So I perused the Health NY marketplace today as my company is probably going to stop providing us insurance through the company and provide us the $'s to pay for it on our own.

So, basically for what I pay for insurance today, I can get an amazing policy that is 100x better than what I currently have...so I am slightly confused and looking for the gotcha in the entire thing, am I going to get my ass kicked down the road or something else...

Right now as a middle of the road, I don't lean towards either party, I have been waiting to see what this has produced...and if it is what it says it is...I am amazed. But I have a feeling the gotcha is there somewhere (I know, taxes, infrastructure costs, all that) more then the inherent costs associated with this.

Yeah I was also excited once I got to actually look into the policies. It's going to be much, much better for me than I anticipated.

It's war, and have you really seen much indication of me expecting anything from anyone other than a sincere effort?

Politically, I tend to expect the actors to behave within the rules -- or face both real consequences and damaged perception -- although I'll admit that I'm sliding consistently further toward a more literal interpretation of "by any means necessary" as I grow older/perceive the threat to be more significant.

New York is obviously the best place for this, because it's the most regulated state in this arena. Pre-existing conditions must be accepted there under existing state law. All Obamacare does is add healthy people to the self-insurance pool, because buying insurance on your own is ridiculously expensive. New England, with the exception of New Hampshire (strong libertarian streak) wasn't far behind. So for a few high-cost states in the northeast, Obamacare is a big help.

For most of the rest of the country, it increases costs significantly, but the subsidies might help a lot if you're struggling financially. So taxpayers will pay for that benefit.

It is a huge change because what it introduces is the concept that the government can force you to have health insurance (the fines will get larger). It's an important step toward single-payer. I don't know any other way to look at it.

Now the US pays about 18% of GDP for health care. That's about twice the world average. So taking 18% - Medicare - Medicaid of our economy and putting it under government control is maybe the biggest transfer of power from private to public that we've ever had in this country. I'm not trying to over-dramatize it. It's a huge change.

Health care was already broken in this country, though, as indicated by how much we pay. Even if we could get down to France's level (11% of GDP), there's still so much we should do. For Obamacare to work - and for the next logical step to work - we must address these costs. And we aren't. This legislation basically takes the insurance out of insurance and let the insurance companies manage the exchanges. I don't see that making a dent in that 18% figure, let alone moving us toward our eventual goal of 9%.

As for the Republican/Democrat conflict, both sides are filled with stubborn asses who don't play fair. It's been like this for a long time. My first WTF moment was when the Republicans decided to impeach Bill Clinton for lying about his affair. OK, I get it, Clinton did something morally repugnant. If Hillary decided to rake his ass over the coals in divorce court over it, she'd have my hearty congratulations. But it still was something more appropriately addressed within the Clinton household. Impeaching the president is embarrassing for all of us and it certainly didn't help bridge any divides. Since then, it seems, the two parties can't compromise on much of anything. Or maybe before. I wasn't very interested in the subtleties of national politics until the '90s.

Anyway, I side with the Republicans on the budget impasse. Obama hasn't been honest about his budgets, and Obamacare is the rule, not the exception. Something needs to be done here, and it's unfortunate that no one in Washington seems to have the skill to negotiate this. We cannot keep increasing the debt. We cannot keep printing money like it's candy.

There are a lot of cost control measures, the payment board for Medicare, shifting hospital payments to outcomes from fee for service, shifting ER to doctor visits, the 80% rule for insurers, etc. What isn't there that you would like to see?

I'll admit for me the biggie is negotiating drug prices through Medicare.

I can only respond in generalities. I think this chart speaks for itself: Health expenditure, total (% of GDP) | Data | Table

If I had to guess where to start, I'd start with tort reform.

Tort reform isn't going to bring down prices much at all.

Allowing to negotiate drug prices is a huge start. Would immediately bring down the cost of health care.

Except it's not transferring any business from private to public. "Big Insurance" made sure of this. You are still buying from Anthem or UHC or whoever. You're not buying from the government- they made sure of that 2 years ago through the insurance paid for candidates like Max Baucus. There's no single payer, there's no public option, and there's no expansion of Medicare that I can find (tho there may be a modest one that I cannot). There is a significant expansion of Medicaid but, let's face it- most who qualify for Medicaid weren't in the insurance pool before anyway.

SI

GOP is not taking as much as a hit as I would have thought. My gut tells me as this drags on Obama has the upper hand.

CNN Shutdown Poll: Plenty of blame to go around – CNN Political Ticker - CNN.com Blogs

From what I've been reading in the news, Boehner would have the votes for a "clean" short-term spending plan. I'm for Obama pressuring Boehner but asking him to "prove it" seems counterproductive, he should be trying to provide a "face saving" alternative for Boehner.

http://www.cnn.com/2013/10/07/politi...html?hpt=hp_t1

Like Rainmaker said, tort reform wouldn't reduce costs greatly. That said, I'd trade it for a reformed approval process and/or advertising restrictions.

I asked because I hear a lot of people dissatisfied with the ACA say that we need real cost controls, but I never hear any specifics. The ACA is trying a lot of things that may reduce the rate of medical inflation and we're already seeing the rate decrease, in part according to most experts, because of the ACA.

Speaking as someone who was working in the industry into fairly recently, the thing that's going to bring down costs is stuff like this: Accountable care organization - Wikipedia, the free encyclopedia

Note: ACA will actually encourage the growth of the above, due to strict reimbursement rates, etc....

If Americans started being proactive about taking better care of their own health (eating better food, exercising more), healthcare could cost us a lot less as a country. Imagine if everyone did what Ben is doing. Our healthcare costs would plummet. We need more people exercising and fewer people smoking and eating crap food. People should be taking more personal responsibility for improving their own health.

I want my government to help me. They should give me the food I need. I also think they should pay me to be healthy.

Here's the Republican plan: "We have no plan for any plan at all"

'House of Indecision' | National Review Online

I know you're being snarky, but I do think that incentives in the form of lower premiums to get in/stay in shape wouldn't be a bad idea.

Many private insurance plans (employer-offered) now include incentives for wellness activities, such as $ off for tracking your exercise and/or diet, discounted gym memberships, etc....

There's a reason for this. Healthier people are cheaper (en masse) to care for, over time.

My company is doing this with 2014 benefits. All non-smokers pay $750 less over the year for health insurance. I saved another $500 by having an annual physical.

To say people should be proactive is a bit of a false solution. It identifies the problem, not the solution. How do you get people "to do better"- that's the tricky part.

If left with no incentives, they will do as they do now. Heck, we incentivize businesses to sell people crap in the form of corn subsidies for high fructose corn syrup, etc. Alien, you handed a species that is notorious for its short term thinking a cheap, quick alternative which is unhealthy but won't show bad side effects for years and you wonder why they are taking the path of least resistance? Now who's making the illogical decision.

There are quite a few ways out of this, but they all have some sort of side effects. You can just "let the free market sort it all out". Problem is- for evolution to work, you need to kill people off before they are of childbearing age and we've gotten really good at extending life. Again, this stuff kills people slowly so even if it renders people a little impotent, if it doesn't kill, you're talking dozens of generations to make a significant dent in this.

We could go with outright prohibition: sure fruit would be ok but anything with processed sugar is banned. That way you could fulfill your lifelong dream of having a Twinkie speakeasy. But I don't think society would stand for you cutting them off of sugar all at once. Talk about withdrawl- that's a lot of cranky people. And we haven't even gotten to the "you can pry that Ding Dong from my cold dead hands" group.

There's also the sin tax: hey, sugar and fat producers, you have to pay extra because of the burden you are putting on society. If Coke were suddenly $3 per 12oz and chips or fries were $5 for a bag or medium serving, that would change behaviors quick as people would flee to cheaper alternatives. It's been pretty effective with smoking. Along with awareness, the sheer cost of smoking has dropped rates in this country to under 20% for the first time in forever. That's been phased in over 30+ years so this one doesn't fix things overnight but it gradually weans people off.

We're going to start using shame more, I think. In the next 20 years, I think overweight will be one of the popular classes to shame, particularly as it takes money from everyone else. That's hardly fair as health and size are not well correlated but angry mob justice is rarely fair.

Education is good, too, but, there are two problems there. The first is, again, the problem where people, as a whole, are more shortsighted. Heck, show me that something has 800 calories and that's just an abstract number. What does it even mean? And that's to say nothing about how much companies are fighting tooth and nail to prevent basic labeling from being put on the products. Heck, the first search result was this wonderful(ly stupid) piece from the Heritage Foundation about the "menu police" because calorie and fat content is going to be required on menus. THE HORROR! And the Nabiscos of the world are fighting the box labeling guidelines, wanting to use their own standards, that I'm sure won't be market tested to minimize impact to the consumer. I mean, these are companies that try to scientifically come up with the "bliss point" to best addict you to their product. But, really, education is more of a supplementary solution to go along with a primary one.

In short, you can say "people just need to do better" but it's like "parents need to do a better job getting involved in school". That's not a solution- that's identifying a problem. Now how do you fix it?

SI

A lot of that stuff you just mentioned is covered in Salt Fat Sugar by Michael Moss, which I just finished reading. I think individuals need to take more personal responsibility when it comes to what they eat. The food companies are working as hard as they can to make their salty, fatty, sugary food as irresistible, convenient, and cheap as possible, and the government is usually their ally in keeping people ignorant about how bad processed food is for your health. People need to work to get themselves off of the processed food and start eating more unsweetened fruits, veggies, unsalted nuts, fish, whole grain oats, etc. As long as people are buying the processed food, these companies will continue to get rich by feeding us food that will slowly kill us. And they couldn't care less. They are only willing to make their food healthier up to the point where it doesn't hurt their bottom line. And nothing helps their bottom line more than pumping more and more salt, sugar and fat into each bite.

But that's my point: you've identified the problem but that's not a solution. You're either complaining about it but with no expectation of change ("those people suck because they don't take personal responsibility") or you need to look at actions to change these behaviors ("because people don't take enough personal responsibility, we need to take X, Y, and Z actions to encourage different behavior").

So you either need to make these foods less attractive (price controls like a sin tax, food purity laws, etc)...

Or you need to incentivize people to eat better.

If the choice is "C. Do nothing", don't expect changes for the reasons you outlined above.

SI

By all means, let's further reduce the reasons people have to want live whatsoever. It's already getting pretty fucking scare as it is.

On the other hand, that would probably cut down on health care costs as the population decreases. Except maybe for the tricky failed suicide attempts.

Not everything that makes life fun to live is a vice detrimental to your well-being, Jon.

Don't take his Ho Hos! They're all he has left!

This Obama press conference is an unmitigated disaster. He's coming off as incredibly childish and petty. I'm certainly not saying that the Republican leadership is any less petty and childish in their stances, but the difference is that they're not interrupting soap operas on a weekday afternoon to do it on national television. Some may tune in during his press conference and wonder whether they're watching Obama or their soap opera.

Are those the talking points from Faux News and RedState?

Really? We're worried about interrupting soap operas now?

C'mon now. You're better than that.

What redeeming value did that press conference provide other than proving that he wasted two hours of valuable time telling us that he's as hard-headed as the other guy?

Someone's sarcasm meter just took a turn for the worst.

I hate when my favorite shows are interrupted, too, but I'm sure you can catch up with your Stories online.

SI

You did just throw this in so we could hear Ebenezer Scrooges words about "decreasing the surplus population" in our head, right?

SI

Uhm, because he's the president and needs to exert leadership and because if he didn't respond people would be complaining that he's not reacting to the situation...can't win either way...btw stocks taking a big tumble...if the Republicans want to destroy America, they're doing "heckuva" job.

Maybe you aren't the best judge of whether or not it was effective.

I'm not sure what Obama has to gain by saying he won't negotiate on the debt limit. I get not negotiating on Obamacare and the republicans have even backed off that. But, every president has negotiated on the debt limit - it's part of being president. He can easily bring the republicans to the table, keep Obamacare out of it and find an acceptable budget. Instead, he's moving on from one "must have" to the next. At some point, he is going to start paying the price for this.

Also, I feel like the Republicans were silly for originally basing this shutdown on "defunding" Obamacare. They looked disorganized and like sore losers with that move. But, the more this goes on, the more I think this hurts the democrats.

The Republicans have no interest in compromise, they want their agenda and that is it, and they are using the shutdown as leverage, furthermore if Obama publically caves, then ACA will be at risk.

I think its hurting Republicans (as it should), the Virginia race is having a big boost to the Dems (people are fed up with the rhetoric).

Obama wants Congress to do their job, I agree.

It seems like neither side has an interest in compromising and that's why this shutdown will continue.

Reposting because seriously...can you not read??? Or do you just hope that if you keep repeating that bullshit line enough that people will stop calling you on it and take it as the truth???






Who isn't compromising now?

I think this meeting concerning the shutdown was more productive than any meeting actually held on Capital Hill thus far........

The fact that an asswipe like Terry McAuliffe is starting to run away with the VA race should terrify the GOP. I'm not sure I could find a more loathsome Dem in VA.

No President other than Obama has had to deal with demands to increase the debt limit. The minority party blusters and often block votes against, but never before has one party demanded concessions in exchange for not blowing up the economy. The biggest blunder Obama made was negotiating the debt limit in 2011. If ransoms for the debt limit become routine the country is in big trouble regardless of which party is in power.

Uhh, I really hope this transcript isn't an exact quote from this OK GOP rep:


btw- The four branches isn't a big deal to me, but the plural/singular confusion is awful.

quad dola?

Thanks GOP. Interest rates on short term Treasury bills are exploding.

You're even worse at promoting the GOP then you are Sony.

I didn't think that was possible ;)

It's a pretty picture but it's already out of date as the republicans have already dropped the defunding of Obamacare. In terms of the other propaganda, I'm not sure where each item is but given the republicans are asking for cuts across the board I'm sure some will impact women's health.

I don't think having a candid discussion involving cuts to keep the budget under a certain amount (with concessions from both sides including the military) is a terrible idea. That said, I doubt it happens with this congress-president combo and its drunken sailor spending tendencies.

Sorry Arles, you are completely, utterly and totally wrong here. The spending has already gone down significantly, and is not driving the reducing of the deficit. Increased revenues are like 90% of the driver. We should be talking about raising spending from the current levels, not cutting it.

Well at least this problem is solved! And an entirely different approach at that.

Republicans propose new supercommittee - MarketWatch

2014... maybe a few new members elected to each team for the sham and repeat the same nonsense again. Anyone on here who seriously thinks they are not going to vote to increase the debt limit is just as bad as the people lining up on both sides worrying about it. All political theatre. I am willing to take any paypal bets on the debt limit being increased for the chicken littles on the board who continue to fall for this nonsense.

LOL at the bolded. Please tell me more. The crazy part is I think you actually believe this to be true. Its like a guy driving 150 in a 65 that gets mad at the cop because he actually slowed down to 145.

Let's see what gets signed by the president and what the actual costs are. The $986 limit set back in 2011 (and agreed to by both parties in congress) has yet to be signed.

Deficit down 32% so far this year - May. 7, 2013

The deficit is falling not because of the 85 billion in cuts demanded by sequestration, it's because revenues have increased 16%.

Austerity won't work because even when everyone loses, folks will not agree to cut their projects and demand that the other people's projects take the hit. Sequestration proved that.

(Personally, I think that the out of control spending on military boondoggles like the F35 should be a major driver.. but the lobbyists has painted anyone who thinks that one cent of military spending hates 'Merica.. and others want to cut social net programs)

Gee, It's Sequestration Committee 2: Cruz Bugaloo.

The Republicans have no plan at all, except pray to God that Obama blinks, because there's no plan that will pass with GOP only votes.. they've linked hands with the suicide caucus, some of whom think default would be a good thing.

Hopefully this is just the fevered imagination of a few nuts. Blocking up the Beltway will cause a whole lot of anger.