Hacking Obamacare


I have read extensively on the new Obamacare law and have discovered a weakness – an unintended consequence, really – I think can and will be exploited by many as soon as they figure it out. I haven’t read of anyone else figuring this out, but, then, I probably haven’t read everything ever written on the subject, so someone out there may have beaten me to the punch. I’ll lay it all out for you, but before I do, a story that pretty much describes what’s going to happen to countless people.

One of my son’s best friends – let’s call him Tom – is getting clobbered by Obamacare. It was his plight that lead me to reason out the exploitable flaw in the program.

Tom is married and has two children ages 10 and 5. His wife had a tubal ligation (had her tubes tied), so no more pregnancies are in the picture. Tom works in construction in a job that is neither blue collar nor management, so kind of a light-blue collar job. He makes reasonable money ~60K per year, and his wife works part time. After the Fed and the rapacious State of California take their bites, Tom and fam are left with a lot less than they started with. They don’t live an extravagant lifestyle. In fact, quite the opposite. They are extremely frugal and, like so many people, live paycheck to paycheck.

Neither Tom nor his wife get health insurance through their employers, so they purchase their own. They shopped around and found a policy that meets their needs and is within their limited budget. They pay ~$300 per month for a policy that has a large deductible and doesn’t have pediatric dentistry or maternity benefits. Tom and family decided that due to financial constraints they would fund routine medical care out of their own pocket to keep insurance costs down but still allow them to be covered for anything major.

Last week they received notice that their policy was going to be canceled next month.

How could their policy get canceled when they were assured, “If you like your policy, you can keep your policy. Period.” by the President, himself?

Because that guarantee only applied if the policy they liked conformed to Obamacare’s minimum coverage standards. Under Obamacare, no insurance company may issue a policy after 2013 that does not meet the law’s minimum coverage requirements. Tom’s family’s plan was canceled because it did not. Not because it was a bad policy, but because it didn’t offer maternity (which his wife didn’t need) or pediatric dental (for which they took good care of their children’s teeth and paid out of pocket for cleanings.)

They were able to get on the exchanges and found that the least expensive policy they could get under Obamacare was $600 per month, which they can’t afford. (And far from being better for them, the new policy had an even higher deductible they’d have to meet out of pocket!) So, now, they are confronted with cutting something else to come up with the extra $300 per month or going without insurance. Given that most of their expenses are fixed, they have no choice but to go uninsured and pay the $95 tax penalty. At least for the short term until they can rearrange their finances.

Their plight made me realize that under Obamacare there were doubtless going to be as many uninsured people after the law took effect as there were before. It was just going to be a different group. The new group of uninsured were going to be the hard working families who lost policies they liked and could afford, but who couldn’t afford the new policies available to them under Obamacare and now have nothing.

Trying to help them figure out what to do led me to discover a way to hack the system.

Why do people buy insurance? For a few reasons:
* First, they want help with routine medical needs, i.e., doctor’s visits, x-rays, lab work, etc.
* Second, they want coverage for any kind of unexpected or catastrophic development. In the pre-Obamacare days, this could be easily accomplished if one were healthy by purchasing a catastrophic insurance policy for a few bucks a month. Now, impossible, because all policies have to meet or exceed the Obamacare standards.
*Third, and probably most important, people want to keep from becoming uninsurable.

And all it took to become radioactive to an insurance carrier was developing a serious disease.

Historically, if you were uninsured and you had a heart attack or developed cancer, you were pretty much screwed as far as getting insured was concerned. You had what is called a pre-existing condition, and though you could get insurance, it would cost you an arm and a leg. If you were insured and got a serious disease, it was a different story. You could still get screwed, but in most states, individual health insurance policies were guaranteed renewable, meaning as long as you paid your premiums your insurance company couldn’t drop you. Your premiums, depending upon your policy, might go up at renewal time, but not to the same extent as they would were you applying for new insurance with the pre-existing condition.

So, one of the big reasons young, healthy people would spend the bucks to purchase insurance is so they won’t become uninsurable should they have the misfortune to develop a serious and expensive-to-treat disease. I have a friend who had a heart attack in his 40s. His wife is in perfect health. Since his heart attack, it has cost over $2,000 per month for them to get insurance even though his heart attack was almost 20 years ago, and he is now the picture of health. (Thanks in no small part to his conversion to a low-carb diet.)

With this third reason that people opt to buy insurance in mind, here is the hack.

One of the central pillars of Obamacare is that people with pre-existing conditions can get insured easily and at essentially the same rates as those without the pre-existing condition. This means that those of us who have no pre-existing conditions will end up paying more to compensate for the higher expected insurance payouts needed to cover those who do have pre-existing conditions. Insurance companies are required to pay out a fixed percentage (which is much higher than most people think) of their premium income. So if they are going to be paying out more – which they certainly will if they are forced to take on people with pre-existing conditions – the only way insurance companies can compensate is to charge those of us who don’t have big payouts a lot more. Which is what Obamacare has done. There’s no free lunch, no matter what is decreed from Washington. The higher health care needs of the sick and the old will be borne on the backs—and out of the wallets—of the young and the healthy.

So, if you are healthy, just go without insurance. Pay the $95 fine, which you have to pay only if you are getting back a federal tax refund. If something bad happens to you, God forbid, then go on one of the Obamacare plans and sign up. Simple as that.

You can’t be denied for any sort of pre-existing condition. And your rates won’t be affected. So why pay for insurance until you need it? Obamacare has effectively removed the main incentive for the young and healthy to opt in responsibly to avoid bankrupting themselves or becoming a drain on their families or neighbors should catastrophe strike.

In the case of our son’s friend, he can self insure for all of the routine medical visits with the $3,600 he will save by not paying his current $300 monthly premium. And if he, his wife or one of their kids should develop a serious medical condition, he simply needs to apply through the exchange for insurance, and he will be assured of getting it at the same $600 per month premium he was recently quoted.

If everyone did this, it would, of course, raise rates over time because the young and healthy, who are the ones keeping the system afloat, will be gone from the premium pool.

And, since Obamacare is in such flux right now, who knows if it will even exist in a few months. Democrats up for re-election are already in a blind panic and may force legislation through to kill the program. Or modify it greatly. So I, myself, probably wouldn’t chance it.

But I’m just throwing it out there for anyone who has had a major unaffordable premium increase who might be looking for a way to deal with it. Many, such as my son’s friend, are just going to go without because they can’t afford it. Maybe my interpretation of the situation will bring them a little peace of mind.

Here is a good book on dealing with Obamacare.   I have not read it myself because my and MD’s health insurance policy exceeds the Obamacare standards, so it hasn’t been canceled.  At least not yet.  But I have had many people tell me it’s the best book they’ve read on the subject.

As always, please feel free to set me straight in the comments section.  Or let us all know if you’ve read any books or articles dealing with Obamacare that might benefit us all.

ADDENDUM:  Okay.  It looks like I should have read the above book.  Turns out there are parts of the AHA I was unaware of.  The open enrollment period being one of them.  Which makes the above hack not work so well.  It will still work, but not without accepting more risk than most people are probably willing to accept.



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292 thoughts on “Hacking Obamacare

  1. To signup outside of open enrollment, you need a Qualifying Life Event (TM). For something like cancer, you could game this by moving (or claiming to move) across state lines, or waiting until the next open enrollment. For something else, like a car accident, you could not buy insurance in the ambulance on the way to the hospital. It’s certainly not a foolproof hack.

    Mike h

  2. Couple of things that change the calculation:

    The penalty of $95 is only for the first year. In Obamacare’s “maturity” it’ll be based on income: between $1000 and $1600 for someone making 60k a year.

    Secondly, the Obamacare compliant insurance policies will only be offered during a specific open-enrollment period every year. If, uninsured, you get cancer in March and the enrollment period isn’t until November, you’ll have to cover the 8 months of treatment on your own.

    • (Sorry if this is mentioned below; haven’t read the rest of the comments yet.)

      The “penalty” is NOT $95 for the first year: if Tom is making $60k a year, then his penalty will be $600 in the first year! 1% of income OR $95… and of course “whichever is higher”!

      Just an additional whine: the cheapest plan I can get on the exchange would be $400-600 a year (the site wouldn’t narrow it down further without me signing up) WITH a $6,300+ annual deductible! So, it was going to cost me (at the least): $11,100 for the year. Going by the bill for my kidney stone last year (I’m uninsured, like so many); this great new Commie-Care would pay not one red (oh-so-red!) dime for my “health care” and I’d still risk everything to get care!

      My penalty will “only” {eye roll} by $630 for 2014, so guess which way I have to go?! (And I STILL won’t have health insurance!) Helluva deal….

      • Oh, and I don’t actually MAKE $63k a year — I own an LLC, so all profit for the company counts (against me {frown}) as “my income” even though I obviously can’t take it all out of the company!

        So I get to pay the penalty on money I don’t even pay myself! (If it wouldn’t kill the company — I own an actual *American small manufacturing* company (there are a very few of us left here!) — I’d move to Canada and be done! (Well, be covered…)

  3. There may be a problem if the catastrophic illness falls outside of open enrollment. The exchange has a provision for special enrollment, but usually a life changing event is the trigger, such as change in employment status or a new child in the family. Open enrollment for 2014 will expire on March 31, 2014.

  4. I’m not sure that this would work if you were involved in an injury car crash or some other sort of injury accident. I seem to remember that if you apply for insurance after some sort of accident, they will not cover treatment related to that incident. I may be wrong though.I know that this the case for car and homeowners insurance.


    • ^ This is the only comment that matters. Your “hack” isn’t really a hack at all. Even if you ended up with some sort of condition that required constant medical attention, odds are, you’re going to find out about it through a sudden, expensive hospital visit. At that point I hope you enjoyed having those extra couple hundred a month when you’re staring down a $50K+ medical bill. I spot a hack here but it’s not your strategy…

  5. Only problem is that one can only sign up for individual health insurance during the open enrollment period. This initial year is an expanded enrollment period until March 31, 2014. In subsequent ears it is a very abbreviated period in the fall. Outside of this one has to have a qualifying event to sign up for individual health insurance.

      • Qualifying events are things like losing employer coverage (e.g., through job loss), getting married, getting divorced, having a child, etc.

        I looked at Covered California, and for a four person household making $75k, two adults aged 45 and 42 and two children. The lowest cost was $621/month, but that was before subsidy. The subsidy was $233/month, bringing the monthly cost to the family to $388.

  6. I agree that there will be no end of unintended consequences due to this bill.

    I have thought about this loophole you describe as well.

    But I believe this will only work during the open enrollment periods. Otherwise, one needs a “qualifying event” to be eligible to sign up, and I don’t believe that accident or illness is a qualifying event.

    In 2014, the open enrollment periods will be Jan 1- Mar 31, and then Oct 1 – Dec 31.

    In 2015, the open enrollment period will be only Oct 1 – Dec 31.

    And I’m not sure about this, but the sign-ups during the Oct-Dec open enrollments would not be effective until the next Jan 1.

    So if you get sick or have an accident at an inopportune time, you may have to wait months for the next open enrollment / activation period. A person may or may not be able to wait for treatment in this scenario.

    I would love to be corrected if I am wrong.

  7. Another loophole is that you’re also exempt if you are a member of a religion that opposes Obamacare. So if folks are willing to lie about that, they too can save their precious $95, and be smug about it as well.

    But is a $95 a year penalty that’s not due until October 2016 really such an outrage? Really?

    To be fair, a ton of people are getting better insurance for less money under the act.

    And Mike, come on — if ending insurers’ ability to drop people for having medical conditions were the only thing the act accomplished it would be a success. I’m sorry, but in my mind, that’s the headline.

    The truth is that your young son’s young friends (or their kids) WERE GOING to have a medical condition at some point in the next forty years. Not “might”, WERE. And without this messy rat’s nest of an act, they WERE going to be absolutely screwed beyond belief.

    Also, I’m guessing your son’s friends, like your son, live in the “Great State” of Texas. If so, they’re really being screwed by the Texas Republican leadership that is so determined to have Obama fail that they didn’t actually try to have their exchange work.

    In states where they don’t have the balls to crucify their own supporters in an attempt to regain the Senate & the White House, people are doing just fine through the state exchanges.

  8. I have lived in the Netherlands and currently I live in Canada. In both countries I enjoyed universal healthcare, and yes I paid more in taxes. Oh, and both countries have a higher standard of living, and rate higher on every other standard that measures quality of life.

    The thought of having to purchase insurance that might be cancelled, or that my claims might be contested, or worst of all, not being able to afford medical insurance chills me to the bone.

    • Yes, some people are terrified of being in control of their own lives and are willing to turn it over to others. Some people are not so terrified.

  9. qualifying life event
    A change in your life that can make you eligible for a special enrollment period to enroll in health coverage. Examples of qualifying life events are moving to a new state, certain changes in your income and changes in your family size (for example, if you marry, divorce or have a baby).

    This is from: https://www.coveredca.com/glossary/

    There is no kiosk at the ER!

  10. BTW, Tom would probably qualify for a Federal Subsidy at his income and family of four. Federal subsidy is available up to 400% of the Federal poverty level. I’m sure everyone has mixed feelings about this as it is really going to mess up the economy.

      • Um, Mike, don’t you think that would have been a relevant fact to include in your post originally? Because that missing fact changes a story about a supposed injustice into a story about an extremist Tea Partier who’s hurting his family by making a pointless gesture.

        Now you’re not actually writing about Obamacare, you’re writing about someone who’s cutting off his nose to spite his face.

        Does this Tom refuse to drive on roads? They’ve been paid for by other taxpayers.

        Does he ascertain that the post office does not spend more than 46 cents to bring him each letter, lest his fantasy of pioneer purity get smudged?

        I swear, most times I see someone bitching about Obamacare, in most cases their arguments collapse upon closer inspection.

        Certainly that applies here.

        • It wasn’t relevant to me because it would never occur to either Tom or me to turn to the government for subsidy. Since it’s something I couldn’t imagine either one of us doing, it didn’t occur to me in writing this post.

          And I didn’t realize I was “bitching about Obamacare.” I was simply laying out a strategy that I thought might be helpful to some. From the comments I’ve received, it’s apparent that it won’t work.

          I do think Obamacare is an ill-conceived boondoggle that wasn’t thought through, and I figure it will collapse sometime next year. Probably be ridden out of town on a rail by the same Democrats who voted it in. At least those up for election in 2014.

          I agree with the aims of the program. I dislike the idea that people who have pre-existing conditions through no fault of their own are denied insurance or charged so much they can’t afford it. That shouldn’t happen in a country like ours. But, I think there are better, less costly ways of bringing that goal to fruition than the AHA.

          • “I think there are better, less costly ways of bringing that goal to fruition than the AHA”

            Well, certainly. But none of those would be passed by a Republican majority House.

            In present-day America, only way you’re getting rid of the pre-existing conditions windfall/fraud is by starting with Mitt Romney’s plan, then letting the Repubs lard it with every cynical poison pill they can. So of course the act is a mess. Yet it’s also already reducing healthcare price inflation while it’s keeping ins. co’s from abandoning the sick.

            Time will tell if the act will be abandoned. I personally think not, as it appears to be working. But then I read Paul Krugman & the NYT, and you sound like a Fox viewer. So you and I will handicap the future very differently.

          • I read everything Paul Krugman writes. And I watch Fox and CNN. It’s my way of warding off the confirmation bias, which is extremely difficult to do. That’s why these kinds of posts are invaluable to me, if not to my readers, because I get to learn there are different ways of thinking about virtually everything, especially when it comes to anything remotely political.

          • You have now stepped on the current third rail – politics. You can write about nutrition, religion, finance, sex or whatever and your readers will stay calm. But politics is unbelievably polarized now and you will now get more invective from this posting than probably any other blog you have written, Dr. Eades.

          • I’m curious, Tom. What channel do you watch? You think Fox News is so horrible, but CNN, MSNBC, etc are totally legit?
            My policy has been canceled, but they have offered me an Obamacare compliant policy at a 30% increase. If I buy a policy off the exchange, I can’t keep either of my doctors. I have a great relationship with my GYN, and I am comfortable with him, so when people tell me to just “find a new doctor”, I get pretty irritated.

            Thanks for this post, Dr. Eades. It’s a shame you’re being attacked for posting it.

          • I would be very interested in what your solution would be instead of the ACA? Opponents never seem to have any ideas other than to go back to the way it was before, with skyrocketing health cost increases, millions uninsured…

          • They will need a 2/3 vote in both the house and Senate to override Obama’s certain veto of any such attempt. On top of that, Obama seems to have adopted the power, with little resistance from any party in congress, to create, follow or not follow any laws he wants. An example is by waiving for political reasons, the clear law specified timelines for, implementation of his law upon certain classes of citizens that he alone chose. This is far beyond normal bureaucratic discretion and more clearly lies in the territory of Chavez type tyranny in Venezeula. There are many other non health care examples that for brevity I won’t go into here.

            Thus it seems to me the likelyhood of any “riding it out of town on a rail” are slim, even if up for election Dems decide to vote against it. Also by this time, there will likely be so many people already signed up, that voting to kill it will put the fear into even the most brave “moderate” Republicans. Some of latter have after all told us many times to just accept it because it is already “the law of the land”.

            This is why I was part of a very small minority of like minded folks who strongly advocated strangling it through defunding a few months ago as a first step.

            Never underestimate the power of the main stream media to change the subject once that website starts working a little better. Did anyone notice today that the #1 headlines today suddenly for some reason shifted to that that great national concern over fast food wages? You would think the unemployed college grad millennials would be coming out of their parent’s basements marching in the streets and throwing molotov cocktails when you consider how they are getting screwed by Obamacare and being forced to cover their parent’s type II diabetes amputations. But they were trained well when they drank the Obama koolaid in college, so they are silent.

  11. Your friend should check if (a) he or his wife would be eligible for subsidies or (b) if they could granted an exemption that would allow them to purchase one of the low-cost catastrophic-only policies that are generally available only to people under 30. See https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/ . Also, I’m single so I don’t know how it works if you are married, but maybe there’s a difference if just he applies, or just his wife applies, or if they apply jointly.

  12. More from coveredca.com/glossary/

    special enrollment
    The opportunity for people who experience a life-changing event, such as the loss of a job, death of a spouse or birth of a child, to sign up immediately in a health plan, even if it is outside of the plan’s specified enrollment period.

    Cost-sharing subsidies and premium assistance reduce the cost of premiums and out-of-pocket expenses for health coverage that qualifying individuals and families purchase through Covered California.

  13. The penalty is $95 or 1% of family income, whichever is GREATER. Next year it goes up to 2% of family income. In 2016, 2.5% of family income.

      • Thanks for your excellent dietary articles and books. I often link to your analysis of stable isotopes determining our ancestral diet, as it’s one of the best out there.

        However, I was not happy to see this article. You just wrote an entire piece on the ACA without knowing one of the key elements of it?

        You owe your readers an apology. I think they would appreciate less self-righteous smugness from you and Naughton, and more concrete ideas for improving the health of everyone (not just the ones who can afford it), like those offered by Lustig and Eenfeldt.

        In the end, it is they who will be remembered for shifting the health paradigm. Harping all day about how the government of yore made us all sick does nothing to make us healthy today.

        Remember, it took the government to get us to wear seat belt as well, which saved and continues to save countless lives. Government is not some evil socialist ploy to take all your money. Government is primarily concerned with the well-being of its citizens. And while governments can be (and have been) misinformed, it’s our duty to fix it, and not just complain about it. After all, it’s *our* government! Let’s take some personal responsibility for it!

        PS: This site should help to get a more accurate view of the real amount people will be paying: http://kff.org/interactive/subsidy-calculator/

        Your friend’s family of four making $~60k will end up paying about $300 for coverage comparable to what they currently have, along with the additional benefits that the ACA requires.

        PPS: My state’s exchange got me a comparable plan to what I used to have, while saving me about $40/month. At a cost of about $100/month, it’s definitely affordable.

        • My intent was to be neither self righteous nor smug. I’m sorry you took it that way.

          As to your contention that government is “primarily concerned with the well-being of it’s citizens,” I couldn’t disagree more. Government isn’t an entity that pumps out money or food or housing or goodwill. Government is composed of people, all of whom have their own best interests at heart. The best interests of those who are elected is to stay elected. And the best way they can stay elected is to pander to those who elected them in the first place. If that means trampling the rights of those who didn’t get them elected, then, in the words of Barbara Boxer (D. Sen CA), elections have consequences. Anyone who believes the government is benign, has never had a run in with it.

          And remember, government never creates anything. It lives off of people who do create and who do produce. Government takes its piece of the action, consumes part of it (typically in the most wasteful ways imaginable) and redistributes the rest.

          • Enlighten the people generally, and tyranny and oppressions of body and mind will vanish like evil spirits at the dawn of day.
            Thomas Jefferson

            I could be wrong about this but it seems like the vast majority of politicians and public health professionals are trying to protect the public health. That they are currently ill-equipped to do so is perhaps the fault of an un-enlightened public from which they sprang.

            In this modern age of corporate industrial food systems, the quality of the food supply is of utmost importance to the public health. Politicians and public health professionals need a better understanding as to what constitutes nourishing food. Rather than ragging on politicians for wanting to get re-elected, how about educating them. http://www.americansustainabilityproject.com/bold-ideas

          • Dr. Eades, I can understand your feelings, but perhaps you have gone too far? I don’t deal with health-insurers, but I do deal frequently with property insurers. They make the government look like the good guys. They never pay without a life and death struggle. Government does have a role in this, and the idea of us all prospering because of our own efforts, as if we are all self-made men, is too simple. The more complex view is that without a proper structure, which is part of the purpose of the government, this would be an entirely different place. And probably not, almost certainly not, in a better way. Try living in another country, as I do temporarily, and see what I mean.

            As for your friend, we have to consider that this “subsidy” is an integral part of the law, not sign of humiliating weakness on the part of this hard working and ethical American. For that matter, I would propose that with a proper single payer system, not one compelled to fit within the current insurance structure, there would be no need of a penalty or of a subsidy.

            This is a system of forced insurance and it may also mean increased profits for insurers. All these laws have unintended consequences, and I would suggest that despite the doom and gloom this law will work well for the insurers as well as everyone else.

            I am a big believer in the market-place, even the market-place of ideas. This is going to get worked out. In the meantime, more people getting better health care, with fewer financial disasters caused by unfunded medical emergencies, is better for everyone.

          • “property insurers. … They never pay without a life and death struggle. Government does have a role in this,”

            You think the property insurers are NOT tied up (and tied-in with) government?! You think they’re operating however they wish, and the govt isn’t involved?! (Check out how much they spend in lobbying — bet they’re pretty far up there with the health insurers!)

            And for those of us who cannot GET a subsidy? Tough luck for me, eh? Bet *I* can’t get a tax break — even though I have to provide tax subsidies to folks I don’t know, for health insurance I can’t afford for myself!

          • “…And remember, government never creates anything…”

            Really? How about Apollo 11? The Interstate Highway system? Internet? GPS? Nuclear weapons? Cancer research? Giant border fence?

          • Mike, I’ve always liked your nutrition posts, as well as your books. This post is disappointing to me simply because you clearly didn’t research it like you do with your other posts.

            Despite your “extensive reading” on the subject your entire premise of a hack, your lack of knowledge of how the tax credits work, miscalculated pricing, etc, demonstrate that you aren’t even familiar with some of the main features of how the law works.

            I believe you are an excellent doctor, I trust your medical advice. But you clearly are not an insurance man, you don’t understand the law, and all this post did was contribute to the wealth of misinformation on the ACA, as if there wasn’t enough of that already.

            You are a center of influence, people trust what you write. What you have done with this misguided post is contribute to the problems, rather than solutions.

            Yes, the naivety is palpable, but not from my end.

          • Garry, you are 100% correct. Unfortunately, Dr. Eades’s ego and arrogance won’t allow him to absorb the very good advice you give. He knows deep down that he doesn’t know the first thing about health policy. Still, he used this whole post as a chance to further his politics, which are much more aligned with Sarah Palin and Faux News than anything an actual expert in the field would believe.

            What is more disappointing, to me at least, is that he is not only one of these misinformed right-wing nut jobs, but he’s shown himself to be a truly classless man, with some of the personal attacks in these comments against those who DARE disagree with him. These are the actions of a very small man. And that is what Dr. Eades has turned out to be. He has shown a contempt for readers that have followed him for years, just because they had the gall to advise him to avoid talking politics.

            Pity. Next…

            Oh, and Michael… FU. (do you know what that means?)

          • Did it ever occur to you that the way this bill was/is written, no one knows for sure what’s in it. They’re changing it almost daily. Don’t worry, you, too will be mugged by it sooner or later.

            “We have to pass the bill to see what’s in it.”

        • Affordable, because someone else is paying a good part of it. Do you like being a beggar and freeloader? Are you unable to decide what you need, you have to have a government bureaucrat dictate it to you?

      • The “subsidy” that everyone is talking about is really a “tax credit.” (MY guess is they assumed the poor and uneducated would understand the term “subsidy” over “tax credit.”)

        Let”s say the insurance policy you want costs $600/month and you qualify for a $200 subsidy/tax credit. That credit applies directly to your monthly premium so the insurance company still gets their $600. (You pay $400 and the government pays $200. You don’t actually get $200.)

        If you want to pay the full $600 yourself, you can take the entire $2400 ($200 x12)as a tax credit on the following year’s tax return.

        If you call that a handout, then you have to call all tax credits a “handout.”

        I learned about this by signing up at the government’s website. . Unfortunately, the current administration has done a lousy job of explaining how the program really works.

        • Sorry. This link was already in a response.

          Sorry the government is messing with your friend’s insurance plan. It is a crappy deal but he should probably try to make the most of it from his perspective. And I honestly don’t think that involves exploiting any loopholes or blaming the government for having to live paycheck to paycheck. Even if it is partly their fault.

          As far as health insurance goes. I liked the description of the high-deductable plan he had, paying out-of-pocket for non-catastrophic things. I have the same thing myself (combined with an HSA) and wish everyone else did. It would drive health insurance prices down faster than anything else, imho.

          • I’d really like to get a catastrophic policy with an HSA — but I’m (way) too old to get on on the exchange, and I can’t afford one off the exchange (or any other policy that’s offered!) I’d also like to make the best of it from my perspective — but MY perspective includes the facts that I don’t get a subsidy, can’t afford a policy, and the cheapest policies I can find would not have a paid a single cent towards my (uninsured) kidney stone. (Just under $9,000 for one night!)

            Now, I wasn’t TREATED for the kidney stone — that $9k was just for most of a night in the ER getting pain-mgmt shots, an MRI (what ever happened to plain-old xrays?), and a referral for treatment (which I couldn’t afford, so didn’t follow-up on). All my options for insurance now would not have covered a penny.

            (And did you know, my doctor friend points out, that hospitals automatically bump up the bill for the uninsured by 40% — and then offer (and I fell for it!), that “if only you’ll mortgage your soul to pay this off by this date (starting with a $2,500 credit card charge) we’ll give you a 40% break for the cost!”? {sigh} Neither did I!

            And I’m a home owner (inherited the house when my husband died 2+ years ago), so there was no “not gonna bother to pay the ER bill” for me! But the damned illegals get that ‘free pass’ all the time! The hospital doesn’t even TRY to chase them for payment…

            Commie-Care is NO benefit, all punishment, for lots of us small-biz owners!

      • The subsidy you are referring to is the tax credit, actually called the Advance Premium Tax Credit…”APTC refers to advance payment of premium tax credits. If a person qualifies for APTC, the amount will be applied right away and sent directly to the insurance company each month to reduce the premium.”

        Would you and your friend take the tax deduction on your home interest, “subsidizing” your mortgage?

        Since we don’t have the zip code or specific ages of parents we aren’t seeing accurate numbers here, if they were in my zip code (Oregon) they could get a plan starting around $300.

        Also the penalty is $95 per person, $45 per child, or 1% of income. And it increases substantially in the coming years.

  14. I wish we’d stop talking about “the Government” and talk about the “people in government” who think they’re smarter than everyone else but aren’t. The you’ve written this essay sounds like they tried to find a “one size fits” all plan and failed.

    Are Health Savings Accounts still alive in Obamacare? If this young couple could make regular deposits when they are healthy then use the accounts to pay the bills when they need to they may be better off than $600 monthly.

  15. The Good Samaritan was the hero of a story Jesus told to answer the question, “Who is my neighbor?” (Luke 10:25-37). The Samaritan found a man who had been beaten and robbed, lying half-dead beside the road. He provided first aid, transported him to safety, and paid for his care until he could get back on his feet. At the conclusion of the story, Jesus told his listeners to take the Samaritan as their example and to show similar kindness to strangers in need.

    Many people are willing to help strangers in need today. My wife and I saw a young man crash his motor scooter on the highway while we were driving through town recently. Helpers surrounded him immediately. They mostly argued about how best to care for him until an ambulance arrived, but they came to his aid without hesitation. Their compassion was real, but rushing to the scene of an accident is not enough. Full-fledged Good Samaritans participate meaningfully in providing and paying for needed care.

    Few people can pay for a poor man’s care until he is back on his feet today because the cost of modern medical care is so high. Many people cannot afford to pay for their own or their children’s’ care in the event of a serious accident or illness. The only way to provide the wonders of modern medical care to people who need it is to spread the risk among all of us neighbors. People in London invented insurance in the mid 17th century to cope with threats like the black plague and we still need insurance to care for neighbors in need today.

    People who participate in insurance programs that provide them with comprehensive care in the event of accident or illness and who support making such insurance available to others are modern Good Samaritans. They make substantial investments of time and money in caring for people who need help through participation because they are sharing the risk like a good neighbor should.

    Personal observation: People who hack the system to avoid sharing the risk with everyone else are unbearably selfish. In other words, they suck!

  16. What is a “qualifying event”?
    Each fall, there will be an open enrollment period for those who will be getting insurance through the HIX (Health Insurance Exchange). That enrollment period will cover insurance for the following year. For example, from October through December of 2014, you can enroll for insurance that will cover you during 2015.

    This is to prevent individuals from “gaming the system” by going without insurance until they need it, and it’s very similar to what you’ve probably already experienced with your employer-based insurance.

    However, there will also be special enrollment options throughout the year for individuals and families who become eligible for coverage in the marketplace due to a “qualifying event.” Some examples of qualifying events:

    A change in income.
    A change in your status, such as marriage, death of a spouse, divorce, legal separation or annulment.
    A change in your number of dependents, including birth, death, adoption or placement for adoption.
    A change in your employment status, or the employment status of your spouse or dependent.
    A dependent becoming ineligible for existing coverage due to attainment of age.

  17. Another hack is to enroll and pay the first months premium, then stop paying. The insurance company has to cover you for three months and can refuse to pay the providers should you need treatment during that time. If catastrophe occurs, then pay your arrears. Game the system until the next open enrollment period.

    I’m not saying this is a good idea, but it is an option that will happen to some people whether they plan it or not. Not everyone pays their bills on time, if ever, and Obamacare has a flaw that can be exploited to your advantage. ACA will collapse under its own weight sooner hopefully than later.

  18. As a non-American I’ve heard this “Obamacare” thing mentioned before but never read a whole paragraph about it cos, well, I don’t care. But is this a colloquialism or an actual “as it’s known” term?

    I’m just trying to imagine the ridicule if any of Australia’s leaders tried to name a system after themselves – BAHAHAHAHAAHAAA!!!

    As to the insurance system, I’ve figgered the same thing. Here we have our govt supported Medicare which is designed for people who require assistance with medical stuff, and so as far as I know (I don’t research this) it’s a reasonable system for those with chronic needs (which are likely facilitated by a life of poor diet mandated by govt but hey…).

    If you don’t have private health insurance you get slapped with 1.5% Medicare Levy on income – I think it’s gross but not sure. Now just say I make a good sub-executive salary of $70k, my take-home is ~$40k, I might not have been to a doctor for ten years but it’s still cost me $6k over that time in Medicare Levy.

    Do I think the system is bad? Not really – on the surface us healthy Aussies are supporting those in need, sucks that those in need would likely not be in need in the first place with better nutritional/medical guidelines but hey.

    Also – emergency services and all that comes with it is free. Nearly a decade ago I broke my neck (and a lot of other stuff) in a car accident, I was so worried about leaving the hospital once they had me stabilised as I’d have an enormous bill I couldn’t cover and I was barely able to cover my rent and beer. Asked about it to the outpatient nurse and she gave me an incredulous Laverne from Scrubs look and said “Honey, you was nearly dead, we don’t charge you fo’ that”.

    • Obama didn’t name it after himself. Others hung the monicker on the plan.

      What’s the population of Australia? 25 million? It’s not even as big as California. Programs that work in a country of 25 million are a little more difficult to make work the same in a country with 15 times that population.

      • Heh yeah, whenever someone here gets annoyed at American TV getting something about Australia wrong it amuses me, in the scheme of things we’re a far flung little country town.

        Oh dear – just noticed your comments section has exploded, likely because of the political topic. Haha good have fun! *Good night and good luck*

    • Or maybe Jesus didn’t weep. Perhaps He read the Constitution..

      We the People of the United States of America, in Order to form a more perfect Union, establish Justice, … promote the general Welfare, … do ordain and establish this Constitution for the United States of America.” ( the “…” is to save typing and provide emphasis for the promote the general Welfare phrase.)

      Sounds like that is referring to the well-being of it’s citizens. Obviously, the intent is there. we can all argue about the execution and failed expectations.

      • Looks like someone could use some time reading the Constitution and The Federalist/Anti-Federalist papers. IF! If Congress can do whatever it wants to promote the “general welfare” of the People, then the rest of the Constitution, and the limits it places on the Government would be moot. Congress decides that banning all guns promotes the general welfare and passes the “law”. Which takes precedence, the 2nd Amendment (the one that reminds the Government that We the People have a natural right to have weapons to fight tyranny when it shows its face again) or the new law under the “general welfare” clause?

        Let us analyze this. Since words change meaning throughout time [200 years ago, “nice” meant “precise”], we must learn what the word, “welfare”, meant when the Constitution was ratified. “Welfare”, as used in Art. 1, Sec. 8, clause 1, meant:
        Exemption from any unusual evil or calamity; the enjoyment of peace and prosperity, or the ordinary blessings of society and civil government (Webster’s American Dictionary of the English Language, 1828).
        But The American Heritage Dictionary of the English Language (1969), gave a new meaning: “Public relief – on welfare. Dependent on public relief”.
        Do you see how our Constitution is perverted when 20th century meanings are substituted for original meanings? Or when the words of The Constitution are treated as if they have no meaning at all except that which the statists assign to them?

        Both Madison and Hamilton squarely addressed and expressly rejected the notion that the “general welfare” clause constitutes a general grant of legislative power to Congress. In Federalist No. 41 (last 4 paras), Madison denounced as an “absurd” “misconstruction” the notion that
        …the power “to lay and collect taxes, duties, imposts, and excises, to pay the debts, and provide for the common defense and general welfare of the United States,” amounts to an unlimited commission to exercise every power which may be alleged to be necessary for the common defense or general welfare….
        In refuting this “misconstruction”, Madison pointed out that the first paragraph of Art. I, Sec. 8 employs “general terms” which are “immediately” followed by the “enumeration of particular powers” which “explain and qualify”, by a “recital of particulars”, the general terms. Madison also said:
        …Nothing is more natural nor common than first to use a general phrase, and then to explain and qualify it by a recital of particulars. But the idea of an enumeration of particulars which neither explain nor qualify the general meaning, and can have no other effect than to confound and mislead, is an absurdity…
        Madison was emphatic: He said it was “error” to focus on the “general expressions” and disregard “the specifications which ascertain and limit their import”; and to argue that the general expression provides “an unlimited power” to provide for “the common defense and general welfare”, is “an absurdity”.
        In Federalist No. 83 (7th para), Hamilton said:
        …The plan of the [constitutional] convention declares that the power of Congress…shall extend to certain enumerated cases. This specification of particulars evidently excludes all pretension to a general legislative authority, because an affirmative grant of special powers would be absurd, as well as useless, if a general authority was intended… [boldface added]

        Read more at http://freedomoutpost.com/2013/03/does-the-general-welfare-clause-of-the-u-s-constitution-authorize-congress-to-force-us-to-buy-health-insurance/#v70wScLpukBsu5xZ.99

  19. Nice to see you stretch your comfort zone into the deathly zombie-healthcare world.

    A list of similar articles about Obamacare can be found here:

    http://www.c3headlines.com/2013/12/the-democrats-obamacare-ordeal-a-fiasco-liberals-progressives-own-part-11.html (there is also a link on the page to download a 68-page PDF of article links since October 1.)

    As your son’s friend discovered, millions of Americans are being negatively impacted by Obamacare and it’s likely to get worse, per the experts. For the political supporters of Obamacare, all polls/surveys now indicate a massive blow-back in 2014 is brewing for them.

  20. Hi, Mike. Good article. I think ObamaCare is a hideous, destructive law.

    Here’s my story: I work as an engineer and make ~$60K per year. Like you, I had a good health insurance plan; one that exceeded the requirements. It is now gone. The government will charge your provider a “Cadillac Tax” if they provide something better than the minimum! How ridiculous is that? So my company wants to avoid that extra tax and now I get to pay more for a crappier plan! Great, huh?

  21. HSA plans are indeed still available in 2014. In most cases, they will be the least expensive option available. A couple will be allowed to contribute as much as $6450 – plus an additional $1000 for each person over age 55. That contribution reduces your adjusted gross income, the money grows tax-deferred like an IRA, and withdrawals are tax-free to pay for medical expenses.

    Most people not receiving a subsidy will see their rates soar, but this is at least one way to keep costs down.

    • HSAs have been changed immensely to conform with the ACA, and not for the better.

      We’re Tom, in some ways. A family of six, my husband is the sole income, and we make too much to acquire a tax benefit and not enough to easily weather the changes in our plan. We self insured so that we could get a plan we needed, not one with excess coverage we didn’t want (through his employer, their plan stunk), and just used an HSA with catastrophic insurance to pay out of pocket for our child births and routine medical procedures, but be covered in case one of us or the children had a severe trauma or disease.

      We were responsible. We budgeted and paid for ourselves, scrimped and saved, had a plan in place to manage the medical expenses beyond our ability and money in an account, added to every month, to cover things like child well visits, vision care, dental, and even midwifery. Our original HSA-compatible catastrophic coverage was $440 monthly for our family, and we put any extra money we were ‘saving’ from our previous insurance rates directly into the HSA.

      We just received a cancellation notice in the mail from our insurer, because out policy (a which had already been raised to $700 a month in an attempt to comply with Obamacare) still didn’t comply in a way that allowed our insurer to keep it. It was sufficient for our needs, paid for out of pocket, and exactly what we wanted and could afford. It offered coverage for significant health events. We used plenty of preventative care, including me losing just shy of 100 pounds and maintaining that loss, all to make us lower risk and healthier for a rate we could afford and to forstall complications of metabolic syndrome, which I didn’t want.

      And gone. Poof. Because we look wealthy enough on paper, but our plan is frugal and so are we, we’re left with no coverage and stuck using the next best, cheapest plan the ACA covers under it’s bronze moniker. It costs us $1600 a month (which we don’t know how we’ll afford) and we qualify for no subsidies. It covers things we previously budgeted for by cash pay, sure, but not enough to actually account for the huge rate jump in a way we can easily manage. We’re that young, healthy family getting fleeced, whom the government and overly nosy individuals claim their want to magnanimously assist. We were standing on our own two feet and taking care of ourselves and our four children, and now we’re stuck with a plan we can’t afford and nobody else is picking up the bag, either (nor should they! It is ridiculous to expect another individual to manage costs for our family, and vice versa).

      So yes, we sympathize with Tom’s plight and join him. We budget in things as simple as book purchases and new underwear, but now must cover a four-fold rate increase over what we were paying last summer, and cannot even maintain our HSA which we were paying into to assist with bigger medical hits. It is ridiculous and infuriating.

      And unfortunately, Dr. Eades, even the loophole doesn’t work very well. Thanks to my husband’s income and our status as jointly filed for taxes, the percentage of our take home pay that can be garnished as a tax fine for no medical coverage is in the $3500-3700 per year range, and would require us dropping an item (medical insurance) we had previously paid for. So our fine is huge because of the way the law was written, and yet in practical terms we are still living very modestly and cannot easily absorb a financial bit of this magnitude.

      A budget scramble is ensuing in this house, obviously. And it isn’t easy to consider what might have to give to make it work – gas in our twenty year old vehicles? That extra homeschool curriculum I wanted to add in the spring, or ceasing piano lessons for one of our children? Me not being able to afford my more-expensive low carb dietary fare and having to revert back to cheaper meals that stretch our meats? Who knows, I’m hoping we are blessed with a pay increase in the next few months because, short of that, it’s a hard set out choices before us that we were not having to face when we were allowed to buy insurance we agreed was suitable for our budget and family.

      And that’s my story :(

  22. There’s one tiny flaw in this strategy. If you have a heart attack or stroke, or get into a terrible auto accident, or suffer some other serious acute illness, you will not have the time or means to sign up. You’ll be in limbo as the medical industry piles on the fees. By the time you’re able to act you may already be on the hook for 100s of 1000s of $$$s in bills. As you know, Doctor, it doesn’t take a very long hospital stay to find yourself, upon awakening from a coma, to be flat broke.

  23. Wow – am I glad I live in the UK. Part of my taxes go to pay for my health insurance, ie the National Health, and, to top up the care, my dh’s employer gives us private health insurance for free. My parents lived in France and the state healthcare there is fantastic, and probably costs about the same as we Brits pay in our taxes. There are no ‘deductables’, no co-pays, no worries that we or our children won’t get treated if we are ill.

    I had a friend in the US who got breast cancer. She was well insured but she still had to mortgage her house to pay the co-pays. Right up until her death her insurance company were quibbling everything that the doctors prescribed for her. I was shocked and dismayed.

    • I’ve heard countless horror stories about the UK system, so no system is perfect. A rule of life is that you get what you pay for. Ad it’s a rule, like the laws of thermodynamics, that can’t really be broken over the long term. If you were to reduce your taxes by the amount gobbled by the NHS, you would probably find you could buy yourself a superior insurance policy.

      • I’m surprised to see you assert this. The US pays more per capita for health care than any country in the world, and we are no longer near the top for delivered quality.

        In general, I agree that the “get what you pay for” saying is often if not usually true. But US medicine is demonstrably an outlier.

        • We are at the top for deliverables…WHO beats the dickens out of us for all sorts of things…but healthcare deliverables – #1

      • I know there are faults with the UK NHS, we could learn a lot from the French system. But I think Americans are over charged for their medications – they get the same medications as we in the UK but pay more. That doesn’t mean they get better medications though ! Here’s an example, I may not be fully correct in the exact costs, but I take Omacor which costs the NHS around £50 for a month’s supply of Omacor at 2g per day (as a patient I pay nothing at all as I’m over 60 so get all prescriptions free). In the US Omacor is called Lovaza but it’s the same company pruduce it and it’s the same product, yet the same amount costs around $200. The same goes for Alendornic Acid (which I don’t take incidentally). In the UK Alendronic Acid costs approx 1p (£0.01) per day, in the US it is considerably more because one month’s supply comes in the region of $50. This doesn’t make sense…or rather it seems the pharmaceutical companies in the US are taking advantage of the system.

  24. I swear, whenever I feel annoyed by the not-quite-as-good-as-it-ought-to-be infrastructure/healthcare/criminal justice system here in Norway, all I need to do is read something about the USA to renew my love of my country.

    You people willingly live in a country where you either have to pay huge monthly fees to mafia-like insurance companies, or die horribly if you get in an accident, get cancer, or in any other way have bad luck?

    I would sooner shoot myself in the foot (and get it patched up for free by some of the world’s best medical doctors) than move to a country where the threat of a random event utterly ruining my life would always be at the back of my mind.

    Seriously, USA, get your shit together. Stop fighting your hopeless wars against imaginary enemies for 8 weeks per year and pay for your citizens healthcare. If people are sick, they can’t work. If they can’t work, they can’t contribute to either financially or to the work force.


    • Apparently everyone who lives in Norway doesn’t feel the same since they definitively threw out the socialists in the election last September. Always remember, what works for a homogeneous population such as you have in Norway doesn’t always work when there is a huge underclass that has to be cared for.

  25. One thing that I have seen addressed nowhere is whether automobile insurance policies will retain the ability for the insured to designate them as “Primary Medical” insurance for any accidents in a car. This used to be an option. It cost a little bit more, but all my insurance adjustor and lawyer friends said it was worth it. That option may have varied from state to state, as laws and regulations governing auto insurance vary from state to state (some states are “no fault” etc.) However, if that remains an option, that might ameliorate some of the risk of high medical bills from accidents, as driving and automobile is by far and away the most risky thing one can do.

  26. Dear Dr. Eades, Chris Masterjohn, Richard Kolekey, and the rest of the virulent strain of right-wingers in the paleo/lowcarb community:

    I come to you bloggers for information on the science and biology of diet and nutrition. I do NOT come to you for your political views on the government, Obamacare, or anything else.

    I am a lifelong, proud liberal and a big supporter of Obama and the ACA. If you continue to interject your political opinion into your otherwise fantastic blog, you will lose a lot of people like me. If that is your intent, then proceed, it is your blog. But be aware that WILL happen.

    Dr. Eades, it already offended me enough to hear that you do not believe in global warming (alarming, considering your science background). Now a diatribe on Obamacare. Unless I am mistaken, you are not a policy expert, nor a climate scientist. You are simply airing your political views disguised as “looking out for us”.

    Your choice, but I rather enjoy your normal, non-politicized posts about weight loss and cardiovascular health. It’d be ashame if I had to unsubscribe from your RSS. But after this post, I am quite willing.


    • Sorry to burst your bubble, but there is non unanimity among even climate scientists on global warming. Each side in the debate tends to finger scientists on the other side as stooges of some political stripe or another. I’ve been through another of these scares – the Population Bomb – that ended up amounting to nothing, so I’m not jumping on the bandwagon for this one until there is much more consensus than there is.

      • Consensus??

        “Let’s be clear: the work of science has nothing whatever to do with consensus. Consensus is the business of politics. Science, on the contrary, requires only one investigator who happens to be right, which means that he or she has results that are verifiable by reference to the real world. In science consensus is irrelevant. What is relevant is reproducible results. The greatist scientists in history are great precisely because they broke with the consensus. There is no such thing as consensus science. If it’s consensus, it isn’t science. If it’s science, it isn’t consensus. Period.” Michael Crichton

        Consensus would have us all eating high carb-lowfat and taking statins.

        We don’t have to agree that something is true, but there should be an evidence based system to determine the most likely truth of a matter without resorting to an election or poll. (Oh wait.. we have science)

      • Wow, you are waiting for “unanimity”? I am going to guess that E=mc^2 is not yet unanimous. In any event, according to Wikipedia, no scientific body of national or international standing rejected the findings of human-induced effects on climate change.

        • You’ve misinterpreted my use of unanimity. I’m not waiting for a consensus. If I were the kind of guy who depended on a consensus, I would have been recommending the low-fat diet instead of bucking the trend. The difference is that I made myself an expert in nutrition by reading deeply in the scientific literature and comparing what I learned from the literature with what I learned from hands-on care of thousands of patients. What I learned was almost the opposite of what the consensus was touting. But I figured that I was more knowledgeable and had more direct experience than the vast majority of those who were part of the consensus.

          I’m not a climate scientist, nor do I really want to be. I went to some of the original papers, i.e., the direct sources vs indirect sources, which are those reporting and, in many cases, distorting the direct sources. I was bored to tears and figured my time would be better spent buried in the nutritional literature. But I did learn that a number of people who do have expertise in climate science were so-called deniers. Whenever those who fervently believe in AWG are presented with the views of these scientists, they invariably respond that they are in the pocket of big oil or that they have some other financial interest keeping them from supporting AGW. And they respond that “all legitimate” climate scientists are on board with AGW. Which simply isn’t true, which is why I pointed out that there was far from unanimity on the subject.

          As far as I can tell, belief in AGW is a political thing. If you’re of a particular political persuasion, you believe it wholeheartedly – if you’re of an opposite political persuasion, you don’t. I doubt seriously if one fraction of one percent of the people who blindly believe in AGW have ever looked at the direct sources. Same goes for those who disbelieve. Most have simply read what various pundits, who may or, more likely, may not have ever themselves read the climate science literature, have to say and then think they, themselves, have read the literature and formed a learned opinion. Sadly, this isn’t the case.

          • Oberlin College geologist Dr. James Powell reviewed 13,950 Papers published in peer reviewed scientific journals from 1991 to 2012 and found that only 24 did not conclude that human produced carbon dioxide emissions were a significant part of global warming. That is 99.83 per cent agreement. If 99.83 per cent of aeronautical engineers told me that the plane I was about to board was structurally unsound and would fly apart on take off, I think I would book another flight.

          • What you don’t know is if there were 10,000 more papers he didn’t review.

            I don’t want to get in this debate because, as I explained, I haven’t gone through the direct sources. But from what I’ve read, I don’t think there is a lot of disagreement about whether or not humans add CO2 to the atmosphere. How could the not? The question is, does it make a difference? Hasn’t been any global warming in the past 15 years or so. And can we do anything about it?

            Here is a nice review in Nature, a journal never considered to be solicitous of ‘deniers.’ You can see how the authors are trying to explain away why we haven’t had any global warming to speak of over the past 20 years.

      • Right on Dr. Eades, and that is why I will continue to smoke two packs a day until there is unanimity on it causing cancer.

      • The same thing could be said of cholesterol – cherry pick the studies which “prove” your argument and ridicule studies which go against your argument.

    • There’s a reason why most low carb bloggers are “right wing”. It’s because, to become a low carb advocate, you had to think for yourself instead of just swallowing what “authorities” told you. That same thinking for yourself causes you to realize that the other things the government wants you to swallow are often just as wrong.

    • Dr. Eades, and the other “virulent strain of right-wingers”, are highly welcome in all their opinions, thank you very much.

      They’re right on the science and biology of diet and nutrition because they understand the idea of a falsifiable hypothesis, and can think critically.

      They’re right on the science and physics of catastrophic anthropogenic global warming because they understand the idea of a falsifiable hypothesis, and can think critically.

      They’re right on the problems with Obamacare because they understand the concept of being skeptical and critical of any government which promises the moon.

      It’s offensive to think that there are otherwise intelligent people out there, who despite understanding the problem with “consensus” in diet and nutrition, cannot extrapolate to the problems with “consensus” in other political sciences (including the very political “science” of global warming).

      Stay skeptical.

  27. @Tom Denham – Jesus gave people choices, the government does not. The subsidy is not from the government is it from other people paying higher premiums…that is not insurance. Insurance is paying for your OWN categorized risk within a pool of like risks.

    @Anne, the ACA does not pay 100%, it has large deductibles and co-pays, so your breast cancer friend would be no better off. And in the UK, let’s talk about the wait for treatment or the denial due to age, every system has issues.

    @Wiley Long – please explain how an increase in rates will keep costs down? A decrease in costs will keep the rates down, supposedly. But just for the record, medical costs has been on a percentage decline since 2002. Not due to any effort by any political party, just a factoid.

    Let’s all come back in a few years when we know someone cannot find a primary care physician due to shortages or specialists are not taking new patients. (although I suspect the government will try to tell them how to do business – YIKES) The ACA is going to have a chilling effect on the way our medical care is delivered.

    • This was happening long before ACA, driven by profit-seeking insurance cos that would much prefer a compliant nurse practitioner to a pesky MD.

      In any US system, the docs & patients will get the short end. The insurers and their CEOs will fare better.

  28. Wow, these people with their sanctimonious “how dare he talk about something besides food!!1!” comments are ridiculous. Some people are so full of themselves. News flash: the doctor can say whatever he likes, ESPECIALLY ON HIS OWN BLOG. And not surprisingly, the people who want to stuff Dr. Eades into a box are the same people who favor using government force to compel Americans to pay other peoples’ bills.

    Not to mention the fact that nutrition and healthcare are closely-related topics in the first place. Half the reason we even HAVE such a healthcare crisis is that the government used taxpayer money to push nutritional guidelines that ended up being largely wrong and damaging to health. But sure, let’s get the government MORE involved in the system, because that always works out great!

    • So bored with people who think they don’t even have to offer evidence, that simply mentioning “government” is enough to carry the argument.

      Um, roads. Electromagnetic spectrum. Law enforcement. National defense. And, yes, healthcare must be regulated, or we are back in the 1800s when patent medicine practitioners got rich by killing people, then moving on to the next town.

      • Um, hello, “government” is what this post is about. Or do you deny that the government is forcing Americans to buy something that millions of them don’t want to buy? Do you deny that the government pushed the Food Pyramid on Americans, promoting a grain-heavy high-carb diet, with disastrous consequences? Do you deny the existence of War on Drugs, the War on Poverty, the War on Cancer, in which the government has taken TRILLIONS of dollars from taxpayers over decades fighting “wars” that they have utterly failed to win?

        The fact that there are some valid functions of government, such as national defense, does not mean that the government is justified in doing anything and everything it wants to do, especially things outside the scope of its constitutionally-limited powers.

        • Bravo twice over, Anthony!

          And Tom? Every single of your putative necessary benefits of govt ALSO has its downsides! There is no unalloyed good that can ever result from one group of people (“govt”) taking *at gunpoint* from another group of people (“taxpayers”). Commie-Care is has nothing to do with “regulating healthcare” — it is forcing people to do things they may not choose to do (young folks WAY overpaying for health insurance (<– INSURANCE! not healthcare… Gotta those terms accurately!)

          ObamaCare has nothing whatsoever to do with "patent medicine prac…" — oh wait, yes it does! It FORCES people to participate in the medical system that prescribes statins to people the drug can only harm; and it takes away insurance (<–) from folks who already HAD a good solid policy that met their needs, at a price they could afford, and replaces it with a lesser policy at a higher price. Yup, you must be right — the govt has arrived to help!

          RUN FOR YOUR LIVES!!

  29. one of the best “hacks” for healthy individuals and families, i.e. those can be underwritten, is to buy a new plan with an effective date before 12/31/2013. that way you take advantage of 2013 rates without the a.c.a. requirements. it is what i recommend to many of my clients. it will likely only work for 1 year, however you may just save quite a few bucks over that year and/or have a policy with a smaller out of pocket downside risk as well.

  30. Anthony,

    I assume you are referring to my post. or Manahan’s.

    We never said Dr. Eades can’t talk about whatever he wants. your putting “IT’S HIS OWN BLOG” in your post is redundant considering I said the exact same thing.

    I am simply saying that I will stop reading his site, buying his books, or anything else. If that’s what he wants, fine. But I can’t imagine him wanting to alienate so many of his followers just so he can blow off some of his personal political steam.

  31. Well, it seems, Dr Mike you are a man of more courage than I imagined!
    Wading into a subject certain to ruffle some feathers, you soldiered on and I salute you! I have found you to be fair in all you postings and your aim is to educate, to help, and to challenge our thinking. And once more you succeeded. Thank you for this post!! It was fascinating to watch some writers try to turn into a political wrestling match! When my 44 year old daughter’s insurance increased 67%, the theory of the government being able to take care of it’s citizens went out the window! She is a single mom, going through a divorce and raising 3 wonderful teens. It will come down to mortgage or insurance; insurance that mandates paying for pediatric dentistry and maternity care among other things. This was a law that was passed without being read, by only one party in our system, and was presented deceptively in order to be passed with those famous words, “If you like your plan, you can keep your plan.”
    My husband and I are 74 and have learned our premiums, copays, hospitalization, and prescriptions costs have gone way up. I am frightened by what I see happening…. Changes being made in the law for special interest groups like unions and others. Exemptions that don’t include people like us… we are mandated to follow the law… congress isn’t.
    My cousin in Canada watched her best friend die while waiting for her cancer treatment, from the initial appointment to the treatment that never happened. We will most likely see the same scenario as more doctors and hospitals leave the program and more people are included.
    Thank you from the bottom of my heart for your clear, concise explanations once more!

  32. I think this was an extremely reckless and uninformed article about the ACA as many other commenters have already pointed out. I agree that the law is flawed and the implementation of it has been rocky at best. I work for an insurance brokerage and work closely with the benefits department so I know about the nightmare storm that Healthcare Reform has created across the board (although well-intentioned). But your complete lack of acknowledgment of how the open enrollment period works (thereby preventing what you’re suggesting for the majority of every year) just tells me you’ve been watching too much Fox News.

  33. One last point: of course you can and will write about anything you choose. But through this blog you have built a five or six figure “tribe” of people who trust and I bet are very fond of you.

    So articles like this are your prerogative, but I suspect that you are not aware of how distancing and disappointing the are to those not on the right wing.

    I’ve followed you for many years and this article has me feeling a profound sense of loss and estrangement. I’m quite sad, in fact.

    Not that you should alter your behavior, but I bet you were completely unaware of this post’s emotional punch. It immediately splits your tribe.

  34. $300 per month for a family of four is an incredible bargain. My husband and I were paying close to $1900 per month and were unable to switch to a lower-cost plan because we kept getting denied. Reason? His cholesterol numbers, classified as a “pre-existing condition.” Also, our insurer doubled our rates over the course of five years, leaving us with absolutely no recourse. Obamacare has allowed us access to a lower-cost plan, finally, and we are incredibly grateful to the President for making that happen. I plugged your friend’s numbers into the Kaiser subsidy calculator and came up with a total premium of $9,063 per year for the silver plan, with a tax credit of $4,150 per year, leaving his family premium at $409 per month. That is an increase, yes, but I’ll bet the coverage is better than his old plan and you never know, he may end up needing it and being glad to have it. Also, it’s a “tax credit” and not a subsidy, so if he’s claiming a tax credit for his kids, which he most likely is, I fail to see the difference. If you are interested the Kaiser subsidy calculator is here: http://kff.org/interactive/subsidy-calculator/

  35. Here’s an alternative for the insurance companies. Add all those ‘required’ (but unwanted) coverages to every policy, for a blanket price of One Dollar. Put a 99% deductable on those new coverages. Voila, problem solved. 😉

    (I don’t know if one could get away with that under Obamacare, but it’s how Hollywood would do the accounting.)

  36. Here are some thoughts no one has mentioned.

    If you have a mid level job but no assets and have an injury with no insurance, the ER still has to treat you. The ambulance still has to take you and the hospital can’t refuse you treatment.

    The ER bill is $50K. You declare bankruptcy because you only have $5,000 in assets or you do nothing because the bill is uncollectable.

    Young healthy people and other people with decent jobs but no assets are going to go without because they will still get catastrophic care and a huge bill they will never pay because they have no assets.

    For these people, the cost of declaring bankruptcy may be less then their Obamacare annual insurance premium. So it makes perfect economic sense for them to go without insurance.

    I’m not sure people will be this cunning but it is more likely that people who are living pay check to paycheck may just do nothing because they know they will not be turned away from the ER if they have an injury. They also know they have a relatively low risk of developing a catastrophic chronic disease if they are fit and healthy now with no symptoms.

    If enough of these people go without insurance (and there are millions of them,) it will cause the system to collapse because they will not be paying premiums and the hospitals will go bankrupt or have to close their ERs because the number of uninsured they have to treat will not go down and may actually go up. This will be especially true in low to mid income areas.

    How many people are driving around California in cars that are uninsured even though it is against the law? The answer is 25%.


    If they have no assets and have a catastrophic injury, they lose their job and are then immediately eligible for free healthcare.

    Even many of the very poor who are eligible for 100% free coverage are not going to sign up because of the hassle. They are not computer literate, can’t take off work or be bothered to stand in line to get help. They also know they will not be turned away at the ER if they are very sick.

    How do you like them apples?

    Average household incomes have declined in the last 5 years under Obama while prices continued to rise. Many people, even with subsidies, will not be able to afford any incremental raise in premiums.

    Obamacare is going to collapse because people with few assets acting in their own self interest will make it too expensive for everyone else.

    There may also be politically motivated people who will go without because they want to make a political statement and show their displeasure with a law they see as taking away their freedoms.

    When that happens the Dems will be voted out. Period!

    • Uh, did you read your whole message as you wrote it?

      “the hospitals will go bankrupt or have to close their ERs”
      “If they have no assets and have a catastrophic injury, they lose their job and are then immediately eligible for free healthcare.”

      Where/how do you think they’re going to GET that “free” healthcare? Do you think the doctors are going to keep doing emergency room work if they know they’re never going to get paid? Please go watch Dr. Doug McGuff discuss an ER doctor’s financial life here (including the effects of ObamCare). It’s long but it is SO worth your time!

  37. Someone says, “…it already offended me enough to hear that you do not believe in global warming…”

    I don’t believe in your modern-day religion either. And I too have a strong hard-science background. Science is not supposed to work from ‘belief’, nor from cherry-picked evidence or massaged data. Dr.Eades has conveniently written an article about that very problem… I’d say if anything the global warming ‘consensus’ is even more lacking in objective scientific foundation than the cholesterol ‘consensus’.

  38. Too many people today are looking to the government to solve problems….problems, I might add, that they themselves have created over decades of bad legislation. Why we would want these imbeciles to fix what they broke is beyond me.

    I read the comments about “Tea Partiers” or “Paul Krugman” or “Fox News” or “CNN” and can’t do anything but shake my head. Left vs. Right, Progressive vs. Conservative, blah blah blah.

    When the boot of the government is on your throat, it matters not whether it is a left boot or a right boot.

    To back up Dr. Eades, Obamacare is not about insuring the uninsured. The bottom line of Obamacare is that it a massive redistribution of wealth plan.

    The argument here should not be about right vs. left but one of tyranny vs. freedom. Obamacare reduces freedom and that is what should concern everyone! Instead of figuring more ways to get people dependent and suckling the government teat, we should be looking at real ways to help those in poverty; and those real ways lie in Capitalism (which we haven’t had for decades now so don’t even try!).

    Taxation is theft. Period (to use the word of our fearless “leader”). If you can’t force your next door neighbor to buy or subsidize your insurance, then it is not ok to use the government to do so on your behalf.

    Government is never the answer, unless the question is: What is never the answer?

    • Then what, pray tell, is the answer to China shipping tons of melamine-poisoned cat food — or radioactive wallboard — to the US?

      If you say “the market”, you may have trouble landing the cat owner vote.

      • You don’t think the market would iron that out? I know it would, especially in the internet age with social media. “Hey this stuff will kill your cat. Don’t buy X brand of cat food.” Company X either goes bankrupt because nobody will buy their cat food or they will fix the issue and spend millions to get people to trust them with their cats again. The market works.

      • (I thought you already left in a huff.)

        Do you think “the govt” did anything to PROTECT us from poisoned cat food and radioactive wallboard? Are you suggesting that China did NOT ship us that poison? That animals in the US were NOT poisoned by the … you know… Chinese poison that had already been shipped here? The govt *reacted* after the fact — and that isn’t protection, that’s clean-up!

  39. I am a RN working in the trenches in the hospital and I am very upset by the suggestion to not carry insurance “until you need it” as I have seen the tragic consequences of people suffering accidents without insurance. What if your friends kids get in a car accident that requires multiple surgeries and a long stay in the pediatric ICU? The cost of the interventions and days in the hospital until the parents can secure insurance (in the midst of their vigil) will cause the family to be bankrupt. No one thinks it will happen to them, until it does. Extremely irresponsible to suggest this, doctor!!!
    I am not upset that you are wading into politics, but I am upset you might be encouraging people to live without insurance: something that could ruin their lives…

    • Josie, I’m already living without insurance. I have no choice.

      My husband died suddenly (heat-stroke-related heart attack at age 60) in 2011 — thankfully, the court wiped out his debt (but not mine) — including the hospital, doctor(s), and ambulance bills (about which I feel guilty, but could not possibly have paid anyway). I an frantically looking around for how to protect myself from this onerous and impossible “penalty” — I can’t possibly afford to actually pay for insurance. (Well, my own insurance; obviously I’ll be paying for OTHER people’s Commie-Care coverage…)

      I barely skirted bankruptcy and complete (financial) destruction of my life when I had a kidney stone in 2012. As I’ve mentioned above — NONE of the insurance polices (that I can’t afford anyway) would have given me a penny towards the huge, huge costs of that ER visit. (OR any follow-on/actual treatment – which I did not get because I could not possibly afford it!)

      If Dr Mike — or anyone else — can find a way for me to keep my as-yet-unstable (financial) recovery by carrying on without insurance, I’m all for it. (The kidney stone is long gone — thank … well … Big Pharma for strong painkillers!) Alas, there is no ‘escape’ — so I’ll be paying the penalty and STILL not having health insurance! (God help me, cause the govt sure won’t!)

  40. Also, I would add that the cost to your friend on the Bronze Plan is likely to be lower than the silver plan mentioned above, possibly bringing it close to his current $300/month. And in regards to that $300/month premium, my guess is that he never really had need to use his insurance plan, correct? In my experience, under the old system if you ever dared to actually use your insurance, your premiums skyrocketed upon annual renewal. That’s another thing that the AHA has put a stop to, which I do believe is going to benefit everyone in the long run.

  41. Ah, nothing like a post about politics to bring out the True Believers in the Religion of Leftism. You see, they only liked you for as long as they could imagine that you agreed with their politics, or had the “good taste” to never, ever say anything even remotely political if you disagree with them. It doesn’t matter that they find that your posts on nutrition are trustworthy and useful. If you don’t also agree with the Dogma of Democratic Talking Points, without question and without reservation, you will be accused of being a Fox-watching lunatic rightwinger and SHUNNED. It won’t matter if they think you’re right about nutrition: you are now a heretic, and the works of heretics are forbidden. Debating with heretics about facts is forbidden. The only appropriate response, when someone reveals themselves to be a heretic, is to let him know that his crimethink has caused the good religious leftist to designate him as an unperson who will henceforth be totally ignored.

    It’s never okay with political cultists for you to disagree politically with them. They’re very careful to never expose themselves to any kind of political disagreement, which is why they will have to start absolutely ignoring you entirely now, in case you ever espouse any other heresies.

    Those of us who are not political cultists thank you for your courage in writing about this controversial topic, especially your willingness to engage in conversation with those who dare to face uncomfortable facts!

  42. Yeah, right … if people get subsidies, then everything is just ducky. Let’s review:

    1. You had high-deductible insurance that suited your needs. You paid for that insurance yourself.

    2. Despite His Highness promising over and over that you could keep your insurance if you liked it, we The Anointed decided you can’t keep a “noncompliant” policy if it was signed after March 23, 2010. (I signed mine two days after that. Woops.)

    3. You are now required to buy a “compliant” policy … you know, because at age 55, you really need that maternity coverage. The “compliant” policy, of course, costs WAY more. (In my case, the premium would go from $369 per month to more than $1,200 per month. That’s an extra $10,000 per year for coverage I don’t want or need.)

    4. You say that premium is too high? Oh, don’t worry … we’ll now happily put you on the latest form of welfare! Yup, you get to go from being a self-supporting and responsible adult to being a burden on your fellow taxpayers. Just what a country that’s $17 trillion in debt needs — millions of new middle-class welfare recipients.

    5. Oh, wait … you mean you earn over 400% of the poverty line? Well, you idiot, that’s what you get for working hard. You don’t get a subsidy. You get to pony up that extra $10,000 per year for coverage you didn’t want or need out of your own pocket. Perhaps you should consider dropping your income by $5,000 or so. You’ll come out ahead. We don’t mind introducing perverse economic incentives into this robust economy.

    6. Either way, we took away your insurance, so if you don’t want to be uninsured, you need to sign up online. Don’t worry about those IT security experts who testified that the web site has virtually no security and is a hacker’s dream. We don’t think anyone will steal your identity or anything like that.

    7. Look at those great plans! Lots of coverage you don’t need, with higher deductibles than your old “junk” policy! So that knee surgery that cost you $2,000 out of pocket will cost you $6,5000 if you need another one. Let’s see … an extra $10,000 per year in premiums, plus an extra $4,500 if you need surgery. Yup, what a deal! In just three years with another knee surgery, you saved $34,500. Wait, sorry … it would cost you an extra $34,500. But you get the idea. We’re really helping you out here. It’s not as if you should be putting that money into your retirement fund or your kids’ college funds. We’ll happily lend your kids the money for college so they can graduate with $100,000 or so in debt. Since employers are cutting people back to 29 hours per week to avoid the ObamaCare mandates, your kids won’t mind paying back that debt on a part-timer’s earnings.

    8. By the way, we haven’t actually built the payment part of the system and we just discovered that the back-end code is so badly written, perhaps a third of the people who signed up aren’t actually enrolled with an insurer. We don’t have any way of identifying who didn’t actually get coverage despite signing up on the web site, so you’ll find out when you end up in a hospital with a torn ligament in your knee and require surgery. Sorry about that.

    • Tom,

      Great points.

      People who are living pay check to paycheck may do nothing because they know they will not be turned away from the ER if they have an injury.

      If enough of these people go without insurance (and there are millions of them,) it will cause the system to collapse because they will not be paying premiums and the hospitals will go bankrupt or have to close their ERs because the number of uninsured they have to treat will not go down and may actually go up. This is especially true in low to mid income areas.

      How many people are driving around California in cars that are uninsured even though it is against the law? The answer is 25%.
      Are these people going to buy Obamacare insurance before they buy car insurance?


      If they have no assets and have a catastrophic injury, they lose their job and are then immediately eligible for free healthcare.

      Even many of the very poor who are eligible for 100% free coverage are not going to sign up because of the hassle. They are not computer literate, can’t take off work or be bothered to stand in line to get help. They also know they will not be turned away at the ER if they are very sick. So even though they were eligible for free coverage, because they didn’t sign up…the hospital is still stuck with a bill they can’t collect.

      One of the ways Obamacare was sold was if everyone was insured, it would take the pressure off of ERs getting stuck with bills from people who were never going to pay them.

      As it stands now, there are more people becoming uninsured than insured with Obamacare. That is certainly going to be true on January 1, 2014.

      Average household incomes have declined in the last 5 years under Obama while prices continued to rise. Many people, even with subsidies, will not be able to afford any incremental raise in premiums.

      If they have a job but were uninsured, they may not have the incremental extra thousands of dollars it is going to cost them for coverage even if they are subsidized.

      The young who voted for Obama are turning on him now that they see what is going to cost them personally. He was great as long as he was promising them benefits and giving someone else the bill.

      Obamacare is going to collapse because people with few assets acting in their own self interest and going to go uninsured and that will make it too expensive for everyone else.

      There may also be politically motivated people with who will go without insurance because they want to make a political statement and show their displeasure with a law they see as taking away their freedoms.

      When that happens the Dems will be voted out. Period!

      Loved your documentary.

  43. @Tom – your comment about insurance company profits and CEO’s are not as knee jerk as the comments about government? The insurance and healthcare industries are regulated. Every word of every policy is regulated, every premium is approved by a governmental agency. There is a misconception that insurance companies operate willy-nilly with little or no oversight. They are among the most regulated industries. Healthcare is also regulated by county, state and federal entities. Just saying…

  44. Oh for pity’s sake. Re the UK and the Canada systems, Yes they have problems, I have lived with them both. Americans have the weirdest idea of what “socialised” medicine is like. Even the word “socialised” is enough to set a lot them frothing at the mouth. Never mind taxes. Sure there must be incidents in Canada such as the one mentioned earlier, someone dyeing waiting for treatment but it’s absolutely, definitely, not the norm. We don’t lose our homes when we lose our health, we don’t end up hundreds of thousands of dollars in debt, and believe it or not, when we get sick we go to our doctors and get treated…..for free. Americans have the quaintest notion that they have complete control over their lives, they work hard and pay their way and so nothing will go wrong. And then….surprise surprise someone loses their job, gets sick and loses everything. Well, must be his own fault eh. That seems to be the prevailing belief.

    I notice too that when there is a disaster, as the U.S. has experienced in the last years, people are only too happy to accept help from the government, they expect it. Good thing someone pays their taxes.

  45. @Maureen — That is exactly what a high-deductible plan like mine prevents: losing my home and going hundreds of thousands of dollars into debt. My maximum financial exposure with that plan — assuming every medical disaster under the sun — was $10,000 in a calendar year. The one time I actually needed to tap the policy — for knee surgery — my contribution totaled $2,000.

    So His Highness banned me from buying an affordable policy that would prevent me from going into massive debt and is ordering me to spend an extra $10,000 per year for “insurance” I can’t possibly use. (Maternity care? Seriously?) The plan His Highness approves also has higher deductibles should I need surgery or cancer treatment.

    So … $369 per month, or $1,200 per month with higher deductibles. Under which scenario am I more likely to go into debt and lose my home?

    • Tom Naughton, I’m curious — did you ever refer to any previous President as “His Highness”?

      You are aware this act was passed by Congress, and has been blessed by the Supreme Court?

        • While I agree both sides say very nasty things about each other – the very Liberal MSNBC CROSSED THE LINE last month when Martin Bashir suggested in a on the air prescreened commentary that someone should defecate in Palin’s mouth because of a remark the former vice presidential candidate made comparing the United States’ indebtedness to China with slavery.

          Really NBC?? You own MSNBC and no comment?

          Bashir was a very respected reporter and came to MSNBC in 2010 from ABC News’ ”Nightline.” He had joined ABC as a correspondent for “20/20.”

          Where are (Bashir’s) bosses at NBC and how could they approve something so vile?

          What’s happened to our big three “NEWS” outlets? All sides need to clean up their acts and get back to reporting the NEWS not hate …

      • No, I didn’t refer to a previous president as His Highness. I believe my term for Bush was “that idiot.”

        I refer to Obama as His Highness because after Congress passed “the law of the land,” His Highness waved his magic scepter and pronounced, “This is the law of the land. But I grant thee an exemption, and I grant thee an exemption, and I grant thee an exemption. And I hereby declare a delay for this group, and a tax break for that group. But everyone else has to comply with the law as written, because it’s the law of the land.”

        That is how kings treat laws, not presidents.

        Congress passed the law based on what we now know was a huge lie. A law passed under those circumstances isn’t valid in my book. Nor is a law that doesn’t apply equally to everyone.

  46. > So, if you are healthy, just go without insurance. Pay the $95 fine

    I strongly suspect BHO will informally instruct the IRS to punitively target those that elect to simply pay the fine for retaliatory tax audits. Barry is small and petty “man”.

    • It’s not $95 — for me it’s $630 for 2014. Almost no one will pay “$95” that’s just another of the Obamination’s lies!

      See, to pay only the $95 penalty? You have to have income of only $9,500 this year. Otherwise, it’s 1% of your income.

  47. I am so grateful to live in a country with universal medical coverage, Australia. A hospital visit or serious illness does not have the threat of bankruptcy

      • wow. really, Dr. Eades? You are revealing yourself to be a real mean-spirited assh*le. now I myself am glad you brought this issue up…. so that I can promptly unsubscribe from your feed and encourage my friends to do the same.

        I hope you got what you wanted when you decided to turn your blog into a place to promote your right-wing bullsh*t.

        BTW – I work in a public policy school in Washington DC. Just for giggles, I showed one of the professors of health policy your post here on Obamacare. He emailed me back “that was good for a laugh”.

  48. Tom Naughton pretty much nailed it – most Americans are not really enthusiastic about being pushed into a welfare health system that will deliver crap-care like Medicaid.

    If the New Jersey populace is any indicator, socialized health insurance is not what floats their boat. Only 741 people from NJ signed up for Obamacare in October, and in contrast, over 50,000 signed up for a new online gambling program in one week (see: http://www.nationalreview.com/article/365559/roll-dice-john-fund).

    Obamacare “success” is looking like ‘New Coke’ and the Edsel combined.

  49. I too have a story that I think you would enjoy. This doc lets call him Doc Jones. He has a really good practice making a lot of money. Then along comes Obamacare and he says darn look at all the money I will lose. How? Simple. Doc Jones sees 40 people and charges them 100.00 each thats 4000.00. Not bad for a days work but now he has to pay taxes on the 4000.00. How did Doc Jones solve this problam. He said well if I see 20 people and don’t charge them 100.00 out of the goodness of my heart ( ya right) then I can write that off of my taxes as a lost. AHHH but then comes Obamacare and almost every one will be covered so where to find 20 people for a tax lose. Hmm. Guess our Doc Jones just lost his tax brake, but we know he never ran his practice this way. He was to proud. Not really I say thats the reason all people in the medical field are up in arms. There loseing there tax write offs. You people have a great PR. Lets see it goes “do no harm” but really its ” do no harm to my pocket book”

    • Hmmm. Not only do you verge on being illiterate, you’re completely out of your mind. Not only does the medical profession not work the way you describe it, the tax laws don’t work the way you describe them.

  50. Wow. “The new group of uninsured were going to be the hard working families who lost policies they liked and could afford, but who couldn’t afford the new policies available to them under Obamacare and now have nothing.” Gee, that “NEW” group looks an awful lot like the “OLD” group to me. The implication is clearly that the ‘old’ group wasn’t hard working. You know, those of us who worked for major corporations that shipped our jobs overseas (Thank you President Bush for giving them incentives to do so.). Yeah, us. You know, the ones who are working away trying to make ends meet and cannot afford insurance and guess what? More and more jobs don’t offer insurance. Sorry and sad that your friends are affected but seriously, instead of bashing the one attempt that has been made to provide coverage, you might, I don’t know….support the effort or come up with some alternatives, do something productive to move the effort forward? We finally get a president who sees that millions are going without coverage and tries, and people stand in line to bash. I just cannot understand this. If people put as much effort into trying to find a solution as they do in ripping any effort to create one, we’d be golden. Much as I have learned from you, this points to where we diverge. I have no interest in feeling sorrier for your friends who finally have to adjust like I did or many millions like me than I do for those I worked and currently work with. The only thing you got right is going without insurance makes sense. I already pay my naturopath out of pocket, why change that. But honestly, boo hoo…. We all work. Not just you and your friends and we all should have equal access to insurance. It amazes me that you are more concerned that your friends lose inferior insurance that wouldn’t cover things they need (or it would qualify under the Affordable Care Act), than you are that they wouldn’t be covered if they had that insurance and something happened.

    • I think this “hard working” euphemism is a key aspect to Dr. Eades’ post, and not in a good way. The idea seems to be that the non-hard working (the bad people) don’t deserve to have health insurance anyway, while the good Americans get to pick any plan they want.

      Unfunded health care is not just an individual disaster, it is a societal disaster and an uncontrolled mess. The simple way to see that is that people without insurance still get treated and still get billed. And billed a lot. They just do not pay. Who pays for that treatment? The rest of us pay for it. The work done to save the patient and the charges and costs incurred do not just evaporate and disperse. They get paid by everyone else, in a haphazard and uncontrolled way.

      Dr. Eades seems to willfully ignore that aspect of the problem, or simply does not care. I do not think this reflects so badly on his nutritional advice, but it does make me wonder about his lack of worldliness. A lot of “successful” people seem to truly believe that they did it on their own, and that they alone are responsible for their success. The world is not so simple.

      The lesson from medicine could be that everything is interconnected, and that there are multiple feedback loops. Or we could take note that the countries that have more inclusive medical coverage seem to be doing just fine, and certainly are not collapsing under the weight of “socialized” medical care.

      • You would do well to read Bastiat’s essay, That Which is Seen and That Which is not Seen. Not just read it, but understand it. Then tell me how wonderfully well those countries with socialized medicine are doing.

        I worked for several years as an ER doc, and I am extremely familiar with how the indigent or those who simply don’t want to pay for medical services abuse emergency rooms. Hospitals depend upon Medicare reimbursement to survive, which means Uncle Sam calls the tune. And Uncle Sam says to hospitals, If you want federal funds, i.e., Medicare reimbursement, you’ll have to see anyone who shows up at your ER for any reason irrespective of whether they pay or not. So, people end up using the ERs as their primary care physicians. Unlike what you see on TV dramas, most of an ER physicians shift is taken up with upper respiratory infections, sore throats, urinary tract infections, and a host of other problems that aren’t really emergencies. In fact, emergencies aren’t all that common unless you’re in a large inner city hospital. And even those have tons of basically primary care visits. The people without insurance typically never pay, so the rest of us pay for them, and they get free care.

        The indigent have figured out how to work the system. I don’t worry about them. It’s the working poor who honor their commitments who get screwed in the current insurance system. I’m not talking about Obamacare here, I’m talking about the insurance system pre-Obamacare. Obamacare may screw them even worse. Only time will tell.

        • A letter to the editor in our local paper said that he had recently visited a local hospital after agreeing to help a friend who required hospitalization.. He was immensely impressed with the hospital, and expressed that opinion to a hospital pastor standing behind him in the cafeteria line. The pastor said “Yes, it is” but without missing a beat he added, “and 44% of the people who get services here don’t pay.” The author of the letter, who was from Canada and thus fully insured, wondered who paid for those 44% who couldn’t afford insurance (and I will add who could afford but didn’t want to pay for insurance.). I’m pretty sure the question was rhetorical.

        • I think you are referring to Medicaid, not Medicare…what would happen if these poor people had insurance so they weren’t clogging up the ER? A large part of the ACA is the expansion of Medicaid, which provides coverage to these people, which of course you are against.

  51. As I read it, the penalty is a bit steeper than $95. It seems it would be $600 for this family this year and $1200 the next. Still cheaper than $3600, though.

    • Well… unless something happens. The $600 — $640 in my case — does NOT include health insurance; so it’s still just one small slip from the cliff-edge!

  52. SOMEHOW, through some alchemy or science we can’t quite grok, the rest of the “developed world” figured out how to do this. Me, I live in a Lefty state near Canada, and I’ve gone there a few times for care. Nice place! Good doctors! The docs are way less motivated by their stock portfolios.

    Obamacare is a good example of what happens when you “compromise”. I’d probably just fire the insurance companies and go for it.

    I happen to have one of the best insurance available. The docs suck. In 20 years, only ONE has given me a solution that works. That one (a temp) mentioned using heat to get rid of MRSA … which worked GREAT. The others were all about “take this drug” (which usually did not in fact work long term).

    We do have really GOOD doctors and I am proud of them, esp. in the emergency room, after a bad accident. OTOH, I had chronic sinusitis which I FINALLY cleared up after 30 years … using xylitol + salt. But the doc’s (a highly recommended ENT) only recommended a powerful antibiotic, clindomycin, for a month. The xylitol actually works better, and has about zero side effects.

    I’m not sure how to feel about all that. I’m happy that my sinuses (finally!) work. I’m not happy that my ENT doesn’t know that xylitol actually works.

    I’m not against Obamacare. May be the best we CAN do in this country. But it won’t fix the fact that insurance companies, drug companies, and malpractice insurance rule our health care, at this point.

    • I live in a lefty state near Canada and know some people who immigrated from there. They are impressed at how much more promptly doctors can see patients here in the U.S. – or at least they were prior to Obamacare.

  53. Dr. Eades, I’m disappointed in the quality of this post. You claim to have read extensively on Obamacare, but you were uninformed in regards to the tax credit and enrollment periods, two cornerstones of the law’s administration, not to mention the continued existence of HSAs (which as far as I can tell are going to grow in importance as employers push employees towards high-deductible plans). Essentially, you’ve presented us with a half-baked idea. I’ve come to expect much more from your writing.

    Regardless of politics, I think all readers of your blog can agree that the US wouldn’t be such a miserably unhealthy country if it weren’t for the interference of the government in nutritional guidelines and farm subsidies. I’d be interested in hearing your opinion on an alternative to the ACA (as you alluded to in an earlier comment). As a physician well-known for treating patients with a nutrition-based approach, I believe you have a particularly interesting point of view to offer.

  54. As I write this, I see you have already had 130 comments, which I plan to read a little later. For now, I wanted to tell you that at my job, because of Obamacare, the cost of our coverage is now dependent upon certain health markers. As a male, if my waist is more than 40 inches, my fasting glucose above 109, my blood pressure more than 130/80, OR my total cholesterol above a certain number that currently escapes me, then I am placed in a higher risk category for — you may have guessed it — Metabolic Syndrome, which is what’s driving up the cost of our health care here at work.

    Having followed a lower-carb plan for a while with success, I eventually became lazy (which I really enjoyed your previous blogs about why that happens) and went off plan, ballooning back up to my previously unhealthy self. When we got news of these new, minimum requirements, I literally that day purchased the latest paperback copy of PP at Barnes & Noble and have been working the plan with great success ever since.

    Several of my friends are experiencing the same thing in their workplace. One of them, in fact, is having to attend “education” sessions with a dietician, a personal trainer, and an MD just to the coverage she already has and not be booted into a high-risk category.

    BTW, I hope your insurance plan isn’t “too good”, because you’ll then have to pay that “cadillac” tax!

    • I would love to know what company is providing you a completely non-compliant health plan “as a result of ObamaCare”. Since preexisting conditions no longer apply, there are no health questions to be answered, and so no dependence on health markers, no high risk category.

      Here in Oregon in fact the state run high risk pool is ending at the end of the year, and all those people will be moved into the same rates and plans as everybody else, and that is a result of ObamaCare.

    • @Lee: Providing incentives to help yourself is one of the NICE things that institutions can do. Right now, neither the drug companies nor the doctors have any intrinsic reason to make the patients actually get well. The sicker you are, the more business. The insurance companies and the companies that pay for insurance, are the only ones with real incentive to make you healthier.

      The Canadian and German governments do a fair bit to keep people healthier. The German government, for instance, paid to have real studies done on herbs … which ones really work? In what dosages? The Canadian government did advertising for vegetables.

      In my local area, our local electric utility is run by the local government. Unlike with Enron, they encourage everyone to install efficient heating, solar panels, etc. so you use LESS of their product. They also do all they can to save us money, including dragging Enron through a lawsuit for overcharging.

      I’d personally rather have a single-payer system, but I’m encouraged that AT LEAST I can’t get booted off health care for stupid reasons.

  55. Dr. Eades, what would you offer as a solution to the health care mess?
    I apologize if I missed it above.

    I do not personally see anything of value added to the system by the Health Insurance industry, only value removed. I’ld be for some sort of common sense single payer. I’ve read some of the information from PNHP that resonates with me, but I’m guessing you don’t agree with them.

    This is meant as a legitimate question – I would be interested to hear your opinion of what would solve so may of our current problems. Or do you feel the pre-ACA was, while not perfect, total acceptable?

    Thank you,

    • I didn’t mention it above. I said it was not something to dash off in the comments section where it wouldn’t be read by all that many people. But I would start off by repealing the McCarran–Ferguson Act. That alone would change the complexion of the whole insurance situation. Insurance companies are exempted by the act from many of the anti-trust provisions that govern other businesses.

      • The exemptions from antitrust law are of course problematic, but McCarran Ferguson’s exemptions from federal regulation are what allow life insurers to look at the risk factors that actually cause death instead of those that are condemned by the “health authorities”. This really came home to me when I got life insurance at considerably less than the average cost due to low TG/HDL ratio when my doctor was talking about statins due to high TC.

      • And to be constructive, I’d suggest that the first thing to repeal is the tax free nature of health insurance when provided as compensation by employers. That tax status is part of what slants the entire system towards treatment of diseases after they happen, rather than prevention before they happen through things like diet.

  56. So let me get this straight. Our healthcare system was bad, costs were skyrocketing due to uninsured people going to the ER where they had to be treated costing 10’s of billions per year.

    In order to fix this, the solution is to create a behemoth of a federal bureaucracy, which costs hundreds of billions of dollars, in order to administer a system which is stripping health insurance from those that already have it and like it (PERIOD), offers “new” plans that have worse coverage (maternity for guys?) and cost more, uses money stolen from other Americans in order to “subsidize” the higher premiums brought about by the law, encourages doctors and hospitals to not participate by lowering the payments they receive for services…often below the cost to provide those services, and provides disincentives to work hard and do better?

    The real solution? Let’s quit using “insurance” as pre-paid medical care. Let people talk to their doctors one to one without “insurance” in the middle. I call it the “Doc Hollywood” method. Doctors would have a menu of services and the costs associated with them. Doctors could then compete in the market for patients thereby driving costs down. Insurance policies would be for catastrophic events, as it was intended. Do we use insurance to maintain our cars? No, it’s for accidents.

    As for the poor, we as a People, should choose to care for the poor ourselves because it is the right thing to do. Having the government steal money from people and care for the poor doesn’t make anyone magnanimous. Doctors could treat the needy for free. Hospitals as well. This is America. We can do anything….without the government

    I see a lot of promise in the “Concierge Doctor” where an annual fee is charged by the doctor and then a small co-pay at the time of the visit. Tests are paid for by the patient. The patient gets the care they deserve at a price they want.

    There are better solutions than a giant government bureaucracy and the initiation of force upon our fellow Americans.

  57. Dr. Eades,

    Nice article. As others have said the penalty is $95 per person and $47.50 per child or 1% of income and it eventually grows to 2.5% of income.

    The subsidy is only on the books for one year at this point. I am sure it will be extended but it is not forever and all those plans have deductibles and co-pays. So those who think they are going for free will still have to pay out of pocket and they won’t do those wonderful diagnostic tests and screenings because it isn’t free.

    People who are attacking you don’t know what they are talking about. Doctors and hospitals are running away from this program in droves. The people who say that the Government will pay subsidies or credits are correct, but they get that money from the penalties and Medicare/Medicaid cuts which in turn they take that money from the reimbursement rate to the physicians. More doctors therefore will move from serving the aged and poor. We will soon have two systems in this country. One for the poor and and one for the wealthy. Those of us in the middle will have to get in line with the poor as we can’t afford what the wealthy and unions can.

    People who think insurance means care are just ignorant. Insurance is merely a payment system and this new system dictates the rules of engagement which de-motivate the doctor. I want my doctor to want to see me, I want him/her to know me and I want to trust they are doing all they can. I am afraid I will be thinking they are doing as little as possible to get me out the door in order to see more patients so as to keep their revenue at least where it was last year even as they have increased costs.

  58. Dr. Eades –

    Hey there! I’ve been a log time fan and was surprised to see you on the Wall Street Journal. You may be in for deluge. :)

    A complete “hack” might look like this: If you can’t afford medical insurance, check the bankruptcy laws of your state. Most states protect cars, houses, and tools of the trade. (Do not run up credits cards etc thinking they’ll be discharged in any bankruptcy for medical reasons, because that’s fraud and they won’t.)

    Used money saved from premiums is used to pay for the provider of your choice. (Especially preventive measures.) Ask the office manager for cash discounts or to be billed whatever the major insurance carrier in your state is paying. Emphasize that you’re in this position because the insurance premiums have become too high but you can write a check on the spot.

    Go to any near hospital in the event of accident. When they send the bill for $200 per aspirin, write the billing department and ask for a reduced bill. They’ll send you paperwork about your net worth. Reduce your bill as much as possible through their formal write off/reduction system.

    In the case of chronic illness, go to the best system that will take you. Hold off collections by calling the billing departments and arranging small payments you can send on a regular basis. If they suggest unaffordable payments, state what you can pay even if it’s $10 per month. Many hospitals have private endowments to deal with it. (That’s why they overcharge in the first place, by the way, is to deal with write offs.)

    If bills from the above become too high, work with a lawyer and declare bankruptcy. If you have a chronic illness, enroll insurance during the next open enrollment.

    Basically the ultimate “hack” after Obamacare is the same as the one before: bankruptcy. It’s not pretty but unfortunately like your friends they are going to have to rely on it when they would have rather been responsible by insuring and spread risk. At least they will have more money to actually pay providers, even with the fine.

    • I’m guessing you’ve never actually looked into bankruptcy?

      Sure, you might be able to keep your car — depends on the state you’re in — but only if your car is worth below a certain dollar value (and it’s a low, low dollar value)! Yes, in Florida you can keep the house regardless of its cost — which is why all the Enron mgrs and OJ Simpson live down there; but in other states? Not so fast! Do you have dependent children still at home? That sometimes matters. And how many people do you know actually have ‘tools of the trade’ nowadays?

      “In the case of chronic illness, go to the best system that will take you.” And if that “best system” costs more money that you have or earn (remember: you’re chronically ill) … your suggestion is ‘just’ file bankruptcy. “Chronic” means long-term, lots of care. Bankruptcy is a one-time (and not available again for many years) event. So, the very day after you filed bankruptcy (well, after a few months more, until the court allows it, if they do), you STILL have to somehow buy your chronic care needs.

      And since you still have a chronic condition, and still have to pay for that care — then what? No credit cards, you STILL can’t afford insurance (which means you have to somehow pay that lovely Commie-Care penalty…) and now you’re trying to sell your house (if you haven’t already lost it) in a down market…

      ‘fraid your suggestions are NOT good ones…

  59. When I finished reading the “Hacking” article, I looked for an Update: but didn’t find one. So I thought, how could someone like Dr. Eades write something so spectacularly unresearched, leading to so many wrong conclusions? Then I read the comment by the poster that said that Rush Limbaugh had already figured out this “hack,” which further confirmed the lack of research done. Then I read the post about his being unware his friend in the UK could get D3 online, then the one with his stand on global warming, and not only has my hero worship of him taken a deep hit, I have begun to question his ability to think deeply and analytically. I’m not sure I’ll ever be able to read another article written by Dr. Eades without thoroughly verifying the research.

    .Sure, the ACA is a complicated mess, but it’s the only thing that could get past our dysfunctional Congress. It’s certainly not the plan that most liberals would have chosen. It’s incomprehensible to me that ANYONE, much less MANY of the posters, including Dr. Eades, cannot see the long-term consequences of young, healthy people not sharing in the risk pool for the purpose of insuring everyone, not only against illnesses and accidents, but also against medical bankruptcy. It’s as if these posters actually believe that these healthy young people won’t ever be old, be in an accident, or become diseased.. When reality hits, my guess is they will be glad others are helping to pay their costs. The ACA will profoundly affect the lives of Dr. Eades, his peers, and his patients. The least he could have done before writing such a critical article was a cursory review of the freely available authoritative facts, instead of relying on the “facts” as supplied by talking heads on television. As a side note, doctors and hospitals long ago gave up gave up their right to complain about interference with their practices when they refused to grow a spine and stand up to the private HMOs that have most of them practicing in lockstep and substandardly.

    • I just have to wonder about what could have happened if the right wing of congress could admit they lost, that they accepted that the ACA is really a law, and that it’s not going away. And then rather than 40+ useless votes to repeal which every single time had 0% chance of passing, they work together with the other side to fix the problems and improve the law. You know, like do-their-jobs? After all, they did take an oath to uphold the laws of the land, not to fight every single thing the president wants, simply because he wanted it.

      Reminds me of a time when the right wanted to de-fund birth control. Rather than spend money on a condom, they would instead have some expectant (poor) mother show up in the ER for her delivery (of course she had no pre-natal care, so higher chance of complications) then pay for ongoing ER care (since this mother likely would be uninsured, nowhere else to go when the baby is sick) school, food stamps, welfare and maybe eventually, prison costs. And then whine about the poor feeling entitled.

      • I can’t think of a major law that was passed on a strict Republican vote. There probably were such laws passed, but I can’t recall them. But if there were such a law passed that violated the basic principles of the Dems, would you want them to cave and go along with it or would you prefer them to fight it tooth and nail?

        • After the supreme court validated it, after another election where the law was one of the main campaign issues, and Obama said “if you like the health care law, vote for me, if you don’t, vote for my opponent. The people have spoken, you guys lost again (by a substantial margin), it is here to stay, get over it. Are there problems in the law? Absolutely.
          What I am suggesting is that republicans earn their $170k+ salaries for a change and work together with democrats to fix problems, improve things that need improving. Voting 46 times to repeal is nothing but a complete waste of time, accomplishes nothing.

          I’m glad we have opposing views in the government, but at the end of the day both sides should come together and compromise, work for the benefit of the American people, which is their job, not to whine and complain, and to say no to anything uttered by a democrat, particularly our black (that has nothing to do with it, say our red former slave states) president.

      • Gary, the “law of the land” is the CONSTITUTION. Just because a bunch of imbeciles in black robes say something is Constitutional doesn’t make it so. The States have the ultimate authority and can and should nullify laws they deem unconstitutional. If the Supreme Court said gun confiscation was constitutional would you hand your guns over willingly (based on your comments, you probably don’t have guns…but I digress)?

        • Incredible.

          You may be shocked to learn that those imbeciles are mentioned in the Constitution. Which is on the net, available for reading. You can navigate to it as easily as you can find those prepper blogs you frequent.

          • @Tom


            You may be shocked to learn that the Constitution (on the net, available for reading) does NOT specify that the Supreme Court is the final arbiter of what’s constitutional. The court assumed that power for itself in Marbury v. Madison.

            Jefferson thought the states should be the final arbiter of what’s constitutional and wrote this about Marbury v. Madison:

            “You seem to consider the judges as the ultimate arbiters of all constitutional questions; a very dangerous doctrine indeed, and one which would place us under the despotism of an oligarchy. Our judges are as honest as other men, and not more so. They have, with others, the same passions for party, for power, and the privilege of their corps…. Their power [is] the more dangerous as they are in office for life, and not responsible, as the other functionaries are, to the elective control.”

          • Looks like the Supremes are going to get another crack at ObamaCare. I suspect Roberts won’t be so concerned about how the SC might look politicized this time.

          • Tom, show me, in the Constitution, where it is the Supreme Court’s job to determine the Constitutionality of laws passed by Congress.

            Don’t worry, I’ll wait.

            Oh, wait! What? It isn’t there? That’s because the Supreme Court took that role for themselves in Marbury v. Madison circa 1803.

            Having the Supreme Court determine Constitutionality is like having the assistant coach of a basketball team referee the games his team plays it. He may claim impartiality, but there will no doubt be some bias.

        • Ah yes, private gun owners are the only thing keeping the evil Kenyan, muslim, terrorist loving communist from declaring martial law and enslaving the population. As if you would have a chance against the military in such a ridiculous scenario.

          • Ah yes, there is only one reason why someone would want to take away guns from honest, law-abiding citizens. And, in my opinion, I’m betting that over half the military wouldn’t be on the “evil Kenyan, muslim, terrorist loving communist[‘s]” (your words, not mine) side.

            It also always fascinates me to no end how people on the right are always called intolerant yet it’s not intolerant for the left to call names and denigrate other beliefs (whether religious or political).

            Kudos Garry. I’ll pray for you.

          • Great point, Garry. Because as you know from your careful reading of history, powerful armies have never turned tail and retreated after learning the hard way they couldn’t control an armed indigenous population.

          • I remember in college during the Reagan years having to sit through an “activist” spiel about how the gov’t was building all these giant prison camps to reign in all those in opposition, the country was about to be put under military rule any day, and on and on. The difference now is the enemy is no longer Reagan, now it’s Obama (my terminology above coming from the right) who is supposedly doing the same things.

            This was a totally delusional idea then, still is now, and will be during the next presidents term.

            And BTW, when has Obama ever tried to take away a single one of your guns? I think what you really need to worry about is if he takes away all your tinfoil, then you will have no protection from chem trails, the new world order, and of course agenda 21 which calls for killing 6 billion people. That’s assuming the grey aliens don’t get to you first of course, they secretly conspire the gov’t too.

          • Garry, you are making some huge assumptions. I am neither Republican nor Democrat. I don’t believe in chem trails, nor do I know anything about Agenda 21 other than the name.

            Not really sure what names anyone has called Obama on this page other than “His Highness” which isn’t pejorative.

            It is stunning to see how many people fail to understand freedom and choose to worship at the feet of the State. Garry, you appear to be a high priest in the Church of the State. Which is cool with me. It doesn’t make you right.

            I on the other hand believe in rugged individualism, charity, and personal responsibility. I believe my way is better than your way, that doesn’t make me right.

            Your continued insults demonstrate that we have won the battle. You have yet to refute any of our facts concerning your original claim that per the Constitution, the Supreme Court decides the Constitutionality of laws passed by Congress. I assume it is because you can’t refute them and therefore you are left with name calling and mocking.

            I, for one (and I assume Tom Naughton as well), will not be deterred by name calling and mocking. Facts are facts and the truth will set you free. Sticks and stones…etc.

          • The name calling you refer to only comes from the right wing media, all I did was combine things they say all the time, look at the numbers of repubs that call Obama is a muslim, or a communist, or a socialist, or insist that he was born in Kenya, or “he pals around with terrorists”. Tea party rallies inevitably have posters portraying Obama as hitler, or dressed up in a loin cloth with a spear in hand, and/or other similar themes.

            What I really think is that simply because something is connected with gov’t doesn’t make it wrong or evil. Government should do the things that private businesses can’t. I’m all in favor of capitalism, I’ve owned businesses that I started from scratch. Can gov’t overreach at times with too many regulations? Of course. But consider the alternative, leaving BP to police it’s own oil spills for example, or how about the unregulated fertilizer plant that exploded in Texas, next door to schools and homes. I for one like my food inspected, just last month…”the USDA had cited Foster Farms 10 times for noncompliance with safety standards after inspectors found “fecal material on carcasses” along with “poor sanitary dressing practices, insanitary food contact surfaces, insanitary nonfood contact surfaces and direct product contamination.” Yum, what do you suppose those plants would be like without the evil gov’t inspectors?

            Other countries around the world have partnerships between gov’t and private industry, they are stronger and more successful together. Every time? Of course not. Not all business ideas work, private companies fail all the time. But when they don’t have an ideological bunch within that gov’t that wants nothing other than to torpedo anything and everything the incumbent wants, they can be, and have been, very successful.

            And to get back to the original discussion topic, I do think we should have universal health care in the US, like every other “rich” industrialized country in the world. And yes, I think gov’t has a role to play in that coverage.

          • Um, Garry … do ya happen to remember when Democrats held hearings in Congress last year and proposed banning all sorts of “assault” weapons? They didn’t succeed, but unless you were in a coma, surely you remember they tried. They would happily take away my guns if they had the votes.

            Yes, it’s ludicrous to believe that Obama is planning to declare martial law and herd people into prison camps. But it’s not ludicrous at all to believe that our government is creating a debt bomb that will explode and turn the U.S. into the next Argentina. Perhaps you should do some reading on what life was like in Argentina when their debt bomb exploded. Look up articles from 2001-2002. If thugs invade my farm to try to steal my livestock and kidnap my children for ransom (which was common in Argentina), I sure as hell want to be able to shoot back.

            If you believe what happened in Argentina couldn’t happen here just because we’re the good ol’ USA, you’re the one who needs to remove the tinfoil hat.

          • And the ban on assault weapons was only on future sales, current owners would have been able to keep them. Again, Obama has never tried to take your guns. And since you obviously haven’t noticed, there wasn’t even a majority of dems that wanted the ban, guns are one issue that totally crosses party lines, we can’t even have registration due to resistance on BOTH sides. I live in a very liberal place, yet I hear radio ads to “get your concealed carry permit today” all the time.

            Libertarians have been predicting the collapse of our monetary system since early in the 20th century. As far as the “debt bomb” goes, you should check your facts and realize that our current deficit is falling at the fastest rate since WWII, it’s less than half of W’s last budget. National debt doubled under his fine leadership, only to be topped by the republican demigod, Reagan, who tripled it. You can look that up on the US Treasury site, and see real numbers, instead of believing what you hear on right wing propaganda channels. If you were to actually look up numbers, you would see that repubs have increased our debt more than dems by a huge margin.

    • Dru: “Sure, the ACA is a complicated mess, but it’s the only thing that could get past our dysfunctional Congress.”

      Oh, well, that’s okay then. It’s destroying millions and millions of people’s financial lives… but since the harm in unintentional … what … it doesn’t COUNT!?

      Dru: “It’s certainly not the plan that most liberals would have chosen.”
      Then who do you think wrote it?

      Dru: “long-term consequences of young, healthy people not sharing in the risk pool for the purpose of insuring everyone, not only against illnesses and accidents, but also against medical bankruptcy.”

      Some of us are more interested in NOT forcing young healthy people (and also many of us older healthy people without much income) to pay lots of money they/we may not have (“totally sucky economy” ring any bells?) in order to pay for, among other things, other people to have insurance they can’t possibly use! (Why in the hell do 20-yr-old males need to pay for obstetrical insurance? Are we expecting the first male pregnancy? For that matter why do I need to pay for it? I’m 57 with no uterus — but somehow you think *I* need to pay for obstetrical insurance?!) (And no, I canNOT buy a policy without it — ObamaCare REQUIRES compliant policies, yes? And compliant is whatever he and his liberal bill-writers decide it is.

      • Dru: “Sure, the ACA is a complicated mess, but it’s the only thing that could get past our dysfunctional Congress.”

        Elenor: Oh, well, that’s okay then. It’s destroying millions and millions of people’s financial lives… but since the harm in unintentional … what … it doesn’t COUNT!?

        –Thus far, there’s no evidence to support that it is “destroying millions and millions of financial lives.” OTOH, there is evidence that it has, and will continue to save thousands and thousands of people’s financial lives.

        Dru: “It’s certainly not the plan that most liberals would have chosen.”
        Elenor: Then who do you think wrote it?

        — A consortium of people trying to find something that could appeal to conservatives at least minimally – a hybrid of capitalism with socialism (i.e., Romneycare). This consortium would also include insurance companies lobbying behind the scenes..

        Elenor:Why in the hell do 20-yr-old males need to pay for obstetrical insurance? Are we expecting the first male pregnancy? For that matter why do I need to pay for it? I’m 57 with no uterus — but somehow you think *I* need to pay for obstetrical insurance?!)

        — Jeez, you’d think this wouldn’t need explaining. If you don’t believe that it’s in our best interest to have humankind continue, then you might have a point here, we could just let the b#tches pay for their own damn right to reproduce. And why should women have to pay for any treatment involving the prostate? Men have higher rates of cardiovascular disease, diabetes, are less risk-adverse, work in more hazardous occupations, etc. There’s a reason older men are generally charged more for private health insurance than older women. So, I ask you, why should women have to subsidize health insurance for men? Answer: the point of insurance is to SPREAD THE RISK pool.

    • Dru,
      “Hero worship” of Dr. Eades? Really? He’s just a man like you and me. Sometimes right, sometimes wrong. Mostly somewhere in between. As you gain experience in this world, you will learn you can’t trust anyone. Not government officials, not doctors, not lawyers. Not even engineers. (I’m an engineer.) So you can’t trust me. Trust me, I know!

  60. Dr Eades,

    Thank you for having the courage to speak on this subject. Please and add us to the list of impacted ….

    Our household received one of the 1 million health insurance cancellation notices sent to Californians this last month. What fails to get reported is that each of the 1 million notices sent out has effected far more than 1 million Californians.

    In our case Obamacare has impacted my wife and I harshly. Our Health insurance policy cost has soared from $363 to nearly $1000 per month with $5000 annual deductible per person and a co-insurance payment of 30% after that (Bronze plan). We exceed the 400% poverty level so do not qualify for any assistance.

    We are both native Californians, registered as independents but do agree quite a bit we Tom Naughton’s assessment of the deeply flawed law.

    I can’t imagine how Obamacare can ever pencil out. I work at a very large California university (Grad) and converse daily with hundreds of students (not on their parents policy and over 26). Not ONE has shared with me that they will sign up for Obamacare.

    Their reasoning is that they can’t afford it or don’t care or may get around to it later next year. But as we all know that won’t happen as they are young and immortal.

    Last thoughts : If Obamacare is the LAW, only congress can make or change law. The president (from any party) cannot, nor should they in this case. The President by his actions delaying or excepting individuals from
    Obamacare is changing the law

    As independent voter s we are DEEPLY troubled with both parties solutions to health care in this country. One could easily mandated two or three key provisions to all private policies and be done with it – no need for the government to manage and control another 20% of our economy.

    Who will pick up the pieces once Obamacare goes bankrupt? The Young…. Think about it.

    • I agree with you. Although I have been accused by many people of being a Republican, I’m not. Like you, I am an independent. I am now and have been for years disgusted with both parties and with the fact that we have few statesmen but many politicians. If our politicians had as keen a sense of what is good for America as they do for self preservation, we would all be a lot better off.

    • It is seriously difficult to change “just a bit” of the current system. Our state did that some time ago, adding a system that gave a market for several competing insurance companies, and mandating some standards (like birth control is always covered). THAT law was what allowed me to actually have insurance at all, after I become a small business owner. Otherwise I would have been uninsured.

      However, the law was a failure, because no one signed up at all until they had some major condition. A lot of the doctors left the state … a couple I know personally said they could make a whole lot more money by moving, and so they did (mind you: they made WAY more than me in any case). I suspect the doctors in Canada make even less than Washington State doctors.

      I’m sure Dr. Eades is the exception to this, but it seems to me from the medical people in my family, is that “being a doctor” in the US is all about money, not about healing people. The system is the same: everyone is making money, except the patient.

      • Being a doctor is all about making money. Being a lawyer is all about making money. Being an accountant is all about making money. Being a [fill in this blank] all about making money. People choose a profession because they think they will enjoy it, but they expect to be paid. I started out as an engineer but thought I would enjoy medicine more, which turned out to be true. But I got paid for being an engineer and I always figured I would get paid for being a doctor. I doubt that many of the people (if any) who castigate doctors for getting paid would be willing, themselves, to get up and go to work if they didn’t get paid for it.

        There is an old saying that brains follow money. Today no one would go through the years of intense work it take to become a doctor in order to become rich. No one but a fool. The writing is on the wall as to the future of medicine being a highly paid profession. In the old days, being a doctor insured you would have a relatively high income and be a respected member of the community. That may still be so to an extent in small towns, but no longer in larger cities. All the brains today are going into law and business. Our eldest son is a lawyer, and he makes a greater income on his own than MD and I ever did combined as working physicians. I don’t begrudge it because that’s just the way things are.

        My worry is that the pool of doctors is becoming more and more filled with less bright people because the income incentives are gone. People are getting into medical school today who wouldn’t have had a chance 20 years ago because of the intense competition then. Why the intense competition then? Because at that time, being a doctor insured one of a highly paid career. Which, sadly, is no longer the case.

        • 1. Your son must be an established lawyer; law schools are cutting back on class size due to poor job prospects for graduates
          2. Maybe your speaking about entry medical school classes nationwide, but if you look at the grade and MCAT scores for admission, I have a hard time accepting your statement about today med students vs. 20 years ago.

          • He is an established lawyer. He’s been working for 20+ years. But when MD and I had been working for 20+ years, we din’t make as much combined as he does every year.

        • I agree totally. Which is why accountants are usually highly scrutinized and audited. Lawyers are noted for lying … we have one in our family too, and he tells us happily that “being honest” is not part of his profession. His job is to give the best defense, knowing that he is lying.

          The more a person gets paid for a job, the greater the chance of corruption. That is one reason why blood donors and organ donors are not allowed to be paid. And yet … it’s perfectly legal for drug companies to give kickbacks to doctors for prescribing their products? And to subsidize medical schools?

          In the past 10 years, I have not had ONE doctor actually cure a condition I had. I use alternative methods … including your high protein methods, which none of my docs would ever talk about. Most of them prescribe drugs and that’s it.

          I’ve always kept our family insured, at great cost, and it did pay. Esp. when my son was born with a condition that required lots of high-tech stuff to fix. In a previous relationship, the insurance paid off big time when my husband got hit by a car. Obama care this year is awesome … we save $1,000 or so a MONTH and get lower deductables.

        • The major difference is that when if I find my lawyer isn’t up to par, I can easily get another lawyer, or I can even take over my own lawyering. There is LOTS of competition among lawyers, and someone with the time and inclination can do lawyer work. Ditto for accountants.

          However, if my doctor decides to steer me to a certain treatment … because he gets a kickback from the drug company, or the clinic has decided to invest in that treatment, or the medical supply company has made a good presentation lately … I really don’t have a lot of choices, and I certainly can’t treat myself in most cases.

          Further, it is well known that the more money is involved, the more likelihood of corruption. That’s why accountants get audited, and there are rules about who can influence lawyers. And it’s illegal to pay blood or organ donors. And yet, it’s ok for drug companies to influence medical schools and give kickbacks for doctors prescribing their drugs.

          The US has the highest doctor salaries, and so lots of good doctors want to move here.


          And yet we have about the worst outcomes of any developed country


          Clearly we are doing *something* wrong.

          I’ve gotten the best medicine though, from the nurses and nurse practitioners, who are not paid nearly as much as doctors. Also they have more time to talk, and are willing to give nice eips that are not drugs. Maybe those professions attract people who have an innate interest in helping people.

    • You may be deeply troubled, but as long as you think Obamacare, which was passed strictly on party lines, is a solution by “both parties”, the problem will remain.

      I used to be an independent, but though I’m still registered as such, it has become clear that the Democrats have no chance of offering useful solutions. The Republicans, on the other hand, have some factions that understand the futility of government intervention as a solution for most problems, so I choose to support those factions. Once they take over the party, then the party will be able to do something useful.

      • The right can vote another 46 times to repeal the ACA, and it will fail another 46 times. Is that what you call productive and helpful to the American population? I have yet to hear any positive ideas from the right, where is that free market solution you are all so proud of? How was that free market working before the ACA?

        I read a story about a very successful CEO of a corporation who had an open door policy, with the caveat that if you brought him a problem you also had to offer a solution. Where is your solution? More deregulation? More tax cuts? Let the working poor die?

        • The ones who pushed the empty repeals were Republican leadership, which is not the faction I support. I support the libertarian leaning faction – people like Rand Paul, Ted Cruz, and Justin Amash.

          The health care market was working much better before Obamacare than it is now under Obamacare. Millions more people were insured, and as Dr. Eades’ story points illustrates, their insurance was more cost effective. Poor people were eligible for Medicaid, and no one was turned away from ay emergency room.

          That said, it was far from a free market, and that did cause problems. In particular, the fact that health insurance was tax deductible if paid by an employer, but not if paid by an employee, decoupled the purchasing decisions from the payment decisions. This made it impossible to optimize decisions about whether one extra test, for example, was worth the cost. The malpractice world also distorted the market, driven as it was by rare but huge awards, with no controls on lesser cases of professional incompetence, such as the excessive prescription of statins that Dr. Eades frequently notes.

          These issues, as well as the issue of some states allowing insurance cancellations for “preexisting” conditions that were developed while insured, would have been addressed in Romney’s health care proposal, among others. You probably never heard of it because the press avoided covering it, but it’s still the best federal level health care proposal out there:


  61. I have been stunned by some of the vitriol expressed towards you, Dr. mike and others who agree with your post. It is so telling when someone states another poster “watches too much Fox News.” It is obvious that they don’t and perhaps it could be said , “you watch too much MSNBC.” Insulting and ridiculing others who have a different point of view accomplishes nothing. No wonder our country is is in trouble.

    • I very seldom watch Fox News because I very seldom watch TV. When I do watch the news, it is usually because I’m stuck somewhere – an airport, say – where the news is blaring. So I get whatever is on offer. I’ve heard all the complaints about Fox News, so when I do watch it, as I did last night, I watch carefully to see if there is a bias I can notice. There is, of course, in the opinion shows, of which there are plenty on Fox. But the news itself is, in my view, pretty straightforward. For example, they had a story last night on the report from some agency that Kathleen Sibelius had met with President Obama only a few times during the run up to the launch of ObamaCare. They then reported that the White House scoffed at that report and said there had been numerous meetings between the two, practically on a daily basis. And, as I recall, they reported on even another source that said the report was flawed and that the White House logs are notoriously inaccurate. I thought they did a pretty good job of providing both sides of the story.

      I think what those who hate Fox object to (and they couch it in terms of Faux News and biased reporting) is that Fox airs subjects the rest of the media ignores. When they do air these stories, Fox has a pretty balanced perspective on them. But those who don’t want these stories aired get annoyed because Fox airs them. Thus the animosity towards that network.

  62. I get a kick looking at the posts from those of you “who come here looking for nutrition advice” and are appalled that the good Dr. Dare right about something you may not agree with.

    Did you pay for his domain name?

    Do you pay for the web hosting service?

    Do you pay for his time to research and write the blog?

    Then push the delete key and go on to the next article in your reader. Nobody is forcing you to read this.

    At this point anyone who has read this far has spent far more time on Obamacare than Obama has. It’s supposedly his signature legislation, his political legacy and he has had exactly one meeting with the person in charge of implementing it? If you think the website is the only thing that isn’t going to work in this plan you are at best naive.

  63. I’m not sure how I feel about some of this. My husband and I paid for health insurance, dental and vision insurance (when available… they didn’t have all the stuff they have now when I was in my 20’s) for over 40 years and never used anything other than for routine care… no major illness. Now, when we are older and need good insurance, all this mess is going on and has been since the “economic downturn”. Thankfully, I have Medicare (still not much in the dental and vision area without an additional premium) but my husband won’t for another few years. I guess we were paying for the care of those older than ourselves all those years and now we are sunk good and proper. No benefit to us that we were conscientious about having health insurance all those years.

  64. Wow, this is fantastic fun! By my count, fast approaching 200 comments, 4 videos and a couple dozen links.You have responded about 40 times. Insults, outrage, condemnation, praise, and best of all, Spanglish acronyms. I love it, and I can’t, for the life of me, figure out why some readers object to you going off- topic.

  65. I believe I may have found a practical work-around to the ACA increased cost/decreased real coverage problem. Companies like Humana and United Healthcare (its Golden Rule subsidiary) offer short term (12 mos. or less) term health insurance whose coverage is exempt from the strictures of the ACA. This insurance is not automatically renewable, but must be re-applied for periodically in order to assure an individual or family has continual insurance. Premiums and coverage are both very comparable to pre-ACA conditions, even taking into account to having to pay the ACA tax if not enrolling in that Ponzi scheme. For the same or less money, deductibles are less than with BarryCare, and insurer coverage rates are greater. This short term insurance reportedly originated as a means to provide health insurance coverage to people when periods of change were encountered in their lives — the ACA certainly qualifies as such. Note that such coverage is not available in all states, but is apparently available in most.

  66. @Garry — I have looked at the real numbers, genius. I don’t form opinions without checking the data. “The deficit is falling!” means that after ramping up the deficit to astronomical levels, we’re now bringing it down somewhat. If you’re not mathematically challenged, then you understand that means we’re still going deeper into debt, just at a somewhat slower rate. If I put $100,000 on my VISA for three years in a row but then put $50,000 on my VISA this year, that doesn’t mean I’m paying down my debt. Do you grasp that?

    And yes, I’m aware of how much Bush jacked up the deficit. That’s why I often referred to him as “that idiot.” I have zero respect for politicians who claim to be fiscal conservatives and then spend money like they went bar-hopping with Ted Kennedy.

    If you don’t believe we’re facing a possible debt-bomb explosion, then enjoy your rampant optimism. But at the very least, you ought to able to grasp the simple mathematical truth that interest on the debt will eventually squeeze out other spending. Paying heavy taxes and getting little in return except the privilege of paying off your parents’ debts does not make for a healthy economy.

    • Tom! Your blood pressure!! Calm down before you have a stroke.

      Yes the total debt is still climbing, but at a progressively smaller amount each year (and again, at the fastest rate since the end of WWII), not even Ron Paul thinks it’s possible to balance the budget instantly. The repub budget guru Paul Ryan would take until after 2040 to balance his (this from Forbes- http://www.forbes.com/sites/beltway/2012/08/14/paul-ryans-real-goal-its-not-a-balanced-budget/ a clearly conservative viewpoint) and that includes all his major spending cuts to to safety net programs.

      And here is a little math for you, if the spending continues on it’s current downward trend we will get there. Want to make get there faster? How about this-

      The US spends more on our military than at least the next 12 countries combined, and most of those aren’t even considered hostile. All necessary spending?

      We have 11 carrier battle groups, the rest of the world, ZERO. What are we waiting for, another attack on Pearl Harbor? Each new carrier runs around $13 billion, plus $4.7 billion on research & development of new carriers, plus around $6.5 million per day to run each carrier group. Here’s some math Tom, $6.5 million x 12 x 365, and that’s assuming we just keep them floating, not if we actually use them, at which time the cost explodes. Think we might be able to cut some spending there?

      The military bought 195 F-22’s, according to the GAO in 2012, the per unit cost is $412 million. Best part about that? These planes have never been used in combat, seems they have this habit of killing their pilots, but I digress, can you see any potential savings there?

      Imagine what we could have done with the $3 trillion spent in Irag, had we intelligently spent it here at home instead?

      Clinton said it best during the dem convention…the republican position goes like this: We made a huge mess, he didn’t clean it up fast enough, so fire him, and put us back in office…

      • Garry, it is hard to balance the budget when there hasn’t been a budget since Obama took office.

        So let me get this straight. Bush was a nightmare (which I wholeheartedly agree with). Obama comes into office and increases spending by 100%(ish) causing deficits of over $1 Trillion for multiple years.

        Now, in order to “reduce the deficit” there are 3 things you can do, only one of which is acceptable.

        First, you can print vast amounts of money which, in turn, devalues the money that is in circulation causing prices to rise. This is beneficial to government because they can now pay back their indebtedness with money that is worth less than it was before. This is unacceptable because this leads to inflation for the consumer (simple supply/demand curve for money) and debtor nations don’t want devalued money back (google China and dollar devaluation…we’ve had many warnings).

        Second, you can increase taxes. Nobody wants to pay higher taxes. It leaves less disposable income for other things and generally is wasted by the government anyway (IMO).

        The real trouble starts when the First and Second option are done together. More money in circulation means higher prices at the grocery store, fuel pump, etc. Higher taxes mean less money for groceries, fuel, clothing, etc. You get my drift, I hope.

        Third, cutting spending. There’s a novel idea. I agree with you, the military industrial complex is a huge waste of money. I, for one, would prefer to close all our military bases around the world, quit meddling in other nations affairs, bring our men and women home and have them defend our actual borders, should the need arise. Enough of this world policeman business. It isn’t our job to “spread democracy” as we always hear on the news.

        So, how is Obama “cutting the deficit”? He surely isn’t using the Third option by any means.

        Oh, also, cumulative deficits add up to what we call the “national debt”. If Obama is cutting the deficit as you claim, how is it that the debt when Obama took office was $10.7 trillion and is now $17,239,000,000,000 (and change, scary when millions is a rounding error) as I type this?

        Some of it was due to the fact that revenues were down because of the recession (that we are still in and struggling through). In my opinion, and history bears this out, the recession would have been over in two years if the government had done two things: cut taxes and cut spending.


        • Valid points. However, Congress just passed a budget for the first time, courtesy of Republican Paul Ryan. Specifically, courtesy of his increasing spending and and increasing taxes.

          Granted, the increase in spending was “only” about 5%, versus 50% the first year Obama was in office with the Democrats in control, but the Republicans still have some house cleaning to do, it seems.

          It’s a real pity, since I was previously under the impression that Ryan was one of the good guys.

      • Garry, you don’t have to convince a libertarian like me that our military shouldn’t be all over the world. I’d like to see the U.S. turn into a giant Switzerland, staying the @#$% out of everyone else’s affairs.

        But if you think reducing military spending is going to lead to balanced budgets, then you haven’t looked at the numbers. We could eliminate the Department of Defense entirely and we’d still go belly-up if we don’t deal with entitlements in a big way.

        And when you are going to get it through your head that I’m not a Republican? You seem to think we’re playing a game of Red Team/Blue Team, arguing about whose team sucks more. Both teams contributed to this mess by refusing to reign in spending and expanding entitlements to buy votes.

        • Mostly agreed. The Federal budget is 3 trillion dollars. Defense is about half a trillion of that.

          I personally think that some defense spending – and some overseas bases – are justified. Specifically, I believe that by virtue of having long coastlines on both the Atlantic and the Pacific, the U.S. is naturally a maritime nation with a stronger vested interest in international trade than any other nation. Maritime trade depends on the safety of trade routes from piracy and other threats, so it behooves us to keep a strong Navy.

          Staying in Afghanistan 10 years after Al Qaeda was driven out, not so much.

      • A couple more points, Garry, and then I’ll go away so we don’t turn Dr. Mike’s blog into a two-person budget debate.

        “If the spending continues on it’s [its, by the way] current downward trend …”

        That’s a rather large assumption, wouldn’t you say? Even without ObamaCare, we’re looking at tens of trillions of dollars in unfunded liabilities coming due over the decades. Depending on whose figures you believe, that’s another $30 – $70 trillion. But we now have ObamaCare added to that mix. Given how it’s going, with HHS already talking about bailouts for the insurance companies because the math isn’t working out, I wouldn’t bet the farm that the “downward trend” will continue.

        Since you’ve advertised yourself a man who checks the data, I’m also wondering how you concluded that Democrats are the party of superior fiscal responsibility. Yes, Bill Clinton likes to brag about those balanced budges and surpluses during his term, but he conveniently leaves out the part of the story where he got stuck with a conservative Republican Congress he didn’t want. Budget bills, as I’m sure you know, begin in Congress. Being a skilled politician, Clinton ran to the front of the parade and declared himself the leader.

        But if we look at the data, there’s never been a balanced budget when Democrats controlled both houses of Congress. We’ve had several when Republicans controlled both houses of Congress. So out of curiosity, I looked up deficits since 1982 and put them next to the makeup of Congress — Republican, Democrat or Split. Then I calculated the average deficit for each makeup. And these deficits are adjusted for inflation, by the way, so we’re comparing apples to apples. Here are the results:

        Democrat Congress: $548 billion
        Split Congress: $541 billion
        Republican Congress: $137 billion

        That’s in spite of the fact that were at war in Afghanistan and/or Iraq during 4 of the 10 Republican-Congress years.

        So while I’m not a fan of the Blue Team or the Red Team (I don’t know what color the libertarian team is), the data says we run bigger deficits when Democrats control either house in Congress and they’re the biggest when Democrats control both.

  67. There are companies that offer the short term health STH policies you are talking about, the rates are very affordable. Some things you need to know about them are:

    First, they do not cover pre-existing conditions, as in five years prior to your start date.

    Second, they are “short term” by definition, typically 6-11 months, after that, you go somewhere else, you can maybe renew them once, if that.

    Third, they do not qualify under the ACA law, so you would still have to pay the penalty at the end of the year, and you also don’t get the tax deduction. Coverages tend to be more limited than what you are suggesting.

    Having said all that, they are an option that makes sense for some people, just be careful if you are thinking of this as an alternative. Talk to a professional insurance person before you make that move.

  68. And for Tom and DW, you both remind me of with one of my favorite quotes:

    It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt.”
    -Mark Twain

      • Nina,

        Great spirits have always encountered violent opposition from mediocre minds.
        -Albert Einstein

        The difference between genius and stupidity is that genius has its limits.
        -Albert Einstein

        • Garry, I hate to break it you, but quoting smart people doesn’t make you smart and doesn’t negate the fact that your arguments are weak. If you believe you’re a great spirit and I’m a mediocre mind because you managed to find a nice quote from Einstein, your standards for measuring intelligence could use a serious upgrade.

          But if you’re a fan of Twain, here are some quotes relevant to the discussion:

          “Government is merely a servant – merely a temporary servant; it cannot be its prerogative to determine what is right and what is wrong, and decide who is a patriot and who isn’t. Its function is to obey orders, not originate them.”

          “The mania for giving the Government power to meddle with the private affairs of cities or citizens is likely to cause endless trouble.”

          “I think it is not wise for an emperor, or a king, or a president, to come down into the boxing ring, so to speak, and lower the dignity of his office by meddling in the small affairs of private citizens.”

          “No country can be well governed unless its citizens as a body keep religiously before their minds that they are the guardians of the law and that the law officers are only the machinery for its execution, nothing more.”

          I don’t imagine the man who wrote those lines would be a big a fan of the federal government telling private citizens what kind of insurance they can and cannot buy.

  69. Hey Tom,

    I happen to have my Mensa test results right here on my desk, just came across it while I was organizing, I will put my IQ score against yours anytime

    • Oh hey it’s an IQ battle now, sweet!

      On my Mensa test back in 2002 I was officially listed as “>99.9% percentile”, the highest they can test for.

      FWIW they don’t even bother to tell you your IQ at that level because it’s about as accurate as calculating cholesterol…

      What was the question? :p

    • Hey, Garry —

      According to a national test we all took in college, I was in the top 1% of college seniors — that’s college seniors, not the general population — so I’m sure I’d qualify for Mensa, but I have no interest in joining a “we’re all so smart” organization to boost my ego.

      For someone with a high IQ, your arguments are nonetheless pathetic, as demonstrated by your belief that if you quote Einstein and Mark Twain, this somehow proves you’ve won an argument. Same goes for your latest argument, which apparently boils down to “My arguments cannot be weak, because I belong to Mensa.”

      Any idiot (or Mensa member) can pull a quote off the internet. But someone who isn’t an idiot (or a Mensa member) would ask himself if quoting Mark Twain while simultaneously arguing in favor of a big-government program that prohibits people from buying the insurance they prefer is a good idea. Someone who isn’t an idiot (or a Mensa member) would recognize that he may as well quote Karl Marx while arguing in favor of free-market capitalism.

      A person who isn’t an idiot (or Mensa member) would read Twain’s works and ask himself what Twain believed about government. So when you’re not busy admiring your Mensa membership card, you might want to pick up a copy of “A Connecticut Yankee in King Arthur’s Court,” which I recently read for the second time. I suspect Twain’s wry humor will be lost on you, but it’s a terrific novel. Read that, then come back and tell me which sections convinced you Mark Twain was a fan of government power.

      p.s. — Did your Mensa test include a section on the proper use of a comma and how to avoid a comma splice in a sentence?

  70. Wow. It’s just sad. I live in Canada and have had medical ( dental is private ) all my life. No deductible

    All Canadians receive same treatment across the country regardless of who they are. When my Dad had cancer, we did not pay anything for world class treatment. Maternity is one year benefits at 70% wages through employment insurance.

    Here are the costs for British Columbians…just above Washington State
    In B.C., premiums are payable for MSP coverage and are based on family size and income.

    Effective January 1, 2014, monthly rates are $69.25 for one person, $125.50 for a family of two and $138.50 for a family of three or more. From January 1, 2013, to December 31, 2013 monthly rates are $66.50 for one person, $120.50 for a family of two and $133.00 for a family of three or more.

    • You do pay, you just don’t pay directly. All the doctors, nurses and hospitals don’t operate for free, even in Canada. Someone has to tote the note for it all. I suspect your various tax rates are fairly high to pay for all this ‘free’ health care. Plus many Canadians have to fork over out of their own pockets to come south for various elective surgery procedures that require long waits in your country.

      When any service is provided ‘free’ or at an artificially reduced rate, the only way costs can be controlled is by rationing. Or keeping taxes at a level at which the services can be paid for by many who don’t use them. Typically, it’s a little of both, which I suspect is the case in Canada.

      But don’t fool yourself. You can delude yourself that it is free or almost free, but it’s not. Nothing is free. Someone is paying for it somehow.

      • Great to see the dialogue.

        I’m avg income for a female and have never minded my taxes. My husband is higher income (helo,pilot) and also does not complain about taxes. We like our parks, medical, police, roads, inspectors, etc.

        I’ve torn two acl – the last one 3 yrs ago. Physio free. MRI scan two weeks. Surgery within 2 month . Not so bad.

        I don’t know anyone who went to the states, maybe rich folks.

        I have never seen rationing even when my 97 yr old gran had a stroke and would not be leaving the hospital. Treated with dignity (and no deductible) until she died.

        Husband tore ligament last year, And had surgery withu 6 weeks. I have a possible fibroid, have ultrasound scheduled within two months,

        I’m not scared if I get cancer that I can’t afford the treatments and the pills to stop vomiting,

        Of course nothing is free! but the shared cost works, it’s a blessing to not worry about health care, or the health care of friends and family and those I don’t even know,

        when canada brought in medical, the doctors were against then, now doctors like it too. Even though docs make less than US docs. Of course insurance companies don’t want it.

        I guess it’s as much as a mystery to Canadians why the richest country in the world is the only first world country with no universal medical as it is to Americans why a country would have universal medical when folks can just,..what? Go to a charity hospital and hope for the best?

        oh, and I choose my doctor, etc. and get second opinions when I want too.

        I think there is a lot if misinformation regarding the Canadian medical system.

        • Nice to hear your perspective. I work with Canadians who have a completely different perspective. So I guess the perspective differs according to who pays the bills.

        • Six week’s delay in nonelective surgery would be unthinkable in my area of the U.S., and I suspect in most parts of the U.S. When my wife had a possible fibroid, she got an ultrasound within a couple of weeks. A couple of months could be fatal if it turns out to be cancer. Then our insurance covered $60,000 worth of fertility treatments to help us get our first kid.

          If you have no money and go to an emergency room here, you can go to any hospital. They’re all required to treat you.

          • ” Then our insurance covered $60,000 worth of fertility treatments to help us get our first kid.”

            So much irony right there.

  71. Interesting how people in other countries that have single payer plans seem to be happy with their healthcare, at lower cost than here, often with higher quality of care, and yet we can’t have that here? Oh wait, we do, Medicare…most people on Medicare seem to like it, lower cost to the gov’t (taxes) than advantage plans run by private companies. We just can’t have it for the under 65 population, that would be “socialism”.

    • You might want to take a closer look at Medicare before you form an opinion that’s rock solid. More and more doctors are bailing out of the Medicare system because they barely get paid for seeing Medicare patients, which is why it is cheap for the gov’t. But, because more doctors every day are discontinuing to take new Medicare patients, it acts as rationing, which is what has to happen when the supply of goods and services is artificially controlled. The ‘progressive’ solution, of course, is to force doctors to see Medicare patients, but that has its own long term consequences.

      • I’ve heard the rhetoric that doctors are leaving the profession in droves, especially for Medicare patients. So I did a little experiment, I went to a large insurance company website, and did a search for doctors accepting new patients in my area for one particular Medicare Advantage plan. There are 540 doctors listed, and I am not living in a large metropolitan area. Apparently they can afford to see Medicare patients at the paltry reimbursement rate of around $65 for that five minute office visit. If I were a new Medicare patient I wouldn’t be worried.

        There are something like 10,000 people a day reaching Medicare age, sounds like a huge market to me. Millions of new insureds due to the ACA, another huge new market. I suspect that some entrepreneurial doctor is going to figure out how to make a lot of money on those people. That doctor might well be from India or China, but I think it will happen.

        I looked on Salary.com to see that the national average for a family practice physician is $179,000, surgeons and specialists are way above that. What I am wondering is where these doctors are going if they leave medicine? Where else are they going to make 4 to 20 times more than the national average? Don’t misunderstand, I want doctors to be well paid, I just have a hard time feeling sorry for someone making mid six figures complaining about not getting paid enough.

        • Perhaps your time would be better spent writing about things you know something about.

          Docs are leaving in droves. A lot of docs who are in their late 50s who still have a few more good years left in them are saying screw it and retiring. And any doc who has been in practice for 30 yrs is a true resource society doesn’t want to lose.

          And many, many more are refusing to take Medicare. I can speak from long experience that there are very few 5 minute visits with Medicare patients. Most show up at your office with a sackful of meds and a host of complaints. Takes much longer to do workups on them that acutely ill younger patients. And give the expense of maintaining an office, staff, malpractice insurance, supplies, etc., $65 a visit won’t keep the lights on.

          As to the avg pay for family physicians, you may think $179K is a lot, but I wonder what the typical middle management guy thinks who’s pulling down $250-$300K per year. Wonder if that person, who probably has a BA in business, thinks $179K is a lot after spending four years in medical school, three in residency and having to take call on nights and weekends.

          Brains follow money. So why be a doc and have to put up with all the BS and go to school for four years followed by a residency when you can go straight from college to making pretty big bucks? Then after seven years, when the people who graduated from college with you are just starting their careers after all the training, you are really making the big salary and bonus. With nice vacation and benefits packages and all holidays off. Pretty soon smart people will avoid medicine like the plague and instead pursue careers in other fields where they can pull down six figures easily without jealous, know nothing, pricks like you thinking they’re overpaid.

          As I said, stick to commenting about something you know about.

          • Thanks for the venom, clearly you know more about being a doctor than I do, but I gotta wonder why anybody with brains (your term) would want to be one when a typical middle manager makes $250-$300k, with only a BA? (really?)

            And how come I can find 540 doctors that are taking new Medicare patients? I did my search again, this time just looking for doctors within a ten mile radius, and there are 575, so only 35 are not taking new Medicare patients. If what you say is true, why isn’t it the other way around?

            I never said being a doctor is easy, and I never said they were overpaid. I did say that I felt doctors should be paid well. And my original comments had to do with insurance and Medicare, not with whether or not it was worth it to become a doctor.

            And back towards the top of the comments you said you would be happy to educate me on how the health care system should be run, I’m still waiting on that. Because again all I hear from the right, or libertarians if you prefer, is that the ACA is a “train wreck”, and that it should be repealed, but I still have never heard an alternative solution.

            Do you, as a doctor, think it wise to leave millions uninsured?

            And when you wrote this original post about a subject you clearly know nothing about I didn’t resort to calling you a prick, are you becoming a grumpy old man?

          • I’m not sure of the “typical” middle manager, but most middle management people I know working in large corporations earn in that range. I know a guy who runs a filling station who makes around $450K per year. It’s not all that difficult to out earn most physicians, which is my point. Once people figure this out – and a lot have – who will be willing to go through the brain damage of four difficult years of medical school, three years (minimum) of poorly-paid residency and go into a profession requiring one to be on call a fair amount of time? Back in the old days, when physicians were the pillars of society and got paid a lot, everyone wanted to be one. Not so much anymore. And when that happens, the very people who will hold our lives and health in their hands will not be as smart as lawyers and bankers and middle managers and filling station owners.

            Only 35 are not taking Medicare patients. That’s now. Probably more than last year and certainly fewer than next year. They don’t all quit at the same time. I read a bunch of what we call throw-away journals. These are journals sent to docs just because they’re docs. They contain some pretty good clinical practice articles and a ton of drug ads (which is why they’re free) and also an article or two on practice management. These articles are typically case histories of various kinds of medical practices that found themselves in financial trouble. In virtually every case, the consultant recommends the practice discontinue seeing Medicare patients. When the practice complies, income goes up and financial troubles go away.

            I do have my own ideas about how the healthcare system should be run, but, as I think I wrote before, the comments section is not the place to elucidate.

            And I think even the most ardent Obama supporters admit now that the ACA is a total cock up, or a train wreck, if you prefer. Even Obama himself said so. And he is busy dismantling it as quickly as he can.

            As a doctor, I don’t think millions should be left uninsured. Though many people are uninsured that would rather not be, a whole lot of people are uninsured by choice. They would rather not spend the money on insurance and take the risk. I just read a Washington Post poll that said 58 percent of uninsured Americans hadn’t even bothered to either get online or call to get on the ACA program. So not all uninsured people are desperate to get insurance. All the ACA will do is trade one group of uninsured for another. The number of uninsured people won’t change – it will just be different people. People who can afford a minimal policy now won’t be able to afford the ACA standard version, and since the insurance companies can’t write any policies that aren’t ACA compliant, these people will do without. Whereas at first they were insured, after ACA they won’t be.

            The entire ACA program was ill conceived from the get go and was doomed to fail. If you recall, the Senate powers twisted the arms of a lot of senators to get theM to sign onto this by saying, you’re going to get to vote later on the full bill. We just need your signature now to get the ball rolling. All these folks signed on to get the ball rolling figuring the House would come up with its own version. The two versions would go to reconciliation committee, get the differences worked out, and present a more polished bill to both chambers to vote on. The Senators who had been iffy or on the line would then have a chance to vote on the final bill. If enough voted to pass it, it would go to the president to be signed into law.

            As I’m sure you recall, after it was passed in the Senate and sent to the House, the voters of Massachusetts, doubtless the most liberal voters in the country, voted in the first Republican Senator in memory simply to ensure there not be 60 votes in the Senate when Obamacare came around again. At that time everyone thought the bill was dead in the water. But, in a bizarre move, the House, which knew it was its only chance, exercised a rarely used tactic and passed (without changing so much as a comma) the Senate’s half-baked version of the law because that was the only way it was ever going to get passed. And we ended up with this piece of crap that now every endangered Democrat in the Senate and the House is running away from.

            Not exactly the way a law affecting one sixth of the US economy should be passed. At least not in my view.

            There are many problems facing our country right now. My issue with those on the Left is that if they come up with their version of a solution to a problem and those of us who are libertarian or to the right (not the same thing) disagree with the proposed solution, those on the Left then say we don’t care about the problem. It’s not that we don’t care about the problem, it’s that we disagree with the solution. We do care very much about the problem.

            Part of the reason I wrote this post that has engendered all this commentary was to collect data to test an hypothesis. I’ve heard it said conservatives think liberals are stupid while liberals think conservatives are evil. The comments on this post have certainly borne that out.

            So, why don’t we quit all this back and forth, and let’s just stipulate that I am evil and you are stupid and be done with it.

            I will admit that you are probably right. I am becoming a grumpy old man.

            Nonetheless, I do wish you a Merry Christmas!

          • I’ve been lurking but am annoyed enough by this idea that middle-managers have it easier salary-wise than doctors.

            Let’s stop arguing from specific examples and look at the averages as well as the distributions. Saying that doctors have it tough compared to other fields is ridiculous and not supported by any statistics. Even dumb doctors make too much money, of which there are many.

            The people that want to be doctors are not and have never been the best and brightest. They have always been those that want a high-paying job and can handle a decade of school and training. It doesn’t take a lot of ingenuity or intelligence to become a highly-paid doctor. The same is not true of other fields. It used to be true of Lawyers but law school must be too easy because there are way too many now that can’t find jobs. A doctor doesn’t have to do anything genuinely difficult or creative to get a high-paying job. They just have to go through the motions and they are set for life. Tell me that isn’t still true.

            Anyway, doctor salaries have gone up. Not down. It’s very probable that the people making the most money on the incredible health care cost increases are not the doctors, but that doesn’t mean that the industry is troubled and hurting. To me it looks like you are too close to the industry to see the whole picture–ironically.

          • “It is no secret we had a number of Republicans damage our brand this year with offensive, bizarre comments — enough of that,” Jindal told Politico. “It’s not going to be the last time anyone says something stupid within our party, but it can’t be tolerated within our party. We’ve also had enough of this dumbed-down conservatism…”

            “Republicans should stop being the stupid party”

            -Bobby Jindal

          • You are still making statements about the ACA which are not based in reality, but rather in the alternate universe that the right prefers to live in (don’t confuse me with facts), and additional name calling; first I’m a prick, now I’m stupid.

            But I am smart enough to actually know something about what I post. Learn something about the tax credit and how it gets larger as income goes down, negating your argument about affordability. Realize that 48% of the US population are insured by group plans, and so have no need to go on ACA websites to shop. Obama is dismantling the ACA? Give me an effing break.

            Do some more of your extensive reading, and understand that many of the ideas that went into the ACA were originally from conservative side, only to be obscured by wailing about death panels, killing grandmas, unaffordability, and all the other ridiculous gibberish from fox, limbaugh, palin, etc. If the right had worked together with the other side we could have ended up with a more well written law. But that wouldn’t help the Koch brothers now would it?

            Use some realistic numbers, the health plans are not nearly as expensive as you claim. Try actually going to Covered California and look up some quotes, rather than blindly accepting that nobody will be able to afford coverage. What do you think will happen to the uninsured people when something bad happens and they end up in the hospital? Think that will be affordable?

            To quote an earlier post from someone on your side “…Your continued insults demonstrate that we have won the battle… I assume it is because you can’t refute them and therefore you are left with name calling and mocking. I, for one…will not be deterred by name calling and mocking. Facts are facts and the truth will set you free.”

          • Hello. Did you just emerge from a long sleep or something? Nothing for a month, then two adversarial posts within a half hour.

            I thought we left it with the stipulation that I was evil and you were stupid. Since you’re back, I guess not.

            Not to belabor the point of the absolute disaster of the ACA or the perfidy of the president in lying about it to get it passed, time and history will tell the tale. And will tell it soon. Let’s just wait to see what happens. The polls are already telling what the public at large thinks of it, and I suspect those polls are going to get nothing but worse as time passes. But I might be wrong. We’ll know soon enough.

            Already, Pres Obama has unilaterally changed much of the ACA using methods that aren’t entirely legal. We’ll have to wait to see how all that works out, too. But it was done in a state of panic because the ACA is causing so much harm to so many people. Not because it is the godsend you seem to think it is.

            Here is what I predict will happen. As 2014 draws ever closer to November, vulnerable Dems will demand the ACA be watered down even more. While at the same time, horror stories will start to surface about a) people who thought they were insured, but weren’t, and b) the disaster that will set in when the employer mandate comes around. Pres Obama’s hubris will cause him to hang in there and keep pushing the ACA, and the Senate will go to the Republicans. The House will become even more Republican. The first order of business in the new congress will be to come up with a bill to repeal the ACA. Obama will, of course, veto it. Then the fun begins. With the next election less than two years away, will the 10-15 Dems up for re-election vote to override the veto? I can assure you, the ones up in 2014 would in a heartbeat if they had the opportunity. But it depends in great measure what the public sentiment is about the ACA at that time. If you’re right, and it turns out to be a wonderful piece of legislation, then a veto wouldn’t get overturned. If, as I suspect, it will be viewed as even more of a disaster then than it is today, the vulnerable Dems will vote with the Repub majority to overturn it.

            As I say, only time will tell. So instead of wasting time going back and forth on this, let’s just sit back and watch.

          • Actually only one adversarial post, where I was responding to your childish insistence that I am stupid, the other was simply agreeing with another person who also doubts your salary statements. You are obviously convinced that you are always right, and that anyone who disagrees is wrong or stupid. Guess he must be stupid too.

            So go back to your Ayn Rand fantasy world where the free market solves everything and facts don’t matter. Where there is no need for regulations because everyone hails the awesomeness of the system, and all work together fairly and honestly. Where there are no people with BA’s working at Starbucks because they all make over six figures.

            Where medical insurance companies are more concerned with honesty and integrity than the next eight figure bonus for the CEO. And of course all the doctors are hugely wealthy, and only have to treat wealthy patients.

            Social safety net programs, forget about it, tell those lazy asses to get a job. Which of course they could all do any day of the week if they weren’t so busy waiting for the gov’t to take care of them.

            I hope that in the future you will continue to post things related to nutrition and medicine, areas where you are very competent, where you provide links and references to support your comments, where you actually make sense.

            Unlike this original post, where your entire premise was that people shouldn’t sign up for health insurance till they get sick. Speaking of stupid…

        • One of the reasons for the “lack of physicians” is that the number of physicians is rationed. It’s kind of like DeBeers and diamonds … by only releasing the diamonds slowly, DeBeers kept the cost of diamonds high.

          Forbes has a great writeup on the AMA and physician compensation, and how the high doctor salaries are way more of a problem than malpractice issues or uninsured care compensation:


          “But how has the AMA managed to get away with such princely remuneration that ordinary mortals in other professions … even ones such as law and engineering that also require arduous training … can only dream of? After all, in a functioning market, a profession offering such handsome returns would become a magnet for more people who, over time, would bid down “excess” wages.”

          “One way to relieve the shortage of providers that the medical industry has created would be for the AMA to abandon its aggressive game of turf-protection and allow nurses, midwives, physician assistants and practitioners of alternative therapies such as chiropractors, to offer standard treatments for routine illnesses without physician supervision. For instance, midwifery, once a robust industry in this country, has been virtually destroyed, thanks to the intense lobbying against it by the medical industry.”

          • Hey all you need is a BA and you can make $300k as a middle mgr! Remember Mitt Romney being asked “how much income is middle class?” and he said “around $200,000”.

          • I think middle managers are lucky to make $150k. However, it is true that doctors rarely start pulling down the big bucks until they are 30. While the AMA is part of the issue, I think the shortened career – with extra student loans to go along with that – is the biggest part.

          • I’ve been looking around on salary.com, have yet to find a middle manager type position that is over $125k, but then I don’t live in Santa Barbara, maybe it’s different there

          • You again? I don’t know what your definition of a middle manager is, but mine is someone in the middle level of management of a large corporation, of which I know a number. These aren’t the CEOs, the COOs, the CFOs or the GCs. The people I’m talking about are the people on their way up to those levels and they don’t read the classified ads to find jobs. They are promoted from within or change companies with the help of employment agencies. The ones I know – none of whom live in Santa Barbara – all make from $350K to $500K per year. Two make closer to $1M with bonuses.

  72. My cousin who lives in Vancouver and some of her friends have had a far different experience. One of her friends dies while waiting 9 months for cancer surgery. I had a doctor here in Oregon who left Canada because of the system and the frustration he had with the system. So there’s another perspective.

    • The people I work with also live in Vancouver. Your perspective on any system is a function of how it affects you. If you pay to maintain it but don’t use it often, then you’re going to have a different perspective than someone who is a user and not a payer. All the people commenting about how wonderful it is all tell tales of the free medical care they get, so I have to conclude most are users and not payers.