Health Care Hype Part 3:Beyond the Hype and Fixing the Cracks

So we have looked at the numbers, the political hype, and now it's time to look at the law.  Before I begin, I want to point out that 1. I am only trying to list what the law does and what it fails to do. 2. I have no vested interest in the success or failure of the law.  I have insurance and will continue to.  3. I am often surprised how little reporting I've seen on the actual law.

What does the law do?

From the onset, the law was designed to try and get control of skyrocketing health care and insurance costs.  As a nation we pay more for health care than any other industrial nation on the planet.  The economics of the cost as a nation before the ACA was unsustainable.   The question is will the ACA contain this raise in cost?  The US pays nearly 18% of it Gross National Product for health care. Growth before 2006 was a little less than 5% but after that growth rate was lower at about 2%.  It is true that since the ACA the growth rate of health care is at an all-time low. There is, however, no direct correlation between the ACA and the drop in cost.

There are other reasons cost are higher.  America tends to try and buy the new technology while it is still more expensive, but also cutting edge.  We have an inordinate number of people without any insurance. About forty-four million do not have insurance and 8 of 10 those are employed or are their dependents.    This means they rely on the most expensive form of health care, the emergency room.  What is more, if they cannot afford the cost of the ER, someone has to pick up the tab.  Guess who that would be? It is those of us who do have insurance and money to cover that cost.  By forcing many to get insurance, the idea is to create large groups to negotiate the cost of insurance.  Large companies get better rates because of numbers. The other essential is that these group policies include everyone from those with pre-existing to the young and healthy.  This means everyone pays the same, but the healthy are actually covering the cost of having less healthy folks in the plan.  The exchanges have the same goal, and that is why it is important that everyone get signed up.

It is the law. Like most laws of this nature the odds of it going away are not good.  Changes that repeal, gut, or defund will not pass for at least the next two years. Like it or not, eventually the exchanges will be up and running, and there will be more and more people getting them.  The current conversation is still over a much smaller number of people who are losing plans than those 44 million that have no plan.  So really, most votes that do not truly improve the law are moot and symbolic be it a Democrat or Republican vote. The law may grow more slowly or collapse under its own weight, but little that congress does will get rid of it.

So what has health care do?

1. It closes the "doughnut hole" in the Medicare Part D program expanding medicine coverage for older Americans.

2. It prevents insurance companies from charging more or denying anyone coverage for a pre-existing condition.

3. It prevents insurance companies from charging more because the client is a woman.

4. It allows children to stay on their parent's plan until they turn 26.

5. It prevents companies from putting lifetime caps or limits on payout.

6. It requires that insurance include coverage of preventative care.  This also includes the controversial birth control option.

7. It requires that any company that has employees of more than 50 to offer insurance to their employees or to offer them help in paying for insurance on the exchanges.


8. It offers small business up to 50% tax breaks for the employer's share of the employees cost in the exchanges.

9. If all states were to be involved in the Medicaid Expansion, it would cover 15 million Americans who do not have and cannot afford assurance.

10. People entering the exchanges will in many cases qualify for some subsidy to help reduce the cost of the insurance.  The subsidies cover people making up to the 400% of the national poverty levels.  Those above the 400% threshold will not receive any tax subsidies.

11. Persons not entering into the exchanges or not having insurance will pay $95 or 1% (whichever is greater) in the first year rising to $685 or 2.5% (whichever is greater) by 2016.

12.  No person may be discriminated against by insurance companies. Factors such as pre-existing conditions, health status, claims history, duration of coverage, gender, occupation, and small employer size and industry can no longer be used by insurance companies to increase health insurance premiums.

13. Factors that can affect premiums of new insurance beginning in 2014 are income, age, tobacco use, family size, geography and the type of plan you buy. This applies to all plans including those sold in state exchanges.

14. Congress must shop on the exchanges.

15. Pharmaceutical companies will be subject to new taxes.

16. Insurance companies will be taxed on the basis of their market share.

17. Insurance companies cannot handout outrageous bonuses and then pass that cost onto consumers.

18. Establishes a reserve corps of doctors and medical personnel for emergency response during disasters.

Note there are a number of items that will continue to be implemented until 2020. I also keep stumbling across more things the ACA is supposed to do.

Until a few days ago other than the call for tort reform which would basically protect insurance companies more than they already do, I had never heard any changes, add-ons or fixes from a Republican.

Sean Spicer who is GOP National Committee Communications Director offered this.  He didn't announce we need to defund, and I don't think he mentioned tort reform. He suggested that we open the selling of insurance across state lines and allow small businesses and individuals to gather into groups so they can get the discounts enjoyed by larger employers and continue to allow those under 26 to stay on their parent's plan.  It was an odd statement for someone who was opposing Obamacare.  Why? This is exactly what the national exchange does.  It allows anyone to join the exchange making it a group and it allows anyone from any state to buy insurance across state lines.

Oddly, on paper, this looks very reasonable. So what are the fixes?

First is the "keep you policy" fix.  There is intent by both congress and the white house to try and make sure that the "You can keep your insurance" promise is fixed.  Obama admitted in a news conference that the grandfather clause in the ACA did not cover as well as he thought it did.  In an effort to correct this, he has left the determination of policies that have been cancelled up to individual state's insurance controller and the insurance companies until 2014.  There is some question though what Obama can actually do without the Congress weighing in.  As I discussed in a previous blog, that could be a reality, if it actually fixes the problem.

Second is getting the website up and running.  The website is not the law, but it is a part of implementing it.  It will continue to be a complex site to build and update.  One thing we could do to avoid the problem of how we get technology bids in the future is to simplify the process and not take the cheapest but oick the best company for the job.  We also need to encourage states to create their own.  Most states that have their own website are actually doing better.


Third we need a way to make sure the Medicaid  Expansion works.  It needs to become less of a political football and be seen as the economic add to the state that it is.

Fourth with the horrendous roll out, getting the young healthy back on the site is essential.  As more people join the insurance the better the rates and offerings.  I do not know what the solution is; only that it needs to happen. I do know that it behooves the insurance companies involved to get the so called "young indestructibles" into the plans to make money.  Insurance companies do bear some of the responsibility in this since so many failed to explain the options to their clients and continued to sell plans they knew would eventually be cancelled.

What does it all boil down to? The ACA is the law.  The press needs to inform as do insurance companies.  The constant sensational story mongering serves no purpose.  News reports and informs, but so far it hasn't done much informing.  We have problems to fix.  If congress had actually spent time trying to fix it as they eventually have on every social program ever passed from Social Security on, we would actually have something that both parties could actually run on instead of against.

I still believe that if we use our voice and our vote, we can make politicians do the hard work.  Polls show that while many do not like the Affordable Care Act, they want it fixed, not repealed or defunded.  We are all tired of the congress playing politics.  Its 9% approval rating proves it, and somehow they still don't hear us.

It is time to govern.

Health Care Hype Part 2: The Politics

We know that this program was no small issue.  Big programs never do run well to start.  The Bush Medicare Part D program did not go well either.  It was unpopular according to the polls.  Its rollout was rocky despite having two and half years to prepare.  It was opposed by Democrats, although not to the point of shutting down the government. It is now a very popular program.  According to Reuters even Social Security was no picnic. "Social Security, that now beloved centerpiece of the nation's social safety net, offers a case in point. Created in 1935, the program took 40 years just to include all working Americans." It was "blamed ...for a slowing economy and a swelling federal bureaucracy. Fierce congressional opposition led to the formation of a blue-ribbon panel to overhaul the measure. Medicare fared no better.  The elderly didn't like it, and it had to be sold door to door. No one knew if it would even work.  Giving birth to a big program is not easy.

Does it mean we shouldn't try?

In 2008, President Obama, who had as a part of his campaign promised to try and get Health Care reform, began to push for exactly what he promised.

Perhaps more than any other issue, the Affordable Care Act has created the division. When it was passed in 2009 by Democrats, no Republicans in either the House or the Senate voted for its passage. One Republican did not vote in the Senate as he was absent.    It should be noted that even though Republicans had been involved in the crafting of the Senate bill, they voted against what they had helped to build.  The passage gave rise to the Tea Party.  The ACA was passed without bipartisan support, but not without input. The Bush Medicare Part D was passed in much the same way except 16 Democrats did vote for the law.


Riding a wave of resentment by many red and purple states and in an off year election, the Senate lost its super majority and Republicans took control of the House. The loss was actually not just due to the ACA, but it contributed.  It was at this point that the Republicans became known as the "Party of No."  The battle over the health care culminated with a shutdown of the government and a threat to not raise the debt ceiling.  The majority of Republican Senators remained for the most part seeming more centrist Republicans.  There are a few that cater to the far right.  The House took over 40 votes to repeal the law.  These were votes that they knew could not be any more than a political statement. Their concerns about the cost, it turned out, was somewhat justified, but they spent so much time in opposing everything, the problems became more and more convoluted.


Here is the problem with both parties playing politics with the law.  It is a law not a policy or a bill which frequently appears in talking points.  It is a law.  Never in the history of the US has any Congress done so little.  It is the price of playing politics without governing.  What needs to happen is what should have happened is once the ACA was passed into law, the Republicans should have immediately began to work on making it work for them.  Opposition without a plan is not governing.   If one team stands at the goal line and refuses to play, they forfeit.  They don't get to complain about how the other team is playing.  It is time, dear congress, to share the sandbox and play together.

But it doesn't stop there.  With the dismal rollout of the website, we immediately had hearings.  That is a good thing.  Oversight is one of the things congress is supposed to do.  The question is that will the hearings actually offer up solutions or will they continue to be, as I have watched them, political grandstanding.  I remind you, that the shutdown cost by every economist's point of view at minimum 24 billion dollars. The outrage that started out was about a website that cost $70-$93 million dollars to build, not $500 million as has been reported on the right or the under $50 million as reported on the left. So the question became who is responsible for this disaster? Personally, if I contract someone to do work, I think they should do it.  If they fail, they don't get paid.  Unfortunately, government contracts don't work that way.  Perhaps, they should.  The fact remains the site was not ready.

Then came the loss of insurance by what will most likely turn out to be around seven million people.  The Republicans actually have a bill in the House which would prevent the loss of the insurance.  There is hope...or maybe not.

You see what it boils down to is how the bill is worded. Right now, as it stands, the actual bill doesn't just protect those folks who have cancelled plans because of the roll out.  It protects those who have junk plans, it allows insurance companies to continue selling plans that do not meet the basic needs, it allows insurance companies to deny because of pre-existing conditions, and it allows insurance companies to charge more for women.  In other words, it basically is another attempt to gut the ACA and not just protect those who might be damaged by it.  Still, all bills are negotiable, but will they negotiate.  Perhaps, they will negotiate the bill in the Senate which seems to prevent the loss of those insurance plans.  The only problem is that some of those plans were to go into the exchange which would help support the cost of the law. In other words, it could subtract money from a law that was essentially supposed to be paid for. The fact also remains that Obama is not running again and will veto any bill that undermines the law. It still requires a 2/3 majority to override a veto and that is not likely to happen.

News programs have their own politics to play as well.  I am not talking about Fox or MSNBC either.  We all know their agendas.  I am talking about mainstream media which continues only to report on the failure and not the success.  Why?  I have my suspicions that it goes back to that fear of appearing unbalanced.  The Republicans took such a hit during the shutdown in mainstream, now mainstream media outlets are feeling the pressure to report only the problems of the Democrat created program.  When the reports turn out to be inaccurate or based on partial leaked information, little is done to correct the error. It is also easier to report on the failure on either side because it guarantees better ratings and more sensational reporting.  Even the news now worries about the bottom line.

So far the playing of politics has outweighed governing and reporting.  Sad but true. So what does the law do? Surprisingly, little is covered in reporting and the White House has not  been successful at getting this information wide spread.  The opposition party has also done a lot to prevent the public from getting an acurate picture.  So in my last post, I want to try and list what the law is supposed to cover.

Health Care Hype Part 1: The numbers and the lies.

So I've been trying to sort out the whole Health Care thing from the massive hype. This is going to take at least three blogs maybe more to work through it.  Like or dislike the ACA, there is a boatload of information that is just wrong from both sides of the fence.

The website was a mess.  Obama's promise about keeping your own insurance was a lie, misleading, poorly stated...take your pick of terms. It was wrong.  Politicians lie.  From "I am not a crook" to "I did not have sex with that woman" to wondering where the WMDs in Iraq are, it is what politicians do. To quote H.L. Mencken, "A good politician is quite as unthinkable as an honest burglar."

So now what?

 Quite honestly, I didn't worry too much about it.  I've pretty much always had insurance through work, and now I buy it through my retirement plan, so I haven't gone on the website except to see what it looks like.

This is, as I understand it what is supposed to happen.  You can go on a state website if your state has one or on the national one which is not working if you don't .  From there you can look at insurance plans from bronze level to gold.  You can also call or find one of the places that will help you.  You can see plans from several companies and then pick the one you like.  Depending on your income, you may receive a tax subsidy to reduce the cost.  For some the cost will remain the same.  For some the cost of their new insurance will go up. But everyone who applies will get insurance and for millions it will be the first affordable insurance they will ever have. It has never been a secret that the insurance would not cost something.

The Medicaid expansion was designed to help millions who could not afford that cost.  The Supreme Court, however, ruled that states could choose to expand Medicaid.  Most thought that since it would actually save state money for the first three years and then still be 90 percent covered by the Federal government making Medicaid still cheaper than it is now, states would jump at the offer.  They didn't.  Again, take your pick of political view point. Some states honestly believe that Medicaid is going to create more poor or are just being obstructionists not caring about the poor.  Add to this that states have the option to create their own exchanges or rely on the Federal exchange. Again, many states decided not to create their own.

We also know that because of these options given to the states, the plan may struggle.  We also know that when it became apparent that many states were leaving it up to the Federal Government, the request for funds to expand the system was denied by Congressional appropriations. So the website, which was badly designed to begin with, then took the extra hit of having way more traffic than it was designed for. The question is will the exchange work? It is not government health care.  The insurance is through private insurance companies but has an oversight by government statute.  The other problem is that it is not just connected to insurance companies but must also be connected to the IRS, Social Security and other agencies for the subsidy portion to work.  The website becomes pretty complex.


Next came the cancellations.  Insurance policies are cancelled and changed every year. So to say every cancelation is a result of the ACA is wrong.  A number of the policies cancelled are junk policies but not all.  Some were not cancellations, but notification that the insurance would now be offered on the exchange.  Some of the cancellations are unscrupulous insurance companies trying to take advantage. And some were caused by the implementation of the ACA.


Predictions of the numbers are hard to come by because some states just don't know. The last figure I saw on cancellations was 3.5 million, but that was without the information from several states.  Another estimate was that the policies cancelled would be about five percent.  If we use the 3.5 million figures, then that means, given the projected population by the US Census Bureau of the US on November 10, 2013 which is 317,044,892, we are looking at 1.1 percent of the population losing their current insurance.  The five percent figure then means 15,852,245.  We begin to see how these numbers matter.


The other thing that I've found little in the way of numbers is how many of the plans cancelled are individual and how many are from the plans known as small group plans.  We also know that when the ACA was passed that most could actually keep their old plans.  The problem is that plans change and turn over at such a high rate that any plan that didn't meet the standard after the law was passed is not protected by the law.  So insurers continued selling bad plans for the past three years knowing they would have to replace them.  We can also look at the numbers from the above link which say about seven to eleven million will be cancelled.

Again we face the issue that the website was so poorly done, people who could get better plans and possibly cheaper cannot get through.  We also know that a "young, healthy people who had cheap plans with high deductibles, will end up paying more."  That's a fact that was not actually hidden.  It was just that many getting sticker shock never bothered to find out.

Those are some of the numbers which seem to change daily, but what of the politics of the law. That's up next.

Really? This is What You're Complaining About

Some memes are just too easy...

And in case you think Obama has never held his own umbrella...

 I also thought you might want to see this one of Palin, in case you're tempted to post that one that uses her instead of the queen.

And in case you think no one ever holds the umbrella for her majesty...

Although Queen Elizabeth II does have a reputation for always carrying a clear umbrella with trim made to match her outfit.

How about a picture of a president holding an umbrella for a senator?

And finally there is this. 

And lest you think I am picking on George W....

Everybody has problems with umbrellas sooner or later,

even the Navy.  Sorry, couldn't resist.  

In all honesty, if you hate someone but all you can come up with is who holds the umbrella, you need help. Feel petty yet?

Thor Is A Sequel but Is It Thunderous?

Allow me to rant for a moment.  I will get to the movie, Thor: The Dark World, but I need to set something up.

One thing you need to know is I will generally forgive adaptations be they novel or comic book providing they do a few things.  Tell me a good story and stick to the essentials of the original story.  They need to capture theme and mood that transports me just as the original did.  Do this, and I will forgive a lot of indiscretions. If you are going to do a show called Sleepy Hollow then changing Ichabod Crane into, oh I don't know, say a resurrected Revolutionary War Soldier who married a witch and is now working with a cop who happens to be one of two of the witnesses of the coming Apocalypse, I may be a bit less forgiving.   I mean why bother naming your characters after those in a famous story?  Don't get me wrong, I like Sleepy Hollow.  It's just that it has zero to do with the original story.  I digress...

I did not regularly read Thor comics as a kid, teen or adult.  I have read perhaps only handful total.  I always found him too egotistical for my taste and thought his over-sized hammer kind of silly, even for a comic book.  That said I have liked the movies.  I feel that, from what I know of the comics, the movies do meet my requirements for an adaptation. The first had that majestic spectacle of a great play, a clear mark of its director, Kenneth Branagh.  It had a powerhouse actor, Anthony Hopkins in the form of Odin and pretty straight storyline.  So what makes Thor: The Dark World different? It has more character and less over-driven action sequences.  Although I didn't see it in 3D, I am pretty sure it would be pointless pay the extra money so I could wear the glasses.

THERE BE SPOILERS HERE!!!!!

Thor: The Dark World is a comic book movie.  It takes its time to find its legs, and it doesn't really take any risks except one at the end that I thought was pretty pointless.  There was something though that once it does start moving draws us into the story.  Like most comic book movies some things are never going to make sense.  It is the nature of the beast plus the fact there is probably a ton of different back stories and alternate stories and other world stories from the comic book world to sift through.  It is probably why all comic book movies eventually must make their own way much to the fans' chagrin.  The other thing is this: this Thor movie is darker and at the same time not as serious as the first movie was.  Like Tony Stark in The Avengers, we have moments of fun such as the intern's intern and their sudden romance, the naked professor and, of course Loki suddenly becoming Captain America.  There are some moments of nudge, nudge, wink, wink fun.  Just ride it.  I was also not over-whelmed by the battle sequences.  I have to admit that in several of the comic book movies, the battles are almost too long.  Yes, I know every Avenger needed screen time, but it just seemed to go on and on.  The battles in Thor: The Dark World are tight and creative.  There was also more character and back story, but the narration at the beginning was over the top, but then again, IT IS A COMIC BOOK MOVIE.

THERE ARE HUGE SPOILERS COMING!!!!!!

I want to take a moment's thought and point to the Loki storyline.  There are moments when the movie is not Thor's but Loki's.  I loved the whole idea of a redemption storyline.  Tom Hiddleston has played the character to the hilt.  He owns the screen when he's on it.  The killing of Loki was from a comic book/morality tale point of view perfect and then...it is just completely trashed with Loki suddenly becoming Odin in disguise.  Let's face it, the movies have pretty well set up future villains, and unless we desperately need one for Thor 3, the noble death of Loki should have stood. Did Loki fool Thor by being stabbed using illusion and then play dead? Did he replace the guard sent to find Thor and him and then replace Odin, and as the trickster god fool everyone including King Odin, Thor and all his buddies, even though Thor told Loki to stop the illusion?  It did not need to become a clever plot twist. It wasn't. It stole the moment from the audience.


Stay for the credits.  Half way through the credits we meet The Collector and have a statement about the Infinity Stones which connects the Thanos appearance in Avengers, and the upcoming Guardians of the Galaxy.  We now have two stones (there are six): the Tesseract and Aether.  The Collector is one of the oldest aliens as is Thanos who originally collected all six stones to make the Gauntlet of Infinity a Guardian story. The last scene after the credits is like the one in The Avengers, just kind of a treat.

Overall, I liked the movie.  Is it the best, no, but it is fun to watch, and it was nice to have some story rather than one continuous action sequence. I will buy the DVD when it comes out.

The Election

I've actually got very little to say.  What passed and failed yesterday was not unexpected.

 Off year elections are usually dominated by issue-driven and older voters. These voters tend to be conservative. It's why unattached recall elections work and why states nation wide frequently see the more radical elections in the off year.  I had hopes that Amendment 66 to fund schools would pass, but I knew that given the off-off year of the ballot issue and the state's abysmal record on supporting school bills or for that matter any tax bill it was highly unlikely. In all honestly the only way to help our schools, roads, and many other state issues is to find a way to repeal TABOR.  It was also true for the only tax issue likely to pass because most of the folks who passed the legalization of marijuana were also the group not likely to show up to oppose the taxes on it while those who were opposed to the original issue were.

I am also glad that reason ruled on the secession vote, and most of the counties involved voted no. As one news writer I read pointed out that given traditional turn out in the eleven counties the actual number of people who might support this issue was really about two percent of the Colorado electorate.  Although given the political nature turn out in an off year, I must admit some surprise that it was not closer in several of the counties. Still, many also had to realize the futility of the attempt since it was unlikely the state congress would support it or the national congress who can currently barely tie its metaphorical shoes would even take it up.

The fact is that if you wanted 66 to pass or to change out the extremely conservative board in Douglas County or pass even the most basic of sales tax bills, EVERYONE needs to participate in more than the regular presidential elections.

How to Turn Ender's Game into Movie

It has probably been 15 or 20 years since I last read Ender's Game. I am not going to spend much time on the differences between the novel and the movie.  Nor will I spend much time on the controversy about the author of the novel, Orson Scott Card, and his political and moral views.  I believe that art can be and should be separated from its creator's personal views.  In a way, even the artist is separate from his or her individual life.  A work of art stands on its own.  Poe was a binge alcoholic and married his thirteen-year-old cousin.  Hemmingway would have knock down drag out fights with the women in his life. If the Agony and the Ecstasy is to be believed, Michaelangelo was no walk in the park to deal with, and if we go by Amadeus by Peter Shaffer, Mozart was a "giggling dirty-minded creature." I am not comparing the work of Ender's Game to Don Giovanni, but art must stand for its viewer.

And so to the movie...

The problem has always been what to do with Ender to adapt the novel into a movie without killing its incredible spirit.  In the novel, Ender is only seven and the book is brutal.  To put such brutality on the page is one thing and to put it on film, quite another.  How do we make Ender's Game without the audience becoming turned off by the brutality used on a seven year old?   Making Ender a young teen for the movie is still a risk.  Perhaps, with movies like Hunger Games paving the way, the audience could be more accepting of the training of Ender Wiggins.  Perhaps it was that so much of the violence between the children was toned back for the big screen.  It was possibly more though that the young actor Asa Butterfield exudes absolute innocence mixed into an incredibly violent culture. His interactions with his fellow characters are well-crafted. Ender is so likeable and so driven by his need and his innocence, we forgive the character of Ender his many indiscretions.  It was that tone that carried the novel, and it was that tone that is captured in the movie.

The problem with any adaptation is capturing not just the plot lines of a work, but capturing the emotional tone of a work.  When the Lord of the Rings movies were made, the success was not just following the important plot lines of the trilogy. It was also that Peter Jackson had done something no one else had. He captured the magic and wonder for every fan of Middle Earth on film.  The same is true for Ender's Game.  The characters of Colonel Graff, played by Harrison Ford as both father figure and enemy, and Mazer Rackham, as the legendary war hero played by Sir Ben Kingsley, are just right for fans of the book.  If a book has a feel to it that is then captured by its movie adaptation, even those who have not read the book will understand why people are drawn to it.  While personally, I would have liked to seen more growth of character particularly between Ender and the other children like Bean and Petra, the idea of the relationships are in the movie, just not quite as complex.  It is an unfortunate reality of a film that it must compress time and story where a book can take it out and examine it from all sides. The movie captures that feeling for fan and newbie alike.

The other issue is the theme which is blatantly stated up front.  War is not a game, and to win a war, one must understand his enemy.  The problem is, as Ender puts it in both movie and book, "In the moment when I truly understand my enemy, understand him well enough to defeat him, then in that very moment I also love him." It is that love - that understanding - which will nearly destroy Ender.  While the movie simplifies its statement about the horror of war, it does capture the intent of the original work.

All in all, Ender's Game is a strong movie and involves us as an audience, especially in the IMAX format. We understand Ender.  We feel for him.  We want him to succeed and understand his reactions when he does.  No small task to put on the shoulders of Asa Butterfield because ultimately the young actor must carry the theme, the emotions, and the weight of this movie.  Well done.  Ender's Game is all that it should be. This is one I will definitely add to my DVD library.