The Downsides Of Single Payer Medicine.


You have to ask the horrible question, “who does the doctor work for?”

The answer to that question affects your life, liberty and health in so many ways.  If the Doctor works for you, his patient, then there’s a high degree of trust in the relationship.  With the various forms of single payer, you the patient doesn’t run the show anymore, the government does.

That means that your doctor just became a spy for the government on your lifestyle and activities.  He doesn’t have a choice unless he wants to risk his livelyhood.  Rush points out how this works with guns, but maybe there’s far more to it.  After all, governments aren’t well known for respecting people’s rights.

Of course it goes further than doctors.  You might have to submit to constant monitoring, for your health of course.

And big government isn’t known for it’s flexibility and understanding.  Nor for it’s competence.  An electronic friend of mine had and encounter with this as he was forced to change his health insurance due to a layoff. Here’s description of what ensued, details removed.

So last year I lost my full time job and with it, my healthcare coverage. Which meant that yes, we had to go to The website seized up four times, but finally we were able to make our application. We never got to the marketplace, because my salary as a part time adjunct was so low we automatically qualified for Medicaid. I want to stress this point. We never got to the marketplace because the system automatically booted us into the Medicaid application for our state. I will come back to this later. So we got covered. Our kids got covered under Medicaid and we got covered under XXXXX XXXX XXXXX which is XXXXXX’s iteration of Medicaid. And, it’s great. As good as coverage as I’ve ever had, low copays, no complaints. Fast-forward to today. We get our 1095 form. It shows that our kids have been covered under Medicaid, which qualifies as full coverage under the ACA, but my wife and I, who have XXX do not. XXX is apparently only a “limited” plan and does not qualify as full coverage under ACA. We are now on the hook, for penalties, going back four months, for not having adequate care under the ACA. And the enrollment period ended on Jan 31st. So we will be on the hook, for the next year as well. We are talking thousands of dollars here.

This, understandably, sent my wife into a panic and tears. It’s money we don’t have.

I want to re-iterate, we went to the gov’t website, which funneled us to a state website, where we got coverage, and NO ONE informed us that this did not comply with the law or that the coverage for us was not enough under the standards of the law. My wife and I are not dumb bunnies. This wasn’t an oversight. There was simply no way, we could have known.

The website was worthless, an endless maze. So we worked the phones. We sat on hold for over an hour, but finally got a hold of a person, who admittedly, was very nice and helpful. We told her our situation, told her we acted in good faith and wound up here anyway. She told us that since we make so little, we may qualify for an exemption. She gave us the info on how to apply for this exemption through the IRS, what forms to use etc. Part of this application for an exemption requires that we go to and look up and submit what the lowest bronze plan would have cost us. But now you are probably seeing the first paradox. Our income is so low that the website automatically sent us to the medicaid site without ever taking us to the exchanges. How do we get there to know what we didn’t know? She doesn’t have an answer. Now comes the second paradox. Even if we get this exemption, how will we make sure we get adequate coverage in the future? My employment situation is unlikely to change in that time. How can we even get to the exchanges to get a plan we are REQUIRED to have when the applications immediately moves us back to the Medicaid application? Where do we go to buy into a plan we can’t even see because the application process won’t let us see it? Again, she was very nice, but didn’t have an answer. She thinks there might be a “tool” to help us on She suggests that we go to and search for “exemptions.” A search for “exemptions” on produces 50 hits BTW.

Finally she suggested we talk to the local Medicaid office in XXXXXX. Perhaps they can help. Maybe XXXXXX offers a Medicaid benefit plan that has full coverage and qualifies under the ACA. So we do. The person at the XXXXXX Medicaid office is very nice, but told us that there is only one full coverage Medicaid plan and it is basically only offered to invalids. XXX, which is frankly, very generous (Thank you, XXXXX Tax Payers) is what they offer to most of their clients. It seems crazy that XXX somehow does not qualify under ACA and here’s where the story gets surreal. The person tells us that they have never been told if XXX qualifies under ACA, OR NOT. Let that sink in for a moment. The ACA has been law since Jan 2010, been implemented since 2013. Six years in and the state government Medicaid office STILL does not know if their main Medicaid program complies with the law. They still don’t understand the ACA. This is obviously the root of the confusion. Is everyone on Medicaid in XXXXX in violation of the law? Are they all paying penalties or forced to go through the exemption process? Do they even know? The person, who again, is very nice, has no answers. Who does know? Again, no answers.

All of this happened this morning. We have been delivered into a system that is completely opaque, with a curtain of websites and applications processes that are nearly impenetrable and been left to the mercy of bureaucrats who do not even know the full meaning of the law they expect us to live under.

This simply cannot stand.


And More:

An update…of sorts. My wife just threw up her hands early this morning and said there has to be SOME WAY to be compliant with the law, right? I didn’t answer, I just don’t know anymore. So she entered the valiant cause of digging through the healthcare .gov website. She ran down every gopher hole like a manic hunting dog going after the white rabbit. It was quite the effort. She eventually found this:

It’s a long list of all the reason you may be granted an exemption, or allowed to enroll outside the enrollment period. It’s a VERY, long list and includes everything from technical errors to cases of domestic abuse.

It has a section titled: Medicaid/Marketplace transfers

Check this out. You may be owed an exemption and/or a special enrollment IF:

“If you applied for Medicaid through your state, or were sent to Medicaid from the Marketplace, but you weren’t eligible for Medicaid.”

Also if:

“Your state transferred your information to the Marketplace but you didn’t get an answer about your eligibility and/or didn’t get enrolled before the end of the Open Enrollment Period.”

Thinking this clearly applies to us, the wife is on the phone right now with someone who doesn’t sound as friendly as the person we spoke with before. She is having to explain the situation to her MULTIPLE times. Despite quoting the above page SEVERAL TIMES, the woman appears disbelieving of our situation. The woman on the other side of the phone has told us that we will be subject to penalties for 2016. The penalty is 695 dollars PER ADULT, PER MONTH.

This EXCEEDS my humble annual income.

FINALLY, only when we read to her, LETTER-BY-LETTER, the http address above, did she relent and concede we MIGHT have an issue.


Now we are talking to a supervisor.

My wife just yelled into the phone “I’m 45 years old I am NOT going to have a baby!”

Okay, apparently the supervisor told us that the above language, which clearly seems to apply to our situation, DOES NOT in fact apply to our situation. It only applies if Medicaid was late in processing our claim. Merely not informing us that we did not qualify for coverage under the ACA isn’t good enough. Even though the XXXXXX office STILL does not know if XXX qualifies, when apparently it doesn’t. So if they don’t know and don’t know to inform us, how could we know? We are now going to have to pay, MORE than my annual income, in penalties, and we can’t now enroll and become compliant with the law, even if we wanted to. We will have to apply for an exemption.

Ironically, we would probably qualify for a subsidy, HAD we known, which of course, we couldn’t.


And we are doing this to help the poor people without insurance? Madness

And still more.

Update to the update. After spending all morning working the phones, and talking to two different supervisors (and having to start over again because our call kept getting dropped) my wife finally broke down and cried. The supervisor on the other end of the line decided to take pity on her then and started the application process over again, but did it over the phone. Even then we weren’t sure how that would help, but she presumably could see all our numbers and see what exemptions were available. We started from scratch, gave all our info over the phone, our coverage, our income, our dependents, the whole nine yards. At the end of that long process she told us, we apparently qualify for Medicaid.

Headtodesk. Repeat several times. Yes, we know this, but how does that HELP us? We have medicaid, as we had explained countless times before, and we thought XXX qualified as full coverage under the ACA but apparently it does not. And apparently if you qualify for Medicaid, the system immediately moves you over into that application process and there appears to be no way to get back. My wife exhausted every possibility, is there supplemental insurance we can buy to make the XXX coverage acceptable? Apparently not.

So it’s futile. If you qualify for Medicaid in XXXXXX, you are still on the hook for penalties for not having adequate coverage under Obamacare. Our best option now is to file for an exemption with the IRS (So I guess that’s definitive, Obamacare IS a tax, thank you John Roberts! My wife’s least favorite person right now), for last year and pre-emptively for next year. We talk to a tax expert next week. I think we can make a pretty good case as the cost of penalties or the lowest plan would exceed our annual income.

There’s an  entire Facebook page of stories like this.

Here’s still more horror stories.

What the people who came up with this monstrosity can’t  seem to understand is that real people don’t have the flexibility and resources to deal with sudden changes in

Systems failures like this are all too common in socialized medicine.  The problem with bureaucracies is that the feedback loops get impossibly long and all decisions get made from the top down as the disasters become large enough to actually attract attention.

And where is the individual in all this? It’s pretty obvious that we, as a people are losing big chunks of the ability to manage our lives.  Look at the amount of time it took just to setup insurance.  And what it took to get around the BUREAUCRACY’s screw up.  My friend did nothing wrong.  He did everything right and is still in the hock for large sums regardless of which way he goes.  More money than he even has.  This is America?

What single payer in all it’s variants, of which the ACA is one as everything is government mandated does is change the citizen to a subject.  It takes the ability to make health decisions out of the individual’s hands and put’s those decisions on the hand of an uncaring bureaucracy with terrible consequences.

A bureaucracy never has to face the consequences of it’s actions. They live their lives like this. Where are the people who are supposed to have their needs taken care of in this environment?

A bureaucracy that, it turns out is fundamentally incompetent.  At least at anything involving customer service. This being the IRS, I suppose that they are used to customer abuse and punishment and this healthcare thing is  a whole new experience for them.

ObamaCare Has Made The IRS A Shambles

It’s not as if the architects of the ACA didn’t have expert help.  Here’s John Gruber.

Note how he explains how the bureaucrats were going to take over  the system and then explains why moral hazard tells us why they shouldn’t have done that.

Is Obamacare Intended to Fail?

It’s likely that the already bloated healthcare system is going to start having people like this working in it.

First it starts with rationing as companies drop out of the drug business because they can no longer carry the regulatory burden in an environment of strict price controls and stay in business.

Then your doctor sells their practice to BigHealth because they can’t deal with the paperwork anymore.  Followed by hospitals closing or selling out to Bighealth because they aren’t getting referrals anymore.

Of course the closing hospitals for efficiency’s and cost savings sake will mean fewer beds and more triaging. With the inevitability of more horror stories like this.

Of course the likelihood of horror stories gets worse, the older you get. Great Britain has already had experience with that.

Euthanasia doesn’t seem to concern the architects of the ACA.  I guess that they feel that it’s better that people, once they aren’t making a contribution to the state anymore should just get out of the way and make room for those who are contributing.

This death worship is somehow a fundamental part of Progressivism.  They only value people by their potential contributions to society and not as individuals.  And when you are nothing but a number you become all too easily disposable.

Single payer medicine takes the individuals health decisions out of their hands and puts into the hands of an unfeeling bureaucracy created by sociopaths and run by fools.  If health care is a right then it should be the right of free people to make health decisions on their own in private consultation with experts of their own choosing and with the full knowledge of the consequences. 90% of healthcare is maintenance and should be handled et place just like most of the things we do.

Pursuing a free market solution was not the decision made by the Democrats in 2010.  Instead they cobbled together  a health plan that could not, by the statement of the bill’s own architect, Mr. Gruber, actually work the way it was intended and proceeded to ram it through Congress without hearings or debate, pursuing nefarious methods to overcome reasonable objections by various Congresspeople and Senators who had very good reason to think that there were grave issues with this thing, telling us literally that they had to “pass the bill for the public to find out what’s in it.”  This folly has been compounded by the president who refuses to admit that the thing was a mistake and that the whole mess should be repealed and if healthcare was a real issue taken back to the drawing board.

In the debate there was no discussion of pursuing a more market based approach, reducing taxes on medicine and allowing more competition to decrease costs.

I don’t think that there was  more misguided action taken  by the government since the NIRA in 1933.  Unfortunately the Supreme court has heretofore refused to support human liberty and the right of people to live their own lives and allowed this monstrosity to go on, killing jobs, the economy and yes people as time goes on. I think that the first candidate that says that they will, on the first day in office, sign the legislation that kills this monstrosity will get the biggest landslide of all time.  The ACA needs to die before it kills us all.

An important comment from Instapundit.

First, socialized medicine is a zero sum game. All the money to pay for care comes from a single pot so a dollar that goes to pay for my care is a dollar that’s unavailable to pay for anyone else’s care.

That’s bad enough but what makes socialized medicine erosive of democracy is that access is a function of political power.

In a private system I don’t get lousier care so Bill Gates can get better care. But in a socialized system I have to get lousier care so that everyone with more political influence then me can get better care.

Exacerbating that problem is the inherently private nature of medical care although the secrecy is not impermeable. My favorite example, mainly because its one of the few that made it through to the media, is the “line jumping” by the Calgary Flames accessing H1N1 flu vaccine back in 2009 ahead of the old, the young and the vulnerable. Given what’s not uncommonly at stake its a much more widespread phenomenon then is reported

All’s well that ends well, for now.
The postscript. We talked to our tax expert and she responded with a laugh. Not at our situation, but because she’s heard it all before. We qualify for the exemption and will most likely get it, she’s handled many dozens of these. In fact, the whole system appears to work only because of the generous application of exemptions. And she says the people online or on the phone, NEVER know what they are talking about….

Okay, so a postscript to the postscript. Talking to our tax professional, she spent a lot of time reassuring us that we would be fine and that many people come her panicked over just this issue.

When asked how it is that the tax professionals know the law better than the people at, she laughed. It’s because if we didn’t know the law, we could go to jail. No such punishment is held over bureaucrats.

Official site of Affordable Care Act. Enroll now for 2016 coverage. See health coverage choices, ways to save today, how law affects you.

What’s happened to the land of the free that people are forced to go through this sort of stuff by ignorant, unaccountable and uncaring bureaucrats causing them enormous stress and wasting their time. What kind of system works so badly that everybody is essentially exempted and no heads roll as a consequence. Freedom shouldn’t end where government begins.

For more on the dysfunctional economy click Here or on the tag below.



  1. penneyvanderbilt · February 14, 2016

    Reblogged this on Ancien Hippie.


  2. ChrisA · February 14, 2016

    Dear Mr. Carlton,

    Before I get started on my rant, I need to make a few things clear. I am a health insurance agent in Colorado, I have sold Obamacare compliant plans since the stoopid law went into effect and each year it’s a very unsatisfying experience. Since Colorado runs their own exchange, I don’t deal with and also Colorado has expanded Medicaid. So I haven’t dealt with the problem described in your post, which is basically going viral on libertarian/conservative blogs.

    Furthermore, I think Obamacare is a travesty, way too complicated and just basically sucks. It makes the “Rube Goldberg machine” look like a great example of simplistic art. In regards to single payer, I believe the words don’t mean what their supporters thinks it means in their fantasy of dreams. Well at least the un-knowledgeable supporters.

    All that said, please stop this madness. This families fear of the penalty is based on talking to stoopid people and not doing a good job of finding information on the website and simply doing some well thought out google searches.

    First of all, the family does NOT owe a penalty… period. But I’ll get back to that later.

    In the original part of the story they talk about a penalty in “the thousands (plural). That is NOT happening, no way no how. For 2015 the penalty for adults is $325 each or 2% of the taxable household income, whichever is greater. Since they are a family of 4, the first $20,600 of income is NOT TAXABLE. So for 2015 their penalty will be (if there was one) $650.

    The situation is worse for 2016 with a $695/adult penalty or 2.5% of their taxable income. I’ll let you do the math. It’s still not thousands with an ‘s.’

    The statement that the penalty if $695 per month is ridiculous. C’mon, it takes very little navigation of Google or to figure that out.

    So it took me 5 minutes on to find the exact exemption that applies to their situation. Excuse me while I go find it again. Let’s see, I go to, then I click on “Get 2015 exemptions”, then click on “See all hardship exemptions, forms and how to apply”… and there’s also a link to learn about the 2016 penalty. Item #12 describes their exact situation and it brings you to the following web page:

    How to claim an exemption if you’d have qualified for coverage if your state had expanded Medicaid

    There are instructions on this web page ON on HOW TO CLAIM THE EXEMPTION. It doesn’t require any brainless droid to assist in getting this exemption.

    It also occurred to me that if this was a REAL problem, why are we just hearing about it now? Seems like you should have asked yourself that same question. There would be a lot of people in this situation, not only in Utah but in any state that didn’t expand Medicaid. So I googled the phrase: “Utah non compliant medicaid” and the 5th entry down is titled in google:

    Utah health insurance exchange / marketplace: Obamacare …

    and the link is:

    About a 1/3 the way down the (entire) web page is a section headlined “BYU student plan not compliant with ACA” and the 3rd paragraph reads:

    But since Utah hasn’t expanded Medicaid, any adults in the state with household incomes under 138 percent of the federal poverty level are exempt from the penalty. Young adults also have the option to remain on a parent’s health insurance plan until they turn 26, which is an option that many college students utilize.

    END OF STORY. These folks do not owe a penalty for 2015 or 2016 but we are left with this story endlessly echoing across the blogosphere. What it does point out is that the law is so complicated that no one understands it. I am sorry that they keep talking to stoopid people but unfortunately that’s the norm. They need to understand that they are smarter than the people they are talking to, take a deep breath, meet with their tax expert and put it in the rear view mirror.

    Regarding Medicaid and enrolling, etc. Since their household income is below 138% (or 133%) of the Federal Poverty Level, they do NOT qualify for a tax credit/subsidy. So their options are to enroll in Utah’s excuse for Medicaid or to purchase an Obamacare compliant plan with no subsidy. It is truly unfortunate that doesn’t allow them to enroll in a plan with no subsidy. There may be a way, but as I mentioned at the top of this rant, I’m not familiar with the enrollment process since I do my business in Colorado. That said, may I suggest that if they want to purchase an ACA compliant plan without a subsidy in the future, that they go directly to the health insurance companies website. There is no magic about the plans offered on The health insurance company will be glad to sell them a plan as well as send them a 1095 that will show have compliant coverage.

    However, just to throw a curve ball, if they do go directly to the carrier, then they will NOT be eligible for a subsidy even if the household income were to increase. If they acquiesce and enroll into Utah “Medicaid”, when they get “kicked off” because their income has increase, that will create a qualifying life event and they WILL be able to enroll on WITH a subsidy. There are those complications again. Acquiesce is the way to go, then the system sorta works.

    In closing I wish to reiterate that Obamacare is a travesty of a law that has way to moving parts and is way too complicated. Furthermore, the complications fall mostly onto people that are in financial distress or simply don’t have the sophistication or finances to deal with it.


    • jccarlton · February 14, 2016

      Chris, I’m going to point out that 90% of people don’t have the sophistication to deal with dealing with this crap. Nor should they. Look the guy I quoted apparently did what he was supposed to do and was telling us the response he was getting from the various agencies involved. Apparently those agencies are telling him that he will owe a penalty. And far too many people are in financial distress these days for reason that even a short look here should tell you. I put up four posts about the economy and I was trying, trying to cut down. I have more stuff, a lot more. And the ACA is just a sick bootstomp on all of us.

      Liked by 1 person

      • craig · February 15, 2016

        “They need to understand that they are smarter than the people they are talking to, take a deep breath, meet with their tax expert and put it in the rear view mirror.”

        People in this situation don’t have their own tax expert on retainer. They can’t afford one.


      • ChrisA · February 15, 2016

        I don’t disagree with a single statement you just made. It’s a sick, overly complex law (and substantially more complex than that) that’s supported by, in general, a fairly un-knowledgeable staff, and a travesty of a website. If you fall outside of the narrow set of white lines where the system works, you’re like a fish in the bassomatic.

        I would say that a large % of my clients end up navigating the system fairly well, i.e. they fit inside the white lines. The ones that stray outside can cause me endless hours of pain trying to fix the problems and most have no appreciation that I’m trying to swim upstream against the system on their behalf.

        I would recommend that this family seek the advice of a competent broker but there are a couple of issues. One is finding a competent broker. There are many, but there are many who are the equivalent of a used car salesmen. The other issue is that there is no financial incentive for a broker to assist. We are paid by the insurance company and in this case there isn’t one.

        I do feel for this family, I realize it doesn’t come across that way. I do work with people that have been chewed up and spit out by the system and are hanging on by a string. Most of the time I an help but other times I can’t.


      • ChrisA · February 15, 2016

        Well I messed that up. My supposed response to Craig was actually supposed to be to jccarlton. So I’ll respond to Craig here.

        Craig, the only reason I mentioned a tax expert and the family said they were meeting with one next week. I totally agree that most people in this situation don’t have one. The system has the greatest complexity for the people who are least equipped to dealing with it.

        I apologize for messing up my replies but I don’t make a habit of posting on blogs, sorta like most people don’t know how to navigate Obamacare I supose.


  3. Pingback: Instapundit » Blog Archive » HIGHEST CAUSE OF DEATH IN THE CIVILIZED WORLD: The Downsides Of Single Payer Medicine….
  4. Diggs · February 15, 2016

    I have the answer. Don’t pay the penalty, and state on the IRS for that you do have complaint insurance. If the IRS questions you on this, tell them that your proof was on a hard drive in your computer, but the hard drive crashed and you no longer have access to the proof.
    If they question that, tell them to go !@#$% themselves.

    Liked by 1 person

  5. Andrew · February 15, 2016

    I explained all of this to friends in 2008 who were adamant in electing Obama. I had just returned to the US from having lived for six years in Canada, after having lived there for two years in the late ’90s and in Britain for three years during the early ’90s. And I’m an economist. I understand the adverse incentives of state-run health care systems and their terrible brutality to individual liberty. And I’ve both observed and experienced them firsthand over many years.

    My “friends” would not listen. They were immune to the simple observation that replacing a system of 25,000 competing insurance companies with on that places decisions regarding your family’s health in the hands of elected officials, let alone unaccountable bureaucrats, is insane.

    It reminded me of a comment that a Canadian friend made. He had suffered from cancer in his 20s and again in his 30s. He observed that people ignore the inhumanity of state-run systems because (1) they don’t want to think about it; and (2) they rarely use the system to any appreciable degree beyond a doctor’s visit until they’re in middle age or later. By the time they come face-to-face with the reality of the system when they really need care they suddenly understand the horror of it. But most of them can blithely skip through life paying enormous taxes for these systems without ever realizing what they’re funding. Until it’s too late.

    You’ll never find a line item on a UK or Canadian pay stub with a specific amount deducted for health “insurance.” (Which isn’t any kind of insurance at all, of course; it’s a fee for 100% reimbursement of costs in a bloated, inefficient system legally exempt from competition.) No one in those nations knows how much he’s paying for health care. Ever. And the bureaucrats and politicians have no incentive whatsoever to make it plain to the individual.

    And my “friends” who scoffed at my explanations? I find myself sometimes hoping, uncharitably, that they lose their jobs having comfortable health insurance coverage and are forced into the abhorrent, dehumanizing, Kafkaesque system they so eagerly advocated for years. Because until that happens they will rationalize away anything resembling the article above that describes it.


  6. Dave · February 15, 2016

    There’s absolutely nothing the IRS can legally do to you if you don’t get qualifying health insurance and don’t pay the penalty. Your friend suffers the delusion that he’s a bad person if he doesn’t comply with the letter of the law. Everyone not in a coma breaks dozens of laws every day; lucky for us that government employees would rather watch porn all day than enforce those laws. (all 33 kept their jobs).

    “More regimes have been brought, piecemeal, to their knees by what was once called ‘Irish Democracy,’ the silent, dogged resistance, withdrawal, and truculence of millions of ordinary people, than by revolutionary vanguards or rioting mobs.” -James Scott


  7. Teapartydoc · February 16, 2016

    End run: abolish medical licensing.


  8. traitement entorse cheville · March 19, 2016

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  9. website · March 22, 2016

    Very nice blog post. I certainly love this site.
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