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Life After Jan. 1
February 3, 2014 2:18 PM   Subscribe

As a result of new coverage under the ACA, many previously uninsured people in eastern Kentucky are giving the nation a glimpse of life under the new health care law.
posted by reenum (132 comments total) 58 users marked this as a favorite

 
jesus.
posted by jepler at 2:39 PM on February 3 [3 favorites]


OH NO A BLASTED HELLSCAPE OF … affordable medical care for long-ignored chronic diseases, mostly.

I hope more stories like this get around, since all the sturm und drang around Healthcare.gov really hurt outreach, and there are also a tremendous number of people who are just flatly ignorant about their health care options. I know more than a few people who complained about losing their terrible, rip-off insurance because they didn't realize how little it covered for their ultra-low premium, just like I have a friend who is still pitching a mighty fit over losing her employer insurance despite that she's paying less and has better coverage.
posted by klangklangston at 2:45 PM on February 3 [58 favorites]


Fucking hell.
posted by Skorgu at 2:45 PM on February 3


“Sometimes my heart hurts,” her new patient said as she listened to his stomach. “All I know is when you get 30, you start falling apart.”

“Poor old man,” Terri Wagers said to her 30-year-old husband.


People should not be physically falling apart at 30. If for no other reason then they've got 35 productive tax-paying years ahead of them.

Also, it looks like there is at least one more article in this series.
posted by any portmanteau in a storm at 2:46 PM on February 3 [20 favorites]


[a physician at the small, non-profit clinic in rural eastern Kentucky] was used to answering late-night calls from patients panicked over chest pains but afraid to go to the emergency room lest they incur thousands of dollars in bills and wind up with their name published in the newspaper, which is how the local for-profit hospital went about collecting bills.

“I’m always hearing, ‘I don’t want to get my name in that paper,’ ” he said.


...The Aristocrats!
posted by clockzero at 2:46 PM on February 3 [33 favorites]


He was used to answering late-night calls from patients panicked over chest pains but afraid to go to the emergency room lest they incur thousands of dollars in bills and wind up with their name published in the newspaper, which is how the local for-profit hospital went about collecting bills.

This is the first I've heard of this practice. Christ. What assholes.
posted by brundlefly at 2:50 PM on February 3 [62 favorites]


Wow. Those are some stories of some very unhealthy and chronically under-served humans. Wow.

I really hope by the next election cycle all of the website freak out is over and some real public understanding of a system that's at least incrementally better, but by no means fixed, is forged.

Given the surreal country we live in, my hopes are not in line with my expectations.
posted by mcstayinskool at 2:52 PM on February 3 [9 favorites]


Short term it will seem like these patients are going to generate a ton of additional costs but long term actually managing chronic conditions or even better preventing them should result in significant savings.

That's not even getting into the likelihood of savings because people aren't going to be forced to go on disability to survive. Just about every single one of those patients seemed to be one major illness away from disability and bankruptcy which is all too common.
posted by vuron at 2:55 PM on February 3 [7 favorites]


and wind up with their name published in the newspaper, which is how the local for-profit hospital went about collecting bills

Holy shit that is so fucked up I can't even.

How can hospitals even do that with patient confidentiality? As I understand it, doctors (at least in Canada, at least how it's been explained to me by a couple of doctors) aren't even supposed to confirm or deny if J.Q. Public is even a patient.
posted by feckless fecal fear mongering at 2:58 PM on February 3 [7 favorites]


This is the first I've heard of this practice. Christ. What assholes.

The Post has another article about the ACA in Georgia that should also boil the blood, like it did Charlie Pierce's:
How do you sleep at night knowing that you have monopoly control over the health of the people in your region? How do you sleep knowing that you exercise that monopoly power the way every monopoly power always has been exercised?
Many insurance brokers and residents place the blame for high premiums on the expanding Phoebe Putney Health System, the nonprofit group that runs six hospitals in southwestern Georgia. The Federal Trade Commission and Georgia's attorney general unsuccessfully tried to reverse Phoebe's 2012 acquisition of Palmyra Park Hospital in Albany because it made the system so dominant that they said Phoebe could essentially dictate prices. In a settlement, Phoebe was allowed to hold on to Palmyra, giving it 86 percent of the regional health-care market. It's challenging to assess hospitals' prices here because, like most places, contracts between insurers and hospitals are kept private. Morgan Kendrick, president of Blue Cross and Blue Shield of Georgia, the only insurer in the marketplace, said Phoebe is "slightly more expensive" than hospitals in other markets, but the insurer has no other options."There are not many choices from the provider perspective," Kendrick said. "They deliver the care in that area, period, stop."
There are many charms to a profit-based health-care system. This has been only one of them. This is another.
In recent months, Phoebe has taken some steps to reduce its costs. Last year it cut 160 jobs and hired consultants affiliated with the Geisinger Health System, which runs a central Pennsylvania hospital group known for efficiency, to help identify ways to save money"We may have to start lopping off services that are not economically rewarding," said Doug Patten, Phoebe's chief medical officer. "We probably have been overly permissive in the past in saying, ‘Yes, we will take care of you.'"
That last sentence is the death knell of Doug Patten's profession. Permissive? Jesus.
posted by zombieflanders at 2:59 PM on February 3 [17 favorites]


Kentucky has been way ahead of the curve on enacting the ACA, and I have to give credit to Governor Steve Beshear and his staff, who knew that our state had a crying need, and just went for it. They never used the word "Obamacare." Instead, they rolled out Kynect and sent teams to county fairs and every other little community gathering you can think of to get Kentuckians signed up. We were at the Wooly Worm festival in October and they were set up right by a booth selling t-shirts that said "God Guts and Guns Made this Country Great - Don't Let Obama Ruin It", and they passed out tote bags and asked people questions, and made it happen. I don't often get to brag about my state doing something particularly well unless it's playing basketball, but we did this.
posted by tizzie at 3:00 PM on February 3 [178 favorites]


All the disabled people in their 30s and 40s. You wonder how many of them would still be healthy if they'd had access to health care 10 years ago. How many kids could have stayed in school, how many families could have stayed above the poverty line.

It's an absolute disgrace.
posted by fshgrl at 3:02 PM on February 3 [55 favorites]


On the downside, Pizza Hut had reduced her hours from 30 a week to 24. For Pizza Hut, this meant it was not required to provide her with coverage, which the new law mandates for employees working more than 30 hours a week. For Turner, it meant even less money.

Those numbers don't compute, but if the essence is true, fuck you, Pizza Hut.
posted by Huck500 at 3:04 PM on February 3 [22 favorites]


I appreciate the focus of this article (on actual people - zooming in). Whatever the numbers show, and however that data evolves over time, it's hard for me to accept a system that leaves people to suffer, become disabled, and die instead of helping them.
posted by prefpara at 3:04 PM on February 3 [8 favorites]


Those numbers don't compute, but if the essence is true, fuck you, Pizza Hut.

Hello from the land of people who got full-time hours taken away to keep us from getting health insurance! I'd be surprised if there were less than eight digits of us.
posted by Pope Guilty at 3:07 PM on February 3 [26 favorites]


All the disabled people in their 30s and 40s.

It's worth bearing in mind that the American disability program is complicated because of how it is used as a kind of proxy welfare to compensate for both the lack of light work in many areas that could be done while having a heart condition or some other minor disability and the slashing of the welfare rolls. See this Planet Money story.
posted by Going To Maine at 3:09 PM on February 3 [2 favorites]


Those numbers don't compute, but if the essence is true, fuck you, Pizza Hut.

What about the numbers don't compute for you? That she was working 30 hours a week? Or, that Pizza Hut cut her to 24 to avoid having to provide healthcare coverage? I assure you both scenarios are common throughout the nation.
posted by Thorzdad at 3:11 PM on February 3 [1 favorite]


So are all of our hospitals now going to see a massive influx of people with long-untreated medical conditions seeking care?

Cripes, I hope so.
posted by DirtyOldTown at 3:11 PM on February 3 [15 favorites]


"What about the numbers don't compute for you?"

I think he's saying they don't compute because her hours already fell right under the cutoff. Pizza Hut could have cheaped out on her health coverage without reducing any pay.
posted by Kevin Street at 3:13 PM on February 3 [4 favorites]


These Re the kinds of things I have to show my foreign (or rich enough to basically be foreigners) friends to really underline no I am not kidding, I am not making stuff up, it is really this bad in America, our health care system is terrifying and even small improvements are still improvements.
posted by The Whelk at 3:20 PM on February 3 [8 favorites]


"People should not be physically falling apart at 30."

I'm with you, but 30 is the traditional start of the "I'm not a kid anymore" health gripes.
posted by klangklangston at 3:22 PM on February 3 [2 favorites]


the sick and the poor get insurance, seek treatment for long-neglected illnesses and prevent other health problems down the line, ultimately saving the health-care system billions in emergency-room visits and other costs.
Sic semper tyrannis.
posted by grouse at 3:22 PM on February 3 [1 favorite]


So, given the conversation about companies cutting hours to make employees ineligible for company-paid health plans, I've been curious about something. Why are laws written this way instead of prorating so that a person working 20 hours a week must receive, say, half the cost of a "bronze" plan?
posted by Blue Jello Elf at 3:24 PM on February 3 [9 favorites]


I'm with you, but 30 is the traditional start of the "I'm not a kid anymore" health gripes.

Seriously. Not that I'm great shakes at taking care of myself (ok so I have treated my body like a temple to a dark and profane god, let's be honest here), but the past 5 years have been filled with medical issues--more doctor visits in this period than in the previous 15, probably.

And I live somewhere I can just waltz into a doctor's office or hospital and get treatment paid for by my tax dollars.

I shudder to think what 30's and onwards are like for people who don't have that freedom.

Why are laws written this way instead of prorating so that a person working 20 hours a week must receive, say, half the cost of a "bronze" plan?

Lobbyists.
posted by feckless fecal fear mongering at 3:26 PM on February 3 [5 favorites]


Part-time work as a concept is very problematic when "full-time" work is the gateway to very necessary services. I understand its genesis, but along with "internships" it's just a giant loophole to let the rich fuck over the poor.
posted by maxwelton at 3:27 PM on February 3 [31 favorites]


30 is the traditional start of the "I'm not a kid anymore" health gripes

Sure, but that's, like, I get hangovers now and sometimes my back hurts sort of stuff. Not heart problems and chronic pain.
posted by Sara C. at 3:27 PM on February 3 [17 favorites]


So, given the conversation about companies cutting hours to make employees ineligible for company-paid health plans, I've been curious about something. Why are laws written this way instead of prorating so that a person working 20 hours a week must receive, say, half the cost of a "bronze" plan?

Because that would still force the employer to pay something, instead of nothing. As long as nothing is an option, that's what employees will get.
posted by dogrose at 3:27 PM on February 3 [4 favorites]


Sure, but that's, like, I get hangovers now and sometimes my back hurts sort of stuff. Not heart problems and chronic pain.

My 23-year-old daughter has a co-worker of the same age who was recently diagnosed with breast cancer. Probably an outlier, for sure, but still.

I had my first back surgery for a ruptured disc when I was 30. Shit happens.
posted by Thorzdad at 3:32 PM on February 3 [1 favorite]


They never used the word "Obamacare." Instead, they rolled out Kynect and sent teams to county fairs and every other little community gathering you can think of to get Kentuckians signed up. We were at the Wooly Worm festival in October and they were set up right by a booth selling t-shirts that said "God Guts and Guns Made this Country Great - Don't Let Obama Ruin It", and they passed out tote bags and asked people questions, and made it happen.

I enjoyed that anecdote more than a psychologically well-balanced person probably should. The idea of tricking ignorant people into letting you help them... it's like getting to be as good as a superhero and as cool as a supervillain at the same time.
posted by officer_fred at 3:35 PM on February 3 [73 favorites]


Sure, it's possible to have significant health problems at a young age. Nobody's saying young people are invincible. But, yes, a life of physical labor and lack of access to healthcare really does wreak havoc on one's body.
posted by Sara C. at 3:37 PM on February 3 [5 favorites]


There are also controls in place to keep companies from cutting down to entirely part-time employees in order to save on healthcare costs. I forget the numbers, but it's something like that if you have a minimum of X 40-hour week shifts being worked, then you have to cover your employees, whether that's from X 40-hour employees or 2X 20-hour employees.
posted by kafziel at 3:41 PM on February 3 [1 favorite]


My guess is there's a whole constellation of factors that can affect someone's chances of developing a chronic disease, along with when those diseases first appear. If you grow up in a poor household with less access to childhood medical care and more treatable diseases going around the population, live on a diet of cheap, high calorie low nutrient food, and you're constantly stressed from working and worry (not to mention smoking, alcohol and drug problems) - then the chances of getting a chronic disease are much higher than they would be for a middle class tech worker in the suburbs.
posted by Kevin Street at 3:45 PM on February 3 [3 favorites]


Thorzdad: " My 23-year-old daughter has a co-worker of the same age who was recently diagnosed with breast cancer. Probably an outlier, for sure, but still."

Sure... and some people have congenital heart defects. I'm not sure what the co-worker's breast cancer has to do with 'falling apart at 30' being usually said in jest (at least by those of us with some approximation to health care).
posted by hoyland at 3:48 PM on February 3 [1 favorite]


I couldn't find the article the last time I looked for it, but in the year before the 2008 election, there was a story about a kid who died in intensive care under the old system for want of a tooth extraction. The red tape of getting him into a dentist was so prolonged that a simple tooth infection became a brain infection.

It scared me shitless because, a few years back, I had my own charity root canal nightmare.

officer_fred: I like that anecdote more than a psychologically well-balanced person probably should. The idea of tricking ignorant people into letting you help them... it's like getting to be as good as a superhero and as cool as a supervillain at the same time.

Wasn't "Obamacare" Republican spin anyway?
posted by CBrachyrhynchos at 4:03 PM on February 3 [1 favorite]


Yeah, Obamacare is basically Romneycare and Romney is the guy the Republicans wanted for president last time around.
posted by any portmanteau in a storm at 4:04 PM on February 3 [2 favorites]


For Want of a Dentist
posted by postel's law at 4:07 PM on February 3 [3 favorites]


http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116.html
posted by postel's law at 4:09 PM on February 3 [1 favorite]


Has there been an FPP about the recent Brookings Institute study on the economic effects of Obamacare? If not, this thread seems as good a place as any to drop it in. I remain, as ever, mystified that liberals in the US are so unexcited by this massive new redistributive instrument that will have a truly powerful effect on the lives of so many poor people in the US. To say nothing of one of the first reductions in the risk burden being so increasingly borne by the poor and lower-middle-class in recent decades.
posted by yoink at 4:10 PM on February 3 [25 favorites]


I will probably need to have my gallbladder out at some point. It's happened to plenty of women in my family and in my age group, so. I'm trying to eat well, etc. But the thing that gets me is that the only reason I think this way is because I spend most of my time associating with people who have more money than the community I grew up in, where it was widely accepted that the way you dealt with gallbladder trouble was to wait until it rendered you completely useless, and until then try to follow one of a long list of allegedly gallstone-friendly diets, usually at least part of which was of negligible scientific value. Most of it just boiled down to "you will never enjoy food again, but you will suffer through it because this is just a thing that happens to fat women, you should have been skinnier".

And for people with health care, it's like: you should eat better and exercise, but you don't actually deserve to endure awful physical pain and digestive distress for the whole rest of your life, we can do this. It's an entirely different way of life. Pain is not just an ordinary thing that everybody lives with 24/7 past a certain age. I think that a lot of people who are against the Affordable Care Act would feel differently if they had to go without seeing a doctor for just twelve months.
posted by Sequence at 4:11 PM on February 3 [8 favorites]


Wow, it's like being there for the birth of social security. Spread the word. Obamacare works!
posted by valkane at 4:12 PM on February 3 [13 favorites]


I can't get past the part where a newspaper would publish the names of people who couldn't pay for emergency health care. What in God's green earth.
posted by roomthreeseventeen at 4:14 PM on February 3 [10 favorites]


Publishing notices is an old thing (my hometown paper still publishes all marriage license and divorce applications, as well as arrests. It's a small town. I don't know if this is still true, but at least in the 80s you had to publish an announcement of intention to file for bankruptcy yourself.), but doing it for purposes of debt collection was federally outlawed in 2011, if I remember correctly.

That doesn't mean that the hospital collections department (or collections vendor) isn't still doing it, or threatening to. It's not the newspaper doing it of their own volition, though; anybody can take out a classified ad.
posted by Lyn Never at 4:26 PM on February 3 [1 favorite]


I can't get past the part where a newspaper would publish the names of people who couldn't pay for emergency health care. What in God's green earth.

Well, as an ex-newspaper guy, I can tell you this: with dwindling revenue, the local auto dealerships, floor-covering companies, health care providers and health insurance providers own the local newspapers.

And public shaming of people who owe debts is a huge revenue stream for papers, as witnessed by the back taxes notices that are routinely run.

The good news is that papers are pretty much dying, so this kinda shit will soon go the way of the dodo. Although, maybe Craigslist is ripe for a debtors column.
posted by valkane at 4:28 PM on February 3 [1 favorite]


roomthreeseventeen: I can't get past the part where a newspaper would publish the names of people who couldn't pay for emergency health care. What in God's green earth.

Taking a page from Idiocracy, I could totally imagine the heading of this lovely feature being "PEOPLE WHO STOLE FROM THE HOSPITAL".
posted by dr_dank at 4:33 PM on February 3 [3 favorites]


I'm with you, but 30 is the traditional start of the "I'm not a kid anymore" health gripes.

Would you really characterize deteriorating disks, "sometimes his face will get real red like he’s going to blow up" and "Sometimes my heart hurts" as "health gripes"?

For that matter, how many of those things do you think he would have developed if he'd had better access to health care in the previous three decades?
posted by Etrigan at 4:41 PM on February 3


The good news is that papers are pretty much dying

I really, really hope that that's not the "good" news. And if it is, please don't tell me the "bad" news.
posted by yoink at 4:48 PM on February 3 [7 favorites]


Every time I hear some politician with an American flag lapel pin talk about how America is the greatest country in the world, I'm going to remember that hospitals print the names of the people who owe them money in the fucking newspaper.
posted by dry white toast at 4:50 PM on February 3 [57 favorites]


I made the mistake of posting this link elsewhere and was told I should shut up until I start paying $6k out of pocket per year for shitty health coverage.
posted by roomthreeseventeen at 4:54 PM on February 3


These results - people who have never had access to care before - are why the House voted 40 some times to repeal the ACA - they know it's going to change the political equation in this country and not in their favor.

And count me in among those absolutely horrified by hospitals publishing people's names like that - truly evil. How we can beat our chests as the "greatest nation" and so forth when we have so many people living in really abject poverty and instead of working to solve it we publish their names to shame them for being poor is just beyond me.
posted by leslies at 5:03 PM on February 3 [7 favorites]


@Going To Maine: "while having a heart condition or some other minor disability"

When did a heart condition become a "minor disability"?
posted by Ardiril at 5:04 PM on February 3 [1 favorite]


When did a heart condition become a "minor disability"?

I believe many for-profit hospitals consider it a minor disability. They also list cancer as "a moderately severe cold."
posted by Joey Michaels at 5:06 PM on February 3 [3 favorites]


Hospitals publishing the names of debtors in the paper is exactly why there should not be a profit incentive in the provision of health care. Same goes for prisons, the military, and public schools, by the way.

folds up tiny socialist soapbox, steps away...
posted by ambrosia at 5:08 PM on February 3 [36 favorites]


I am strongly in favor of my government paying (with my taxes) for socialized health benefits so folks with long untreated medical conditions can get the care they need, so our nation can be healthier in general and so that they can pay it forward.
posted by kalessin at 5:08 PM on February 3 [9 favorites]


I have been in ERs in all sorts of hospitals, and all I have to say is "heart condition" and I get moved to the front of every line.
posted by Ardiril at 5:09 PM on February 3 [2 favorites]


Wonderful to see folks finally getting the care that they deserve. Frustrating that it took this long.

Interestingly, Sen. McConnell is only polling equal to the Democratic challenger in the senate race in KT. Maybe healthcare will end up turning Kentucky blue.
posted by octothorpe at 5:11 PM on February 3


They never used the word "Obamacare." Instead, they rolled out Kynect and sent teams to county fairs and every other little community gathering you can think of to get Kentuckians signed up. We were at the Wooly Worm festival in October and they were set up right by a booth selling t-shirts that said "God Guts and Guns Made this Country Great - Don't Let Obama Ruin It", and they passed out tote bags and asked people questions, and made it happen.

I enjoyed that anecdote more than a psychologically well-balanced person probably should. The idea of tricking ignorant people into letting you help them... it's like getting to be as good as a superhero and as cool as a supervillain at the same time.


Thirding this. Tizzie's statement actually, literally made my day.
posted by triggerfinger at 5:16 PM on February 3 [6 favorites]


These stories are simultaneously heartwarming and infuriating. I love the idea of people getting consistent medical care for the first time ever. My doctor takes a lot of Medicaid patients, and I love the idea of offices like his being flooded with new business. As I've mentioned here before, Medicaid was the most useful thing ever to happen to me, insurance-wise. Just amazing what it would cover, and how little you had to worry about it.

The infuriating part is, those of us who don't qualify for Medicaid or Medicare, are still stuck in the most ridiculous hole of a system, with people avoiding getting care because it's so expensive; premiums are high, deductibles are astronomical, and if you're sick at the wrong time of year, pow, you meet your deductible only to roll over into a new year with one to meet all over again (as I've just done, hurrah).

I know which system I'd pick, if I had the choice. Good for you, Kentucky. I'm jealous of you and happy for you at the same time.
posted by mittens at 5:16 PM on February 3


valkane: "The good news is that papers are pretty much dying..."

yoink: "I really, really hope that that's not the 'good' news. And if it is, please don't tell me the 'bad' news."

A friendly word of advice: avoid the link in the post.
posted by koeselitz at 5:18 PM on February 3


Single Payer Rises Again: As the ACA takes effect, an alternative gains ground at the state level.
posted by audi alteram partem at 5:18 PM on February 3 [3 favorites]


I really hope by the next election cycle all of the website freak out is over and some real public understanding of a system that's at least incrementally better, but by no means fixed, is forged.

Given the surreal country we live in, my hopes are not in line with my expectations.


The Republican window for bowderlizing the ACA is pretty much closed at this point. Taking benefits away from people is infinitely harder than torpedoing them in the first place. By the time the next election rolls around people -- including that always baffling number of poor Republicans -- will have adopted it as the new normal.
posted by Tell Me No Lies at 5:20 PM on February 3 [1 favorite]


By the time the next election rolls around

...the Republicans will have figured out how to make people believe that the healthcare they are now receiving is bad for them. And ~50% of the population will vote R.
posted by feckless fecal fear mongering at 5:23 PM on February 3 [4 favorites]


Nah, they'll just take credit or conveniently forget that these particular changes were ever part of "Obamacare".

I predict we'll also see the end of the term "Obamacare" once the changes go into effect and Republicans realize that people are happy with the way things are.

See also, Medicare, "Keep Your Government Hands Off My..."
posted by Sara C. at 5:27 PM on February 3 [7 favorites]


"Obamacare? Oh, no...this is Republicare! Remember how hard we fought for it over Obama's objections?"
posted by The Card Cheat at 5:46 PM on February 3 [25 favorites]


Going to Maine: As an SSDI recipient, I well remember the Planet Money, This American Life, All Things Considered story. It wasn't a complete picture.

The most important fact unmentioned was our aging population. As we get older, we tend to get less well. The disability benefits discussed in the NPR stories are tied to time in workforce and social security taxes paid. Huge numbers of women entered the workforce beginning in the 70s, and that's another reason disability numbers are increasing as we age.

This piece from the Center for Economic and Policy Research is all about the numbers:
> While the story did note the impact of the economic
> downturn on disability claims, it failed to recognize
> the actual importance of the economic collapse.
> Instead the piece turned to a variety of other
> explanations, for example citing the 1996 welfare reform bill.

Eight former Commissioners of Social Security opine in the linked PDF:
We feel compelled to share our unique insight into the Social Security system because we know firsthand the dangers of mischaracterizing the disability programs via sensational, anecdote-based media accounts, leaving vulnerable beneficiaries to pick up the pieces.
posted by Jesse the K at 5:50 PM on February 3 [11 favorites]


Re: minor disability - Heart disease is the #1 killer of Americans.
posted by Pirate-Bartender-Zombie-Monkey at 6:12 PM on February 3


"Obamacare? Oh, no...this is Republicare! Remember how hard we fought for it over Obama's objections?"


Not to mention the chocolate ration went up 25 grams last week! Thanks, Rand Paul!
posted by Ray Walston, Luck Dragon at 6:15 PM on February 3 [6 favorites]


Hello from the land of people who got full-time hours taken away to keep us from getting health insurance! ...

... So, given the conversation about companies cutting hours to make employees ineligible for company-paid health plans, I've been curious about something. Why are laws written this way instead of prorating so that a person working 20 hours a week must receive, say, half the cost of a "bronze" plan?

For many people they will actually get better and cheaper insurance if their hours are cut. This is because the plan offered by the company is probably pretty poor and requires the employee to pay at least half of the premium out of their pay. But if their employer does not offer insurance, then the employee is eligible for subsidized insurance on the exchange that is actually cheaper. If their income is low enough, they receive Medicaid that is essentially free healthcare (in blue states participating in Medicaid expansion).

Having your hours cut and reducing your income is bad, but with regard to health care most are better off as a result. Those are exactly the people Obamacare is designed to serve.
posted by JackFlash at 6:19 PM on February 3


For many people they will actually get better and cheaper insurance if their hours are cut. This is because the plan offered by the company is probably pretty poor and requires the employee to pay at least half of the premium out of their pay. But if their employer does not offer insurance, then the employee is eligible for subsidized insurance on the exchange that is actually cheaper.

This is actually the case for my sister. With subsidy, she could get a decent plan off the exchange, but unfortunately her employer offers insurance which is too expensive for her anyway so she's not eligible to use the exchange. Luckily she's switching jobs soon (to a place without insurance!), so hopefully she'll be able to get the better option.
posted by heathkit at 6:26 PM on February 3 [1 favorite]


This sentence nearly made my head explode:

This is the world that many critics of the new health-care law have worried about, one in which the sick and the poor expand the ranks of Medicaid while other Americans see premiums rise, policies canceled or favorite doctors booted out of networks.

I mean, Christ, I know that they're just reporting on the "fears" of "critics," but it's hard not to read that without wanting to punch something. I mean, WORRY? You're worried that a mass of poor, sick people are going to finally get health care? Finally be freed from the painful, debilitating, easily-preventable illnesses that they've been subject to as a result of the complete indifference of American society? Finally start experiencing a first-world quality of life?

That's what this article is describing, isn't it? A third-world country subsumed within first-world America, its ever-present suffering invisible in the mainstream media or political narratives about how America is the greatest country in the world (Hey! Look at those fighter jets fly over that football game!). This is describing a group of people - millions of them - who've never known what it's like to have routine access to a doctor. You could set this story in some poor corner of China and I would believe it. Kentucky? The mind boggles.

The people who voted against Obamacare, who try to shut down the government or force a recession-inducing default in order to kill it - they're trying to send the people in this article back to lives of pain, suffering and illness. Where people are afraid to go to the doctor because it might ruin them financially. How many millions of years of human life are going to be saved by Obamacare? Just how callous and inhuman do you have to be to want to take those years back, throw those people to the vicissitudes of nature, because you don't like the government telling you to be healthy. Or - God forbid! - a single-payer system - no insurance mandate - just like every other OECD country - but your taxes will have to go up.

No, sorry, Mary. Sorry, Marlene. Sorry, John. You're on your own. If you spend every day of your much shorter life in pain, well, I guess you should have worked harder to save yourself some money to buy real insurance. Not my problem.

I mean, Christ. What is the purpose of being on earth? Is it to try to lessen the suffering of those around us, or to keep taxes low? Yes, the website is a fiasco. Yes, it's a gift to the insurance companies. But Obama has saved the lives of Americans. Thousands of the most economically and medically vulnerable Americans. Give him another Nobel. Wrap it in this article.
posted by Dasein at 6:28 PM on February 3 [95 favorites]


The Republican window for bowderlizing the ACA is pretty much closed at this point. Taking benefits away from people is infinitely harder than torpedoing them in the first place.

I wouldn't be so sure about that. The ACA primarily serves only the 15% of the population that does not get their insurance from their employer or from government programs like Medicare and the VA. Most of these people are low income and as we are currently seeing with the fight over food stamps, programs for the poor become poor programs and ripe for cuts. You don't see the broader support for the ACA from the middle class that already gets their insurance from their employer. It simply doesn't do much for them.
posted by JackFlash at 6:31 PM on February 3


When did a heart condition become a "minor disability"?

A minor valve insufficiency might count, or a detectable but minor murmur, or a minor arrhythmia. Which isn't to say that Going_to_Maine meant things like that.

It simply doesn't do much for them.

It lets them keep their kids on their plans until they're 26, and it means that they don't need to worry about rescission, and it means that they don't need to worry about yearly or lifetime caps.
posted by ROU_Xenophobe at 6:39 PM on February 3 [5 favorites]


The other day, one of my relatives in NJ was commenting about how they got a great deal on a private insurance plan that was actually pretty good and reasonably affordable, "in spite of Obamacare."

Sigh.
posted by schmod at 6:39 PM on February 3 [4 favorites]


I mean, WORRY? You're worried that a mass of poor, sick people are going to finally get health care?

Reading between the lines, I assume the actual worry is that this group of newly insured people are going to get their health care. As in, waiting times will be longer, the doctor they like may no longer be covered in their insurance network (due to byzantine medicare/private insurance ratios,) and the ever terrifying notion of utilizing the same service a poor "person" does.
posted by angerbot at 6:42 PM on February 3 [1 favorite]


Taking benefits away from people is infinitely harder than torpedoing them in the first place.

House Farm Bill Includes 8 Billion of Cuts to Food Stamps
posted by potsmokinghippieoverlord at 6:52 PM on February 3 [1 favorite]


It's an interesting experiment in redistributed health. In exchange for one person receiving major remedial benefits, a few people begin to need to save up for their deductibles, are less likely to see a doctor, and will tolerate a little more illness. I am sure all kinds of public and private actuaries are keeping track and I hope we, the public, get to see how it works out.
posted by michaelh at 6:54 PM on February 3


health care is not a zero sum game.
posted by benzenedream at 7:07 PM on February 3 [5 favorites]


health care is not a zero sum game.

Of course it isn't. But when people's rates go up, they complain, without thinking that perhaps they are helping subsidize people who work at Pizza Hut to get health care.
posted by roomthreeseventeen at 7:17 PM on February 3


It seems a lot of those who are against "Obamacare" tend to be (or so it seems) people who are religious. I don't understand where in their religious doctrine that says it's OK to deny people the opportunity to be healthy and taken care of. You'd think it would be, you know, immoral (take care of your fellow man, etc). The hypocrisy is unbelievable to me.

But YAY Kentucky! I am so glad these people are finally able to get treated.
posted by littlesq at 7:21 PM on February 3 [3 favorites]


Enough with the "heart condition minor?" misreading. A minor disability keeps you from performing various intense activities but it's not a major disability because you can still hold down a desk job, etc. Obviously if there are no "light duty jobs" it's not so minor but "heart condition" does not mean WILL DIE ANY MINUTE any more than pregnant women on bed rest will. Yes, risk of death doing intensive stuff is too damn high but we're not in the business of giving everyone with AFIB or MVP for example a life of free income. Health care free? Fuck yes. The kind of free where the people who benefit most from the collective value of a healthy population invest a barely noticeable chunk of their magically growing (it doesn't grow on trees, it grows with ease when you you can pay them fees) wealth. And yeah as a middle class dude I'm on the hook too, but I'm just speaking rhetorically, if anyone was gonna drop some TANSTAAFL on my azz
posted by lordaych at 8:03 PM on February 3 [1 favorite]


Jesse the K: Yep. Planet Money: long on anecdote, short on data.
posted by professor plum with a rope at 8:10 PM on February 3 [2 favorites]


It's weird when the phrase "expand the ranks" is applied to giving the poors access to less misery. Of course I'm biting on that in the way others bit on "minor disability"
posted by lordaych at 8:11 PM on February 3


It's also funny that we used to think we could eradicate poverty like we wanted to eradicate malaria. It was policy, like the war on drugs. Now we call the tattered remnants of a safety net an "entitlement" that can be changed or yanked away at a whim. Fancy entitlement, that. Romney be like "my entitlement bought its own island and built its own shell corp, motherfuckers." Meanwhile yeah in ten years it'll be "it was Romney's idea anyway, even that black guy said so." Sure, Romney just signed it because his party was a 2% minority on his state but let's not mince the details, it was really more of a Gingrich thing anyway
posted by lordaych at 8:17 PM on February 3


We used to *believe* we could eradicate poverty that is, and then the common sense policies of "get a job fuckers" took root and proved that shaming people was more fun than helping them.
posted by lordaych at 8:19 PM on February 3 [2 favorites]


My initial impressions, briefly:

The first wave of ACA enrollees largely seem to be a slice of the working poor who for years have been infuriatingly shut out of health care despite working harder in any given week than I could in a month, while our Medicaid population remains stubbornly fixed in their trenchant and dismal health habits all the while in no danger of being turned away from a clinic, or more commonly an ER, for any ailment however minor.

So I don't really know in the end if this is a "good thing" economically. I suspect very strongly that it is, but the reasoning is a bit abstract. That is, these types (working poor) in my opinion have a million better things to do than waste time on trivial health issues. They work hard, and I suspect will utilize the system more efficiently in some ways than most other economic strata while placing fewer unnecessary demands for 'concierge' (read:useless) care. And I also suspect they'll show interest in managing their chronic health issues with compliance and dedication, which is going to save billions.

Morally, we should be striving for something more inclusive, and if other first world capitalist economies can do it we should be able to as well. But I will say that taking care of someone who is grateful just for the chance to finally come in to talk about help quitting tobacco or treating high blood pressure without risking bankruptcy is incredible and wonderful.
posted by docpops at 8:21 PM on February 3 [5 favorites]


Also I would like to pre-empt and agree with the first person who says "ironic use of 'poors' has lost any luster it may have had, and is ultimately dehumanizing regardless of intent like ironic racism"
posted by lordaych at 8:22 PM on February 3 [1 favorite]


I wouldn't be so sure about that. The ACA primarily serves only the 15% of the population that does not get their insurance from their employer or from government programs like Medicare and the VA. Most of these people are low income and as we are currently seeing with the fight over food stamps, programs for the poor become poor programs and ripe for cuts. You don't see the broader support for the ACA from the middle class that already gets their insurance from their employer. It simply doesn't do much for them.

Eh, I dunno - trying to rebottle the preexisting conditions genie would be a really tough sell. Ditto lifetime caps.
posted by jason_steakums at 8:23 PM on February 3 [3 favorites]


You don't see the broader support for the ACA from the middle class that already gets their insurance from their employer. It simply doesn't do much for them.

The middle class are just poor people with jobs. If not now then very soon they'll understand very clearly why the ACA may literally save them from starvation and living in their car.
posted by docpops at 8:26 PM on February 3 [17 favorites]


I've been told that part of the reason private health insurance costs are so high is that hospitals have to charge enough to also amortize the cost of the "free" care they have to provide via the ER.

Now I wonder: over time, this "free" ER care will become rarer and rarer, as more and more of the uninsured population slowly gets some form of insurance and access to regular care. (Yes, I know about the Republican asshole governors and the Medicaid gap. But that's just a matter of time before the gap gets patched over - a miserable time for those in the gap, but it'll get covered eventually.)

So now that that hospitals will no longer have to subsidize the uninsured (certainly not in those quantities), will healthcare costs and private health insurance rates actually start coming down?

(Stop laughing, that was a serious question.)
posted by RedOrGreen at 8:48 PM on February 3 [4 favorites]


Uncompensated care is a problem, but it's not as big of a problem as hospitals would have you believe. I unpacked the numbers in a previous comment here. (The link in that comment seems to be borked now, I could swear it was good when I posted it, but in any event, a working link is here.) The upshot is that 3/4 of the "subsidizing" of uninsured patients (which itself only represents 6% of their revenues) comes from government subsidies.

Getting more people insured is its own reward, and there are provisions of the ACA to put downward pressure on costs, but I don't think the emergency room care problem is what's driving healthcare costs.
posted by tonycpsu at 9:05 PM on February 3 [3 favorites]


RedOrGreen - that's already anticipated in the ACA, under Title III of the Reconciliation Act, section 1104. Medicare currently disburses funds to hospitals with a disproportionate share of non-paying patients in an effort to offset their costs. The ACA calls for 25-50% reductions to DSH payments by 2020.

On preview: as tonycpsu points out, this is a drop in the bucket compared to other healthcare costs, but it's one of many battles to be fought in the war on healthcare costs.
posted by notpace at 9:09 PM on February 3 [3 favorites]


that's already anticipated in the ACA, under Title III of the Reconciliation Act, section 1104. Medicare currently disburses funds to hospitals with a disproportionate share of non-paying patients in an effort to offset their costs

...and this may turn out to take hospitals in Republican-controlled states and fuck them sideways. They're going to keep facing the same number of people who get care, because their governments are controlled by the pure distilled essence of assholery, but their federal funding is going to get hammered because the law assumed that those people not paying would be moved to Medicaid.
posted by ROU_Xenophobe at 9:23 PM on February 3 [3 favorites]


Anecdata from WA state:
Washington has been trying to move towards universal coverage, using a variety of models, for over a decade. Our program is Applecare (I wish it was as good as my computer's while lasting a lifetime!) I was an activist, speaking around the state for 3 years, to promote more complete coverage. When the ACA passed, the legislature quickly began preparing the state for expanding Medicaid and subsidized access for uninsured working folks and their dependents.
About 100,000 folks in Washington had no coverage at all. Now they can get it. Another 250,000 or so are underinsured. Now they're more likely to have effective coverage.
I believe the state goal is 280,000 ACA enrolled by the end of 2014.

The problem for Washington, as most other states and territories, is this increase is during a severe recession, when all state department personnel and budgets are being cut, such as the Health Care Authority (HCA). So, legislation moved folks on Medicaid (Welfare Disability, SSDI, AFDC, and so forth) to a variety of mostly new-to-Washington state HMOs. Yes, the ACA comes with substantial Federal funds, but nothing like what is needed to restore the ravaged health and human services administrations.

Now, what happened when the most medically needy - expen$$$ive - folks in the state were assigned to organizations whose main purpose was reducing costs per enrollee? Denial of care, that's what. On an epic scale. About 90,000 people are affected.
I'm one of those co$$tly people; and in the last 2 years with assignment to 4 different HMOs, it's taken legal interventions to get a GP appointment and just some of the roster of medications that prevent my perforating intestines, seizures, strokes, and heart valve damage. Much less the PT I need to walk and use both arms. I haven't had quarterly lab tests, or 2x/year imaging just to track my issues, and have had NO treatment (with the exception of a torn tendon from a preventable seizure). I have had 3 specialist appointments in all that time - when it usually takes a group of 8-10 specialists around 20 appointments a year just for maintenance. That doesn't include mental health care, dental, or glasses. I'm still in litigation to stay out of the HMO system.
I just want to be able to take care of myself, play music, and maybe finish grad school. A lot of that's on hold after being on track for years since starting SSDI.

The ACA had me hoping I might go back to work part time, if my health care could be totally separated from employment/income. I wanted this for everyone in my state!

Not a zero-sum game in Washington State. Not exactly.
posted by Dreidl at 9:26 PM on February 3 [7 favorites]


House Farm Bill Includes 8 Billion of Cuts to Food Stamps

How the fuck is it even legal to do that to legislation?

(I know, I know. Lobbyists. But still.)
posted by feckless fecal fear mongering at 9:47 PM on February 3


Millions Are Now Realizing They're Too Poor For Obamacare
posted by homunculus at 10:44 PM on February 3 [2 favorites]


If the latest Obamacare lawsuit succeeds, Obamacare is in big trouble
posted by homunculus at 10:45 PM on February 3


(From homonculus' HuffPo link)
The expansion of Medicaid coverage to anyone making less than 133 percent of the federal poverty level, or about $15,300 a year for a single person. Since the court's ruling, 24 states, including Florida, chose not to expand the program.
HOW. HOW DO THESE PEOPLE GET VOTED IN? This is such naked outright hate and contempt for people who need help.

I'm not American and I'm an atheist, but in some sense I am praying for a blue resurgence in your next two elections. Tens of millions of people need it to happen.
posted by feckless fecal fear mongering at 11:13 PM on February 3 [4 favorites]


I was visiting my dentist here in Kentucky last week, and as I sat in the chair with mouth full of gauze, I heard another patient walk in. The guy started chatting with the dentist, and before long the conversation turned to Obamacare.

"You know who's signing up for Kynect?" the patient asked. "It's people on Medicaid."

As if that was a bad thing.
posted by Sir Cholmondeley at 1:42 AM on February 4


feckless fecal fear mongering: “I'm not American and I'm an atheist, but in some sense I am praying for a blue resurgence in your next two elections. Tens of millions of people need it to happen.”
I fear you would probably be stunned by the number of people receiving SNAP (food aid) and whose children are on Medicaid, who are proudly, obstinately conservative Republicans.

Despair is a sin, though…
posted by ob1quixote at 4:03 AM on February 4 [3 favorites]


Meanwhile, Arkansas Republicans are planning to strip coverage from the people who have already signed up for expanded Medicare because Obamacare is so horrible.
posted by Bromius at 4:25 AM on February 4


feckless fecal fearmongering: HOW. HOW DO THESE PEOPLE GET VOTED IN? This is such naked outright hate and contempt for people who need help.

Othering is remarkably effective. I hear it all the time at family gatherings that illegals and welfare people have everything handed to them for free and are bankrupting the country. Not one single mention is ever made of the cost of two wars plus whatever black bag military adventures are going on lately. There is always a blank check for the projection of force in the US. Police, military, prisons, etc. When it comes to social programs whose costs are absolutely dwarfed by the spending on military et al, there's suddenly a fear that someone is going to get something that they didn't earn or deserve.
posted by dr_dank at 4:38 AM on February 4 [8 favorites]


Just about every single one of those patients seemed to be one major illness away from disability and bankruptcy which is all too common.

It's not limited to the working poor. I'm "middle class" with a white collar desk job.

All it will take is for me to get sick/injured badly enough to not be able to work, and the same will be true for me and anyone else who isn't independently wealthy.

There are legions of Americans who blindly think it can't happen to them because they have a job and "good" insurance.
posted by Fleebnork at 5:50 AM on February 4 [3 favorites]


health care is not a zero sum game.

I'm not exactly disagreeing with you, but there are a limited number of resources when it comes to anything, health care included - only a certain number of pills, pharmacies, hospitals, MRI machines. There is also a finite amount of time for doctors to see and treat patients. I think this is what is fueling the fear, that those with healthcare are worried that the newly-enrolled will use up the resources that they previously had a lock on.
posted by chainsofreedom at 6:18 AM on February 4


I'm not exactly disagreeing with you, but there are a limited number of resources when it comes to anything, health care included - only a certain number of pills, pharmacies, hospitals, MRI machines. There is also a finite amount of time for doctors to see and treat patients. I think this is what is fueling the fear, that those with healthcare are worried that the newly-enrolled will use up the resources that they previously had a lock on.

There is actually evidence that excess health care is bad for you. Once you cross a certain threshold you are in the realm of over-responsiveness and over-treatment and you start getting aggressive side-effect inducing treatment for false positives or you are getting prescribed 'go away' pills. So perversely, some rationing may result in benefits even for the moderately well off if it were to apply to them.
posted by srboisvert at 6:44 AM on February 4 [3 favorites]


I mean, WORRY? You're worried that a mass of poor, sick people are going to finally get health care?

Of course they worry about this. The only way to deal with it, short of completely bankrupting the country, will be to bring tax rates back up on the wealthy to what they used to be. And they wealthy are really really really anxious not to have that happen.

Wealthy conservatives have worked very hard to get tax rates lowered generally and moved from the federal to the local level as well, and kissed a lot of icky fundie ass along the way to build uncomfortable coalitions. All that hard lobbying work and pandering would be undone if our nation started to pay for caring for the impoverished and disadvantaged in a serious way.
posted by aught at 7:13 AM on February 4 [1 favorite]


I'm not American and I'm an atheist, but in some sense I am praying for a blue resurgence in your next two elections. Tens of millions of people need it to happen.

Republican are assuming (and it's a pretty good bet, sadly) that those people will not vote.
posted by aught at 7:20 AM on February 4 [2 favorites]


HOW. HOW DO THESE PEOPLE GET VOTED IN? This is such naked outright hate and contempt for people who need help.

That's basically the Republican Party platform. "The people who need help are socialist leeches sucking at the tit of you hard-working American future millionaires. Most of them are brown too."
posted by Pirate-Bartender-Zombie-Monkey at 7:43 AM on February 4 [5 favorites]


That's basically the Republican Party platform. "The people who need help are socialist leeches sucking at the tit of you hard-working American future millionaires. Most of them are brown too."

Nah - they don't say brown. They say "urban".
posted by Pogo_Fuzzybutt at 8:01 AM on February 4 [5 favorites]


Meanwhile, Arkansas Republicans are planning to strip coverage from the people who have already signed up for expanded Medicare because Obamacare is so horrible.

I don't.. this.. how? "How can people be so heartless / how can people be so cruel?"

How and why are people not literally storming State legislatures with pitchforks and torches?

Up until this fiasco started I thought maybe I could understand, in some little way, where Republicans were coming from. But this isn't even "Fuck you I got mine," this is just "Fuck you, and you can't do anything about it." I don't, at a truly fundamental level, comprehend how anyone can look at thousands, millions of other people and say "Nope, we're taking away your ability to go to a doctor because Reasons."

I can almost wrap my head around not allowing this in the first place. But to take it away? I just can't.

The banality of evil, indeed.
posted by feckless fecal fear mongering at 8:44 AM on February 4 [4 favorites]


The people most affected are too infirm to storm the gates.
posted by agregoli at 9:05 AM on February 4 [1 favorite]


Republican are assuming (and it's a pretty good bet, sadly) that those people will not vote.

And in the areas where we do vote? Actively trying to make it harder via Voter ID Laws.
posted by spinifex23 at 9:26 AM on February 4 [8 favorites]


"People should not be physically falling apart at 30."

Heh. I've been physically falling apart since I was 17. Actually, 16, but my doctors here could not for the life of them figure out what my problem was, and my fucking insurance company wouldn't allow for certain tests that were reserved for older people.

Then I moved to Germany. Because I was there on a program sponsored by the US Congress and the German Bundestag, I was covered under Germany's national health care program. My German doctors, free from the bean counters, figured out in short order that I had RA. For the next year and a half, all I needed to do was show my Krankenschein, and that was it. No fussing with copays, no being denied testing or treatment at the whim of some accountant somewhere, no fuss, no bother. If I was sick, I saw a doctor. When I was injured in a car accident, I was taken to the ER and treated immediately. When my RA flared up, I saw the rheumatologist immediately, without having to get permission from the insurance company first.

I miss my German healthcare.
posted by MissySedai at 10:00 AM on February 4 [11 favorites]


There is actually evidence that excess health care is bad for you. Once you cross a certain threshold you are in the realm of over-responsiveness and over-treatment and you start getting aggressive side-effect inducing treatment for false positives or you are getting prescribed 'go away' pills. So perversely, some rationing may result in benefits even for the moderately well off if it were to apply to them.

This is so true it should be on a plaque in every waiting room in every doctor's office, urgent care and ED in America.
posted by docpops at 10:22 AM on February 4


I needed to do was show my Krankenschein, and that was it.

Oh, gurl...

Sorry, that's just a really great word to take out of context.

You may now continue your entirely serious discussion of the US healthcare clusterfuck.

posted by Sara C. at 10:24 AM on February 4 [6 favorites]


I'm not exactly disagreeing with you, but there are a limited number of resources when it comes to anything, health care included - only a certain number of pills, pharmacies, hospitals, MRI machines.

Treating everyone as early as possible prevents desperately ill, expensive patients in the emergency room. And since very few people will (publicly) tell a poor person to go die in the gutter, you're going to pay for it one way or the other.

I got free preventative dental care in Canada as part of elementary school. That minor expense likely cut my lifetime dental bills in half.
posted by benzenedream at 10:35 AM on February 4 [4 favorites]


Here's the GOP's latest Obamacare attack: The GOP Has It Wrong: Obamacare Won't 'Cost' 2 Million Jobs.

Because what really makes America great is having to work extra hours to pay for expensive, worthless healthcare.

And of course Politico is just reporting the spin and not worrying about those stubborn little facts.
posted by tonycpsu at 1:29 PM on February 4 [2 favorites]


Here's the GOP's latest Obamacare attack

I was pretty fucking disappointed that the NYT headline played this straight from the GOP spin machine--they originally went with a headline that claimed the Healthcare Law would cost "2 million jobs." I see they've now corrected it to a much less slanted "May Result in 2 Million Fewer Workers," although that's still somewhat tendentious. I think that's one of those cases where they tied themselves into a knot from fear of looking like they were trying to "spin" the story the other way, so ended up spinning it in favor of the law's critics rather than giving a neutral take on the CBO's actual findings.

2 million poor people realizing they don't have to do as much work to live comfortably is one of the benefits of the ACA, not one of its problems.
posted by yoink at 1:36 PM on February 4 [3 favorites]


You're worried that a mass of poor, sick people are going to finally get health care?

To be fair people are worried it will happen the wrong way, which is any way that involves the government shifting wealth around.

And as much fun as it is to accuse Republicans of uncaring greed, they really _are_ worried about the future of the country as a whole. They believe that a large uncontrolled government will lead to the decline and fall of the United States. They worry that our once mighty economy has declined as much because Americans have lost their values of independence and hard work as it has declined because of foreign competition.

And that's why you find poor Republicans as well. Because they value independence and hard work and find it humiliating to be given handouts. They accept them because they need them, not because they think they're a good idea. What is needed is to return to the heady days when the U.S. was a manufacturing powerhouse and skilled manual labor was valuable, and the way they believe we do that is to return to the values that got us there before.

I don't particularly think that plan will work. I think the golden days of skilled manual labor are dead in the U.S. and dying elsewhere. The opportunity is gone and no set of values is going to bring it back.

The decline and fall of the United States on the other hand is almost inevitable. Every country and empire that has ever existed has fallen apart eventually, and short of war or weather nobody really knows why. Given that I think the best thing we can do is to take care of each other now, today.

Eat, drink, and heal thy neighbor, for tomorrow we may die.
posted by Tell Me No Lies at 1:58 PM on February 4 [4 favorites]


they really _are_ worried about the future of the country as a whole

No they're not. They're worried about the future of the rich people.
posted by Sara C. at 2:12 PM on February 4 [6 favorites]


Germans whip out their Krankenschein, they get a free ride in an ambulance. Americans whip out their Krankenschein, they get a free ride in a police car.
posted by dr_dank at 2:21 PM on February 4 [2 favorites]


They accept them because they need them, not because they think they're a good idea.

Unpack that sentence a little bit. If they're accepting welfare or Medicaid because they need it, and if they didn't have it they'd lose their houses or starve or sicken and die, then how exactly is a not a good idea for these programs to be around? Or is the point that these welfare-Republicans think they're the only ones who really need these programs, whereas all the other people taking advantage of them are just lazy? So the programs aren't a good idea in general, but they sure are in their particular case, right?

In other words, poor Republicans are largely hypocrites. I'm sure that didn't used to be the case. There was a time, before Gingrich, before Reagan, when the Republican party didn't hate poor people. But if you're receiving government assistance because you're poor, it's basically impossible to support the Republican party today without being a hypocrite.

It reminds of the people Matt Taibbi met at a rally for Sarah Palin:

Seemingly every third person in the place is sucking oxygen from a tank or propping their giant atrophied glutes on motorized wheelchair-scooters. As Palin launches into her Ronald Reagan impression — "Government's not the solution! Government's the problem!" — the person sitting next to me leans over and explains.

"The scooters are because of Medicare," he whispers helpfully. "They have these commercials down here: 'You won't even have to pay for your scooter! Medicare will pay!' Practically everyone in Kentucky has one."

A hall full of elderly white people in Medicare-paid scooters, railing against government spending and imagining themselves revolutionaries as they cheer on the vice-presidential puppet hand-picked by the GOP establishment. If there exists a better snapshot of everything the Tea Party represents, I can't imagine it.

After Palin wraps up, I race to the parking lot in search of departing Medicare-motor-scooter conservatives. I come upon an elderly couple, Janice and David Wheelock, who are fairly itching to share their views.

"I'm anti-spending and anti-government," crows David, as scooter-bound Janice looks on. "The welfare state is out of control."

"OK," I say. "And what do you do for a living?"

"Me?" he says proudly. "Oh, I'm a property appraiser. Have been my whole life."

I frown. "Are either of you on Medicare?"

Silence: Then Janice, a nice enough woman, it seems, slowly raises her hand, offering a faint smile, as if to say, You got me!

"Let me get this straight," I say to David. "You've been picking up a check from the government for decades, as a tax assessor, and your wife is on Medicare. How can you complain about the welfare state?"

"Well," he says, "there's a lot of people on welfare who don't deserve it. Too many people are living off the government."

posted by Dasein at 2:25 PM on February 4 [14 favorites]


the other day someone who I know was in the peace corps was going on about the ills of government money going to undeserving people a la the ACA and the concept of paid maternity leave, spouting bootstraps tropes.

I told him perhaps I felt he didn't deserve to have my tax dollars fund his once in a lifetime experience in Africa that he still goes on about as being the best thing ever.

he unfriended me.

good riddance but it's no different than those free scooter republicans who think everyone else is getting too much.
posted by sio42 at 2:37 PM on February 4 [6 favorites]


the concept of paid maternity leave

The lack of any sort of system of paid maternity leave in the United States is, to my mind, the most shocking example of structural sexism in modern American life. It's of course a product of the Neanderthal-like attitudes of large numbers of American men to the idea of paid maternity leave, which I can only chalk up to the utter failure of empathy so richly displayed in American attitudes to social programs in general.
posted by Dasein at 2:56 PM on February 4 [4 favorites]


"2 million poor people realizing they don't have to do as much work to live comfortably is one of the benefits of the ACA, not one of its problems."

Seriously, it's like a glazier's complaint about a law against breaking windows. Getting inefficient uses of labor (to pay for health care that's cheaper when provided universally more broadly) out of the market will allow those folks to put their time toward other things of value.

It's like Republicans don't believe in the wisdom of the market after all.
posted by klangklangston at 5:05 PM on February 4 [4 favorites]


Think of how many people will now be able to start small businesses without having to worry about their family's health.
posted by grouse at 5:10 PM on February 4 [3 favorites]


The lack of any sort of system of paid maternity leave in the United States is, to my mind, the most shocking example of structural sexism in modern American life. It's of course a product of the Neanderthal-like attitudes of large numbers of American men to the idea of paid maternity leave, which I can only chalk up to the utter failure of empathy so richly displayed in American attitudes to social programs in general.

I don't think it's pure sexism (plenty of nations are well beyond mere mat leave and now guarantee paid parental leave, gender be damned, even for adoptions)--though sexism most probably does pay a large role--so much as it's just plain Conservatism. Conservatism, at the best of times (i.e. when it's not full-on Regressivism, which it very often is), is synonymous with inertia. You're one of the four countries without maternity leave for the same reason you're one of the three that don't use the metric system: Conservatism says no.
posted by Sys Rq at 5:45 PM on February 4 [2 favorites]


The lack of any sort of system of paid maternity leave in the United States is, to my mind, the most shocking example of structural sexism in modern American life. It's of course a product of the Neanderthal-like attitudes of large numbers of American men to the idea of paid maternity leave, which I can only chalk up to the utter failure of empathy so richly displayed in American attitudes to social programs in general.

You realize that America doesn't have any sort of system of any kind of paid leave, right?
posted by Etrigan at 5:51 PM on February 4 [4 favorites]


Ugh. MSNBC's Chuck Todd is riding the "Obamacare kills jobs tire swing.

Of course, Econ 101 says when the supply of labor goes down (due to people choosing to work less because they don't need to work for health benefits) the price of labor (wages) will go up.

Don't expect to hear this from the "liberal" media.
posted by tonycpsu at 6:09 PM on February 4 [3 favorites]


Etrigan, of course. But men don't have to breastfeed or heal from labour. If they had the same physical connection with babies that women do, there'd be parental leave. No parental leave is shitty. No mat leave is in my view sexist because of the radically differential effect it has on women.
posted by Dasein at 7:21 PM on February 4


Can We Even Have a Functioning Democracy If One Major Party Lies About Everything and the Press Just Nods?
posted by tonycpsu at 9:48 PM on February 4 [8 favorites]


But men don't have to breastfeed or heal from labour. If they had the same physical connection with babies that women do, there'd be parental leave.

Men have been well over 90 percent of the American participants and casualties in our wars, but Veterans Day and Memorial Day aren't universally paid holidays either.

No parental leave is shitty. No mat leave is in my view sexist because of the radically differential effect it has on women.

I agree that we should have it, but I attribute it more to the fact that we don't have any form of mandatory paid medical leave than to sexism. Pregnancy isn't treated differently from cancer, and "I'd go to the doctor more, but I can't afford the time off work" is a common problem in increasing preventive care.
posted by Etrigan at 6:52 AM on February 5 [1 favorite]


Ugh. MSNBC's Chuck Todd is riding the "Obamacare kills jobs tire swing.

Of course, Econ 101 says when the supply of labor goes down (due to people choosing to work less because they don't need to work for health benefits) the price of labor (wages) will go up.

Don't expect to hear this from the "liberal" media.


Even Paul Ryan is managing not to be a complete shitnozzle over this (although just barely).
posted by zombieflanders at 10:06 AM on February 5 [1 favorite]


It may be possible to get paid leave at a job but that sort of benefit is only available to people making a ton of money already because they have negotiating power. also, you generally have to use all vacation and sick time before materntity leave kicks in so hope your or your kid doesn't get sick when you get back cause then you have more unpaid leave to take. if your job allows it.

so the ACA is a good step in moving this sort of thing out of the hands and discretion of employers.
posted by sio42 at 2:11 PM on February 6


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