The Skull Beneath the Skin of the 'Affordable Care Act'

One of the men who gave us Obamacare One of the men who gave us Obamacare

And now we can see it for what it really is: a vicious assault on free enterprise, a whopping tax increase on the middle class, a new way to get the Internal Revenue Service involved in the most personal aspects of our lives, the addition of another layer of complexity to the citizens' interactions with the federal government and, most of all, a way to break the public's will to resist further intrusions by the Leftist fascist state of Obama's dreams. All masquerading under the guise of "health care." It is the greatest scam in American history, and every single Democrat who voted for this fundamentally un-American monstrosity should be tarred, feathered, and run out of town on a rail, beginning with former Speaker Maerose Prizzi and Sen. Pat Geary. 

Now the house organ of the Obama administration, the New York Times, is belatedly discovering that, hey, just because you might be forcibly "insured"under the Patient Deflection and Unaffordable Care Act, that doesn't mean you're actually "covered" in any meaningful sense, thanks to the zillion pages of bureaucratic regulations that attend the ACA. Suckers!

When Karen Pineman of Manhattan received notice that her longtime health insurance policy didn’t comply with the Affordable Care Act’s requirements, she gamely set about shopping for a new policy through the public marketplace. After all, she’d supported President Obama and the act as a matter of principle.

Ms. Pineman, who is self-employed, accepted that she’d have to pay higher premiums for a plan with a narrower provider network and no out-of-network coverage. She accepted that she’d have to pay out of pocket to see her primary care physician, who didn’t participate. She even accepted having co-pays of nearly $1,800 to have a cast put on her ankle in an emergency room after she broke it while playing tennis.

But her frustration bubbled over when she tried to arrange a follow-up visit with an orthopedist in her Empire Blue Cross/Blue Shield network: The nearest doctor available who treated ankle problems was in Stamford, Conn. When she called to protest, her insurer said that Stamford was 14 miles from her home and 15 was considered a reasonable travel distance. “It was ridiculous — didn’t they notice it was in another state?” said Ms. Pineman, 46, who was on crutches.

She instead paid $350 to see a nearby orthopedist and bought a boot on Amazon as he suggested. She has since forked over hundreds of dollars more for a physical therapist that insurance didn’t cover, even though that provider was in-network.

In other words, as a "matter of principle," this woman accepted much worse and more expensive insurance for... what, exactly? And now she's getting exactly what she voted for and she doesn't like it. This is what happens when ideology trumps common sense, and when misplaced racial guilt overwhelms the body politic's natural defense mechanism against mountebanks and con artists. And all for a bright, shining lie -- the Big Lie of Obamacare.

In fact, everything about the Obama-Axelrod administration is a lie, including (as Mary McCarthy said of Lillian Hellman) the words "and" and "the." But they don't care. Take this example from Jake Lingle's new memoir, a passage from which is recounted in Time magazine:

Barack Obama misled Americans for his own political benefit when he claimed in the 2008 election to oppose same sex marriage for religious reasons, his former political strategist David Axelrod writes in a new book, Believer: My Forty Years in Politics. “I’m just not very good at bullshitting,” Obama told Axelrod, after an event where he stated his opposition to same-sex marriage, according to the book.

Axelrod writes that he knew Obama was in favor of same-sex marriages during the first presidential campaign, even as Obama publicly said he only supported civil unions, not full marriages. Axelrod also admits to counseling Obama to conceal that position for political reasons. “Opposition to gay marriage was particularly strong in the black church, and as he ran for higher office, he grudgingly accepted the counsel of more pragmatic folks like me, and modified his position to support civil unions rather than marriage, which he would term a ‘sacred union,’ ” Axelrod writes.

The insider’s account provides the clearest look yet at Obama’s long-established flip-flop, one of the blemishes on his record as a progressive. The admission of Obama’s embrace of deception also calls into question the President’s stated embrace of a new kind of politics in 2008, when he promised to be unlike other politicians who change their views to match the political winds. “Having prided himself on forthrightness, though, Obama never felt comfortable with his compromise and, no doubt, compromised position,” Axelrod writes. “He routinely stumbled over the question when it came up in debates or interviews.”

"Blemish on his record as a progressive"? All progressives ever do is lie, and this one will lie about anything and everything; indeed, he lies reflexively, even when he doesn't have to. Every sentient being in America knew the fey candidate from Chicago was in favor of gay marriage (why wouldn't he be?) and yet the media -- led by former journalist Axelrod, playing both sides of the street, as always -- pretended not to notice. Until the moment when Obama finally came out of the closet, policy-wise, and then the media cheered his "evolution." What a crock.

Back to Elisabeth Rosenthal's story in the Times and its belated realization of what a monster Obamacare is:

The Affordable Care Act has ushered in an era of complex new health insurance products featuring legions of out-of-pocket coinsurance fees, high deductibles and narrow provider networks. Though commercial insurers had already begun to shift toward such policies, the health care law gave them added legitimacy and has vastly accelerated the trend, experts say.

The theory behind the policies is that patients should bear more financial risk so they will be more conscious and cautious about health care spending. But some experts say the new policies have also left many Americans scrambling to track expenses from a multitude of sources — such as separate deductibles for network and non-network care, or payments for drugs on an insurer’s ever-changing list of drugs that require high co-pays or are not covered at all.

For some, like Ms. Pineman, narrow networks can necessitate footing bills privately. For others, the constant changes in policy guidelines — annual shifts in what’s covered and what’s not, monthly shifts in which doctors are in and out of network — can produce surprise bills for services they assumed would be covered. For still others, the new fees are so confusing and unsupportable that they just avoid seeing doctors.

One of the men Obamacare gave us One of the men Obamacare gave us

Wait -- what? "They just avoid seeing doctors"? I thought that the whole point -- the whole selling point, at least -- was to increase access to doctors, especially for the poor. Ha ha ha ha ha!

It is true that the Affordable Care Act has erased some of the more egregious practices of the American health insurance system that left patients bankrupt or losing homes to pay bills. Insurers can no longer deny coverage to those with pre-existing conditions, for example. And the new policies cap out-of-pocket spending so long as the patient receives care within the plan. Most important, the act has offered health insurance to an estimated 10 million Americans who did not have any, often by expanding Medicaid or providing subsidies.

But by endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.

In fact, as the painful part of the ACA now rolls out, it's becoming clear that the whole enterprise was a bait-and-switch from the jump -- a way to actually increase health-care costs by (as the ineffable Jonathan Gruber famously said) relying on the stupidity of the American public, many of whom to this day are under the impression that Obamacare = free doctor visits.

“I’m always curious when I read this ‘good news’ that health costs are moderating, because my health care costs go up significantly each year, and I think that’s a common experience,” said Mark Rukavina, president of Community Health Advisors in Massachusetts.

While much of the focus in the past has been on keeping premiums manageable, “premiums now tell only a part of the story,” Mr. Rukavina said, adding: “A big part of the way they’ve kept premiums down is to shift costs to patients in the form of co-pays and deductibles and other types of out-of-pocket expenses. And that can leave patients very vulnerable.”

Such policies desperately need improvement, patients and professionals like Mr. Rukavina say. But with the Republicans attacking the Affordable Care Act at all turns, even political supporters seem reluctant to acknowledge that it has some flaws. The narrative has been cast in black or white: It’s working, or it’s a failure. The reality, of course, is gray.

In one sense, it is working: it's separating middle-class Americans -- the kulaks of their day, whom Obama despises -- from even more of their money, giving them little or nothing in return, exposing them to financial and criminal penalties, and winning the votes of the indigent, the stupid, and people like Ms. Pineman. But the screaming skull beneath the skin of the most malevolent act of Congress in American history can no longer be rouged and powdered away:

A recent New York Times/CBS poll found that 46 percent of Americans said they had trouble affording health care, up 10 percentage points in just one year. Some of the cost problems may ease as patients — now known as health care consumers — learn what to expect and how to choose and navigate their plans.

But other problems may be related to the process by which the plans are created. Under the Affordable Care Act each state was asked to select a benchmark plan as its standard. It had to cover certain “essential health benefits” like maternity care and prescription drugs; it had to have a defined actuarial value depending on the level of plan. Silver plans, for example, had to cover 70 percent of charges, leaving consumers with 30 percent. But within those parameters, competing insurers had leeway to set premiums, co-payments and deductibles, and to create networks by negotiating with doctors and hospitals. Naturally, they created policies that met the core criteria while minimizing their financial risk.

Suddenly there were hundreds of new insurance products that had never been tested in real time. Their shortcomings are now playing out in various ways.

"Never been tested in real time." This is what you get when you elect a man of no accomplishment but a high level of self-esteem and a great deal of animosity to the country as founded to the highest office in the land: a maleficent dissimulator who could not care less what happens to folks like Karen Pineman as long as she keeps voting for him and men like him. Which, of course, she will.