Almost Nothing About Obamacare's Federal Exchange System Works

Whitehouse.gov

Almost nothing about Obamacare's federal exchange system is working. It's almost impressive how comprehensive the federal system's technical failures are. Just about every part of the system that has been reported on seems to have problems, many of which are quite serious.

• The account creation system necessary to even start the process of using the exchanges basically didn't work at all when the site launched. Administrators appear to have improved this functionality since launch, but Jeff Zients, who is overseeing the troubleshooting project, says it's still not working for about 10 percent of users.
• The vast majority of people who can create accounts still can't complete the enrollment process. According to Zients, only about 30 percent of users are able to get through the system.
• Anyone who successfully logs in gets to the point of shopping for specific plans on the exchanges may see prices displayed incorrectly, as the system has had problems calculating eligibility for public subsidies for insurance. (Subsidy calculation has also proven difficult for several state-run exchanges.) 
• Anyone who decides to browse for plans without logging in first is also liable to see incorrect prices. The "shop and browse" feature installed to mitigate problems caused by the broken account system often displays the wrong prices, because it lumps together premiums for anyone who is 49 and under, and anyone who is 50 or older. Everyone under 50 is provided prices for a 27-year-old, even though prices for people in their 40s might be quite a bit higher.
• Several exchanges are having trouble accurately displaying provider and network information for the plans on offer. This is not a big problem for the federal exchanges yet because they are still so dysfunctional, but if the state-run exchanges are any indication, it could eventually create headaches for people who want to know which doctors and hospitals are attached to which plans. 
• Even with just a trickle of individuals making it all the way through the process, insurers are not getting correct enrollment information from the exchanges. As a result, many are reviewing applications manually. If larger numbers of applications ever make it through the system, that won't be sustainable. And there may be longer term problems as well: If enrollment data is transmitted incorrectly, people could eventually find out they didn't enroll in the plan they selected, or didn't actually enroll at all.
• The small business exchanges aren't fully up and running either. Enrollment in those exchanges, already delayed once, was delayed again, the administration announced this week.
• The federal exchanges were supposed to seamlessly interface with multiple state Medicaid programs, but that functionality, originally delayed until November 1, was also further delayed last week. And at this point, federal officials won't say when they expect that functionality will be complete.
• Security testing for the federal exchange system was never completed. An internal memo warned that too little testing "exposed a level of uncertainty that can be deemed as a high risk." (The temporary security authorization under which the site is operating also appears to violate the administration's own web security guidelines.)
• The Spanish language version of the website has been delayed indefinitely.
• The "data hub" that routes information between multiple databases has gone down on multiple occasions due to hosting facility outages.

It's a near-total failure. All the major segments of the system—the user end, the insurer end, the data-routing in the middle, the plan information on display, the connections with state-run legacy systems—are either problem-plagued or broken entirely.

Comments

[Alice Bowie]

I had ZERO Problems with the New York State site. It worked pretty good.

I just wish the plans were pretty good.

[Tonio]

Thanks for sharing.

[Sevo]

So it was easy to sign up for a pile of shit?
Sounds like what a con-artist offers.

[Anonymous Coward]

If you can pay for it, it must be Affordable.

It says so right there in the name.

[Kaptious Kristen]

It will have worked good [sic], too, when someone steals your identity because the security sucks.

[John]

The fact that sites don't work is actually the best security feature about them. No kidding.

http://securitycigarsfud.wordp.....-security/

[MikeP]

To be fair, New York is one of the five or so states that have such incredibly screwed up insurance regimes that ACA is actually an improvement.

[Sevo]

I'd read that several months ago when the O'care sleazes were flogging how people were going to 'save money'; NY was one of the few places for the reason you mention.
I guess it's comforting to know that Obo didn't fuck things up as badly as he could have.

[Brett L]

Give him a chance, NY has been regulating health insurance for 60 years, the Feds just got here.

[Ska]

Yeah, my insurance only went up 16% this year. It's fucking awesome.

[MikeP]

Four-year old comment on how messed up New York is:

Going to ehealthinsurance.com and trying a 35-year-old male in California, I find a nice $3500 deductible 0% coinsurance plan from Anthem for $108 per month. There are 113 other choices that get you down toward $73 per month but cost you some coinsurance.

Trying the same person in Albany, New York, a grand total of 3 plans show up. The cheapest of them that isn't hospitalization only is $425 per month.

Now if you got the $108 per month California policy for a year and were unlucky enough to spend the whole deductible, it would cost you $4796 for the year. The New York policy, on the other hand, would cost you $5100 for the year even if you never saw a doctor.

[Corning]

So everyone else's higher prices and increased levels of insurance "screw" is paying to slightly lower and improve New York...

Sounds about right

[GILMORE]

Please to quote % increases in premium and deductible, thank you.

[Specail Sauce]

I just logged onto the California Exchange, one of the few that "works", and it crashed on me twice. On the third attempt I was able to see pricing for 9 specific plans, however they were different prices than what was offered just two weeks ago? After selecting one of the plans so I could see the details, the web page crashed for the third time. It's the gift that keeps on giving!

[Red Rocks Rockin]

On the third attempt I was able to see pricing for 9 specific plans, however they were different prices than what was offered just two weeks ago?

You have to sign up for the plan to find out what's in it.

[Suthenboy]

Why do I think you are lying, Alice?

[cavalier973]

Does anybody else get the impression that Obama doesn't mind so much people talking about the Healthcare.gov website problems?

It seems to me that he'd much rather people be talking about Obamacare, even in a negavite manner, than that they ruminate on the fact that the GOP "shutdown" of the FedGov basically did not affect the lives of a majority of Americans in any majorly negative way.

[JohnD]

The so called "shut down" was a joke. Obama tried to make it worse by dispatching his park service Gestapo goons
to harass the National ark visitors.

They should all be summarily executed.

[James Anderson Merritt]

The system that WAS working fine, when we abandoned it in search of tax breaks and to get around government imposed wartime wage and price controls, was very much closer to the free market than we have had for almost 50 years. Let's scrap health care as we now know it and once more try health care as we once knew it. This would not be "regressing into the past." Rather it would be scraping the rust and barnacles off of the old boat (the one that we're all supposed to be in 😉 ), and resuming the original course, after the present-day shipwreck.

[James Anderson Merritt]

Ahh, the (mostly free) market! They don't make 'em like they used to, that's for sure!

[John]

The free market is great. But it doesn't always produce results people are willing to live with. The free market is likely to give you the most efficient result possible. But people don't always value efficiency above all. Sometimes they value security or fairness or other things more.

[robc]

It will give you security or fairness...for a price.

[John]

For sure. And people will sometimes pay that. They will happily take a more expensive but more secure option.

[robc]

And that is efficient in its delivery of security!

[John]

when we abandoned it in search of tax breaks and to get around government imposed wartime wage and price controls,

It was only working fine because health care before World War II was pretty useless for anything but very basic procedures. Once technology took off and expensive treatments became available things changed.

First, medical care became an expense worth insuring for. Second, since you can't predict your costs and run the risk of having huge costs, it became an expense you had to insure for.

Second, insurance if it functions as it should, is cheap as long as you a good risk, expensive if you are a bad risk, and impossible to get if you are a bad enough risk.

That is no big deal if you are insuring most things because you can control your risk by not doing things that make you uninsurable. But in healthcare everyone will eventually become a bad risk and eventually uninsurable at any price.

So unless you can pool the risk of the old, the young and the healthy and the sick, you will end with a situation that everyone had cheap and good healthy insurance right up until they get old or they get sick and become a bad risk, in which case they won't have it anymore.

The only reason we never hit that situation is because everyone or most everyone got their health insurance from their employers and were thus forcibly pooled. Had that not happened, people would have demanded single payer.

[Cytotoxic]

Do you know that you can get a heart surgery in India for less than $2000 dollars with a survival rate as good or better than Mayo Clinic? Prices always fall in a free market.

[John]

Do you know that you can get a heart surgery in India for less than $2000 dollars with a survival rate as good or better than Mayo Clinic?

Sure they do. But they would have to fall so much that people wouldn't worry about getting old and not affording health care. And I am skeptical they would.

The problem is what do you do with the guy who needs a procedure that costs more than he has put into the system or has to pay? The easy answer is, too bad, that is what we have charity for. But that answer will never fly with people. They are too afraid of being in that situation to just walk away. So for that reason, you have to figure out a way to get the market to ensure them some measure of security. Being cheaper and more efficient isn't going to sell.

[Corning]

The problem is what do you do with the guy who needs a procedure that costs more than he has put into the system or has to pay?

Actually the problem is that everyone will eventually need procedures that cost more then what they individually put in and the little that do put in the government has long since spent by the time those people need it.

People get old and die...and apparently we need to spend truckloads of money in the last few years (months?) of life for some random reason...

I am also wondering if this how ancient Egypt ended up building the pyramids.

[John]

People get old and die...and apparently we need to spend truckloads of money in the last few years (months?) of life for some random reason...

the problem is we don't know what is end of life and what is life saving care until after we do it. If I get in an accident tonight and linger in ICU for two weeks and die, I am just an another example of how we spend so much money on dying people. If I live, I am another example of the miracle of modern trauma care. We don't know which I am when I come in the door most times.

So when someone says they are going to cut down on the money we spend on old people and end of life care, what they are really saying is "we could get along a lot better if we would just stop treating the old and the sick", because that is how it is going to work in practice.

You tell me how old someone should be when they are not longer worth the effort. And you tell me when someone is just a goner and not worth the trouble.

Hell, forget old people, what about young people. What do you do with the 30 year old who needs a million dollars in treatment but is a high school drop out? Tell him to die that he should have gone to college?

These questions are not so easy as you pretend they are.

[John]

Also, what are the barriers to the practice of medicine in India? I don't care what kind of free market system you create, if you don't do something to make it cheaper to hire a doctor, you are not going to lower prices. And competition can only go so far. There still is a supply curve part of things. How much bigger is the supply of doctors and nurses and how much more can each class of professional do in India as opposed to the US?

I think your example says more about the AMA than it does about the insurance industry.

[Old Man With Candy]

I've got an Indian physician (an internist) working for me. His training was, as far as I can tell, pretty much the same as he would have gotten here.

[Old Man With Candy]

His comment about health care costs in India were basically, "We don't have the sorts of lawyers and legal system that you have here. This is why I didn't bother to practice medicine in the US."

[John]

Our legal system has a lot to do with it. As does our regulatory system. But those things have nothing to do with employee provided insurance.

[James Anderson Merritt]

"I think your example says more about the AMA than it does about the insurance industry."

This is why I describe the pre-Medicare health care system in the U.S. as "mostly free market" or "closer to free market." By constraining the supply of medical practitioners and medical colleges, the AMA bears a lot of shame for how things are today, as does the FDA (for its slow approval process). But technological advances could have ultimately prevailed to improve care and lower costs (as they do already, in elective medicine), in the absence of cost-raising paperwork requirements that are a direct result of shifting health care toward an insurance model.

[John]

What drove the price of health care up was things like the FDA, the AMA, the insane medical malpractice liability system and various other regulations.

But none of that has anything to do with employee provided health insurance. In fact, that saved us from single payer. That is what makes it so people don't worry about getting old and no longer being able to get insurance and being unable to pay for health care.

[James Anderson Merritt]

Thanks for contributing that. It saved me a fair amount of time in rebuttal to John.

Had we stuck with the more-or-less free market system we had, more of the money spent on health care would have gone to actual care and improvement in medicine. The forces of competition and innovation would have allowed new technology to function as a cost REDUCER (as it does in every other industry) rather than as an excuse for ever-higher costs and fees. Ultimately, health care in this country would have been both cost-efficient AND at least as acceptable (in terms of intangibles like "fairness," etc.) as what we have now, or what some people hope for from single-payer.

[John]

The forces of competition and innovation would have allowed new technology to function as a cost REDUCER (as it does in every other industr

Sure it can reduce costs. It can also improve quality. You could build a car to 1960s standards for practically nothing today. But not all cars or very many cars are built that way because people want better cars.

The market can make things cheap. But it can also make things better. Cars still can cost a fortune. They are just a lot better.

The same is true for health care. If you want health care from the 1970s, it is really cheap. But to get the 21st century stuff, not so much.

The problem is that we can live with there being Bentleys that cost $200,000 because the country is fine with only a few people having the ability to own a Bentley. They are not going to feel that way about only a few people having access to the best health care. They are just not.

In the end James you are telling me that the market will work so well that health care will be so cheap that the majority of people one will have to save for it or insure against getting sick. And that is fucking fantasy. It is just as big of a fantasy as liberals claiming single payer will create perfect fairness.

[Cytotoxic]

This is such a bunch of shit. My Samsung Galaxy 2 was cheap as dirt my parents brick cellphone was expensive as hell and still wouldn't be much cheaper to build today as my SG2.

The fact is, before Medicare/aid fucked it all up, American healthcare was near perfect. Charity EASILY covered poor people and stuff so much so some cities tried limiting the number of charities running because there were so many. Free-market capitalism is inherently perfect.

[John]

This is such a bunch of shit. My Samsung Galaxy 2 was cheap as dirt my parents brick cellphone was expensive as hell and still wouldn't be much cheaper to build today as my SG2.

Not everything is a computer. My car sure as hell isn't cheap as shit. My house isn't cheap as shit. What the hell kind of fantasy land do you live in? Some things are expensive and that is not just because the evil government made it so. Sometimes shit just costs money.

Even if you got rid of the FDA, developing a drug would be expensive. You have to pay people who are highly trained and whose time costs a lot of money to work a lot of hours using expensive facilities. No amount of free market is going to make those costs go away.

Hell, even your India example is not totally the truth. How much does India spend on medical research? Most of the world rides on the back of US medical research. So that surgery isn't the real cost of it.

Do you have any understanding how markets work? Or do you just think they magically make anything and everything cheap and abundant such that cost is just not an issue for anyone?

[Bryan C]

"You have to pay people who are highly trained and whose time costs a lot of money to work a lot of hours using expensive facilities. No amount of free market is going to make those costs go away."

What? The point isn't to make the costs "go away". The point is to operate at a net profit.

"Hell, even your India example is not totally the truth. How much does India spend on medical research? Most of the world rides on the back of US medical research. So that surgery isn't the real cost of it."

You're looking right at the point and yet completely missing it.

A global free-market in medical technology has made the inventors of that technology rich, while at the same time driving prices down to a level where far more people can afford it. In fact, it's cheap enough that charities can afford to give it away to the very poor who still can't afford it on their own

Everyone wins. New stuff is constantly created, rich people get stuff that didn't exist before, poor people get stuff they could never afford before, and at every stage people make money. And yet, for some reason, you don't want that happening here at home. Why?

[John]

Sure things over all get better Bryan. But that doesn't mean it is going to be cheap or not result in the the problems I outline. It doesn't mean everyone wins. The guy who can't afford insurance or care doesn't win. And you can't just say fuck him. People won't take that answer.

[JohnD]

Sorry but your example is a logical
fallacy. One of the prime reasons for the high cost of modern automobiles is the extreme government mandates for gas millage, safety and pollution control.

[Jordan]

The same is true for health care. If you want health care from the 1970s, it is really cheap. But to get the 21st century stuff, not so much.

This doesn't change the fact that after adjusting for inflation, you can get a far better car for the same amount of money than you could in 1970. And yet if the car market were as highly regulated as the healthcare market, that would not be the case. And you would be here telling us that 21st century cars are just naturally vastly more expensive.

Healthcare technology is not magical.

[John]

This doesn't change the fact that after adjusting for inflation, you can get a far better car for the same amount of money than you could in 1970.

That is exactly my point. You can get a far better car. But it still costs a lot. That doesn't matter with cars because people are okay with only the rich being able to afford the best cars. But people are not going to accept that with health care.

And lastly, so what if health care would be cheaper? Unless you can show me that it would be so cheap that most people would not consider it an expense worth insuring for or worry about paying for it when they are old, you still have the same problem I outline.

Yeah, you can make things cheaper. But you have to make them cheap enough to solve the problem.

[Bryan C]

This is wrong in so many ways that I don't even know where to start.

"But in healthcare everyone will eventually become a bad risk and eventually uninsurable at any price."

I don't think you understand how insurance works.

[John]

I don't think you understand how insurance works.

I think I do. Can an 80 year old man buy health insurance, assuming it is priced according to his individual risk? I don't think so. Who would insure that risk? And if they did, it would make more sense to self insure and save the money and take his chances.

Everyone will eventually get old and become a bad health insurance risk. Or before that they will get sick and become a bad risk.

If you have some magic insurance that charges you the same even though you are a bad risk or have developed a way not to ever get old or sick, I would like to hear about it.

If you think there is so much wrong, do tell. Being smug is not an argument.

[MikeP]

You buy insurance with guaranteed issue throughout your life.

The guaranteed issue is a premium upon your premium -- essentially extra money the insurance company can invest for 40 years on your behalf to pay for your greater expense in your later life.

This is basic actuarial stuff. It's not rocket science.

[John]

You buy insurance with guaranteed issue throughout your life.

I used to think that. But then I talked to someone who did such things for a living. You can't do that with health insurance. It is not life insurance. To be able to sell you what amounts to "term health insurance" I would have to be able to know not just your projected health but what medical costs are going to be. And that is impossible. Even if I knew the cost of today's' treatments, I can't even guess what future treatments will cost. You could never do an actuarial table on it and thus couldn't price it.

And even if you could, there is a limit to even that. At some point you get so old and your risk gets so high, that the policy is no longer profitable. This is why term life insurance policies only go until you are in your 50s or 60s. You can get life insurance that runs forever, but it is universal life and that is really just a savings plan. At the end of it, if you live long enough, you just get out of it what you put into it.

So really it would just be a savings plan. And that is good and all. But people are not going to be happy with "save a lot so you can spend it on heath care when you get old".

[robc]

You buy insurance with guaranteed issue throughout your life.

This. Its the same way that term life insurance guarantees you life insurance until the end of the term. If you get 30 year term, it doesnt matter what happens to you, you still have life insurance if you pay for it each month.

Lifetime term could, and would, exist. For a price.

[John]

Lifetime term could, and would, exist. For a price.

that few people could afford. Wouldn't solve the problem. And again, you can't price it. No insurance company is going to bet on the future of health insurance costs combined with the likelihood that you will die an inexpensive death versus an expensive one.

Think about it rob. Just because I can construct a table on when you are likely to die doesn't mean I can tell how with any probability how you are going to die to such a certainty I can guess how much care you will need before you die. And that is what you would have to do here.

[MikeP]

Of course you can guess how much care he will need before he dies.

I thought your dispute was that the entire insurance industry can't really make bets on health care inflation versus overall inflation over a period of 40 years. And that would be a valid point. But the insurance companies can simply write the inflation bias of future premiums against some standard into the contract. As your earnings grow, you will be able to afford the premium increase.

But as for guessing how much care you will need before you die, that's basic actuarial stuff.

[robc]

And again, you can't price it.

Like hell you cant.

You cant price it for ME, but you can price it for 100,000 mes.

[John]

Show me where anyone is doing it Rob? And further, look at term life insurance. Even though you can price it, it doesn't last your whole life. That doesn't matter with life insurance because no one needs it when they are old. But with health insurance it does matter. What do you do with old people whose term health has run out and can't buy insurance?

And beyond that, in order for that system to work, even if you could price it which you can't, you would have to have the money to buy in young. If you don't buy in young you are fucked. So what about people who are sick or poor when they are young and can't buy in?

Again, tough shit is not an answer that people are going to take. You might take that answer but society won't.

[robc]

Tough shit.

[robc]

John,

When have I ever cared about whether other people or society gives a damn about the right answer?

The right answer is the right answer is the right answer.

[John]

Rob,

I don't think an answer that most people subjected to its consequences don't want is the right answer. Most people don't want to live in a system where they have no security, beyond hope for charity, against getting old and sick and not affording health care. And there is nothing wrong with that.

[JohnD]

Actually, everyone doesn't eventually get old. Quite a few people die before they reach 50 yrs old.

[robc]

So unless you can pool the risk of the old, the young and the healthy and the sick, you will end with a situation that everyone had cheap and good healthy insurance right up until they get old or they get sick and become a bad risk, in which case they won't have it anymore.

The same thing occurs for life insurance. Its cheap, then its expensive, then its ungettable.

There is a solution...term insurance.

In a free market, there is no reason there wouldnt be term health insurance.

The pooling argument is BS as there is, mathematically, only one pool per insurance company. 1000 individual policies makes up the same risk pool as 1 employer policy covering 1000 individuals.*

*assuming we are talking about same 1000 people.

[John]

I used to think that too. See my answer above.

Here is the thing, if it would possible to sell term health insurance, it would exist in the individual markets. And to my knowledge it doesn't. You just can't price it. You could for a few years. But not long enough to solve the problem.

[HazelMeade]

We're getting there though. With genetic testing and our knowledge of risk factors, it's becoming increasingly possible to predict future health care costs. And to the extent you can't you just need to average over a larger group of people.

Ignorance of the future = similar rates, knowledge of the future = different rates.

A lot of the problem here is that people are discovering that they have genetic risk factors and think it's unfair that they have to pay more for that.

[John]

A lot of the problem here is that people are discovering that they have genetic risk factors and think it's unfair that they have to pay more for that.

For sure. And under a true free market individual health insurance system, some of those people would be insurable. What do we do with them? Here is the thing, if we ever get to the point that we can tell who is going to be sick then everything but insurance for injuries that result from accident goes away. The sick people couldn't get insurance and the healthy people wouldn't want it.

What do we do then? That is what I am trying to get through here. Just because it is the "market result" doesn't mean it is a result people are going to want.

Free market advocates have to come up with an answer to people's anxiety over being uninsurable and unable to buy health care. And I don't think "well the market will make things so cheap it won't matter" or "just save a lot" will satisfy many people. If those are the answers, people will take single payer every time.

[robc]

What do we do with them?

Charity.

There is a reason all the old generation hospitals in my city have a religious affiliation (in name, if not in fact).

Louisville has Catholic, Methodist, Baptist and Jewish hospitals, at least. They arent really affiliated any more, but that has more to do with the nature of health care changing. They could come back.

[John]

Charity.

So you are telling people, you can have health care provided you are fortunate enough not to have bad genes and can afford to save a lot of money. Otherwise, you can depend on charity.

Meanwhile, the progs are going to be telling them, "just do single payer and not worry about what your genes are or if you lose your job and the government will take care of you."

Who do you think is going to win that debate?

[robc]

Who do you think is going to win that debate?

The winner of the debate is the person who is right.

I dont give a damn about votes. You should know that about me by now.

[robc]

A lot of the problem here is that people are discovering that they have genetic risk factors and think it's unfair that they have to pay more for that.

Boo fucking hoo.

[John]

Boo fucking hoo.

That makes you feel good to say that Rob. But it is not that simple. And when you do say it, prepare for them to say "boo fucking hoo" when you are crying about our new single payer system.

[robc]

See my 4:44 post.

[John]

See my 4:46 post Rob. I would like to figure out a way to win that debate.

[robc]

Being right is how you win debates.

[John]

Being right is how you win debates.

What is right? To me right is the system that best gives people what they want. I no more would shove a pure free market on people than I would single payer. The people own this country and own their lives, not the market. If they don't like the result the market gives, they are free to reject it and do something else.

[robc]

To me right is the system that best gives people what they want.

If the system has to use force or fraud to give people what they want, then it isnt right.

You have been around here long enough to understand that.

The end NEVER justifies the means. And you are arguing in favor of ends -- giving people what they want. Thats nice, but only if the means are moral. And the means to provide people with secure, guaranteed health insurance for life are immoral.

Come up with a moral way to do it and I will hop on board. Ive given my suggestion: charity. It provides as much of a guarantee as possible without violating anyones rights.

[robc]

^^^notice that this argument has nothing whatsoever to do with "efficiency". Its about morality.

[John]

Sorry Rob, I am not putting my boot on anyone's face in the name of the free market.

[Jordan]

Sorry Rob, I am not putting my boot on anyone's face in the name of the free market.

Wow, you're not even Red Tony anymore. You've morphed into full-on Blue Tony. FREEDOM IS SLAVERY! STOP IMPOSING FREEDOM ON ME!

[JohnD]

No, winning debates is based on how ignorant your audience is.

[A Secret Band of Robbers]

Incorrect. Being right has no impact on debates.

Being right frequently has no real world implications whatsoever.

[robc]

Its simple John, anything other than a true free market is immoral. Period. End of story.

Transfer payments are always wrong.

[HazelMeade]

John, risk factors are statistical likelihoods, so you won't get to 100% certainty about who will get what, and different people will have different risk factors. So I doubt there would be very many people who would have such a cluster of risk factors that they would be uninsurable. People with lots of risk factors will tend to pay more for insurance, though. Including term insurance.

[MikeP]

You realize of course that InTrade was shut down just to prevent betting on whether ObamaCare would work on October 1 and now on November 30.

[John]

Really? Do you have a citation for that? I am not doubting you. I would just like to know where you heard that.

[MikeP]

I made it up. But you can go ahead and use it.

[John]

you can't tell satire from the truth anymore.

[wareagle]

and the hits just keep coming. Okay, maybe hits is the wrong word choice here.

[Andrew S.]

In an October 30 letter addressed to Congressman Jim McDermott (D-WA), U.S. Department of Health & Human Services (HHS) Secretary Kathleen Sebelius left little to interpretation: qualified health plans purchased through the marketplace do not constitute "federal health care programs" under the federal Anti-Kickback Statute (AKS). The Secretary stated that this determination was made in consultation with the U.S. Department of Justice.

The Secretary provided a specific list of programs that would not be considered federal health care programs--state-based and federally facilitated marketplaces; the cost-sharing reductions and advance payments of the premium tax credit; navigators for the federally facilitated marketplaces and other federally funded consumer-assistance programs; consumer-oriented and operated health insurance plans; and the risk adjustment, reinsurance, and risk corridors programs--although notably, the Secretary made no indication that the above list was exhaustive.

[she went on to say there was "Other oversight", but ... yeah]

[sarcasmic]

You know, the ACA is just too complicated. Better to go with Single Payer. Much easier to implement. I mean, we already have Single Payer. It's called Medicaid. And everyone who is on it likes it. Just do away with the HealthCare.gov and put everyone onto Medicaid. There. Problem solved.

/derp

[Caleb Turberville]

In all honesty, the ACA is such an evil, shitty piece of legislation that even single-payer would be preferable.

[John]

I am not sure you are wrong about that. Or at the very least a two tier system were you can buy your own care outside of the government system. This thing doesn't benefit anyone.

[Cytotoxic]

I'd prefer a system with a clearly defined public subsidy and a clearly defined undisturbed free market. Statism is like human waste: if you're going to have it around, keep it in a discrete pile in a corner.

[John]

it is not statism. It is people valuing things like security and fairness over efficiency. The market is going to give you the most efficient result. But most efficient might not be the "best" result for someone. That depends on how much they value efficiency.

[Brett L]

See, the jump that people fail to make is that the efficiency is ALWAYS going to make up for the distribution skewing. It has to, otherwise the distribution would change. More total commodity gets delivered so the next person willing to pay the cheaper clearing price gets some commodity. The proof is longer, but once you've seen it demonstrated, you can't understand why anyone would believe different.

[John]

Over the long term sure. But sometimes that isn't good enough. Yeah, under the market some day my children will be able to afford the care I can't today. But what good does that do me? I don't really want to die for the market.

You guys assume that everyone is homo economicus and will always chose the option that results in the best long term efficiency. And most times they will. But not every time.

[robc]

You guys assume that everyone is homo economicus and will always chose the option that results in the best long term efficiency.

Ummm...two answers.

1. Bullshit, we assume nothing of the sort, we assuem people will buy what they want.

2. I agree, but I define efficiency as "giving you what you want", which might be security or fairness.

BTW, is this John different from our normal John? Cause this is a weird, new argument.

[John]

BTW, is this John different from our normal John? Cause this is a weird, new argument.

No. It is the same person. It is just that the issue of how someone values something and its effect on their preference rarely comes up. Most of the time you can assume "the cheaper more efficient option" means the option that best fits their values. Healthcare is one of those weird times where it doesn't always work like that.

I am all for efficiency and choice. But I also understand that people want a health care system where they feel like they are not going to be at risk of dying old and broke because they didn't save enough or plan enough for health care. They just won't generally accept that result. So any free market system has to be designed where most people can feel confident they will still get health care when they are old and or sick and a bad insurance risk.

[robc]

Most of the time you can assume "the cheaper more efficient option" means the option that best fits their values.

I dont know what you mean by efficient, but I mean "the one that best fits the buyers values".

If it doesnt fit my needs, price doesnt matter, it isnt efficiently solving the problem.

[Brett L]

No, the market wins everytime. It will always be more efficient until some competing resource that has more features or lower price takes its place. Always. I am arguing that you have deceived yourself, necessarily, if you argue that the distortions we added to compensate for other distortions made things better over any term.

[John]

The market doesn't win or lose Bret. It just is. The thing is that people's values and preferences may not be for the system that gives the most efficient result. So they are in some cases going to interfere with how the market naturally works.

[robc]

Efficiency is defined by values and preferences!

So, the most efficient result takes those into account, thats how the fucking market fucking works.

[HazelMeade]

I think the problem is the pareto optima is impossible to define because people to not share a common set of definitions of what is good.

In order to get to an optima, everyone needs to agree on what the axes are, which direction is positive, and how much each variable in the utility function is worth.

You might THINK that it's better for me if I get free preventive care, but for it to be objectively better we would have to agree on the relative value of health care to good life compared with other things I could spend the money one.

[robc]

The optimal solution is individual. There are 320 million different optimal solutions in the US.

This isnt a problem.

[Red Rocks Rockin]

I'd prefer a system with a clearly defined public subsidy and a clearly defined undisturbed free market.

The problem is that both those are going to impact the market in their own unique ways.

Right now I have progtards arguing that the exponential cost in healthcare is all the fault of "for-profit medical care," people getting expensive treatments in ERs and such and leaving everyone else to foot the bill, and things put in place by Nixon and Reagan. The stuff by Nixon and Reagan they have a point about, but it never crosses their mind that the government insurance programs costing over $1 trillion a year now just might be a part of the problem, too.

To them, government and private health insurance exist in their own special vacuums and the former has nothing to do with blowing up costs. In the first breath, they'll bawl and complain about people without insurance plans being subsidized for expensive treatments if they're not on Medicaid, and then in the next breath argue that we should be subsidizing expensive treatments.

You honestly can't reason with people that partisan, but you can shove the government numbers in their face and tell them to get fucked.

[John]

Nothing is free. If you subsidize things you are going to raise the price of them in return for helping people out. Security and fairness are all nice things. But they come at a price. Progs don't get that. They think it is free.

[Rasilio]

The funny thing is single payer would almost certainly be better than Obamacare. Not better than what we had, not the best we could not, not even a good long term option, but undoubtedly better than Obamacare.

[JohnD]

Wrong. Medicaid is a poor health care policy. Most doctors and hospitals won't touch it.
You may be thinking of medicare, but many doctors will not accept that either, as I found out to my dismay.

[jester]

'Marque dos para: tu estas jodido!'

[Sevo]

Hey, not true (I'm gonna wear out this link):
"Sex workers embrace Affordable Care Act"
"In the all-cash, off-the-books sex industry, workers can be particularly high risk and insurance is often out of reach."
http://www.kxly.com/health/hea.....index.html

[MikeP]

Nice try, but I'm not clicking on that link. I don't even know what kxly means!

[Sevo]

It's a broadcast station; the story is real.
We're subsidizing med insurance for hookers! Doesn't it warm your heart?

[Brett L]

Well, I do get a tingle somewhere...

[Tonio]

Latest proggie idiocy: ACA is the result of the Heritage foundation's war against single payer.

Nothing is ever a failure on their part; it's always shadowy enemies.

Kulaks! Hoarders! Wreckers!

[Swiss Servator, Burn a B??gg]

*narrows gaze*

I notice you left out splitters, comrade...

*writes Tonio's name in small notebook*

[John]

So Obama is a Heritage Foundation mole? That will news to a lot of people.

[HazelMeade]

Progressives are going to eat each other alive over this. Half of them are going to defend the ACA to the death, the other half want to jump ship and blame it on the Heritage Foundation.
The internecine warfare is certain to be delicious.

[Red Rocks Rockin]

Progressives are going to eat each other alive over this. Half of them are going to defend the ACA to the death, the other half want to jump ship and blame it on the Heritage Foundation.

I don't see that. I do see them saying both things in the same argument, though.

The longer this fiasco goes on, the more that the left's insanity will manifest itself. They're already crowing about people losing their insurance plans and saying that they deserved it. I read one progtard today bitching about a woman who didn't have insurance because she saved money every month for her family's medical expenses and "God provides." He started complaining that when "the inevitable" happens, we're all going to have to pay for their medical care.

Reliance on divine intervention aside, his whole argument was thoroughly loathsome--this POS was literally hoping that this woman and her family came to some sort of serious harm just so he wouldn't have to admit the law is crap and Obama's a dumbass for letting the website go live. When I pointed out to him that she was--HORRORS!!--paying for medical care and saving out of her own pocket, he didn't care. He's absolutely sure that some massively expensive catastrophe is going to happen, and it's going to leave her bankrupt (as if she couldn't work out payment plans with the doctor or, heaven forbid, acknowledge mortality in the event of a serious disease and just say goodbye). That's sociopathy on a deeply disturbed level.

[The Rt. Hon. Serious Man, Visc]

OT, but it appears they are now confirming that the LAX shooter was a disgruntled TSA agent.

The gun-control crowd will be so disappointed.

[Swiss Servator, Burn a B??gg]

TRAINED PROFESSIONALZ?

[Bardas Phocas]

Was he disgruntled about the Obamacare fuckedup-site?

[Kaptious Kristen]

No, because gubmint employees get the "cadillac plans" we've all been told only monocle-wearing billionaires have.

[Tonio]

...and they just withdrew that according to Update II on the HandR story about the incident.

[Caleb Turberville]

If we had sane leadership in Washington, this would be the point when Obamacare would be handed over to the military for weaponization.

[HazelMeade]

It was a psy-ops operation by Marxist Islamists!

[Kaptious Kristen]

OT: will this end up like this?

[Swiss Servator, Burn a B??gg]

Not the Khian Sea?

http://en.wikipedia.org/wiki/K.....l_incident

[Rasilio]

No I heard that the barge was a secret prison for captured Fthip prisoners

[Brett L]

+Foot

[albo]

You're all obstructionists and racists. Suderman and all the rest of the Reason crew and everyone commenting here and me, too. Raycessts!

[GILMORE]

Its media coverage like this that truly highlights how out of touch Right-Wingers are and how much they truly hate Women, The Poor, and Minorities.
(tm)

[JohnD]

Actually, we only hate idiots like you.

[Cytotoxic]

I remember hearing a day or two ago about a 'tech surge'. Sebelius issues or is issuing a clarion call for all the tech giants like Google to come rescue her. I bet it's a trap. I bet it still won't work and Sebelius can them blame all these EVIL KORPORASHUNS. It'll be a tar baby for everyone involved! Cronyism can backfire.

[Rasilio]

Anyone who has ever worked in IT will now that bringing in outside programmers who are unfamiliar with the coding standards and architecture will make it take LONGER to finish your project than if you just kept plodding along doing nothing.

[John]

I don't think they are ever going to fix that website.

[tarran]

They are going to 'fix' it by eliminating functionality.

HEre's what I guess is going to happen. They'll get the account set-up working.

They will take self-reported data to lookup the subsidies.

They will take your application and send it without validation to an insurance company which will then call you back and get the rest of the data it needs. IT will be the electronic equivalent of printing out a pdf form and processing it by hand.

Six weeks later you get your bill for your first premium. And the amount you owe will jump around based on what they think you are making.

[Red Rocks Rockin]

Each "fix" I'll bet is going to make it exponentially more difficult to get the damn thing working in any reasonable fashion.

Here's the main problem with bringing in a "tech surge" (hahaha)--the administration is already waaaay outside the OODA loop on this. The smartest thing they could do is shut it all down, delay everything for two-three years, and start over with a completely new tech team. But President Cornball is way too proud to admit that he can't execute this the way he planned.

[Brett L]

Well, not doing nothing, but there is a point at which each new resource brings a diminishing return. Just like trying to have enough construction workers so that each need only drive a single nail and be finished will not get your house built in 10 minutes.

[Rasilio]

"Well, not doing nothing, but there is a point at which each new resource brings a diminishing return. "

You actually rapidly go from diminishing returns to negative returns in that each additional worker on the project adds more man hours in meetings, training needs, coordination of effort, and duplication of effort than they actually contribute in man hours.

Basically for a project that will take 4 guys 1000 man hours, 8 guys will take 1400 man hours, 12 guys will take 2000 man hours, 16 guys will take 3000 man hours, and 20 guys will take 5000 man hours. Every guy past that 20th will create more additional work that wouldn't be needed without him than he will contribute in hours of effort over any given time

[Brett L]

Right. They want the 167 hours per person optimum at 12 people. Because they want it soonest on the calendar, not least cost (fewest man hours).

I assume your overall point is correct. That manpower is not their problem, and they are already on the overstaff side of the optimum.

[Sevo]

.."will now that "...

...will know that...?

[robc]

Brook's Law.

[GILMORE]

I would characterize it as more an attempt to ensure the program gets a least the smallest modicum of input from "REAL PRIVATE SECTOR WHIZ KIDS!" etc. so that even in the instance of abysmal implosion and complete failure they can attribute said disaster as much as possible to the failings of their attempt to work with the "Free Market", and having determined this to be impossible, it is now preferable to go FULL STATIST and just have State Run care and eliminate all this middleman shit.

Just a thought. Either way, I think the key take away is that Republicans hate the poor. This should be repeated anytime anyone talks of problems with Obama's policies.

[Homple]

Tar Baby = Racist

[HazelMeade]

But will the tech surge be sufficient to stop the civil war among the Democrats before the ethnic cleansing is finished?

By the time this is over, the single-payer Progressives and the Party-line Democrats will have rows of eachother's dried heads hanging from their ceilings.

[Lady Bertrum]

Winter is coming.

[Dweebston]

You're being facetious, but I'm curious whether this mess incites any division in the ranks among democrats. I'm surprised they've hung together as much as they have up till now, with minor recrimination from a few notable talking heads but not much by way of consternation or introspection.

[PACW]

If introspection were their thing they would have become uncomfortable with the muslims/gays/women/rap(e) culture mess of coexistence and tolerance.

[GILMORE]

Almost Nothing About Obamacare's Federal Exchange System Works

That's only because you are purposely ignoring all the *good* things about the ACA. The website is just a website. Why do you keep failing to discuss the positive impacts of Affordable Healthcare, like Obama told us about just the other day?

/testing out new prog-talk-point

[JohnD]

LOL!
You jest, right?

[Alice Bowie]

I Think Single Payer would ONLY work if the the government controlled costs like it does in Medicare.

I would prefer to scrap ACA and just make anyone that wants medicare can just apply and start paying premiums.

But Still, my favorite idea is
1. Outlaw ALL private Healthcare insurance (This is necessary due to 3rd party problem...this is what raises costs.)
2. Close down Medicare and Medicaid (Also part of 3rd party problem)
3. Have a complete free market where doctors and providers can charge whatever they want.

By doing this, the doctors will only be able to charge what people can pay.
Let's try it for a while

[tarran]

the government controlled costs like it does in Medicare.

Alice sweetie, spending money like a drunken sailor isn't controlling costs.

1. Outlaw ALL private Healthcare insurance (This is necessary due to 3rd party problem...this is what raises costs.)
2. Close down Medicare and Medicaid (Also part of 3rd party problem)
3. Have a complete free market where doctors and providers can charge whatever they want.

Are you going to outlaw lodge practice as well? Because if you don't you haven't really outlawed health insurance, and if you do, well, that's a nice nutstomp on the poor's access to health care.

[Alice Bowie]

The reason I've been on the soapbox lately on OUTLAWING Health Insurance came from Libertarians actually.

I've been totally convinced by personal Libertarin friends (not on site here) that the THIRD PARTY PAYER (medicare, medicaid, private health insurance) disconnects the customer/patient from the provider in a way that the PROVIDER abuses the system and just keeps charging more and more and more.

If the patient/customer had to pay the provider/doctor directly, costs would be contained just like in LASIK.

[tarran]

If the state governments weren't limiting the number of practicing doctors, practicing nurses, hospital beds, medical school seats, pharmacies and clinics, you would also get a drop in prices.

And you wouldn't be kicking the poor in the teeth.

[Alice Bowie]

This problem is caused by the AMA.

[MikeP]

This problem is caused by states kowtowing to the AMA.

[Cytotoxic]

Your friends tried to explain something to you that you are incapable of understanding so you and your extra chromosomes turned into EVUL KORpORASHUNZ.

[HazelMeade]

Third party payment is employer-based care.

If you are paying your own premiums it doesn't apply.
Problem is that when someone else pays your premiums, you want to use your insurance for everything.
If you're paying your own premiums it doesn't make financial sense to have comprehensive coverage.

[Alice Bowie]

When someone else is paying your doctor, there's where the problem exists.

GO ahead call your doctor, asking him/her how much the visit is. They won't know. That's because it's $500 if you have insurance or $100 (or whatever you can negotiate if you don't).

[HazelMeade]

High-deductible polices don't pay for office visits. If everyone just had high-deductibles for the bad stuff, we'd all be paying out of pocket for office visits.

[robc]

It doesnt work that way with other insurance.

When the tree fell on my house, they wrote me a check for the damage and then I shopped for service to fix roof/siding/remove tree.

While it might not happen in that order for health care, no reason it wouldnt be the same.

The key is to make insurance INSURANCE. It shouldnt cover basic care.

[Zeb]

#1 violates libertarian principle, but I must give you credit for at least thinking of something different. I'd love to somehow have the ability to try ideas like this out as somewhat controlled experiments. Though obviously in reality that would be a moral and ethical nightmare.

[Alice Bowie]

I think #1 has to happen.

You will always have the phenomenon of the cost problem with the third party.

Look at colleges. It's not like the GOvernment writes a check to the colleges. And still, tuition went up because they know the poor are getting money from the government.

[John]

That is insane Alice. I have no way to predict what my health care costs will be. They could be zero or they could be millions. There is no way to tell. So therefore, I couldn't save for those costs even if I wanted to. The only way I can have any kind of security or do anything but gamble with my finances and health is to buy insurance and fix those costs.

Whatever the costs my buying insurance creates in the third party payer problem are just inherent in the market. Buying insurance is the rational thing for people to do. It is just the nature of the expense.

[Alice Bowie]

Think about this John.

You seem to be concerned with that $100k open heart surgery bill.

Or, that $100k perday bill for your wife giving birth to a kid that ends up in the NIC-U. Neither of these cost this much in Canada/UK...let alone places like India.

If you imposed a free market with no regulations at all and NO THIRD PARTY PAYER, these services would not cost that much.

There are people I know that don't use cerdit. THey save up and buy a modest home and car. They save and go on vacation. These people refuse to pay interest. One can do the same for healthcare.

But, if the provider knows your financial appetite, they'll charge accordingly. Third Party gives you a big-big-big appetite.

[HazelMeade]

Insurance is for high-cost unexpected expenses. It is perfectly fine and makes total sense to have a high-deductible catastrophic plan. The problem is that when someone else is paying for your premiums, you are incentivized to start using insurance to pay for everything. If you are paying for your own premiums, it doesn't make financial sense to do that. Let people buy insurance and they will naturally gravitate towards high-deductible policies.

[Alice Bowie]

I disagree with one point Hazel.
People dont' abuse insurance cause someone else is paying the premium. People abuse going to the Doctor because someone else is paying for the service.

[HazelMeade]

Yes, Alice, if you have a high-deductible plan YOU are paying for the office visit, not the insurer.

Office visits don't cost $10,000.

[Cytotoxic]

Neither of these cost this much in Canada/UK

You pay in wait lists and inferior survival rates.

[PACW]

So you also want to outlaw credit card companies?

[Tonio]

The stupid...it burns.

[Cytotoxic]

1. Outlaw ALL private Healthcare insurance (This is necessary due to 3rd party problem...this is what raises costs.)

Fuck you cunt. It's my right to insure or be insured for whatever. Contract rights.

[HazelMeade]

Alice, Medicare is already bankrupting the country, and you want to add MORE people to it's rolls?
Fuck that.

Actually, on second thought, yes, please, I'll have my Medicare now, as long as I don't have to pay anything more in FICA taxes. I want my share of the loot before we get to the pile-of-smoking-rubble stage.

[Alice Bowie]

Medicare is not bankrupting this country.

The rest of the modern world has medicare for all. And, they control the doctor cost. And, almost all of them are two tier and those with more money can go to other doctor.s

[Cytotoxic]

Yes Medicare is bankrupting America you stupid cunt. Reason has detailed Medicare's destruction of the US fisc for years.

[Lady Bertrum]

Alice, Europe and Japan and the UK are broke. The yokels on CNBC will tell you that they're on the verge of surging back to a robust economy. They aren't. They will all fail miserably because the mother or all credit expansions burst in 2008.

Does this have anything to do with healthcare? Yes, dear, it does.

They, like us, have engaged in a Ponzi scheme of credit and bond creation. The only reason they were capable of paying for the healthcare of their citizens was because they paid for it with Ponzi Euros or Pounds. Now, with a demographic death spiral setting in permanently, they cannot borrow from the future to pay current accounts.

Watch and enjoy, or don't enjoy - your choice - as benefits are cut because they will no longer be able to sell bonds as future debt to finance current spending.

[Red Rocks Rockin]

Medicare is not bankrupting this country.

Um, wrong. Medicare and Medicaid cost over $1 trillion a year. That's about 6.5 times more than it was 30 years ago on an inflation-adjusted basis.

[PACW]

The NIH in England recently decided that hospitals had to change sheets in between patients; even if the sheets weren't dirty. When a hospital has to be ordered to provide the same level of cleanliness I get at the Motel 6 I'm going to have to argue that their system is broke.

[Ted S.]

I Think Single Payer would ONLY work if the the government controlled costs like it does in Medicare.

Single-payer legal care.

[Jimbo]

So other than all that stuff Suderman listed, it works fine!

[LynchPin1477]

At this point they really should just Rule 34 the whole website. At least it would be useful, though I doubt they could handle the traffic.

[David R]

As we speak, I am unable to get into the Anthem BC website to check up on my individual policy. Wondering if it's related.

[MikeP]

Hmmm. I'm also unable to get into the Anthem BC website to check up on your individual policy.

[David R]

Well, let me know when you get in. I have to see if my plastic surgery is covered. Thanks.

[Alice Bowie]

If all of you can have your FREE MARKET Healthcare with NO GOVERNMENT intervention whats-so-ever ( Not even the obligation for a doctor or hospital to have to treat you in emergency situations ), would you guys at least compromise in OUTLAWING health insurance?

[Cytotoxic]

No. Piss off.

Not even the obligation for a doctor or hospital to have to treat you in emergency situations

Dumb cunt doesn't understand what a free market is!

[Alice Bowie]

I want to hear from others as well.

In a free market with no regulations, providers won't be forced to offer services to those with no money. That is how the free market works.

[robc]

And they wont be prevented from offering a service either, such as, oh, lets say, health insurance.

[LynchPin1477]

No. Because, ideological arguments aside, as has been explained above, the presence of a third party payer does not necessarily lead to higher costs. Outlawing insurance is an awful, awful idea.

[Alice Bowie]

everybody is saying the same thing.

It clearly appears that outlawing health insurance is nothing anyone is open to.

But i still say that it is almost Similar to Government Grants for colleges and student loans. Libertarians regularly argue that college tuition has gone up because of this. I felt all THird Party payers including Health Insurance cause the same effect.

But i heard all of u loud and clear. The outlawing insurance idea just won't fly in america. Thanks for the feedback.

[HazelMeade]

How about having a few public emergency rooms run at government expense and let the private hospitals turn people away?

No mandate, no single payer, just have a public hospital in each city with it's own budget. Obviously it would be below-average care, but free to the very poor.

[Alice Bowie]

YES. I'll take it.

This would be A-OK with me!

[Lady Bertrum]

Alice - your premise that health insurance causes healthcare inflation is just wrong.

Health insurance is like any other insurance - home or life.

You pay a premium incase a catastrophic event occurs. If something happens your insured against that risk.

[robc]

That isnt a compromise. Outlawing health insurance is a violation of the free market.

[PACW]

Even if you could convince libertarians to outlaw a business other than slave trading, Health Insurance wouldn't be it. The county taxes I pay and the opportunity to be treated at the county hospital is a very loose form of Health Insurance. I choose to purchase additional Insurance through my husband's employer because it's worth the $400+ a month to go to a hospital that doesn't smell of urine.

[Alice Bowie]

Thanks everyone.

I did like Hazel's Idea: THIS is a COMPROMISE most liberals can live with. And, if liberals feel so passionate about bettering the public hospitals, we can contribute more of our money.

HAZEMEADE's comment below:
How about having a few public emergency rooms run at government expense and let the private hospitals turn people away?

No mandate, no single payer, just have a public hospital in each city with it's own budget. Obviously it would be below-average care, but free to the very poor.

[Alice Bowie]

In addition to emergencies, these public hospitals should treat the poor for leukemia and shit like that....not just emergencies. They should be public clinics that ONLY the poor, disabled, and retired can go to.

And, have a 100% completely, unregulated free market with insurance and providers being able to do and charge whatever works within the market itself. And, absolutely no government intervention on that part.

However, every tax payer would have to flip the bill for the public clinics.

[ax123man]

I'm always amazed that so many people view this as the start of health insurance/care regulation. The Feds have been regulating health care since 1940's. There's little Roosevelt didn't regulate. The IRS ruling that allowed employers to deduct health care premium as a business expense was the start of destroying price transparency for consumers. Employees got the same tax break, unless you were self employed. Hmmm, wonder why? The effect of this was similar to the effect of income tax withholding. If consumers don't make a connection between cost and service, prices creep up. Btw, we can thank Friedman for this idea. This had many side affects, such as helping to create the need for Medicaid in the 1960's, when the state really ramped up the socialist takeover.