Obama Care Part II

[12thMan]

The roll out was a complete disaster. The buck stops with President Obama on this one. You don't campaign for several years on your signature legislation and just hand something of this magnitude and consequential over to bureaucrats and government contractors without fierce accountability along the way. This has been poorly managed and, frankly, reflects badly on the president's executive skills.

All of that said, the kinks will get worked out and people will enroll. To say Ocare is a failure or a success without any deep knowledge of changes taking place in the marketplace and how many people will ultimately enroll is premature. We simply don't know at this point. Drips and drabs of data here and there will inform us, but we can't conclude a whole lot. We might not know for a few years. My guess is premiums will rise in some states and fall in others. People will cherry pick the data to suit their partisan purposes. What we do know is that more red states are starting to warm up to the Medicaid expansion, which will help.

Here's a good link from a credible source breaking down winners and losers.

CHART: 'Winners And Losers From Obamacare'

[Chico23231]

Originally Posted by Daseal

So you would rather hire hundreds of thousands more government employees? There is an important place for contractors in government work. It allows the government to expand and contract as necessary. It puts the stress on the contractors rather than the federal government.

There was a reason those big companies were called the beltway bandits. They made obscene profits on government work. That has since changed. They do make money, but it is competitive and prices are going way down. However, as prices go down, so does the quality of the talent you can attract. Thus leading to a worse overall product for the government.

There are a few other issues. First, contracts. It really depends. The scope of what we do here goes far beyond what our contract stipulates, but we give it the best effort we can based on current staff and expertise. Other contracts are an amazing value to the government, but have started pulling out the contract and telling the government "No, we will not do that. It is not part of our contract." Secondly, the requirements put forward often require a bachelors degree minimum and the ability to obtain certain clearance levels. Cleared personnel typically are able to demand more money because it's something that is difficult to get and necessary to even walk through the doors of most facilities.

There are issues with contractors, but don't act like every person drives a Porsche to work and cleans up. My charge rate the the government is pretty high, but in that it is expected my benefits and salary will be taken out along with a cut for my company to make a profit. That money goes into things such as R&D for other Government work. It's a complex exosystem and it's difficult to say it's good or bad.

No i would like to simply cut both. I respect the work and understand its why, but not everything in between. Im sure its alot bs you deal with and its not easy, but its compensated. The government contractors i know, father and son, traveled during the shutdown.

[firstdown]

Originally Posted by Daseal

I have a few quick things to input into the conversation.

1) The website debacle. When speaking to the availability of the site, this is a tough topic. They could have taken precautions to ensure the load didn't crash the site, however the hardware costs for the project would be through the roof. A good analogy for the launch of this site is a brand new video game. When a brand new video game launches, it typically crashes a lot. The reason for this typically isn't technical ignorance, it's hardware. Very rarely will your game (or site) see the amount of traffic it will see the first couple weeks. The decision you make is if you invest in a ton of hardware that keeps you up during the huge spike in demand early, or have plenty of resources to maintain down the road and deal with some up front issues with availability. Many games/sites that have to make this decision opt to save money on hardware and deal with some customer inconvenience. As a tax payer, I'm okay with them not wasting thousands upon thousands on unnecessary hardware. Perhaps a system only allowing people with certain info registering at certain times would have helped, but I don't have enough information to make that recommendation.

2) My company has sent some e-mails barely disguising their hate for ACA and the massive impact it has on the company. After comparing the exact same plan between last year and this year the total paid went up 10 dollars a pay period. Here's the fun part. The company pays 4 dollars a check LESS this year and the employee pays $14 dollars more this year. Either way, a fairly small jump all things considered, but it's better for the business than before.

Your going to compare a 650 billion dollar investment into this site to a video game? the ACA is messing around with about 20% of our nations anual spend and you think Obama worried about the cost of the site. Tells alot about this president.

[firstdown]

Originally Posted by 12thMan

The roll out was a complete disaster. The buck stops with President Obama on this one. You don't campaign for several years on your signature legislation and just hand something of this magnitude and consequential over to bureaucrats and government contractors without fierce accountability along the way. This has been poorly managed and, frankly, reflects badly on the president's executive skills.

All of that said, the kinks will get worked out and people will enroll. To say Ocare is a failure or a success without any deep knowledge of changes taking place in the marketplace and how many people will ultimately enroll is premature. We simply don't know at this point. Drips and drabs of data here and there will inform us, but we can't conclude a whole lot. We might not know for a few years. My guess is premiums will rise in some states and fall in others. People will cherry pick the data to suit their partisan purposes. What we do know is that more red states are starting to warm up to the Medicaid expansion, which will help.

Here's a good link from a credible source breaking down winners and losers.

CHART: 'Winners And Losers From Obamacare'

That's about as bias of a chart as I've seen. Its say's "cancellation notices for stripped-down individual market plans that failed to meet the benefit requirements of the ACA". That's not all true. If my plan changed from a 20% co pay to a 10% copay anytime after they grandfathered plans I will not be geandfathered and reguired to purchase a new plan. I like how they also use the term stripped-down plan. So if we elected not to carry a coverage like maternity because we will not be having any more kids then our plan will get dropped because it does not meet the requirments. So I guess having choises of what we need and don't need is considered a stripped dow plan. It also assumes that employers will not take measures to cut back cost. It also seems they assume prices will stay the same. Well who the hell is going to cover the people who cannot affored coverage, have reduced rates, etc...

[Daseal]

Originally Posted by firstdown

Your going to compare a 650 billion dollar investment into this site to a video game? the ACA is messing around with about 20% of our nations anual spend and you think Obama worried about the cost of the site. Tells alot about this president.

FD,

It's a fairly accurate analogy. The scope is not exactly the same, but the technical challenges remain the same. Both will have traffic that is significantly front loaded but will quickly dissipate to an level that is easy to manage. If we had spent an extra 500,000 - 2,000,000 on the necessary hardware to support the types of loads its seeing, you'd be complaining about that. I'm not saying the rollout was perfect, I'm also saying that no technical implementation will be perfect. Part of my job is to work new tools into a fairly complex environment. Every piece we add has challenges you prepare for, and challenges you do not foresee, regardless of the planning put into place. To take something like a website up to the Presidential level is simply ridiculous. You can't point a finger directly at him for screwing it up. I don't expect my President to understand highly technical situations, I do expect people closer to the situation to understand, and I believe they did a fairly decent job given the constraints they were under.

** I do want to make it clear, I have no connections to this website or its development. That's not my area, but I was interested in what happened and why.

[mlmpetert]

Yeah that chart is complete garbage. And it not breaking down anything. Its just a pie chart some dude made off of guesstimates of generalities summarized in a dumb downed cartoon publication for liberals from a short conversation between a liberal author and an obamacare friend, supporter and architect.

The most ridiculous part of the whole thing is how its divided up. The 6% that is split 50/50 as either losers or those without consequence, is specifically refereeing to people who already have insurance through the individual market place, NOT people with insurance through work (most Americans).

Secondly, its impossible to know what Gruber is referring to when he says 80% of people are unaffected, but he is definitely not talking about ANY of the people who are receiving cancelation letters in the mail from their group insurance providers. Not to mention the fact that at least 15% of that 80% HAVE TO BE people who are covered through Medicare.

And 14% of people are clearly not clear winners. Of the 14% or so of people with or without insurance, many of them don't want it. To broadly state that all of them are "clear winners" is completely disingenuous.

This graph isn't a reflection of anything more than off the cuff optimistic liberal water cooler talk.

[Giantone]

Originally Posted by mlmpetert

Yeah that chart is complete garbage. And it not breaking down anything. Its just a pie chart some dude made.

From M.I.T., the dude .

[BaltimoreSkins]

I have to admit I have beaten up Obama for his statement about being able to keep you insurance if you are happy with it, but I like that he did man up, although I would like a little more formal of an apology. I know his critics will still ridicule him, but that comes wioth the territory.

[mlmpetert]

I got another letter in the mail over the weekend....

This time is was an announcement from my doctor, a primary care physician/ internist, that his practice was going to a concierge service.

For those unfamiliar with concierge type doctors, all it means is that they charge a yearly fee on top of the standard cost of a doctors visit. Basically a retainer to go to your doctor. In the past most of the doctors did this to cater to wealthy and/or demanding patients who wanted to spend more than 10 mins with their doctor each visit or perhaps to call them to get a prescription instead of going in for something minor.

Its become much more common place in the last few years with the growing shortage of doctors. I also personally believe established doctors are going concierge to cut back their hours without significantly cutting back their incomes as they transition into retirement. It probably makes sense from a succession planning perspective too. And now with Obamacare its never made more sense. With more patients on the immediate horizon (increasing demand) and an aging physician population (reducing supply), doctors are now in good position to charge all of those who can afford it (the middle class) a retainer.

[mlmpetert]

Originally Posted by Giantone

From M.I.T., the dude .

The dude who made the pie chart wasn't from MIT. The MIT dude was the obamacare friend, supporter and architect who spoke in generalities with a liberal "reporter".

Of course, GW went to Harvard so im sure you must think hes right about everything too.

[Daseal]

Interesting. Never seen a Dr. do that before, but not surprising. Out of curiosity, what is the retainer? Is it significant?

Originally Posted by mlmpetert

I got another letter in the mail over the weekend....

This time is was an announcement from my doctor, a primary care physician/ internist, that his practice was going to a concierge service.

For those unfamiliar with concierge type doctors, all it means is that they charge a yearly fee on top of the standard cost of a doctors visit. Basically a retainer to go to your doctor. In the past most of the doctors did this to cater to wealthy and/or demanding patients who wanted to spend more than 10 mins with their doctor each visit or perhaps to call them to get a prescription instead of going in for something minor.

Its become much more common place in the last few years with the growing shortage of doctors. I also personally believe established doctors are going concierge to cut back their hours without significantly cutting back their incomes as they transition into retirement. It probably makes sense from a succession planning perspective too. And now with Obamacare its never made more sense. With more patients on the immediate horizon (increasing demand) and an aging physician population (reducing supply), doctors are now in good position to charge all of those who can afford it (the middle class) a retainer.

[mlmpetert]

Originally Posted by Daseal

Interesting. Never seen a Dr. do that before, but not surprising. Out of curiosity, what is the retainer? Is it significant?

It wasn't on the letter but I just called them and its $1,650 per year. That seems on the higher end of what ive heard from other people. Plus there isn't really anything special about my doctor, so in my opinion it seems really high.

I think normal in the Richmond area is 1k - 1.5k. I think for the really good doctor practices where you are truly getting additional care, the people who can afford it are paying 5k. I have a client whose wife has chronic illness and they pay 20k for her doctor, but that's for someone who needs special medical attention and things like regular house calls.

[BaltimoreSkins]

Trio of young coders build health-care website in days - CNN.com

After all the problems with the website this is kind of funny to me. I heqard it on NPR this morning and can't find the story so I put this CNN link up instead.

[mlmpetert]

Thought this was pretty neat

Americans 34 Times More Interested In Buying Guns Than Obamacare | Zero Hedge

[RedskinRat]