The Arrogance of Our Soon to be Former President of The United States

For the past two weeks I’ve been hearing (in the media) a lot about President Obama’s effort to “protect his legacy.”  It reminds me of the last week of my Junior year of high school when I jumped into my big economics project.  I’d blown it off for the entire year but still thought I could pull an A.  Nobody remembers that project now.  If they did, it would serve as a study on how not to approach life’s big challenges, and of one student’s incredible arrogance.

Because this site is oriented around healthcare, I want to focus on the legacy question in that context.  To the degree I have been personally involved in self-insuring my family since before the ACA, I believe I have some credible perspective.  My situation is representative of at least some individuals who have been directly involved in Obamacare.

 A good place to start with an assessment of the ACA is to go back to the President’s original statement of his objectives for what he wanted to accomplish with his healthcare initiative.  On June 11, 2009 at a speech in Green Bay, Wisconsin, President Obama launched his presidential push for universal healthcare.

He stated,  “After decades of inaction, we have finally decided to fix what is broken about healthcare in America. We have decided that it’s time to give every American quality healthcare at an affordable cost.” He also said, “We have decided that it’s time to give every American quality healthcare.”  And this one was very powerful too,  “The status quo is unsustainable. If we don’t act, and act soon to bring down costs, it will jeopardize everybody’s health care. If we don’t act, every American will feel the consequences in higher premiums.”

In my opinion, if we want to  assess the President’s legacy related to his accomplishments on healthcare, we must answer the questions stated as objectives in his 2009 speech.  Specifically, have we given every American:

1. quality healthcare?
2. at an affordable cost?

As the “deal was done” the White House published an outline of the meat of the ACA  on its website (article pasted below as link above may not be live much longer).

Again, in my opinion, the President’s legacy as it relates to healthcare should be judged against his efforts to improve the quality and affordability of healthcare.  For at least one reader of Robert Pirsig’s, Zen and the Art of Motorcycle Maintenance, the question of whether the President’s legacy will support the objective in an improvement in the “Quality” of healthcare leaves him scratching his head.  Instinctively, I would say the quality of healthcare has not been significantly impacted for positive or negative by the ACA.  However, were one to apply Pirsig’s Metaphysics of Quality (MoQ) to the question, I suppose an argument could be made that “quality” has improved.

Is Medicaid better?  Is Medicare better?  Do we have better drugs as a result?  Have the quality of outcomes improved? Are Americans living longer?  Is it easier to see a doctor?  Are our Emergency Rooms more efficient? Is infant mortality down? Are accidental pregnancies down?  Are those enrolled in Obamacare healthier than they were before?

What about the ACA’s success at achieving better healthcare at an “affordable cost?”  Based on my personal experience with Obamacare and more recently the $6,500 bill for an MRI of my son’s ankle presently in dispute; survey of one says, the ACA has been less than successful.  In fact I get rankled every time I hear a statistic that correlates the number of individuals enrolled in Obamacare as a metric for success.  I wonder how many folks there are like me out there who paid for 100% their own insurance prior to the ACA but because of it were basically forced into Obamacare. Why?  Because their premiums skyrocketed (mine well over 100%), and they were now eligible for/needed a government subsidy/hand out.  I wonder, how many individuals enrolled in Obamacare believe they are receiving healthcare at “an affordable cost?”  Let us not forget the concepts of “insurance” and “healthcare” are not synonymous.

I have no problems with the objectives outlined by President Obama. I believe there are admirable and successful pieces of Obamacare but on the whole it appears fatally flawed.

I think if  Congress, the outgoing, and the incoming administration would conduct a study of those enrolled in Obamacare to survey its performance against the original “promises of Obamacare,”  it might level the policy playing field a bit.  It would be  enlightening for all of us.

In the meantime, I suggest a reading of Hans Christian Andersen’s, The Emperor’s New Clothes. 

QED.

Overview below from:  the White House President Barack Obama website referenced in link above

Overview of Health Reform

Health reform puts American families and small business owners in control of their own health care.

• It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today.  This helps over 32 million Americans afford health care who do not get it today – and makes coverage more affordable for many more. Under the plan, 95% of Americans will be insured.
• It sets up a new competitive health insurance market giving tens of millions of Americans the same choices of insurance that members of Congress will have.
• It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.
• It will end discrimination against Americans with pre-existing conditions.
• It puts our budget and economy on a more stable path by reducing the deficit by more than $100 billion over the next ten years – and more than $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.

Health reform bridges the gap between the House and Senate bills and includes new provisions to crack down on waste, fraud and abuse. 

It includes a targeted set of changes to the Patient Protection and Affordable Care Act, the Senate-passed health insurance reform bill.  Health reform reflects policies from the House-passed bill and the President’s priorities.  Key changes include:

• Eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid;
• Closing the Medicare prescription drug “donut hole” coverage gap;
• Strengthening the Senate bill’s provisions that make insurance affordable for individuals and families and increase protections for out-of-pocket costs;
• Strengthening the provisions to fight fraud, waste, and abuse in Medicare and Medicaid;
• Increasing the threshold for the excise tax on the most expensive health plans from $23,000 for a family plan to $27,500 and starting it in 2018 for all plans.

The Chronicles of Obamacare Enrollment – Lessons Learned

A few random lessons learned from my six (I think) attempts to enroll for insurance eligibility on Healthcare.gov (see previous postings for colorful details):

• One can input essentially the same information into the healthcare.gov forms repeatedly, expect and receive different results (goes against the laws of nature I know).
• If one wishes to re-open for revisions an existing enrollment form, one should expect to re-answer some of the previously answered questions because some previous answers appear to be arbitrarily deleted.
• There is no identifiable logic to which answers are saved, and different ones may be saved between enrollment or revision sessions.
• If one is speaking with either a Representative or Specialist, just know, they are working off the same form in seemingly the same web application you have access to.  Therefore, they will experience the same problems you are.  For example, in filling out the form, they are as likely to get kicked off the site as you are. In otherwords, their tools to help you are NO BETTER than what you have.
• The only difference I could tell between a Representative and a Specialist, is that a Specialist has the ability to go back into your enrollment application after it has been submitted to revise information. BUT REMEMBER, even if one wants to change one field in the form, the act of going back in at all will arbitrarily wipe out info previously input.  Therefore, do not expect the Specialist to be able to work through the revisions faster than you can on your own.
• If you put in your estimated annual income,  but you have no income at this moment and  enter $0 monthly income into the form, expect to be kicked into the Medicaid bucket.
• If you are kicked over to state Medicaid, Healthcare.gov and its representatives will tell you must get proof from the state that you are not qualified. In my case they suggested a three way call or a letter from the state.
• In Georgia, to qualify for Medicaid one basically has to be disabled, have no income, or be a child of a parent with no income to qualify. Even though the information I provided Healthcare.gov and its representatives clearly suggests I could not qualify for Medicaid; if the enrollment notification says you may be qualified for Medicaid, the Representative and Specialists not lead you around this issue—basically they will shut you down.
• For one of my enrollment attempts I agreed to have my application “reviewed” (kicked up the ladder). However, the specialist could not and would not even guess, either how quickly my file would be reviewed or even how I would be advised. To this date and it has been close to a month at this posting, I have had no communication from healthcare.gov. (beware of black holes)
• Due to some sort of internet security threat I was asked to re-set my password with a new one. I reset it with the old one and it worked just fine.
• In all my conversations with the Healthcare.gov representatives and specialists, not one time have they ever suggested that they do not really have the tools, training or knowledge to effectively do their jobs, nor have they ever registered any frustration with their lack of tools.   They will however,  admit at times their customers do get frustrated from time to time and I was thanked multiple times for being nice. These folks seem obliviously bulletproof.
• Do not expect empathy, any sense of humor, or too much guidance from representatives.   Once I realized this, it made my interactions far more tolerable.
• There should be some quick pre-screening tools to determine eligibility and even subsidies, however, these are limited. When calling healthcare.gov, they will not pre-screen you. You will have to go through the entire enrollment process to see if you qualify to purchase off the exchange.
• Each time you call Healthcare.gov, plan to have an hour to spend with your new friends.
• Some (if not many) of the questions I answered in the enrollment process, online, were not asked when I enrolled by phone (for example, COBRA is a specific one not asked by phone).
• Do not expect a representative or specialist to advise you with regard to how you answer the questions; especially related to income. I made it very clear over multiple calls, that I was unemployed and my goal was to get as large a subsidy as legally possible. In order to do so, one must answer the questions in a certain way. However, the representatives and specialists either do not know, are unwilling or are not allowed to really help you obtain the correct subsidy.
• If you know approximately what your subsidy should be, there is a chance, if you are patient (and I mean REALLY patient) that you can keep re-working your enrollment application until you get results that align with your expectations. In my case, because I knew about what my subsidy should be based on my situation and qualifications, I just kept re-working the enrollment form until it got into the ballpark of reality (this was accomplished over many hours and weeks).
• Remember in the end, your subsidy is pegged to an estimate, so if you under or over estimate it, you will be obligated to true up come tax time, but as best as I can tell, there is no penalty for being unable to predict the future.
• When attempting to enroll for insurance through Healthcare.gov expect (a) TMD experience 🙂  (Google it).

Obamacare – Welcome To The Land Of The Lost

Apparently I am both eligible to purchase health coverage through the Marketplace and I am also ineligible. At least that is what my eligibility letter says…

So last Friday I went through the online enrollment process…online….again. If you want the history of my first two attempts read my previous post. Friday was attempt #3.

I spent 1.5 hours re-applying/re-enrolling, ultimately to be told on my eligibility letter that (and I am paraphrasing here) while I am eligible to purchase health coverage through the Marketplace, I cannot enroll at this time. So in effect, I am NOT eligible (although I actually am) to get coverage. Can you see why this might be confusing and perhaps frustrating?

During the course of attempting to complete my application, I was booted off the site four separate times. Each time I was kicked off, I had to go back and re-enter various bits of information which were not saved prior to me being disconnected. I should mention, because there are four members in my family, I had to answer most every question 4 times….over….and over…..and over again.

I fought the healthcare.gov website for 1.5 hours and was then dismissed. You can pick your own colorful adjectives for the word “dismissed” and you will probably have a sense of how I felt I was being treated. Rejected if you will.

I should note, that during the process a tree fell on a power line down the street, and I completed the application using my mobile hot spot. I was determined to succeed.

WRONG! I think it was divine intervention that the tree fell on the power lines, because the power was knocked out for 5 hours and by 7:00 Friday night, I knew I had until Monday to cool off from my rejection.

In the meantime I am sitting here wondering if anyone is actually benefitting from Obamacare, if the government is counting all 3 of my applications as enrollments, what the heck I put on my application that caused the rejection, if this will ever be resolved, and why exactly am being forced to waste my time mucking around with this when my time would be better spent trying to gain employment with a friggin’ health plan.

“If This Does Not Work, I Can’t Tell You What To Do”

These are not the words of comfort you want to hear from the enrollment specialist after trying for three hours to enroll in the Federal Health Insurance Marketplace.

After receiving the panic inducing quotes from my insurance broker, she recommended my wife and I come into her office. This way we could go onto the Exchange together, and we could explore our options on the fly. The fact that I had to enlist the expertise of a broker might suggest that attempting to sort out individual insurance in the era of Obamacare/ACA alone, may not be a good idea for the average bear.

Prior to my meeting, I went on the Exchange and created an account. I didn’t want to create an account because all I wanted to do at that moment was research, not enroll. Unfortunately, after the general enrollment deadline on March 31, I could not find the tools I had used prior to the deadline to research plans and estimate costs. If they are still there, I could not find them. Perhaps they figure individuals experiencing death, divorce, or loss of job don’t really need the tools. This smacks of the Nancy Pelosi comment years ago when she basically said we had to pass the ACA and then we would figure out what was actually in it. Enroll first, then we can tell you what you are enrolling in….

Anyway I did not complete my first enrollment because ½ way through the process they asked for my broker’s agent ID number, which, not surprisingly, I did not have at my disposal.

Yesterday, when I tried to log in….over and over and over again unsuccessfully, I finally threw in the towel. I started the entire process from the beginning and amazingly it allowed me to re-use the same user name and password as I had the first time, and then it let me go through the process.

After two hours later, the system was telling me my daughter could be eligible for catastrophic insurance, my wife and I could be eligible for Medicaid, and my son could be dumped onto the state CHIP (Medicaid for kids) plan. Well this recommendation was patently absurd because I had included my income for year to date plus expected unemployment insurance and neither my wife nor I are disabled.

After failing online, my wife, our broker and I called the healthcare.gov customer service number and spoke to a nice man named Nathan. Nathan informed us that he could flush our application from the system and then we could wait 24 hours for it to re-set and try again online, or he could re-enroll us by phone, which he estimated would take another 20 minutes.

At the end of an hour with Nathan, he informed us my daughter could be eligible for catastrophic insurance, my wife and I could be eligible for Medicaid, and my son could be dumped onto the state CHIP (Medicaid for kids) plan. Sound familiar?

Our hypothesis relates to a single question on the enrollment form, which asks if you had any income “this month.” Being unemployed and not yet receiving unemployment, the answer was $0. Apparently, the system is having trouble reconciling the estimated income for the year with a single month of no income. Nathan could change the monthly income figure from zero to one twelfth of the estimated annual income, but the system could not handle it…….neither could Nathan….neither could I….nor my wife…nor our broker.

Because my broker had already wasted 3 hours and I had now spent 3 hours not looking for employment, we all decided to go to neutral corners. And yes, during the course of the conversation Nathan said, “If this doesn’t work, I can’t tell you what to do.”

He offered to trash the second enrollment application and start over, but we really had to get on with our day.

We decided to let healthcare.gov rest for 24 hours before we would try it again.

Stay tuned for more personal adventures of the “Affordable Care Act.”

I Think Congress Just Treated Itself To A Big Can Of American Political Whupass

How do you get past all the political rhetoric media punditry and general ranting of the American public? More importantly what does this all mean? Generally speaking, I’m one of those guys (sorry ladies) who believe the simplest answer is generally the correct one. And at the average American Joe, level I see our nation’s government getting ready to embark on what they are trying to sell as a nearly one trillion dollar fix to our nation’s health care woes. Partisan politics aside, I just can’t get over ANY government spending $1 trillion efficiently and to the maximum benefit of those from whose children’s pockets that money is coming from. Further, any government official who can look in a mirror and with a straight face say the government will not exceed the $1 trillion outlined by several times, probably has had their face frozen through Botox and plastic surgery. So what does health care reform really mean for average Americans? Well, I think our government just opened a can of whupass on themselves. I think as people start to really understand what is in the 2,700 page legislative smorgasbord, the majority of them will find out that it exceeds their wildest dreams of government waste, corruption, naïveté, and arrogance which will result in the largest non-election year turnout in the November elections. For most of us who tend not to be as wired into non-presidential national elections, why is November such a big deal we ask? It is a big deal because every seat in the House of Representatives is up for re-election and 36 seats are up for re-election in the Senate including seats in CT, DE, IL, IN, ND, FL, KS, KY, MO, NH, OH, AR, CA, CO, HI, NV, NY, OR, PA, VT, WA, WI, AL, AK, AZ, GA, ID, IA, LA, NC, OK, SC, SD, UT. If we, as a nation, are a sleeping giant, I think we are waking up today.

30 Seconds to Register Your Voice And Help Change Obamacare For A Better American Health Experience

Simply Click Here to make your voice heard.

My representative in Congress is Tom Price of Georgia.  Mr. Price happens to be a Doctor (MD, not Witch) and is strongly opposed to the current version of the health care reform bill.  I sent him a letter anyway.

If you click on the link above, fill in the privacy protected form presented from “Free Our Health Care Now” which,  even if you are a slow typist, will take less than 30 seconds, hit submit and it will generate  letters to your Representative in Congress AND the Blue Dog Coalition voicing you opposition to the current proposal in Congress.

If you are still trying to get your arms around this whole Pandora’s Box of health care reform and want a bit more clarity on some of the problems with it check out this article that appeared yesterday in Investors Business Daily.

Just trying to keep it simple here.  Make your voice heard today.

Health Savings Accounts And Health Care Reform in 1.2 Million Words Or Less

Back in High School I conducted some very scientific research to determine the average person’s attention span.  If you are wondering, it is about twelve and a half minutes.

You see, whilst attempting to listen to my teachers, I found myself cruising off to the Bahamas, putting duel exhaust on my ’66 Mustang, dating the hottest hottie in school, or slapping a game winning home run.  With all due respect to Duckie, Mr. D, Bubba,  Leeeeeeeeeee, The Frau or any of the other gifted educators I was truly blessed to spend quality time with each day, I frankly had a really hard time staying plugged in.

Anyway, I decided I would undertake this experiment to measure my attention span.  Since I figured I was an average person, if I could measure my attention span, it would serve as a worldwide proxy for all the average Joes or Gradock’s out there.  The test was quite simple.  I would go to class, write down the time the lesson began, and the moment I started my cruise to the Bahamas, I would check out the clock again, and write down the time, do a little subtraction and voila, I would know my attention span.   All well and good, but I realized quite quickly that by the time I realized I was daydreaming, I was either half way to the Bahamas,  I had rebuilt the carburetor, or if I was really lucky, ahem, saying goodnight to Miss Hotinsky…

After many unsuccessfully attempts to crack the code of my attention span, I did finally catch myself at the precise moment I was pushing back from the dock.  And then, a few weeks later, was successful again.  The result…. Twelve and a half minutes.  But you already knew that already.

This morning when I got up I was chewing over this whole bit of news I’ve been hearing about the House and Senate reconciling their two tomes; the nearly 2,000 page House Bill and the 2074 page Senate bill.  Besides scratching my head and other body parts, over their continued desire to frost those turds, I started to wonder, what was the longest book ever written?  Then I set out to do some more scientific discovery.

First I decided to count the words in the Senate Bill.  Easy enough; highlight the document, copy it into word, do a word count and presto.  Well I started copying that pig and after 10 minutes (approaching my maximum attention span) I bailed and copied everything I had into word which represented a whopping 397 pages, 114,000 words, or about 18% of the document.  I’ll spare you the higher algebra, but by my count the total document is about 594,000 words.  Applying the same math to the House Bill, assuming they cram about as many words on a page as the Senate, their bill is close to 570,000 words.  Collectively, nearly 1.2 million words.

According to Wikipedia the longest novel written in either the Latin or Cyrillic alphabet, is a 2.1 million word snoozer entitled Madeleine and Georges de Scudéry.  Never heard of it?  Me neither.  I perused the list of the top 15  loooooongest longest novels to determine if there were any on the list that average folks like me might recognize.  There were three.  War and Peace, topping the word scale at 560,000 words (never read it),  Les Miserables weighing in at a slightly lighter 513,000 words (saw the play), and Atlas Shrugged splitting the middle at 540,000 words (on my reading list but after writing this blog, maybe not).

The average American has an attention span of 12.5 minutes.  The average American with a high deductible health plan and a health savings account needs a couple of hours just to begin to understand the benefits of their insurance and tax advantaged HSAs.  The nearly 600,000 word piece of healthcare sausage created by the Senate is anything but average.  In fact, to most average folks, it’s downright insulting.  And here they are trying to do the Vulcan document meld with the Senate and House Bills.

Ladies and Gents.  If you can’t explain the sucker in 12.5 minutes to the average Joe, you lose his or her attention, and more importantly, their confidence.  ‘Nuff said.  Well, almost; if you have made it all the way to the end of this blog, congratulations, you just read 732 words.

Scott Brown Euphoria and Cold Water

If you are conservative minded, care about what’s going on politically in our country, then there’s a pretty good chance you are euphoric, celebrating, or at least smiling a bit over Scott Brown’s victory last night in the Massachusetts.

Personally, prior to last night I felt like the Democrat Party was holding the collective nation’s head under water.   Scott Brown allowed our heads to bob above the surface at least for a moment and gasp for a  breath of fresh air.  The question remains, will we be able to keep our heads The election ofabove the water or will we be shoved back under again?

Only time will tell, but being a bit cynical when it comes to politicians, we need to remember that Scott Brown is one.  I firmly believe he is the lesser of two evils, but he alone can not change the face of politics in America (although he pretty much disfigured it last night).   There needs to be a collective voice coming from the Republican party and perhaps Scott Brown becomes the rallying point for that voice.   

And if they start with health care that will be fine with me.  But they can’t merely kill it and walk away, they need to use their unified voice to address, in a responsible manner, the health care needs of our nation.

Scott Brown And Health Savings Accounts

So being an HSA advocate, I Googled the Scott Brown and Health Savings Accounts together and pretty much discovered bupkiss (is that how you spell that word?).  We know he supported Massachusetts  health care reform in 2006.  We are also told (presumably by him) that he would not support the current House and Senate bills disguised as health care reform.  But we will only know for sure if two things happen:  he gets elected tonight and he stays true to his word.

The health care legislation in Massachusetts has some scary things like “mandates” in it and other provisions those on the right might find hard to digest.  For those unfamiliar with what Mr. Brown voted for, there is a bit of commentary about in at HSAeducator.com.  It is a good read, but not being familiar with Brown’s stated positions on the various pieces of the state legislation, it is difficult (for me at least) to draw parallels and conclusions.

So what next?  Wait ’til the morning I suppose, hope, and pray.

Dr. James G. Knight, Are We Really About To Be Stuck With Higher Premiums?

I was reading the AIS Health Daily Bulletin this morning and gnashing my teeth a bit.  In part because I would have rather been doing anything but reading any bulletin and in part because of what it was saying.

The good news is that CDHPs are projected to continue growing, especially those tied to HSAs (we like that).  What kind of chafed my goodies was a comment  by James G. Knight, M.D., CEO of Consumer Directed Health Care, Inc., that made me wonder if my HDHPmight be turning into an HPHDHP (that would be my own new acronym that stands for high premium high deductible health plan).  Specifically he said,

” …..I would expect little additional market penetration unless health plans begin to see the light and price these products in ways that reflect the reduced insured payout inherent to this kind of coverage. In that case, there could be a big increase. Unfortunately, I have only heard of large increases in HSA premiums, not reductions.

If insurance companies wonder why so many people in the U.S. want the government to regulate them out of business, actions like these (and others) are what have congress pissing napalm on the fire of the health care debate.

You gotta wonder; especially if you are living a healthy life, being responsible about your insurance, saving money to pay for yours and your family’s health care, and paying your taxes what the insurance companies are thinking.

Open enrollment is just around the corner.   I don’t think the, the current debate will result in the total destruction of Consumer Driven Health, but if closed and irrational minds prevail, it could be neutered to some degree (is partial neutering possible I wonder?).   On the other hand, if Consumer Driven Health Plans are given the opportunity to work harder for Americans their ultimate benefit would be healthier  and more savvy citizenry, greater competition, and ultimately lower costs.

Now what’s not to like about that?  It’s about as American baseball and a backyard barbeque.