Glad you caught it in time :)

Me too - hope you will post more often now!

For anyone reading the following and thinking I'm an insensitive git, I should say that Jon's a friend and we've discussed his brush with melanoma at some length.

That said: Jon, I think your understandably focused perspective is blinding you to the fact that the ACA is not "the first step to the only system that's ever worked anywhere on earth: universal, high-quality health insurance." Rather, it's a massive step AWAY from that system--and an all but irreversible step, at least for the next few decades. The ACA institutionalizes and entrenches corporate health care in the US, making it all but impossible for us to get universal health care in any form.

The one good piece of the ACA that people consistently point to (as you have here) when they're trying to show that it's not all bad is the fact that insurance companies can no longer use preexisting conditions to deny coverage. And yeah, that's good. But a) it's resulted in far higher premiums, copays and deductibles for most people (whether or not they can afford it), who are now funding those who would have been denied because of preexisting conditions (and all of that money is going straight to the insurance companies, making them even stronger); and much more importantly, b) it doesn't remotely offset the tremendous damage the ACA/Obamacare has done to the cause of genuine health care reform in the US.

An analogy: citing preexisting condition cases and saying "Thank you, Obamacare!" is like a German man in 1941 explaining how his grandmother with the serious respiratory condition was able to move out of a moldy apartment and into the cleaner flat upstairs, thus possibly saving her life, because the Jewish couple who'd lived there had been shipped off to Auschwitz. "Thank you, Herr Hitler!"

It's true that some people will benefit from Obamacare--just as some people benefit under almost any major system, no matter how twisted or broken that system might be otherwise. But just because the ACA has some positive effects doesn't mean it's either a step in the right direction or a net positive.

@john caruso: i have a sense of proportion, so i won't call your analogy an atrocity. it's just FOUL.

Sorry if you feel Auschwitz-referencing analogies are beyond the pale, but the point is that even the worst systems can benefit some people.

As far as proportion, Jon made it clear that he feels higher deductibles and co-pays are life-or-death issues in his posting: "I probably wouldn't have gone if I had insurance but it had a big deductible, or even any real co-pay. The only reason I went to have my life saved is because it cost me zero dollars." But the ACA is driving higher deductibles and co-pays--and therefore, by Jon's own explicit logic, it's going to kill people.

I'm experiencing this firsthand. I've just moved to a new state and have been forced back into the corporate health insurance market, and the "exchange" here is a joke--just a central gathering point for shitty private health insurance plans with sky-high deductibles, premiums, co-pays etc. It seems even worse to me than the last time I was thrown into the corporate insurance shark pool. And if I found myself in Jon's situation after I buy one of these plans I likely wouldn't go to the doctor either, for the very reasons he cites, and so I'd find myself at the lower percentage survival rates if and when I did finally get it checked out. I wonder if the Huffington Post would publish a "Thanks for trying to kill me, Obamacare" video?

Jon's perspective is skewed because he's benefiting from a unicornesque top-flight health plan provided by an employer (who had no choice but to provide that kind of plan, given his filmmaking background). But his experience doesn't even generalize to other employer-based plans, much less private plans, and it doesn't come close to offsetting the health care disaster that is Obamacare.

I am delighted to see you back and well, Jon. Thanks for sharing the story and thoughts.

A few years ago, I had a growth that seemed to be, well, growing ('twas on the face, much easier to see), so, insuranceless and dreading what might lie before me, I hied me off to a dermatologist. I sat in a waiting room glaring at a TV that blared Fox News at me. I saw a physician's assistant -- never got near an actual doctor -- who took the growth off. I paid well over $300 for about ten minutes with that PA. Then I had to call and call and call the lab number they'd given me in order to get the test results: not malignant. I suppose I was relieved by the news, but mostly I just remember anger. I still feel angry when I think about that experience. Thoroughly unmindful of me, I know.

Perhaps I should think of the tumor as being named "Ted." Then there'd be a certain satisfaction in contemplating it being scraped away, experimented upon, and discarded as reviled waste. Ah. Better already.

--JW

@john caruso:

1) i understand what you're saying and as a supporter of PHNP from the beginning i completely agree with your assessment of the brutal microeconomics of this program.

2) you fucked up. obamacare is not genocide. admit it and stop trying to move the overton window out to jupiter.

Wow. I can imagine someone dishonestly trying to twist my analogy to mean something as absurd as "Obamacare is genocide", but you're sincerely misreading it that way? Even though I've explained two separate times now what I meant by it (which couldn't be farther from the way you've misread it)?

Unbelievable. It just goes to show that no analogy is safe from misinterpretation, whether willful or unintentional. And it's a reminder of one of the reasons I don't blog anymore: even people who supposedly share your views are perfectly happy to unload on you rather than assuming they may have misunderstood something and trying to resolve the misunderstanding.

@john caruso: why not analogize my "misunderstanding" as a psychotic killer eating human feces because he thought it was a cake? it's just an analogy, a casual reference.

Continued good health to you, Mr. Schwarz.

Love the scare quotes on "misunderstanding" there. Yeah, you've caught me out, hapa--OBAMACARE IZ GENOCIDDE!!!!!!1!!

Holy hell. I get that my analogy gave you a fit of the vapors, but maybe you should consider whether it's really worth acting like a complete asshole over it.

@John Caruso

John you're completely missing the point here, you've questioned the efficacy of Obamacare and that will never do.

Jon, keep well and take care..

For those who may have missed these lines from Jon's post.....

This doesn't mean that I don't understand Obamacare's grievous flaws. But they're not flaws of going too far, they're flaws of not going nearly far enough.

And the awful truth is that while Obamacare will save some of those people, it won't save them all

We have to get rid of the parts of Obamacare that may help the private insurance industry keep squeezing us like an anaconda. And we have to keep and improve the good parts, so the Affordable Care Act is just the first step to the only system that's ever worked anywhere on earth: universal, high-quality health insurance and healthcare for everyone.

@caruso

1) scare quotes go around things no one said. QUOTES go around things people SAID.

2) in my experience, arguing from absurdum and then attacking your opponents for taking it seriously is pure & simple trolling. i'm really upset that you're playing me this way, since we've both been around here so many years.

@coldtype: get a clue.

i'm done. it didn't occur to me that anyone would ~casually~ link institutional discrimination to mass murder. i thought i had the market cornered on frivolous language. done done done.

hapa: QUOTES go around things people SAID.

Ah, ok, now you're just flat out lying. Guess I was mistaken in assuming sincerity on your part earlier; too bad.

rupa shah: Those lines are fine as far as they go, but Jon's overall message is that Obamacare is a step in the right direction--and it's not. You can't "get rid of the parts of Obamacare that may help the private insurance industry keep squeezing us like an anaconda", because those "parts" are the central animating premise of the legislation. Obamacare is health insurance mandates, and it inherently strengthens the insurance industry while making any moves toward universal health care all but impossible. That was the entire point of the ACA, and thinking we can reform or transform it into anything resembling universal health care is mistaken.

@ John Caruso
I am, have been and will always be for universal health care AND I KNOW, Affordable Care Act is NOT going to take care of all that is wrong with the way medical care is given or received in this country. HOWEVER, I am secure with my own ability to seek medical attention as and when I need it. I can not possibly tell a student who could not afford health insurance before ACA went into effect that is is bad because that student is now able to be carried on his/her parents' insurance nor can one tell a person with pre-existing condition, ACA not to her/his benefit as for the first time, that individual will not be denied insurance. In these two instances, individuals affected will certainly be grateful for ACA.

As pointed out, there are extreme shortcomings in ACA. Meanwhile, many groups are working ( and have been working ) towards Universal healthcare/medicare for all. Considering the way the whole political system works in the USA, ACA is a tiny step, a positive step for some.... and nothing changes overnight and those of us who have been fighting for universal health care will continue to do so.... we do not give up....and things DO CHANGE!

ps This is what I believe and I will not respond to further comments regarding my response.....

$2000 deductible? Isn't the average deductible $5000? But isn't that the point? Obamacare is designed to keep people from using medical care, with the reasoning that Americans use too much health care, thus driving up the cost?

And I'm not endorsing that viewpoint - I think it's absurd giving health care costs everywhere in the world other than the US. But congratulations Obama, I can't afford to go to the doctor, even with forcibly placed health insurance.

rupa shah: Yes, just as you couldn't tell a German couple who benefited from Hitler's marriage loans that that was a bad thing. But neither that nor the many other social programs Hitler instituted mean that Nazism was a good system overall, or one that could be "reformed" into being a good system. Benefits like that were just window dressing on a rotten system--just as getting rid of the preexisting condition exclusion is just window dressing on the rotten system that is Obamacare.

That was the point of my analogy above: even the worst systems can (and usually will) have some genuinely positive effects, but that doesn't mean they're either a step in the right direction or even a net positive.

Pepe: I'm often seeing deductibles of the maximum of $6350 at the bronze plan level. There's only one platinum plan in my state, and it still has a $1000 deductible and $10 co-pay for office visits, with a $473/month premium. So the best Obamacare-influenced plan you can buy still leaves your melanoma undiagnosed, using Jon's standard.

That's why I don't get why he's saying things like "If I'd delayed because I had to pay, it easily could have ended up costing the system $500,000.... Multiply that by millions of people and you'll understand why the right's crusade against health insurance is more than just evil and cruel, it's evil, cruel and incredibly stupid." Because that is ALL STILL TRUE UNDER OBAMACARE (and in fact often worse, since deductibles and co-pays are increasing). So by his stated logic, the liberal crusade for mandatory health insurance/Obamacare is also evil, cruel and incredibly stupid.

What Jon's really done here is to write a tribute to Michael Moore's excellent health insurance plan--but for some reason he's assigning the credit for that excellent plan to Obamacare, which deserves none of it.

And don't even get me started on the co-pays - the plan I can "afford" has a $5000 deductible and 40% co-pays. Jesus fucking christ. I will literally only go to the doctor if it's an emergency and the emts bring me there while unconscious.

Yeah, I'm now seriously thinking my best option will be to get no insurance at all, pay the penalty, and then if I get really sick just enroll in a platinum plan since they'll have no choice but to accept me.

(But that'd still leave a melanoma undiagnosed, wouldn't it...)

pepe do you qualify for subsidies?

"Yeah, I'm now seriously thinking my best option will be to get no insurance at all, pay the penalty, and then if I get really sick just enroll in a platinum plan since they'll have no choice but to accept me."

John, I would argue that the approach you outlined above is precisely the logical one to take if one is in good health, and self-aware. Yes, I suppose, that there is always a risk to missing out on early screening, but as has been pointed out, the same holds true for high deductible policies.

A few years back I read The Collapse of Complex Societies by Joseph Tainter. Later the Orwellianly-named ACA took shape, precisely illustrating the book's thesis, inasmuch as it's an additional layer of complexity — at energy-cost to society — that will be far less effective than dropping to a lower level of complexity (e.g. what Britain had in 1948) would have been. My respect for Tainter's thesis rose in retrospect.

I too am glad Jon's still alive. Also I agree with John completely.

I'm glad it was caught in time, Jon. Good piece, and best wishes.

it's not medicare-for-all because it was never going to be. any change was going to include the profiteers and their useful idiots.

a very large group of obamacare opponents just shut down the fucking government for two weeks, partly because many of them DO think obamacare is the same as hitler.

there are 3 possibilities, from hardest to easiest:
1) repeal
2) reform
3) regression (tantrums)

repeal is hard because republican mover-shakers want to PISS on obamacare, not end it. so no allies for medicare fans. unless pissing is the sport here too?

Just one little thing to note: an important service that insurance companies provide is negotiating discounts. The difference can be big. So that's something missing from discussions of deductibles.

Me, I think the status quo is worse than Obamacare, in case anybody wants to know.

Medical costs are going to keep rising fast forever. It just seems to me that something's going to have to give sometime. Somehow.

Every other time I see my dad he's got fresh scars from the latest cancer he's had cut off. I guess it's good thing he never went to the beach much.

he's had cut off.

i'm glad jon received the medical care he needed and i hope that he will continue to do so for the rest of his days

i think he's right that the "no exclusion for pre-existing conditions" provision of the ACA makes it more likely that he will continue to get the medical care he needs if he ceases to be covered by his current medical plan

i have always agreed with the american public health association in a policy position which can be summarized in a three-word slogan - "medicare for all"

strong words are being exchanged here because of different perspectives of this question:

How's Obamacare?
Compared to what?

compared to the status quo ante?

OR

compared to what might or might not have been possible if the public option had not had a plastic bag put over its head while it was in its cradle?

godoggo is right that an uninsured person is charged exorbitantly inflated medical care rates which pretty much guarantee bankruptcy if something major happens (although even insured persons can be and are bankrupted by medical expenses for serious illness)

godoggo is also right in pointing out that things that can't go on forever, won't - something's gotta give - both in terms of the increasing share of national income spent on the medical-industrial complex - and also, of course, in the fact that sickness, old age, and death are part of the human condition - the first two can possibly be avoided under certain circumstances

john caruso is right that jon schwarz's excellent health insurance plan is not obamacare, and obamacare does not deserve the credit for it

but jon schwarz and rupa shah, among others, are correct, in my opinion, in saying that obamacare is better than the status quo ante

whether or not obamacare is a step toward or away from "medicare for all" or its functional equivalent depends on what happens next - and influencing what happens next is part of what michael moore's corporate endeavors are about, i suppose

may the Creative Forces of the Universe stand beside us, and guide us, through the Night with the Light from Above

As someone who's poor enough to qualify for the ACA's Medicaid expansion, and who also has a pre-existing condition, I find Obamacare preferable to what came before (which I like to think of as the entire medical insurance industry telling me, in polite corporate-speak, to die in a fire). I'm not sure letting the great be the enemy of the good is actually the best choice here.

@m jacobs:

1) the point of larger-better medicare is not medicare per se, but that it's a way to guarantee affordable care for all, without holes or doubts.

2) the obamacare mechanism for getting insurers to cover more expensive customers can be much more progressive. in fact we could leave many obamacare prices in place as they are if other tax burdens were shifted upward (where they used to be). getting paranoid elites to stop imagining, or pretending to imagine, epidemic hypochondria... is another thing entirely.

As someone who has been flat broke for many long periods during the last 3 years, I have had to go without insurance for a month or two when things got really bad.

But the coverage I could afford was not generous-- and indeed lab tests are usually not covered until you meet your deductible. (usually $3500 or $5000). So that definitely keeps me from visiting a doctor (and I haven't visited one for 7 years).

The best thing about Obamacare though is that I won't have to undergo underwriting starting Jan 2014. So I can go to the doctor without worrying about losing or being unable to afford my coverage with this company or any company in the future.

Even though 2013 will be a very unusual year income-wise, my income would be low enough that in the state where I live I wouldn't be eligible for subsidies. I wonder if they put you in jail for reporting your income as higher than it actually is for the purpose of calculating subsidies....Welcome to the craziness that is Texas.

(Seriously, I expect 2014 income to be more normal....)

What about the incompetence of doctors themselves? I moved to a rural area and so far have tried three different doctors. The first one I saw said I had diabetes and recommended a diet of meat and beans. Check, scratched him from my list. I went to another doctor and when I went into the office I saw that it was covered with large pictures of Jesus which made me suspicious. He wouldn’t listen to what I had to say, completely misdiagnosed me, gave some poison pills which caused me a great deal of pain, and as it turned all for nothing, so I scratched that moron from my list. The next one I saw also had a painting of Jesus and who prescribed these horse pill sized tablets of vitamin D which had serious side effects that I won’t even mention, I’ll just say I lost a lot of blood. Check, scratched another idiot from my list. I’ve read that an average of 195,000 people die a year because of mistakes by doctors. I’ve come to inalterable conclusion that I will have to travel a fair distance to an actual city to find a decent doctor, fortunately a friend of the family knows of a good one there. I have minimal insurance that costs me about three hundred a month that I can afford only because my mom pays for it. If it wasn’t for my mom I wouldn’t have insurance. And after seeing my options on the California website I know I could never afford it either. I just had two lumps removed that the dermatologist said might be basal cell. I was supposed to be contacted in seven or nine days regarding lab results, that was two weeks ago. I’ll be calling the dermatologist tomorrow because more lumps have appeared and it looks like my arm has become infected where they took a chunk out. All I can say is don’t get old, and if you get really sick in America, well then God help you, and I don’t believe in God.

Wow honey. For once I've read a post that really says it all. I'm so very glad you're ok and I'm going to share this with as many people as I can make read it

Maybe we can make your "Tiny Revolution" into a big one.

speaking of revolutions, size not specified - see

Let’s Get This Class War Started

Oct 20, 2013

By Chris Hedges

I don't have anything to add except I'm glad to see you back--in both the literal and literary sense.

Jon, great to have you back. I agree that it's important that everyone have free or very cheap health insurance. I'm the same way, in that I only go to the doctor if I don't have to pay anything.

But I'm afraid I have to agree with John, besides the awkward Nazi analogy. Obamacare simply doesn't address, or worsens, most of the issues you raise. And I don't understand how anyone can see it as a step toward single-payer health care. It quite explicitly makes that impossible, which I think was the whole point.

People over 25 who couldn't afford health insurance before Obamacare still can't afford health insurance. Providing it to them for free would be great, but the ACA doesn't do that. Instead, it punishes them for not buying a private, corporate product.