Posted on 10/15/2013 7:56:38 PM PDT by 2ndDivisionVet
First, some background: I've spent almost a decade in the healthcare insurance industry now, after departing my last job. I've
•investigated fraudulent Medicaid and Medicare claims , personally having revoked some $113 milion worth, and disenrolled over 25,000 fraudlent Medicaid subscribers
•Investigated fraud / waste / abuse trends in hospital and small clinic claims
•Investigated and testified about waste and abuse in most electronic medical billing and diagnosis code platforms, as well as willful 'bundling' of unrelated and fraudlent charges by hospitals and clinics
•Researched electronic eligibility and risk pool demographics and statistics in studying insurance rate increases and stabilizations
•Worked with CMS, Medi-Cal, New York State Medicaid, Texas Department of Public Health, and Colorado State Health Board, in administering , vetting, and conducting waste/abuse investigations.
I've been relied on by Blue Cross Blue Shield, United HealthCare, Aetna, CIGNA , UPMC, and Kaiser. I know literaly more about medical insurance and the industry than the clowns that wrote this abomination of a law called the (ha) Affordable Care Act.
Thus, it irks me when I see the same , stupid, wrong, lying and ignorant 'arguments' both for and against Obamacare. As a public service, I'd like to sum up a few of the more egrarious ones so you don't repeat them. This will take some time, so it will be split into three parts.
Pro-ACA
Let's be clear: the ACA is not happy puppies, healthy families, money saving or any of that. Bluntly, it's three pieces : a Medicaid expansion to cover the working poor, cheap insurance exchanges to get young people to sign up, and tons of changes to the laws so that healthcare companies have to cover nearly everyone and everything. NONE OF THAT EQUALS SAVING MONEY. All of it will jack up taxes, on a national and state level. It will drain money from other funding needs. It will generate ENOURMOUS amounts of paperwork, busy work, electronic files, fraud, waste, and abuse, in a system already so corrupted that 35 cents of every dollar in Medcaid is wasted.
Yet people think it's a great idea. The top five lies: 1."The ACA helps insure the uninsured , so that will cut down on the amount of money we have to spend on treating them in the ER, and free up the ER for real emergencies." Wrong. The way the ACA works is basically three pieces. One is , very simply, a set of changes to laws and regulations to allow things that the insurance companies would not (due to these things being Bad Business and Generally A Waste of Money). People with pre-existing terminal conditions, pre-existing chronic conditions, access to insurance for 'domestic partners', expansion of coverage options to cover reproductive health, and all of that. The second part is an expansion of Medicaid, paid for at first by the federal government, but then trailing off and requiring the states (already buckling under debt and overloaded outlays) to somehow pay for millions of new enrolles. The last part is the Exchange, where insurance companies get to hawk overpriced indemnity (i.e., we pay $300 per day when you're in the hospital) to the young and stupid, and establishes a tax supported 'common carrier' to pick up the people no other insurance plan will touch. Guess who pays for all of this? The taxpayer. Guess how well it will work? Given that you're shoving millions of people into a situation where there is no money to pay and that the insurance companies are being made to go along with it, you'll get coverages that reinburse hospitals and doctors poorly. What do you do when the doctors don't TAKE your insurance? You head to the ER anyway. 2."The ACA pays for itself -- the federal government covers the cost, states refusing the expansion are throwing away free money" : wut? First, the money isn't free it's taxpayer money. Second, the government only covers it until 2020. After that point , the states are supposed to magically come up with more money. Maybe you LIKE a 15% sales tax and a state income tax and additional fees from everything to gas to garden hoses, but I don't. The expansion will cripple poor states with lots of unnsured, wrecking their budgets and ensuring other WORKING, VITAL programs have to get cut to make up the short fall. Oh, and forget raises for police, firemen, teachers, public works types and new schools. 3."Obamacare needs a chance, socialized medicine works in other countries" -- no it doesn't except in very specific ways. Don't belive me : everyone from the Cato Institute to the Free Republic (http://www.freerepublic.com/focus/news/2201659/posts) point out the huge problems that are encountered with socialized medicine. That's not to say it doens't work .. but it's not going to work ANYTHING like people are used to, and a lot of very sick people are going to fall through these cracks. A subset of hospitals, faced with plans that pay 30% to 50% less than they're used to , will simply stop accepting these exchange insurances. People forget that hospitals and doctors are not required to accept any kind of insurance if it doesn't meet their reinbursement guidelines except Medicare and Medicaid, and not even all doctors accept either of those in the stock government form, often only accepting the HMO versions offered by some healthcare companies. 4."The exchange premiums will cover the cost of the ACA insurance changes" : ha, except that it's up to the STATES to decide if they'll be accepted, and how to apply the premium discounts. Many states, who want nothing to do with Obamacare, are already drawing up challenges to these. To put it simple, the ACA assumes you have, for example, 100 healthy young people , 50 healthy middle aged people, 20 elderly people, and 25 very sick people. The current insurance model covers about 20 of the young people, 40 of the middle aged people, 10 of the older people, and maybe 1 of the sick people -- meaning the heavy cost of the sick person ($100,000) is covered by the premiums paid by everyone else (70 people * $2000 a year = $140,000) with a profit. The NEW model has lots more young people and all the healthy and older people, but also all of the SICK people -- so now you have 195 people paying in (195 *$2000 = $400,000) but 25 sick people filing claims at $2.5 million dollars. ACA tries to get around this by lowering what hospitals get for coverage, giving tax credits to younger people to get them to pay more for their insurance, and lots of other nifty dodges, but once the federal money leeches out of the system, costs will SKYROCKET and the premiums will go way up. Until that happens, premiums won't cover jack. 5."You don't have to particpate , if you like your current plan you can keep it!" : unadulerated bullshit. President Obama said this often. But for a lot of Americans, it's a lie: the CBO has issued a report in which it estimated that by 2022, Obamacare will cause 7 million Americans to lose their employer-based health insurance. That's because many of the Obamacare benefits will make many plans more expensive, prompting employers to drop coverage. Stupidly, this will hit the unions the hardest, dropping them from their cushy plans into bare-bones plans with high premiums.
Some more lies:
"No family making less than $250,000 a year will see any form of tax increase." Lie. Middle-class Americans will get hit by taxes levied on businesses that will get passed through to consumers, particularly the 2.4% tax that covers any medical device that cost $100 or more. Other Obamacare taxes affecting the middle class include a 10% tax on tanning services and a doubled penalty on withdrawals made from Health Savings Accounts (HSAs) for non-medical purposes.
"The ACA won't raise deficits." Not according to the CBO which says the cost of Obamacare has skyrocketed, based on current estimates, from $814 billion to $1.047 trillion. While President Obama has claimed the ACA will actually reduce deficits due to all the money raised from taxes, penalties and fees, most of these so-called "savings" result from accounting tricks and double-counting.
"Obamacare will cut the cost of a typical family's premium by up to $2,500 a year." Sorry, the "Affordable Care Act" will in fact make healthcare insurance far less affordable. Back in January, the IRS released new regulations regarding Obamacare - remember that the IRS is in charge of penalizing you should you fail to purchase the mandated insurance - that included cost estimates for the plans the government will offer. For a family of four, the cheapest plan - dubbed Bronze in ODRAMACARE-speak - will cost $20,000 a year in 2016.
For you math majors, that's an increase of more than $4,000 from the average of $15,745 such families paid in 2012. LOL.
"It's not a government takeover: "I don't believe that government can or should run healthcare." Folks, when a freaking STATIST is appalled at what's going down, it should be obvious that things are serious. Sure, the ACA doesn't station troops in the hospitals or DIRECTLY tell doctors what to do. What it DOES do is give the Department of Health and Human Services broad powers. One particularly troubling example is the Independent Payment Advisory Board, which will have the power to lower payment rates for Medicare treatments, which could reduce the care available to seniors. When payment rates go down, doctors and hospitals are less likely to want to do business with the patient.
Worse, when you add up all the factors, from the troubling IRS involvement (and I have to eat crow and apologize to Mark Vogl on that one, as he was right -- which only shows the IRS I know has somehow gotten even WORSE since I left) to the statements coming out of hte DHHS these days (more on that in the next couple of articles), it begins to look like the amount of interferance in our daily lives that the TSA now causes. Everyone likes the TSA.
Right?
Next week, the lies about the ACA that opponents like to use.
The truth is much easier to explain.
ACA was DESIGNED TO FAIL, so it could be rescued by SINGLE PAYER!
Which the Republicans in Congress will happily enact in order to fulfill their promise to get rid of obamacare.
bttt4later
to post 2.
better explanation.
ACA ia a half-baked idea
because of the timely death of Senator Quacpaqquiddic.
that already happened with Medicare and Medicaid. this just adds more socialism on the existing socialism.
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