As Obamacare goes into effect, new criticisms leveled

[Galteeth]

http://reason.com/archives/2010/12/31/the-obamacare-fraud

This article highlighted some criticisms of the bill that up to now, as far as I know, have not been generally discussed in the media.

I am interested in people's thoughts on this article. Are the criticisms valid? Why or why not?

 

[mugaliens]

http://reason.com/archives/2010/12/31/the-obamacare-fraud

This article highlighted some criticisms of the bill that up to now, as far as I know, have not been generally discussed in the media.

I am interested in people's thoughts on this article. Are the criticisms valid? Why or why not?

I think America's medical/health care system is screwed up. I think the very sound idea of triage has fallen under the feet of opportunism to exploit rampant abuse of those whose insurance companies will fund the machine, while similar abuse at the opposite end of the scale to void basic health care, even simple stitches or antibiotics for pneumonia for those who don't have any insurance.

I think it's a case of the hospital money-making machines running the money-making decisions, while being somewhat played as puppets by the insurance companies. It's difficult to tell who are the puppets and who are the puppeteers, however...

We taxpayers are certainly the crowed, ooh'd and aah'd by the dance, while forking out far more of our hard-earned cash than is required for basic health care.

 

[WhoWee]

http://reason.com/archives/2010/12/31/the-obamacare-fraud

This article highlighted some criticisms of the bill that up to now, as far as I know, have not been generally discussed in the media.

I am interested in people's thoughts on this article. Are the criticisms valid? Why or why not?

I don't understand the criticism? Didn't Obama promise jobs? This will require a huge expansion of Government to oversee all of the - bureaucracy.

 

[mugaliens]

I don't understand the criticism? Didn't Obama promise jobs? This will require a huge expansion of Government to oversee all of the - bureaucracy.

I think we should replace our eagle with a snake eating its own tail, as that's about what we've become.

 

[WhoWee]

I think we should replace our eagle with a snake eating its own tail, as that's about what we've become.

What should we expect when - we no longer require that our representatives actually read the legislation they are voting on - 2,300 pages worth.

 

[JaredJames]

What should we expect when - we no longer require that our representatives actually read the legislation they are voting on - 2,300 pages worth.

I assume that everyone here discussing the healthcare reform has also read all 2,300 pages?

 

[Proton Soup]

I assume that everyone here discussing the healthcare reform has also read all 2,300 pages?

we have people for that.

 

[WhoWee]

I assume that everyone here discussing the healthcare reform has also read all 2,300 pages?

What are you suggesting?

 

[JaredJames]

What are you suggesting?

Well as bad as it is that they didn't read it before voting (if that's true, that really is bad), but to come here and discuss the proposal without reading it makes you no better than them.

(This goes for many topics discussed here.)

 

[WhoWee]

Well as bad as it is that they didn't read it before voting (if that's true, that really is bad), but to come here and discuss the proposal without reading it makes you no better than them.

(This goes for many topics discussed here.)

In the context of this thread - I'll assume you've read the article cited?(sorry)

I can't speak for other persons that have engaged in the health care debates on PF, but I work with these issues on a daily basis. The reality is that we're learning more about the consequences of the legislation on a daily basis. Part of the problem is the Bill was designed to be enacted in phases - over time - there are a lot of variables.

 

[nismaratwork]

Jared makes a good point, and as he's ONLY called people on talking about something they haven't bothered to read, and not commenting on it himself, you can't really turn this around on him WhoWee. You can certainly argue the point, but just flipping it as though he had claimed some knowledge of the bill is obvious and gauche, especially when you posted concerns about who read the bill on THIS page.

WhoWee: I haven't noticed an acceleration or abatement of the issues plaguing our healthcare system (in which I work). Doctors are still leaving some states, or limiting practice because of high insurance premiums (read: fear of lawsuits), and I don't blame them... hell I've considered it. Remember when a surgeon only worried about something other than their batting average?

 

[russ_watters]

Well as bad as it is that they didn't read it before voting (if that's true, that really is bad), but to come here and discuss the proposal without reading it makes you no better than them.

(This goes for many topics discussed here.)

I didn't have a vote on Obamacare, so it can't be said that I voted for/against something that I haven't read. That's a big difference between them and me. Or, more simply: I pay them for that.

 

[WhoWee]

I didn't have a vote on Obamacare, so it can't be said that I voted for/against something that I haven't read. That's a big difference between them and me. Or, more simply: I pay them for that.

This is correct - reading (understanding) the information they are voting on is imperative.

To suggest a standard that PF members should be required to read a 2,300 page Bill (in this example) before commenting is fine with me - let's get an official opinion as per forum rules. My guess is a new standard of this type will have unintended consequences for the PF - quite appropriate in this thread - IMO.

 

[nismaratwork]

Ah, circling the wagons... joy. This didn't come out of nowhere:

What should we expect when - we no longer require that our representatives actually read the legislation they are voting on - 2,300 pages worth.

By the way WhoWee, I haven't seen anyone suggest that this reading issue be a "forum rule"... Jared just described what he believes is moral equivalency resulting in hypocrisy. Straw man... bad boy!

Russ: Yeah, you don't get paid to read it, and you don't vote directly for it, however we live in a representative democracy: just as we're all at war, you're all in for the outcome of votes. You can violently disagree and even claim that your representative failed to uphold your interests, but the country as a represented whole DID vote the bill in.

And plenty of them didn't read it, nor do I see that candidates are being elected for qualities that would allow them to do so, or comprehend the language. You DID have a vote in Obamacare (call it what you want), it's just that your indirect vote was insufficient to carry your view through. I had a vote in this country going to war in Iraq, but it happens that my vote, as expressed through my congressmen was in the minority. That's what representative democracy is about; we DO have collective power, and therefore responsibility. What ideologues on all sides of issues always seem to forget (when they're losing) is that you can exercise what power you have, lose, and it's STILL OK.

I find it deeply ironic that the people (no, not anyone specific here) who spent so much time telling their fellow Americans to support the war or move to another country fail to turn that logic on themselves. You don't want to pay for Obamacare... move, otherwise you can complain and lobby and vote, but you can't claim that you didn't vote... you did... you just lost.

 

[WhoWee]

Ah, circling the wagons... joy. This didn't come out of nowhere:



By the way WhoWee, I haven't seen anyone suggest that this reading issue be a "forum rule"... Jared just described what he believes is moral equivalency resulting in hypocrisy. Straw man... bad boy!

Russ: Yeah, you don't get paid to read it, and you don't vote directly for it, however we live in a representative democracy: just as we're all at war, you're all in for the outcome of votes. You can violently disagree and even claim that your representative failed to uphold your interests, but the country as a represented whole DID vote the bill in.

And plenty of them didn't read it, nor do I see that candidates are being elected for qualities that would allow them to do so, or comprehend the language. You DID have a vote in Obamacare (call it what you want), it's just that your indirect vote was insufficient to carry your view through. I had a vote in this country going to war in Iraq, but it happens that my vote, as expressed through my congressmen was in the minority. That's what representative democracy is about; we DO have collective power, and therefore responsibility. What ideologues on all sides of issues always seem to forget (when they're losing) is that you can exercise what power you have, lose, and it's STILL OK.

I find it deeply ironic that the people (no, not anyone specific here) who spent so much time telling their fellow Americans to support the war or move to another country fail to turn that logic on themselves. You don't want to pay for Obamacare... move, otherwise you can complain and lobby and vote, but you can't claim that you didn't vote... you did... you just lost.

It sounds as though you support any actions the Republicans take in the House now - given the people spoke quite clearly last November?

 

[Galteeth]

Jared makes a good point, and as he's ONLY called people on talking about something they haven't bothered to read, and not commenting on it himself, you can't really turn this around on him WhoWee. You can certainly argue the point, but just flipping it as though he had claimed some knowledge of the bill is obvious and gauche, especially when you posted concerns about who read the bill on THIS page.

WhoWee: I haven't noticed an acceleration or abatement of the issues plaguing our healthcare system (in which I work). Doctors are still leaving some states, or limiting practice because of high insurance premiums (read: fear of lawsuits), and I don't blame them... hell I've considered it. Remember when a surgeon only worried about something other than their batting average?

Well, the legislation only recently went into effect. But there has been a run up in drug prices, likely in anticipation of Obamacare.

 

[JaredJames]

I didn't have a vote on Obamacare, so it can't be said that I voted for/against something that I haven't read. That's a big difference between them and me. Or, more simply: I pay them for that.

I never said anyone here has voted for/against something they haven't read.

Well for me it comes down to the same thing as the UK ID card debate (I keep coming back to this but it seems to cover a number of points).

I had a house mate who was strongly opposed to it and gave some rather persuasive arguments against them. However, she had never read the full documentation and formed her opinions based on snippets from anti-ID websites.

I sat down and read the entire policy and was able to shoot down every single argument she gave. Her opinions were formed on mis-information and quotes taken out of context. This for me, was enough to make her view point moot and not to be entertained any further.

Now we can discuss anything here, but if people are trying to praise / shoot down a policy without understanding it, they are no different to those politicians who voted it in.

My house mate is in numerous TV reports demonstrating ID cards outside parliament, based on what amounts to no more than fairy tails. She is fighting to get rid of a system she doesn't understand. If you sit here, posting about how bad (or good) the system is without understanding the policy itself, you are no different to her.

For me, this is the downside of a democracy. Firstly, people who have no idea what they are talking about get a say in matters which truly don't concern them (my Scottish sheep farmer campaigning against a third runway at Heathrow example). Secondly, people get a say in matters when they don't fully understand what they are talking about (ID cards).

I think PF should at least have a policy that requires people to have a knowledge of the topic at hand (well technically you do, it wouldn't stand anywhere else in the forums and I don't think it should here).

EDIT: I agree with Nismar, it's hypocrisy (couldn't remember the word).

 

[WhoWee]

Well, the legislation only recently went into effect. But there has been a run up in drug prices, likely in anticipation of Obamacare.

You have identified the challenge in this debate - it is very difficult to pinpoint what is "likely in anticipation of Obamacare", what is a direct result of the legislation, and what would have happened without legislation. The determination is further blurred due to the slow (creeping?) phase-in of the legislation - over several years.

 

[WhoWee]

I never said anyone here has voted for/against something they haven't read.

Well for me it comes down to the same thing as the UK ID card debate (I keep coming back to this but it seems to cover a number of points).

I had a house mate who was strongly opposed to it and gave some rather persuasive arguments against them. However, she had never read the full documentation and formed her opinions based on snippets from anti-ID websites.

I sat down and read the entire policy and was able to shoot down every single argument she gave. Her opinions were formed on mis-information and quotes taken out of context. This for me, was enough to make her view point moot and not to be entertained any further.

Now we can discuss anything here, but if people are trying to praise / shoot down a policy without understanding it, they are no different to those politicians who voted it in.

My house mate is in numerous TV reports demonstrating ID cards outside parliament, based on what amounts to no more than fairy tails. She is fighting to get rid of a system she doesn't understand. If you sit here, posting about how bad (or good) the system is without understanding the policy itself, you are no different to her.

For me, this is the downside of a democracy. Firstly, people who have no idea what they are talking about get a say in matters which truly don't concern them (my Scottish sheep farmer campaigning against a third runway at Heathrow example). Secondly, people get a say in matters when they don't fully understand what they are talking about (ID cards).

I think PF should at least have a policy that requires people to have a knowledge of the topic at hand (well technically you do, it wouldn't stand anywhere else in the forums and I don't think it should here).

There is a new thread discussing the income tax system in the US - should everyone posting first read the entire US tax code? If you intended to derail the thread - you have been successful.

 

[JaredJames]

There is a new thread discussing the income tax system in the US - should everyone posting first read the entire US tax code? If you intended to derail the thread - you have been successful.

Just making the point.

If people want to discuss something, they should at least know what they are discussing and not making arguments without correct information.

You brought up the issue of people not reading what they are voting on, and to come here and discuss something you haven't read either (not saying you haven't but who knows) makes you no different.

I'm actually reading through the policy now (or trying to) to see what the fuss is about. Could take a while.

 

[JaredJames]

OK, I'll focus on the article only for now.

Starting at the top, this repayment of subsidies.

Can someone point out the problem? From what I've read, if your income goes up mid year, you are expected to refund a certain amount of the subsidies.

OK, so if halfway through the year your income goes up, you are officially no longer entitled to the same level of subsidy (if you get $1000 for up to $20,000 income, once you get above this level midyear, you are no longer entitled to $1000).
If you are now required to refund what you aren't entitled to, let's say the next band is up to $30K income and for that you get $500, now you're in the next band you should pay back $500. I can understand this, as your annual income for that year was in the band above the one you were given the subsidy for.

So basically, if you earn a total of $30,000 in a year you would be entitled to $500 subsidy. But, because you only earned $20,000 the previous year you received $1000. So you've had twice as much as you should have. Why do people think it's wrong to pay it back? Or have I completely missed the point?

(Figures for demonstration only. Post based on the article, still working on the policy.)

 

[Galteeth]

You have identified the challenge in this debate - it is very difficult to pinpoint what is "likely in anticipation of Obamacare", what is a direct result of the legislation, and what would have happened without legislation. The determination is further blurred due to the slow (creeping?) phase-in of the legislation - over several years.

Right. Here's an article about the run up in drug prices.

http://www.nytimes.com/2009/11/16/business/16drugprices.html

Merck's spokesman Ron Rogers claims it's not related to Obamacare. The economists interviewed disagreed.

 

[WhoWee]

Right. Here's an article about the run up in drug prices.

http://www.nytimes.com/2009/11/16/business/16drugprices.html

Merck's spokesman Ron Rogers claims it's not related to Obamacare. The economists interviewed disagreed.

Let's not forget that HHS has made it clear they don't want the insurance companies blaming any increases on the legislation.

 

[WhoWee]

OK, I'll focus on the article only for now.

Starting at the top, this repayment of subsidies.

Can someone point out the problem? From what I've read, if your income goes up mid year, you are expected to refund a certain amount of the subsidies.

OK, so if halfway through the year your income goes up, you are officially no longer entitled to the same level of subsidy (if you get $1000 for up to $20,000 income, once you get above this level midyear, you are no longer entitled to $1000).
If you are now required to refund what you aren't entitled to, let's say the next band is up to $30K income and for that you get $500, now you're in the next band you should pay back $500. I can understand this, as your annual income for that year was in the band above the one you were given the subsidy for.

So basically, if you earn a total of $30,000 in a year you would be entitled to $500 subsidy. But, because you only earned $20,000 the previous year you received $1000. So you've had twice as much as you should have. Why do people think it's wrong to pay it back? Or have I completely missed the point?

(Figures for demonstration only. Post based on the article, still working on the policy.)

Please step back and look at your post (are the details confusing?)- next, please consider the massive expansion of the IRS to oversee these new rules - now consider that currently citizens either purchase insurance or they don't. The freedom to choose has been taken away.

The elected officials tell us this is for our own good and that this will ultimately save money - basically to trust them.

 

[JaredJames]

Please step back and look at your post (are the details confusing?)- next, please consider the massive expansion of the IRS to oversee these new rules - now consider that currently citizens either purchase insurance or they don't. The freedom to choose has been taken away.

The elected officials tell us this is for our own good and that this will ultimately save money - basically to trust them.

Let's simplify it:

If you get more than you are entitled to, why shouldn't you repay it? It already happens with income tax. It's only fair if you expect a refund if you pay too much tax.

Expansion of the IRS? Surely that's more jobs?

I'm not getting into the debate of whether or not people should be entitled to free healthcare. Suffice it to say though, without knowing the specifics of the medical insurance system in the US, I can't comment on saving money and only say that government funded, NHS style healthcare is a big drain on resources if not managed correctly (as per the UK situation now).

And let's not get me started on 'freedom'.

 

[WhoWee]

Let's simplify it:

If you get more than you are entitled to, why shouldn't you repay it? It already happens with income tax. It's only fair if you expect a refund if you pay too much tax.

Part of the problem is the mandates of the legislation may not be legal - the matter is in the courts now. We have a thread on the topic.
https://www.physicsforums.com/showthread.php?t=456324

 

[JaredJames]

Part of the problem is the mandates of the legislation may not be legal - the matter is in the courts now. We have a thread on the topic.
https://www.physicsforums.com/showthread.php?t=456324

So what are me discussing here? Is there a discussion of the article to be had or was it just pointing out there are criticisms (as if we believed there wouldn't be any / more)?

Everything I've read in that article doesn't seem unjust to me. In fact, it seems that they are targeting areas which do need looking at.

For example, people claiming too much in subsidies is fraud, whether they knowingly do it or not is a different issue (although you'd be hard pressed proving you didn't know your income increased).

 

[WhoWee]

So what are me discussing here? Is there a discussion of the article to be had or was it just pointing out there are criticisms (as if we believed there wouldn't be any / more)?

Everything I've read in that article doesn't seem unjust to me. In fact, it seems that they are targeting areas which do need looking at.

For example, people claiming too much in subsidies is fraud, whether they knowingly do it or not is a different issue (although you'd be hard pressed proving you didn't know your income increased).

I'll go back to my post that started our exchange - because the legislation was rushed through Congress (there was no time to read the Bill) - the specificity of these rules was not known.

Further, Speaker Nancy Pelosi, Majority Leader Harry Reid, and President Obama did not explain in great detail how complicated the subsidies and fines would be - nor did they stress that a major expansion of the size and scope of the IRS would be required to oversee healthcare reform.

 

[JaredJames]

I'll go back to my post that started our exchange - because the legislation was rushed through Congress (there was no time to read the Bill) - the specificity of these rules was not known.

OK, I'm going to drop out here because it would appear that we aren't discussing the content, but more the legality of the bill and how quickly it was implemented.

 

[Galteeth]

Let's simplify it:

If you get more than you are entitled to, why shouldn't you repay it? It already happens with income tax. It's only fair if you expect a refund if you pay too much tax.

Expansion of the IRS? Surely that's more jobs?

I'm not getting into the debate of whether or not people should be entitled to free healthcare. Suffice it to say though, without knowing the specifics of the medical insurance system in the US, I can't comment on saving money and only say that government funded, NHS style healthcare is a big drain on resources if not managed correctly (as per the UK situation now).

And let's not get me started on 'freedom'.

This is what i wanted to discuss.

The most troubling part to me is the following:

"More chillingly, however, the administration is defining Medicare fraud down to include “unnecessary” and “ineffective” care. And to root this out, it plans to make expanded use of private mercenaries—officially called Recovery Audit Contracts—who will be authorized to go to doctors’ offices and rummage through patients’ records, matching them with billing claims to uncover illicit charges. What’s more, Obamacare increases the fine for billing errors from $11,000 per item to $50,000 without the government even having to prove intent to defraud."

Having deal with government health care, and having gotten completely screwed over, I could see numerous ways this could be disastrous. Of course the devil is in the details, which is why I brought it up.

The tax thing, I think this was the key point:

"This will make it very hazardous for poor working families to get ahead. In the original law, the loss of subsidy with rising income already meant absurdly high effective marginal tax rates—the implicit tax on every additional dollar of income earned. How high? The Cato Institute’s Michael Cannon puts them at 229 percent for families of four who increase their earnings by an amount equal to 5 percent of the federal poverty level or $1,100. In other words, a family that added this amount to an income of $44,700 would actually see its total income fall by $1,419 due to the loss of subsidies."

If I understand that correctly, it means that for some poor families, modest increases in income actually lead to taxes that are in excess of that income increase.

 

[Galteeth]

On a further note, when i was dealing with the medicaid system in new jersey, i was encouraged by workers there to give certain answers that were technically fraudelent, as the system is so messed up, this is apparently business as usual. I had to be very careful to answer questions in a way so as that i was not committing fraud, but still giving the "right" answers.
As i said, I got completely screwed by the whole thing (I knew it was a mistake, and I had moral issues with government health care, my dad sort of pressured me into it), and I got no help but wound up owing a hospital $75,000.

EDIT: The reason for this is, at least the jersey system, the rules makes no sense. Literally.

 

[Galteeth]

Here is an article that expands on the new fraud provisions.

http://www2.tbo.com/content/2010/jun/18/na-stopping-the-medicare-fraud-gusher/news-opinion-commentary/

 

[WhoWee]

Here is an article that expands on the new fraud provisions.

http://www2.tbo.com/content/2010/jun/18/na-stopping-the-medicare-fraud-gusher/news-opinion-commentary/

I'd like to see the (isolated to this topic) CBO analysis of total cost of enforcement versus actual fraud recovery moving forward.

 

[Galteeth]

I'd like to see the (isolated to this topic) CBO analysis of total cost of enforcement versus actual fraud recovery moving forward.

I would think those who were actually committing fraud would cover their tracks. It seems like it would be easier to prosecute cases where fraud wasn't the intent, especially since their doesn't seem to be a need for the government to prove intent to commit fraud. In other words, people who weren't intending to commit fraud would show their records and such, whereas those whose intent to commit fraud would likely create fraudelent records.

 

[WhoWee]

I would think those who were actually committing fraud would cover their tracks. It seems like it would be easier to prosecute cases where fraud wasn't the intent, especially since their doesn't seem to be a need for the government to prove intent to commit fraud. In other words, people who weren't intending to commit fraud would show their records and such, whereas those whose intent to commit fraud would likely create fraudelent records.

How much money can be "saved" by massively increasing the size and scope of the IRS - if the limitation you described is accurate?