Will Obamacare improve health insurance market?

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Republicans say Obamacare with a sneer, Democrats with a smile.

But Obamacare — either used as a pejorative or a reflection of pride (depending on your view of health care reform) — is coming.

The Patient Protection and Affordable Care Act, the official name for Obamacare, is law and will be a reality in 2014.

The political debate continues even as Obamacare goes on the books. Our elected officials from the political right and political left are not willingly pulling in the same direction.

Yet, the carping might ultimately yield some public benefit — at least in Washington state.

There might be be some positive news for consumers related to the Obamacare-mandated health-insurance exchange, essentially a competitive marketplaces for individuals and small businesses to purchase insurance.

This summer Washington state Insurance Commissioner Mike Kreidler, who under the new law is required to establish a state exchange, caught heat from Republicans for rejecting some applications from insurance companies to list policies on the exchange. The overridng concern was that accepting only four companies (one of which is a subsidiary of another) would eliminate the competition that was supposed to keep prices low.

Sen. Linda Evans Parlette of Wenatchee said the “companies that have dominated Washington’s insurance market in recent years will likely operate without new competition in the exchange.”

Despite Kreidler’s assertion that the four companies would provide enough options and value, we saw Parlette’s concern as valid.

However, a few days after the August uproar Kreidler approved new plans from a couple of companies that were originally rejected, according to Seattle Times’ editorial writer Bruce Ramsey in his editorial blog. A few days after that Kreidler approved another and then another.

After the companies’ plans were rejected, they changed their proposals to make them acceptable enough to get Kreidler’s approval. This would seem to be a positive development.

The GOP concerns might not have had anything to do with adding more companies, but they probably didn’t hurt.

Still, the concepts in the Affordable Care Act have yet to be tested in real life. Expect some bumps along the way and more political rhetoric with each bounce.

It’s not possible to keep partisan politics out of this (or any other resulting from congressional action), but it would be best for Washingtonians if the variety of plans approved for the exchange meet their various health-care needs.

Comments

PearlY 7 months, 2 weeks ago

Obamacare is going to drive overall costs dramatically higher. I've been checking out how it will affect people like me, and here's what I've found.

I've had an individual plan for more than three decades. It started out as exactly what I wanted - moderately high deductible, no coverage of predictable events, and limited maximum out of pocket (OOP) cost. And low premium. Over time, state law mandated coverage for things I consider of marginal to no value - acupuncture, massage therapy, naturopaths, chiropractors, and mental health counselors. This added to the cost, but even so, premiums were relatively modest - $300 a month for an over 55-year old. Deductible $1,750, 80% coverage, $3,750 maximum OOP. No preventive care coverage (I prefer to budget for that, since it's entirely predictable). No prescription coverage.

So I paid $300 a month, another $300 a year for check-ups and the odd prescription, and once every four or five years, exceeded my deductible and got 80% coverage above that. If I'd had a major health problem, though, the worst that could happen to me might be $4,000 in a year, plus possibly in very unlikely circumstances, several thousand more for prescriptions. I was happy because, even though I rarely exceeded my deductible, I was protected against costs that would financially cripple me, and my insurance company negotiated lower prices for what care I did receive, to my benefit.

Obamacare had increased my maximum OOP to $10,000, and my deductible to $2,500, giving me in return about $300 a year in check-ups coverage. To do that, it's increased my premium so far to $457 a month, BUT under the new exchanges' "silver plan", the premium will increase to over $700 a month.

HOWEVER, because in my early retirement my income will likely be "low", Obamacare will subsidize me by almost $500 a month. So I'll only pay $200 a month. In fact, I could switch to a "gold" plan and still pay just about what I was paying pre-Obamacare, with much more comprehensive coverage.

So, obviously, this is good for me. I'm paying less or about the same for coverage that far exceeds what I consider adequate.

But is it good for the country? Since I'll have more coverage, I'll use more health care services; before, I had to weigh whether it was worth it and often it was not: most health issues self-resolve with a little time and home remedies.

The result in my case, and in most other cases of low to middle income people, will be to increase utilization with little to no financial constraint on decision-making, at the same time that nominal premiums will have nearly tripled, offering coverage more generous than most people would buy for themselves.

There is simply no way this is going to bring health care costs down. It most likely will make them skyrocket.

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NewInWW 7 months, 2 weeks ago

You continue to confuse your personal situation with national results. Uninsured patients now go to acute care hospital ERs to get care. That is the most inefficient and expensive way to deliver care. If the people who are currently uninsured go to a PCP instead of a hospital ER, the cost for those patient will go down dramatically, and the cost of one day in a hospital will also go down.

I'm sorry you don't like Obamacare, but you really need some facts to back up your stories, and right now you have none. Frankly, no one can tell what the overall cost or benefit of Obamacare will be, because it's pretty complex. How do we calculate the value of better health for our currently uninsured children who may pass a bug on to an entire class of insured children? How much productivity do we lose to sick days for uninsured workers?

You live in your cute little world, with the certainty of your individual experience - I'm sorry, the world is bigger than that.

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PearlY 7 months, 2 weeks ago

You continue to confuse your hopes and dreams for meaningful predictions, and political propaganda for reality.

Do you seriously think sick children are going to stop going to school and infecting others, or that workers will no longer take sick days because of Obamacare? Talk about a cute little world!

Can you seriously deny that premiums are shooting up as Obamacare is implemented? That's not just my personal situation, it is reported across the country, from virtually every state.

The health insruance estimators are now available online. Anyone can run some numbers - not necessarily their own - to see what the cost consequences will be. Those are facts: Richer plans at a higher cost, but an externalized higher cost, so that recipients will be effectively encouraged to over-utilize. In fact, this was a big part of the rationale for the excise tax on Cadillac plans - that they encouraged over-utilization by trimming co-pays and deductibles; apparently even Obamacare advocates can bow to the basic laws of economics when it justifies a new tax.

It's stunning to me that you approve of completely restructuring an industry that is about a sixth of the entire economy, throwing the lives and fortunes of millions into chaos, and blythely declare that "no one can tell what the overall cost or benefit of Obamacare will be." But it's sweet that you are already preparing the defense of its inevitable failure to lower costs by adding amorphous and completely unprovable fake benefits to the equation.

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NewInWW 7 months, 2 weeks ago

The US spends more on health care per capita than any other nation, yet has a huge population that has no basic health care. I would reverse your question and ask how we could NOT restructure an industry which is so abjectly failing us?

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PearlY 7 months, 1 week ago

NewInWW.

I believe I've gone over the statistics before on who made up the uninsured population but maybe you weren't on that thread: About 15% were people who earned more than $50,000 a year and therefore can definitely afford "basic health care", about 20% are undocumented immigrants most of whom have government provided health care available in their home countries, and almost all the rest qualify for Medicaid but just haven't had reason to apply yet. The population of those who don't have basic health care available one way or another is trivially small, not huge.

It's not "the US" that spends more on health care, it's the combination of the US government (mostly through the forcibly implemented program called Medicare*) AND millions of individual citizens making their own decisions. How is it your or the government's business how much I spend on my health care?

I'm pretty sure Americans also spend more on pet care than any other nation, and yet have a huge population of pets that lack health care. Is the American veterinary industry abjectly failing us, despite being the best in the world? Must we restructure that, too?

*Are you aware that if I were to refuse to apply for Medicare when I reach 65, not only would I not get back the tens of thousands of dollars that have been extracted from me for that program, but I would also lose my Social Security benefits, for which I've ostensibly been paying many tens of thousands of $$ more all my life? Once the government gets it into its mind to control some part of your life, it's not gentle about it.

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NewInWW 7 months, 1 week ago

"Are you aware that if I were to refuse to apply for Medicare when I reach 65, not only would I not get back the tens of thousands of dollars that have been extracted from me for that program, but I would also lose my Social Security benefits, for which I've ostensibly been paying many tens of thousands of $$ more all my life?"

This is surprising. Do you have any authority for this statement?

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PearlY 7 months, 1 week ago

Yes. See the article at http://www.govhealthit.com/news/lawsuit-challenges-rule-coupling-social-security-and-medicare-wants-scotus-ear and read the opinions linked in the article. A refusal to accept Medicare benefits at age 65 (in favor of opting for private insurance or self-insurance) not only requires you to forego your future Social Security benefits but to pay back any benefits received if you elected early retirement and started collecting Soc Sec at 62.

The article mentions that the plaintiffs have appealed to Scotus. Scotus has since declined to hear the case.

Why would you find this surprising? "Choice" (personal liberty) is not viewed favorably by big-government planners.

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NewInWW 7 months, 1 week ago

Who knew? However, I'm not sure I see the terrible governmental imposition of applying for premium free part A. Thereafter, nothing says you have to use it (other than perhaps your private insurance company which will want to use Medicare for part of what the insurance company would otherwise be liable for).

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PearlY 7 months, 1 week ago

I think there's quite a bit you don't know about this:

If you're on Medicare, it is illegal for any doctor who accepts ANY Medicare patients to treat you and bill you except through Medicare, and in treating you through Medicare he/she MUST conform to Medicare regulations concerning treatment choices.

So, No, it is not an option to enroll in Medicare and then not use it. There would be few to no providers available to you, since they could not accept a single Medicare patient and also treat you outside of Medicare.

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fatherof5 7 months, 2 weeks ago

PearlY, I appreciate that you went to some lengths to outline your experience thus far. For me, there were three takeaways:

1) Your net cost/coverage will be similar or improve under Obamacare. This is a good thing.

2) Your concern about this is that you will more readily use the expanded healthcare services that are now covered. My guess is that - over time - and spread out amongst the entire population - a greater utilization of health services will result in lower costs. That sounds counter-intuitive, but there are a LOT of expensive diseases out there (see coronary or cancer, for example) that cost a whole lot less when caught early. (Not to mention the fringe benefit that people tend to survive, too.)

3) If your net experience is roughly a wash, isn't it great that we can do that for folks like you who were already are covered, and still add coverage for millions of previously uninsured folks without increasing the deficit? (see CBO) If that isn't a "win-win," it's at least a "not-lose - win."

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PearlY 7 months, 1 week ago

Fatherof5, you raise intelligent points.

1) Consider that I paid $300/mo for a plan that was (nearly) exactly what I wanted. Under Obamacare, the plan that most closely approximates the traits I liked of my old plan will cost over $900/mo. (and will also offer additional coverage that I don't much value). If my new premium for that coverage is $250 a month, with the rest subsidized by someone else, I will have received a $50/mo benefit, at a cost to others of $650/mo. Economists probably have a special name for this, but I would just call it a waste of $600/mo 2. Lots of stuff about economics is counter-intuitive. But I don't think you're right about expensive diseases being caught early costing less. Spend $2,000 to give each of 60 million people a colonoscopy, and you'll probably catch a few hundred early stage colon cancers at a point where you can treat them easily, but you'll also have a few tens of thousands of questionable polyps so those people will be returning every few years for re-dos, and you'll have a few hundred more who will be aggressively treated at huge expense and saved, etc.

It is probable the mortality rate for colon cancer would go down, which is undeniably a good thing. But that doesn't mean the COST would go down.

3) As the Spartans said to Philip of Macedon, "If."

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PearlY 7 months, 1 week ago

I should have added that, in addition to the so-called "benefits" that Obamacare offers and the dollar costs to individuals and the taxpayers, there are other, less easily quantified costs that everyone is ignoring.

In a collectivized health care system, each individual is responsible to the collective for his/her health care decisions. He who pays the piper always finds a way to call the tune, and this is/will be no exception. With responsibility goes control, and with government responsibility for paying for health care will come government control over every aspect of health care. Are you really OK with that?

Already it's been reported that the Centers for Medicare and Medicaid Systems proposes to require health care providers to report "social and behavioral data" on their patients. Granted that would help improve the health care of "the population," their stated objective, but only at the cost of making the population little better than livestock to be professionally managed. I'm not thrilled about my government viewing me, you or anybody else as cattle to be managed.

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fatherof5 7 months, 1 week ago

I haven't heard about the "social and behavioral data" and couldn't comment yet, but as for "government control over every aspect of health care," you ask if I am really okay with that. I have two responses.

First, Obamacare is not single-payer, government-controlled, socialized medicine. "Control" is roughly divided between one's doctor, one's insurance company, and government regulations...plus whatever control the patient has.

Second, I would very much like to remove the insurance company from the equation, so that decisions are made between the doctor and the patient - and made within the parameters of regulations created by a government that at least has some accountability to the people and is not motivated by profits.

Someone has to set the reasonable limits. By law, insurance companies must put the interests of their shareholders first and maximize profits. They are inherently motivated to take as much of my money as possible and give me as little in return as possible.

A government agency - while also run by humans who are flawed - at least does not have a motivation to screw me over. Like the FDA and the USDA, a government agency like Medicare exists to serve the public. It is not always perfect, but it doesn't take profits and it is accountable to someone.

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PearlY 7 months, 1 week ago

Obamacare is not single-payer socialized medicine YET. However, as I've said before, it is my view that the purpose of Obamacare is to destroy the remnants of private health insurance so that no option will remain but socializing it.

Your dream of patient--doctor control is exactly what I have enjoyed for over three decades with Regence - a non-profit as it happens - and have now lost due to Obamacare. I don't WANT them removed from my equation - they've been nothing but helpful to me for all that time at a reasonable cost while respecting my privacy, my time, and my wishes as to health care issues.

I know it is hard for those who are enamored of socialist solutions to understand, but maximizing profits is exactly the reason most businesses focus like lasers on the interests of their CONSUMERS. In order to take your money from you, since they're not allowed to do it with guns the way the government can, they have to get you to WANT to give it to them.

A government agency is run by people who are just as self-interested as business employees, but who lack the motivation to persuade you to give it your money, because their agency already has the power to take it. In other words, they have the same bad motives, but little in the way of countervailing pressures to behave well toward consumers.

Last week I had to call Social Security with a question. After navigating a half-dozen phone tree choices, I was on hold for 48 minutes before my call was answered by a rude and ignorant individual whose answer to my question left me convinced only that I still had no idea of the correct answer. This has been typical of all my dealings with federal bureaucracies (except for the rudeness, which runs at about 50/50). On the other hand, I've called Regence many times, and never waited more than a minute or two to speak to a polite, friendly and knowledgeable operator. Even non-profits have to compete. The government does not.

Year after year, administration after administration, we have politicians demanding more money for education and decrying its inadequacies - Washington DC youngsters whose cost of education is the highest or second highest in the nation but mostly can barely read, etc. Yet government has run education for many decades, without figuring out how to do it competently. It seems delusional to me to believe, as you apparently do, that it will do better with a health care system which is vastly more complicated.

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VinoTinto 7 months, 2 weeks ago

There is so much technology associated with The Affordable Care Act and Meaningful Use that is going to cut overhead and provide access to so many patients and providers, the like which we have never seen before in this country. October 1, 2014 is a major implementation date for many of these technologies, so consumers will not fully enjoy the benefits of Obamacare until the 4th quarter of next year.

This is going to be revolutionary! People will not give up Obamacare unless something better is offered in its place. I'm sorry where is the Republican plan? Exactly, they don't have one. Instead of bemoaning Obamacare, put your heads together and try to resolve one of the country's problems for a change. Whining, complaining and being paranoid is not sexy.

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downhillracer 7 months, 1 week ago

Using "Breitbart" as a source of unbiased news is the funniest thing I've seen all day. What. A. Joke.

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namvet60 7 months, 1 week ago

downhillracer - "NUMBSKULL" - that piece came from Obama network MSNBC. Do you ever wakeup or are you in a coma all the time?

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downhillracer 7 months, 1 week ago

This was a piece spun for effect and to support your narrative, shallow-it-may-be. If you're going to quote MSNBC, then quote them, not the reconstituted nonsense of a dead cocaine addict. For factual information, there are plenty of academic resources, should you care to invest the time with an open mind (not likely).

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PearlY 7 months, 1 week ago

That implies there IS some source of unbiased news. That would be what, in your opinion?

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VinoTinto 7 months, 1 week ago

And there's Nanny Vet's go to, "I don't understand so you're stupid". Total schmuck!

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VinoTinto 7 months, 1 week ago

And Nam Vet sounds like a lonely old man who needs attention!

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PeggyJoy 7 months, 1 week ago

Obama CareFacts: Dispelling the Myths Obama's Health Care Refordm http://obamacarefacts.com/

ObamaCare ObamaCare Bill ObamaCare Facts What is ObamaCare? Cost of ObamaCare Obama Health Care Summary Health Care Reform Timeline How Does ObamaCare Work? ObamaCare Small Business ObamaCare Employer Mandate Health Insurance Exchange State Health Insurance Exchange ObamaCare's Medicaid Expansion ObamaCare Medicare Benefits of ObamaCare ObamaCare Taxes Health Insurance Premiums Women's Health Services Impact of ObamaCare on Jobs Affordable Care Act Summary ObamaCare Myths ObamaCare Pros and Cons Health Care Facts ObamaCare Stories

This should answer everyone's questions about "ObamaCare."

NamVet............I bet you wouldn't be complaining if it was called "BushCare" or "GOP-Care." Would you? So quit your complaining and be happy, that this available for the millions in this country.

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PeggyJoy 7 months, 1 week ago

Thanks! Hopefully, Nam and his buddies will read and educate themselves on the ACTUAL FACTS, instead mouthing the right-wing jackasses on talk radio and Fox "Factless" News.

For Nam and his buddies: Obama CareFacts: Dispelling the Myths Obama's Health Care Refordm http://obamacarefacts.com/

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namvet60 7 months, 1 week ago

There are some of us that have not joined this Administrations flock of sheeple.

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fatherof5 7 months, 1 week ago

Even if Obama were right on healthcare or other issues, namvet, you wouldn't support those ideas. Your mind is set to oppose everything he does. That simply makes you sheeple from a different flock.

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namvet60 7 months, 1 week ago

It is just really sad that the incompetence of this Administration hasn't accomplished anything worthy of support.

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downhillracer 7 months, 1 week ago

No, it's sad you're so blinded by your hate for "this Administration" you can't look up and find anything of value. What a sad, selfish and lonely ending you face.

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PeggyJoy 6 months, 4 weeks ago

You should know, Nam. You've been a member of the GOP sheeple for decades.

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PearlY 7 months, 1 week ago

As I continue to study my options when Obamacare is implemented, it turns out my earlier assumption that at least my own health care would be less expensive was over-optimistic.

I only get a subsidy on the dramatically higher premiums I face IF I purchase my insurance through the state exchanges. However, if California is typical of how these will be set up, the State's requirements on insurers will make entry into the exchange undesirable by limiting the number of doctors who will be available, ensuring that patients will face long wait times for appointments and poorer quality care from rushed and overburdened doctors, while quality doctors will be disinclined to accept exchange patients.

Or so we can conclude from the LA Times' report on how California is implementing its exchanges.

Bummer. Looks like I'll have to go with the unsubsidized plan that is considerably worse than the one I had for $300/mo, and will pay $700/mo for it. And unlike the unions, who are only now "learning what's in it" and freaking about it, I won't get any Obama waiver.

Thanks, to all of you who elected the politicians who have dramatically worsened an important part of my life and those in my situation, of whom there are millions. I'm sure your feeling of self-satisfaction at helping a few others at our expense will shield you from any concerns.

From Investors' Business Daily of 8/29/13:

"We will keep this promise to the American people. If you like your health care plan, you can keep your health care plan. Period. No one will take it away."

That was President Obama selling ObamaCare in 2009, and it was a promise he repeated on numerous occasions. As recently as this spring, Obama claimed that "for the 85% to 90% of Americans who already have health insurance ... they don't have to worry about anything else."

[For careful readers, the part of the quote represented by the ellipses is only "he says". I looked it up to make sure he was not being quoted out of context.]

Even those of you who adore Obama have to admit these are promises he has broken and moreover, had to have known he was going to break when he made them.

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namvet60 7 months, 1 week ago

Perfectly stated PearlY and I totally agree with your total post. Just as the Unions are finding out if some of these people actually read and find out what the legislation reads I don't think that they will be as happy with it as they anticipate.

Of course fatherof5 will state that I'm falling into a flock of sheeple of another nature. I'm finding that this President cannot make up his mind if he wants to be a war hawk or just relinqush all credibility and allow the Soviet Union to become the new world power?

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Jo99362 7 months, 1 week ago

I am disappointed that vision and dental is not deemed necessary for healthcare coverage.

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VinoTinto 7 months, 1 week ago

I totally agree, especially where the dentist is concerned. I think there may me a small vision benefit in these plans. You get an amount to spend every two years on either glasses or contacts, but it's really not enough.

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PearlY 7 months, 1 week ago

Indeed. And think how important good car tires and brakes are to one's health. They should be covered, too. Not to mention fruits and vegetables, multivitamins, smoke detectors, well-lighted and clutter-free stairways, dishwashing and laundry detergent, toilet paper, hand soap, properly fitted shoes and orthodics, toothpaste and toothbrushes, floss, soothing music, relaxing hobbies, etc., etc., etc.

Let's cover it all! Sure, the premiums might be a little steep, but the government can subsidize them, so it's not really a problem.

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VinoTinto 7 months, 1 week ago

Pearl, your plan isn't comprehensive enough!

Seriously though, when the British start having better teeth than us, then we really need to examine our oral health.

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PearlY 7 months, 1 week ago

I know. I'm so looking forward to the housekeeper to keep my stairs clutter-free. And any seats at the opera that are not center orchestra are so stressful they can add 20 points to my blood pressure; I can handle the floss and toothpaste, but my opera seating cries out for subsidy.

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jubilado 7 months, 1 week ago

What's wrong with U.S. healthcare and how does it compare to other developed countries? Listen to this fast-talking, irritating guy for 7 minutes and you have a bushel basket's worth of facts. Hope some of you "regulars" report back.

https://www.upworthy.com/his-first-4-sentences-are-interesting-the-5th-blew-my-mind-and-made-me-a-little-sick-2?c=upw1

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bj84711 7 months, 1 week ago

I just got informed by my insurance co. that my current plan does not qualify so my rates will more than double. Thank you Mr. Obama. I don't get to keep my plan that I like!!!

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VinoTinto 7 months, 1 week ago

It sounds like your state's insurance commissioner is not doing his/her job. Insurance companies are taking a last stand and raising their prices. You're actually paying more because people are presenting at the ER with no insurance.

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PearlY 7 months, 1 week ago

Vino, insurance commissioners can only do so much. If they set the allowable premiums too low, people will find that the premiums are fine but there's nobody offering coverage.

As of yesterday, Regence in Washington and Oregon - a major, NON-PROFIT insurer with many satisfied long-term customers, among whom I count myself, will NOT be joining the 'exchange' at least through 2014, so there will be no subsidies for their customers. My premium for the "bronze" level plan will go from the $305/mo I paid before various Obamacare mandates kicked in two years ago, to $588 a month, AND my deductible will go from $1,750 to $5,000 a year, while my maximum out of pocket will be double what it was, and the coverage will drop from 80% in-network to 70%.

In other words, it's a disaster for me and anyone like me in an individual plan. At a minimum, I'll be paying $3,400 a year more than before, assuming I need NO health care. If I do, I could end up paying as much as $10,400 a year more. The promise that I could keep my plan if I liked it is obviously not being kept.

You can pretend all you want that this is somehow "better" and that I'll no longer be "paying more because people are presenting at the ER with no insurance," but the math is simple, and there's no way it's better.

By the way, this is all Washington info, where we have a Democratic insurance commissioner, who is so aggressively pro-consumer he's been driving as many companies out of our market as possible. He's doing exactly the job you want him to do.

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namvet60 7 months, 1 week ago

For all of our Liberal friends and foes this is the latest of many alternative health plans being presented to replace Obamacare.

http://thehill.com/blogs/healthwatch/health-reform-implementation/322955-conservatives-unveil-obamacare-replacement

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fatherof5 7 months, 1 week ago

According to the article, the Republican plan scraps "popular provisions in ObamaCare like a prohibition on denying health insurance to people with pre-existing medical conditions."

So once again, we'd be about the only industrialized nation where your screwed if you get cancer and lose your insurance. Who knows what else is in there, but that's enough for me to say, "Thanks, but no thanks." I'd rather join the rest of the civilized world.

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PearlY 7 months, 1 week ago

fatherof5, you are confusing two different things: Guaranteed renewability, which prevents an insurance company from canceling you because you get sick, and guaranteed issue, which prevents an insurance company from denying you coverage AFTER you get sick.

As far as I'm aware, most Republicans support guaranteed renewability and portability. What we don't support is guaranteed issue.

The whole point of true insurance is that a whole bunch of people pay into a pot to cover the UNPREDICTABLE expenses some of them will face. I pay because I MIGHT need it, and everybody else pays for the same reason. Why would I pay while I don't need it, if I can join after I get sick? If people can wait until they are sick to buy the insurance, then of course they will. Premiums then rise, since more and more sick people are joining while more and more healthy people are dropping out. Our state already went through this experiment in the 1990s when guaranteed issue was imposed on the individual market, and the individual market barely survived until the regulations were changed.

When I spoke with Regence a couple of days ago, I asked this question:

If I join an insurance exchange now, so that my premium is subsidized, can I switch back to Regence if I get sick, and will you be obligated to accept me? The answer was that, from the information the operator now has, yes, I could.

Regence has a superior network of providers, superior customer service, and low administrative costs. How long do you think those qualities will last if it is punished for them by being forced to accept sick people who chose low-cost inferior products while they were healthy?

Obamacare guarantees a race to the bottom for insurance companies and eventually for health care providers as well.

Before Obamacare, there were affordable plans almost everyone could afford, and for those who couldn't there was Medicaid. People who chose to go bare took the same chance as you and I would if we chose not to buy fire insurance on our houses. As long as there's no fire, or only a little one, we come out ahead. If there's a big one, we lose big time.

There is really nothing wrong, in my book, with a middle class family going bankrupt due to medical bills because they elected not to carry insurance. They gambled and lost, but many others are gambling and winning. I own property in the Gulf. Windstorm insurance is very expensive due to hurricane risks. Some years, I've been strapped for money and elected to go bare. I sweat out the hurricane season and so far have won. It's my choice, and I value the ability to make that choice.

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fatherof5 7 months, 1 week ago

If I lose my job, I lose my insurance. If I have a pre-existing condition and check the cancer box on the application for new insurance, I am likely to get denied. We are the only industrialized nation that puts people in such jeopardy. It's wrong. It's unnecessary. Obamacare addresses it, just as it addresses a number of serious problems.

PearlY, you say "Before Obamacare, there were affordable plans almost everyone could afford, and for those who couldn't there was Medicaid." Actually, in Washington state we have been lucky. In many Republican-controlled southern states you would have to earn less than $10,000 per year to qualify for Medicaid. Try working two full-time minimum wage jobs where you net less than $25,000 and have to spend 25% of your wages on health insurance. You can't do it. That's not a choice, but it's the reality a lot of hard working folks faced.

Ideally, we'd all be pooled together and covered through our taxes and the insurance companies wouldn't get a piece of the pie. But we're not there yet, and may never be. Until then, Obamacare helps a lot more people than whatever plan those ridiculous politicians in the House will come up with. History will wonder how in the heck people like that were ever elected.

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PearlY 7 months, 1 week ago

The linkage of health insurance to employment was a huge mistake, traceable back to the WWII Roosevelt administration's decision to make compensation in the form of insurance non-taxable. But having made one mistake, the cure is not a bigger and better one.

As a self-employed individual, it was impossible for me to "lose" my insurance except by non-payment of the premiums (to the best of my recollection, it's been guaranteed renewable all along). So I enjoyed guaranteed renewable affordable health insurance all my life until now. You could have done the same, except that you were deceived by 'progressives' into thinking that someone else - your employer - owed you that coverage.

Don't you get that I don't WANT to be pooled with you? Of course you want the opposite: People like you drive up costs; people like me don't. I'm now being forced into pools with people like you, so unsurprisingly, my premiums are skyrocketing, while my coverage for what I want - real insurance - is far worse. That's better for you, but worse for me. Of course you like it. History, as always, will be written by the victors. My guess is that will be your kind - the collectivists - so you are probably right about that last sentence.

About the only positive I can find in this is that I have invested my money according to the pessimistic outlook I have had of the Obama presidency, and have made a very nice return. I just wish I didn't have to waste so much of it on exorbitant health insurance premiums for coverage I don't want.

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fatherof5 7 months ago

We agree that the linkage of health insurance to employment was a huge mistake. Where we disagree on this - and on other issues - is on individualism vs. collectivism. You seem to be very far on the individualist side of the spectrum, whereas I believe there are more things we can do together (collectively) that will result in a greater good for the vast majority of people, not just the lucky few who were born into wealth or happened to make a few decisions that turned out well. On healthcare, education, fire/police/military protection, environmental/food/drug safety and national parks, I'm a collectivist. On private property, business ownership, and so on, I'm a capitalist.

If 20% of our population is underinsured or at risk of catastrophic financial failure if they get really sick, that isn't just their problem, it's our problem too. Insuring ALL people is both humane and pragmatically in our own self-interest.

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PearlY 7 months ago

Anyone who advocates individuals should be free of collectivist violence is not some kind of loner or miser. Our difference on the issues you claim to be a collectivist about is that I advocate voluntary non-violent cooperation on those things to the greatest extent possible, instead of the violent coercion you prefer.

All my life, I've had "cooperative" health insurance - a non-profit. My grand-parents and great-grandparents did too, through various fraternal organizations. My staunchly Republican aunt and uncle made it clear to the family years ago that we should not expect any inheritance from them because their considerable hard-earned wealth is going to their community hospital. My own Will provides sizable gifts to community welfare groups and I donate a lot now, in both money and time. Studies consistently show that conservatives are more charitable than progressives: We accept community welfare as a PERSONAL responsibility, not something that can be demanded of others at the point of a gun.

You also confuse individualism with capitalism. Capitalism is the economic system that most respects individuals, but individualism is more than that. It involves not regarding others as mere objects to be maneuvered into whatever you regard as the most convenient arrangements for them. It means that if you want poor people to have health care, you go out and provide it to them, or do as my aunt and uncle did and fund it with your own money. I might decide it is more important to use my money to fund parks, or as I did, pay for the private education of some children. It's ironic to me that the party that calls itself "Democrat" and claims to have more love for people has so little confidence in their willingness to step up to the plate voluntarily to do what needs to be done, in spite of our long history in this country of immense individual generosity.

You also confuse insurance with health care. Insurance is simply a way to administer the payment of health care. It is not health care itself. If people are getting health care, whether they own an insurance policy is not an issue of humaneness but administrative convenience.

By Obama's standards, I've been "underinsured" all my life because my chosen plan did not include preventive care. That never interfered with me getting regular check-ups, mammograms, colonoscopies, etc. So how was it "inhumane" that I didn't have coverage for those things or in your self-interest that I should?

People are at risk of catastrophic financial failure (CFF) in starting businesses, breaking laws, going bare on flood, earthquake or windstorm coverage, driving older vehicles, and many other ways. CFF is not necessarily the end of someone's world; for many it is an experience that sets us on a better path. Everyone should be broke for a few years of their life; it sure did me a lot of good.

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namvet60 7 months ago

fatherof5 - don't go past go, don't collect $200 dollars - Hello Socialism!

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namvet60 7 months, 1 week ago

fatherof5 - I'm happy to see that you recognize that an alternative bill was submitted. But to draw such a dramatic conclusion on just one part of the legislation is rather frightening. How much do you really know about Obamacare? With all of the delays and waivers and we still don't know what is in the other gazillion pages that haven't even been read yet makes one believe that this does not constitute a civilized world. American freedom makes a great country.

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downhillracer 7 months, 1 week ago

What a pile of ideological, xenophobic hyperbole jammed into a single paragraph! Nicely done! Too bad it actually didn't present an idea, concept, or fact.

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namvet60 7 months, 1 week ago

That's funny - your comments never have any context to them except criticism which just shows your lack of intellectual capability. If you utilized an ounce of comprehension you might be able to add something useful to this thread.

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campbell_rd 7 months ago

I have one simple fact to state: IF THIS PLAN/LAW IS GREAT, WHY ARE CONGRESS, UNIONS AND GOVT. WORKERS EXCLUDED??? Yes the caps are me shouting. If this Act becomes law and gets total funding then let's make it one plan for all with no exceptions!!!

The Law was enacted and Obama illegally changed several provisions and made exclusions.

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namvet60 7 months ago

campbell_rd - well said and don't forget all of the multiples of delays and waivers.

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fatherof5 7 months ago

They aren't excluded. That's a debunked rumor.

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namvet60 7 months ago

How do you explain the healh care subsidies in place for government employees (Congress (staffers), Senate (staffers)) and all Adminstration employees?

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fatherof5 7 months ago

Give me a link to a credible source that explains this, so that I know what you are talking about.

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campbell_rd 7 months ago

Proof of this would be greatly appreciated. It is a published fact that there are thousands of "exemptions". This law should cover EVERYONE of be thrown out.

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fatherof5 7 months ago

Okay, deep breath. I read the links, namvet. Thank you. This isn't that complicated and it isn't scandalous. Congressional staffers have long had healthcare benefits as a part of their job benefits package. When the Affordable Care Act was passed, it included amended language that required employees of Congress to buy their insurance on the exchanges.

But the wording was vague and lacked detail as to how do deal with the fact that these employees, most of whom are paid relatively low wages, were receiving healthcare subsidies as part of their benefits package, just as millions of other employees do across the nation. The poor wording amounted to a significant pay cut for these employees, who would suddenly be spending an extra $500 or more out of pocket each month for their health insurance - not because prices and risen, but because their benefits had been cut.

“I don’t care what the answer is,” fumed Sen. Tom Coburn (R., Okla.). “Give us an answer so that if we want to do a legislative fix to take care of the people who actually work for us,” we can. “I mean, they’re going to be the only set of federal employees that actually get paid by the federal government that have to go into the exchange..... I want time to legislate on it before we lose half our staff.”

Remember...the exchanges were designed for people who don't get their healthcare through their employers, but who would benefit from a clear way to shop and compare insurance plans from multiple companies, who would be forced to compete. Traditionally, those individuals have had little bargaining power. The exchanges weren't designed for employees who already had insurance benefits from their employers.

The Forbes article you linked, Namvet, went on to say: "Because most Congressional staffers are poorly paid, but are paid enough to not have eligibility for the Obamacare subsidies that low-income Americans will receive, losing their current health insurance subsidies would be a big financial blow. Many members fear that their staffers would leave for better-paying jobs in response."

So, that's why they had to make the fix in the wording. It wasn't to avoid Obamacare. It was to avoid inadvertently taking away the health benefits of congressional staffers. It's just a common sense fix to a 3-year-old poorly written amendment to the law. Your links explain it pretty well, I think.

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PearlY 7 months ago

Yet there is no "fix" for the "big financial blow" many of us in the private individual market will suffer if we don't abandon our current plans - the ones we liked and were promised we could keep - to join the exchanges.

It's also absurd to think that Congressional staffers "would leave for better-paying jobs." Those positions are almost gold-plated guarantees of huge future earnings and power; there are more than enough young people who would fill them for free.

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PeggyJoy 6 months, 4 weeks ago

Yes, PearlY.........you sound like a mouth piece for some insurance company and Chamber of Commerce.

<p>Forbes.com writes :

At the very same time the American Health Insurance Plans (AHIP)—the health insurance industry super lobby—was cutting a deal with the White House leading to its stated support of the proposed Obamacare legislation, they were secretly funneling huge amounts money to the Chamber of Commerce to be spent on advertising designed to convince the public that the legislation should be defeated.

Why would health insurance companies conspire against a law that would bring them 30 million new customers?

The reason is the “MLR” (medical loss ratio) which requires health insurance companies to spend 85% of premiums on claims. The MLR for small group and individual health plans is 80%. You see, insurance companies don’t want limits put on their profits (or the million dollar salaries they pay their top management).

The MLR rule is in effect already, and health insurance companies are sending rebates to their customers. For 2011, these rebates totaled around $1.1 billion.

Medicare Advantage MLR

Medicare Advantage companies must meet an 85% MLR starting in 2014. Last year, at a training held by a Medicare Advantage company in Tucson, the company rep boasted that their MLR was 70%. Wow!

The rep was boasting about how his company manages the care of its members – and many of them have chronic illnesses. The company model is successful because their proactive care keeps people stable and out of the hospital. This is a very good thing for their members and for the company profit margin. But is it good for Medicare?

All of this company’s revenue comes from Medicare. The company has a great model. The company makes big profits. But Medicare actually pays them more money for their chronically ill members than for healthy patients – and Medicare is saving no money from this business deal. Starting in 2014, when the 85% MLR requirement kicks in, maybe Medicare will save some money on this deal.

The original premise for Medicare Advantage was that turning Medicare beneficiaries over to insurance companies would save Medicare money. Turns out it was really about making profits (unlimited) for the insurance companies. The Affordable Care Act is one step towards saving money for Medicare . Given the dire forecasts for Medicare’s financial future, who could argue against this? And will the billions of dollars in savings be lost if the Supreme Court throws out all of the Affordable Care Act?

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PearlY 6 months, 4 weeks ago

No, Peggy, I am not here spouting others' talking points. Unlike you, I have detailed exactly what effect Obamacare is having on my finances and those of others in my situation. I've spent hours researching my options. I've spent decades covered by a plan I liked and wanted to keep and which Obama lied to me about keeping. All you've done is repeat the optimistic hopes and dreams of Obamacare advocates. You say the ACA is "one step towards saving money for Medicare." If I thought that were true, I'd still have problems with the ACA, but they would not be on economic grounds.

But I don't think it's true. There's simply NO chance that the ACA overall will save money unless it is by cutting back heavily on services. If that's what you want, be honest and say so. Tell us honestly that people who need knee surgery should wait for a couple of years instead of a couple of months. Tell us honestly that people who have breast cancer should die in greater numbers to save some dollars. Tell us honestly that people with macular degeneration should get treated only when they become legally blind, and then only in one eye. These are the consequences of letting the government decide how to ration health care, and if price is not the method of rationing, then something else will be.

You know, it doesn't bother me that other people have different priorities than I do. What bothers me is people like you who pretend that their choices have absolutely no bad consequences. You're living in a dream world and don't even know it.

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namvet60 7 months ago

fatherof5 - Thank you for responding but if you refer to a few posts above you will find that you were the one that was inquiring about links to show that Capitol Hill is getting health care subsidies. You obviously read through a different mindset to come up with the breathtaking dialogue. I have read through a conservative viewpoint and have a totally different perspective. So I'm not going to argue over issues that will never be resolved until the President allows the total legislation to be put into force rather than delays and waivers.

I just pity the children, grandchildren, great grandchildren, etc. that will be paying for this fiasco in the decades to come.

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fatherof5 7 months ago

Right. You and campbell_rd seemed to be suggesting that congressional employees were now exempting themselves from the horrors of Obamacare because they see how awful it is going to be....and that it isn't fair for them to exempt themselves.

I didn't know what you guys were talking about, but your links explained it well. What they explained, however, was not what you had depicted. It isn't like Obamacare and some recently passed new laws are going to give congressional employees new subsidies that are unfair. To the contrary, the recently passed laws allow them to keep their health benefits, just like every other American who has a job with health benefits (aka "subsidies").

If you work for Boeing and get $700 per month toward your health insurance, that is a "subsidy." If Obamacare suddenly made it illegal for you to get your $700 per month health insurance subsidy, it doesn't matter if you are a liberal, a conservative, a namvet, or a fatherof5, you will quickly recognize that that is a stupid clause in the law that would cause you to suddenly lose your subsidy. So, they fixed it.

Are you unhappy that government employees get health benefits as part of their overall payment package? I know you hate Obamacare, but I'm not sure what your beef is with this particular issue.

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namvet60 7 months ago

When one loses a subsidy they are going to be upset and might go looking for other employment. BUT - when your government employee is averaging higher wages than the private sector in 8 out of 10 jobs would you really go looking for another job? It also shows where the gap has widened by 8% in the last year alone. Would I really think that the grass was greener on the other side of the fence? I have a problem with government employees that are on the golden plans on a reduced rate that make more money than the private sector (who are the taxpayers) and still get a subsidy to bring there health plans lower yet. Let's make the playing field level.

It's really funny you should bring up Boeing - would you take a cut of $700 for a subsidy or get laid off? This year alone Boeing is laying off over 2000 employees. You also check out all the larger companies that are either laying off employees and/or cutting there families benefits because of Obamacare. The government keeps telling us that the unemployment levels are doing just fine - in that case what about the 90 million without a job?

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fatherof5 7 months ago

First, federal employees have had their wages frozen since 2010. Obama signed the latest freeze extension in March. There has been a net loss of over 700,000 government jobs since June of 2009. Do you want their wages slashed too, so they can fall from the middle class into poverty? (I prefer finding ways to raise the standard of living for private sector employees.)

Second, if there is a widening gap between public and private sector salaries, it isn't because public sector wages are going up.

Third, your "golden plan" description of government workers and your claim that private sector workers "are the taxpayers" is pure B.S.. It is true that the corporations have decimated unions and retirement plans since Reagan, and that the attack on private sector employees' wages and benefits has been more aggressive and effective than the attack on government workers, but don't take it out on government workers. Take out your anger on the corporations.

Fourth, you write that "the government keeps telling us that the unemployment levels are doing just fine." Prove it. Find me some quotes from the Obama administration saying this. It's not true.

Finally, your whole comment changed the subject. Do you really think that congressional staffers should just lose their health benefits that have been a part of their pay package for years??? That's what the law would have done if they hadn't addressed it.

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namvet60 6 months, 4 weeks ago

With your liberal parsing of the issues - pass the buck (blame Reagan, Bush & Corporations) and sympathy (those poor government employees) has made this a short post.

The Affordable Care Act was crafted and forced through by a partisan group (Democrats) with the Quote "We have to pass it to be able to know what is in it". Since that time with almost 3,000 pages of legislation there has been nothing but delays, waivers and changes to the law. This health care law was to cover "every" man, woman and child with the same standards of one and all.

Since this health care law has been dissected and we find that it is not equally accessible among the citizens, it has totally blindsided some families that thought there health care could be affordable. So it isn't how you look at it but how much it will cost to cover your health care or pay the fine. Or your other option is if you have the money to donate you can possibly get a waiver.

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downhillracer 6 months, 4 weeks ago

More cut-and-paste nonsense, not an original thought to share - you're only repeating the Talking Points sent out by the Koch Brothers, and not from academic resources worth a tinkers ding. It's not worth "debating" with you as your mind is made up, based only on what you've been told to think. So sad, indeed.

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namvet60 6 months, 4 weeks ago

downhillracer - you seem to consistently try to fantasize and put your own hypothesis on my posts. Well Big City Boy why don't you go out and do something contructive such as dumpster diving or tipping over garbage cans which would fit into your lifestyle?

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PearlY 6 months, 4 weeks ago

According to federal employment reports, at the beginning of 2009, total federal personnel stood at 4.206 million. By the end of the year, it stood at 4.430 million. By the end of 2011 (the last year I could find for total employment including military) it had dropped back down to 4.403, almost 200 thousand more than at the beginning of 2009, albeit slightly lower than at the end of the year.

"Take out your anger on the corporations." Right. Would that be the thousands of businesses that have gone under in the last six years because their revenues were not enough to keep up with their payroll, or are you just resentful that there are any businesses still left standing?

You don't seem to understand that what you call the "attack" on private sector wages and benefits is being carried out not by your bogey-man, the corporations, but by the market - including you, me and every other consumer who chooses what to buy on the basis of price rather than what the company's wage and benefit levels are.

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fatherof5 6 months, 3 weeks ago

PearlY, regarding the corporations, on the one hand I acknowledge that there are increasing global competitive forces that make it harder on American corporations to succeed. However, when their CEO bonuses and other executive pay keeps going through the roof, while pensions are cut for employees, I don't buy the argument. They'll have my sympathy when their CEOs work for $400,000 and they still have to cut employee pay. Until then, I call BS.

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PeggyJoy 6 months, 4 weeks ago

Pearl and Nam................your both wrong. Watch this video from the Kaiser Family Foundation explaining "ObamaCare."

https://www.youtube.com/watch?feature=player_embedded&v=JZkk6ueZt-U#t=10

The Simplest Explanation Of Obamacare. Ever. Published on Jul 17, 2013 2014 is coming--are you ready for Obamacare? Join the YouToons as they walk through the basic changes in the way Americans will get health coverage and what it will cost starting in 2014, when major parts of the Affordable Care Act, also known as "Obamacare," go into effect. To download the video, please visit https://www.youtube.com/user/kaiserfoundation/videos

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barracuda 6 months, 3 weeks ago

I was talking to a friend last eve, his notification states he will owe almost double next go around to stay on his own plan that he has had for years.... Here is another view.

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