Obamacare

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#1
Now that The Affordable Healthcare Act (TAHA!) has opened exchanges today and implementation deadlines are approaching and passing quickly, we will probably need one thread to catch all the stuff that's not important enough for its own thread, but still bears discussion.

I'll start off with two negative articles from Forbes discussing the current issues the act is facing:

http://www.forbes.com/sites/jeffrey...obamacares-price-tag-will-surprise-americans/

Three big problems are likely to occur as more people are drawn into the Obamacare universe.

First, cost is likely to be a huge issue. As documented by Chris Conover here on Forbes.com, Obamacare will actually lead to many families paying more for their healthcare than they were before the law went into effect. This cost increase is not some trivial amount, but is estimated to run an average family of four between $650 and $1,000 per year over the next decade.
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The second problem that will become obvious as the program is fully implemented is the unfairness of the subsidies provided by Obamacare. If an employer offers its workers health insurance, but an employee turns it down because the cost is too high, that worker is not eligible for a government subsidy in the health care exchanges. Thus, two families with the same income could pay very different rates for their health insurance because one was offered insurance at their job and the other was not....
The third big problem with Obamacare that is beginning to come to people’s attention is the quality of the plans that will be offered on the exchanges. According to Robert Pear in the New York Times, people who purchase health insurance on the exchanges in many states may be offered only plans that allow access to fewer doctors and hospitals than many privately-purchased plans and employer-sponsored plans include.
http://www.forbes.com/sites/merrill...rry-obamacare-rollout-will-hurt-them-in-2014/

If Democrats aren’t worried about President Obama’s “Problems? What problems?” response to the multiple glitches and snafus of his ObamaCare rollout, they should be. The public is deeply suspicious of the law and it wouldn’t take much to create an electoral backlash...While it is possible that some of the kinks could be worked out shortly after rollout, it is just as possible that some, perhaps even most, of them will plague us for a year or more. And the public will know who to blame if those problems persist.
...
Impeded access to doctors = rationing health care.
The U.S. already has a shortage of doctors. Recent studies indicate that within seven years that shortage could rise to 45,000 primary care physicians. Fewer doctors means it will be harder to see one in a timely manner. The Affordable Care Act will make that problem much worse by greatly increasing the demand for doctors.
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You can just imagine all those middle-class Americans complaining about how they used to be able to get in to see their doctor—until ObamaCare kicked in.
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Timely access to a doctor is a key component of what people see as a quality health care system. Americans will likely see it as the government rationing care, even if it is just a result of supply and demand.
...
Higher costs means fewer votes.
Two-thirds of workers with single coverage and 57 percent of workers with family coverage will see their costs go up in the exchange. In addition, recent stories claim that some of the premiums are lower than expected because the copays and deductibles are so high.
Those forced to pay higher out-of-pocket costs, as well as higher premiums, will perceive that ObamaCare is hurting them financially and voters may well decide to return that pain on those who forced them to pay more.
Complexity = failure. ObamaCare is complex. There are numerous rules about who qualifies for what subsidies and additional help. The technology was supposed to handle much of the complexity, but we hear that many of the exchanges aren’t yet ready for prime time. That complexity could frustrate a lot of people who may see it as a failure because they can’t figure it out.
The drawbacks to clawbacks. If you qualify for a subsidy based on your estimated 2014 income and then make more than you estimated, you will be required to pay back part of that subsidy at the end of the year. And those who received too much subsidy may discover that problem during “open season” in 2014 when they begin considering their coverage for 2015. That open season will start about three weeks before the November elections. Those having to write the government a clawback check, which could easily be more than a thousand dollars, may want to engage in a little November clawback themselves.
Personal info becomes public info. A lot of people, government officials as well as non-government employees, will have access to your health information, income and other valuable data. They could snoop or they could share it with others, even if by mistake—just look at recent incidents by the IRS and National Security Agency.
We are likely to see a lot of security breaches—indeed, we already are. Some will be intentional, some won’t. But there will be a lot of them.
It could undermine Democrats’ faith in efficient big government. Everything Obama does is based on his faith in big government’s ability to do things right...
While Obama has made it clear he would prefer a single-payer health care system...ObamaCare is close enough. But if it crashes, it will undermine his and Democrats’ claims.
Hang on tight, it's going to be a rough ride.
 

Dave

Staff member
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#4
In actuality, a lot of the issues being attributed to Obamacare are the result of the sequestration. Lowering the budgets of a bunch of different governmental entities had the unintended (or was it?) effect of lessening payouts for Medicare and Medicaid. This has caused several hospitals and clinics to cut back. Like the one my wife was working at. That wasn't Obamacare but the sequestration cuts. Which happens to sit squarely on the shoulders of the...wait for it...Republicans. Again.
 

GasBandit

Staff member
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#6
In actuality, a lot of the issues being attributed to Obamacare are the result of the sequestration. Lowering the budgets of a bunch of different governmental entities had the unintended (or was it?) effect of lessening payouts for Medicare and Medicaid. This has caused several hospitals and clinics to cut back. Like the one my wife was working at. That wasn't Obamacare but the sequestration cuts. Which happens to sit squarely on the shoulders of the...wait for it...Republicans. Again.
Sequestration is a joke. A drop in the bucket. However, everyone involved is making sure that the pain is felt as acutely as possible by cutting the meat instead of the fat, so that we'll damn sure never dare mess with their funding ever again. Who do we think we are, anyway?

Obamacare isn't constitutional no matter what the Supreme Court says :)
FTFY
 
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#7
In actuality, a lot of the issues being attributed to Obamacare are the result of the sequestration. Lowering the budgets of a bunch of different governmental entities had the unintended (or was it?) effect of lessening payouts for Medicare and Medicaid. This has caused several hospitals and clinics to cut back. Like the one my wife was working at. That wasn't Obamacare but the sequestration cuts. Which happens to sit squarely on the shoulders of the...wait for it...Republicans. Again.
So what you're saying is the government can't manage money? I'm shocked! Clearly the only solution is to put them in charge of more things and throw money at problems until they're solved.
 
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#8
Clearly the only solution is to put them in charge of more things and throw money at problems until they're solved.
Why not? It worked so well with the drug epidemic and airline security, right?

I do not know enough about the ins and outs of Obama'sNameIsOnItSoItMustBeAllHisFaultCare to be able to criticize it adequately, but I will say that I'm getting pretty sick and tired of the fact that, every time I streamline our family budget, decide to amputate some bourgeoise "luxury" (like cable television, or even cell phones, fer gods' sake), or find some way to live a hair more efficiently, all because the numbers say we have to eliminate $25/month to survive, any benefit I carve out gets immediately swallowed up by some dumb cost increase which is supposed to make my life "better." Well...it isn't.

--Patrick
 
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#10
Why not? It worked so well with the drug epidemic and airline security, right?

I do not know enough about the ins and outs of Obama'sNameIsOnItSoItMustBeAllHisFaultCare to be able to criticize it adequately, but I will say that I'm getting pretty sick and tired of the fact that, every time I streamline our family budget, decide to amputate some bourgeoise "luxury" (like cable television, or even cell phones, fer gods' sake), or find some way to live a hair more efficiently, all because the numbers say we have to eliminate $25/month to survive, any benefit I carve out gets immediately swallowed up by some dumb cost increase which is supposed to make my life "better." Well...it isn't.

--Patrick
It's not for you, it's for the poor. Of which you eventually become because of all the cost increases meant to provide for and benefit said poor. What's sad is the insistence that there's no problem here.
 

GasBandit

Staff member
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#13
I like all the strawmen at the beginning. "I HERD OBAMACARE IS AILENS."

And they also bandy about the 47 million uninsured number that was pretty much debunked years ago.

Of that 47 million number:
6 million are illegal aliens
4 million are documented foreign nationals who don't qualify here
9 million have an individual income of over $75,000 and could afford it if they really wanted it, but just don't or opt to pay out of pocket
10 million are already eligible for existing government programs (before TAHA) but haven't
6 million are already eligible for employer provided health insurance but opt not to
Leaving somewhere between 12 and 15 million who genuinely have no affordable health insurance options, which is not ideal, but WAY less an alarming (or alarmist in this case) number.

He also parrots the "if you have insurance from your job, nothing will change for you!" except of course for all the places that have had to change or drop their coverage due to the financial burdens of the act.

But he does tell all this to the camera in the pandering, pedantic method that's so popular with the ill informed.
 
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#14
Tried to sign up. Site is stuck at the security questions page. There are none. And it won't let you just enter any old answer.
 
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#15
Finally got in. To the login page. No further.

PREVIOUS VERSION REDACTED.

There is only one participant in the Marketplace for WV. Highmark. The cheapest unsubsidized coverage is $251/month. I couldn't log into the marketplace from work, but according to a calculator from the Henry J. Kaiser Foundation, I would qualify for the middle level of coverage at $529 per year. $44/month is well within my reach.
 
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#16
Tried to sign up. Site is stuck at the security questions page. There are none. And it won't let you just enter any old answer.
Virginia's ACA site is also stuck on the security questions page, both today and yesterday. I got choices, but it kept telling me that I couldn't use the same answers for more than one question, even though I wasn't.

I'll give it a try again later to see if I get any further. I'm currently paying about $5,900/year for medical at 80% coverage. $7,000 if you add in dental/vision. Though I know I don't qualify for any kind of subsidy (I make too much money and my job's insurance meets minimum requirements), it'd be interesting to see how marketplace prices compare.
 
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#18
Or they're running on government servers with poor load balancing and lack of scaling. Crashing servers doesn't mean everyone loved the new Sim City.

I would bet good money the government is running all their software on prem, with little to no visualization.
 
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#20
Or they're running on government servers with poor load balancing and lack of scaling.
This. Back when I was working for OPM, they were running millions of document requests per year through a single crappy server, and were wondering why it was slow during peak time. After scrambling for months for a code fix, another contractor and I finally convinced one of the feds that it was a load balancing issue. Upgrade to multiple servers with load balancing, and voila, problem solved.
 
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#21
Tin, they need your help, obviously. I'd tell ya to offer it to them, but you probably wouldn't get paid right away. Y'know, shut down and all.
 
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#22
More money isn't going to help. More servers will only mask the problem.

Even google does a gradual rollout of most of their services. Remember how you had to get invites for gmail?

Even if the servers are sufficient, the law is so complex that the business logic is even more so. It doubtless had some testing and debugging, but there's no way they could have done enough testing to 1) verify it will work completely in most cases (nevermind all cases) and 2) handle the load in the majority of cases.

They needed to have granted early access to a few million random people, done performance, logic, and load testing, fixed the problems found, then invite another million and so on.

There's simple no way this could have worked on the first day for everyone who wanted to try it out.
 
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#23
Guess they should have been given enough to make it work, eh?
Throwing hardware at a congestion problem is a very expensive solution (so perfect for government!). Sharing datacenters across organizations with everything running on virtual machines would allow for a much more efficient use of resources (especially at a time when many government sites are now only serving up an index page, which is idiocy in itself, but that's for the shutdown thread) as the vms will be able to scale up and down as resources are needed and available. It's possible this is already done, but if there's one thing I've learned from nearly every interaction with a government policy or agency (a lot of large organizations really), it's take the logical solution and assume they're doing something else.

The other affordable solution (which is in addition to above) is to rent out resources on a company's datacenter (like Amazon's Elastic Compute Cloud, Rackspace, or SoftLayer) where you can quickly deploy more servers to meet demand. The issue here is government security standards, which make this kind of hosting close to impossible for a lot of government contractors let alone government organizations.
 
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#24
It's running on Java. On IBM's websphere application server.

There's simply no way it would work on rollout. It is not possible to write a java application for websphere and have it work out of the gate.

Well, unless it's a static website with no logic or database - then it might - might, mind you - work on day one. With a light load.

But, as is usual for these sorts of snafus, it'll be good enough for 90% of those that need it within 90 days, and that's good enough for the purposes of the healthcare act.
 
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#25
It's running on Java. On IBM's websphere application server.

There's simply no way it would work on rollout. It is not possible to write a java application for websphere and have it work out of the gate.

Well, unless it's a static website with no logic or database - then it might - might, mind you - work on day one. With a light load.

But, as is usual for these sorts of snafus, it'll be good enough for 90% of those that need it within 90 days, and that's good enough for the purposes of the healthcare act.
I wish I could say I'm surprised, but I'm really not. It's probably not just WAS either, it's most likely Portal. Where's the link, I want to see more.

<-- Job is developing Cloud Images of WebSphere Portal.
 
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#26
Just thinking out loud here, from an outsider's (Canadian) perspective, why is the "Obamacare" solution what was given, instead of "insurance of last resort" for people? If the stated goal is "health care for everybody" then why wouldn't the "simplest" solution work, i.e. if you can't get coverage with somebody else for a reasonable price, the government insurance (medicaid?) will cover you for a maximum price of $2k/year (or whatever, I pulled that number from nowhere), and we'll subsidize you on a sliding scale for low-income. Private health insurance can offer beyond that level of care (they'll pay for your botox, or whatever), and if they can offer insurance cheaper, then go ahead. But the "minimum standard of coverage" will always be the "safety net" below all others.

Why wouldn't that work, and wouldn't that be far simpler (and potentially cheaper) than what you're doing now?
 
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#27
Obamacare was a trainwreck of a compromise. No one really likes it, but the democrats like it better than nothing.
 
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#28
Stop putting so much logic into things! After all if it's not terribly convoluted, difficult to understand, and full of strange and arbitrary exceptions, it's poor legislation that's potentially full of loopholes. No one should be able to understand a law that's how you know it's good. Don't worry someone will explain the law to you and how it's perfectly great and wonderful for you just like that interest only mortgage you signed on your house.
 
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#29
When you go with in-house solutions, there's a big division between those who want lots of little tiny servers v. those who want dozens of VMs running on huge, monolithic machines. There are advantages to both, but I think pitching it to government would be a matter of portraying it like "It's like hiring a bunch of little people to do your jobs for you" v. "It's like creating a whole new department to handle it."

All this discussion made me want to take a peek at the text itself to see if I can make some sense of it "as written," but it's gonna take more than the few hours I have left before work to get through it all. I do find it amusing that the Wikipedia article has been locked.

--Patrick
 

GasBandit

Staff member
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#30
Just thinking out loud here, from an outsider's (Canadian) perspective, why is the "Obamacare" solution what was given, instead of "insurance of last resort" for people? If the stated goal is "health care for everybody" then why wouldn't the "simplest" solution work, i.e. if you can't get coverage with somebody else for a reasonable price, the government insurance (medicaid?) will cover you for a maximum price of $2k/year (or whatever, I pulled that number from nowhere), and we'll subsidize you on a sliding scale for low-income. Private health insurance can offer beyond that level of care (they'll pay for your botox, or whatever), and if they can offer insurance cheaper, then go ahead. But the "minimum standard of coverage" will always be the "safety net" below all others.

Why wouldn't that work, and wouldn't that be far simpler (and potentially cheaper) than what you're doing now?
Basically, you're saying extend MediCare (Medicaid is for the elderly) to all citizens. That's very much not cheaper, and it's an expansion of federal entitlements that is anathema to many.
 
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#31
When you go with in-house solutions, there's a big division between those who want lots of little tiny servers v. those who want dozens of VMs running on huge, monolithic machines. There are advantages to both, but I think pitching it to government would be a matter of portraying it like "It's like hiring a bunch of little people to do your jobs for you" v. "It's like creating a whole new department to handle it."
Depending on how you set it up there's no reason you can't have both. Dozens of VMs running on monolithic machines provides the advantage that a lot of business already have monolithic machines that can be re-purposed for heavy visualization, but it's a much more even debate when you're starting up a datacenter. It's a really interesting time to be in the server world.
 
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#32
I wish I could say I'm surprised, but I'm really not. It's probably not just WAS either, it's most likely Portal. Where's the link, I want to see more.

<-- Job is developing Cloud Images of WebSphere Portal.
I just browsed the various error message screenshots people are tossing up online. I don't have a link handy, sorry.

why is the "Obamacare" solution what was given, instead of "insurance of last resort" for people?
Cost. They couldn't simply say, "Let's spend trillions of dollars with no way to pay for it, and force insurance companies to accept anyone, anytime."

It became a very slippery slope, so to speak. From those two desired features you find that we have to force people onto insurance, or tax them, otherwise people will only get insurance when they are sick. You have to pay for it (even the individual mandate won't cover that) so from there they tax pharma, medical, insurance. This will drive up costs significantly across the board (we are, after all, collectively paying for 10 million more insured who aren't going to pay for it), so we have to offer subsidies. Of course the subsidies will cost more, but if we force more employers to pay for insurance then it won't be as bad. This'll raise the cost of goods, particularly in the segments of the market the poor need (walmart, etc) to survive, so again we're taxing the poor more heavily for their own good.

Once we've decided we have to have additional taxes, forced insurance purchases (or a penalty fee) just to meet the needs of the two desired outcomes, you realize that you have to have a way to get insurance to those that aren't employed. The current system doesn't work that well, and results in expensive self employed insurance, so let's set up a marketplace. Given that this is a state's rights issue we can't simply force one federal marketplace, so we give the states a choice, and if they choose federal then we'll take care of it, and if not then it'll be their responsibility. Further, the healthcare act only targets those that aren't currently aided by medicare, but medicare is again a state issue, and isn't even across the nation. We can't cover everyone with gapless coverage unless we normalize medicare federally, so we must add skirts to cover the gaps.

And so on, and so forth.

It's really just terrible, and it can only get worse.

Eventually you'll find an 8 year old that isn't provided treatment because of a clause meant to save money for those at the end of their life where medical care is pointless, and so we'll add extra clauses to the loopholes, and then we'll need to add loopholes to the clauses to the loopholes. And it still won't be ideal.

The rich, of course, have little to worry about other than significantly higher costs. They will always be able to get a hip replacement at 76. But the poor won't be able to, and even if they could they'll be on waitlists months long since we're slamming another 10-20 million people into a healthcare system that is already unable to meet demand, particularly in elder care.

But it was the only thing they could pass, and they honestly believe it's better to do it wrong and then try to fix it than to do it right.
 
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#33
If I remember correctly, my state opted out of the exchange program (FUCK YOU, WALKER), so the bronze program would cost me over $5000 a year. Considering that's a significant portion of my income, that just isn't going to happen.
 

GasBandit

Staff member
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#34
If I remember correctly, my state opted out of the exchange program (FUCK YOU, WALKER), so the bronze program would cost me over $5000 a year. Considering that's a significant portion of my income, that just isn't going to happen.
Is that for individual or does it also cover your spouse?
 
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#35
we're slamming another 10-20 million people into a healthcare system that is already unable to meet demand, particularly in elder care.
Oh, don't worry. Over the next 20 years, demand should go waaaaaaay down. And this will happen regardless of whether you think of this as a horrible tragedy or as Justice finally being served. It simply will be, and there's nothing anyone can do to stop it. However, supply will also fall during this period, and for the exact same reasons (after all, doctors themselves will be aging out of their practices at the same rate). Has anyone planned for these occurrences? As a former investment advisor, these are the kinds of things I look for, long-term.

--Patrick
 
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