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ObamaCare Clusterfuck: FDL's Jon Walker on why exchanges won't work

(That is, "work" in any other way than further enriching health insurance parasites. To my knowledge, this is the first time a prominent poster at a "progressive" blog has ever said that ObamaCare's problems are architectural, hence cannot be "fixed.") Jon Walker:

Two numbers from the report really stick out. The survey found 54 percent of workers would prefer not to be more in control over their health insurance expenses and options because they will not have the time or knowledge to effectively manage it.

Parallel to the 410(k) scam. The rentiers take a cut for "managing" our plans, but the market is such a lemon market for us that management isn't really possible. So they shift risk onto our shoulders, take a cut, and then to add insult to injury, structure our "choices" so we get nothing for the cut they take. Note also that "the paradox of choice" shows that too many choices make people unhappy.

This is completely understandable. Selecting the best insurance plan requires not only significant knowledge about every component of insurance, but also the ability to accurately predict the likelihood of future medical needs.

"Well, I think I'll postpone that kidney transplant a couple of years; kidney futures aren't looking so good right now...."

The other important number is 89 percent, that is the number of workers who choose to stick with the same plan year after year. This is in large part because many find the process so daunting.

A market where very few have the knowledge of what is the best bargain and where almost no one ever even tries to shop around simply can’t be effective. Looking at other countries where there is a “market” for health insurance indicates this will be a real problem. In Switzerland almost no one ever changes plans even though standardization makes it much easier to comparison shop* than it will be here under Obamacare.

The way  the “technocrats” claim the exchanges will be used and the way they will actually be used is likely to be very different. Health insurance plans are extremely complex, and expecting millions of people to every year to successfully spend days researching/shopping for their best plan is simply not believable.

If that was indeed the "expectation," as opposed to the rationalization for another decade or two of looting, which, under The Sachs Conjecture, is what it would be. In general, technocrats and "progressives" tend to assume good faith on the part of all actors, as Walker does here.Pas si bete.

NOTE * If I understand this correctly, citizens consumers will comparison shop in the health exchanges on the basis of actuarial values, which though expressed in dollar terms, really are not commensurate in terms of services delivered.
NOTE "Patient engagement" -- another form of risk-shifting -- has similar problems.

UPDATE Adding, Walker is assuming people don't understand that health insurance is a defective product. But if I had insurance, and if it had worked at all for me, I wouldn't change, because the odds would be that the good plan is the exception, not the rule.

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Rainbow Girl's picture
Submitted by Rainbow Girl on

Jon Walker is noting how impossibly complex it would be for anyone to make informed "choices" in the exchange "marketplace." That's true. One reason is that no matter how much "transparency" in pricing and description of what is and isn't covered, you still never know until something happens what your insurer covers (or how much [little] it pays.).

I've had the same policy for 6 years; I've read every micro-inch of text on every possible piece of paper that describes its terms. Despite this, it has never failed: every time there's a claim I learn that whatever the claim is for isn't covered or is reimbursed at (the equivalent of) half the Medicaid rate.

This is why uprooting and eliminating the insurance industry from healthcare is essential to any reform that is honest about reforming the availability and affordability of health care to all Americans (as opposed to using the health care system as yet another means to take money from us and give it to rentires -- here the insurance companies).

Single Payer, Medicare for All, is the only way to go. LBJ rolled it out to all over 65's in one year. With no computers.

How about we launch a national challenge to get Medicare for All operational on October 2, with some festivities recalling LBJ?

Submitted by MontanaMaven on

Using the phrase "LBJ rolled it out to all over 65 in one year. With no computers." Is catchy and works as I have used it for many years in the struggle for single payer. But it's not technically correct . There were large main frame computers that ran the space program for one thing. But now we could get it up and running instantly on the Internet. It wouldn't take a year. And all kinds of jobs - real feel good jobs-would be created. My dream.

Rainbow Girl's picture
Submitted by Rainbow Girl on

... the pithy line about LBJ launching and rolling out Medicare to all over 65-ers in 1 year with no computers. I agree that it is a brilliant vehicle to show up the monstrous complexity of ObamaCare and how easy it would be to roll out Medicare for All.

Submitted by lambert on

Maybe I should change it... Damn, it sounds so good.

Rainbow Girl's picture
Submitted by Rainbow Girl on

It doesn't need an iota of change. Especially the period after "one year" and before "Without computers."

caseyOR's picture
Submitted by caseyOR on

of Medicare, the prescription drug plan, shows how insane it is for most people to try to pick the "best plan" for their needs. Every autumn I wade through plans trying to find one that I can afford and will cover my medications. It drives me crazy.

There are too many plans with just enough variance that they are not interchangeable, but it is hard to figure out which is best for me. Also, I am forced every year to somehow divine what medications I might possibly need in the coming year because all plans do not cover all drugs, nor do the plans place the drugs in the same payment tiers.

Part D was written by and for the drug companies, just like Obamacare was written by and for the health insurance companies. Neither plan was written with the primary goal of making things easier and better for the people who would have to use the plans.

Part D was the warning that everyone ignored.

Rainbow Girl's picture
Submitted by Rainbow Girl on

"I am forced every year to somehow divine what medications I might possibly need in the coming year ..."

Exactly. And it's impossible. And the great "marketplace of myriad choices" is a grand illusion because it is designed precisely to make it impossible for anyone to pick a policy that will serve present needs as well as those that may arise in the next 12 months. It's totally deliberate. And it is no accident that ObamaCare's exchanges marketplace copies this model and enshrines it into federal policy.

It is very, very ugly.

Submitted by MontanaMaven on

And the passage of that bill with the grinning max Baucus at the side of Bush woke me up to what role the Democrats were playing in this kayfabe. Soon after I tried to change the party from within as the radio host Thom Hartmann urged. Ha, ha, ha, ha. Turned out that Progressive Democrats for America was just more co option and kayfabe.

ralphbon's picture
Submitted by ralphbon on

Snark, of course. The public options plans under consideration in 2009 were deliberately cobbled to be hobbled--so private plans could remain competitive versus what systemically should have squashed them like bugs. And the definition of a "robust" PO continually shifted, so that it never meant anything more than varying shades of dilute.

I await the blog post where a former advocate like Jon Walker comes clean on this point.

It seems like sour grapes to dredge this up, but the narrative among progressives -- not just veal pen residents -- will remain distorted if we don't. History in this instance has been rewritten badly not just by the victors but most of the vanquished.

Submitted by lambert on

The problem with the health exchanges isthat they are exchanges....

Submitted by jawbone on

And, actually, they're just insurance information access sites, right? In some regions or states they may have good input -- or bad input, right?


Even the legislation's title is a lie: It's not Affordable CARE that was legislated, but (Somewhat) Affordable Insurance. And the insurance may not cover the health care needed by the person who has bought the insurance.

What a mess.

Rainbow Girl's picture
Submitted by Rainbow Girl on

At this point that is *all* ObamaCare seems to be. How much more "meta" (corrupt) can you get! It's not health care, it's insurance.

It's not actual insurance; it's insurance information.

It's not an insurance exchange; it's access to an insurance exchange.

It's not access to an insurance exchange; it's *information about* access to an insurance exchange."

The only thing not "meta" about this is the hundreds of millions of dollars paid and being paid and to be paid to the "creative class" and crony vendors getting the IT contracts to implement "information about access to an insurance exchange."

Great way to spend tax money, Obama.

ObamaCare is FrankenCare (TM)