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ObamaCare Clusterfuck: People can't find coverage that include their doctors or their drugs on the Exchange. Could that account for their unhappiness?

First, the user experience:

[T]he hunt for a health plan that would cover a particular drug or a favorite doctor proved particularly frustrating for many consumers navigating the new insurance exchanges under the federal government's health care overhaul, according to a report released Monday.

In nearly half the 85 health plans analyzed, it was difficult or impossible for people to determine what drugs were covered, according to the report by market research firm Avalere Health, the first systematic analysis of consumer experience on the exchanges.

The report analyzed health plans in five states that relied on the federal website, as well as state-run exchange plans in Washington, D.C., and a dozen states.

A directory of doctors was somewhat easier to find, but there were still some cases in which it was a very demanding search, the report found.

What's more, the websites typically ranked plans by premium price, which could have misled patients who needed a specific costly medication if it wasn't covered by the cheapest plan, Avalere spokeswoman Caroline Pearson said.

"It was very difficult for consumers to get a more nuanced view of what their plans covered," Pearson said. In some cases, a consumer would have to click six times to find drug coverage information. Even worse, no links to lists of covered drugs existed for some health plans.

That forced consumers to search insurance company websites, and, even if they found the covered drug lists, it could be tough to determine which lists went with the exchange plans they were comparing, Pearson said [and that's before we get to generics vs. brands].

"Many chronic conditions rely on medications for management and to keep people out of the hospital," Pearson said. "If your drug is not covered, then you're responsible for the full cost or you have to switch to a different drug. The impact on the patient could be several thousands of dollars a year." ...

"None of the sites has done a good job helping consumers compare out-of-pocket costs," [Robert Krughoff, president of Consumers' Checkbook] said. "That results in consumers wasting thousands of dollars a year."

And now the user reaction:

Obamacare is expected to play a major role in the midterm elections, and some numbers suggest the law could be a major hindrance for Democrats:

  • By a 44-48 margin, voters say they oppose the health-care law.
  • 50% of respondents said the implementation of the law is going worse than they expected, compared to 41% who said it's going better than they thought. This comes despite the fact that enrollment exceeded original targets, as more than 8 million people signed up for insurance through exchanges set up by the law.
  • 47% say the law is making their health-care costs go up. Just 7% say it's making costs go down, and 41% say their health-care costs have stayed about the same.
  • By an even wider margin, respondents said they think the ACA is leading to health-care costs increases across the country — 58% said Obamacare is making health-care costs rise, while only 11% said they think costs are decreasing.
  • By a 44-24 margin, respondents said the law is helping to make the quality of the nation's health-care system worse

Democrats and Obama enablers always focus on premium price. I suggest that, as rational consumers, "voters" are focusing on value for money. And ObamaCare's narrow networks, narrow formularies, high co-pays, and high deductibles lower its value in the eyes of consumers, especially those who formerly had employer-based insurance. But for people who need a particular doctor, or need particular drug, ObamaCare could be not only poor value, but actually defective, in that they could well purchase a policy they thought would cover them, but doesn't.

The plans are crapified. People get this. For good or ill, the political class intends to crapify everything in more or less the same way because markets.

NOTE Democrats and Obama enablers will note that the Exchanges will be improved in future. First, they had five Fucking years to get it right. Why didn't they? Why weren't the needs of the patient a priority? Second, a single payer system makes all these problems go away. You don't have a lemon market of plans competing with each other by concealing information. In fact, you don't have a health insurance market at all, which what allows Canada to save a shit ton of money with better health outcomes.

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quixote's picture
Submitted by quixote on

Compare that to theMedicare website that helps you choose a "Part D" supplemental private insurance. One of the first things you do is enter the medications you regularly take. The only plans that come up are the ones that cover those.

It's not like there's nobody working for the government who knows how to do these things. But for some reason they didn't want their help for Obamacare.

a little night musing's picture
Submitted by a little night ... on

Who the heck knows what medications s/he will be taking in the future? That's the job description of a psychic, I think: and also, the opposite of insurance, which is supposed to insure us against risk.

Oh, dang, I keep expecting logic.

mellon's picture
Submitted by mellon on

so they can point to us when they are negotiating trade deals and say "look, we don't give our own people any sweetheart deals"

That's what this is really about. The middle class in Asia is growing - rapidly and its already several times the size of the middle class in the US.

Here, its shrinking.

Alexa's picture
Submitted by Alexa on

on ObamaCare "solutions."

The PtB (according to a Employer Healthcare Consultant that I heard last week on C-Span) agree that a single-payer plan is out-of-the-question.

So, in response to "consumer discontent" with ObamaCare, Democrats are looking at "reforms" that are considerably more conservative and market oriented.

Several Senate (DLC/Blue Dog) Democrats are calling for another even more "catastrophic" plan.

Today, we have the Platinum, Gold, Silver and Bronze Plans--they want an even cheaper plan--anything to stop calls for a single-payer plan, LOL!

It will be a "Copper" Plan. I have no idea what the actuarials are, but the bronze plan is "60."

So, let's see if I have this right--because many working class individuals and families are too low income to be able to afford a "Bronze Plan," they should be herded into even more insufficient and sorry coverage--leaving them even more vulnerable to medical bankruptcy, etc.

This--so that [DLC] Democratic Senators can "save their *sses" during the midterm elections.

(IIRC, this includes Begich, Landrieu, Manchin, Warner--and I can't remember the fifth Democratic Senator, right now. But, it does include "No Labeler" Senator King.)

And these same pols wring their hands because they fear that "the American People" are becoming cynical.


Alexa's picture
Submitted by Alexa on

mellon, tonight I really don't have time to go over a bunch of healthcare reform material from the 90's. (I've read a lot that you've posted about NAFTA--no argument from me on it.)

And, I'm all ears if you'd care to condense and explain the material.

'Cause I really don't have the first clue what you mean by "that trick."


mellon's picture
Submitted by mellon on

From the beginning, its been obvious to me that Obamacare would fail, it was only a question of how long. However, they dont want us to know that private insurance CAN'T work because we can't have single payer because of teh FTAs, so they (both parties) have to figure out a way to plausibly kill it, as they did in 1994. They will argue and have gridlock, then they will whittle it down until nobody cares if they kill it, and then they will say PUBLIC HEALTHCARE FAILED!

LOL. And the media will play along and the 65-70% of us who realize something is seriously wrong will just get shouted down when we try to bring it up on the blogs. Lifespan will decrease, people will start getting cancer earlier and earlier and eventually most people will be sterile, there will be a war, only robots will be left and then in around 2000 years, they will have a big conference and present lots of papers about why it happened. Then climate will change and they will all be frozen under the ice.


mellon's picture
Submitted by mellon on

I think the chances are basically zero that this wasn't all planned out in advance.

Look at pages 8 and 9 of this document from the 90s on NAFTA. See how NAFTA banned single payer but Clinton was still hinting that "maybe" he would consider it. And the unions fell for it. And they did the exact same thing in 2008-2014

If you read this article on the WTO you'll see what the real policy on single payer is.

Also, read this article about the good cop bad cop routine with the selling (and then abandoning) of "Clinton-Lite"

Submitted by lambert on

... are the relevant quotes:

The "free trade" aspect of NAFTA can be found in the serious restrictions that the agreement places on a government's ability to regulate. It explicitly requires, for example, that governments treat social institutions -- such as education or health care -- as service commodities open to the competitive pressures and the dictates of the marketplace. ....


Here is what happened in Ontario. In 1990 the people of Ontario, which is the most populous province and the industrial heartland of Canada, elected a social democratic New Democratic Party government in this province for the first time. A part of their election platform, included the proposed setting up a government run, universal, single payer, no-fault auto insurance plan. Although this might sound like a major reform in the US, this is no big deal in Canadian public policy. It's a modest and popular reform which the NDP has already introduced in British Columbia, Saskatchewan, and Manitoba, prior to the passage of the "free trade agreement." But early in its proposed reform, the provincial government was stopped in its tracks. The provincial auto insurance companies claimed
that according to the Canada-U.S. Free Trade Agreement, (Article 2010 Monopolies) the action would create a government monopoly. This in turn would have an "adverse affect" on US insurance companies operating in the province and would constitute an action "tantamount to an expropriation" (Article 1605 Expropriation). Under the FTA, such action required "effective compensation at fair market value." The insurance companies demanded billions of dollars in compensation if the government went ahead with its election promise of a provincial auto insurance scheme. The provincial government of the largest and most powerful province in Canada, shamefully, backed off
and walked away from its proposal.


if we apply what has already happened in Canada with the blocking
of a provincial auto insurance scheme -- isn't it likely that a move to single payer health insurance could similarly be precluded here in the US? That is, couldn't a state-run single-payer health care system be interpreted as a monopoly "tantamount to an expropriation?"

Apologies, mellon, if you've already quoted these and it didn't register with me.

Alexa's picture
Submitted by Alexa on

Okay, this will be brief (for me) due to lack of time to expound. And because I'm not in any disagreement about NAFTA precluding single-payer, etc.

(IIRC, I recently stated that I thought that the Dem Party Base should demand that ALL Presidential nominees should state their position on the repeal of NAFTA, and the rejection of the TPP. Again, we have no disagreement on the effect of free trade agreements, etc.)

Here's the facts: Several Senate conservadems and one Independent Senator have proposed very conservative "fixes" to ObamaCare.

One of the worst of them is to propose a new (cheaper) even more catastrophic health care product--the Copper Plan.

There are several other hideous proposals that these Senators are putting forth for consideration, but frankly, I don't have time to get into them this evening, which is "why" I just mentioned "the one fix."

Just found all the Senators' names:


The first five are Democrats, and Senator King is an Independent who caucuses with the Democrats (as I understand it).

It's been about a month since they presented their conservative proposal for "fixing" ObamaCare.

These suggestions are in keeping with the ones I heard proposed by a conservative Health Care Expert/Employer Consultant at an "ObamaCare" Reform Forum last week on C-Span.

Don't take my word for it--"Google" it, please!

And it's not exactly a secret--you can't turn on C-Span, and not hear about it.

The irony is that the Democratic Party's solution to the "massive discontent with ObamaCare," is to go even further to the right, when looking for policy solutions. (Of course, that's exactly what DLC Dems have ALWAYS done--and nothing's changed.)

Makes me wonder if this isn't another "intended" consequence, which will be sold to the Dem Party Base as yet another "unintended" consequence.

And I believe that these changes will likely be enacted immediately after the 2016 Presidential Election (Lame Duck, anyone?), because as some Health Care Policy Experts suggest, some course of action needs to be taken very soon in order to head off the demand for a single-payer system--due to the obvious failure of ObamaCare to deliver for many millions of Americans, who are not covered under ObamaCare simply because they cannot afford the health insurance premiums.

This new even junkier "Copper Plan" may "give cover" to politicians of both parties--and help stave off the demand for a single-payer system.

BTW, this piece was discussed on Julie Mason's program today:

"The Biggest Reason People Didn't Sign Up For ObamaCare."

(Please excuse typos--pushed.)

Submitted by lambert on

I don't have time to listen to it. You don't have time to do clips.

Is there some blog or service somewhere that summarize... Or gives transcripts?

Alexa's picture
Submitted by Alexa on

Not that I know of.

Sometimes, the videos have a small "scrolling" transcript as a video is playing, but I haven't figured out a way to print it (or capture it).

We also don't have the luxury, much of the time, of literally sitting in front of a screen to watch a live hearing or forum--but we "listen," as often as we can.

I'm not sure, but I think that now a person can get "computer streaming only" radio programming, and that it is a reasonable price. I think that our rate is even cheaper, because we have the hardware service (so it's discounted).

Here's the Sirius/XM Customer service number, if anyone is interested. There might be a 30-day trial, available.


Ironically, when we started subscribing to satellite radio, we did so because of "Air America."

Now, we don't even bother to listen to any of the so-called progressive programming. (And tellingly, what was the lefty channel, dropped the word "left" out of the Channel name!)

mellon's picture
Submitted by mellon on

It doesn't matter to the powers that be if it works, or if its affordable, or even if it fails to work at all.

as long as it continues the ongoing orgy of looting and privatization of all public services around the whole globe.

That's what matters to them.

Read this new report which just came out yesterday:

TISA versus Public Services: The Trade in Services Agreement and the Corporate Agenda

Submitted by Dromaius on

Insurance commissioners act like they're surprised about the lousy formularies and networks. However, cynical me, I think they were done on purpose. In the near term it was better for Obama and the Democrats to have narrow crappy plans rather than "rate shock".

Now watch the networks be the new reason why we have to elect Democrats this fall.

Alexa's picture
Submitted by Alexa on

According to Employer Health Insurance Consultant Laszewski, ObamaCare reform will come in 2017 (not 2016)--heard so much lately, got the dates mixed up!

[Stan Collender, Bloomberg, also believes that the Grand Bargain (and the bulk of the entitlement and health care reform) will come after the 2016 Presidential election.]

And no one is planning to directly "fix" narrow networks--only offer more skimpy and downsized policies.

Although, one fix that is being considered (aside from VERY catastrophic plans) is to allow individuals and families to "fashion their own policies," like they did before ObamaCare. Some categories of coverage would remain mandatory, though.

OTOH, some types of coverage would likely be elective, again. (IIRC, he was referring to "maternity" coverage, for one.)

Submitted by lambert on

Thinking of "ratchet" and "standstill" -- could there be a trade deal deadline that affects the timing? Like, "we can't fully implement ObamaCare until 2013 because we don't expect ____ to be in place until 2018, and we can't ratchet back more than 5 years?"

I'm sure the detail is wrong, but you see the idea.

mellon's picture
Submitted by mellon on

never looser. So any given privatization becomes silently irreversible. It doesn't matter how corrupt it is or if it fails, miserably, that business sector from then on forever is owned by corporations in that market and no more public services are allowed there. If the government tries to re-establish public services they have to compensate the corporations for the size of the POTENTIAL not actual lost business. So, rememberback in the early days of the web when ads were sold by the POTENTIAL number of visitors to a site (basically everybody in the world with an internet connected computer) Kind of like that. So the fine the US taxpayer would have to pay for our healthcare manumission (freeing of a slave price) would be the biggest fine ever levied.


Now do you see why I'm worried? We're being set up for the biggest ripoff in the history of mankind.

mellon's picture
Submitted by mellon on

They absolutely cannot have poor people sitting next to rich people in the waiting room comparing treatments with one another.

That would cause huge problems. They have tried separate waiting rooms but that doesn't work well enough, even when they RFID tag patients to keep them in segregated areas. So they need to shunt the poor into a separate healthcare system where everything is designed to limit costs, prevent or delay diagnosis and abbreviate treatment.

Their long term strategy of lowering the standard of care (which is determined by geographical area) depends on the poor treatment becoming the dominant treatment - thats to allow ERISA preemeption to bar any lawsuits against the insurance companies. They demanded this.

So the treatments will get worse and worse. Then they will say that to lower costs they have to eliminate the rules against allowing doctors and nurses from any other country to practice (eachers too, similarly with privatizing education) This is to prevent any attention from being focused on TISA and GATS, services agreements - etc. the real places where these changes are occurring.

mellon's picture
Submitted by mellon on

Wedge in which "party"'s favor, which one is worse? They both are the same and are just playing good cop bad cop. They both couldn't care less about the people. We're dealing with a major problem here.

See this article- for a historical parallel -

Sick people will find they have to leave the country. Thats probably the goal. And they would probably be wise to do just that. There is no way to solve this under the private system. Look at what happened with South Africa and GATS. The apartheid regime as a parting shot, committed health care insurance under GATS.

That was ten years ago they discovered that GATS was going to prevent their health reform..


The same thing will happen to us, here, now if we don't speak up now and expose this free trade agreement situation!

In South Africa- GATS lock-in caused by the previous apartheid regime- even though that regime was globally seen as illegitimate- the investor-state rights won out- created an unfixable problem after the majority government came to power because democracy cannot fix this

One corrupt administration is all it takes with the FTAS.

They know that but they pretend it is solvable with "just another cut" here or there.

Their real goal is to trigger GATS making it irreversible forever.

Its not- Read more about the WHY of this here.

Thats their game and they are playing it to the hilt. Beleive me, the private system wastes so much and is so broken it cannot work, it is criminal as it gets worse too.

Submitted by Dromaius on

Both parties will be equally bad depending on the point of view. That's how wedge issues seem to work. But speculating on the buzz words:

The Republicans want to narrow your networks more and keep you from seeing your doctor.

The Democrats want "Socialism" and want to raise your taxes so that the welfare queens will get better medicine than you.

Done and done. Wedge issue.

But of course, behind the scenes the two parties will be playing golf together at the golf course of corporatocracy ;-).

Submitted by lambert on

The 2005 link to GATS is great, but the link at "THEY STILL ARE WITHOUT A FUNCTIONAL WORKABLE HEALTH CARE PLAN!!" is about the US, not South Africa. So, did South Africa find a work-around?

mellon's picture
Submitted by mellon on

They will get much worse. Every indication, as well as the pattern - as you saw in your own state, the people who buy will self select. the sick will buy insurance, the healthy poor will do without. That means prices may even double or triple next year. ("Death Spiral" as its called) There wont be a year three. Then they will kill it and say "Public healthcare failed" when of course, public healthcare has been WTO-illegal all along.

They're so smart!

Rainbow Girl's picture
Submitted by Rainbow Girl on

For bringing the, apparently dispositive, influence of these quietly unmentioned international "trade" treaties. It had never once occurred to me that the blue v. red jersey Single-Payer v. Markets health care (insurance) ping-pong games in Congress over the last 20 years might (in all probability appear to) be orchestrated to adhere to, and conceal from the public, these "treaty" obligations whereby any government services programs is a violation of international corporate interests' commercial rights (to rent-streams) and therefore a takings, damages for which would destroy the U.S. economy worse than the 2007 financial crash.

God I hate Clinton and his Rubinite circle more and more. And to think that in the public's eye the man was "bad" because lying about a **** ***. Meanwhile, off we went to ShaftaVille (though the only visible victims then were the 100s of thousand Americans who lost good jobs).

Well, this theme *has* to get out in to the mainstream - NOW. Paging Ms. Maddow and Mr. Stewart? Yeah, right. Maybe BIll Moyers -- or the fellow who did the documentary with Lanny Look-At-My-Tie Breuer.

In any event, I greatly appreciate your posts on this subject and feel as though I am being educated all over again.

mellon's picture
Submitted by mellon on

>Well, this theme *has* to get out in to the mainstream - NOW. Paging Ms. Maddow and Mr. Stewart? Yeah, right. Maybe BIll Moyers -- or the fellow who did the documentary with Lanny Look-At-My-Tie Breuer.

Please write the media people you read and ask them to do a story on this, NOW. It is the story of the century, seriously.

Whichever news outlet is seen to have broken it, will get the eternal gratitude of the American people AND THE WORLD, because our enslavement is being held up as an example of "how to" do it in the FTAs.

Time is of the urgency. Any of these Obamacare fixes WILL have this poison pill they are exposed, now, soon.

People have to get the media involved. I am too emotional about this and despite numerous promises to publish things, as far as I know only a few organizations are involved in this and they seem to be reaching a very limited audience. The MSM has a media quarantine on everything related to single payer and I think they also quarantine news about these FTAs.

Its the only explanation.

But its such a big thing, that the media WILL cover it if they HAVE to.. That will scare poiticians away from supporting this.

The possibility of exposure will scare them and make them want to be disassociated from it.

Fast because its a very bad thing they have been doing.

Its a crime against humanity. The people responsible for it I suspect will eventually be prosecuted in an international court.

AGAIN- Please, everyone, write the media people you read and ask them to do a story on this, NOW. It is the story of the century, seriously.

Alexa's picture
Submitted by Alexa on

Hope to swing back on topic of "wedge issues."

They won't work (and shouldn't) if we don't allow them to do so.

To a point that Dromaius made earlier--perhaps her Democratic (?) Commissioner wants to use his ability to "rewrite regulation" to help the narrow network situation (Kudos, if he does, and succeeds)--however, mostly this won't be done, unless the ACA is repealed or completely overhauled (by design of the insurance companies who wrote the bill).

The topic of "narrow networks" is one that many Republicans are running on--including a female neurosurgeon (IIRC) who is running.

This is a topic that they can (and will) make great hay out of--and rightfully so!

Let's remember, it was mostly Democratic Party insurance company "minions" who wrote the ACA--and the Democratic Party "deserves" the blame for the sorry piece of cr*p that they produced (IMO).

One of the speakers that I referenced yesterday (apparently, he had a hand in awarding an European company the oversight--?--if that's the word--of the building of the Health Exchanges--which I am NOT applauding, of course) is going to beat Dems to death over the narrow network problem, in order to get the conservadems (and it's working) to go along with further privatizing the ACA, and with lifting many of the "regulations" that it puts into place.

To be continued . . .

(accidentally hit submit button)

Submitted by Dromaius on

Our commissioner did unilaterally create the rule that was discussed at my link. It is in effect. Unfortunately it is (probably intentionally) vague so any effect will be minimized.

Rainbow Girl's picture
Submitted by Rainbow Girl on

This is exactly what the Insurance Commissioners do in New York. There's a loud press release once in a blue moon about some "consumer-rights" nugget that's been added to the statutes governing insurers. Then you go an try to invoke that nugget and you find out that "there's a regulation under that statute that [basically neuters the legislation.]"

State legislatures and state insurance commissioners are wholly-owned by insurers and real estate tycoons.

Example from NY. There's a "Prompt Pay" law on the books - if the carrier fails to pay a "clean claim" within 60 days (60 days!!), then they have to pay interest as a penalty, after the "consumer" has wasted 6 months navigating the Ins. Commissioner's administrative procedure. And guess what. At the end of that road, even if the state agency finds that your insurer failed to pay on time, there's this little obscure sub-clause (no doubt slipped in for a specific dollar amount from the Ins Co Lobby in NYS) with words to the effect "if the amount of the interest is less than a few dollars, then they don't have to pay it."

But here's the best part: let's say Ins. Co. failed to pay your claims timely for a whole year, and the money involved adds up to thousands of dollars. The interest on those thousands of dollars (collectively) would be more than that stupid "few dollars" benchmark, and thus presumably payable. But no. The way the Ins. Commissioner has "decided to interpret the provision" is that the interest amount is calculated PER-CLAIM, and therefore consistently falls UNDER the "few dollars" threshhold, and therefore no interest-penalty (a pathetic enough deterrent - bwa ha ha - in the first place) is payable.

Gotta love it. So not only did policy holder have to waste untold hours EVERY MONTH corresponding with the Ins. Co. about how they "never received the claim" and "please resubmit" -- yes, it's exactly like with the mortgage forecloure and refi frauds by the banks and their servicers - but at the end of the whole bloody process, you get a letter from the Commissioner (after escalating to another time-suck process of filing a claim with them) telling you about this "rule" that if you'd known about it in the first place maybe you wouldn't have wasted the enormous time and cortisol-surges carrying coals to Newcastle.

Shorter. The Insurance Commissioners are about as trustworthy when they make a "consumer-friendly" festure as the Democrats with their populist head fakes.

The Looters have the machinery set up and working for them and against us at every possible level. With ObamaCare, it's been a huge success for them. See today's post about the lady in California shelling out $200 per month when there isn't a doctor around to actually deliver care she needs. (Obot response: "But she gets a subsidy -- Yay and Double Yay.")

Alexa's picture
Submitted by Alexa on

["Narrow Networks," McKinsey & Co., The Wall Street Journal]

Pretty powerful "visual" evidence against the ObamaCare Health Exchanges, IMHO.

So now, I have to "wonder" if this entire ObamaCare debacle has been orchestrated, since neoliberals in both legacy parties seem to be reaching agreement that they need "to quit fighting over the ACA," and join hands to enact much needed "reforms" [after the 2016 election].

Hmmmmmmmmm . . .

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Submitted by Dromaius on

Just a side point regarding the graph.

The thing that many people are still not getting, including media and maybe the pollsters here, is that platinum, gold, silver, bronze is typically just a means of defining different payment structures, i.e. how much you pay up front in premiums versus how much you pay in deductibles and copays.

In many cases, you won't get a better network by signing up for gold or platinum (at least this is true in my state). The notion that they're measuring silver plan seems meaningful, but may be meaningless. Measuring silver does imply consistency, but it also implies that gold and platinum might give you something better. The reality is probably not.

Submitted by lambert on

It's just how much you pay up front vs. how much pay later. "Quality" but in financial terms and not medical?!?!??

mellon's picture
Submitted by mellon on

They couldn't allow people to get a broader network by paying more while they still are in the exchange because even poor people will probably switch into a higher metal plan if they get sick.

They need to segregate all ACA clients into basically a different healthcare system because since they already gave away the store on dozens of health care savings strategies, they are left with giving people criminally abbreviated care.

If you look on the net you'll find some articles talking about how HMO and self-pay(wealthy) clients are segregated now in a lot of medical facilities.

Did you see kais erpapers dot org?