by Reverse Engineer, Doomstead Diner
Published on the Doomstead Diner 03 November 2013
Inside the Diner this week I FINALLY got a bug up my butt to write about the CLUSTERFUCK that is the Affordable Health Care Act, AKA Obamacare.
I have basically ignored this piece of legislative insanity here on the Diner, it is fundamentally a Derivative Problem of a Failing Monetary System, and bogging down blogging on it when I am quite sure it will collapse along with the monetary system supporting it seemed unnecessary to me for a long time here. However, the Integral Part it played in the Kabuki Theatre that played out in the most recent Debt Ceiling stand-off motivated me to take a look at the various problems and failings in the methodology chosen to try and get Every Amerikan access to “Affordable” Health Care.
I will start this examination with a paste from inside the Diner of my Original Post Obamacare Online Fiasco, followed by a few Pithy Comments from some of the Diners.
I’m going to have to write a Blog Article about the complete INSANITY of the so-called “Health Care Marketplace” that was supposed to be integrated by Healthcare.gov for getting everybody Insured for Medical Issues, but for tonight for the Diner Regulars I want to drop on a few initial thoughts on this Clusterfuck.
First, the IDEA of getting everybody “covered” in some sense for Health issues is obviously important. All Men are NOT created Equal if one guy can get a New Heart when his ticker stops working right and another cannot. If your access to the best Medical Care is dependent on your economic status in the society, obviously being POOR makes you Less Equal.
At the same time, providing exceedingly EXPENSIVE medical care to EVERYBODY is on its face impossible. Given the typical income of most people, the exceedingly EXPENSIVE Drugs and Proceedures modern medicine is CAPABLE of cannot be offered to EVERYONE. Insurance does not solve that problem. All insurance does is distribute out risk, but if everyone is at risk and eventually everyone comes down with some disease that takes expensive care to maintain life. This comes as a result of aging no matter WHAT. Does not matter how well you take care of yourself, EVENTUALLY you will need the same medical care that somebody who does NOT take care of themself does.
Look at the Smoking Issue. If you are a Smoker, they tack on a huge premium because you are more at risk for Heart Disease, Emphysema etc earlier in your life. But if you live long enough, you’ll STILL come down with the same diseases! Long as you will provide the same level of Medical Care for 80 year olds as 50 year olds, it does not MATTER if you smoked or not, eventually you will need the same level of medical intervention. EVERYBODY gets sick and dies eventually. EVERYBODY.
No distinction is made on Age as far as any of this stuff is concerned, and this is the fundamental problem. If you made a distinction on Age, you could say at age 50 say you would give a Life Saving Operation to a non-Smoker as opposed to a Smoker, since the NS took better care of himself. If you make no such distinction, the non-smoker will get the same diseases just a few years later in life and the same expenses incurred in keeping him ticking. He pays premiums a few years longer, but the premiums do not cover the costs on an actuarial level. If they did, you could just save money to cover your eventual health issue that WILL come down the pipe eventually.
The next issue is the insane COMPLEXITY involved in this exercise, they based it all on the ability to create a Google-like massive database that could handle MILLIONS of people seeking Health Care options. Insane really, even Google evolved over the last decade or two to become the behemoth it is, it did not develop overnight. They have many vendors all contributing glitchy software to this thing, and it is a fucking MESS. Very few people that the system targets could negotiate it even if it worked properly! Not only do you need a functioning laptop with good Java Script capability, you yourself have to be literate enough to negotiate the mess. Most people who have a laptop just use it to surf Amazon for buying crap or surf for Porn, they do NOT engage interactively with even basic software. The difficulties many people have just negotiating the SMF we run the Diner on is an example of this, and SMF is WELL DESIGNED software!
In reality, Health Care has to be SIMPLIFIED, not COMPLEXIFIED, and the services you can get need to be limited to what the society as a whole can afford. REQUIRING everyone to buy insurance is plain NUTS! How is any price “affordable” if you are already maxed out paying rent, buying groceries and transportation costs to get to the workplace, assuming you still HAVE a job? Forget the car, in NYC these days the Public Transport of the Subway is up to $2.50!!!! I was not alive when it was a Nickel, but in my youngest years is was 15 cents, and last price I paid still doing Subway commutes was around 35 cents. Today, to get to and from work on the Subway would cost you minimum $5. I shudder to think what the cost is these days on the LIRR.
So what is gonna HAPPEN here with “Affordable Health Care”?
First off, the objectives of getting Millions of Uninsured people on the Insurance Roles by Jan 2014 is NOT gonna happen. The computer system is too fucked up to begin with, and even if it wasn’t most of the people this is directed at can’t afford “Affordable” Health Care at ANY PRICE. If I currently cannot meet my bills, I sure am not going to sign up for an additional Monthly Bill even IF threatened with fines or Jail, and Jailing people for not paying their required premium is just a joke. Talk about increasing your Prison Population! LOL.
In a large society, availability of Health Care SHOULD be a right of the Citizen of such a large society. It should not be dependent on your personal means as an individual. However, we cannot AFFORD large societies anymore. We cannot afford complex Health Care of the Wealth Care system anymore either. If you get sick and there are not basic remedies that can help you, you DIE. Take good care of yourself, eat healthy, avoid Radioactive Fallout, maybe you last a decent amount of time here. Getting your Femoral Arteries rotor rootered out with Lasers and Ultrasound as I did a couple of years ago is not gonna be an option too much longer.
Forget Medical Care of this type. When you get sick enough, you die, end of story. If you are young enough and WANT to live long enough to see the whole biz crash big time, eat well, exercise and avoid radioactive fallout zones. Personally I am past this period of living. I’m a dead man walking waiting for some real nasty consequence of not taking good care of myself for 57 years, and Obamacare will not Save Me.
A plane trip to a Brazilian or Indian Hospital might though, for a year or two more.
In reality, Health Care has to be SIMPLIFIED, not COMPLEXIFIED, and the services you can get need to be limited to what the society as a whole can afford. REQUIRING everyone to buy insurance is plain NUTS! How is any price “affordable” if you are already maxed out paying rent, buying groceries and transportation costs to get to the workplace, assuming you still HAVE a job?
Single Payer, or “Medicare for everyone” would address much of that, but single-payer was off the table from the beginning of hearings. Advocates of single payer were forcibly ejected and otherwise prevented from making the case, let it become part of the public record.
Plenty of evidence and links here.
Recall that this was at a time when Dems controlled both houses of Congress. Thus, feel free to lay the blame at the feet of the people responsible: the Democrats. Perhaps the realized that the insurers were so strong that they would crush any proposal which threatened their sugar-tit. Or perhaps they were afraid of waking up with a horse’s head in their beds. Or, maybe they just liked it that way. Check out the video; and may Max Baucus roast in hell.
“We need more police…” “Hahahaha…”
Funny stuff. Not.
From Uncle Bob:
Taking an across the board general approach, there’s a shrinking tax base and healthcare is paid for by deficit spending. But here’s where there is a lot of waste:
1. Procedures on palliative patients. Ambulances and beds tied up too much, as well as just not allowing people to die with dignity. Its all about money, they buy lotsa drugs.
2. Drug addicts. Again, ambulances and beds especially in psych wards. Also most likely to abuse staff.
3. Extremely overweight. Problems of their own making end up taking too much of the pie.
4. Disability. While I agree things such as wheelchairs and other technology and care options improve quality of life most times, there are also massive costs for profoundly disabled patients such as Cerebral Palsy and achieve nothing really. A “coordinated care” monthly meeting will have numerous service providers and professionals present all getting paid to achieve not much. I sat through so many for no real reason when an email to several recipients should have sufficed.
Tighten up those areas and increase funding to Pediatrics and Mental Health. Many psychiatrists and psychologists are effectively prostituting their professionalism because they are paid by the insurance companies and dance to their tune. When you are paid by medicare you are more independent and more likely to report objectively. Its fine for medicare to fund 2/3 of consultation for a limited number of appointments for those without insurance (an ever increasing number now), but many people cannot afford the 40 or 50$ out of their pocket to make up the Scheduled Fee, and they should not have scheduled fees, they should have a scale based to some extent on what patients can afford.
To make universal care work, several things need to happen.
One is that people have to “age out” at some age. Perhaps 75 would be about right. This would eliminate much of the huge amount of waste we spend on dying elderly people in their last year of life. Is that the same as a “Death Panel’? No, because it would take the judgment out of the process. People would just have to accept that there are LIMITS on what we can pay.
Secondly, we would need to limit the care we give to barely viable premature children, who run up huge bills before their 1st birthday, and then burden the system for the rest of their lives. This is harsh, but right now what we do is completely crazy and based on emotional decision-making.
Thirdly,we would need to go to single payer, and then relentlessly prosecute doctors ( and hospitals) who try to game the system.
Or make the practice of medicine a government salaried job, so that no motivation would exist to steal from the system.
No huge online marketplace needed. Cost reduced by maybe 75% from where we are now.
Boom, I just fixed the system for ya.
Unfortunately, none of that will ever happen.
Indeed, the first thing to cut off is the End of Life Extend-a-Care where many if not most of the huge bills get racked up. This of course does not play well with the aging demographic of the society. Then the insane neo-natal care for barely viable infants needs to be axed, but this does not play well with Right-to-Lifers and people who generally like Babies and think they all should be taken care of, no matter how badly malformed they are.
You have the problem of Inequality if Rich people can just BUY the services others cannot afford, so essentially you have to make it illegal to purchase health care outside the system. The equivalent idea to this is to just make Health Care a Goobermint service, paying the Docs and Nurses through Taxation. This of course is way too “Socialist” and besides Libertarians would have a COW. It also would basically collapse the Pharmaceutical company scam kicking back Money to docs to prescribe their medications.
So, none of the above possible fixes will happen, and basically when the monetary Ponzi of perpetual debt issuance collapses, the whole Medical Industry goes with it. You may still be able to see a Doctor if you have a Chicken to trade for his House Call, but he won’t have any medicine unless he is out there picking Medicinal Plants himself. He won’t have a CT Scanner or even an X-ray machine.
How FAST will it drop down to this level? That remains to be seen, but it will get there in the bye & bye for sure.
From Uncle Bob:
About 15 yrs ago I was in the dept of Family & Children’s Services and responsible for supervising Social Workers. From a remote aboriginal community of Full blooded aboriginals an alcoholic woman had birthed a profoundly disabled child, Lee-Shaun Wurramurra and had made a decision to let him die. The do-good SW’s saved him and he lived in constant agony his fingers and toes curled and knotted eyes rolled somewhere in their sockets, and limbs twisted as well with tension, in nappies for life, groaning and dribbling and needing to be rolled over etc.
The FCS and hospital SW’s entered him for the Chief Minister’s (like a governor) Bravery Award, which he was awarded. While the SW’s were tut tutting about how horrible his natural family had treated him to leave him dying.
The point I make here is that aside from the huge cost in $, it is highly debatable whether the western ideal is in fact more humane IMO.
And RE you’re wrong thinking having the govt fund medication shuts down the pharmacos bribery scam. It still goes on unabated. PBS = Pharmacuetical Benefits Scheme eg RU486 1700$ abortion pill available for 1$ – No insurance required, taxpayer funded.
The point I make here is that aside from the huge cost in $, it is highly debatable whether the western ideal is in fact more humane IMO.
Highly debatable for sure, but the Christian concept here is that ALL life is “Sacred”, and whatever it takes you are supposed to try to keep any person born living out of the vaginal canal ALIVE as long as you can, no matter WHAT.
The example of Stephen Hawking is often used here as an example of a Genius with extreme physical disability who would not live without extreme intervention of high tech medicine. Value of his contributions to understanding Physics notwithstanding, how many such people can a society keep living?
If I lose my legs to the PAD, should *I* be kept living on SSDI? I don’t think so. Time to take my trip to the Great Beyond.
And RE you’re wrong thinking having the govt fund medication shuts down the pharmacos bribery scam. It still goes on unabated. PBS = Pharmaceutical Benefits Scheme, e.g. RU486 1700$ abortion pill available for 1$ No insurance required, taxpayer funded.
Well, in theory you squash this kind of kickback also.
From Lucid Dreams:
Forget Medical Care of this type. When you get sick enough, you die, end of story. If you are young enough and WANT to live long enough to see the whole biz crash big time, eat well, exercise and avoid radioactive fallout zones.
Well I eat well (all whole foods cooked at home with the occasional trip to a Mexican joint), and I exercise well, but avoiding radioactive fallout zones is going to be difficult. Only way to do that would be to have a bug out machine big enough for my family with very expensive radiation detection equipment. The cheap shit doesn’t pick up the real small radioactive particulates…at least that’s my understanding. At any rate that would require money, which I don’t have.
Far as the Obamacare bull shit, my wife and two kids have Medicaid, I am uninsured due to making too much money (although I’m not even employed so figure that shit out…they said it was because we “own” a home…so if you have a mortgage that you can’t pay, and you move in with family and rent your house, you make too much money for medicaid). My wife, on the other hand, does make some money and qualified (I think it’s cause she was pregnant at the time and she’s in a glitch of state gov incompetence right now).
My plan with this Obama care shit is to do nothing. Fuckem. Maybe they’ll show up and try to cart my ass off to prison…good luck with that. They’d have to catch me with my pants down, cause I’d grab a bugout bag and disappear into the woods. They ain’t takin’ me away from my family on account of fascism. At that point they would be taking me to prison for not having a job is essentially what it would boil down to. At that point I get violent if need be because the revolution will have been long past due. You can’t take people to prison for doing nothing wrong (well you can, but not in an open and democratic society). What we have is a clusterfuck society with a clusterfuck government whom is incapable of dealing with reality.
My healthcare plan is the plants I grow, and am going to be growing, in my yard.
When I need healthcare…guess I’ll just be f***ed, won’t I?
So, here you see a nice cross-section of Opinion on the various problems faced in trying to get EVERYONE access to Health Care at an affordable price, which is basically impossible since the absolute COST of Health Care has gone out of reach for everyone except the Uber-Rich. Insurance does not reduce the absolute cost, it merely distributes out the risk across all the people in the Insurance Pool. Since everybody is going to get sick and die at some point, if everyone has access to expensive procedures to keep them ticking, EVERYONE will rack up a huge bill at SOME point in their life.
Obamacare doesn’t make any of the procedures undertaken these days to keep people alive any cheaper. It just mandates that everyone drop into the Insurance Pool, and if you are too poor to afford the Insurance, Da Goobermint will Subsidize your Premium. Then it purports to make this whole signup procedure possible for ALL AMERIKANS by loading up a BEHEMOTH WEBSITE called a “Healthcare Marketplace”. Has a nice “Free Market”, “Capitalist” ring to it, no? This of course is pandering to the FEAR OF SOCIALISM! God Forbid we Socialize Medicine like the Hosers in Canada or the Brits in Jolly Old England! EVERYBODY KNOWS those systems don’t work! Long waits for treatment, substandard care yadda yadda are all always brought in here as failings of Socialized Medicine, and some of those Critiques are Valid also!
Let us get back to some REALITY here, how the Health Care Conundrum affects REAL PEOPLE, like you, me and my Sidekick on the Collapse Cafe Monsta666, who just got released from Hospital over in the UK after suffering a Heart Attack in his 20s!
If it was not obvious to you that the Single Payer, Socialized System that the UK is running does a better job of distributing Health Care to Young Brits than the nonsensical insurance Scheme of Obamacare does before this, I hope you can see it now.
Is it PERFECT? Hardly, but it is not the CLUSTERFUCK Obamacare is, basically pandering to the Insurance and Pharmaceutical Companies. Besides that and thousands of pages of legal mumbo-jumbo in the act is a sorry-ass online system for sign up about nobody can negotiate, which apparently now is supposed to be FIXED by the very same Obama-sam Cronies that set it up in the first place!
Until we get complete crash here, your best bet for Health Care at an Affordable Price? A Plane Ticket to India and Cash on Hand. For lesser illnesses which Drugs might ameliorate, cross the border into Mejico and buy them on the cheap. Otherwise, eat well, stay away from GMO foods and take some Vitamins if you wanna try to live a bit longer than average. If you are already past average, make your peace with your Maker and prepare for the trip to the Great Beyond if you get really sick.
Discuss this article at the Economics Table inside the Diner.