What are you taking about Jon? Exchanges will “work” fine (as mechanisms to protect the current profit structure and extract wealth from the poor schlubs who have to buy from them).
Oh, you meant as a means of providing adequate, affordable Health CARE. Nevermind.

Yes it does work well at putting up a great show to make it seem like these useless middleman companies have some reason for being.

Once again with the unintended consequences.

It gets worse Jon. When we went to a Provider’s session explaining their coverage, we were told they were NOT allowed to compare their product to anyone elses & explain the differences, they could only tell us what theirs did. Additionally, the Presenter was paid by how many enrolled in one of their programs!

This is as predictable as the day is long.

On edit: In fact I have been thinking about it for several weeks now, wondering when it would become public. Complicated paperwork is part & parcel of the plan to get peeps to pay premiums for worthless services.

“Everyone must be trained actuaries and insurance experts”

This is the problem with all mechanisms that rely solely on “free market” principles (Hi, Ron Paul!); everyone must know everything about everything all the time and act rationally based on that perfect information.

http://en.wikipedia.org/wiki/Perfect_information

And, no, price is not a substitute for information; if it was we wouldn’t need all that fine print in contracts or hundred-page packets of information for insurance.

This is true of almost EVERYTHING related to health care. In order for the market theory to work for health care, like like health insurance, the “consumer” would need to basically be Doctors, like you stated they need to be actuaries and insurance experts.

This is why health care DOES NOT work well as a market (it does work very well for the profits of providers though) for citizens. If I go to a Doctor and he says I need X, Y, and Z that costs D dollars, I have no way of knowing if indeed I really do need X, Y, and Z AND I have no way of knowing if the prices of X, Y, and Z are competitive.

It’s difficult for a lay person to even understand how much a plain office visit is priced at because providers “price” their services based on the rate of return they get from insurance providers. For example, if they need to get $80 per office visit, they will set the “price” at say $110, so that the insurance payout will equal $80. This is how it’s done. I know. I managed a pediatrician’s office for years.

Nothing in health care is compatible with market theory. It’s not just the insurance part.

Heh, “useless,” while true, is being too kind to this part of the health care industry that adds NOTHING to health care yet skims billions in profits and administrative costs.

Parasitic would be a better word, IMO.

Assholes works too though.

Looks like my medicare supplemental coverage packet. Part D, the donut hole, all that crud.

I understand mine. But I was 99th percentile in school testing, had gamer geek experience dealing with very thick rule books of various fantasy/SF role playing game systems, had to deal this or that to help my mother’s disability from MS on occasion, and I’ve had almost two decades on disability myself with almost nothing else to do but that.

I wasn’t kidding when I said being disabled is a full time job.

Excellent post. We need an Elizabeth Warren for health insurance.

o.m.g.

I knew it! Insurance inflates prices for everyone. And then the provider always asks: “don’t you have insurance?” Because their world is structured assuming everyone is covered.

confusopoly
Definition from Wiktionary, the free dictionary
Jump to: navigation, search
[edit] English
[edit] Etymology

Coined in The Dilbert Future by Scott Adams. From confuse by analogy with monopoly and oligopoly.
[edit] Noun

confusopoly (plural confusopolies)

1. (neologism, economics) An economic condition whereby the market force of competition is evaded via intentional obfuscation.  [quotations ▼]

http://en.wiktionary.org/wiki/confusopoly

Who says reading comics has no intellectual value:)

Indeed last I looked – as an actuary – by illness by treatment data was available for reserve calculation purposes – if you wanted to use it. Indeed probability of occurrence data is quite old but is available. But pricing is not really based on a fine screen of all possible problems that are then added up as geographic expense variations are much more important than minor coverage changes.

Those coverage differences are there to make certain that you CAN NOT COMPARE policies. The selection of choices an insurance company puts in a given plan reflect past history of that company with what once was a plan put together to satisfy what an employee of a large company thought they wanted in a health plan. Now bed costs and lab costs are major items that without regard to the illness involved can be priced and provide a logical basis for price differences – but the final pricing is – in casualty insurance like health – more the result of what sales supervisors called “underwriters” think the market will bear. Now there are some fantastic models that claim to price a great deal – but every time I discuss how well they back fitted with history I found these large fudge factors were need, commonly called medical inflation.

It is not as much of a science the way life and disability insurance is – but in a world where the rich and corporate refused to fund medical care via their companies or allow the government to do so, it was the best the unions and their actuaries could come up with to fill that hole via union contracts – and the government in the 40′s encouraged its development.

So the exchanges will be as informative as your visit to your insurance broker in the past – a fellow that pushed the highest cost plan he thought you could afford and agree to – and then sat back because you had to live with the results of whatever was purchased.

Meanwhile, I’ve blogged http://my.firedoglake.com/papau/ about Governor Patrick’s Massachusetts bill to change how health care folks are paid – ending fee for service. And Edger at http://my.firedoglake.com/edger/2011/05/22/single-payer-reality-vermont-approves-universal-health-care-program/ has blogged the approval of Vermont’s single payer.

The exchanges was a way for an economist working at MIT to make a million or two a year as walk around money – and in a world where actuaries – even those in the Social Security Administration who gave us the costing of over 20 ways to “fix” funding – are not listened to – we end up with his ideas. Sure wish Krugman – a teachable economist if that is the correct term – was the economist that government listened too. But that was not to be. So we will all get to enjoy a massive mailing from our exchanges in the future! :-)

Any bets the insurance agent has googled your past health and your family history and has a plan designed specially for you? Its designed not to pay out for what you need rather its designed so the insurance company avoid paying for your medical bills as much as possible.

And the sad part??

Providers are forbidden BY LAW to charge the uninsured a different amount. For example, if you need to actually receive $80 per visit in order to make a living (basically break even and pay your workers and Doctors) so you set the price to $110 in order to actually get the $80, then BY LAW you HAVE TO charge a poor, unisured person $110. Even though you accept $80 to see someone that is insured.

And don’t even get me started on the WASTE. We had to have 1.5 employees (and we weren’t that big) just to handle the different insurance issues, like different rates, different forms, different procedures covered, different procedures requiring pre-approval, etc.

It’s so messed up it’s really hard to fathom just how messed up it is.

My working assumption (based on only moderate experience but no more is needed) is that NO insurance will pay out what is advertised OR needed. Hard lesson. Point of anger. Only way to deal with it is to accept it.

I understand. Thank you. This is what I have been ‘reading’ from the outside looking in based on my own experiences and individual fact gathering.

It’s rigged. And reform did nothing but encourage that to continue and expand.

This sounds like an excellent system for extracting as much money out of people while provided the least service possible. I wish everyone that worked for the health insurance companies would quit their jobs and go find an honest line of work. But I guess if you are a ruthless cocksucker you can still sleep at night. Some things are simply not appropriate for the so-called ‘free market’.

This sounds like an excellent system for extracting as much money out of people while provided the least service possible.

Absolutely.

At risk of starting another pie fight …

Those of us who were/are single payer proponents, said this was going to happen

Yes – we did – and indeed the Society of Actuaries had meetings on the need for Single payer back in the late 80′s and early 90′s. A few congress types showed up – but in general we were ignored in favor of campaign donations and “don’t rock the boat”. Clinton was brave to propose change – but even then Bill took single payer off the table before he began the process, before he asked Hillary to form a task force.

Obama – and change we can believe in – not so much unless it is to screw the non-rich and non-corporate.

But we must vote for Obama because look at the alternative(s)! /s :-)

Heck – more than half of FDL would not vote for Hillary over Obama – even now. So sit back – and enjoy the show as a “not-Hillary” is found to primary Obama and lose big time – giving Obama a boost in PR going into the general (folks forget how small the base really is in terms of activists).

yah for the 5& 1/2 minutes they spend with ya

the people in this country are so used to taking it up the arse,they just automatically bend over and ask how much….sheesh…wake up peeps

I’m sure you know these numbers better than I do, but I did a quick run through here

Three or four years ago, a healthcare blogger challenged his readers to “do their homework” to look for a better deal for health care insurance. Husband is a disabled federal retiree with a Ph.D. He has good health insurance (like our Congress-critters), with annual choices to switch providers. I went online to see the various plans available to fed.retirees. Ever since disability shortened his career, we have used Federal Blue Cross/Blue Shield. (Yes, premiums rise every year, co-pays increase . . . but you dance with the devil you know.) Thinking we were reasonably intelligent, we spent three days poring through the fine print provided by the 3 or 4 insurers . . . and found the the Letter Carriers Association offered the best price/best coverage, so we switched. Premiums were almost $200/month less . . . but the first time we tried to use it, we found that the local doctors have banded together to promote Capital Healthcare, and did not accept the coverage provided to the Letter Carriers by Cigna. Ultimately, we spent the next year filing our own insurance papers, and when the annual decision-making time rolled around, we switched back to BC/BS, just for the convenience and familiarity.

So as we ponder our Medicare future (next year), we certainly understand your premise (the need to be an actuary & a fortune teller). What I find most troubling, though, is that I recognize that mentally we are NOT as sharp as we were 10 or 15 years ago–a condition I do NOT expect to improve. As our decision-making capabilities and our memories are challenged, is it even REASONABLE to think we can appropriately navigate the complicated morass.

Age related confusion is part of the plan.

This is why all of this nonsense about HCR exchanges was so ridiculous. I remember the Ezras and Matts — and all the rest of the ass-kissers — waxing eloquent about the wonder of exchanges for private, for profit insurance. And why a public option was just a “sliver.”

Pathetic.

Only thing worse than exchanges for relatively low income Americans is exchanges for 85 years olds like Paul Ryan’s plan.

Uh??? The odds of getting cancer is 1 in 3

Unintended consequences usually aren’t unintended.

Fostering early onset age related confusion.

A good reason to get patients back in the game. It should be up to the patient to file his/her own insurance forms.
Payment should be required at the time of treatment..the patient is given the proper insurance forms with which to apply for a refund.
Costs would plummet…

I’m sorry but there are better things to do with my life than graduate school of insurance.

there is NO disposable income in the USA….Big ins,big pharma,and visa/Mc are stealing all your money

LOL!!

What color is the sky in that world, purple??

Actually, today is very clear, very blue..it is 71 outside, a little windy..

Thanks, John

I did not have those links although I am familiar with the data.

The http://web.archive.org/web/20091103062222/http://www.nchc.org/facts/coverage.shtml is of course what we presented to Obama – but he chose to ignore the data – the other two items http://richardpierpetit.blogspot.com/2009/04/cliffsnotes-for-harpers-indexapril-2009.html and
http://www.calnurses.org/research/pdfs/ihsp_sp_economic_study_2009.pdf are more recent, and show that little has changed.

We know our export manufacturing is crippled by our health care financing system – but who knew that Obama was down with staying the course as only 15% of the manufacturing jobs we lost in the Bush “no regulations are good” disaster came back. No trade law or trade affecting tax law change was proposed during the two years we controlled everything.

Costs would drop – as would patients – into the grave – indeed we already lead in western nation short lifespan contests – this idea would lock down that lead forever and we could challenge the early death rates of third world countries.

It does indeed.

Always find your coverage and viewing points of what For Profit American Health Insurance Plans are all about informative and accurate on the political/social/fiscal contours Jon.

Thanks again.

Too bad Barack Obama was so spineless about being a leader and taking the USA into a Medicare For All health care regime. He deserves to be voted out of the WH in 2012 for the political duplicity he gamed over and over while the so called HCR “debate” took place during 2009.

Barack Obama is a DINO political charlatan who has served AHIP well.

Just like he has served/serviced the M-I-C,Pentagon,CIA and performed roles for Torture,WOT and Security Theatre to protect/preserve what Bush/Cheney did.

Barack Obama does not deserve another WH four year term.

Vote Barack Obama(DINO) out of the WH in November 2012.

Whew, good, that was a close call.

Welcome back to reality, even if it’s only for a little while.

what would plummet would be use of services

already happening,a win,win,for big ins

The intended GOAL is to make it confusing, esp for Seniors, who are already at an intellectual disadvantage. So much easier to rip everyone off and/or force Seniors out of the system bc they made some mistake. Too bad, so sad: get used to it, Grandpa. We don’t like your kind around here.

Even the most “with it” Seniors need help figuring this stuff out as they age, and the vast majority aren’t that “with it.” No offence intended. Anecdotally speaking, but I have been assisting quite a few seniors – both relatives and relatives of friends – for the past decade, plus witnessing family friends, etc. Once many hit 80 – I call it the line of demarcation – a lot of Seniors’ mental capacities diminish substantially.

Talk about tossing granny down the chute… bastards!

have you ever read your home owners ins…my lawyer said its simply .un comprehendable ….period….she is teh smart too

That might result also, but there’s no way costs are going to plummet. Costs to the Doctor’s might indeed go down, but then when every lay person in the country, who can’t possible be expected to know and understand all this crap (which is what this post points out), would end up resulting in insurance companies having to hire telephone (and maybe in-person) aides to all those folks not understanding the forms and requirements.

I can only imagine how insurance companies phones would be ringing off the hook with folks demanding answers as to how to fill out this form for this procedure and/or that form for that procedure. It would just shift the costs from the Doc’s office to the insurance companies office, AND it would likely go UP since the patients will require MORE help since they’d be less expert than the folks Docs’ offices hire.

Just another right wing bullshit talking point that results in more profits for someone. In this case the providers. And likely the insurance companies too. I can only imagine how high they’d raise premiums to pay for all the hands on help patients would require, but I’d bet it would enough to cover the added costs plus some added profit.

LOL, I JUST got mine in the mail today.

And yep, it’s about 35 pages of stuff that a)nobody has time to read, and b)most wouldn’t understand even if they had time to read it, and c)limits the liability of the insurance company in every way possible.

EDIT: And I forgot to mention that for the FIRST TIME since the housing collapse, my premium went down. Couldn’t understand the last two years when the value of the house plummeted yet the insurance premium remained about the same. This time it dropped. Not much (less than $40) but at least it finally dropped.

An Elizabeth Warren for health care would help, but as long as we continue to treat health care as if it were just another commodity, we have a bigger problem.

where do they find the fiends to write that stuff?

That booklet of papers contains errors.

There is no way on earth that the complex set of schemes described in that booklet can be expressed in writing and be correct.

And the programs used by the companies to screen claim also have errors (a difference set of errors).

How can the insurance companies possibly test what’s contained in that booklet?

@Jon Walker

Oh, that would be a big problem with the PPACA if it was not the case that the PPACA actually addresses that very problem. But that couldn’t be – that you would scare people by withholding information of what’s actually in the law?

Starting in 2014 all HCI insurance plans sold through the exchanges will have to provide coverage according to a simple scheme with four levels of coverage: Bronze, Silver, Gold and Platinum. The PPACA is not a simple market scheme but a heavily regulated one aiming to ensure that the customer has access to all the information needed to easily compare price and service provided. The exchanges forces the providers to make their product available in one place, under strict rules where they can’t hide behind one hundred pages of legalistic mumbo jumbo.

So you’re in fact lying to people and fooling them that life with the PPACA will be just as bad as it in fact is for you right now (without those provisions). While the reality is that – starting in three years – life will be much, much better. So this:

President Obama, in order to make this law work, is expecting the majority of people making about $30,000 a year to be able to read and fully understand all the information contained in roughly eight of these packets, so that they can compare the health plans offered.

Is pretty much a bald faced lie, or a case of horrendous ignorance on account of someone pretending to know sh-t about what’s in the law.

Furthermore, one of the more important things to know for those people making 30K$/yr is that they will get a $3,100 subsidy to pay for their bronze/silver/gold/platinum HCI plan. That subsidy is paid for by taxing rich people, e.g. a redistributive policy generally understood as “progressive”.

So while they would have paid $5,609 without the PPACA they will pay $2,509 with the PPACA. Obamas law will work just fine and help working people afford HCI whether you choose to fool your readers or not. Bummer.

(The example was calculated using a single household buyer 45 years old, making 30K$/yr, with a “medium” regional cost factor. But anyone can calculate their own costs in 2014 using the KFF health reform subsidy calculator).

….and 50 preceding comments, not one pointing out that the whole post is based on ignorance of what’s in the law or plain dishonesty. This is stuff that was widely discussed and reported at the time. How do you work to keep your community informed? Quite embarrassing.

the bronze and silver levels are simply actuarial values, you can structure benefits, co-pays, deductibles, etc… in literally hundreds of ways to achieve 70% actuarial value. It has been stated even by the supports of the law that depending on your health care needs choosing one silver plan or another can result in huge differences in what you end up paying.

There’s no such animal as consumer driven health care. It’s all a cruel immoral hoax played out for God almighty profits by insurance companies and their shills in the government. If the government was going to mandate and subsidize health insurance, the very least they could have done is to set a baseline comprehensive policy standard that covered no less than 95% of a patients costs.

Shifting the goalposts by a couple of miles already. First implying that the PPACA does nothing to provide the buyer with sufficient and accessible information, now falling back on arguing that the solution proposed isn’t perfect.

Would you then for starters clarify if you believe that the “level of coverage” scheme will:

1) Make it easier for HCI customers to make a rational choice.
2) Make it harder for HCI customers to make a rational choice.
3) Same as today.
4) Impossible to say.

Furthermore,

Kaiser Family Foundation: What the Actuarial Values in the Affordable Care Act Mean (pdf)

The Patient Protection and Affordable Care Act (ACA) establishes various tiers of health insurance coverage. These tiers are used for three primary purposes:
[...]
- To establish standardized levels of insurance individuals and small businesses can buy in health insurance purchasing Exchanges or in the outside market.
[...]
The ACA identifies a range of services that must be included in the benefits package that all individual and small business plans must use – and requires preventive services to be covered with no patient cost-sharing – with further details to be developed by the Secretary of Health and Human Services (HHS). These requirements apply to all tiers of health insurance coverage, meaning that differences in the levels of coverage will reflect variation in cost-sharing, not differences in the underlying benefits.

In other words, the PPACA establishes a set of services that every plan will cover. Leaving the amount of cost sharing to be specified by the level of coverage (bronze, silver, gold or platinum).

Sure, there’s still potential for complexity but 95% of your big stack of papers just went out the window because it’s gonna be regulated by the PPACA and the HHS. But you failed to mention that right? But apperently it wasn’t out of ignorance since you seem to be well read on the subject. Just wish you had shared…

It should also be noted that PPACA caps deductibles and out-of-pocket costs, and the cap is also determined by the “level of coverage” the plan belongs to. E.g.:

For a person with income at 250-300% over the poverty line, buying a “silver” plan, out-of-pocket costs are capped at 1/2*$5,950 = 2,975$/yr. That is true no matter what “silver” plan he chooses.

So when you implied that “you can structure [..] co-pays, deductibles, etc… in literally hundreds of ways [which] can result in huge differences in what you end up paying”, that’s deeply misleading to your readers. Unless you also mention that there’s one – easy to find out – cap on deductibles and co-pays for plans at the same “level of coverage”.

Are you planning to come back and adress any of this?

Don’t get too worked up. This one seems to be sin by omission. He’s taken legit news articles and altered the headlines before to slur those he apposes. Some around here fancy themselves as journalists, others don’t even try.

How is he gonna improve if he won’t own up to his mistakes? It took me an hour or two with google to research this…

Wow, what a uniquely American troll.

If you had followed Jon’s coverage of the healthcare debate, he was the, by far, the best journalist on the HCR beat. By the end of that death march, his coverage was so tight that he had gone from accurately reporting events to accurately predicting them. It was hilarious to read Jon predict, contra to what Harry Reid and the WH believed, the HCR reconciliation bill would trip over a Byrd rule point of order and sure enough he was right. He’s too modest to say this, but the take away from this post is, if a guy who is clearly an expert on health insurance policy has to make sense of his policy, who on God’s green earth wouldn’t? There is no free market in health insurance; information asymmetries is one of the classic types of market failure.

Also this statement of Jon’s is correct, even if a bit on the low side: “you can structure [..] co-pays, deductibles, etc… in literally hundreds of ways [which] can result in huge differences in what you end up paying”.
Let’s see, there are 4 different health plans (bronze, silver, gold, platinum), 5 different income levels (not counting those under 133% FPL in Medicaid), and community rating can be adjusted by family status (1. single or 2. family), 5 age brackets (55-64 and then working backwards by decade to 18), tobacco use (either 1. Yes or 2. No), geographic “rating area” (we’ll say 50, but any state can choose to have multiple rating areas).
Let’s see– 4 x 5 x 2 x 5 x 2 x 50, so in terms of premiums paid and benefits received, Obamacare can be structured at least 20,000 different ways.

Simply expanding Medicare to cover all ages and paying for it out of general revenue certainly would be more straightforward. The single flaw with Medicare is that, as a government agency, its not allowed to use premiums to fund campaign contributions, private insurers don’t have that problem– and that’s why we have Obamacare; (or will have, starting in 2014 after we’ve thinned the herd a bit) instead of Medicare for All.

Wow, what a uniquely American troll.

Ad hominems would be less of a turnoff if you’d taken the time to soften me up with a more subtle form of sophistry first. But I guess you’re saving the foreplay for later, and Jon is surely pleased to see what a dependable yet economic sycophant you can be.

If you had followed Jon’s coverage of the healthcare debate, he was the, by far, the best journalist on the HCR beat. By the end of that death march, his coverage was so tight that he had gone from accurately reporting events to accurately predicting them. It was hilarious to read Jon predict, contra to what Harry Reid and the WH believed, the HCR reconciliation bill would trip over a Byrd rule point of order and sure enough he was right.

You’re absolutely right: I didn’t follow Jon’s coverage of the HCR debate and judging by his performance in this post & thread I should probably consider myself lucky. The fact that he did a quick driveby here and then went AWOL is telling. Why would he need you to fight his battles with that rock solid pedigree?

He’s too modest to say this, but the take away from this post is, if a guy who is clearly an expert on health insurance policy has to make sense of his policy, who on God’s green earth wouldn’t?

Look: you only just got started and you’re already forced to lie to stick up for your hero. The “takeaway” from his post was this:

President Obama, in order to make this law work, is expecting the majority of people making about $30,000 a year to be able to read and fully understand all the information contained in roughly eight of these packets, so that they can compare the health plans offered.

Falsely pretending that the PPACA does nothing to address that very problem of ensuring that the presumptive HCI buyer has the information he needs to make a rational choice. That’s so dishonest right there that no further discussion is really necessary.

There is no free market in health insurance; information asymmetries is one of the classic types of market failure.

There’s a good discussion to be had of whether it is possible to ever get a healthcare market to provide as good a service as a government run scheme would and whether the information assymetry problem can be completely solved w r t HCI. There’s also a good discussion to be had about how good a job the PPACA does in both those regards.

If Jon had stuck to making that case all would be fine and there’d be no beef.

But he didn’t. Instead he pretended that the PPACA does nothing at all to address those issues, and that current HCI plans available are the same as those that will be available through the exchanges in 2014. And that’s just not true. That’s bullsh-tting your readers.

And what’s worse – it looks like the omissions are by design and not by accident. After all, if one goes for the grown up discussion instead of the lying and sophistry, one would have to concede that the PPACA makes life as a HCI buyer on the individual market much less painful than the status quo. One would have to argue that the problem with the PPACA is not that it doesn’t do good, but that it doesn’t do good enough.

And therein lies the rub. It’s hard to provoke outrage by telling people that they will save money and have a better regulated, easier to understand market to deal with as consumers. And outrage seems to be what was aimed for here.

As it happens I also think that e.g. Single Payer is the superior policy – as do many progressives. I’m just not willing to lie to people to mobilize opposition to the guy that at least solved half the problem.

Also this statement of Jon’s is correct, even if a bit on the low side: “you can structure [..] co-pays, deductibles, etc… in literally hundreds of ways [which] can result in huge differences in what you end up paying”.
Let’s see, there are 4 different health plans (bronze, silver, gold, platinum), 5 different income levels (not counting those under 133% FPL in Medicaid), and community rating can be adjusted by family status (1. single or 2. family), 5 age brackets (55-64 and then working backwards by decade to 18), tobacco use (either 1. Yes or 2. No), geographic “rating area” (we’ll say 50, but any state can choose to have multiple rating areas).
Let’s see– 4 x 5 x 2 x 5 x 2 x 50, so in terms of premiums paid and benefits received, Obamacare can be structured at least 20,000 different ways.

There are hundreds of thousands of permutations in which to assemble the contents of my shopping bag at the grocery store. But in fact shopping for groceries is not very hard.

In much the same way it isn’t very hard to know if I want to buy a lettuce, and onion or beer, it isn’t very hard to know where I live, how much money I make, how old I am and whether I smoke or not and type that information into a couple of web forms on the exchange website.

That will give me prices for different levels of coverage and different providers. The price will likely be subsidized and much cheaper than it would be today.

The plans available will all cover the set of benefits mandated for all the four levels of coverage (bronze, silver, gold, platinum). The cap on co-pays and deductibles will vary depending on the level of coverage I choose and the information about myself I have already provided. The actual cost in co-pays and deductibles during a year will depend on the plan and what medical attention I require but will never exceed the cap.

There’s nothing intractable about any of that. It’s not Single payer and I wish it was – but it’s infinetely much better than what you got today shopping for your own insurance.

Anyway, while both you and Jon were deeply misleading about how these provisions will work that’s not the capital sin here. My big beef was Jon trying to use present day complexity to smear the PPACA, when in fact the PPACA makes life much easier. When one is willing to take shortcuts to fire up the mob, one has to be prepared getting called on one’s BS. That’s what keeps us all honest and the public informed.

Jon should get back here and own up to it, otherwise his credibility will be zero going forward.

Simply expanding Medicare to cover all ages and paying for it out of general revenue certainly would be more straightforward.

Agreed that medicare would be preferable, if Jon had stuck to making that argument on the merits everything would be hunky dory. But he didn’t and he should come clean.

The single flaw with Medicare is that, as a government agency, its not allowed to use premiums to fund campaign contributions, private insurers don’t have that problem– and that’s why we have Obamacare; (or will have, starting in 2014 after we’ve thinned the herd a bit) instead of Medicare for All.

There’s a grain of truth here – that could be more accurately described this way: “The oversized influence of big corporations on american politics is a problem in general and an obstacle to passing the preferable type of HCR bill. It’s not the only obstacle – voter sentiments in some states and the oversized influence given to states with small populations in the senate are other obstacles.”

And that’s the reason we don’t have Medicare for all. Yet. But you know what? The PPACA is no obstacle for getting Medicare for all in the future. And working for achieving it does not require lying about the PPACA.