Wednesday, November 4, 2015

Cognitive Dissonance, again.

So, here is a link from Forbes  that talks about the Republicans winning the governorship in Kentucky. The article notes a couple of things, one is that mega health insurers are doing quite well under Obama care, and the other is that Kentuckians polled in one direction in favor of keeping Obamacare, yet voted in the opposite direction fora candidate who promised to roll it back. This doesn't make sense to me, but it's another example of the odd dissonance that abounds in this country.

Democrat voters claim they are for many things, and are opposed to things like giving endless tax breaks for Wall Street, and are also opposed to foreign intervention. What I think a lot of these voters say they are for, is what Bernie has actually voted for in contrast to Hillary who voted more like a moderate Republican. I won't bother listing any more Republican examples, though there are many. It is just becoming mind boggling to me that people can be convinced to vote for candidates who have openly or covertly lived in opposition to what the voters say they want.

I kinda hope this guy does exactly what he promised he would do. I hope he goes in and literally yanks the insurance away. I've become cynical on the matter. Republican assholes refuse, literally refuse to do a damn thing to fix our system and yet, they stand back and throw rocks and bitch about how expensive everything is. Let the market solve it. Take away ALL publicly funded insurance, ALL employer funded insurance, ALL ability to pay for insurance with tax free dollars, and do what the lord of the flies conservatives want us to do, which is cull the herd of the weak and stupid.


  1. I have always wondered the same thing Mike. Why do so many poor whites especially, living in trailer parks barely making it, commonly referred to as "Rednecks", vote consistently for the party whose ideas are exactly the opposite of what they really want or need. It is a baffling question. But I think it is a variety of reasons,. They are uninformed and dumbed down watching FOX News which most of them do, they are 1 issue voters, (for guns, For God, against Gays, against abortion, etc). When the Rev ( a seminary student who worked for me) worked at the restaurant we used to have many late night chats about these issues after the bulk of the business was over, he really never had a good answer although he would minister to the people. he was also a classic case, strongly republican but got Medicaid for his wife and child, food stamps, student loans, yeah. Classic.

  2. Here is a good example of voter dissonance as reported in the New York Times.

    Ex-convict Joe Ganim is declaring victory in his bid to retake the Bridgeport Conn. mayor’s office five years after his release from federal prison.

    The Democrat defeated incumbent Mayor Bill Finch in the party primary and faced a total of seven other opponents in Tuesday’s election.

    Ganim spent seven years in prison for a six-year scheme to steer city contracts in return for hundreds of thousands of dollars in wine, clothes, cash and home improvements. He was supported by the Police Union

    1. How soon we forgive and forget...... or we just don't care........ who knows.

  3. This comment has been removed by the author.

  4. Twelve of the twenty one State Obamacare outlets have already gone belly up at a cost of billions to taxpayers. This all in less than three years.

    Barrack, you didn't build dat ting.

  5. Republican assholes refuse, literally refuse to do a damn thing to fix our system

    Yet you don't chide the Democrat assholes that created this mess and have done nothing to fix it.

    The basic principles of health insurance are:

    Let insurance be insurance, understand that ordinary, regular medical procedures, such as physicals and prostate exams, are not insurable events.

    The only way to mitigate the effects of scarcity on health care is to make it less scarce by expanding the supply of medical practitioners and facilities.

    If insurers have to cover you no matter what, then there’s no point in buying insurance until you are sick enough to need it.

    Insurance is a prospective financial product, one that exploits the mathematical predictability of certain life events among very large groups of people.

    Insurance is always forward-looking, considering events that have yet to come to pass but that may be expected. Under the ACA, insurance is retrospective. ACA mandates that insurance companies cover pre-existing conditions renders the basic mathematical architecture of insurance, the calculation of risk among large pools of people, pointless.

    So the ACA isn't about cheaper healthcare, fixing healthcare but covering more people regardless of the availability for the newly insured. If you are required to purchase insurance and cannot afford the deductible, you buy the cheapest insurance possible.

    So here we are, never mind the economics, we’re the democrats, we're the good guys, and the republicans want poor people to die. The reality doesn’t matter, only the purity of the left's motives matters.

    1. The only thing I give the Democrats credit for is trying to make an effort to get people covered. As for the Republicans, I have yet to hear any Republican in office express what you said, I have yet to hear them offer any plan of their own, I have yet to hear them say what they want to change about the ACA. So yeah, I think they are assholes about that. This does not, however, make the Democrats a vision of purity in my eyes.

      Point one, you are basically making a case for catastrophic care only. IE pay a lot of basic care out of pocket. I don't fundamentally have a problem with that. However, the people who pay for insurance do not agree with you and that knows no specific political ideology. That's the market at work.

      Your third point there is conceptually true, which is why I think everyone should have to pay for some level of insurance. The mathematical concept is also something I think is mostly true, but in addition, risk pooling gives the insurer bargaining power. The probability curve is only one input variable.

      Having spent a year in clinical, I have seen plenty of ways that money can be saved, but that will have to be it's own thread sometime soon. Insurance companies are not making health care cheaper either and they are indeed rationing care and they are also dictating terms to doctors. Without insurance, people wait and wait and wait until they are very sick and then go the ER. This setup isn't saving money either.

    2. The only thing I give the Democrats credit for is trying to make an effort to get people covered.

      So here we are, never mind the economics, we’re the democrats, we're the good guys, and the republicans want poor people to die. The reality doesn’t matter, only the purity of the left's motives matters.

      Perhaps you should read more.
      Republicans unveil new ObamaCare replacement plan
      Published February 05, 2015

      Key Senate Republicans Offer Their Plan To Replace Obamacare
      January 27, 2014 5:25 PM ET

      Aug 28, 2013 @ 08:03 AM 60,737 views
      Seriously? The Republicans Have No Health Plan?
      It’s arguably the favorite myth of progressives, the oft-repeated claim that Republicans have no health plan. Hence, President Obama was fully justified in ignoring them and proceeding to enact a comprehensive health reform law on a strict party line vote—something completely unprecedented in American political history.

      Republicans Do Have Ideas for Health Care
      But liberals don't like to admit it because the GOP would put patients, not government, in charge.

      But don't let the truth get in the way of your hatred.

      Catastrophic care? It's how it works today like it or not. Some people buy insurance because it is mandated and they really cannot afford it. The buy the cheapest policy possible with the highest deductible so their cost is minimal. High deductibles cause them not to see a doctor as they cannot afford the payment.

      Let insurance be insurance, understand that ordinary, regular medical procedures, such as physicals and prostate exams, are not insurable events. Adding routine care to insurance does nothing but move the immediate cost of out of pocket to the insurance premium. So many people think they get a free physical or immunization, etc. When the reality is it's added to the premium.

      The game played on people is the free part where the ACA offers free services and after receiving the FREE services people bitch about the cost of healthcare.

    3. From the first article,

      "Congressional Republicans are unveiling what they say is a new plan to repeal and replace ObamaCare, but the ‘blueprint,’ as they call it, looks an awful lot like what’s been floated before."

      Tax credits to help people pay for insurance
      Kids can stay on parent plan oil age 26, can't be denied coverage(same as ACA)
      Tax Cadillac plans to pay for it (not new)
      I don't see how this addresses cost.

      The second link,
      Give people tax breaks to help pay for insurance
      Allow pooling across state lines
      Create coverage for the poor through tax subsidies (this doesn't sound new(
      Using technology to create better access to health records (also not new)
      Increase access to health care by providing money for nursing and medical degrees (this is part of ACA)
      I'm not seeing a ton that is new there, nor does the author really claim how much this will save. But in fairness, his point is to go at dickhead critics like me, fair enough.

      The WSJ piece requires subscription. Calling it my hatred is not quite accurate. Yeah, I get tired of hearing the same bitching coupled with the same floatation of ideas and repeal votes that don't fix anything. Medical care is expensive for many reasons, but I believe one of the biggest reasons is that we use way too much of it because we are way too unhealthy. In the long run, I believe people would be healthier if they had better preventive care, but respectfully Lou, here is a dilemma. If we don't want insurance to pay for preventive care, we are essentially back to a position wherein we are telling people, "It's personal responsibility. Pay for your own primary care, make good health choices, and stay out of the hospital". On the one hand, I can understand a frustration. Americans do want a ridiculous amount of benefits, and I have seen quite a few people basically demand a pill rather than work at living healthier. But, none of these proposals even name this as a problem, nor do they, IMO, really offer something that addresses it differently from the ACA.

      Another myth, since we are playing myth buster, is that the ACA, by some alleged mechanism, takes away the freedom of doctors to practice how they want to, and also allegedly robs patients of freedom. None of these articles, or frankly any articles I have seen offer any real explanation of how exactly this happens. The ACA is not free. People have co pays for visits and they do have to pay something. All the people that came to our practice this year under the ACA were paying money out of pocket for the plan, and also co pays. Your use of free is not really entirely honest.

    4. Regardless of proposed changes have been proposed before says nothing to the fact they have proposed legislation that has been killed. Your statement is disingenuous. I understand you dislike the bastards in the GOP almost as much as I dislike the bastards that passed the abortion called the ACA. But this is the state of politics today. Perhaps when the leaders of the house and senate and the president are gone maybe we will get back to compromise and running the country. Until then get use to it.

      Personally it's a waste of time even thinking about changing the ACA until our leaders change.

      Insurance isn't insurance if it pays for everyday junk. It only offloads upfront costs from today to the premium tomorrow. Then everyone bitches about the high cost of premiums.
      What do you want free stuff you don't want to pay for today or cheaper insurance premiums. Nothing is free, physicals cost money as do birth control pills. A neat freebie when you get it but does cost money. Pay me now or pay me later.

      The freedom of choice? People with ACA insurance cannot go to my physician he does not accept their insurance. He recently cancelled his contract with Cigna as they tried to force him to take their ACA customers. Cigna is now out of network for his Cigna patients.

      Didn's say the ACA was free. I did say the ACA says physicals will be free, birth control pills free, immunizations free, colonoscopies free, etc. A colonoscopy is a 10 year event, why should it be free and not part of the deductible? Physicals are yearly, why should they be free under the ACA.

      You cannot offer free services and have cheap premiums. You cannot allow people with medicaid to go to the ER for a cold and have cheap medical care.

      Medical costs soar because free is never free.

      People head to the ER because they cannot get a doctors appointment isn't cheap.

    5. Well, I will always make a distinction between gestures designed to look good, and action that actually brings about change. I think Republicans, plenty of years ago, were ahead of the curve on this, but I also believe that many elected Republicans today now reject those former ideas.We'll have to just disagree that voting over and over to repeal Obamacare is a genuine effort to fix the system. As for some of the plans on the links you put out here, some of them take what is already in Obamacare, which, to be honest, incorporated SOME previous Republican ideas. Regardless, I see one major fundamental difference, Democrats want universal coverage and near as I can tell, Republicans do not. In our current environment, I simply see no way to bridge this gap and it will not be solved anytime soon.

      I'm not seeing the freedom of choice issue in you example. People switch jobs, change insurance, and lose their doctor all the time. This, IMO, is a bigger problem with having multiple insurance carriers in the market. I have heard multiple arguments about how the ACA takes away freedom, and I'll concede, some of them are true. Yet, I have yet to see something that is so totally unique to the ACA that is not already an issue with the insurance market.

      I said it in my last post and I'm again inferring something in your post here, medicine is expensive in large part because of overuse and inappropriate use. I don't believe all the things you mention are delivered at zero cost to the patient because there is usually a co pay, and the individual also pays premiums. I am never ever going to understand the obsession with birth control because I see that no differently than I do offsetting the cost of erectile dysfunction meds for middle age men who have no intention of fathering a child. I think a perceived solution is to let the market solve the problem by basically pricing care out of the range where it is affordable and hence, reducing the amount of services that are used.

      Suppose you are a gastroenterologist and colonoscopies are a moderately big piece of what you do. How much do you think they get paid for giving them? 50 bucks? 500? If we take away insurance and paying for a colonoscopy is an out of pocket expense, either we will see a lot fewer people get them, or GI docs will make a lot less money and I think a lot of people are okay with both outcomes, until they need one and can't afford it. We see A LOT of ACA patients who have shitty paying jobs and would be unable to pay for health insurance without the subsidy. Perhaps it's not fair or accurate on my part to assume that many Republicans, "Too fucking bad, not my problem your shitty job doesn't provide insurance. You want insurance, be a better competitor and get a better job" Nonetheless, I believe this attitude exists just as a believe there is an opposite liberal attitude that basically says the inept have a right to have a m moderately comfortable and safe given to them at the expense of the rich. I have no use for either attitude.