsy on Mon Dec 09, 2013 at 03:26:54 PM PST

  •  Don't get cocky. (15+ / 0-)

    Leave it to the mainstream media to peddle a new GOP fear tactic a few months down the line. The MSM isn't malicious, it just seeks to sell itself...and fear has always been a path of least resistance to achieve that aim.

  •  Govsend. Not Godsend. EOM (21+ / 0-)

    "There is just one way to save yourself, and that's to get together and work and fight for everybody." ---Woody Guthrie (quoted by Jim Hightower in The Progressive Populist April 1, 2012, p3)

    by CitizenJoe on Mon Dec 09, 2013 at 03:31:37 PM PST

  •  This is an Open Competition auction. (21+ / 0-)

    It is insurance reform, minimizing the information disparity between insurance companies and customers.

    Of course for the Republican Party this move to regulated capitalism is The End Of The World.

    The GOP works for the crooks. Wall Street. Insurance. Where ever there's a buck to be pocketed.

  •  Good, they can go back to he!! where they belong (4+ / 0-)

    nosotros no somos estúpidos

    by a2nite on Mon Dec 09, 2013 at 03:45:47 PM PST

  •  On to single payer...TY Vermont (17+ / 0-)

    we can do it!

    An idea is not responsible for who happens to be carrying it at the moment. It stands or falls on its own merits.

    by don mikulecky on Mon Dec 09, 2013 at 03:49:36 PM PST

  •  In my Diary last night I wrote: (17+ / 0-)

    (it was late, mind you….)

    Once again, we are running against Orcs and Death Eaters who are completely lacking in self awareness -- while the voters will have taken possession of a common human right as basic and well-established as guaranteed health care. And this new personal security is one that Americans are experiencing for the very first time in their lives.

    They will never, ever let it go.


    This is just horrible news for Republicans. Especially if Democrat opponents throw the terrible lies they fostered to destroy a program designed to save lives.

    I doubt they will attempt to repeal the PPACA even once in 2014.

  •  It will be interesting to see people (13+ / 0-)

    Voting with their feet. They will move to Medicaid covered states, or stay in covered states. So, yes, there will be more sick people in those states, but also more people who want to start businesses.  Young moderate income retirees will move to CA and AZ instead of FL so they can get Medicaid until Medicare kicks in.  That will affect FL bottom line if they don't break down and join up. Hopefully the result will be improved economies in the Medicaid states, and the wingers can sit back and moan, or get with the program.

    Be bold. Be courageous. Americans are counting on you. Gabby Giffords.

    by Leftleaner on Mon Dec 09, 2013 at 04:00:00 PM PST

    •  Little known fact. (4+ / 0-)

      28 percent of Americans move every year, because of health care.

      •  I doubt it, sorry (8+ / 0-)

        I don't know where that statistic came from -- last figure I recall is about 20% of Americans moving each year total, and that was well before the Great Recession -- now many people are stuck with underwater mortgages and can't move.

        I personally have never known anyone to relocate "because of health care." I have known a few people who chose which side of the line to live, when they were relocating to a new area. I thought about it myself -- Massachusetts is only a few miles away -- but then I'd be outside the bus lines.

        Link to source???

        •  I know. It sounds crazy, right? (8+ / 0-)

          Numbers and headlines stick in my brain. I got it off an actuary site. Lemme see if I can find it. I think it was on Benefits Pro.

          Meanwhile, here's an article I saw today:

          40 percent of people under 30 would move for better health insurance

          (MoneyWatch) More than 40 percent of Americans under the age of 30 say they would consider relocating if it meant access to better and/or less-expensive health insurance, according to a new study.

          While teens and 20-somethings are the age group usually most willing to move in general, the survey by also found that 28 percent of all Americans, no matter the age, would consider moving to a new state or county if it improved their coverage or made it less expensive.

          Lower income earners also showed a big interest in relocating to improve their coverage. Nearly 30 percent of those with an annual household income of less than $30,000 said they would consider moving under these circumstances. Location has a greater practical impact on this group in particular, because half of the states declined federal funds to expand Medicaid, and so where they live can dictate their access to coverage.


          Hold on! Here's a 28 percent number. Maybe that was what I saw:

          NEW YORK, Dec. 3, 2013

          More than one in four Americans (28%) would consider moving to another state or county to get better and/or cheaper health insurance, according to a new (NYSE: RATE) report.

          Young adults (18-29 year-olds) are the most likely to consider moving. Over four in 10 members of this group – which is generally more mobile than its older counterparts – say that health insurance would factor into their decision on where to live.

          About one-third of the lowest-income respondents (annual household income under $30,000) would consider moving for health insurance reasons. Since half of the 50 states are not expanding the Medicaid program, this is one of the groups most affected by geography.

        •  Obviously I got the who did what when wrong (6+ / 0-)

          …but the 28 percent was accurate ;-)

          That will teach me to read headlines targeted to insurance salesmen.

          OTOH:  I'm really glad I looked it up. That's a very interesting story. I would have never guessed those numbers.

          I guess health care insurance is a matter of life and death to people, after all.

    •  I agree. It could have some adverse effects (3+ / 0-)
      Recommended by:
      annan, mmacdDE, kj in missouri

      if it gets out of hand.  (As in skewing the insurance premium rates, etc.)  Of course, there would be little that anyone could do to stop it, that I can think of, LOL!

      We've known several couples and two families who've expatriated for reasons of obtaining decent healthcare.

      Their expenses are a fraction of what they would be stateside, and they receive excellent care.  Doctors "house calls" are still made in some parts of Europe and Latin America--if you can imagine that!

      We also know a couple of people who have engaged in "medical tourism," which we are exploring for next year (for a very major surgery).

      If we go through with it, I plan to blog about the experience.  We are currently working with our insurance company to see if they will approve it.  (It is a very tedious procedure--looks of paperwork required.  Whew!)


      "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


      by musiccitymollie on Mon Dec 09, 2013 at 08:27:08 PM PST

      [ Parent ]

  •  I live in SD and our governor is not expanding (31+ / 0-)

    medicaid. A few months ago my 40ish year old husband died on the side of the road, while changing a tire, from a massive heart attack. We knew he needed a bipas because 4 yrs prior he had his first heart attack and was told he needed this procedure. He was uninsured. We had many finacial problems from the first episode. They are still sending me bills that add up to more than 6 grand for trying to revive him this last time. I am also currently uninsured. My eldest son has been hospitalized 2x since his dad passed do to anxiety and depression. I am not working outside the home yet because his condition is iffy and needs to be monitored. Also, he has missed so much school that they finally suggested he do online public school and I must assist him until he is more stable. My younger son has an Asperger's diagnosis and my presence is needed sometimes in his case as well.  We are living on less than 1600 dollars per month, plus about 220 in snap.  I believe I make too little to qualify for subsidies, does this mean my option is to pay full price or is it to just not get sick and hurry up and die.

  •  The Republican party is nothing but a bunch of (10+ / 0-)

    murderers at this point. Period.

    I got gay-married in Maine!

    by Rumarhazzit on Mon Dec 09, 2013 at 04:35:07 PM PST

    •  I agree...accompanied by non-murders (2+ / 0-)
      Recommended by:
      Buzzer, Rumarhazzit

      in deep denial, I think. I have a healthcare provider-someone who has been very kind and helpful to me-- who I recently found out is deeply Conservative (he says, but he's actually Reactionary as he/they want to go backwards) Tea Party member. I was taken aback, even upset, because I rely on him for my health and I believe that the Tea Party does not care about my health. Even, they support policies that would lead to my death (I'm on SNAP and other government programs right now).

      His story is that the Tea Party cares about people in need and believes "the deserving" should get help but too many people are cheating the system. He himself has a brother on disability and SNAP.

      I conclude that this kind man just projects his own kind heart and well meaning motives on the Tea Party as a whole. He sees them through oddly rose tinted glasses. I pointed out how none of their leaders nor their supported policies EVER talk about taking care of the "deserving" or how they are going to protect the "Deserving poor" (I think almost all like are deserving, myself but I was using his own paradigm in order to reach him) from crashing to the ground when they slash the safetynet suddenly as they say they want to do.

      I think I made him think.

      •  The Tea Parties, the Religious Right, (1+ / 0-)
        Recommended by:

        the Libertarians, and the 1%ers, the main Republican factions, all have fairy stories about how they are the only moral and deserving ones, and how everything they do is for the benefit of the victims of their racism, bigotry, nativism, misogyny, Exceptionalism, and Mammonism. These riff-raff are at best the undeserving who are ruining our great country by pursuing greed or other individual faults, or at worst a conspiracy among all of the enemies of all that is Good and True, who are intent on destroying Civilization as We Know It. The particular excuse varies: moochers, sinners, tyrants, No You're the Racists, followers of Marx/Hitler/the Antichrist/Darwin…but it all comes down to John Kenneth Galbraith's observation

        The modern Conservative is engaged in one of man's oldest exercises in moral philosophy—the search for a superior moral justification for selfishness.
        and to basic Cognitive Dissonance. The lying politician or talk show host may well know that he is lying; the common or garden-variety hypocrite, never. Such people are too deep in denial.

        Ceterem censeo, gerrymandra delenda est

        by Mokurai on Tue Dec 10, 2013 at 08:00:13 AM PST

        [ Parent ]

      •  "Deserving" = "White" (1+ / 0-)
        Recommended by:

           In teabaggerland.

        "Le ciel est bleu, l'enfer est rouge."

        by Buzzer on Tue Dec 10, 2013 at 08:15:05 AM PST

        [ Parent ]

        •  not to to this one guy I am pretty sure (0+ / 0-)

          He is in deep denial of Teaparty racism as a part of its hidden core. He admits isolated incidents and acts indignant/angry about them and says he calls them out. He lives in suburban to rural MA so maybe the overt racism is less prominant here. I have read that local Teapartiers may villify the struggling a bit less than some other places so perhaps their are other differences. Or maybe not and maybe also his guy is bullshitting.

          Regardless, I completely agree with you that most think as you say and was not arguing otherwise except to point out this interesting case of denial of the sordid aspects of the Teas. I was not specifically discussing denial of racism in my comment but this individual's noverall blindness to how the Teaparty really does not care if the struggling suffer or die. I do wonder if there is a rabidly "libertarian" of the no government is best type of Tea Partier who is in denial as much as this.guy. If so they may be a small minority but I found it curios nevertheless.

  •  This is indeed a good story from the NYT but... (1+ / 0-)
    Recommended by:

    Right now, the fifth most emailed article in the NYT is a story about how premiums for insurance on the exchanges may be lower, but other expenses higher. And that people don't know they are eligible for federal help for copays if they buy a silver plan. I don't think we're at a turning point in Obamacare coverage yet.

    •  I realize that this may be controversial, (2+ / 0-)
      Recommended by:
      Pluto, kefauver

      but from a "keep heath care costs" down point of view, are not low premiums and high deductibles good at managing the utilization problem in health care?  Since we spend 2-3x western countries in health care, couldn't an unmentioned but intentional effect of the ACA be this high deductible mechanism to control overall costs?  Distasteful, yes, but it might slow down the 6-7% health care inflation we see year after year..

      Some would say that insurance should be high deductible/ low premium as it is really insurance that way-a way to deal with disasters, not a run to the doctor for free mechanism.

      Some economists are behind the ACA, Gruber of MiT for one.  Didn't he see this happening?  And maybe he thinks it is a good idea? Note they didn't write deductible amounts into the legislation.  Medical loss ratios, yes, deductibles no.

      •  Did you know that Americans (3+ / 0-)
        Recommended by:
        mmacdDE, annan, kefauver

        see doctors fewer times per year than citizens of any other of the 30 most developed nations.

        All another per capita costs remaining the same.

        And, yeah. I got the data on that.

      •  There isn't a utilization problem in health care (1+ / 0-)
        Recommended by:

        There has been a lack of access  to care problem.

        For real Texas Kaos, you want, not .com. Before you win, you have to fight. Come fight along with us

        by boadicea on Tue Dec 10, 2013 at 07:53:21 AM PST

        [ Parent ]

        •  Hmm. (0+ / 0-)

          Most of our no or low income people have instant access to medical care currently-it is called the woefully inefficient emergency room.

          •  It's your assertion (0+ / 0-)

            prove it.

            Prove that the real problem with medical care in this country is that there are TOO many people using too much medical care.

            And that medical care delivered in an emergency room is adequate for anyone as an access to health care.

            Back it up, or take your bullshit to another corner.

            For real Texas Kaos, you want, not .com. Before you win, you have to fight. Come fight along with us

            by boadicea on Tue Dec 10, 2013 at 09:26:19 PM PST

            [ Parent ]

            •  Nice. Nice name calling (0+ / 0-)

              You see, but pointing out that access is through the emergency room I was pointing out a FLAW in the current access system.

              I think by your answer we ACTUALLY agree with each other, but I tend to not use words like you in an argument.  It indicates a lack of education.

              I guess it is not only the tea party people who emote first and think later.

              What part of woefully inefficient did you not understand?

              •  Telling you to back up your assertion (0+ / 0-)

                is hardly name calling. You don't want to be called out on peddling bullshit, stop peddling it.

                And I note you haven't backed it up still.

                You trot out a RW canard that anyone can get treated at an ER-have you EVER had to rely on an ER as your sole access to medical care?

                Do you have ANY data to back up your  assertion that the problem with medical care in this country is utilization? And how exactly are you defining that term if it is not too many people using too much care?

                For real Texas Kaos, you want, not .com. Before you win, you have to fight. Come fight along with us

                by boadicea on Thu Dec 12, 2013 at 06:58:25 AM PST

                [ Parent ]

                •  hmm (0+ / 0-)

                  what part of woefully inefficient did you not understand?

                  Woefully inefficient implies that it is horrible system for anyone including the indigent to get health care.

                  I never made the assertion that the problem with medical care in the is country is utilization, although I can give you a ton of articles that show higher deductibles lead to lower utilization.

                  See the Rand Corporation to start.  A ton,

                  I can back up anything you ask me to name caller, just make sure you state what what I said.

                  No college degree I take it?

                •  emote, don't think (0+ / 0-)

                  Am I watching fox?

                •  Here is the argument (0+ / 0-)

                  Rising health care costs (2-3 x) faster than inflation are a function of several variables: high technology linked with an inefficient private health care system (where competition in combination with technology often leads to higher prices), utter lack of transparency in pricing by providers (the constant gaming of one consumer versus another creates enormous inefficiencies, even for employees of large companies that think they are winning the game), the aging of America, lousy distribution systems (the point of care being the emergency room above-i.e. woefully inefficient)  and last and perhaps least overall utilization levels.  Of course, there are other variables too.

                  Rising health care costs, near 20% of GDP are 2x most other nations are in themselves a reason ALONE for health care reform, a notion that the right wing does not seem to embrace.

                  Utilization is and has been effected by economic variables, particularly in the past recession.  In fact, if you look at the performance of HMO's over the past few years in the stock market, it has been excellent.  Company managements indicate that superior medical loss ratios are due to declining utilization due to a bad job market.  This is now changing, slowly.  Now since you are a very emotional person, I am here to remind that in NO way do I think supra-normal medical loss ratios for HMO's are good.  In no way do I enjoy the great stock performance of HMO's.  But this is math, not emotions.  And this is not FOX news.

                  There is little doubt that individual stress  (like in the past recession) and increased deductible incentives lead to lower health care costs, but it would be naive to suggest that this is a major factor in the overall trend in health care costs.   However, micro studies-too numerous to mention confirm the consumer effect in health care and as concrete evidence, private employers are adopting health savings accounts to exploit these economic incentives.  Again, since you are very emotional, I am not saying this adoption of health care savings plans is good.  It is simply a fact.

                  Since it seems that the ACA is leading to increased deductibles (unless the New York Times is totally wrong on this), that one possible benefit to higher deductibles is a slight diminution in health care costs.  Something to counter anti ACA arguments.  Get it?

                  I would be interested if you had something to add that didn't involve the b-word.  I think where you are getting so mad is that most social phenomena are multi-factor in approach.  When discussing complicated issues, it is often quite common to discuss an endogenous variable such as utilization one at a time.  This does not mean that this is the only factor that determines an overall trend. It is my fault that I did not spell out this implicit assumption beforehand.

                  •  cites please. (0+ / 0-)

                    typing longer blocks of assertions is still assertions.

                    For real Texas Kaos, you want, not .com. Before you win, you have to fight. Come fight along with us

                    by boadicea on Thu Dec 12, 2013 at 08:38:30 PM PST

                    [ Parent ]

                    •  Math is not an assertion, but if you need help (0+ / 0-)

                      Well, first a Rand article.


                      Rand is a world famous research organization that gave us the first plans for earth satellites, conceived the modern computer and developed packet switching, a technology that made the internet possible.

                      Another Rand article:


                      Now, remember, these articles may be difficult, but they back up the assertion that higher deductibles lead to lower utilization and lower health care costs.  This is a statement of what is, not what ought to be, so you may have to control your emotions once again.  None of the articles claim that utilization is a huge driver of medical care costs.  It is simply what social scientists call a first derivative argument.

                      The growth of HSAs's in 2012 was 22%.   Contributions reached $13.2 billion.   See:


                      To see the effect of technology on health care costs see:


                      The Henry J. Kaiser Family Foundation (KFF), or just Kaiser Family Foundation, is a U.S.-based non-profit, non-partisan, private operating foundation.  

                      Too see the effect of price confusion in health care and the excellent work done by Princeton economics professor, Uwe Reinhardt:


                      I assume you know something about the New York Times and Princeton University.

                      To understand how emergency rooms effect the poor, you can literally pick hundreds of articles. Here is one;


                      Except for the last article, I tried to pick sites that are from very credible organizations based upon my experience a Ph.D. in statistics and econometrics.   I have tried to give you a feel for the relative status of these organizations, so you simply won't discount them.  I have to do this since it is obvious you are far more intelligent than most, so at least you will feel challenged by refuting the likes of the Rand Corporation and the very smart (and liberal--see Paul Krugman) Princeton Economics Department.  

                      To see the recent performance of HMO's, simply type in the tickers AET, CI, CNC, UNH-major HMO's in Google Finance and look at stock charts and recent financial statements.   If you need help in understanding medical loss ratios, the statements will 1) show administrative and marketing costs 2) medical costs and 3) profit.  Taking 100% and subtracting 1) and 2) as a % of sales will give you the profit-generally about 5-6% of revenues.  Medical costs/divided by revenue is the Medical Cost ratio.  

                      By the way, several of the articles reference the 20% of health care to GDP bogey-but simply typing in the Economic Report of the President will tell you that.

                      By the way, most of freshman students can do these searches themselves.

                      Now I need some cites from you.  Your argument is?  

                      •  the rand articles were cut-off on my editor (0+ / 0-)

                        You can find them easily at the site.

                        •  Your links were fine (0+ / 0-)

                          If you notice the buttons at the bottom o f the comment box, there are some shortcuts to formatting you might find helpful.

                          Particularly helpful is the "link" one, which allows you to cut and paste the link and put the naming text in you want to use.

                          For real Texas Kaos, you want, not .com. Before you win, you have to fight. Come fight along with us

                          by boadicea on Sat Dec 14, 2013 at 10:22:41 AM PST

                          [ Parent ]

                      •  This uprate was made it error (1+ / 0-)
                        Recommended by:

                        But since it somehow stays on my profile page even after I take down the uprate, I'll go ahead and chime in:

                        If there was any rating I'd give, it'd be an HR for you, tlm, for twice attempting to belittle boadicea by calling their intellect into question. 'No degree, I presume?' Ugh. You give other academics a bad name.

                        I've noticed you share a lot in common with the only single Kossack whose comments you've ever uprated

                      •  Let's take a look at what you have there. (1+ / 0-)
                        Recommended by:

                        Your continual sneering does you no credit, btw.

                        First article is specifically about a particular type of plan-High Ded plans.  What poin t is it you're trying to make about utilization or access with it?

                        Here are a couple of key points, bolding is mine:

                           The effect of HDHPs on consumer financial risk will depend largely on the individual's level of health care spending.
                            Several analyses suggest that consumers with few health care needs will see savings if they switch from a standard plan to an HDHP, whereas those with chronic diseases and moderate health care needs will likely face higher out-of-pocket costs for health care. Read more below
                            Low income individuals may be disproportionately burdened by the cost sharing associated with HDHPs. Read more below
                        File that under not a surprise. Healthy folks get a better deal with  a High Ded plan-whereas folks with more of a need to access care are at a disadvantage.  

                        You are suggesting that less care for folks who might need care is a good thing here.  Good for whom?

                        2nd Rand article Gave me a smile that you linked to it.  Did you actually read it before you did? Because the headline pretty much says it all...but here's the lead para, with my emphasis added

                        The largest-ever assessment of high-deductible health plans finds that while such plans significantly cut health spending, they also prompt patients to cut back on preventive health care, according to a new RAND Corporation
                        Preventative health care. That is what gets cut.  How do you consider that a positive thing?  Accessing care preventatively, or screening to find problems earlier in the disease process is generally the goal of adequate and cost effective medical care.

                        Wasn't familiar with Alegeus, so I asked my friend google and found this in businessweek

                        Alegeus Technologies, LLC offers healthcare and benefit payment solutions. It offers a suite of solutions and services, including benefit accounts administration solutions, such as the administration of consumer directed healthcare, flexible spending, health reimbursement, medical expense reimbursement, voluntary employee beneficiary association, dependent care assistance, and transit accounts, as well as health savings accounts (HSAs); and benefit card processing, participant online account access, mobile account access, customer service outsourcing, payment distribution, output fulfillment, lockbox, and eBill presentment and payment solutions. The company also offers an employer portal tha...
                        So, a company that sells services to support HSA plans suggests HSAs are growing. It may very well be a fact-what does that have to do with the price of butter?
                        The study also broke average account balances down by demographic. According to the EBRI, men generally have higher account balances than women, older individuals have higher account balances than their younger counterparts and account balances increase with household income. Further, rollover amounts rose with household income and education, and individuals with single coverage rolled over higher amounts than those with family coverage in 2012. Despite these findings, no correlation could be found between healthy adults and higher account balances.
                        Bolded section seems to be the only element possibly related to outcomes.  So, again, I ask, what is the point you are trying to make with this cite?  How does it relate in any positive outcome to utilization-by which I mean the appropriate access of medical care to needs.

                        The KFF cite you give is from 2007, prior to the ACA.  Little outdated. Here's amore recent article that seems more relevant to your point (you're welcome):

                        If we are witnessing something other than the lingering effects of a weak recovery, then a likely explanation is the growth we have seen in cost-sharing and high-deductible plans. The share of workers in a plan with a deductible of $1,000 or more grew from 18% in 2008 to 31% in 2011, and from 35% to 50% in smaller firms. The Affordable Care Act (ACA) will not arrest, and could accelerate, these trends. The individual deductible for a bronze plan in the new insurance exchanges could easily exceed $4,000, and the family deductible is about double that amount. In other words, to reference a different debate currently in the news, what is actually “mandated” for about 30 million people under the ACA is basically catastrophic coverage. As insurance begins to look more like catastrophic coverage and less like comprehensive coverage, there is an impact on utilization. Of course, in some cases people may be cutting back on unnecessary care and in some cases they may skimp on needed care, which could lead to higher costs down the road. Much more research is needed on this issue.
                        Of course, even these authors suggest the picture is mixed, and you notice the key phrase- more like catastrophic coverage and less like comprehensive coverage, there is an impact on utilization. .

                        That is what we here in less hallowed intellectual circles call an "apples and oranges comparison".  

                        The thrust of Dr. Reinhardt's linked op ed seems to be suggesting a large issue is the employer based control of the health insurance market and a lack of transperency in pricing.  What is your argument with this cite relative to what you said about utilization or access (or are you making a different argument here-perhaps a Medicare for all approach?)

                        The first would be an all-payer system on the German or Swiss model, perhaps on a statewide basis, with some adjustments for smaller regional cost differentials (urban versus rural, for example), as is now the practice in the Medicare price schedules. In those systems, multiple insurance carriers negotiate jointly with counter-associations of the relevant health care providers over common price schedules, which thereafter are binding on every payer and every health care provider in the region (an analysis in Health Affairs offered more details). One can easily link such a system to the growth of gross domestic product.

                        The second alternative would be a marriage in which the financial risks of ill health are shared up to a point and raw, transparent price competition for the remainder. In such a system, called “reference pricing,” a private insurer, as agent for an employer or for a government program, would cover only the price charged for a medical procedure by a low-cost provider in the insured’s market area, forcing the insured to pay out of pocket the full difference between that low-cost “reference price” and whatever a higher-cost provider in the area charges for the same procedure.

                        Such a system, of course, presupposes full transparency of the prices charged by alternative providers in the relevant market area.

                        Your article actually makes my point-the ER as a delivery system for healthcare is indequate, as you seemed to be initially arguing that access to an ER = access to health care.  If that was indeed not your point in your reply to my comment on access being an issue-then you'll have to clarify. I'm sure your PHd in econometrics and statistics will help in that regard.

                        Here, with emphasis added, is the money quote from the article:

                        The investigators noted that U.S. data consistently show that poor patients use less preventive care and are more likely to become acutely ill and require urgent hospital care, something that can't be explained solely by lack of insurance. This pattern of health care use costs $30.8 billion annually, and leads to poor health outcomes for these patients.
                        Oh, and for good measure-regarding accessibility:
                        To generate systemwide savings, it's important to make outpatient services more appealing to [poor] patients by addressing their concerns around cost, quality and accessibility. For instance, health systems might reduce barriers such as complicated referral systems that are often required for seeing specialists. These barriers may actually drive patients to the higher-cost, one-stop shop hospital setting," Kangovi explained.

                        The study included 40 poor patients in Philadelphia who were interviewed about why they decided to get treatment at the hospital/emergency department instead of from a primary care doctor.

                        The patients felt that hospitals were better able to diagnose and treat health problems. They also said that the emergency department provides a "one-stop shop" for health care services, has shorter wait times, and is easier to get to than a doctor's office.

                        Hmm, that seems to suggest accessibility is related to cost (utilization).  Whoda thunk it?

                        With that, I think we can let this thread die. I've had about enough of wading through your pretentious self-importance to get to actual substantive discussion.

                        For real Texas Kaos, you want, not .com. Before you win, you have to fight. Come fight along with us

                        by boadicea on Sat Dec 14, 2013 at 10:21:02 AM PST

                        [ Parent ]

      •  No, high deductibles are bad. They cause people (0+ / 0-)

        to forgo medical care until the condition gets so bad that they are willing to pay full price.  They cover big expenses but make delays in getting treatment more likely.

        •  Keeping in mind (0+ / 0-)

          that full price with insurance and full price without insurance are vastly different things.  No-cost preventive care is also a significant ameliorating factor.

          High deductibles can be a reasonable, even cost-saving option for people who have some savings and for whom the difference between a co-pay and the insurance-mediated "full price" isn't a barrier to care.  Just not otherwise.

      •  I don't think deductables work like that... (0+ / 0-)

        Getting health care isn't a luxury - you either have to go, or you don't. We shouldn't have a system where people have to "think twice about if they really need to go to the doctor"... as it can mean simple problems get much worse and costly by the time they're addressed.

        Sure, there are probably a few hypochondriacs who go to the doctor too often, but that's not what's driving our health care costs. And a higher copay isn't going to dissuade those people anyway.

        There are lots of ways to reduce costs... ultimately, most of them mean that doctors, providers, equipment manufacturers, hospitals, etc... will all have to make less money. That's basic math - you can't reduce costs without reducing the amount of money paid. That's why it's such a difficult problem - those interests are powerful, and they like things the way they are.

        Freedom isn't free. That's why we pay taxes.

        by walk2live on Tue Dec 10, 2013 at 09:13:40 AM PST

        [ Parent ]

        •  I know high deductibles are not ideal. (0+ / 0-)

          I was simply suggesting that no matter how we slice it, we have a health care cost issue.

          I was also suggesting that the folks behind ACA (not the website) are pretty smart.  Nearly 20% of GDP to health care and no difference in mortality among advanced nations is pretty appalling.  They know this.

          Since single payer or anything close in not currently feasible and the ACA is an intermediary "real world" solution,  I hastened to suggest that some behind the ACA may have thought it might arrest health care inflation via declining utilization pressures.  And although it is distasteful, declining overall costs would be a feather in the ACA's cap.

          I did not say it was a great idea, just that I doubt that the folks behind this did not see deductible pressure.  Although many here seem to be anti ACA, I think that its founders knew it was a trade-off between low premiums, no pre-existing conditions, more money out of pocket for premiums for the $100k + a year crowd  and higher deductibles, etc.  

          The right will pick on the high deductible issue endlessly-I was just giving a possible counter argument.  

          •  Sure, we have a health cost problem. (0+ / 0-)

            Just as you stated. I'm not sure if the ACA will help radically, but hopefully by making insurance more competitive, it'll help drive pressure back up the chain to the providers, who will have to become competitive.

            At the moment, there is not much real pressure on providers, they just charge what they want. The insurance people pay it (well, they pay a silly negotiated rate), and when costs rise, they stick us with the bill.  

            If people can more easily switch insurers, we might end up with a situation where lots of people are covered in limited networks (because they're cheaper). If the numbers of people utilizing high-cost networks plummets, it's going to put pressure on them to reduce their costs.

            But, this is pretty indirect, and the cycle on this is long - with a new contract only once per year. It's really not that great.

            Anyway, I'm generally positive on the ACA. Though, it's just a small step in the right direction.

            As for the opponents, they'll grab at anything. Any problem related to health care at all = blame ObamaCare. It doesn't matter if the problem has anything to do with the ACA or not.

            Freedom isn't free. That's why we pay taxes.

            by walk2live on Thu Dec 12, 2013 at 09:38:16 AM PST

            [ Parent ]

    •  About those other costs..... (7+ / 0-)

      I'm one of the people profiled in the NYT article - the last person. Right now I'm not sure what my plan will look like - the Cover Oregon site seems to have conflicting information, with different deductibles and OOP costs for the same plans, I have an email in to them asking about this.

      Regardless- I've done the calculations, and paying $300/month vs $820/month will put me ahead no matter what, even if I have a big deductible. That's even if I need medical care and wind up having to pay off the whole deductible. And if I don't need medical care (which is likely - other than The Cancer I'm in good health!), then I really make out like a bandit. Will be paying $3600/year rather than about $10K.

      So, definite party time for me over here.

      •  That's great to hear (0+ / 0-)

        When I first read your quote, it did seem to me that the NYT was putting an unnecessarily negative spin (by emphasizing the high deductibles part of your quote) on what was essentially a positive outcome. I still fear that given the complexity of the law and the difficulty of acquiring information, we won't have an accurate count of the large number of winners versus the small number who lose out.

        •  I don't think my part of the article... (0+ / 0-)

          ...mentioned a deductible? The other part of what you said though is so true. One huge problem in my mind is that those who were trashing the ACA before can't now admit that they were wrong, or at least they won't.

          I know a number of people, either friends or from my cancer-related groups, who were heartily bashing Obama and the ACA previously. I've made it a point to follow up with them to see how things have turned out, and guess what? Crickets. That infuriates me.

  •  They should never have called it "Obama"care (8+ / 0-)

    They've helped a black man improve his standing with culturally habitual racists, even the inherently unaware variety.

    Less power for Republicans on another wedge issue: racism.  The others being LGBT, guns, women and God, of course.  Pretty much anything not both white AND male.

    "So, please stay where you are. Don't move and don't panic. Don't take off your shoes! Jobs is on the way."

    by wader on Mon Dec 09, 2013 at 04:55:54 PM PST

  •  yes but... sabotage (4+ / 0-)

    republican sabotage will affect democrats politically in certain states. we must address that head on.

    in states like new hampshire, which has only 1 insurance company participating in the federal exchange, people are getting screwed.

    democrats need to aggressively tie that albatross around repubs' despicable saboteur necks.

  •  I anxiously hope this kind of news filters thru (5+ / 0-)

    all layers of the poor and middle class communities between now and the next elections and we can properly position the elections as a battle between the greed and evil of the GOP and the forces of good for the people.

    Stiill, it's going to be tough.  The republicans I know would rather eat a jar of dirt than help anyone unlike themselves...everyone else being, of course, lazy, no-good shiftless tax sucking layabouts.  

    The darkest places in hell are reserved for those who maintain their neutrality in times of moral crisis. - Dante Alighieri

    by Persiflage on Mon Dec 09, 2013 at 05:13:32 PM PST

  •  It'd be interesting to hear insurance front lines (3+ / 0-)

    and to know if as an industry it is more rewarding to work for because of the new prohibitions on certain cruel practices (like denying healthcare coverage to people when they need it most).

    •  We've had an insurance and securities brokerage (1+ / 0-)
      Recommended by:

      in our (extended) family now, since my last sibling retired a couple of years ago.  

      Anyway, I don't know about what you're wondering, but  two of our cousins have come out of retirement because of the ACA.  It will be very lucrative.  (My sibling debated it, but decided that he didn't want to give up RV'ing.)

      But since the folks who rescind policies or deny coverage aren't front liners, doubt it affects most brokerages.



      "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


      by musiccitymollie on Mon Dec 09, 2013 at 09:05:49 PM PST

      [ Parent ]

  •  Having followed the ACA debate (19+ / 0-)

    - more like Obamacare hysteria - over several years, this Canadian has become more aware of and grateful for our universal health care through reading these people's stories. These are things I've never had to worry about at any point in my life, so I couldn't relate until relatively recently.

    I wish you all single-payer before too long.

    Big-tent progressivism for 21st century Canada:

    by puckmtl on Mon Dec 09, 2013 at 05:56:09 PM PST

  •  Winning voters over 1 at a time (13+ / 0-)
    For 12 years, Heidi Dragon of Raleigh has been running her own business as a graphic designer, and she's been on her own when it comes to health insurance.

    She now pays $176 a month for what she calls a "bottom of the barrel" plan, so she started shopping on with the help of a federally trained navigator.

    "We got through the application online – whizzed through it – so I'm not sure what everyone was talking about," Dragon said, referring to complaints about site delays that frustrated millions of people nationwide since early October.

    She took about a week to compare plans and enrolled in one that provides better coverage than her current plan. With federal subsidies, her monthly premium for her new insurance will be $91 a month – a 48 percent decrease.

    This kind of success story lays the GOP lie-machine wide open for the world to see.

    Filibuster reform, 2013 - woulda, coulda, shoulda.

    by bear83 on Mon Dec 09, 2013 at 08:46:53 PM PST

    •  One can only hope... (1+ / 0-)
      Recommended by:

      ....that those who benefit so substantially from the ACA actually WILL go out and VOTE.  This is the reason the Republicans were throwing fits at the idea of providing voter registration links on  

  •  This is COMMIE (7+ / 2-)

    PROOF: POWER handshake with Raul CASTRO JUST AS OBAMACARE AVOIDS COMMIE CRASH!!next are BIG CHINESE IN MAO JACKETS making your daughter a LESBIAn read JOHN 3:4 so WAKE UP amwerica before it is TOO LATE.

  •  Meanwhile, after a ton of activity last week (5+ / 0-)

    ...the spreadsheet has been a bit quiet over the weekend; I'm guessing there won't be too many new numbers released until the next official HHS report, which I assume will come out sometime this week.

    A few noteworthy items:

    --New York has broken 100K total enrollments, but the private/public breakdown is interesting--it went from 50K/41K a week earlier to 69K/31K this week. That means that about 10,000 people had their status changed from Medicaid/SCHIP to Private Enrollments. Clerical error last week, error this week or some other change?

    --Oregon has FINALLY started enrolling people on their private exchange in real numbers: 3,500 to date (thanks to rsmpdx for the tip!)

    --Connecticut is well ahead of their projected enrollment for the first year: They're at almost 44% of the target number at around 35% of the enrollment period elapsed.

    --Otherwise, still waiting for what should be the biggest update: California, which hasn't posted numbers since 11/19. At the rate they've been enrolling people, I'm expecting their total to be up to around 112,000 as of 11/30 and at least 135,000 as of this week, but we'll see...

  •  The ACA is a godsend for those who were locked (2+ / 0-)
    Recommended by:
    boadicea, DMentalist

    out of coverage before.

    It's also a blessing (to various degrees) for those who have felt locked into a job for fear of health problems.

    I haven't yet figured out if it's good for me, because the exchange costs are pretty hefty where I live, but it's clearly good for some people.

    The big question: Will the young and healthy people on whom the rates rely step up and buy insurance?

    Will those who did not buy insurance before buy it now, even though it is likely to be more expensive because of the need to subsidize those with pre-existing conditions, and (for men) the abolition of gender-based pricing differences?

    This first year is not a very good test as penalties are so low.  That may turn out to be a blunder, too -- Will insurance companies pull out of the exchanges in a year when the incentive for healthy young people to sign up is lower than it will be in subsequent years?

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Tue Dec 10, 2013 at 07:47:32 AM PST

    •  Medical costs should not be "forgiven" for those (1+ / 0-)
      Recommended by:

      who refuse to buy insurance. A young man would have to pay his costs for however many years to pay back the hospital if this working person refused to be insured

      "The poor can never be made to suffer enough." Jimmy Breslin

      by merrywidow on Tue Dec 10, 2013 at 07:51:39 AM PST

      [ Parent ]

      •  Why would they be forgiven? (1+ / 0-)
        Recommended by:

        Well, actually, there is a reason -- at least for a portion of the costs:

        No pre-existing condition exclusion.

        Lots of young people do that risk calculation -- they tend not to need a lot of expensive health care.

        I suppose you could remove medical expenses from the list of things that are dischargable in bankruptcy, but that seems like a terrible thing to do:

        1. It saddles somebody with crushing debt for a long time
        2. It rewards the criminals at hospitals who so relentlessly charge rates that have little to do with reality.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Tue Dec 10, 2013 at 08:02:28 AM PST

        [ Parent ]

        •  they saddled themselves with crushing debt (2+ / 0-)
          Recommended by:
          DMentalist, LMS44

          i am seeing the premiums for young people and they are absurdly low so low you really have to be penalized for not signing up

          "The poor can never be made to suffer enough." Jimmy Breslin

          by merrywidow on Tue Dec 10, 2013 at 09:15:49 AM PST

          [ Parent ]

          •  So we continue a trend that excuses the debts (0+ / 0-)

            of the wealthy but holds the poor accountable?

            Great thinking.

            We already have things like this as non-dischargable:

            1. Income tax is dischargable in bankruptcy, but payroll tax isn't.  Of course, payroll taxes may be the biggest tax burden carried by low income workers, but relatively small to non-existant for the wealthy.

            2. Student loan debt -- much bigger problem for kids of the not-so-well-to-do than for kids of the wealthy who are able to go on mommy and daddy's dime.

            Yup. You're right. Better punish the crap out of those working class folks.  The rich, however, need special understanding.  it's so hard being rich!

            LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

            by dinotrac on Tue Dec 10, 2013 at 09:47:49 AM PST

            [ Parent ]

            •  Off point here. a young man who does not pay (0+ / 0-)

              $50 a month to be insured should not expect to have someone else pay for his care....period.

              "The poor can never be made to suffer enough." Jimmy Breslin

              by merrywidow on Tue Dec 10, 2013 at 11:35:51 AM PST

              [ Parent ]

              •  $50 a month? (0+ / 0-)

                Maybe where you live.

                LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                by dinotrac on Tue Dec 10, 2013 at 12:52:40 PM PST

                [ Parent ]

                •  A second thought: How does $50 a month (0+ / 0-)

                  contribute to keeping insurance costs down for those with pre-existing conditions, those who are older, or, for that matter, those who are female?

                  There can't be a whole lot to spread around from a number like that -- especially as some of it has to go to administration and some to the actual costs of doctor visits and health care.

                  LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                  by dinotrac on Tue Dec 10, 2013 at 12:54:48 PM PST

                  [ Parent ]

                  •  That is how insurance works. nt (0+ / 0-)

                    "The poor can never be made to suffer enough." Jimmy Breslin

                    by merrywidow on Tue Dec 10, 2013 at 01:10:26 PM PST

                    [ Parent ]

                    •  Sorry, but actuarial principles are another (0+ / 0-)

                      part of how insurance works.

                      That $50 a month has to cover the actual costs associated with that person's health care AND subsidize the health insurance costs of others.

                      So -- if I am entitled to $400 a month in subsidies, it will take an awful lot of healthy young men to pay for that.
                      Even if you assumed that the actual costs that fellow's insurance were only $25 a month, that would require 16 healthy young me to cover my subsidy.

                      And -- if that young man's health costs, spread out over the pool of  young men, were really only $25 a month, I could understand him deciding that health insurance is a rip-off.  It's certainly a bad bet, with an expected return of only 50 cents on the dollar.

                      LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                      by dinotrac on Tue Dec 10, 2013 at 03:17:35 PM PST

                      [ Parent ]

                      •  WE are all subsidizing someone else's costs (0+ / 0-)

                        and then one day, YOU will need a $100,000 bone marrow transplant and others will subisdize YOUR care

                        "The poor can never be made to suffer enough." Jimmy Breslin

                        by merrywidow on Wed Dec 11, 2013 at 05:39:03 AM PST

                        [ Parent ]

                        •  I have certainly subsidized a lot of health (0+ / 0-)

                          care over the years since I entered the work force, and that's fine.  I understand that.

                          But that has nothing to do with the question of $50 a month health care, which isn't going to subsidize much of anything.

                          Young men, in particular, are being called on to subsidize other young men, which has always been the case.  They are also being called on to subsidize to a greater degree than ever, young women, people with pre-existing conditions, and older people of both genders.

                          A lot of those young men need to sign up and they need to pay more than $50 a month if those subsidies are going to be covered.

                          LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                          by dinotrac on Wed Dec 11, 2013 at 07:37:20 AM PST

                          [ Parent ]

                          •  Ins companies dont voluntarily screw themselves (0+ / 0-)

                            so I imagine their actuaries figured this out

                            do you NOT believe in insurance of any kind? I have never had a traffic accident or crash so I have paid for lots of other people but that is how it works

                            "The poor can never be made to suffer enough." Jimmy Breslin

                            by merrywidow on Wed Dec 11, 2013 at 08:44:03 AM PST

                            [ Parent ]

                          •  You are missing the real questions: (0+ / 0-)

                            1. How many of those young men are being asked to pay just $50 a month (without a subsidy)

                            2. How many young men are getting insurance.

                            Last I read, only about half as many young healthy men are signing up on the California exchange as expected.

                            That could be a problem.

                            LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                            by dinotrac on Wed Dec 11, 2013 at 09:14:11 AM PST

                            [ Parent ]

          •  the false assumption here (0+ / 0-)

               Is that the cost of medical care without insurance is reasonable.  If I travel to London and break my leg, I can go to a hospital to treat my broken leg without it costing an arm AND a leg, even though I'm not a citizen of Britain and I've never paid taxes there.  It's been a similar scenario in virtually every country I've traveled to.   In some countries medical care is more expensive than others, but nowhere is it so absurdly high as in the US.  That's why there is a thriving industry called "medical tourism." Throughout the developed world, most people can get access to medical care, even without insurance, without going bankrupt.  So why is it considered reasonable that in America a single trip to the emergency room will cost THOUSANDS of dollars?  And that will be the tab even if all you do is wait for eight hours, see a doctor for five minutes, and the doctor doesn't even order any tests or perform any procedures.  

                 The truth is, I helped to pay for that hospital that charges me thousands of dollars for an ER visit.  My tax dollars contributed to the education of the doctors who work there.  My tax dollars contributed to the research that resulted in the cures and treatments that hospital offers.  My tax dollars contributed to the development of the medical technologies available at that hospital.  My tax dollars contributed to the Medicare system responsible for much of that hospital's income.  So why is it reasonable that the medical industry, which owes its existence largely to public financing, is entitled to act as a monopolist, charging whatever it likes, price-gouging patients, maximizing its own profits, and giving NOTHING back to the public which makes its very existence possible?

                 I don't disagree with you that anyone who can afford medical insurance should buy it, and so I believe the mandate penalty in the ACA is justified.  But a person who chooses not to buy affordable insurance and take the risk of being bankrupted by a single accident or illness is merely STUPID.  On the other hand, the system which ALLOWS it to be possible for a person to be bankrupted by a single accident or illness is EVIL.  If you leave your keys in your car and it gets stolen, then it's fair to say that you're an idiot.  But the person who STOLE your car is STILL a THIEF.  

            •  Really cheap insurance means you are irresponsible (1+ / 0-)
              Recommended by:

              for not signing up, expecting others to pick up the if you are insured you can't be bankrupted, how about that?

              "The poor can never be made to suffer enough." Jimmy Breslin

              by merrywidow on Tue Dec 10, 2013 at 11:34:51 AM PST

              [ Parent ]

              •  Like I said... (0+ / 0-)

                    I agree that people should get insurance if they can afford it, and that it is justifiable to impose a penalty if they don't.  

                     But I am a bit wary of the "personal responsibility" argument, because that's what you usually hear from the right-wingers.  It doesn't sound much different to me than arguing that we should have no compassion for lung cancer patients, because they chose to smoke, even though every cigarette package is labeled with a clear warning from the Surgeon General, or that we should have no compassion for AIDS patients, because they may have chosen to engage in unprotected sex, even though they knew there was a risk in doing so.  I went off a bit on my aversion to this "personal responsibility" argument as it relates to health insurance a bit more in this comment on another diary: Not a new argument

                     It's not yet clear to me that the ACA means that insurance really will be affordable for everyone.  Some states took the Medicaid expansion, and others didn't.  The cost of insurance varies WIDELY from state to state, and is much more expensive in states like California than elsewhere.  I'd also wager that it costs more to buy insurance on the individual market than it does for those lucky enough to have an employer-provided plan.  So if I can't afford insurance because of the state I live in, does that make me less "responsible" than someone who can afford it because he lives in a different state or has an employer with a decent benefits package?

                     The diary we are commenting on here was followed a few hours later by another diary: 30% of Americans now skip some medical care.  Since that figure includes people that do have insurance, it's obvious that having insurance does not solve the problem of out-of-control medical costs.  If the cost of an international airline ticket, a 2-week hotel or hospital stay, and 2 weeks worth of meals in a foreign country, COMBINED with the cost of a medical procedure in that country still comes out to be substantially LESS than the cost of that same procedure in the U.S., there is something wrong with that picture.  If we believe that there is a line between honest lending and exploitative usury, why should there not be a similar line between reasonable medical costs and exploitative profiteering?  If it's illegal for banks to charge 500% interest rates on a loan, why is it legal for hospitals to bankrupt you for merely getting sick?

                     Yes, it is stupid not to buy insurance, and you can even say it's irresponsible.  Just like if a person has lung cancer or AIDS, it might be the result of stupid or irresponsible behavior.  But I would not deny a person with lung cancer or AIDS relief from their suffering if it is possible to provide such relief.  I think if a young person makes a stupid and irresponsible decision not to buy health insurance when he can afford it, and must pay a penalty as a result, that is a reasonable consequence.  Bearing the financial burden of reasonable medical bills would also be a reasonable consequence.  But to be bankrupted, to have one's entire life ruined by crushing, inescapable debt that only serves to increase the medical industry's obscene profit margins?  That doesn't seem like a reasonable consequence to me.  Such a punishment really doesn't fit the "crime" of getting sick.  

  •  It continues to surprise me that I never hear (4+ / 0-)

    anything, except perhaps an occasional comment here, about the boost the ACA will be to the economy - not in regard to all the extra money flowing to ins cos and providers and the many jobs that will be available - but the millions that individuals will no longer be throwing at the insurance companies.

    Actually, I do now recall one diary a week or two ago about someone who would be traveling to Paris on the savings they would realize from the ACA, but I can't help but think what a MAJOR boost to the economy the ACA will be just from the $ it saves individuals.

    "Don't Bet Against Us" - President Barack Obama

    by MRA NY on Tue Dec 10, 2013 at 07:57:13 AM PST

  •  I don't know whether I'm crying because I'm so (2+ / 0-)
    Recommended by:
    True North, LMS44

    happy that Obamacare is working so well, or because it's so devastating to read about what people have gone through. OTOH, my anger at Republican still trying to impose death sentences for low income Americans is drying up my tears.

  •  Somewhere, far far away, (3+ / 0-)

    Ted Kennedy's got a great big smile on his face.

  •  Obamacare + Evolution = Single Payer Medicare-for- (1+ / 0-)
    Recommended by:


    I like the sound of that . . . . . . . .

    It sorta sounds like Liberty & Justice for All!

    (The right-wing heads exploding sound like bombs bursting in air.)

  •  But, but - we're enslaved now! (2+ / 0-)
    Recommended by:
    TofG, LMS44

    This is worst law since slavery, or prohibition, or the ban on machine guns... one of those, I forget, some fathead will be screaming about it on the radio later, so I can check.

    As a spinal cord tumor grower who has had many broken bones and other surgeries, my last offer from an insurance company was the only High-Risk provider in CA: $1570/month; $15,000 out of pocket; $70,000 annual cap. In other words $32K from me if anything went wrong, then still bankrupted by any hospitalization of more than a day or two.

    Now? Silver 87 percent Cost Sharing Reduction Plan; $2200 max OOP; $153 premium.

    Repeal that, World-Class Idiots!

    Roo and me nail us some varmints at the OK Corral on The Dog in the Clouds, 2013 Petties Award winner for Funniest Blog.

    by Gottlieb on Tue Dec 10, 2013 at 08:11:27 AM PST

  •  A friend of mine (4+ / 0-)
    Recommended by:
    Miss Curmudgeonly, TofG, True North, LMS44

    who runs a small company was interviewed on local TV about how the ACA saved money for him and his employees.

    Hige sceal þe heardra, heorte þe cenre, mod sceal þe mare, þe ure mægen lytlað

    by milkbone on Tue Dec 10, 2013 at 08:12:10 AM PST

  •  Your diaries have been and are (2+ / 0-)
    Recommended by:
    kj in missouri, TofG

    an optimistic reason to visit DailyKos

  •  yep, and the Dems up for election need to start (2+ / 0-)
    Recommended by:
    Miss Curmudgeonly, TofG

    pounding this home, as in we were right all along, they were just wrong, and going backwards to stay on course for health care that bankrupts people!

  •  and on a more sour note... (1+ / 0-)
    Recommended by:

    I'm really happy for these people getting great deals I wish I was one of them.

    I live in the not-so-great state of PA, where our idiot governor refused to take the extra money and expand medicaid (not that I qualified for that either).

    I am in that sweet spot where I make too much money to qualify for the medicaid expansion, but not enough for my stingy subsidy of $61/month to make health care affordable.  I've budgeted this out several times: I get paid twice per month, and after I pay the big bills (like my mortgage, child support, IRS back taxes, student loan) and my utilities (gas heat, electric, water, car insurance) I am left with about $455/week to pay for gasoline, groceries, beer, going out. You throw in healthcare reform, and on one of those weeks I have to get by on $255.

    So I spoke to a navigator yesterday, and she told me to delete my profile and start from scratch, so I could provide a more accurate picture of my deductions. So I did what she said, and when I re-applied not only did the questions skip that part about deductions, it gave me a lower subsidy than last time. So now that $203/month silver plan is more like $225, which is even harder to afford.

    I've been working at this now for well over a month. These are reforms I supported and that I expected to benefit from. I will not be, sadly; AND I will be punished for being too poor to afford the admission.

    Suffice to to say that at this point, I detest, as well as my republican governor, AND Max Baucus.  This is a great plan for those who already HAD insurance. But for a lot of us, the reforms are not enough, we're going to be punished due to stingy subsidies we had no part in calculating, and it's a total wash. I've had conversations with employees in my congressman's office who say they are in the same boat: they want insurance, they can't afford it, and they're going to be hit with a fine for what they want but can't afford.

    And now I'm waiting for the navigator -who's really just a child, an Americorps member- to call me back and figure out how I can get my subsidies back.

    •  You have $1800/month AFTER all main expenses? (1+ / 0-)
      Recommended by:

      Just wanted to make sure I read that right.

      •  Ummm yeah (1+ / 0-)
        Recommended by:
        Miss Curmudgeonly

        Most people would be happy with $1,800 in disposable income.  That's investment money if all your needs are taken care of.

        When I do good, I feel good. When I do bad, I feel bad. That is my religion. - Abraham Lincoln

        by EntrWriter on Tue Dec 10, 2013 at 10:31:57 AM PST

        [ Parent ]

      •  more like $1550 (0+ / 0-)

        That sounds like a lot, but it really is not.

        That has to pay for gasoline every week, groceries, going out (I'm single and would someday like to meet a nice laaaaady), beer for home, parking meters.

        Put it this way: if I was old and stayed home all the time, it would be no problem. But I'm not, I don't, and I shouldn't have to.

        It's a big expense.

    •  I'm in a similar situation (0+ / 0-)

      I have a 3-person family and we make too much money to qualify for subsidy.  However, the lowest priced plan in our county would cost us about 20% of our income.  

      Here's what I intend to do:

      There is a part of the ACA which states that if the lowest cost plans available to you are more than 8% of your income, you are eligible for an exemption for the requirement to have insurance.  ALSO, you are qualified to purchase catastrophic insurance, which is cheaper.

      So I'm gonna try to buy the catastrophic insurance.

      Now, the catastrophic has a huge deductible, but it still has to provide those basic no-cost services that the other plans do.  And it will save your butt if you ever have some horrible medical thing happen.

      Here is the bad part of my story:  the darn application for exemption is not available yet.  The people at keep telling me "they will be available later this year".  GUESS WHAT Y'ALL, THERE ARE LESS THAN 21 DAYS LEFT IN THIS YEAR.  

      Not only that, if you need to be insured January 1 (as we do), you only have about 15 days to get the exemption and buy the plan.

  •  I wish to note for the record (2+ / 0-)
    Recommended by:
    TofG, Miss Curmudgeonly

    that I, a employer-insured person, benefitted from Obamacare this morning. No $30 co-pay on my annual physical, baby! And I think no $70 co-pay on my upcoming mammogram, either.

    OTOH, Blue Cross Blue Shield needs some serious competition in North Carolina, because I paid a $40 co-pay on a freaking albuterol inhaler, which is only "new" enough to merit such a high co-pay because they changed the propellant. Not the drug, the propellant in the inhaler. No wonder there are so many people walking around with poorly controlled asthma in this country.

    If you think education is expensive, wait until you see how much ignorance costs in the 21st century. --PBO

    by kismet on Tue Dec 10, 2013 at 09:50:13 AM PST

  •  Please keep these stories coming! n/t (1+ / 0-)
    Recommended by:

    Mix the blood and make new people!

    by Yonkers Boy on Tue Dec 10, 2013 at 09:52:48 AM PST

  •  Help please (2+ / 0-)
    Recommended by:
    KayCeSF, NinetyWt

    Please help us put pressure on our Governor to expand Medicaid (Phone number) 334-242-7100 or fax 334-353-0004

    Please help us put pressure on our Governor (Robert Bentley) to expand Medicaid (please use the phone number)   Please support the citizens of Ala. (Medicaid expansion) please sign the petition

    Here's his facebook page also (let him have it)

  •  When are these stories (0+ / 0-)

    going to be reflected in the poll numbers The favorable numbers are stil not good and they are brining down many elections.

    a long habit of not thinking a thing WRONG, gives it a superficial appearance of being RIGHT, and raises at first a formidable outcry in defense of custom.

    by Jamesleo on Tue Dec 10, 2013 at 09:58:18 AM PST

  •  As Stephen Colbert might sarcastically say:"What's (1+ / 0-)
    Recommended by:
    Miss Curmudgeonly

    the point of being rich (say, a Colbert Platinum Club member---anyone else stop reading!) if EVERYONE can get good, affordable health coverage?"

  •  Help Please (1+ / 0-)
    Recommended by:

    Please help us put pressure on our Governor to expand Medicaid (Phone number) 334-242-7100 or fax 334-353-0004

    Please help us put pressure on our Governor (Robert Bentley) to expand Medicaid (please use the phone number)   Please support the citizens of Ala. (Medicaid expansion) please sign the petition

    Here's his facebook page also (let him have it)

    thank you

  •  Pile on. (2+ / 0-)
    Recommended by:
    Miss Curmudgeonly, NinetyWt

    Whenever the subject of Obamacare comes up, I always like to throw in my son's story, to pile onto the Republicans' misery about the (basic) success of the law.

    My son was diagnosed with a lifelong condition at the age of six. He's 19 now. Not only can he stay on his dad's (or my) insurance until he's 26, but no one can bar him from coverage for his pre-existing condition. The old way meant that if you had decent insurance in childhood and were able to be diagnosed in order to live a decent life while young, you were screwed forever once you turned 23 because you would automatically have a pre-existing condition when you got dropped from your parents' insurance and sought your own. Basically, pre-Obamacare, it worked AGAINST kids to get diagnosed.

    How idiotic is that?

  •  Arizona (1+ / 0-)
    Recommended by:
    Jon Sullivan

    I'm guessing like most Arizonans, the guy in the story usually votes for Republicans, and even after this will find reasons to keep doing so.

    •  checking R for wrong wing (1+ / 0-)
      Recommended by:
      Miss Curmudgeonly

      Jim I see your reasoning but keep in mind we are the state of Gabby Gifford and now Ron Barber and as myself many past and future voters are waking up to mind changing in their face facts and punching D for Humanity? Equality just sounds nice.

      Fox viewers seek a mascot for solidarity? Maybe an Ostrich? Seek Truth young birds....

      by Jon Sullivan on Wed Dec 11, 2013 at 05:26:52 AM PST

      [ Parent ]

  •  $1800 a month (2+ / 0-)
    Recommended by:
    Jon Sullivan, Miss Curmudgeonly

    Hard time feeling sorry for that.  That's less than I get a month on Social Security.  I'm a senior citizen, widowed, and thankfully with a paid off house.  After I pay utilities, car gas, house & car insurance, property taxes and $104.50 for Medicare Part B, I have about $450 a month for groceries and everything else.  I consider myself comfortably blessed but not rich.  I know some families living on less than that before they start paying for anything.

    As for blessings from ACA, this year I had co-pay free pap smear, mammogram, dexoscan, colonoscopy, flu, pneumonia and shingles shots. It saved mea $400 in co-pays.  My BCBS of AZ just notified me that for 2014 my primary care co-pay is going from $25 to $15 and my specialists from $50 to $40.

    My 42 year old son with pre-existing conditions of pancreatitis with pancreatic cysts and high blood pressure has been without insurance for 3 years.  He lost his job and insurance and his new job doesn't include insurance.  On ACA he will be paying $188 a month.  When he lost his prior job the private insurance quotes were $1400-$1600 from 3 different companies and EXCLUDED his pre-existing conditions.  In other words, they did not want to cover him and made it impossible to afford or accept their deal.  

    This former Eisenhower Republican left the Party over the Iraq War and has stayed because I found my real values are the more in line with the Democrats on things like helping the less fortunate and health care.   I say I didn't leave the GOP because I have always believed like I do now, but they left me and it took a few years for me to realize it.  

  •  " it's going to play out in every state until next (1+ / 0-)
    Recommended by:
    Jon Sullivan


    Not exactly.  Those of us in states where the Medicaid expansion doesn't take place will have hundreds of thousands of people who don't qualify for subsidy.  This is a huge problem.

    We need help from the progressive community to spotlight this problem, and push these idiot Governors to expand Medicaid.

  •  Obamacare is a godsend for people getting coverage (1+ / 0-)
    Recommended by:

    I am curious. With these stories of Americans obtaining health insurance policies, in the end, what are the numbers/percentages of  independents and Republicans realizing that this is a positive for our nation?  Are opinions being changed? Is the fear of the unknown being overcome?

    •  It's my belief it's up to each and every one of us (1+ / 0-)
      Recommended by:
      Miss Curmudgeonly

      to spread the word. I helped someone navigate Covered Ca a couple days ago who got an excellent deal, and my final word to her was, Tell all your friends.

      Welcome from the DK Partners & Mentors Team. If you have any questions about how to participate here, you can learn more at the Knowledge Base or from the New Diarists Resources Diaries. Diaries labeled "Open Thread" are also great places to ask. We look forward to your contributions.

      “As I walked out the door toward the gate that would lead to my freedom, I knew if I didn't leave my bitterness and hatred behind, I’d still be in prison.”
      – Nelson Mandela, proof that the final form of love is forgiveness.

      by smileycreek on Wed Dec 11, 2013 at 11:09:00 AM PST

      [ Parent ]

  •  The worst part of the Teabaghead/Republican (0+ / 0-)

    attacks on ANY attempts at reform of a bad situation is, simply, their deliberate mis-identification of whatever is being changed.  And the best example remains their constant references to "Obama-care", rather than to the ACA as it is.  

    The ACA IS NOTa Bill that deals with actual health care.  Rather IT IS a Bill that deals with the COSTS of such care.  And is designed to bring these COSTS into line with what a reasonably civilized Nation would recognize as being realistic for ALL CITIZENS to have genuine HEALTH CARE; not just those in the "upper 1%" of wealth.

    Unfortunately however, the Teabaghead/Republicans prefer to confuse COSTS with actual CARE; and constantly harp on the fallacy and falsehood of the ACA being - for them(!) - "socialized/communist/colletivist/-medicine".
    This kind of fallacious and false mis-identification has led many to fail to seek improvement to their own financial drain for INSURANCE PREMIUMS, even for the kind of "junk insurance" that really covers and pays for little or nothing, at ridiculous profits for the insurance companies selling it.  Not to mention the fallacious and false blame put upon President Obama for those insurance companies selling "junk" cancelling such policies in advance of their becoming unavailable for not meeting ACA standards in the first place.

    The more we are able to publish and spread abroad the knowledge that the ACA REALLY WORKS - as it should work - and REALLY DOES what it should do, the sooner we will be able to deal with the opportunities to improve even upon the good being done now.

    (Yes, Virginia.  I do know something about the subject, having started as an Claims Adjuster, and making my living as a Licensed Insurance Broker, before going on to grad school in another field.)

    We have made great progess in the past 75 years; and the Republicans have been AGAINST every bit of it.

  •  THEIR NIGHTMARE (1+ / 0-)
    Recommended by:
    Miss Curmudgeonly

    Honest to GOD real, accurate, official, substantiated STATISTICS....GOP's WORST REALITY PROGRAM!

  •  Bad government... (1+ / 0-)
    Recommended by:
    Miss Curmudgeonly

    Republicans have been busy denouncing government as a means to their ends ever since Lincoln first clashed with bankers, even further back, when Jefferson mused over how business dared to try to steal the reins of government.

    The Republicans do a disservice to our Founders and the democracy they created (which we no longer have), and to the many government employees who do honest and often dangerous work on behalf of the interests of the People.

    The Affordable Care Act (ACA) WILL stand on its own as both a credit to the capability of government to stand up for the good of the people and to make those fundamental changes necessary to improve life for all Americans, the primary purpose of Democrats who don't place party interests first.  And ACA will also stand, through its performance, as a brilliant proof that Republicans have lied with intent to deceive and defraud Americans of the legacy the Founders' government promised, the precepts of the Declaration and the Constitution, to provide Life, Liberty, and Happiness (opportunity) for Americans, which the Republican-appointed Supreme Court majority threw out into the Court's reflecting pool when they ruled for corporations in Citizens United.

    And never forget that, in the struggle to deny the benefits of ACA to Americans, Republicans turned to their standard device of inducing fear, with the lie that ACA would mark the birth of "death panels," which would decide who lives and who dies in the delegation of the plan's benefits.

    These lies and despicable tactics remain in the hearts of the conservatives who control the Republican party today, even as they smile and temporarily sheave their knives in the face of outrage at their attempts to ruin America by defunding government and blackmailing default, as they regularly turned their cold-hearted disrespect upon the poor and women, now seeking to simmer the upset and avoid the electoral consequences with cooperative words of compromise and establishment of candidate training schools on tact and sensitivity.

    The work needed to undo the harm Republicans have done, from vast, historic wealth and opportunity inequality to the destruction of the assets of everyone they see beneath them, through the cheating and criminality of the Great Recession to the self-interested manipulation of the tax code, has only just begun with the enactment of ACA... only just begun.  And have no doubt that when the heat of Republican outrages of the recent past has died down, their knives will quickly appear again to cut through any attempt to overturn more of their abuses and provide relief for the greater majority of Americans.

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