Say, What Defines Success For Obamacare?

That’s something The Politico’s David Nather asks

Democrats have a general idea of what it would take to put the Obamacare rollout back on track. Fix the damn website, they say, and most of the other problems will take care of themselves.

But will they? The problem is that neither the administration or the House and Senate yoked to it can describe a threshold for when the public will view the health law as on the way to recovery.

What does the moment of success look like? Democrats aren’t quite sure – which makes party faithful up for re-election in 2014 increasingly nervous and makes the White House’s ability to set realistic expectations exceedingly difficult.

Most Democrats insist that the main path to recovery is as easy as fixing the website. That’s the line even from the Senate Democrats who bent Obama’s ear at the White House last week about the rollout. They just can’t give any concrete suggestions on what else it would take — which is why most of them sound like the old Saturday Night Live “fix it” guy: “Identify a problem, FIX IT. Identify another problem, FIX IT!”

Democrats and Team Obama think that fixing the website will enable the Unicorn Of Awesomeness to run free, and then the “Affordable” Care Act will be a rousing success. Yet, the website, working correctly or not, is simply the portal to people obtaining Government Approved health insurance. In order to be successful, it would

  • make sure that the majority of the 30-45 million Americans without insurance obtained insurance, like was used as a talking point prior to passage
  • Is revenue neutral, as Democrats stated
  • Is providing quality health care
  • Bends the curve down on rising health insurance and care costs
  • Doesn’t get in the way of decisions between you and your doctor (death panels, government mandates)
  • Are those who are sicker making up the vast number of enrollees
  • Lowers premiums up to $2500 for families, as Obama and other Dems repeatedly stated
  • Makes it easy and inexpensive for those with pre-existing conditions to obtain affordable coverage
  • Companies aren’t dumping their health insurance plans
  • Companies aren’t shifting people to part-time work
  • You aren’t losing your doctor
  • You aren’t losing the plan you like

Well, since many of those have already been broken, it’s exactly the success Conservatives said it would be. For Progressives, the #1 measure is “how much power has government taken for themselves when it comes to people’s health decisions?” Also, “how much closer to single payer are we?” Of course, most of these folks didn’t think that the law would effect themselves. Surprise!

Meanwhile, the Wall Street Journal reports that the initial numbers should show 40k-50k enrollments. The Washington Post is saying 40,0000. Sarah Kliff, who has mostly been on the cheerleader side, wonders who counts as an enrollee

When the Obama administration releases health law enrollment figures later this week, though, it will use a more expansive definition. It will count people who have purchased a plan as well as  those who have a plan sitting in their online shopping cart but have not yet paid.

“In the data that will be released this week, ‘enrollment’ will measure people who have filled out an application and selected a qualified health plan in the marketplace,” said an administration official, who requested anonymity to frankly describe the methodology.

So, if you are cruising Best Buy’s website and “add to shopping cart to see price”, according to Team Obama that would mean you purchased that product. Even if you haven’t paid for it. If you download a free preview of a book from Amazon, that means you bought the book. Though you haven’t paid a dime. If you are on Rotten Tomatoes and say that you want to see this movie, the studio can report you as having seen it, though you haven’t paid.

I suspect the actual paid enrollments are so low that they don’t dare release the numbers.

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20 Responses to “Say, What Defines Success For Obamacare?”

  1. david7134 says:

    Be careful on the wish list, you are playing into their hand. First, if few people have signed up for this great insurance, maybe there where not that many that needed it. Then, quality, that is being delivered under our prior system. Now doctors will be required to keep quality measures. That means less medical care, thus it is the actual death panel. This is a complicated issue, but I assure you when the government says “quality” that is not what they mean. There is no way a government system can be made without drastically increasing the cost of care, taxes, etc. It has never, ever happened and certainly our stupid government would not be able to figure out the formula. The best would be for the government to pull out of everything. But that will not happen, so we are screwed.

  2. david7134 says:

    One other thing that the left says is that health care is a right. I actually agree with that concept. That is why I don’t understand why the government regulates it and parcels it out as it sees (prescription drugs and other issues). We have a right to see a doctor, have procedures we feel are necessary (not someone else), have ready access to medication (over the counter for all drugs-there is no such thing as addition).

  3. Dana says:

    David, if you agree that health care is a right, then who but the government can insure that?

    The things you mentioned — seeing a doctor, having necessary procedures and medications — all have to be paid for by someone. If someone cannot pay for these things, yet still receives them, then he is sticking his hand into someone else’s pocket to get them.

  4. Cold_Front_Gumballs says:

    Sure, health care is a right. No one stops you from seeing a doctor. No one stops you from making an appointment. This argument is specious.

    The current argument is who is being forced to pay for someone else’s INSURANCE coverage.

    I was ok with Medicaid and Medicare. That covered those Americans really too poor to afford to go to a doctor and those older or sickly Americans who are at higher risk.

    But, now Medi* is given to too many free-loaders and handed out like candy. Now I’m being asked to ALSO pay for the college student who is now mandated to sign up for insurance even though he\she spends all his\her money on beer and birth control. (Granted, now this fancy new insurance will force me to pay for that too).

    GAWD I hate socialism. So unfair and totalitarian.

  5. gitarcarver says:

    I could e wrong, but I think david may be trying to say that access to health care is a right. That would mean individuals and health care providers would both be free to negotiate for services just as any other product or service.

    That would leave both parties the right to exercise freedom of choice in the marketplace, freedom to enter into a contract into the marketplace, etc.

    If health care is a right, then Dana is correct that not only does someone have to pay for it, but also the government can set wages and fees that in essence create “forced servitude” for health care providers.

  6. Cold_Front_Gumballs says:

    Right GC.
    I separated out “access” from service. You are free to access a doctor of one’s choosing.

    However, if the “service” is a right, then yes, health care professionals would become defacto gov’t agents.

    They would be bound by gov’t fiat to provide care\service no matter what. And, they would not be allowed to deny giving\withholding care, or even deny gov’t intrusion and fee structure.

    That in effect would be the Socialists wet dream of a one-party pay… where the gov’t IS the health care provider from top to bottom.

  7. […] David Nather’s question, just what it would take for the PP&ACA to be deemed successful, and provides his own answers: Democrats and Team Obama think that fixing the website will enable the Unicorn Of Awesomeness to […]

  8. gitarcarver says:

    Gummy,

    Just to let you know, I was writing at the same time you were posting. I didn’t see your post and wasn’t trying to address the things that you were saying.

  9. david7134 says:

    Dana,
    It is fascinating that people don’t know how our government works. We delegate certain actions to the Federal government. The retain our rights. The Federal government does not have the right to regulate our health care as it is not specfically addressed in the Constitution. All the recent Supreme Court decision did, besides destroy the union, is to say that Congress can tax, that is it, it did not say that Obama can regulate health care. If you want that, then have a constitutional conventio and lets get at it. We have a right to health care, any way we can get it without government interference. I can go see a witch doctor if I desire, and have sent some patients to one (really). But what is troublesome is that the medical profession in the US is the most regulated industry in the world. Are you aware that I can not give free care secondary to Federal law. In fact, I can’t even give discounted care to needy people, that is call Medicare and Medicaid fraud. When they talk of fraud, that is what most of the cases are, doctors trying to do right.

    Now lets talk Obamacare. There is no correlation between Obamacare and health care. All that Obamacare give you is a very expensive, burdensome health insurance policy. If you look at the policies, you still can’t afford health care if you are an average individual. Believe me, I see people everyday and have to work out their procedures and they can not afford the healthcare under these plans. I just had to blow off getting an ECHO (cost $200) on a patient with congenital heart disease as the only game in town wanted $1000 up front, which is his deductable (this is under Obamacare). The $1000 is his deductable, he is still allowed this small amount as his insurance is with his employer. He will have to pay $2500 next year as that will be the lowest deductable. So most will not get the promised care.

    Then, it is not, I repeat not your right for me to have to pay your expenses. That is wrong. You can work out with your doctor what to do in the free market. It is funny, but here in Louisiana we had no problem with people getting care until the Feds came in. Everyone was taken care of. Now, our charity system is closing and people have less choice than before.

  10. Cold_Front_Gumballs says:

    But what is troublesome is that the medical profession in the US is the most regulated industry in the world.

    There’s good and bad in that. Good in that bad medicine is weeded out and prosecuted. Needless medicines are prevented from being on market and harming people. Bad in much the way that you describe.

    Are you aware that I can not give free care secondary to Federal law. In fact, I can’t even give discounted care to needy people, that is call Medicare and Medicaid fraud.

    I’m not sure I understand this. You go out on your own and provide low-cost care to sick people. What business is it of the gov’t what you charge them? If you are billing Medi* for that service, and it is lower than what Medi* would normally pay you, then how is it fraud? And, why can’t you give free care?

    All that Obamacare give you is a very expensive, burdensome health insurance policy.

    Damn tootin. All this did was create a MASSIVE bureaucracy that redistributes more wealth. It also duplicates much of what is already out there (in web services designed to collate health plans available to you).

    I just had to blow off getting an ECHO (cost $200) on a patient with congenital heart disease as the only game in town wanted $1000 up front, which is his deductable (this is under Obamacare)

    ObamaCare plans have not started yet. They won’t start till at earliest january 1, 2014.

    The $1000 is his deductable, he is still allowed this small amount as his insurance is with his employer.

    that is a very small deductible. and having higher level deductibles allows for the overall price of the health insurance to be lower.

    I’m confused about how you had to have this patient forgo a $1000 procedure (the cost of deductible) when you stated you were going to charge him $200? If he could not afford the $200 then how is he paying for his insurance? food? And, at the end of the year, he has yet to meet that deductible yet? Especially with him having severe heart disease?

    He will have to pay $2500 next year as that will be the lowest deductable. So most will not get the promised care.

    Yep, that’s all thanks to crappy new Fed laws via ObamaCare. However, having open heart surgery is much cheaper at $2500 than $100,000+.

    This has been the case for eons David. People have made that choice between getting minor or even medium level care versus other “things”. Does this person have a cell phone with a data plan? For how long have they had it? Do they drive a newer vehicle?

    We all make choices in how our health care and insurance will be provided versus living a life comfort.

    (disclosure, I paid $15000 out of pocket for a back surgery a few years ago because I did not have insurance. I got a loan and paid it off. I even worked with hospital to give me discount since I was paying up front)

  11. gitarcarver says:

    After positing that most people don’t know how the government works, david wrote:

    We delegate certain actions to the Federal government. The retain our rights.

    I am assuming that “The retain our rights.” is actually meant to be “They retain our rights.”

    If that is what you are saying david you are wrong. The government never retains the rights of the people. The government is designed to protect the rights of the people.

    We have a right to health care, any way we can get it without government interference.

    No, you don’t have a right to health care. You may argue that you have a right to the access of health care, but you have no right to health care itself.

    As I believe someone else stated, if you had a “right to health care,” the government could, in protecting that “right,” force people to provide the actual service or force people to pay for health care for others.

    In essence, you argue that health care is a “right” and then argue that the government can’t take the steps required to protect that right.

    Quite simply, your terminology of a “right to health care” is wrong.

  12. david7134 says:

    guitar,
    Go to the Constitution, note that the Feds are given certain aspects of their jobs and certain rights, such as guns are definitely spelled out. At the end, there is a phrase that says all rights not reserved are granted to the people, or some such language. The long and short is that if it anit’ in the Constitution spelled out as something the government can control, they have no business in it. To date, they use the commerce clause to cover these things. But, what they are doing now effect people directly and thus may not have the right of the commerce clause. Of course none of us are lawyers and I am sure even they are confused. Now, government does not guarntee you your rights. Notice things like the TSA and they Patriot Act. Government is constantly trying to infrige on you and in my case they tried to kill my generation by sending us to Nam. You have to fight the government for your rights.

    Now, regulation in medicine is first by the fact you have to get a license. That is not easy. Thus, doctors are an instrument of the state in that the state grants them the priveledge of practicing. They can take it away and there are multiple boards and agencies that constantly are bothering us. In fact, if you really want to hurt a doctor, a malpractice suit does nothing, but turning him over to his state board can kill him. Now, some of this is good, but with Obamacare it will be much worse and not for the better.

    Then, even though the plans start next year, the regulations have already hit and existing insurance companies are putting the hurt on patients. Now, I did not charge the patient $1000. That was a third party. But it limits me and the patient in our ability to sustain his care. Now, how is charging less money for an office visit fraud? On multiple levels. It is a very complex issue for which most lawyers don’t understand but if I charge a patient low as I think he is poor, and the government finds out, then that is fraud as they feel that if I can charge low and not giving them the same break then I am committing fraud. Now, fraud under Medicare and Medicaid has nothing to do with fraud as defined in usual legal terms. Go to the Medicare fraud site for a definition. The fact is that there is so much about medical care that the average person does not know that it hurts. I could never explain in all even person to person given a week.

  13. gitarcarver says:

    Go to the Constitution, note that the Feds are given certain aspects of their jobs and certain rights, such as guns are definitely spelled out.

    There is a difference between the actions of the government / what can be referred to as the rights of the government and the rights of the people / individuals.

    The government retains its rights – not the rights of the people.

    At the end, there is a phrase that says all rights not reserved are granted to the people, or some such language.

    I am not sure what you are talking about. There is nothing in the body of the Constitution that says what you are putting forth. However. the 10th Amendment does come close when it says:

    The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.

    “Powers” are not “rights” david.

    I have no quarrel with your statement that if it “anit’ in the Constitution spelled out as something the government can control, they have no business in it.”

    My issue is with your belief that you have a right to health care.

    You don’t.

    As for your contention that you can be convicted of Medicaid fraud if you supply medical services to the poor or at a cut rate discount, that is false.

    As you are from Louisiana, here is the statute for your state:

    La. R.S. 14:70.1

    § 14:70.1. Medicaid fraud

    A. The crime of Medicaid fraud is the act of any person, who, with intent to defraud the state through any medical assistance program created under the federal Social Security Act and administered by the Department of Health and Hospitals:

    (1) Presents for allowance or payment any false or fraudulent claim for furnishing services or merchandise; or

    (2) Knowingly submits false information for the purpose of obtaining greater compensation than that to which he is legally entitled for furnishing services or merchandise; or

    (3) Knowingly submits false information for the purpose of obtaining authorization for furnishing services or merchandise.

    B. Whoever commits the crime of Medicaid fraud shall be imprisoned, with or without hard labor, for not more than five years, or may be fined not more than twenty thousand dollars, or both.

    So you can provide medical care to others at whatever rate you want. What you can’t do is provide that care under the auspices of the Medicare program. If you sign onto Medicaid / Medicare, you play by the government’s rules.

  14. david7134 says:

    guitar,
    I have had this issue with you before. I can not educate you in two paragraphs about medial care and economics. At some point you have to take it in trust that an expert with 40 years experience and plenty of court time as an expert witness tells you someting is true, then it is true, period (as per Obama). I know a doctor in Mississippi that tried to avoid Medicare fraud and trouble by billing the lowest amount possible, he is now in jail.

    Now, if you try not to take Medicare, then you get the honor of having a Federal agent in your office daily going over your charts. So you take Medicare. And no, you don’t have a choice in not taking old people and the poor. You get them as a result of mandatory ER call when associated with a hospital. As I said before, there is too much complexity in this to explain the whole thing. Also, lawyers don’t even understand the above regulations that you posted. I have written enough on this, accept it for what it is.

  15. Cold_Front_Gumballs says:

    We don’t mean to be argumentative here David as for most cases we can agree with a handshake.

    But, you mentioned that powers not delegated to the Feds or States are “reserved” to the people. THat means, the people have to give up the rights to those “powers” before the gov’ts can have them. And you are correct, there is a growing movement in our gov’t today that feels people should not have any rights. Or that those negative rights means free license for the gov’t. And yes, we ALWAYS have to fight for our liberties and rights.

    That is the reason why the founders assured that we the people have access to arms to counter despotic gov’ts like what ours has come to.

    And yep, they use commerce clause to cover anything. It was designed to cover interstate commerce, but now is used to cover any type of commerce. States are trying to fight back over that. We;ll see how that turns out.

    Go to the Constitution, note that the Feds are given certain aspects of their jobs and certain rights, such as guns are definitely spelled out.

    Sorry, but that is wrong. Arms are reserved to the people and the gov’ts are allowed the right to access arms by the agreement that the gov’ts must defend us and our territory. It does specify that Feds can raise armies, and in that, purchase arms. But that is not a RIGHT for the feds.

    Now, regulation in medicine is first by the fact you have to get a license. That is not easy. Thus, doctors are an instrument of the state

    Part of that is because being a doctor is a commerce. That is regulated by the States. Not the Feds. But, do you not agree that we should have a minimum standard for doctors? You mentioned earlier, sending patients to a witchdoctor. There is nothing wrong with that if patient agrees and understand that the WD is not licensed to practice real medicine.

    They can take it away and there are multiple boards and agencies that constantly are bothering us.

    And they should if you break the law, violate ethics, or cause harm\fraud.

    if you really want to hurt a doctor, ..turning him over to his state board can kill him.

    Only if there is a cause. Most times, doctors are allowed to skate time and time again. At least those are the stories most often presented.

    even though the plans start next year, the regulations have already hit and existing insurance companies are putting the hurt on patients

    But that is not what you said. And regulations are not at play with your decision to mark down your cost for an ECHO. Now, the regulations can determine if you will get reimbursed by insurance or Medi* or not.

    That was a third party. But it limits me and the patient in our ability to sustain his care.

    Now, I am even more confused. How does a 3rd party FORCE you to charge $1000 or more for a procedure that you agree to only charge $200 for?

    The fact is that there is so much about medical care that the average person does not know that it hurts

    Very true enough. Which is why I was asking questions. I was confused and I knew you being a doctor could help shed some light on it.

    But I guess the bigger question is, aren’t you in favor of single-payer?

    (This time GC got in before me, so you can focus on one of us if you wish)

  16. gitarcarver says:

    david,

    I know a doctor in Mississippi that tried to avoid Medicare fraud and trouble by billing the lowest amount possible, he is now in jail.

    And your point? If he was accepting Medicare and was not billing the agreed to amounts, he was guilty of fraud.

    But that is not what you said. What you have said is that if you bill less than Medicare, you can be convicted of fraud. You can offer your services at any rate you want. However, if you want to be in the Medicare / Medicaid system and bill under that system, you have to accept rates and conditions. Don’t blame others for your signing up with the devil.

    As for being forced to accept Medicare, 10% of the doctors in the country do not accept it. As an expert in the field, are you saying that thousands of doctors can figure out how not to accept Medicare but you cannot?

  17. david7134 says:

    GC,
    If I order a test on someone, they go to another location and are billed by that location. Thus the other charge. You obviously have never been ill, if you had, you would know that you receive multiple bills.

    I am not in favor of single pay, if you read my comments you will get the idea I want the government out of medical care and that it reverts to a much more simple form. This would reduce cost as it is government that is driving the sky high cost currently. That is why I am saying you have a right to medical care. Once the government gets involved, you lose that right.

  18. Cold_Front_Gumballs says:

    Ok, I see what you are saying now David. Thanks for being patient (no pun) with us.

    Very true. Once the gov’t gets involved in anything, by default it is removing individual powers and liberties from the people. It can’t do anything unless it takes that “power” from the people.

    I think for the most part we all agree that the gov’t is too involved in our medical life. Right now, it can choose who will receive treatment and who will not. Who should get a pill and be sent home versus those where cost is no object.

    However, some of us are not as libertian and see a need for the gov’t to provide some level of protection to consumers.

    (handshake)

  19. gitarcarver says:

    david,

    If I order a test on someone….

    Okay david. This doesn’t explain anything but that’s okay.

    I am not in favor of single pay, if you read my comments you will get the idea I want the government out of medical care and that it reverts to a much more simple form.

    Fine. My point was, is and remains that when you say “health care is a right,” that automatically brings the government into the fray as the government is “instituted to [these] protect” rights.

    Three people in this thread have tried to get you to understand that there is a difference between “access to health care” and “health care.”

    What you don’t seem to understand is that when you say “health care is a right” and “I want the government out of health care” you are expressing two opposing ideas that cannot be reconciled.

    It breaks down this way: “health care is a right” = government intervention / control of the health care services and providers.

    “access to health care” = government insuring people can make their own choices on health care and no restrictions on health care services or providers.

    As I said earlier, you idea of no government intervention is good. Your terminology is off.

  20. Cold_Front_Gumballs says:

    Forgive me if I overstep your words David,…
    But I think David was trying to say that like guns in our 2nd Amendment, accessing health care is a right. And like you suggest GC, it is the gov’t that protects that right (supposed to). it is not the gov’t that gives us the right to access health care.

    However, I think David was trying to suggest that in protecting that “right”, the gov’t overstepped their authority. The gov’t is now dictating the commerce and who can or won’t receive care.

    David was being a bit blithe in his remarks as I and many do, as comment sections don’t lend our make us exactly expouse our beliefs as clearly as we’d like to.

    GC, you and I have had this kind of argument before where I blithely make a statement and then you slam me for it. But in the end, I either correct my statement or alter it to do without the generalities.

    David in the past has made some comments that seemed to suggest he was for full gov’t control of health care, ie. single payer. But he, at least to me, clarified his remarks to distinguish between the free and unfettered access to care versus the payment of those services. I take him now as being more libertarian than liberal (in the current meaning of the word) in the world of health care.

    Recall GC, that the US Constitution was originally shared and proffered sans Bill of Rights. Many of the founders fought AGAINST the BoR stating that it was unnecessary and would focus future gov’ts on ONLY those rights. I fall in to that category now. Seems we view the BoR as outlining ONLY those rights that we have. And those not stated are given to the Feds. This is a wrong belief based upon the founder’s writing of the USConsititution. But then, that’s not stopped our gov’t from ignoring it lately, has it.

    So in effect, it is a double-edge sword that we have the BoR. It protects those rights as outlined(not very well, granted), but also allows the Feds to claim those rights not deliberately outlined.

    So, David claiming that access to health care is a right, to me suggest a moral right that the gov’t does not need to define. Like our “right” to breath and exist. (ok, that is outlined in the constitution, but you get my drift).

    clear as mud?

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