1. From the intro — not one of the "5 things" — we're told: "People who have health insurance through their employer, or through Medicare or Medicaid, can continue to get it that way." So, that's the first dumb thing: CNN doesn't think it's a "thing that has happened" that many people have lost what they had before.
2. Two of CNN's 5 things are: "1. Sign up on Healthcare.gov hasn't been easy" and "2. State sites seemed to fare better." Seemed. What has happened is that something seems to be doing better than the thing that's going terribly. I guess seeming is a kind of happening. But what is this seeming even based on? "The Department of Health and Human Services says it won't release enrollment figures before November, but CNN "canvassed" 14 states and the District of Columbia and — "combining what states report as 'enrolled,' and what they're calling 'almost enrolled'" — got to a total of 257,000 people. 134,000 of that total came from whomever they got on the phone in New York. CNN notes problems in Hawaii and California. Thus, CNN accomplishes a halfhearted transmission of the meme that the state exchanges are doing well.
3. "3. Overall enrollment numbers are unclear." So, CNN is revealing that what has happened is that we can't see what is happening.
4. "4. The cost of care has become more clear." This item is about the cost of insurance, not the cost of care.
5. Republicans!!! Needing a 5th item — because a list of 5 things seems better than a list of 4 things — CNN collects a bunch of bad-sounding things that Republicans did. Aren't Democrats ever a thing that happens?
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too often, bad Democrat happens to good people.
I blame Tea Party, Ted Cruz, AGW (gurgle, gurgle)
Oh. My. Are there going to be some red faces.
Wait.
Maybe not.
Liberals can justify almost anything they do.
Hey, maybe the Obamaoids know what they're doin' & see this collapse as forcing Socialized Medicine on us’n “idiots”.
Love it! Great post.
We need Althouse to give a weekly response to CNN.
Is there any truth to the rumor that the reason people can't get in to Healthcare.gov is because the National Park Service is in charge of the site?
All told, we wonder if Nancy Pelosi, Harry Reid and President Obama are as happy today about Obamacare as they were on the day the law was passed. Beyond that, everything that has happened since passage has confirmed our view that far from solving the problems facing American health care, this poorly drafted, poorly executed system makes the problem of health care reform both more urgent and more difficult.
http://blogs.the-american-interest.com/wrm/2013/10/20/the-acas-million-dollar-question-will-enough-people-sign-up/
So far, what I'm reading is that, in fact, the large majority of the sign-ups are people newly-eligible for Medicaid, who aren't actually buying insurance at all.
Re your item 4:
There is a great deal of confusion about whether people are buying health "insurance" or health "care".
This is nothing new people have been conflating the two for the past 30 years or more.
It is actually a combination of both. One is healthcare, the normal, routine visits to the doctor and the like. Or birth control. All this is is pre-paid health care. Expensive pre-paid health care.
Expensive because instead of you paying the doctor in a normal cash or credit card transaction, it gets mushed through an insurance company. This adds a great deal of expense and headaches for the doc such as paperwork, waiting for payment etc.
The other component is health insurance. This is the rare, relatively catastrophic and unforseen event.
Think of it like your house:
You need to paint it periodically. This is not covered by insurance.
There is a brushfire nearby that scorches the paint. This is covered by insurance.
It sure would be nice if everyone (including me) would distinguish between health care and health insurance.
John Henry
Well my experience was to engage in a lot of entering information and getting to a point where I could not go any further. I have an account, they know a lot about me and my family, but I don't have a policy or any idea how much it will cost. Through other resources, I know what it might be, which is not affordable insurance by the way.
Has journalism just now getting this bad, or are we just noticing it more?
George W. Bush, hacker extraordinaire, singlehandedly sabotaged the website to bring shame on Obama, who's only trying to clean up the mess Bush left behind. There is no limit to Bush's mischief.
Megan McArdle at Bloomberg posted a much better analysis last Friday. She cites David Freddoso, who also posted a fine analysis of what "enrolled" means.
Bob Boyd:
The barricades or, as they were affectionately known "Barrycades", were deployed with the usual liberal abandon and excess. The controllers having asserted their power experienced a sudden and overwhelming rush of dopamine, and before they noticed had extended the blockade to healthcare.gov. Unfortunately, there were no veterans and other interests present to return them to reality and prevent them from running amuck.
Yeah, I would have thought that hundreds of thousands of people losing their insurance because of Obamacare would be number 1 on the list.
And that number 2 might be that employers have been cutting jobs/hours because of Obamacare.
And that number 3 might be that even if the increase in premiums was less than experts expected, it was a lot more than average consumers expected.
And that with number 4, we'd get into incompetent web portal/database design, which, while pointing up the Administration's typical incompetence, is kind of a side-show.
I don't know what number 5 would be. That most of the expansion in coverage is just adding people to Medicare, which is a lot simpler?
How difficult is math? If 8 companies offer a service that includes X and the competitive price is Y, how do you figure that the government gets involved and makes the companies offer X+Z and it will cost <Y?
I wonder how much of the media coverage is stupidity and how much is lying.
Trey
TMink: Stupidity. If you have ever known or spoken to a "journalist" you will be aghast at their lack of curiosity coupled with glitches in their thinking.
Comrade Althouse, your tone sounds quite defeatist. Everyone knows that all is well, that the kinks will be worked out, that all of the proletariat will benefit greatly from General Secretary Obama's wonderful Affordable Care Act. There is no place for those who criticize our Dear Leader.
There are colder places than Wisconsin, Comrade. Keep that in mind.
Forward! To our glorious Soviet American future!
You know what websites work? The ones operated by the insurance companies. I'm tired of this. I don't trust healthcare.gov to handle my data. I'm going to get a policy directly through an insurer.
Lance said: "Megan McArdle at Bloomberg posted a much better analysis last Friday. She cites David Freddoso, who also posted a fine analysis of what "enrolled" means."
If you read that and the CNN piece you should give CNN credit for accuracy about who is being counted. It is responsive to what McArdle and Freddoso wrote about what should be counted and what should not be inappropriately thrown in to inflate the numbers.
I do like the title of her article!
She didn't have the 4 things/5 things anxiety I make fun of.
Jeez - Opie and Anthony discussed it last week and their phones lit up. 9 out of 10 had their premiums and deductables go up. If Opie and Anthony can figure out what's going on, you would think CNN could if they wanted to.
This happened in my lifetime. In Red China, Mao sent the physicians out to the rice paddies to spread manure. In this way the physicians would learn to overcome their bourgeoise prejudices. Working people were given first aid courses. Their training was somewhat less than that given EMTs in this country. At the end of their rigorous three month training program they were called "barefoot doctors" and were sent out to the countryside to work with the masses. In the western press, this "barefoot doctor" program was widely hailed as a great success. Lots of people with tractable diseases died painful deaths in China, but the barefoot doctor program was pointed to as the kind of innovative program, third world countries should strive for. That's what the western journalists who were permitted access to Red China reported.
Some of the ACA defenders are now arguing that it should be judged by comparing the prices that people will pay under ACA with the prices that they paid before.
One problem with that is that you can't see the ACA prices without an account and even then, you don't see all prices, you just see your post-subsidy price.
In other words, those of us paying have to take it on faith that other people are saving money.
Yeah right.
the barefoot doctor program was pointed to as the kind of innovative program, third world countries should strive for. That's what the western journalists who were permitted access to Red China reported.
That's nothing new. The New York Times reported the Holodomor as a rousing success. When Stalin said the death of one is a tragedy, but of 1 million a statistic? He was talking about journalists.
The one thing of which we can be certain is that the press will always report the latest Five Year Plan has had rousing success, barring the temporary and scattered difficulties caused by saboteurs and unexpected bad luck.
There are certainly still occupations requiring greater moral corruption than being a modern American journalist. Whoever proposed and managed the Cyprus bail-in. The people in the ChiCom bureaucracy who decide which prisoners to execute next, depending on the demand for black-market kidneys among Hong Kong medical tourists. Probably some others, too. But I'm thinking they've definitely sunk well below divorce lawyers, actors, and used-car salesmen, their traditional ethical peers.
Let us not even talk whores. Compare to a modern mainstream American journalist, your typical street walker is a paragon of integrity.
Of course Dems are things that happen. Good things.
Also, within the Healthcare.gov failures, CNN has conflated two separate problems that really deserve to be addressed separately -- (1) that consumers are having difficulty signing up, and (2) that the portal is spitting out junk data to the insurers. Both of these are big problems but in different ways.
"Where's your god NOW, Moses?"
Some one is missing.
Who can it be?
You know, the fix for the busted exchanges is simple: make the subsidies portable, so people can go onto a private website or even to an insurance agent and still get their government money.
http://janetheactuary.blogspot.com/2013/10/so-heres-crazy-suggestion-on-busted.html
Mind you, I said the solution is "simple" -- not that I believe it would ever be implemented. Better to spend billions and billions more rewriting the code than to allow a competing system!
The Obama administration took a stupid idea and made it worse.
John said
It sure would be nice if everyone (including me) would distinguish between health care and health insurance.
The distinction is actually very simple. Health care is the set of services, devices, medications, tests and related actions performed by health care providers such as doctors, nurses, physical therapists, lab technicians and the like. Heath insurance is how most people pay for health care. That's it.
The problem is that health insurance really isn't insurance in the normal sense. Too many people have this strange belief that nearly any conceivable medically-related expense should be covered by insurance. The closest analogy would be if they expected their auto insurance to cover fill-ups, oil changes, paint jobs, new tires, etc. Health insurance should cover major medical expenses such as hospitalization, surgery, cancer treatments, etc. Routine medical expenses like doctor office visits should be paid out of pocket, perhaps using a health savings account.
It took me awhile to figure out what is going on, but it did. You see, the president felt that there were 30 million without health insurance. So they took over 1/6 of the economy and now have force people to have health insurance. But, that is all they have, they can't afford medical care as the government is taking $300 or more per month and forcing them into plans that have deductibles of $5000. That means that the average person who could not afford health insurance before, but could go to the doctor for $300, no longer has that $300 and doctors are beginning to change their billing practices by asking for the deductible up front before you are seen.
"4. The cost of care has become more clear." This item is about the cost of insurance, not the cost of care.
How can there be two major confusions in just one short sentence?
4a. What's for sale on the exchanges is not care, it's insurance.
4b. And what you can find out there is not the cost of that insurance, but the price of it.
When a merchant offers something for sale, you're told the price of it (but not the actual cost of providing it).
"When a merchant offers something for sale, you're told the price of it (but not the actual cost of providing it)."
Well, it is the cost to you.
david7134 said...
But, that is all they have, they can't afford medical care as the government is taking $300 or more per month and forcing them into plans that have deductibles of $5000. That means that the average person who could not afford health insurance before, but could go to the doctor for $300, no longer has that $300 and doctors are beginning to change their billing practices by asking for the deductible up front before you are seen.
But David, Obamacare gives them all sorts of free stuff for that $3600+ a year insurance premium. They get a free checkup. And a flu shot. And birth control pills! Now, admittedly all of those things bought separately would cost perhaps $300 a year (give or take, depending on where you live). But we must think of the greater good! Young, healthy people will be paying premiums equal to many times what they consume in health care each year so that older, sicker people can pay less. Young, healthy people should be happy to be ripped off, er, contribute to the glorious national cause this way! [/sarc]
The best suggestion is the one Obama made today. Just use the phone. Guess what ? It directs the caller to the web site. The state web sites direct the applicant data to the dysfunctional IT system. It is a clusterf**k.
The thing about having employer based insurance is a standard leftist response. They either don't understand that employer based insurance is going away, or they are lying. Big employers are already dropping family members.
Larry,
I am glad you brought up the "preventative measures". As a physician, I can assure you that there is no such thing as preventative care. Certainly checking your bp is important, something that everyone should do at home. But the rest, forget it. Strict control of diabetes is associated with increased death and morbidity. Cholesterol has nothing to do with any causation of disease and the drugs used for control do not help prevent CV disease and are dangerous. If you don't know that you are overweight, then you don't look in the mirror very often. Testing for CV ailments does little for the prognosis of the disease. Prostates are best left alone, if you have cancer from on either you die quickly with the doctor not be able to effect the course of the disease or you have a slow tumor that does not need treatment. Breast screening is necessary, but self exam picks up more than the doctor (most new doctors don't touch patients).
Now, one other big factor. Preventative care is MANDATORY. In other words you have to see a doctor about twice a year. Most people don't know that. Also, what they don't know is that the more you see a doctor, the greater the chance that bad things happen to you. Then there are the fines. No one knows about this as well. You will be fined for being overweight, having a high cholesterol (note that high cholesterol does not CAUSE any disease), having your bp up, not eating right, not exercising, etc. So a lot is coming your way and no one read the bill!!!!
Re: Larry J:
About all the free stuff, I'm reading now that the deductibles on many plans are super-high now, because of Obamacare:
If the 33-year-old single father wants the same level of coverage next year as what he has now with the same insurer and the same network of doctors and hospitals, his monthly premium of $233 will more than double. If he wants to keep his monthly payments in check, the Carpentersville resident is looking at an annual deductible for himself and his 7-year-old daughter of $12,700, a more than threefold increase from $3,500 today.
At that point, we're really looking at an expensive catastrophic coverage policy. And I'm of two minds about that. On the one hand, obviously, voters were lied to. On the other hand, it's not like voters played any role whatsoever in passing Obamacare since as far as I'm aware its net approval ratings have been underwater from the moment it was passed right up to the present, so the argument that "voters were lied to" has somewhat less force than it otherwise might.
On the gripping hand, the more people who are essentially purchasing all their routine medical services directly and out of pocket, the more price pressure there will be on medical service suppliers. And that's a good thing. To facilitate it, though, we ought to mandate public disclosure of all medical service providers' base fee schedules, and their average effective invoiced rate. So people can compare prices and negotiate their fees down more effectively.
So it's unfortunate for the eggs whose insurance won't really kick in until they suffer some horrible injury or cancer or something, but I can actually see some ways in which -- over the very long term -- this omelet might not be quite as bad as it seems.
"Forget it, Jake. It's CNN..."
"On the gripping hand, the more people who are essentially purchasing all their routine medical services directly and out of pocket, the more price pressure there will be on medical service suppliers. And that's a good thing. To facilitate it, though, we ought to mandate public disclosure of all medical service providers' base fee schedules, and their average effective invoiced rate. So people can compare prices and negotiate their fees down more effectively."
This is where the cash model of health care comes in. Doctors are not allowed to disclose fees to insurance patients and Medicare pays about 20% of the "retail" price seen on EOBs.
If I do a procedure or care for an uninsured patient for cash and the price is less than the insurance or Medicare "retail" price, I am either breaking my contract with the insurance company or, with Medicare, breaking the law.
Not many people outside the health care business understand this. I took care of many people who were uninsured. Some repaid me with barter. For example, I once had a patient clean my house for a year. That was her business.
One thing I did NOT do is talk about the free care or the Medicaid patients I took care of. That would guarantee a waiting room full the next week. Most GPs I knew did not even bill Medicaid. The payment was too small and it took two years to get paid.
One thing that will happen if Obamacare ever gets working is that the demand will far exceed estimates. A lot of doctors have been taking care of people and not charging them.
Personally, I don't think it will ever work. The gov't may waive income limits for subsidies but this will unleash a flood of fraud that will make the housing thing look honest.
The administrative state, like the Soviet Union, cannot do this competently.
Ann Althouse said...
"When a merchant offers something for sale, you're told the price of it (but not the actual cost of providing it)."
Well, it is the cost to you.
Which is always negotiable in a free market.
Obamacare?
Not so much.
Re: Michael K:
This is where the cash model of health care comes in. Doctors are not allowed to disclose fees to insurance patients and Medicare pays about 20% of the "retail" price seen on EOBs.
Yeah -- the fact that doctors are not allowed to disclose fee schedules is absurd. I understand why insurers like to keep their prices confidential, and why hospitals benefit from keeping the published rates high, but secret prices seems to me like an obviously bad thing from the end-consumer's perspective. I think it's one of the reasons that so many routine procedures that are inexpensive elsewhere are gobsmackingly expensive in the US (or at least appear to be).
" I think it's one of the reasons that so many routine procedures that are inexpensive elsewhere are gobsmackingly expensive in the US (or at least appear to be)."
This is why the cash model is gaining and will continue to do so until the Obama folks outlaw it. And they will.
The busiest and best hip replacement surgeon in my area has dropped Medicare and insurance. He works only for cash now. His charge for a total hip is what Medicare was paying. About $1700.
You can still use Medicare for the hospital charges but he has closed his "back office" that did his billing.
The young docs have enormous student loans and are indentured until those are paid off. The older ones are quitting.
Who watches the clinton news network?
Speaking of five things.
1. It's worse than his team has let on. The White House has tried to position the failed first days of Obamacare as mere hiccups caused by the site's popularity. Obama called them "kinks." An administration spokesman told the Washington Post on Sunday that the "main driver of the problem is volume." This is intentionally misleading.
The White House has heard complaints from insurance companies, consumers, and health policy experts about issues embedded deeply in the online system. For example: inaccurate information provided to people about federal tax credits; low-income people erroneously told they don't qualify for Medicaid; and insurance companies getting confusing information about who has signed up.
The administration refuses to say how many people have enrolled through the federal exchange, the key metric for determining how well the online service is working in states that didn't set up their own exchanges. There are two possible explanations for the Obama administration's unconscionable lack of transparency. Their process is so screwed up that they don't have the data, which would be embarrassing. Or they have the data – and it's embarrassing.
And the rest.
@Balfegor
How about:
5. Liberal media outlets like CNN have tripped all over themselves trying to cover up and rationalize the impact ACA is having on this country.
It may be time for Obamacare to bring in the true experts at Internet high demand, high complexity user selection, the porn people.
Yeah, when people finally get through to see premiums, they're going to yell. Then when the deductibles, coinsurance rates, out of pocket maximums and provider network limitations rise up in all their ugliness, people may storm the White House.
Bud Norman has a funny, insightful article on the subject of things that people say that make them sound smart to stupid people. Of course it may make them sound stupid to smart people, but since there are more stupid people than smart people, the odds favor bullshit.
Norman note that Obama used this insight in his recent campaign speech in the Rose Garden again extolling the wonderfulness of ObamaCare when he promised that a “surge” of the “best and brightest” professionals from the public and private sectors would soon have it all worked out.
Other examples abound in Obama’s political career. He once promised “peace in our time,” apparently either unaware or unconcerned that the slogan was famously associated with British Prime Minister Neville Chamberlain’s disastrous attempt at appeasing Adolf Hitler, and his apologists have created such formulations as “leading from behind.” “Hope and Change,” “Yes, We can,” “the failed policies of the Bush administration” and all the other vague slogans of his first presidential campaign had the same winning effect on the stupid and same calculated disregard for the smart, and all were delivered with a smug cocksureness and upraised chin that even our shrewd high school friend could not equal. It might not work with Obamacare, as even the stupidest among us can figure out when their health care costs are rising and grandma’s hip replacement is being put off, but most of the time it seems to work well enough.
We were particularly taken with this epiphany when we though of Ann Althouse, famed blogger and law prof at University of Wisconsin, Madison. She voted for Obama in 2008, totally taken in with his claims. Proof, if anyone needed any more, that stupid is alive and well in academia. It's the one place where you can write an academic paper deliberately designed to be filled with total CRAP, and get it published. And don't get me started on the super-concentrated collection of stupid in the press and the media.
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