[ebuddy]

Originally Posted by besson3c 

They are, because I've said that I qualify for some amount of tax credit, so I would expect my monthly premiums to be less than what they are now due to the tax credit.

Some tax credit and 100%-subsidized are two different things. Again, this neither matched the preliminary figures we bandied about nor what you thought the premium would be and you can't determine how this could be, but I'm missing the logic? Again, I have a hard time accepting that here.

There are far more than 20 million people that are without health insurance, I'm pretty certain.

Correct. There were approximately 45.6 million Americans without health insurance as of 2009. Approximately 25% of the uninsured according to the US Census data were eligible for Medicaid and S-CHIP, but hadn't enrolled. That's 12 million people. 43% of the uninsured have incomes higher than 250% of the poverty level and slightly more than a third have incomes in excess of $66,000. Nearly 75% of the uninsured could afford coverage but simply chose not to purchase it. According to the CBO, nearly 60% are under the age of 35, and 86% report that they are in good or excellent health. What this data says to me is that a hole needed patching, not the entire wall torn down. There were some 38 Republican proposals for hole-patching prior to the passage of the ACA, but they didn't have a public option, an individual mandate, and weren't nearly as criminal in their intent of ushering in a single-payer system.

i.e. There are approximately 20 million people with very real health care needs. You are not among them. When we subsidize your health insurance not by 30%, or 55% or even by 75%, but by 100% -- we leave little for those with very real health care needs.

And I've said that I don't understand how or why it worked out that way for us. Your question seems predicated around the notion that people that make less than me won't be eligible for the same tax credit, that was my point, but no, it doesn't seem sensible nor fair since we can obviously afford to pay something.

You are >400% of the FPL, besson and do not qualify for Medicaid. Medicaid is the only vehicle by which one's health insurance could be subsidized 100% and per the calculators we shared; couldn't get to a $0 premium at an income of < $19k/year at which time it links immediately to Medicaid information. You are by design the demographic to fund the ACA. If you're getting 100%-subsidized health insurance, there are not only a few making less than you and paying more, there are multiple millions of people making less than you and paying more. Period.

Since I've been very forthcoming with you, I'd like to know at what point you start to question your party's lack of ability/success in putting forth something better? Even if you think that this will be possible without repeal, why aren't they trying to gain traction by promoting better, concrete ideas? Your frustration seems one-sided.

I don't question my party on your ignorance of the literally dozens of alternative bills offered by Republicans including the American Health Care Reform Act because I know that's nothing more than parroting another dishonest Democrat talking point. I do question Republicans on getting elected however, so their voices would no longer be wholesale shut-out of the conversation.

[Shaddim]

Originally Posted by Chongo 

They're at it again over at MSNBC:

Melissa Harris-Perry Suggests ObamaCare Is The New N-Word - YouTube

Drag out the race card, bitches!

[besson3c]

Originally Posted by Shaddim 

But only 20M are going to benefit, there are still a very large number who still won't have coverage. As he said, that's a lot to pay for shitty service for 20M people.

You mean in the first year, when penalties are minimal to skip coverage?

[climber]

Originally Posted by Shaddim 

You mean those no-bid contracts that went to the company his wife's college buddy works for? That's all 100% above board, I can assure you. **** me, I'm not sure how it could look worse, it makes other Presidential money scandals seem completely insignificant. Anyone want to place bets on whether Obama will face criminal charges when he leaves office? I have a crisp $10 bill saying he'll be charged within 18 months of leaving office.

I would take that bet, if only for the reason I always loose these kind of things.

[Shaddim]

Originally Posted by besson3c 

You mean in the first year, when penalties are minimal to skip coverage?

You actually need to have a tax return to be penalized, and you don't get those when you don't have an income (or that income is entirely off the books).

Originally Posted by climber 

I would take that bet, if only for the reason I always loose these kind of things.

Okay, I've got you down for a ten spot.

[besson3c]

Originally Posted by Shaddim 

You actually need to have a tax return to be penalized, and you don't get those when you don't have an income (or that income is entirely off the books).

So you're referring to people that show up at the ER with no health insurance? Just trying to find full context for this number, I'm not necessarily disputing it.

[BadKosh]

Actually the FedTax return $ can only be collected by states with exchanges. Tamper with your W4 so you have to pay a teeny bit and they can't go after you.

[Chongo]

Originally Posted by BadKosh 

Actually the FedTax return $ can only be collected by states with exchanges. Tamper with your W4 so you have to pay a teeny bit and they can't go after you.

That is why OK is suing. They don't have an exchange. 2/3 of the states don't. The IRS is saying they can when Obamacare says they can't.

[subego]

I've stayed out of the health care debates here, but, as someone with multiple preexisting conditions, I have to say it was weird just to go to a website, ask for insurance, pick a plan, and be on my way.

When I needed to qualify for a state insurance pool, I needed to show an official rejection letter. I couldn't even get providers to give me that. I needed to call a broker and have them get me rejected.

[besson3c]

Originally Posted by subego 

I've stayed out of the health care debates here, but, as someone with multiple preexisting conditions, I have to say it was weird just to go to a website, ask for insurance, pick a plan, and be on my way.

When I needed to qualify for a state insurance pool, I needed to show an official rejection letter. I couldn't even get providers to give me that. I needed to call a broker and have them get me rejected.

I'm sticking out of the debates at this point too, since they seem predisposed to go a certain direction (see what I did here, borrowing this word from our other thread? )

However, just as a status update, I'm having enormous problems with Anthem, our insurance provider.

At first they did not cancel our old policy. Once it came clear to me that this didn't happen automatically, I requested that it be canceled, told that it was, even though it still isn't. I've been receiving bills for an amount due, plus a second bill in a second envelope saying that we don't owe anything because of our credit. They may have stopped sending us bills though, because I don't remember when the last one we received was (even though I pay our bills through their website, I'm not sure why they insist on this weird hybrid of paper/web).

I've received an updated version of my health card for our old policy for some reason, in addition to cards for our new policy. I've been contacting them via their website to try to rectify this situation, but they have yet to respond. I've also received a check from them for the amount that they billed me for for our old policy which I didn't pay. I have yet to cash this check, I figured I should hold off until they respond to me and give me some inkling as to WTF is going on and what this check was for (there was no explanation in the envelope, just a random check).

It could be that there was/is a problem with our eligibility for the subsidies or something established via the ACA website, I have no clue. However, either way, it is obvious that Anthem has been a mess themselves. In fact, all-in-all, they *seem* to have been the bigger offender. My experience with the ACA site is similar to subego's, once it worked it worked fine, or so it seemed, but at this point I have no clue what is what.

At this point, since we move in July, we might just decide to not bother trying to figure out our situation. It seems to messy to bother with for the short period of time we'll be in the US.

The TL;DR version of this, maybe the best possible synopsis for most people's experiences: it's all a giant mess.

[Shaddim]

My commie neighbor is disgusted, because he has no job, is attempting to get disability and Medicaid (he has MS and Fibromyalgia), and the ACA is telling him he still has to pay $280 that he doesn't have, for something that is entirely impractical to begin with (massive deductible). He's living on something like $190 in food stamps each month, and what little cash he gets from flipping yard sale items on ebay goes toward paying for his prescriptions. If it weren't for the local free clinic, he'd be right ****ed. He won't let me help him any more than I am, we already pay his mortgage and utilities. So I'm not sure what he'll do.

[ebuddy]

Originally Posted by subego 

I've stayed out of the health care debates here, but, as someone with multiple preexisting conditions, I have to say it was weird just to go to a website, ask for insurance, pick a plan, and be on my way.

This absolutely had to be said and it is important for opponents of the ACA to hear. The problem is, while there are many like you who need more robust care, there are many who do not and there are opposing ideas for leveraging that numbers game. Interestingly, they both must rely on spreading risk and to some degree, shifting the burden. The good news is, you can shift the burden back to the number instead of to the wallets of the young, the healthy, and the middle class. You can do it in a way that discourages waste and fraud and does not perpetuate dependency. It also doesn't require mandates or more IRS. This is the beautiful side of the profit-motive you'll never hear about.

When I needed to qualify for a state insurance pool, I needed to show an official rejection letter. I couldn't even get providers to give me that. I needed to call a broker and have them get me rejected.

Can you imagine how distorted a marketplace would have to be that you could be treated so horribly? It reminds me of how this Administration handled the millions of reports of people getting dropped from their care while sending his minister of disinformation before the American people talkin' about -- remember it's only 5% of the marketplace. Notwithstanding the quality experience of their online product and subsequent lack of urgency. The State-by-State monopoly on the marketplace was the Frankenbarbie, predominantly government-managed status quo and what we have now is straight AcmeCare; the slingshot that blows up in Wile E. Coyote's face.

It should be like purchasing your car insurance, but your car insurance does not need to cover your tires and your radio. It is not confined to the lobby-infested, bizarrely bloated bureaucratic state-by-state boondoggle. Had calmer heads prevailed, there are much simpler albeit less exciting solutions to the problem. If there were ever a case for the oft-abused Commerce Clause, I should think health insurance would be among them. The first move, and I mean the very first move should've been to open the marketplace across State lines and let that soak for 18-20 months. Then you begin to introduce HSAs and compatible plans including catastrophic-only coverages as a way of continuing to broaden the base of insureds, spreading risk, and opening up the means for decoupling insurance from employers. You can save to your HSA. Parents can contribute to your HSA. An employer can as part of your compensation package and to energize the labor market. And the government can as a means-tested safety net. The user can roll plan savings from their HSA into the next plan year encouraging them to shop their needs. And think of those procedures such as cosmetic surgery that had traditionally been cash-only services; costs have plummeted. This is how you leverage the numbers game and place the burden back on the numbers instead of people. Insurers will compete in a market that isn't so severely distorted. Providers would no longer charge what they do simply by virtue of a guaranteed clientele. Yes we can would become oh no we can't. You'd get that preexisting coverage option without worry for rejection letters.

Next up... world hunger.

[besson3c]

This whole talk of market distortion when it comes to preexisting conditions is pure bullshit.

If you are an insurance company, it is in your best interest to deny preexisting conditions, because covering people with these conditions is a significant liability that any smart business would want to avoid assuming. Maybe if there were multiple viable competitors in absolutely every location in the states you could have providers that compete with each other by supporting preexisting conditions, but even then, there is certainly no guarantee that they'd want to - there is certainly plenty of market to tap into that don't have preexisting conditions.

No company is going to assume liabilities like this just because it is moral. Just like we need laws to prevent fraud and abuse, we need laws to force insurance companies to support preexisting conditions. This is not something the market will self-correct, this is something that needs to be specifically legislated, period.

[ebuddy]

Originally Posted by besson3c 

This whole talk of market distortion when it comes to preexisting conditions is pure bullshit.

If you are an insurance company, it is in your best interest to deny preexisting conditions, because covering people with these conditions is a significant liability that any smart business would want to avoid assuming. Maybe if there were multiple viable competitors in absolutely every location in the states you could have providers that compete with each other by supporting preexisting conditions, but even then, there is certainly no guarantee that they'd want to - there is certainly plenty of market to tap into that don't have preexisting conditions.

What a silly thing to say. You act as if there weren't already insurers that offered coverage for pre-existing conditions. The whole idea of opening the market across State lines is to more effectively pool risk.

No company is going to assume liabilities like this just because it is moral. Just like we need laws to prevent fraud and abuse, we need laws to force insurance companies to support preexisting conditions. This is not something the market will self-correct, this is something that needs to be specifically legislated, period.

Altruistic? Moral? Do you suppose that was the MO of the ACA? You're kidding right? The way this is set up and the impact it's having on the insurance market, you'd have to be a complete idiot or paid shill to believe the government was acting out of any interest in morality.

No, it should be about the profit-motive as the only real check to abuse. Insurers use your premiums for other investment vehicles. i.e. they make money from your money. To turn down premiums would be counterintuitive. Insurers who know they only have to compete with 3 other insurers won't, 'tis true, but that's a distorted marketplace and a smaller pool. Remember, that's the compassionate State-by-State status quo set up by your philanthropic and loving government. Expand that market nationally and they'll pool those risks more effectively and create coverages for all sorts of specific conditions. In fact, you'd have smaller outfits and startups that could specialize in specific coverage types as well including those of particular occupations. We can't have any of this because the government was not interested in what was moral or right, they were interested in a political pet for some semblance of a career "legacy" that will continue to jack up the health care system until the only thing you have left is a piece of paper claiming you have coverage. Care will be something else entirely.

Preexisting conditions are essentially a mole hill and the ACA is a bunker-buster. Not because it had to be mind you, but because of a political agenda that has almost no regard for the insurance consumer, the patient, or the insurance market. The ACA is the worst government idea since chattel slavery and is only exhibit A of how unimportant people are. It's going to get worse and the opponents of this system have nailed its failings every step of the way. Period.

[Chongo]

My wife stopped in to our doctors office (we've been with for 7 years) to make an appointment and was informed that John C Lincoln Health Network is no longer accepting Aetna. (Freescale's self insured plan administrator)

[besson3c]

Originally Posted by ebuddy 

What a silly thing to say. You act as if there weren't already insurers that offered coverage for pre-existing conditions. The whole idea of opening the market across State lines is to more effectively pool risk.

In addition to the fact that there are no guarantees that providers would even be interested in offering policies across state lines, there is also the fact that the CBO figures this would only lead to a savings of 5%, on average:

http://www.cbo.gov/sites/default/fil...639/hr2355.pdf

Besides, in order to do so it would work best to have a national set of regulations. I thought you were about autonomy of the individual states?

Altruistic? Moral? Do you suppose that was the MO of the ACA? You're kidding right? The way this is set up and the impact it's having on the insurance market, you'd have to be a complete idiot or paid shill to believe the government was acting out of any interest in morality.

Blah blah blah... Again, you are broadening the scope of my statement well beyond its original scope in the hopes to deflect away from the point I've made.

I didn't make a single claim about the ACA as a whole. Again, here is that point:

This whole talk of market distortion when it comes to preexisting conditions is pure bullshit.

This was an accounting for where the market stood prior to this specific clause in the ACA about preexisting conditions being put into place. It was not a market distortion, it was a willful decision by the insurance companies to not assume a liability, because they could.

[ebuddy]

Originally Posted by besson3c 

In addition to the fact that there are no guarantees that providers would even be interested in offering policies across state lines, there is also the fact that the CBO figures this would only lead to a savings of 5%, on average:

http://www.cbo.gov/sites/default/fil...639/hr2355.pdf

Umm... HR2355 applies only to the individual insurance market, what Obama's Minister of Disinformation refers to as "only 5% of the insurance market." The fact that such a move would show an overall savings of 5% in monthly premiums for such a small pool is actually quite encouraging when you expand that ideal across the broad spectrum of insureds.

From your CBO link at the bottom of page 3;
There is considerable variation across states in two areas that have a substantial effect on the price of individual health insurance:

• Mandates that require coverage of certain services or benefits, and
• Rules affecting the extent to which insurers may charge different prices for coverage offered to individuals expected to incur costs above or below the average.

And because we're citing the CBO - An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act:
Nongroup Policies (the individual market)
CBO and JCT estimate that the average premium per person covered (including dependents) for new nongroup policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year under current law.

The proposal I support, you show would decrease monthly premiums by approximately 5% in the individual market whereas the law I'm decrying (which you seem compelled to defend) shows an approximate 10% -13% increase in premiums for the same market and requires a massive infusion of ill-conceived subsidies that would pay 100% of besson's premiums at >400% of the Federal Poverty Level for example.

Worse -- you know how much I LOVE the CBO and their approximate 95% failure rate in projections. Here's a 49-State Analysis of the ACA in November of 2013 showing an increase in Individual-Market Premiums By Average Of 41%.

Besides, in order to do so it would work best to have a national set of regulations. I thought you were about autonomy of the individual states?

Laws under UMRA already have provisions for overseeing interstate insurance commerce, but under very limited circumstances. I'm proposing that we repeal the antiquated McCarran-Ferguson Act from 1945 under the Interstate Commerce Clause and that we begin setting up Charter States. While some new oversight authority might be necessary for managing the broader market, the individual Federal authorities overseeing the State-by-State boondoggle would no longer be necessary. I have no reason to conclude that that bureaucracy would be anything other than a net-wash. Of course, the oversight authority under my proposal would absolutely pale in comparison to the oversight authority granted the HHS under the ACA. Unfortunately this is kind of a non-starter for you.

Blah blah blah... Again, you are broadening the scope of my statement well beyond its original scope in the hopes to deflect away from the point I've made.

As usual, you got caught trying to make a sarcastic hit and run dig against the private market by suggesting they won't do what is moral. I found the ideal laughable as if your government is acting in the interest of morality. I didn't expand the scope, I first addressed the predictable BS and as always -- you didn't appreciate that. Don't wanna go there? Okay, then don't. Otherwise, I'm going to address it.

I didn't make a single claim about the ACA as a whole. Again, here is that point:
"This whole talk of market distortion when it comes to preexisting conditions is pure bullshit."

This was an accounting for where the market stood prior to this specific clause in the ACA about preexisting conditions being put into place. It was not a market distortion, it was a willful decision by the insurance companies to not assume a liability, because they could.

You're still not getting it. The reason they could is because of a smaller, highly regulated State-by-State market that hampers competition resulting in a guaranteed clientele; by definition a distorted marketplace.

This thread is about finding health care solutions. I offer a proposal that establishes exponentially better numbers than what we had before or have now and you're apparently opposed to my view. So... what do you support, besson? You want to separate yourself from defending the ACA, tell me what solutions you're for. *HINT: private industry = bad and immoral is not a solution.

[besson3c]

You are still twisting the toke out of things ebuddy.

Once again, I repeat, I'm not contrasting your solution to the current ACA and "supporting it", as you claim. Do I need to repeat my original quote so that you can focus on what I was actually disputing? Seems so, so here it is again:

This whole talk of market distortion when it comes to preexisting conditions is pure bullshit.

You danced around the issue of preexisting conditions in your entire response to me.

I'm fine with insurance companies competing across state lines. The most optimistic ACA supporters feel that the ACA is an incremental improvement over what we had prior. You seem to be presenting insurance companies competing across state lines as a complete solution to what ails us, please correct me if I'm wrong? It isn't, it is another incremental improvement. I'm most interested in substantial improvements, since that is what is actually needed, and I tend to believe that the insurance company racket will not be a part of a world where we see substantial improvement in this country.

At any rate, whether it is 5%, 10%, or 15% cost savings by insurance companies competing across state lines, this too is an insufficient incremental improvement. An improvement I'd still welcome, but let's not position this as the be-all-end-all that it isn't.

[besson3c]

I'm going to try to make good on my promise to make it clear when my positions on something have pivoted, so here goes...

I did support the ACA because I saw it as an incremental improvement over what existed, the changes relatively minor in scope, but seeing all of the legitimate pain, consternation, turmoil, and conservatives predicting the coming apocalypse, if I had a do-over I probably wouldn't support it again.

Instead, I'd support the ripping-the-bandage-off-quickly approach in embracing far more substantial changes, spending political capital wisely.

This would *ultimately* be in the form of a single-payer system, but I think there would be years and years of foundation laying before I'd support this transition. In order for a single payer system to work, we would have to trust our government far more than we do now, and we'd need assurances that government wouldn't transform things into a corrupt nightmare.

If we were to implement a single-payer system today we would most certainly have a corrupt nightmare in short order: the survival of private insurance companies and/or interest groups in some form that try to take down the public system, silly loopholes for those with power, bloat, siphoning of money, destructive politics, ferocious campaigns of misinformation, sabotage.... Probably all of the above.

Clean up government, then fix healthcare. Make small incremental improvements in the meantime, I like closing the preexisting clause, that is fine, but don't market these solutions as fix-alls because this would be a huge momentum killer. I believe that the healthcare situation is really dire enough that we're going to need countless incremental improvements to really address this problem. At this point, I'm not even sure that a majority of Americans and American politicians really see healthcare in the States as being this badly in disarray, which is probably a part of the problem.

How we clean up government (if we can at all, which is certainly not a given), is an entirely different discussion, so I'll leave this vague this way for now. It's not like I have a magic wand for this problem anyway.

[turtle777]

I don't understand at all how a single payer system will fix ANYTHING.

The issue with the US [s]health]/s] sick care system is quite simply this:
It is a government tolerated/sponsored cartel-like structure of insurance companies, medical services providers and big pharma.
Or, to put simply: it's an issue of PRICES.

NOTHING in a traditional single payer system will address that. Like ACA, it will merely address the funding side ("insurance"), rather than fixing the massive rip-off in terms of prices charged.

Please, all you single payer sheeple, wake up, smell the coffee and realize what the REAL issue is.

-t

[ghporter]

To me, the biggest positive factor in the ACA is that there is a set of standards that all insurers have to meet. Important things that make health insurance worth having, such as covering existing conditions, has been something that has cost property owners billions of dollars in the past; people who could not get coverage because of preexisting conditions often wind up resorting to the ER at the "county hospital," which by law has to take them. Maybe ACA will only shift this cost from my property taxes to some other tax, but if it reduces the burden on county hospital ERs, and if it helps people work but can't afford to miss work because of the cost of waiting in that ER's waiting room, it may be worth it for all of us.

[turtle777]

ACA hasn't changed anything.

The people that now can (just barely) afford insurance (the new ACA) are stuck with $5,000 deductibles.
Therefore, they have insurance that's not good for anything except big catastrophic events.

Nothing has changed about affordability, because the PRICES are as jacked up as always.

-t

[Shaddim]

People are paying what little they have, for plans that essentially do nothing unless there's a very unlikely disaster. It's a scam of the highest order, period.

[turtle777]

^^^ This.

Catastrophic insurance was always available, and for far less money than ACA.

-t

[besson3c]

Originally Posted by turtle777 

I don't understand at all how a single payer system will fix ANYTHING.

The issue with the US [s]health]/s] sick care system is quite simply this:
It is a government tolerated/sponsored cartel-like structure of insurance companies, medical services providers and big pharma.
Or, to put simply: it's an issue of PRICES.

NOTHING in a traditional single payer system will address that. Like ACA, it will merely address the funding side ("insurance"), rather than fixing the massive rip-off in terms of prices charged.

Please, all you single payer sheeple, wake up, smell the coffee and realize what the REAL issue is.

-t

You're right, but the idea is that if the financial liability was the government's, and not large employers', they could negotiate lower prices for large group rates, and help investigate cases of billing fraud and abuse from a medical standpoint (the return on investment for some large companies to do this may not be enough for them to play an instrumental role in auditing hospital invoices and such). Prescription drugs, AFAIK, are cheaper in Canada for this reason, even those with active patents.

My point is that you're right, but a single payer (again, to be abundantly clear, with a hypothetical American government that flat out doesn't exist now) could be a productive part of accomplishing these goals of lowering prices.

Everything I said about cleaning up government, as vague as it was, would ideally address this rampant corruption, if I were the benevolent dictator of this country.

[besson3c]

Originally Posted by Shaddim 

People are paying what little they have, for plans that essentially do nothing unless there's a very unlikely disaster. It's a scam of the highest order, period.

Are you in favor of some system that retires having insurance providers, and with it this idea that the free market can sculpt the whole concept of obtaining insurance into something that works?

[ghporter]

Originally Posted by turtle777 

ACA hasn't changed anything.

The people that now can (just barely) afford insurance (the new ACA) are stuck with $5,000 deductibles.
Therefore, they have insurance that's not good for anything except big catastrophic events.

Nothing has changed about affordability, because the PRICES are as jacked up as always.

-t

This isn't universally true. My son just got his first "on his own" health coverage, and while it ain't exactly cheap, it has reasonable deductibles and some surprisingly customer-oriented rules that exclude a number of things from deductible consideration - he gets meds with a simple copay, most office visits are a simple copay, and so on. Of course he's a single person, so that really doesn't address what I think of as the larger issue: insuring young families. Young families have some of the most expensive care requirements around, like pregnancy and childbirth coverage, "well baby" coverage and taking care of little kids who get all sorts of bugs from just going to school.

It has never been a "you can't afford any insurance so don't bother" situation, but I think that with a number of notable exceptions it is getting better. And I should point out that, as a health care professional, I'm in a position to be hurt professionally by some of the more dire predictions of what ACA will do. I still think we should see if it does begin to run over people's dogs, set fire to their trash cans, and otherwise act unacceptably before we worry about changing or junking it. But I think any change, especially one that at least appears to establish a minimum level playing field, is long overdue.

[besson3c]

Wait, the ACA is going to run over my dog? Why didn't anybody warn me about this? Where were you on this, Michelle Bachmann?

It's a good thing I don't have a dog.

[ghporter]

I'll bet you have a trash can though....

Predictions of the collapse of Capitalism, mass firings and a spike in the price of gold (OK, I made that last one up) due to ACA have been, to say the least, "premature."

[ebuddy]

Originally Posted by besson3c 

You are still twisting the toke out of things ebuddy.

Once again, I repeat, I'm not contrasting your solution to the current ACA and "supporting it", as you claim. Do I need to repeat my original quote so that you can focus on what I was actually disputing? Seems so, so here it is again: "This whole talk of market distortion when it comes to preexisting conditions is pure bullshit."

You danced around the issue of preexisting conditions in your entire response to me.

Is it absolutely impossible for you to engage an honest discussion? You're saying I danced around the issue of preexisting conditions.

• You act as if there weren't already insurers that offered coverage for pre-existing conditions. The whole idea of opening the market across State lines is to more effectively pool risk. *you didn't say a word to refute this.
• Insurers use your premiums for other investment vehicles. i.e. they make money from your money. To turn down premiums would be counterintuitive. Insurers who know they only have to compete with 3 other insurers won't, 'tis true, but that's a distorted marketplace and a smaller pool. *you didn't say a word to refute this. After all, you cited a source that affirms my point here so there wasn't much for you to say.
• Expand that market nationally and they'll pool those risks more effectively and create coverages for all sorts of specific conditions. In fact, you'd have smaller outfits and startups that could specialize in specific coverage types as well including those of particular occupations. *you didn't say a word to refute this.
• You're still not getting it. The reason they could is because of a smaller, highly regulated State-by-State market that hampers competition resulting in a guaranteed clientele; by definition a distorted marketplace. *you didn't say a word to refute this the first time around so I repeated it.

What does besson do when he's got nothing to say? Claim no one has addressed his unsubstantiated, non-argument.

Again, if Insurers already had been offering preexisting coverage, there's no reason to conclude they wouldn't increase this coverage option in a more competitive environment. You tried to suggest that interstate commerce wouldn't have a substantial effect on the price of insurance, but the CBO report you cited explicitly states that the State-by-State system has a substantial effect on the price of health insurance. There's absolutely no reason to conclude that insurers wouldn't be more competitive across-the-board when they have a much broader market to compete against. All it takes is one to offer preexisting coverage on the national stage and that will spur others into fitting this into their models. If there are already Insurers who provide this coverage under the limited market we have today, I see no reason why this wouldn't only continue to expand.

As it turns out, the "I've got bananas in my ears" defense isn't nearly as powerful as you thought.

[ebuddy]

Originally Posted by ghporter 

I'll bet you have a trash can though....

Predictions of the collapse of Capitalism, mass firings and a spike in the price of gold (OK, I made that last one up) due to ACA have been, to say the least, "premature."

Of course, when absolutely every prediction the opposition has claimed regarding the cost of care, the cost of premiums, an increase in the uninsured, the increase in deductibles, and the mathematical failure in the model holds true and the ACA proves to be at least as bad if not worse than the opposition claimed it would be...

... bring in the straw men!

[Chongo]

My out of pocket max doubled, our copay for PCP and specialists increased by 33%.
My nephew in law pays for his own insurance (my niece has her own coverage) and was told his plan was canceled for non compliance. He is now required to purchase a more expensive plan that includes birth control, abortion inducing drugs, sterilization procedures, and maternity care, coverages he will NEVER need.

[besson3c]

Originally Posted by ebuddy 

Is it absolutely impossible for you to engage an honest discussion? You're saying I danced around the issue of preexisting conditions.

• You act as if there weren't already insurers that offered coverage for pre-existing conditions. The whole idea of opening the market across State lines is to more effectively pool risk. *you didn't say a word to refute this.
• Insurers use your premiums for other investment vehicles. i.e. they make money from your money. To turn down premiums would be counterintuitive. Insurers who know they only have to compete with 3 other insurers won't, 'tis true, but that's a distorted marketplace and a smaller pool. *you didn't say a word to refute this. After all, you cited a source that affirms my point here so there wasn't much for you to say.
• Expand that market nationally and they'll pool those risks more effectively and create coverages for all sorts of specific conditions. In fact, you'd have smaller outfits and startups that could specialize in specific coverage types as well including those of particular occupations. *you didn't say a word to refute this.
• You're still not getting it. The reason they could is because of a smaller, highly regulated State-by-State market that hampers competition resulting in a guaranteed clientele; by definition a distorted marketplace. *you didn't say a word to refute this the first time around so I repeated it.

What does besson do when he's got nothing to say? Claim no one has addressed his unsubstantiated, non-argument.

Again, if Insurers already had been offering preexisting coverage, there's no reason to conclude they wouldn't increase this coverage option in a more competitive environment. You tried to suggest that interstate commerce wouldn't have a substantial effect on the price of insurance, but the CBO report you cited explicitly states that the State-by-State system has a substantial effect on the price of health insurance. There's absolutely no reason to conclude that insurers wouldn't be more competitive across-the-board when they have a much broader market to compete against. All it takes is one to offer preexisting coverage on the national stage and that will spur others into fitting this into their models. If there are already Insurers who provide this coverage under the limited market we have today, I see no reason why this wouldn't only continue to expand.

As it turns out, the "I've got bananas in my ears" defense isn't nearly as powerful as you thought.

I don't have bananas in my ears, you have your head in the sand.

You're claiming that by competing across lines there *might* be insurance providers that are willing to support preexisting conditions, just like there are some that might support them now. What if they don't? What if they do, but the prices are insanely high? What if somebody acquires a condition, their coverage is dropped, they leave to a different state, they want to shop around or whatever, and their condition is then deemed preexisting and their costs shoot up? How is "preexisting" defined? Should an insurance company be able to discriminate this way? An auto insurance company can shoot up premiums for those with lousy driving records as an incentive for them to drive better or don't drive at all, but can somebody with a preexisting condition always help that they have this condition? Not every condition is the result of specific behavior.

You've yet to address what would make an insurance company want to take on this significant liability when they don't have to (that is, offering premiums they would expect any normal person to be able to pay for), without simultaneously acknowledging that your solution of competing across state lines would only have a projected small improvement (an improvement which I'd still support nonetheless).

Sure, your solution might help, but that is nowhere near good enough. The whole design of insurance is to spread risk around, not to avoid it altogether. By avoiding it, individuals are a burden on the economy. Denying pre-existing conditions doesn't help financially or morally.

[besson3c]

Originally Posted by besson3c 

You're right, but the idea is that if the financial liability was the government's, and not large employers', they could negotiate lower prices for large group rates, and help investigate cases of billing fraud and abuse from a medical standpoint (the return on investment for some large companies to do this may not be enough for them to play an instrumental role in auditing hospital invoices and such). Prescription drugs, AFAIK, are cheaper in Canada for this reason, even those with active patents.

My point is that you're right, but a single payer (again, to be abundantly clear, with a hypothetical American government that flat out doesn't exist now) could be a productive part of accomplishing these goals of lowering prices.

Everything I said about cleaning up government, as vague as it was, would ideally address this rampant corruption, if I were the benevolent dictator of this country.

Not to mention, Medicare rates are already lower than non-Medicare rates, in many cases.

[ebuddy]

Originally Posted by besson3c 

I don't have bananas in my ears, you have your head in the sand.

You're claiming that by competing across lines there *might* be insurance providers that are willing to support preexisting conditions, just like there are some that might support them now.

What if they don't? Let me try this another way. Most, I repeat -- most -- are covered for a condition that is generally deemed a "pre-existing" condition.

What if they don't?

But they do. See, this is the first problem you're having. They do. For the overwhelming majority of insureds both group and individual.

What if they do, but the prices are insanely high? What if somebody acquires a condition, their coverage is dropped, they leave to a different state, they want to shop around or whatever, and their condition is then deemed preexisting and their costs shoot up?

What if the prices were entirely manageable for the overwhelming majority of those with a preexisting condition? What if this were a perfect illustration of how pooling risk at a much broader scale is the model for covering these conditions? As for your anecdotes; I can't possibly find a better position to be in than to have the entire country of insurers at my disposal. If most insurers cover a preexisting condition now, for the very reasons that interstate commerce would immediately serve; it's the best answer for covering the minority remaining with a preexisting condition today.

Worse, I don't see how you avoid your scenario just because it's law that preexisting conditions be covered. Covered by who? You canceled your insurance without finding a replacement - you're an f'n moron. What if I'm canceled or dropped? Well... again, I'd rather have the entire country of insurers at my disposal. This is why I said I'd start here. I didn't say I'd stop here.

How is "preexisting" defined?

Eesh. Do you burst out the door into the snow without your shoes on in the morning?

Should an insurance company be able to discriminate this way? An auto insurance company can shoot up premiums for those with lousy driving records as an incentive for them to drive better or don't drive at all, but can somebody with a preexisting condition always help that they have this condition? Not every condition is the result of specific behavior.

Not every problem requires a law to fix it. Sometimes, you might be able to repeal a very antiquated, stupid old law to solve a problem. I know you've now officially retracted your support for the ACA, but we could've given each of the apprx. 1.5 million people who would face higher premiums and/or denial for preexisting conditions, a straight $10,000 cash subsidy, paid annually to offset the cost of their care and we'd have been much better off than we are today. It's a shame you had to pass it to know what was in it, but I give you credit for staying after class.

You've yet to address what would make an insurance company want to take on this significant liability when they don't have to (that is, offering premiums they would expect any normal person to be able to pay for), without simultaneously acknowledging that your solution of competing across state lines would only have a projected small improvement (an improvement which I'd still support nonetheless).

I said I'd start there, I didn't say I'd end there. I've addressed your complaint ad nauseam, man.

Sure, your solution might help, but that is nowhere near good enough. The whole design of insurance is to spread risk around, not to avoid it altogether. By avoiding it, individuals are a burden on the economy. Denying pre-existing conditions doesn't help financially or morally.

Right, that's exactly why most insurers don't deny preexisting conditions. For starters, being heartless is bad pub -- the only way this denial could possibly serve your best interest is in a distorted market. There's a way to cover 'em all and the Insurers want to. Do you think they're opposed to the ACA? They're trying their damnedest to make it work. In many respects, the Insurers have their demise coming to them and the only way I'll shed a tear is if there aren't a wealth of new startups to take their clientele.

It would've been more clever to make my arguments for me tomorrow on April fools day, but as usual -- you were premature.

[besson3c]

Thanks for your good response ebuddy, this was definitely far more satisfying to read through.

Insurers didn't deny pre-existing conditions in Alaska, Arizona, Arkansas, Delaware, District of Columbia, Louisiana, Missouri, Nebraska, Nevada, and Oklahoma (a number of these being red states).

Otherwise, they could for periods up to 18 months:

Pre-existing condition - Wikipedia, the free encyclopedia

Do you have any data to support the idea that insurance companies in these other states did not ration by denying access to patients with pre-existing conditions, even though it was perfectly legal for them to do so? I hope you understand that it is hard to see how this belief is rational. Doesn't everybody know somebody who dealt with the pre-existing condition clause? Our own subego sounds like he did...

Maybe I'll come up with some charts and graphs later.

[besson3c]

This study says 1 in 7 people were denied because of pre-existing conditions:

https://www.propublica.org/blog/item...xisting-condit

[ebuddy]

Originally Posted by besson3c 

Thanks for your good response ebuddy, this was definitely far more satisfying to read through.

Insurers didn't deny pre-existing conditions in Alaska, Arizona, Arkansas, Delaware, District of Columbia, Louisiana, Missouri, Nebraska, Nevada, and Oklahoma (a number of these being red states).

Otherwise, they could for periods up to 18 months:

Pre-existing condition - Wikipedia, the free encyclopedia

Do you have any data to support the idea that insurance companies in these other states did not ration by denying access to patients with pre-existing conditions, even though it was perfectly legal for them to do so? I hope you understand that it is hard to see how this belief is rational. Doesn't everybody know somebody who dealt with the pre-existing condition clause? Our own subego sounds like he did...

You saw from your link that there are essentially three insurance markets; individual, small group, and large group and that the insurers' periods for small and large group were much kinder to the insured and their look-back period much shorter, right?

Why? Pooling of risks. Something they could more effectively do if subego as an individual insured for example, could pool his risk nationally as opposed to a single state. It would look more like the large group model.

Maybe I'll come up with some charts and graphs later.

See if you could produce some charts and graphs on the actual number of those who were declined or faced higher premiums due to a preexisting condition. What you'll find is that the overwhelming majority of insureds in all 50 States had coverage for their preexisting conditions. Again, if you want to focus on the individual market, we can, but that only bolsters my argument for interstate commerce. Otherwise, insurers had been covering preexisting conditions for the overwhelming majority of insureds in all 50 States -- to the tune of approximately 98.5% of insureds.

[ebuddy]

Originally Posted by besson3c 

This study says 1 in 7 people were denied because of pre-existing conditions:

https://www.propublica.org/blog/item...ing-conditions

From your article; "A spokesman for Aetna did not dispute the memo’s findings, but told The Wall Street Journal that they “document what many health insurers, including Aetna, have been saying for years – that the individual market needs to be reformed so we can improve access for all consumers.”

Sounds like the spokesman for Aetna is saying the exact same thing I've been saying.

It should be noted, what you've posted is actually very good news. Again, they're talking about the minority, individual market, besson. The overwhelming majority of insureds, even in the individual market @ 6 in 7, are being covered for their preexisting conditions. I claimed approximately 1.5 million were being declined or faced higher premiums due to a preexisting condition and apparently my number was far too generous for your argument. Your link suggests the number of those being declined for coverage is approximately 217,000 people per year.

You don't need massive, sweeping new legislation that has caused upwards of 6 million to lose their coverage entirely in order to address the 217,000-person problem. We might've been able to address this minority problem by repealing old, bad law and ensure the system is solvent and affordable for the remaining 98.5% of the insured.

[besson3c]

I've been focusing on the individual insurance market because the vast majority of those in group markets are covered under their employers. It is not a surprise that the number of those denied for preexisting conditions is less in the employer-covered healthcare categories, because no employer would want to have to face denying coverage to their employees that they promised, nor can they screen hires based on their health history.

But I thought that virtually, if not absolutely every one of us was on the same page that depending on employers for health care is a fatally flawed system for a multitude of reasons? Are you not convinced? Why should the individual insurance market not be the subject of my focus?

[besson3c]

While I would stand by my support of insurance companies competing across state lines, while Conservatives have very little patience for this transition to the ACA, they would cry holy murder once they witnessed the regulatory cluster**** that would ensue if this came to be once people started filing claims with their new out-of-state provider, assuming there was some federal regulation to help prevent fraud and abuse in these insurance companies upholding their end-of-the-bargain once claims have been filed.

Once such way for a company to get out of honoring a claim is by incorporating a dense, complicated matrix of certain tests and treatments that they will not cover in the various states they provide coverage for (and/or facilities that are considered out-of-network), and expecting their customers to consult this matrix periodically to see what they have changed. I think regulation would be needed to normalize an insurance package (which is often complex enough) across state lines. I.e. if an insurance provider provides plan A, B, C in multiple states, it is what it is no matter what state you are in.

ebuddy, do you think that competing across state lines would work while adding zero federal regulation to support this system?

[el chupacabra]

Originally Posted by turtle777 

The issue with the US health sick care system is quite simply this:
It is a government tolerated/sponsored cartel-like structure of insurance companies, medical services providers and big pharma.
Or, to put simply: it's an issue of PRICES.

NOTHING in a traditional single payer system will address that. Like ACA, it will merely address the funding side ("insurance"), rather than fixing the massive rip-off in terms of prices charged.

-t

This can't be said enough. Am I wrong in assuming medical services are the only products in the world where you agree to buy and use the product/service without knowing the price first?

In marketing this is called "baiting" in similar scenarios. It's illegal in many places because it drives prices up. A common example: 1.99 is on a big sign above blueberries, except at checkout they ring it up as 3.99. Most people don't catch it or aren't willing to part with it once they've been "baited". But if you do, the clerk informs you that it was for a different brand which hasn't been on the shelf in a long time [or ever]. This is also common with the sale of in store college books to prevent you from buying online. Any kind of unadvertised "setup fees" or "application fees" are also a baiting tactic. It's funny because the way we use medical services and find out price later is a much more dangerous scenario than the recognized baiting tactics.

Why didn't we try making a law to force medical industry to list prices and rates publicly for their products and services. Insurance, individuals, and independent watch groups would quickly find which is the fairest priced businesses and free market forces would drive the price of that $70,000 scorpion anti-venom back down to $108.

Liberals say we should just give ACA a chance... Why didn't we just give this a chance? It wouldn't require a billion $$ website or a complete overhaul.... So it would be no problem if it didn't work out. Testing this solution would have been FREE

[OAW]

^^^

Actually liberals advocate using the power of government to implement such common sense regulations routinely. It's our conservative friends who instead choose to delude themselves into thinking that the "free market" left to its own devices will result in anything remotely close to what you just said on its own.

OAW

[besson3c]

Originally Posted by el chupacabra 

This can't be said enough. Am I wrong in assuming medical services are the only products in the world where you agree to buy and use the product/service without knowing the price first?

In marketing this is called "baiting" in similar scenarios. It's illegal in many places because it drives prices up. A common example: 1.99 is on a big sign above blueberries, except at checkout they ring it up as 3.99. Most people don't catch it or aren't willing to part with it once they've been "baited". But if you do, the clerk informs you that it was for a different brand which hasn't been on the shelf in a long time [or ever]. This is also common with the sale of in store college books to prevent you from buying online. Any kind of unadvertised "setup fees" or "application fees" are also a baiting tactic. It's funny because the way we use medical services and find out price later is a much more dangerous scenario than the recognized baiting tactics.

Why didn't we try making a law to force medical industry to list prices and rates publicly for their products and services. Insurance, individuals, and independent watch groups would quickly find which is the fairest priced businesses and free market forces would drive the price of that $70,000 scorpion anti-venom back down to $108.

Liberals say we should just give ACA a chance... Why didn't we just give this a chance? It wouldn't require a billion $$ website or a complete overhaul.... So it would be no problem if it didn't work out. Testing this solution would have been FREE

It's funny you should say that. I'm actually working on a very huge web application with a group of medical professionals that will attempt to do some of what you're talking about here in providing consumers a sense as to what a test/treatment should cost based on regional averages, what the return on investment is, what tests/treatments are actually appropriate to see on your invoice, etc.

To say that medical billing is opaque is the biggest understatement of all understatements, I'm learning (and I'm just doing the app development stuff). There are people who have worked in medical billing for a living that still don't really understand it, nor can they make rhyme or reason of some of their prices and policies. Sometimes these numbers seem like they were just conjured out of thin air, and of course these numbers vary depending on whether the patient has health insurance through a large employer, or Medicare, as well as all sorts of other contextual variables.

Needless to say, this would be lovely, but *very* hard to execute. Where would one start? You can say that medical institutions should just "list their prices", but these prices are very contextual and change all the time. There are 209348302948 charge codes for things, and there is no standardization of what these codes represent, AFAIK. It's an absolute mess.

I'm sorry guys, but I really think that the only solution is to wipe the slate clean and start with something new that doesn't involve insurance. I know you vomit in your mouth at the thought of expanded Medicare or anything like it that has the word "national" in it or is connected to government in some fashion, but what el chuc wants here isn't easily possible with each state doing their own thing, no standard baseline for pricing, different laws and regulations in various states, etc.

It is time to "refactor" health care, to use a programming term, simplifying things and devising national standards, databases, prices, regulations, and sanity to a system of 50 systems of individual chaos.

[besson3c]

If these national standards, databases, prices, regulations, etc. would really bother the booze out of you being tied to government, is there some way this could be tied to either some sort of non-partisan group ala the CBO, perhaps some sort of non-elected board of health professionals that are somehow removed from politics, tied to the HHS or not?

I guess you couldn't completely depoliticize such a group, and surely if you look at the department of education you can see some problems with nationalized attempts to oversee various parts of our society, but could there not be a way to create a group like this, learning from mistakes of the past?

No matter who pays for health care, any economic model can benefit from an established baseline of prices, a single set of regulations, billing procedures, records, standardized charge codes, etc. that brings order to the disarray of what we have now, no?

[besson3c]

Originally Posted by OAW 

^^^

Actually liberals advocate using the power of government to implement such common sense regulations routinely. It's our conservative friends who instead choose to delude themselves into thinking that the "free market" left to its own devices will result in anything remotely close to what you just said on its own.

OAW

I have this theory that when you let the free market do its thing, what can/often happen is that the complexity of service increases astronomically. Exhibit a: health care billing/insurance, exhibit b: cell phone companies, exhibit c: the stock market/banking. Do you buy this?

[el chupacabra]

… .

[besson3c]

Originally Posted by el chupacabra 

I only heard 1 representative [on a talk show] suggest forcing businesses to list prices publicly, and he was an R. It never gathered any momentum, the idea wasn't even a footnote to the whole debate; regardless of party. Perhaps it didn't' have enough flare the dramatic.

Because it's not really possible without a *tremendous* amount of work and cooperation, and perhaps some federal standards with things such as charge codes.

There is no evidence government can get a buy in bulk discount. History shows that businesses routinely mark prices up for government because they know government is the richest kid on the block and has no one to answer to.

How about the fact that health care is cheaper in every other country, by far?

It can work when there are multiple companies providing bids for products/services to the government, you're right it doesn't seem like it would work for monopolies. It would seem like there are more health insurance monopolies than medical device/technology provider monopolies? This principle of government obtaining bulk discounts, AFAIK, applies more to devices/technology.

ebuddy's idea of allowing health insurance companies to operate across state lines would likely help with breaking up these insurance monopolies (although I'm still inclined to think that this will not work as well as we'd all like without replacing state-by-state regulations with federal ones), but bulk discounts from medical device/technology providers ought to be nice too.

Then again, any kind of discount would be nice at this point.

[ebuddy]

Originally Posted by besson3c 

I've been focusing on the individual insurance market because the vast majority of those in group markets are covered under their employers. It is not a surprise that the number of those denied for preexisting conditions is less in the employer-covered healthcare categories, because no employer would want to have to face denying coverage to their employees that they promised, nor can they screen hires based on their health history.

But I thought that virtually, if not absolutely every one of us was on the same page that depending on employers for health care is a fatally flawed system for a multitude of reasons? Are you not convinced? Why should the individual insurance market not be the subject of my focus?

It's fine to use the individual market as it really makes my argument for interstate commerce more tenable, but it doesn't make sense to treat employer-coverage as if it's not real insurance, administered by real insurers. The reason insurance companies are able to provide better terms to employers, including the coverage of preexisting conditions and affordable premiums for all is because of the law of numbers; pooling risks into larger groups. It is much more difficult to move away from employer-sponsored care while we're still mired in a State-by-State, smaller group, monopoly situation. By opening the market nationally, you enable an entire country of people to pool their risks and their insurance becomes more portable. This is the first step to begin to address the problem.

[ebuddy]

Originally Posted by besson3c 

While I would stand by my support of insurance companies competing across state lines, while Conservatives have very little patience for this transition to the ACA, they would cry holy murder once they witnessed the regulatory cluster**** that would ensue if this came to be once people started filing claims with their new out-of-state provider, assuming there was some federal regulation to help prevent fraud and abuse in these insurance companies upholding their end-of-the-bargain once claims have been filed.

Prior to the ACA, there were already Federal regulations to help prevent fraud and abuse among insurers, this is generally deemed by their ratings from C to A++ and a certain rating had to be met to administer insurance in a State. Under a market that is opened nationally, you'd still have regulation, but it wouldn't be 50 different packages of regulations as distorted by State lobbies with arbitrary boundaries for pooling risk. It would be regulated under a "Charter State". Insurers would compete for Charter States and States would compete for Charter status.

Once such way for a company to get out of honoring a claim is by incorporating a dense, complicated matrix of certain tests and treatments that they will not cover in the various states they provide coverage for (and/or facilities that are considered out-of-network), and expecting their customers to consult this matrix periodically to see what they have changed. I think regulation would be needed to normalize an insurance package (which is often complex enough) across state lines. I.e. if an insurance provider provides plan A, B, C in multiple states, it is what it is no matter what state you are in.

Remember, insurers are not only expected to behave properly, so are insureds. If you don't think there are a myriad of people attempting to scam the insurance industry, you're not paying attention. Much of the testing is to establish the condition and you paying some of that matter up front is your skin in the game. This is absolutely necessary for cost control and actually serves the overwhelming majority of insureds. If you think Medicaid or Medicare doesn't and will not continue to increase their rationing of care, you've got another think coming. Otherwise, much of this is also the product of distorted State-by-State regulations that bolster this testing apparatus manufacturer or that pharmaceutical that result in required testing combined with a need for tort reform. During your open enrollment period, your policy is what it is until the next enrollment period. The terms of that policy cannot change once your first premium has been paid. Opening the market on a national level and pooling the risk with the entire country of people at your disposal would go a long way toward simplifying coverages, again not unlike the employer-sponsored group plans by essentially affording this same coverage-methodology to all.

ebuddy, do you think that competing across state lines would work while adding zero federal regulation to support this system?

I think it would result in a net-reduction in overall regulation; the oft-realized benefit of simplification through consolidation.

Let me ask you, do you believe that Medicare and Medicaid do not ration or scrutinize care through a myriad of necessary testing and complex bureaucracy?