Fried Twinkies With a Side of Obamacare
August 26, 2013 7:03 PM Subscribe
A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state’s health benefit exchange established by Obamacare.
The man is impressed. "This beats Obamacare I hope," he mutters to one of the workers.
“Do I burst his bubble?” wonders Reina Diaz-Dempsey, overseeing the operation. She doesn't. If he signs up, it's a win-win, whether he knows he's been ensnared by Obamacare or not.
Was it really necessary to say that everyone lined up in XXL shirts and fanny packs? (Paragraph just above the photo of 4 tote bags.)
posted by IndigoRain at 7:13 PM on August 26, 2013 [7 favorites]
posted by IndigoRain at 7:13 PM on August 26, 2013 [7 favorites]
Oregon has a multi-million dollar ad campaign featuring local musicians touting its ACA exchange.
posted by chrchr at 7:20 PM on August 26, 2013
posted by chrchr at 7:20 PM on August 26, 2013
The tote bags ONLY come in ONE color, ugh! Thanks, Obama!
posted by phunniemee at 7:27 PM on August 26, 2013 [4 favorites]
posted by phunniemee at 7:27 PM on August 26, 2013 [4 favorites]
No! Don't mislead him! Obamacare haters must remain uncared so they can get sick and die!
posted by oneswellfoop at 7:28 PM on August 26, 2013 [2 favorites]
posted by oneswellfoop at 7:28 PM on August 26, 2013 [2 favorites]
The new Obamacare rates in Kentucky have yet to be made public. The specifics of the plans are still a mystery. [...]
“I know that the administration believes that Kentucky and Vermont are the two best exchanges that were created, that are models for the country,” Yarmuth, the Democratic congressman, says. “They’ve said that numerous times to the Democratic caucus.”
I'm kind of confused how the Administration can assess the quality of the exchange if the state hasn't even published basic info about it yet.
posted by psoas at 7:37 PM on August 26, 2013 [2 favorites]
“I know that the administration believes that Kentucky and Vermont are the two best exchanges that were created, that are models for the country,” Yarmuth, the Democratic congressman, says. “They’ve said that numerous times to the Democratic caucus.”
I'm kind of confused how the Administration can assess the quality of the exchange if the state hasn't even published basic info about it yet.
posted by psoas at 7:37 PM on August 26, 2013 [2 favorites]
Was it really necessary to say that everyone lined up in XXL shirts and fanny packs?
Of course not, but do you really expect HuffPo not to engage in a little offensive stereotyping?
posted by hattifattener at 7:40 PM on August 26, 2013 [5 favorites]
Of course not, but do you really expect HuffPo not to engage in a little offensive stereotyping?
posted by hattifattener at 7:40 PM on August 26, 2013 [5 favorites]
I know the writer, he's far more insufferable in person. In most of his pieces he lets the reader know how much better he is than the people he's covering. He used to write for the Washington City Paper, I would usually read his articles so I could get to the part where I could nod my head and say, "Yup, Jason is still an asshole."
posted by peeedro at 7:48 PM on August 26, 2013 [17 favorites]
posted by peeedro at 7:48 PM on August 26, 2013 [17 favorites]
Please someone bring a good exchange to Illinois, please let me be able to buy my own care and also at the same time be able to afford other things like rent, and please do it soon.
posted by bleep at 7:57 PM on August 26, 2013 [4 favorites]
posted by bleep at 7:57 PM on August 26, 2013 [4 favorites]
I hope Obamacare gains traction so it's benefits will be appreciated Pryor to the next election. Then it'll hopefully be a case of "hands off my Obamacare" and it stands a chance of expansion.
posted by arcticseal at 8:06 PM on August 26, 2013
posted by arcticseal at 8:06 PM on August 26, 2013
I'm kind of confused how the Administration can assess the quality of the exchange if the state hasn't even published basic info about it yet.
They are no doubt in constant contact with the state to set it up. People are going to be surprised how quick this stands up.
And all the GOP states will rush to set up an exchange.
posted by Ironmouth at 8:16 PM on August 26, 2013
They are no doubt in constant contact with the state to set it up. People are going to be surprised how quick this stands up.
And all the GOP states will rush to set up an exchange.
posted by Ironmouth at 8:16 PM on August 26, 2013
The county’s health department workers worry about doctor shortages that could be caused by the Medicaid expansion. “We actually had a lady in the clinic this afternoon," one worker explains. “She said the pediatrician in this area couldn’t see her child until November. That concerns me that there’s not enough providers in this area.”
“It’s a legitimate concern,” Hoben replies.
Welcome to Canada, Kentucky!
posted by GuyZero at 8:32 PM on August 26, 2013 [1 favorite]
“It’s a legitimate concern,” Hoben replies.
Welcome to Canada, Kentucky!
posted by GuyZero at 8:32 PM on August 26, 2013 [1 favorite]
Yup, the Good Ole' Party, fomenting misinformation and letting people go bankrupt from their health care costs for political gain.
posted by dry white toast at 8:53 PM on August 26, 2013 [1 favorite]
posted by dry white toast at 8:53 PM on August 26, 2013 [1 favorite]
The author hates poor people and loves sneering.
posted by samofidelis at 8:53 PM on August 26, 2013 [3 favorites]
posted by samofidelis at 8:53 PM on August 26, 2013 [3 favorites]
"No sir, it's not Obamacare, it's the Affirdable Care Act" - job done.
posted by Artw at 8:54 PM on August 26, 2013 [4 favorites]
posted by Artw at 8:54 PM on August 26, 2013 [4 favorites]
Welcome to Canada, Kentucky!
Waiting is better than no care at all.
It's better than the fear of crushing, insurmountable debt.
In my informal survey of Canadians, the overwhelming opinion is that waiting sucks, but the current US system is "fucking crazy."
posted by louche mustachio at 8:54 PM on August 26, 2013 [54 favorites]
Waiting is better than no care at all.
It's better than the fear of crushing, insurmountable debt.
In my informal survey of Canadians, the overwhelming opinion is that waiting sucks, but the current US system is "fucking crazy."
posted by louche mustachio at 8:54 PM on August 26, 2013 [54 favorites]
The author hates poor people and loves sneering.
He's not the only one, and it's a really unhelpful attitude to have if you want to help... well, anyone. Nobody is going to believe you have their best interest at heart if you make it clear that you think they are idiots.
posted by louche mustachio at 8:59 PM on August 26, 2013 [1 favorite]
He's not the only one, and it's a really unhelpful attitude to have if you want to help... well, anyone. Nobody is going to believe you have their best interest at heart if you make it clear that you think they are idiots.
posted by louche mustachio at 8:59 PM on August 26, 2013 [1 favorite]
"Ensnared?"
posted by Miko at 8:59 PM on August 26, 2013 [1 favorite]
posted by Miko at 8:59 PM on August 26, 2013 [1 favorite]
This gem was being passed around by my more conservative acquaintances on FaceBook the other day:
"Age 76 Today, I went to the Dr. for my monthly B12 shot that I have been getting for a number of years. The nurse came and got me, got out the needle filled and ready to go then looked at the computer and got very quiet and asked if I was prepared to pay for it. I said no that my insurance takes care of it.
She said, that Medicare had turned... it down and went to talk to my Dr. about it. 15 minutes later she came back and said, she was sorry but they had tried every-thing they could but Medicare is beginning to turn many things away for seniors because of the projected Obama Care coming in. She was brushing at tears and said, "Some day they too will get old", I am so very sorry!!"
I filed this with the rest of the stories labelled "Completely true, totally happened, srsly guys."
posted by sourwookie at 9:00 PM on August 26, 2013 [11 favorites]
"Age 76 Today, I went to the Dr. for my monthly B12 shot that I have been getting for a number of years. The nurse came and got me, got out the needle filled and ready to go then looked at the computer and got very quiet and asked if I was prepared to pay for it. I said no that my insurance takes care of it.
She said, that Medicare had turned... it down and went to talk to my Dr. about it. 15 minutes later she came back and said, she was sorry but they had tried every-thing they could but Medicare is beginning to turn many things away for seniors because of the projected Obama Care coming in. She was brushing at tears and said, "Some day they too will get old", I am so very sorry!!"
I filed this with the rest of the stories labelled "Completely true, totally happened, srsly guys."
posted by sourwookie at 9:00 PM on August 26, 2013 [11 favorites]
Are you sure that wasn't clever satire pointing out the superiority of socialized healthcare?
posted by Drinky Die at 9:04 PM on August 26, 2013 [2 favorites]
posted by Drinky Die at 9:04 PM on August 26, 2013 [2 favorites]
turn many things away for seniors because of the projected Obama Care coming in
what is this i don't even
posted by GuyZero at 9:06 PM on August 26, 2013 [2 favorites]
what is this i don't even
posted by GuyZero at 9:06 PM on August 26, 2013 [2 favorites]
Preying on people's fears in that manner makes me incandescent with rage.
posted by arcticseal at 9:09 PM on August 26, 2013 [12 favorites]
posted by arcticseal at 9:09 PM on August 26, 2013 [12 favorites]
The basic question: what do we do with allll the ignorance.
Everyone will be affected. It needs to make sense to everyone.
posted by Miko at 9:15 PM on August 26, 2013 [1 favorite]
Everyone will be affected. It needs to make sense to everyone.
posted by Miko at 9:15 PM on August 26, 2013 [1 favorite]
An anecdote on waiting:
Last year, my 12 year old daughter injured her knee on a trampoline. After a trip to the urgent care and a follow-up with the family doctor, she was scheduled for an MRI. Due to specific circumstances, the only facility in our 1M person city capable of performing the scan was the local Children's Hospital.
We called immediately to schedule. The first opening was during the Christmas holiday. We would be out of town. We took the second available date. Our wait time would be 12 weeks.
We have excellent, "gold", employer-paid insurance. The hospital is owned by (or named after) an insurance company. We live in the U.S.
Amusingly, the two insurance companies are still arguing about who is going to pay and how much due to a clerical error between them. I suspect this bickering is now costing both companies about the same amount as the procedure itself, even before the extra PT cost to rebuild atrophied muscles.
posted by Mr Stickfigure at 9:26 PM on August 26, 2013 [21 favorites]
Last year, my 12 year old daughter injured her knee on a trampoline. After a trip to the urgent care and a follow-up with the family doctor, she was scheduled for an MRI. Due to specific circumstances, the only facility in our 1M person city capable of performing the scan was the local Children's Hospital.
We called immediately to schedule. The first opening was during the Christmas holiday. We would be out of town. We took the second available date. Our wait time would be 12 weeks.
We have excellent, "gold", employer-paid insurance. The hospital is owned by (or named after) an insurance company. We live in the U.S.
Amusingly, the two insurance companies are still arguing about who is going to pay and how much due to a clerical error between them. I suspect this bickering is now costing both companies about the same amount as the procedure itself, even before the extra PT cost to rebuild atrophied muscles.
posted by Mr Stickfigure at 9:26 PM on August 26, 2013 [21 favorites]
I filed this with the rest of the stories labelled "Completely true, totally happened, srsly guys."
Might be based on at least a kernel of truth, as some states are redirecting Medicare funds to Medicaid rather than accepting the additional Medicaid funding that comes with the AHCA (because it requires covering more people under Medicaid and offers funds for the expansion that some states have rejected on the principle that it's wrong for the Federal government to use taxes to offer services to people).
Of course, people who don't get that there's a state government playing a crucial role in implementing the system will just pass the blame right on up to the Federal level regardless of who's actually cutting the benefits because, well, Big Government.
posted by saulgoodman at 9:30 PM on August 26, 2013 [1 favorite]
Might be based on at least a kernel of truth, as some states are redirecting Medicare funds to Medicaid rather than accepting the additional Medicaid funding that comes with the AHCA (because it requires covering more people under Medicaid and offers funds for the expansion that some states have rejected on the principle that it's wrong for the Federal government to use taxes to offer services to people).
Of course, people who don't get that there's a state government playing a crucial role in implementing the system will just pass the blame right on up to the Federal level regardless of who's actually cutting the benefits because, well, Big Government.
posted by saulgoodman at 9:30 PM on August 26, 2013 [1 favorite]
No, but it no longer "requires covering more people under Medicaid." The states that are expanding Medicaid are taking the money, and the states that are not taking the money are not expanding Medicaid.
posted by gerstle at 9:34 PM on August 26, 2013 [1 favorite]
posted by gerstle at 9:34 PM on August 26, 2013 [1 favorite]
We have excellent, "gold", employer-paid insurance. The hospital is owned by (or named after) an insurance company. We live in the U.S.
My boss is an endless source of "...and then the doctors in the socialized medicine country told my acquaintance he'd better go back to the US or else he would die waiting!" stories. And then couple years ago, she had to have a somewhat urgent but not emergency-level urgant surgical procedure and that she'd probably be out for the next two weeks. Then she called to schedule it. The first opening they had was Christmas Eve a couple months out, and the next was a few weeks after that. She seemed shocked.
posted by Blue Jello Elf at 9:36 PM on August 26, 2013 [11 favorites]
My boss is an endless source of "...and then the doctors in the socialized medicine country told my acquaintance he'd better go back to the US or else he would die waiting!" stories. And then couple years ago, she had to have a somewhat urgent but not emergency-level urgant surgical procedure and that she'd probably be out for the next two weeks. Then she called to schedule it. The first opening they had was Christmas Eve a couple months out, and the next was a few weeks after that. She seemed shocked.
posted by Blue Jello Elf at 9:36 PM on August 26, 2013 [11 favorites]
and the states that are not taking the money are not expanding Medicaid.
Yeah, but they're still left with a budget shortfall for Medicaid, aren't they? Florida's allegedly making up some of the difference by redirecting Medicare funds to cover the gap, potentially cutting back some medicare benefits. The states and the Federal government both play a role in determining Medicare benefits in a particular state.
posted by saulgoodman at 9:41 PM on August 26, 2013
Yeah, but they're still left with a budget shortfall for Medicaid, aren't they? Florida's allegedly making up some of the difference by redirecting Medicare funds to cover the gap, potentially cutting back some medicare benefits. The states and the Federal government both play a role in determining Medicare benefits in a particular state.
posted by saulgoodman at 9:41 PM on August 26, 2013
Oregon has a multi-million dollar ad campaign featuring local musicians touting its ACA exchange.
In Missouri, all state and local officials are prohibited promoting or cooperating with the exchanges in any way.
Score one for the glory of direct democracy.
posted by flug at 9:55 PM on August 26, 2013 [1 favorite]
In Missouri, all state and local officials are prohibited promoting or cooperating with the exchanges in any way.
Score one for the glory of direct democracy.
posted by flug at 9:55 PM on August 26, 2013 [1 favorite]
She seemed shocked.
The U.S. has all the disadvantages of so-called 'socialized medicine' without any of the advantages . . .
posted by flug at 9:58 PM on August 26, 2013 [6 favorites]
The U.S. has all the disadvantages of so-called 'socialized medicine' without any of the advantages . . .
posted by flug at 9:58 PM on August 26, 2013 [6 favorites]
The states and the Federal government both play a role in determining Medicare benefits in a particular state.
Medicare is completely funded by the Federal government and the Feds control and manage all spending for Medicare. The states have nothing to do with Medicare. Eligibility is determined by the Feds and includes most people over 65 and disabled.
Medicaid is a joint Federal and state program for low-income people. The Federal government provides block grants to the states and the states determine eligibility and manage spending. The Feds have little control over state spending of Medicaid funds and this in fact was the basis of the Supreme Court ruling regarding Medicaid as part of their ruling on the ACA.
posted by JackFlash at 10:47 PM on August 26, 2013 [2 favorites]
Medicare is completely funded by the Federal government and the Feds control and manage all spending for Medicare. The states have nothing to do with Medicare. Eligibility is determined by the Feds and includes most people over 65 and disabled.
Medicaid is a joint Federal and state program for low-income people. The Federal government provides block grants to the states and the states determine eligibility and manage spending. The Feds have little control over state spending of Medicaid funds and this in fact was the basis of the Supreme Court ruling regarding Medicaid as part of their ruling on the ACA.
posted by JackFlash at 10:47 PM on August 26, 2013 [2 favorites]
She seemed shocked.
The U.S. has all the disadvantages of so-called 'socialized medicine' without any of the advantages . . .
No kidding. I am always amazed how much waiting is involved in medical care.
posted by gjc at 10:58 PM on August 26, 2013 [2 favorites]
The U.S. has all the disadvantages of so-called 'socialized medicine' without any of the advantages . . .
No kidding. I am always amazed how much waiting is involved in medical care.
posted by gjc at 10:58 PM on August 26, 2013 [2 favorites]
Yeah, both my kids need to see specialists for various issues (one of which is NO LONGER MYSTERIOUS because WE GOT A DIAGNOSIS LAST WEEK YAY), and the waiting time is NEVER less than six weeks. And this is to see a specialist ARNP, not even an MD.
posted by KathrynT at 11:01 PM on August 26, 2013
posted by KathrynT at 11:01 PM on August 26, 2013
Preying on people's fears in that manner makes me incandescent with rage.
Right. But eventually, you fall silent and simply listen. And then you write down your rage based on what you hear.
How dare these evildoers scare people with death panels.
How dare these evildoers exploit the fear of good solid white citizens about the black man in the white house.
How dare these evildoers spread rumors among good christian folk, about Jews and how they have horns and tails.
How dare these evildoers spread fears among decent folk about those "dirty Mexicans" and how they come to steal their America away from them. The America God gave them and only them, telling them plainly in English "it's yours, no need to press one for Spanish". Such injustice.
Nobody is going to believe you have their best interest at heart if you make it clear that you think they are idiots.
Tricky, tricky. You certainly don't want to come across as dismissive and contemptuous. Because who likes to be patronized?
Instead, you should listen carefully to the fears - and treat them as completely reasonable, because, after all, to do anything else is to patronize. Even if, you know, the beliefs are, well, idiotic - or seem that way to you because you know you are merely showing privilege and if you were really down with this, you'd know it's not actually idiotic but totally understandable and even sort of insightful in its own way kinda in a manner of speaking, more or less approximately taking into account disadvantaged backgrounds and economic despair.
Rather than patronize, address them head on. First listen seriously, maybe nod slightly - not too much or it may be seen as belittling. Bring a bald Jew with you, and have him drop trou - see, no horns, and no tail. Have a large copy made of Obama's birth certificate - you know, the one that's already been released and talked about to death. Because, you know, don't patronize, make honest arguments, you'll certainly reach them that way.
And make sure you have plenty but plenty of those various certificates, because it's not like you are dealing with a tiny number of extremists. With all that education you've been doing since 2008 when Obama exploded into the public consciousness - guess what, now even more Republicans believe Obama is a muslim, so you are talking a third of all Republicans - every third one believes this... a number that has doubled since 2008. Clearly, all that educating you've been doing isn't very successful.
So yeah, the evildoers who deceive these fine upstanding citizens deserve all the rage us good liberals can muster. That horrible Palin, and Limbaugh, Hannity, Beck, with their silver tongues! Boy, how devilishly clever of that evil Palin to convince innocent people about death panels - so clever, we liberals are just helpless before such brilliance and all our arguments collapse and the only effect is that ever more people believe Obama is a muslim and a million other lies! Oh, if only liberals had someone as clever and coherent as Beck!
Rage, rage at those brilliant but evil deceivers, they have the cleverness of Satan himself - we liberals are just helpless in comparison with our arguments, because if we were not, it would be US who would be doing all the convincing.
Except us, liberals would use our power for good! Oh, if only we had the power of speech!
But alas, we cannot match those silver-tongued devils. So all we're left with is rage.
Rage at the diabolical Palins of this world, deceiving salt of the earth decent upright citizens!
That's all we have left - rage.
The answer, I hear, is education. Now, when you hear some of these beliefs, you realize you should start the education pretty early because when you're dealing with well-meaning folk who believe in a 6000 year earth and various extraordinary things, you really should start the educational process as early as you possibly can. See that raging Tea Party middle age guy with the "Obama=Monkey" placard? Shave his balls and send him to kindergarten. We must counteract the lies that prey on his fears, we must start the education as early as we possibly can.
Rage! It's all the fault of "those" people who prey on fears - because it's not patronizing to deny the targets of those lies the brains god gave a hopping robin.
posted by VikingSword at 11:03 PM on August 26, 2013 [7 favorites]
Right. But eventually, you fall silent and simply listen. And then you write down your rage based on what you hear.
How dare these evildoers scare people with death panels.
How dare these evildoers exploit the fear of good solid white citizens about the black man in the white house.
How dare these evildoers spread rumors among good christian folk, about Jews and how they have horns and tails.
How dare these evildoers spread fears among decent folk about those "dirty Mexicans" and how they come to steal their America away from them. The America God gave them and only them, telling them plainly in English "it's yours, no need to press one for Spanish". Such injustice.
Nobody is going to believe you have their best interest at heart if you make it clear that you think they are idiots.
Tricky, tricky. You certainly don't want to come across as dismissive and contemptuous. Because who likes to be patronized?
Instead, you should listen carefully to the fears - and treat them as completely reasonable, because, after all, to do anything else is to patronize. Even if, you know, the beliefs are, well, idiotic - or seem that way to you because you know you are merely showing privilege and if you were really down with this, you'd know it's not actually idiotic but totally understandable and even sort of insightful in its own way kinda in a manner of speaking, more or less approximately taking into account disadvantaged backgrounds and economic despair.
Rather than patronize, address them head on. First listen seriously, maybe nod slightly - not too much or it may be seen as belittling. Bring a bald Jew with you, and have him drop trou - see, no horns, and no tail. Have a large copy made of Obama's birth certificate - you know, the one that's already been released and talked about to death. Because, you know, don't patronize, make honest arguments, you'll certainly reach them that way.
And make sure you have plenty but plenty of those various certificates, because it's not like you are dealing with a tiny number of extremists. With all that education you've been doing since 2008 when Obama exploded into the public consciousness - guess what, now even more Republicans believe Obama is a muslim, so you are talking a third of all Republicans - every third one believes this... a number that has doubled since 2008. Clearly, all that educating you've been doing isn't very successful.
So yeah, the evildoers who deceive these fine upstanding citizens deserve all the rage us good liberals can muster. That horrible Palin, and Limbaugh, Hannity, Beck, with their silver tongues! Boy, how devilishly clever of that evil Palin to convince innocent people about death panels - so clever, we liberals are just helpless before such brilliance and all our arguments collapse and the only effect is that ever more people believe Obama is a muslim and a million other lies! Oh, if only liberals had someone as clever and coherent as Beck!
Rage, rage at those brilliant but evil deceivers, they have the cleverness of Satan himself - we liberals are just helpless in comparison with our arguments, because if we were not, it would be US who would be doing all the convincing.
Except us, liberals would use our power for good! Oh, if only we had the power of speech!
But alas, we cannot match those silver-tongued devils. So all we're left with is rage.
Rage at the diabolical Palins of this world, deceiving salt of the earth decent upright citizens!
That's all we have left - rage.
The answer, I hear, is education. Now, when you hear some of these beliefs, you realize you should start the education pretty early because when you're dealing with well-meaning folk who believe in a 6000 year earth and various extraordinary things, you really should start the educational process as early as you possibly can. See that raging Tea Party middle age guy with the "Obama=Monkey" placard? Shave his balls and send him to kindergarten. We must counteract the lies that prey on his fears, we must start the education as early as we possibly can.
Rage! It's all the fault of "those" people who prey on fears - because it's not patronizing to deny the targets of those lies the brains god gave a hopping robin.
posted by VikingSword at 11:03 PM on August 26, 2013 [7 favorites]
I'm glad to see that Alison Lundergan Grimes was at the fair.
posted by pracowity at 11:28 PM on August 26, 2013 [1 favorite]
posted by pracowity at 11:28 PM on August 26, 2013 [1 favorite]
I'm kind of confused how the Administration can assess the quality of the exchange if the state hasn't even published basic info about it yet.
I think this means that the management and outreach are exemplary ("models for the country") rather than a formal assessment of the quality of the exchanges in terms of options and health outcomes.
posted by dhartung at 1:57 AM on August 27, 2013 [1 favorite]
I think this means that the management and outreach are exemplary ("models for the country") rather than a formal assessment of the quality of the exchanges in terms of options and health outcomes.
posted by dhartung at 1:57 AM on August 27, 2013 [1 favorite]
No one needs a fucking "B12 shot." It's pure-D quackery. So I'm glad to hear the anecdote in which it wasn't covered by insurance. Do doctors still peddle that B12 bullshit?
posted by spitbull at 2:41 AM on August 27, 2013 [4 favorites]
posted by spitbull at 2:41 AM on August 27, 2013 [4 favorites]
saulgoodman: "Of course, people who don't get that there's a state government playing a crucial role in implementing the system will just pass the blame right on up to the Federal level regardless of who's actually cutting the benefits because, well, Big Government."
I wonder about this, especially living in current conservative fantasy-world NC and its bare-minimum implementation. I worry that there's not enough preparation from proponents of the ACA for the elements that will be difficult for some people. I mean, I'm all for the ACA (especially since we can't have full on single-payer), but from looking at the scant available information (Humana, healthcare.gov) I get the feeling a number of people will be in an income bracket that will feel the pain a little, especially in this state. I think I'm probably going to have to shuffle around my already tight budget. Or, some areas may have provider shortages, or signups may be confusing... Again, I'm still all for this thing, because I think ultimately it's for the good, and for many people it's a fucking lifeline; but I think there should be some very realistic discussion of the complications or difficulties this will inevitably have in implementation, especially in the beginning. I just don't hear that anywhere, though. It may be because no one really knows; I know that I certainly don't. But get ready for whatever worst-case horror stories to be trotted out next year, no matter what. I don't know yet if it's good or bad that it's starting in an election year; that may have been a get for the Republicans.
posted by Red Loop at 3:07 AM on August 27, 2013 [2 favorites]
I wonder about this, especially living in current conservative fantasy-world NC and its bare-minimum implementation. I worry that there's not enough preparation from proponents of the ACA for the elements that will be difficult for some people. I mean, I'm all for the ACA (especially since we can't have full on single-payer), but from looking at the scant available information (Humana, healthcare.gov) I get the feeling a number of people will be in an income bracket that will feel the pain a little, especially in this state. I think I'm probably going to have to shuffle around my already tight budget. Or, some areas may have provider shortages, or signups may be confusing... Again, I'm still all for this thing, because I think ultimately it's for the good, and for many people it's a fucking lifeline; but I think there should be some very realistic discussion of the complications or difficulties this will inevitably have in implementation, especially in the beginning. I just don't hear that anywhere, though. It may be because no one really knows; I know that I certainly don't. But get ready for whatever worst-case horror stories to be trotted out next year, no matter what. I don't know yet if it's good or bad that it's starting in an election year; that may have been a get for the Republicans.
posted by Red Loop at 3:07 AM on August 27, 2013 [2 favorites]
If he signs up, it's a win-win
No, that would just be win. Win-win would be if he signed up AND was convinced that being anti-social was stupid.
posted by DU at 4:08 AM on August 27, 2013 [5 favorites]
No, that would just be win. Win-win would be if he signed up AND was convinced that being anti-social was stupid.
posted by DU at 4:08 AM on August 27, 2013 [5 favorites]
Waiting is better than no care at all.
You know, people act like you don't wait with insurance. I'm a kidney cancer survivor, had a mass found on my remaining kidney in July while in the hospital. I had a CT Scan on the 7th of August and I get my results today.
I have insurance. I have good insurance (comparatively to most people I know.) You still fucking wait no matter what.
posted by SuzySmith at 4:52 AM on August 27, 2013 [3 favorites]
You know, people act like you don't wait with insurance. I'm a kidney cancer survivor, had a mass found on my remaining kidney in July while in the hospital. I had a CT Scan on the 7th of August and I get my results today.
I have insurance. I have good insurance (comparatively to most people I know.) You still fucking wait no matter what.
posted by SuzySmith at 4:52 AM on August 27, 2013 [3 favorites]
I had a CT Scan on the 7th of August and I get my results today.
That's a long wait. I hope all is well.
posted by pracowity at 5:11 AM on August 27, 2013 [5 favorites]
That's a long wait. I hope all is well.
posted by pracowity at 5:11 AM on August 27, 2013 [5 favorites]
Medicare is completely funded by the Federal government and the Feds control and manage all spending for Medicare. The states have nothing to do with Medicare.
Thanks for the clarification. I had thought that was the case, but the article I linked earlier suggested otherwise, and for a minute there, I thought it was being suggested the state was threatening to administer Medicare in a way that denied some benefits on the justification that the Medicaid deficits required it. More likely, the sources and reporters just didn't know what they were talking about.
posted by saulgoodman at 6:18 AM on August 27, 2013
Thanks for the clarification. I had thought that was the case, but the article I linked earlier suggested otherwise, and for a minute there, I thought it was being suggested the state was threatening to administer Medicare in a way that denied some benefits on the justification that the Medicaid deficits required it. More likely, the sources and reporters just didn't know what they were talking about.
posted by saulgoodman at 6:18 AM on August 27, 2013
My son has fallen into a situation (no longer on our policy, making barely more than minimum wage, and his employer offers coverage that costs a lot and provides nothing), so we're waiting for the enrollment period for the exchanges to open, and see what he can get.
Unfortunately, Indiana is one of those "over our dead bodies" states that has vociferously opposed Obamacare in any shape or form. We really have no idea what's going to be available here, and the state is doing nothing to fill that information gap. Meanwhile, we're being assaulted by Koch Bros. advertising trying to scare people from the exchanges.
posted by Thorzdad at 6:20 AM on August 27, 2013 [2 favorites]
Unfortunately, Indiana is one of those "over our dead bodies" states that has vociferously opposed Obamacare in any shape or form. We really have no idea what's going to be available here, and the state is doing nothing to fill that information gap. Meanwhile, we're being assaulted by Koch Bros. advertising trying to scare people from the exchanges.
posted by Thorzdad at 6:20 AM on August 27, 2013 [2 favorites]
Medicare is completely funded by the Federal government and the Feds control and manage all spending for Medicare. The states have nothing to do with Medicare. Eligibility is determined by the Feds and includes most people over 65 and disabled.I'm sorry. But this is not correct. Medicare coverage that is applied is different for each state.
posted by JackFlash at 10:47 PM on August 26 [1 favorite +] [!]
There is a NCD (National Coverage Database) as well as a LCD (Local Coverage Database). The NCD is ALWAYS applicable, the LCD is based on the billing department of the provider.
An ABN (Advance Benficiary Notice) form is what your provider will give to you if there is a concern that the procedure/test/etc that you're having done will not be paid for by Medicare. It essentially states the procedure, the estimated cost of the procedure, and a reason why it would not be paid for by Medicare.
posted by Blue_Villain at 6:34 AM on August 27, 2013
I thought it was being suggested the state was threatening to administer Medicare in a way that denied some benefits on the justification that the Medicaid deficits required it. More likely, the sources and reporters just didn't know what they were talking about.For clarification, the NCD that I mentioned above is guaranteed to EVERY PERSON ON MEDICARE. This is essentially the "bare minimum" that is funded federally.
posted by saulgoodman at 6:18 AM on August 27 [+] [!]
LCD coverage is when the state can choose to go "above and beyond" the bare minimum. So instead of allowing a certain exam once a year, the state may choose to allow it once every six months.
The "more likely" scenario is that nobody understands what they're talking about. Medicare coverage is confusing as shit.
posted by Blue_Villain at 6:41 AM on August 27, 2013
Ach. Federalism makes everything too complicated.
posted by saulgoodman at 6:52 AM on August 27, 2013
posted by saulgoodman at 6:52 AM on August 27, 2013
No one needs a fucking "B12 shot." It's pure-D quackery. So I'm glad to hear the anecdote in which it wasn't covered by insurance. Do doctors still peddle that B12 bullshit?
posted by spitbull at 11:41 on August 27 [+] [!]
Cite, please? Wikipedia discusses the condition, as does my physician. And I get shots. Mind, Wikipedia says this tends to be fatal without the shots, which I hadn't read before.
posted by Goofyy at 7:01 AM on August 27, 2013
posted by spitbull at 11:41 on August 27 [+] [!]
Cite, please? Wikipedia discusses the condition, as does my physician. And I get shots. Mind, Wikipedia says this tends to be fatal without the shots, which I hadn't read before.
posted by Goofyy at 7:01 AM on August 27, 2013
People are just mad it wasn't called "BushCare".
Whole other story.
posted by stormpooper at 7:24 AM on August 27, 2013
Whole other story.
posted by stormpooper at 7:24 AM on August 27, 2013
People are just mad it wasn't called "BushCare".
Oh, I get that for free. No co-pay, even!
obvious joke is obvious
posted by phunniemee at 7:51 AM on August 27, 2013
Oh, I get that for free. No co-pay, even!
obvious joke is obvious
posted by phunniemee at 7:51 AM on August 27, 2013
I have good insurance (comparatively to most people I know.) You still fucking wait no matter what.
We've kind of swallowed whole the idea that "rationed care" is something that only exists under a single-payer or federally mandated plan. The truth is that care does have to be rationed - over time, at least - because of its expense and the need to manage it without further increasing waste. What the free-marketeers don't want us to recognize is that the market rations care, too - your insurance company has captured you, wants your dollars, and can only move you through the pipeline so fast.
posted by Miko at 7:56 AM on August 27, 2013 [3 favorites]
We've kind of swallowed whole the idea that "rationed care" is something that only exists under a single-payer or federally mandated plan. The truth is that care does have to be rationed - over time, at least - because of its expense and the need to manage it without further increasing waste. What the free-marketeers don't want us to recognize is that the market rations care, too - your insurance company has captured you, wants your dollars, and can only move you through the pipeline so fast.
posted by Miko at 7:56 AM on August 27, 2013 [3 favorites]
Medicare coverage that is applied is different for each state.
No, that is not the way it works. The NCD is a National Coverage Determination that applies nationally. The LCD is a Local Coverage Determination that applies to everything that is not explicitly defined nationally. The LCD is handled regionally by Medicare Administrative Contractors. Individual states have nothing to do with it. It is federally controlled. These are federal contractors. States cannot choose to go "above and beyond." They have no authority over the LCD. The LCD is decided between the national and regional Medicare administrators, all federally controlled.
The article saulgoodman is referring to above is talking about something else. The ACA is reducing payments to Medicare providers, meaning hospitals. You may recall Republicans attacking Obama in the last election as a Medicare cutter to scare seniors. The reason for the cuts is that hospitals include in the charges for every service a certain amount to cover the significant number of uninsured that never pay their bills. In other words, the insured are paying for the uninsured.
Under the ACA, part of this payment reduction is recaptured because of the insurance mandate. Everyone must have insurance. This means regular insurance payments can be lower because there are fewer uninsured who don't pay their bills. However, the mandate does not apply to the very poor who are under Medicaid. So unless states accept the Medicaid expansion in the ACA, their hospitals will still be losing money to unpaid bills.
So the article is not talking about states literally shifting money from Medicare to Medicaid. They cannot do that because Medicare is administered federally. Instead what they are talking about is filling up the hole created by Medicare payment reductions with increased payments from Medicaid expansion and fewer unpaid bills.
Some states, like Florida in the article, are refusing to do the Medicare expansion in the ACA because -- socialism. Even though the Feds are paying for 100% of the expansion to start and 90% in 2020, many red states will not be implementing it. This means millions of low income people will be covered by neither Medicaid nor the ACA insurance exchanges. The hospital industries and lobbyists in these states are applying pressure to their recalcitrant politicians because they stand to lose lots of money if the Medicare payment reductions go into effect and are not replaced by increased Medicaid payments.
This right of the states to refuse to implement Medicaid expansion is part of the goofy split Supreme Court ruling on the ACA engineered by Justice Roberts. Red states are using the opening to refuse the program because they can say they are refusing Obamacare.
posted by JackFlash at 8:25 AM on August 27, 2013 [1 favorite]
No, that is not the way it works. The NCD is a National Coverage Determination that applies nationally. The LCD is a Local Coverage Determination that applies to everything that is not explicitly defined nationally. The LCD is handled regionally by Medicare Administrative Contractors. Individual states have nothing to do with it. It is federally controlled. These are federal contractors. States cannot choose to go "above and beyond." They have no authority over the LCD. The LCD is decided between the national and regional Medicare administrators, all federally controlled.
The article saulgoodman is referring to above is talking about something else. The ACA is reducing payments to Medicare providers, meaning hospitals. You may recall Republicans attacking Obama in the last election as a Medicare cutter to scare seniors. The reason for the cuts is that hospitals include in the charges for every service a certain amount to cover the significant number of uninsured that never pay their bills. In other words, the insured are paying for the uninsured.
Under the ACA, part of this payment reduction is recaptured because of the insurance mandate. Everyone must have insurance. This means regular insurance payments can be lower because there are fewer uninsured who don't pay their bills. However, the mandate does not apply to the very poor who are under Medicaid. So unless states accept the Medicaid expansion in the ACA, their hospitals will still be losing money to unpaid bills.
So the article is not talking about states literally shifting money from Medicare to Medicaid. They cannot do that because Medicare is administered federally. Instead what they are talking about is filling up the hole created by Medicare payment reductions with increased payments from Medicaid expansion and fewer unpaid bills.
Some states, like Florida in the article, are refusing to do the Medicare expansion in the ACA because -- socialism. Even though the Feds are paying for 100% of the expansion to start and 90% in 2020, many red states will not be implementing it. This means millions of low income people will be covered by neither Medicaid nor the ACA insurance exchanges. The hospital industries and lobbyists in these states are applying pressure to their recalcitrant politicians because they stand to lose lots of money if the Medicare payment reductions go into effect and are not replaced by increased Medicaid payments.
This right of the states to refuse to implement Medicaid expansion is part of the goofy split Supreme Court ruling on the ACA engineered by Justice Roberts. Red states are using the opening to refuse the program because they can say they are refusing Obamacare.
posted by JackFlash at 8:25 AM on August 27, 2013 [1 favorite]
States cannot choose to go "above and beyond."
My apologies, you're correct that my wording was poorly formed. The point I was trying to make is that the LCD is different for each state. All of which is governed by a federally funded body...
But it is in fact different for each state/region. Otherwise the LCD files would not be necessary. The logic there is that certain things are approved for Local areas that are different than the National areas.
If this is not the definition of basic versus above and beyond then we're just splitting hairs.
posted by Blue_Villain at 8:36 AM on August 27, 2013
My apologies, you're correct that my wording was poorly formed. The point I was trying to make is that the LCD is different for each state. All of which is governed by a federally funded body...
But it is in fact different for each state/region. Otherwise the LCD files would not be necessary. The logic there is that certain things are approved for Local areas that are different than the National areas.
If this is not the definition of basic versus above and beyond then we're just splitting hairs.
posted by Blue_Villain at 8:36 AM on August 27, 2013
Look, Blue_villain, try to keep up here. Saulgoodman was looking for an explanation of an article about Florida having a problem with Medicare payment reductions because they are refusing to implement the Medicaid expansion. The misunderstanding was that states are shifting Medicare money to Medicaid. As I pointed out that is impossible because the states have no control over Medicare spending. That is exclusively controlled and decided by the Feds.
And then you jumped in with a bunch of irrelevant stuff about NCDs and LCDs which have nothing to do with state spending of Medicare money. States have no control over Medicare spending and your comments have nothing to do with saulgoodman's question. Nobody disputes the fact that payments vary among regions, states, even zip codes, but states do not control that.
posted by JackFlash at 8:51 AM on August 27, 2013
And then you jumped in with a bunch of irrelevant stuff about NCDs and LCDs which have nothing to do with state spending of Medicare money. States have no control over Medicare spending and your comments have nothing to do with saulgoodman's question. Nobody disputes the fact that payments vary among regions, states, even zip codes, but states do not control that.
posted by JackFlash at 8:51 AM on August 27, 2013
Is it any wonder there's so much opposition to the program, when you have people who think they'll go to jail if they don't sign up? Fear sells, and many are buying.
posted by 4midori at 9:31 AM on August 27, 2013
posted by 4midori at 9:31 AM on August 27, 2013
We have excellent, "gold", employer-paid insurance. The hospital is owned by (or named after) an insurance company. We live in the U.S.
When I yell "Go Bucks" you just nod your head. K?
posted by hal9k at 10:10 AM on August 27, 2013
When I yell "Go Bucks" you just nod your head. K?
posted by hal9k at 10:10 AM on August 27, 2013
I'm sorry, saulgoodman, I read your comment and completely failed to notice that it had a link in it. I thought you were saying that all states were mandated to expand coverage but only some states were accepting funding to do so.
Anyway, carry on ....
posted by gerstle at 12:19 PM on August 27, 2013
Anyway, carry on ....
posted by gerstle at 12:19 PM on August 27, 2013
He's a Man You Must Believe
It turns out that of the various sources of information about the ACA, people say they trust "your doctor or nurse" the most (quite sensibly, people claim to trust "social networking sites" the least, although that they say that doesn't, again, mean it's actually true). It's not anywhere close to the most used source; only 22 percent say they've recently heard something about ACA from "Your doctor or another health care professional." But what they hear, they say they trust.posted by zombieflanders at 8:19 AM on August 29, 2013 [1 favorite]
What all this makes me wonder about is whether doctors are in fact a significant source of misinformation about Obamacare.
It's pretty unlikely, in my view, that doctors are particularly well-informed about the ACA -- at least, about the kinds of questions that consumers would have. Why should they be? I suppose some they would know about some of the cost-control reforms, at least to the extent that it directly affects them. But the whole exchanges/subsidies/mandate portion of it doesn't really have much to do with doctors, at all. At least not directly.
Meanwhile, doctors strongly tend to be Republicans, and I'd guess that doctors probably fit comfortably into the Rush Limbaugh listening demographic. The odds that doctors have heard, and would believe, various Obamacare myths strikes as very high. Are they then passing those myths along to patients (and others they meet)? And are people who might dismiss something if it was email forwarded from Uncle Larry assuming that if a doctor said it, it must be true? If so: how much of the misinformation out there does it account for?
I desperately need health insurance and every time I mention how much I am looking forward to January 2014 EVERY doc responds with, "well we don't really know what to expect, do we?". And I suppose we don't but the tone of the comment always gives me pause. I need health insurance! Do they not want me to have health insurance too? My life is basically on hold until I get coverage.
posted by futz at 1:22 PM on August 29, 2013 [3 favorites]
posted by futz at 1:22 PM on August 29, 2013 [3 favorites]
Thanks to all who asked. Luckily, the mass had disappeared. It looked like I had a cyst that went away. Unfortunately the one of the nodules in my lung grew and now I wait for my pulmonologist appointment for my next step. Appointment for that is September 24th.
Again, a wait. Again, with good insurance in the USA.
posted by SuzySmith at 3:27 PM on August 29, 2013 [1 favorite]
Again, a wait. Again, with good insurance in the USA.
posted by SuzySmith at 3:27 PM on August 29, 2013 [1 favorite]
Welcome to Canada, Kentucky!
I've never in my life waited more than a couple of days to get an appointment with my GP or Gyno, and that's almost always due to my schedule being bonkers. If you need to see a specialist it takes longer yes, but if it's urgent, no it doesn't. If you need an MRI then go on non-business hours (after 6pm) and you can get your appt in about a week, sometimes even sooner. Family who needed an MRI got one within 24hrs because they were willing to go to the hospital for it after 11pm. Too many Canadians are massive whiners who don't make any effort to work with the system, throw a tantrum, and then say the system doesn't work. Feh!
posted by zarah at 4:05 PM on August 29, 2013
I've never in my life waited more than a couple of days to get an appointment with my GP or Gyno, and that's almost always due to my schedule being bonkers. If you need to see a specialist it takes longer yes, but if it's urgent, no it doesn't. If you need an MRI then go on non-business hours (after 6pm) and you can get your appt in about a week, sometimes even sooner. Family who needed an MRI got one within 24hrs because they were willing to go to the hospital for it after 11pm. Too many Canadians are massive whiners who don't make any effort to work with the system, throw a tantrum, and then say the system doesn't work. Feh!
posted by zarah at 4:05 PM on August 29, 2013
Too many Canadians are massive whiners
My wife waited a year to see a specialist about painful varicose veins in Toronto. Absolutely, not a very life-threatening issue. Still, not fun just putting up with it. She's having a recurrence of the issue and here in the US and with private insurance she waited... a week.
As for a MRI, ha, who is going to refer you for an MRI in Canada unless you have cancer? No one, Go get an xray.
Don't get me wrong, I think the Canadian system is fine, but it's naive to say it's without any flaws. It can be terribly, terribly hard to find a competent GP who is willing to take new patients, in both big cities and rural areas. This is the same problem people face with the NHS in the UK - that it's much faster to go the private route. It will be the same people face with the insurance plans coming through the ACA.
Is it better than not having insurance? Absolutely! But there will definitely be problems. And people will compare state exchange insurance plans to existing plans that people from big companies get and clearly see that there is a very different level of service. It remains to be seen what things people will see improve.
posted by GuyZero at 4:30 PM on August 29, 2013
My wife waited a year to see a specialist about painful varicose veins in Toronto. Absolutely, not a very life-threatening issue. Still, not fun just putting up with it. She's having a recurrence of the issue and here in the US and with private insurance she waited... a week.
As for a MRI, ha, who is going to refer you for an MRI in Canada unless you have cancer? No one, Go get an xray.
Don't get me wrong, I think the Canadian system is fine, but it's naive to say it's without any flaws. It can be terribly, terribly hard to find a competent GP who is willing to take new patients, in both big cities and rural areas. This is the same problem people face with the NHS in the UK - that it's much faster to go the private route. It will be the same people face with the insurance plans coming through the ACA.
Is it better than not having insurance? Absolutely! But there will definitely be problems. And people will compare state exchange insurance plans to existing plans that people from big companies get and clearly see that there is a very different level of service. It remains to be seen what things people will see improve.
posted by GuyZero at 4:30 PM on August 29, 2013
I've never in my life waited more than a couple of days to get an appointment with my GP
Let me reiterate - that's because you already have a GP. Try moving to a new town and finding a competent GP. I live in Toronto for 10 years and frankly, of all the GPs I dealt with none were even borderline competent. Thank god I don't have any real medical problems.
posted by GuyZero at 4:31 PM on August 29, 2013
Let me reiterate - that's because you already have a GP. Try moving to a new town and finding a competent GP. I live in Toronto for 10 years and frankly, of all the GPs I dealt with none were even borderline competent. Thank god I don't have any real medical problems.
posted by GuyZero at 4:31 PM on August 29, 2013
When Obamacare sabotage turns cruel
Republican officials are still eager to sabotage the federal health care system and prevent the uninsured from getting coverage in the new system. Their other attempts at sabotage have had mixed results, so GOP lawmakers are now launching an intimidation campaign, going after the navigators in the hopes of making sure those who don't have insurance stay that way.posted by zombieflanders at 8:40 AM on September 5, 2013 [1 favorite]
Republicans in different states are targeting navigators in different ways. In Ohio, navigators are forbidden from comparing and contrasting insurance plans for customers. Why? Just because. In Georgia, navigators are now expected to pass the state insurance-agent test. Republicans in Congress are hoping to bury navigators in a mountain of paperwork, demanding that they produce unrealistic amounts of materials by next week or else.
But Brian Beutler reports this week on a heartless twist on the larger effort.Last week, as several other outlets reported, Republicans on the House Energy and Commerce Committee sent letters to state agencies and nonprofit groups that received Obamacare "navigator" grants -- organizations that will help educate people about the law and facilitate their enrollment -- seeking an incredibly broad and difficult-to-compile range of information.This is no small detail.
The effort's pretty clearly intended to bog down the navigators ahead of enrollment, which could easily reduce the number of people who end up insured under the law. Republicans claim that the inquiry is intended to protect beneficiaries' private information.
But if the goal were to establish best practices for the navigators, they have a strange way of going about it. All of the navigator grant recipients are based in states with federally facilitated exchanges and states partnering with the feds to stand up their marketplaces. Salon's analysis reveals that among these states, Republicans directed their inquiries to organizations in states with the largest uninsured populations.
Congressional Republicans aren't just harassing navigators out of partisan spite; these GOP lawmakers are carefully targeting navigators in specific states. The effort could have taken a broader approach and launched a national intimidation campaign, but Republicans instead skipped past navigators helping consumers in states where the rates of the uninsured are already rather low.
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posted by 2N2222 at 7:12 PM on August 26, 2013 [32 favorites]