DEPARTMENT of HEALTH CARE POLICY & FINANCING Colorado Form

In 2009, my husband & I qualified for Chapter 7 bankruptcy. The bulk of our debt was related to healthcare expenses & lost income related to healthcare problems.We lost our home and 9 years later, healthcare related expenses continue to plague us. In addition to our wages being stagnant— we both work in healthcare— our insurance premiums continue to go up, as well as prescription co-pays.Would it surprise you to know that working in healthcare is stressful & the work conditions & productivity expectations add to our struggles?I have written about my many years of rewarding work as a medical SLP.I want out. I don’t want to work where I am subjected to productivity expectations so high I feel like I can’t keep track of people.I don’t want to see my patients as customers.We don’t have the discretionary income we once did.Don’t even get me started on dental bills.I think this may be a oversimplified summary of the positions, but I will take a stab at it.I wouldn’t say I believe we have a right to healthcare in the sense of it being in the Bill of Rights.Public education isn’t either.,I am not of the school of thought that respect for the Constitution means we only fight for things that are outlined in the Constitution.Having infrastructure, libraries, social programs. education, healthcare through the government is not unConstitutional.What I believe is that investing in policies & programs that make healthcare affordable is good for the economy, individual Americans, and the country as a whole.I am a really pragmatic person & most Democrats & Republicans are.I believe Democrats differ with Republicans with regards to healthcare on several key points.the role of the government in healthcare. It isn’t that Republicans don’t like state or federal government spending. They do. They really like it. They just want to direct it to things that are a higher priority to themRepublicans tend to see things like healthcare & education as just another industry, where pro corporate business policies & market ideology is the best solution. I think they are wrong in ideology, and often poorly informed about medicine & healthcare. I not only disagree with their market ideology, I know there is abundant research that proves that not only do competition & market not yield the best results, they often add to costsRepublicans want to over turn Roe V.Wade & make abortion illegal. I understand the moral opposition to abortion & the concern for life. I think they are mostly sincere, but not always. I can’t even think of a legal or ethical term for their platform on abortion & healthcare. Is it immorality? Dereliction of Duty? Sociopathy? Cognitive DissonanceIt looks like they may succeed with Roe V. Wade. The tragedy of the road the GOP is on is that they have poured so much political energy into this fight yet I see scant evidence that they have even thought about how to deal with the consequences of this legal victory. This is something I consider a pathology in the GOP platform. This goes beyond a meme or a soundbyte. This platform is going to cause an increase in human suffering of children & families. I am not sure.. do they not see this? It angers me & it saddens me.Fetal development at week 5 versus preemie.The one with the almost fully developed nervous system feel more pain. This is a fact. Please remember that.Yes, it is all human life.So is this. Many religious groups are opposed to removing a feeding tube or mechanical ventilation as they are pro-life. But the compassion & empathy feels misplaced. These devices can cause suffering & complications.Also, it costs millions of dollars to keep people alive (artificially) who have terminal diseases.There are few fields with as many ethical challenges than medicine & healthcare.People whose primary background is in business & haven’t worked in law, or education or medicine or as clergy don’t get it, usually.They don’t often have an apprecuation for the challenges being in a profession where you directly work with people & have a professional code of ethics to abide by.I think Republican & Libertarian think tanks often demonstrate an astounding level of cluelessness to these issues.

The American health care industry wastes $1T by some estimates, and possibly as much as 30% of health care spending by others. US health care expenditures are twice the OECD average – for instance, we spend twice what the UK does on health care (as a percentage of GDP) – and American health care costs are growing at 5% a year.Healthcare presents one of the greatest policy challenges for our country because profit incentives and care for the patient are often misaligned. It’s clear that the government is going to play some role in making sure the least well-off Americans have access to medicine, but we need healthcare policies that incentivize providers and payors to educate patients to make informed, data-driven choices. Only intelligent consumer choice will stimulate functioning, competitive markets in insurance, patient care, the pharmaceutical industry, and elsewhere. Today, pharmaceutical companies, health providers, electronic health record (EHR) systems, and other actors often have misaligned incentives and fail to enable more efficient solutions that do more for the patient per dollar - indeed, often the winners in these areas are those that unnecessarily charge more. Aligning incentives will spur top technology startups to develop innovative healthcare solutions, bring down costs, and deliver superior outcomes to American patients. Here are a few necessary reforms:Medical SchoolsExperts project a total physician shortfall of between 42,600 and 121,300 by 2030.* We need more medical schools fast, but the Liaison Committee on Medical Education accreditation process takes 8 years on average and most states require new medical schools to obtain a “certificate of need” before beginning construction. In addition, medical schools are required to sustain the high overhead of medical research rather than focusing exclusively on training doctors, and inflexible requirements prevent medical schools from experimenting with new curricula. Organic chemistry and other undergraduate prerequisites are completely irrelevant to becoming a good practicing doctor, and should be optional.High medical school costs force students to become high-earning specialists, e.g. plastic and orthopedic surgeons, when our country really needs more primary care physicians (PCPs). Primary care physicians, nurse practitioners, and physician’s assistants are far cheaper than specialists, but limited medical school and residency supply as well as occupational licensing concerns keep them out of the market. In addition, foreign doctors are almost always required to complete a full residency before being allowed to practice in the United States. Given a current skills gap of 30,000 doctors, adding 30,000 new PCPs, nurse practitioners, or physicians assistants could save $2.3B, $5.1B, or $6B in salary costs alone relative to the current mix of specialists and primary care doctors.In addition, primary care doctors achieve better health outcomes for patients than specialists by engaging in long-term counselling, tracking, and preventive care. Scholars estimate that replacing specialists with primary care physicians at a density of 1 per 10,000 population could save $931 per beneficiary a year. Adding a supply of 30,000 primary care physicians would save our country about $150-200B a year.*If implemented correctly, data-driven telemedicine can ameliorate demand for physicians somewhat. Doctors should be able to digitally prescribe most drugs, and data from increasingly sophisticated wearables will enable physicians to swiftly and efficiently diagnose patients.Reform PBMsIn 2017 the Centers for Medicare and Medicaid Services (CMS) spent $175B on prescription drugs alone, and there are currently shortages of vital drugs across the country. An oligopoly of Pharmacy Benefit Managers (PBMs) generates $200B a year in revenue by forcing drug manufacturers to pay rebates and other kickbacks in order for the PBM to place their drug on the “formulary”, or list of insurable drugs. Securing a place on the formulary is a matter of life and death for manufacturers, and by one estimate the current value of rebates and other price concessions from manufacturers to PBMs increased from $59B in 2012 to $127B in 2016.After speaking extensively with politicians on both sides, we were thrilled to see the Senate recently outlaw PBM “gag-orders” on pharmacies by a 98-2 vote. We are encouraged to see that Alex Azar’s Department of Health and Human Services (HHS) is planning to subject PBM rebates to anti-kickback law, but we would go further and require full price transparency on PBM contracts in the style of Colorado HB 1260. Although some rebate money flows to insurers, we estimate that reforming the space could save America on the order of $50B.End of Life Palliative CareAlthough discredited by hyperbolic language about “death panels”, counselling patients at end-of-life is both cost-effective and humane. 30% of Medicare expenditures are attributable to 5% of beneficiaries who die each year, and acute care in the final 30 days of life accounts for 78% of the costs incurred in the final year of life. While acute-care for the dying should obviously be available to those who want it, our country must shift to a model of counselling and palliative care at the end of life.Just having an end of life discussion with the cancer patient reduces medical costs by 35.7% on average, and given that there are roughly 600,000 cancer deaths in the United States a year, would have saved $687M a year for cancer patients in the last week of life alone! In addition accountable care organizations (ACOs) have saved $12,000 per patient during the final three months of life by implementing home-based palliative care. If extended to all cancer, end stage renal disease, and congestive heart failure patients this program could save the country $11.7B a year.We all agree that we must treat families of the dying with delicacy and compassion. But introducing a program by which families will share in Medicare/Medicaid savings from palliative care would help families and patients factor the overall social cost of end-of-life care into their decision calculus. We estimate that extending proven programs and testing different incentives structures could save our country $30-50B a year.FDA ReformClinical trials are an arduous multi-year process and have become drastically more costly in the last 30 years. Phase II and III efficacy trials cost roughly $400M per new drug, which severely limits the number of drugs that make it to the final stage of Food and Drug Administration (FDA) approval. A “progressive approval” approach would allow drugs to be repurposed for other uses and possibly sold after passing Phase I safety trials, which establish that a drug has a favorable risk balance and qualifies as value-based care. Drug companies could gradually establish efficacy by logging the effects the drug has on each person who opts to use it over the next several years.The extreme costs of clinical trials and FDA approval not only stymie drug development and the application of treatments to new indications, they effectively privilege Big Pharma over other innovators, inhibiting innovation and medical progress. A data-driven approach in which doctors and hospitals verify drug efficacy over time would allow the FDA to concentrate its resources on ensuring safety, particularly as the market for new drugs becomes sophisticated at assimilating information from the progressive approval process. While ramping up the number of drugs approved may not save our healthcare system money on net, a framework which encourages innovation will positively impact millions of lives by improving quality of care.Give Medicare Negotiating PowerTo pass the Affordable Care Act (ACA), the Obama Administration made a critical concession: Medicare would not be able to negotiate the price of drugs by controlling which drugs make it onto Medicare’s formulary. As a consequence, our federal government is a “price taker” that must blindly accept whatever prices drug companies demand, and the American government winds up subsidizing drug development costs for the rest of the world. Drug prices at home are extremely high, representing 10% of total healthcare expenditures, and about $144B of federal healthcare spending.In many other developed countries, governments use their monopsony or near-monopsony buying power to force pharmaceutical companies to sell drugs at much cheaper rates. For instance, Canada spends 70% of what the US spends on brand name drugs, the UK 40% of what we spend, and Denmark only 35%. If the US federal government used its considerably larger “countervailing power” to negotiate reduced drug prices – whether on a case by case basis or by pegging the value of a Quality Adjusted Life Year at a generous but fixed rate - savings could be in the range of $30-40B, possibly even as high as $90B a year.Pharmaceutical industry lobbyists (PhRMA) argue that high drug prices are necessary to stimulate R&D which generates many new life saving drugs every year. But in fact, median R&D spending on new cancer drugs – the most difficult to develop – is only around 40% of total revenue. In addition, most R&D is funded by American universities, and manufacturers of silver-bullet specialty drugs could continue to charge high prices to a federal payor. Giving government negotiating power isn’t a novel solution, but it’s one of the correct solutions to driving down drug costs for Americans.Tort LawThe threat of malpractice lawsuits forces doctors to engage in costly defensive medicine. Although the current administration has made some progress on tort reform (making arbitration legal for federal contractors and nursing homes), Congress must insist on Texas-style reforms including capped punitive and noneconomic damages from healthcare providers, eliminating contingency fees for speculative tort lawyers, reinforced federal preemption doctrine for food and drug products, and more. Unfortunately the trial lawyers lobby – one of the biggest political donors in the country – will fight reform at every step of the way.Some studies estimate that reducing physician malpractice fears to “somewhat concerned” about malpractice would decrease costs by 14%, saving the country $100B a year. Others argue that medical liability reform could save our country up to $210B a year. Congress must protect our doctors from being attacked by unscrupulous prosecutors in order to reduce the cost of healthcare for American citizens. We all agree that we must insist on protecting patients, but unchecked tort lawsuits just punish American patients and taxpayers with an unaffordable system.Data InteroperabilityThe ACA’s “meaningful use” requirements did little to make healthcare data accessible. As of 2015, only 6% of health care providers could share patient data with other clinicians who use an EHR system different from their own. Although 21st Century Cures Act made “information blocking” illegal, big EHR vendors routinely prevent their competitors from importing patient data by disclosing health records in garbled, incoherent formats. As a result, physicians are unable to make fully informed decisions about their patients.Judy Faulkner, CEO of EPIC, famously condescended then Vice-President Biden, “Why do you want your medical records? They’re a thousand pages of which you understand 10.” The answer is that only real, semantic interoperability which makes health data available to third parties via and open application programming interface (API) will allow an innovation ecosystem of apps, medical devices, and novel insurance plans to flourish. Granular, transparent healthcare data will allow entrepreneurs – whether college students or IBM executives – to invent new solutions from the bottom up and swiftly incorporate best practices into their businesses. In addition, direct service-to-service comparisons will allow consumers to make informed decisions about how to stay healthy, stimulating market competition for their dollars.We have been excited to see CMS’s Blue Button 2.0 API program formalize the Fast Healthcare Interoperability Resources (FHIR) standard for health records, which includes programmer resources, a complete API, and gives beneficiaries full control over their data – but EHR providers are refusing to use it. While any EHR system should ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) by storing protected health information on secure servers, we need to make interoperability truly mandatory.If patients could easily share their medical records with new providers and selectively reveal their data to health apps, fitness devices, diagnostic companies, insurers, and academic researchers, our entire healthcare industry would become hugely more affordable and effective. Reliable, real-time information about which treatments work, which failed, and what they cost will enable hospitals to identify and minimize cost centers as they strive to produce care more cheaply than federal benchmarks and share in the savings.Financing ReformOvertreatment and poor physician incentives may be the main driver of health care costs. Most hospital networks are local monopolies with limited incentives to innovate or save money. Replacing this broken system with value-based care models will immediately save over $100B in total, and should grow steadily over time to $200-300B as doctors harness digital technology interventions and other new techniques to make care cheaper and more effective. We break down a few potential sources of savings below:Bundled PaymentsThe Bundled Payment Care Initiative (“BPCI”) introduced in 2013 shows serious promise in making acute care clinical workflows more efficient, particularly in orthopedic care and oncology. Results continue to improve as providers adapt to the program.After adopting a bundled payment model, the NYU Medical center reduced costs to Medicare by 10% and reduced patient stays by 25% for total hip arthroplasty procedures, and a private practice joint arthroplasty generated 20% savings for CMS per episode while decreasing readmissions. The Congressional Budget Office estimates that a voluntary bundled payments system could save Medicare $6.6B a year. If CMS makes bundled payments mandatory for both Medicare and Medicaid, achieves health record interoperability, and allows the ecosystem to iterate on data-driven incentives, we expect savings to surpass $100B.Accountable Care OrganizationsACOs are widely seen as the Affordable Care Act’s main instrument to rein in health care spending, and ultimately we expect that bundled payments will be folded into a broader ACO model. To date ACOs have generated modest savings on average, but some, such as the Memorial-Hermann ACO, have generated 11% savings for Medicare. ACO contracts are more efficient if they involve two-sided risk (rewards for savings, penalties for overages), but studies have shown that even early versions of upside-risk only ACOs are associated with a 3% reduction in Medicare reimbursement. In addition, Medicare ACOs have improved quality measures across the board, despite their old, sickly populations.Provider networks are still adjusting to the ACO model, and returns will increase in the future. Projecting savings at 5-10% and assume that all Medicare beneficiaries are enrolled in ACO providers, ACOs would save Medicare $30-60B a year. If extended to Medicare and Medicaid, full ACO enrollment could generate between $56-112B a year.Preventive MedicineThe ACA now mandates coverage for all evidence-based prevention in non-grandfathered plans, so preventative screening and vaccinations have increased since the advent of Obamacare. However we need to drastically increase the scope of preventive medicine under the aegis of value-based care. Preventable chronic diseases are 7 of 10 top causes of death in the country, and account for 75% of health care costs. Half of American adults have chronic disease, and surprisingly, chronic illness among those younger than 65 years accounts for 67% of total medical spending. 70% of American adults are overweight, and 1 in 3 American kids and teens is overweight or obese. Prevalence of obesity has tripled since 1971.Some of the most cost-effective, successful preventive health interventions include childhood immunization, youth and adult tobacco counselling, alcoholism interventions, aspirin use for people with heart disease, and screenings for common cancers, STDs, and chronic conditions like hypertension. Evidence suggests that many other preventive health interventions are cost-neutral or increase long-term medical costs (because they extend lifespans). However critics often miss the fact that preventive health measures will extend the working careers of Americans, and pay for themselves in the long-run.In kidney care, for example, the federal government subsidizes extremely costly dialysis treatments for end stage renal disease patients but has not crafted incentives to perform preventative treatments before a patient advances to this critical, debilitating condition. Rather than fill the coffers of the corrupt duopoly that runs the dialysis industry, we should give providers incentives to halt the progression of kidney disease in its tracks. As a country we spend $42B on hemodialysis. Just getting prevention right here could save our system north of $10B a year.ConclusionFixing our sprawling, tangled healthcare system is one of our nation’s greatest policy challenges. In the coming years, America should move swiftly to embrace value-based care models which align market incentives to produce a wealth of patient data and an ecosystem of new information technologies geared at preventive treatment. At the same time, we must address specific areas where poor incentives have throttled the production and delivery of medical services. Replacing bureaucratic mandates with proven Western values of entrepreneurial innovation and educated individual decision-making will yield better patient experiences and results for Americans from every walk of life while saving our country $600-$900B annually – a transformative amount of money for the well-being of our nation.

So you wanna learn how to become a copywriter my junior friend? Well it’s very possible. In fact, there’s really no formal education you need. Some of the top-paid copywriters in the world never went to college or took a writing class!No education!No formal training!!Make lots of money!!!…..now before you start getting crazy, let me step you back into the reality of becoming a copywriter:1.) What Is Copywriting?Copywriting is essentially moving words around to sell better.Let’s say I work for a company that has a webpage which gets 1 out of 500 visitors to buy something.If I was a copywriter, I would figure out how to make 1 out of 100 of those people buy. This means 5x more sales from the SAME webpage!A good copywriter will understand how to do this with their words, and also how to re-arrange pictures and buttons to get more sales.A good copywriter is not just a writer. They are a keen studier of the human psychology behind purchase decisions!2.) Understand why people hire copywriters:Think of the huge amount of content a lot of companies have to put out.A single insurance company will have to put out all this stuff:Ads on TVAds on the internetAds on radioBrochures for B2C salesBrochures for B2B salesBrochures for every different productForms to fill outForms to fill out for various different product linesGoogle adsFacebook adsUpdate their TwitterUpdate their Facebook pageMake content for their websiteMake the content for their website about each different productMake sure their content is convertingMake sure customers understand how to signupSend customers packets explaining their policyHave scripts for their sales people to followHave scripts for their customer support people to followWrite press releasesThe list goes on and on and on and on…Allllll of these things need to get written by or looked over by a copywriter. And that’s just a single example! Some companies will rely heavily on copywriters. Some companies (like 37Signals) require ALL members of the team to be great writers before they ever start.So people will pay a copywriter good money to handle these things for them. But YOU my young friend, need to understand that to get that money, you need to keep relationships within those companies that need those services.How to Get Clients As a Freelance Copywriter:This is by far the biggest question I get. And people seem to forget one thing:Establishing yourself as a freelance copywriter is the same as building a business from the ground up.You’ve got to put in LOTS of effort in the beginning, show talent, and not expect immediate riches. There’s no free lunches here boys and girls.A lot of people get entranced by the prospect of working from their laptop from anywhere in the world as copywriter. In fact people go nuts when I post pictures like this from various locations!Since all my copywriting business is conducted from a laptop, I can take off and go work from the beach.Or if I wanted to drum up an extra $10,000 really quick …..I can just devote some of my hours to copywriting gigs.But these luxuries are the result of hard work, actual results, and existing exposure.This won’t happen overnight for most copywriters. And probably NEVER will for a lot of them. However I’ll share some of the ways I’ve personally seen people get amazing (and high paid) copywriting gigs:METHOD #1.) Becoming popular on the web as a copywriter.If you become known as a famous copywriting figure, you will build instant credibility.And if you have high credibility, you can ask for more money.So how did I build credibility for my copywriting career?Building Copywriting Credibility Step 1.) Practicing what you psignNow:I originally ran a couple of businesses starting from high school, and I first applied some copywriting techniques to the email list I had.METHOD #2.) Becoming popular in a specific nicheSo a lot of lower-end copywriters will insist “I can write everything!” But in reality they should niche down when they start. For example, if you worked for a big health company and did a lot of writing for them, you should call yourself a copywriter that specializes in the health space.This will make it easier to gain credibility in a specific area.You probably wouldn’t super-trust the guy who mows your lawn for financial advice…..however you REALLY might take his advice on how to hedge bushes and get a clean line on the edge of a lawn.He has very specific advice, and lots of experience practicing what he’s talking about.Instead of being “just a copywriter” ….it would be better if you were “A female copywriter who specializes in talking to 1st time expecting mothers.”It would be best to hang out and network in places where people are selling stuff to 1st time expectant mothers. If someone need a copywriter, and you have experience in EXACTLY their niche…..guess who has a high chance of getting the gig??My personal niche started out with smaller companies and daily deals. Then moved into medium sized businesses.However if someone approached me to write for 1st time expectant mothers, I could DO It……but I don’t have experience and can’t exactly relate to the struggles of that demographic. So I try to stick to my area of expertise so I can deliver the maximum results.METHOD #3.) Becoming popular for big companiesTHIS method can apply to certain people, and be quite lucrative.Let’s say you worked for a big company in the marketing department and you were exposed to how a big marketing department tests & releases products.If you were to build a nice little network in the same industry, and then become a consultant with a VERY SPECIFIC expertise, then you get some other big companies to fork over A LOT of money.Smaller freelance gigs can pay a few hundred dollars. But a huge corporation who is a doing an 8+ month rollout of $100,000,000+ product will pay you some phat-ass cash to ensure they do it right.Now I personally probably couldn’t get one of these gigs because I’ve never worked inside a huge company. That means I lose major credibility because I’ve never walked the walk.But if you do have some very niche experience within a big corporation and had a few big wins, you might be able to become a very highly-sought-after consultant.The cool part is you only need a few good contacts for this.I know someone who wrote an oil-management program in the 70’s that’s still used today. Till this day he gets sweet-ass gigs from multiple companies JUST to be around if anyone needs help implementing it.Since the projects he consults for are $2billion+ …..the companies don’t mind shelling out major cash just to keep him around.Boring? Yes.Sweet cash flow? Yes.This is one of the benefits of working with a big company:You know how to implement projects within a large company. That is actually a rare skill.METHOD #4.) Get small-time gigs.Now there are some other ways to get copywriting gigs, but I’ve never seen anyone who consistently made big money doing these things alone, so I’ll just list them quickly:Posting on Fiverr for copywriting gigs.You’ll definitely get some leads this way, but your clients will usually be bargain-hunters and not HUGE jobs.Posting on Craigslist as a copywriter for hire. This will generally result in corporate copywriter jobs that are relatively low-paying ($35,000 – $45,000).Posting on UpWork as a copywriter for hire. This will get you small to medium gigs. It’s not my favorite wayMETHOD #5.) Post in Facebook Groups where people can use copywriting services.I think this one is the easiest. Just go to groups like The Cult of Copy Job Board that you are offering your services for a one-time low price of $xxxxx and that you’re for hire.A lot of times people will bite.People also constantly post gigs there such as:Not all the gigs will be good, but some will.In the beginning you will have to scrape together gigs, but if you start putting all your work inside a simple portfolio, you can gain some steam. Which brings me to :Make a Simple Copywriting Portfolio!Ok, listen to me carefully young buck:You DO NOT NEED a fancy website. In fact, I’ve never never ever seen someone get a copywriting gig directly from their portfolio. EVER!!The reason is: people are looking to hire you based on your skills at copywriting. Not “how fancy your website looks.” This is a common mistake. Look how crappy my copywriting consults page is. That page generates huge returns even though it sucks super bad. The desire to buy is created from previous exposure to me, NOT the way the page looks.People will spend months and lots of money and time on a fancy website, only to realize NO ONE IS COMING TO IT. The only people going there are the people they meet directly and tell to go there.The best type of copywriting portfolio is a simple page with the following elements:Your name.Your expertise (Social Media? Landing Pages? A/B Testing?).A few examples of your work.How they can book a session with you.I know it sounds counterintuitive, but some of the best copywriting pages I’ve EVER SEEN are super simple one’s like this:See how simple that is?It also only leaves them ONE option of what to do next, and that’s to book a session with you.These sessions should generally be a minimum of $100.If a client is not willing to pay at least $100 for a consultation session where you point out everything wrong with their page, they are NOT going to buy anyways.My minimum consultation session is $597 now. And I’ve learned the hard way that if people are not willing to pay it, they are not going to be willing to pay you more (or they just simply can’t afford it).Oddly enough, the more I charge for each hour session, the more respect and compliance I get from the client! They want to make SURE they get their money out of that session , so they ensure they show up on time and show up prepared.I would personally avoid doing free sessions. Because what generally happens is:1.) Everyone gets excited about working together.2.) You setup a meeting with this “prospective client”.3.) You prepare for the meeting and draw up a proposal.4.) You talk with the client and tell them what you’re going to do for them.5.) They tell you “let’s talk again soon after I run this by my boss.”6.) You never talk again…..and all that time was wasted.7.) You become sad and poor :-(To get people taking you seriously, you need to charge them for your time. If they decide to go for a full contract with you, then you can comp them the hour long session. However if they don’t go with you, at least you still get paid.Charging people for your time is a sure-fire way to get them to value your services.Every single successful freelance copywriter I know ALWAYS charges for their time.Some Copywriting Books for you to read:I’ve read a helluva lot of copywriting books, and these are the one’s I recommend you read to get off to a great start:BOOK 1.) Read The Gary Halbert Letters (Free) Start by reading “The Boron Letters”. Make sure you print each chapter out for maximum effect!Ch 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25You can also buy The Boron Letters directly from Amazon.BOOK 2.) If you want a book that sits on your desk and can re-cap this kourse quickly, then grab my book called “This Book Will Teach You How To Write Better” from Amazon.BOOK 3.) Read Advertising Secrets of the Written Word by Joseph Sugarman. This book usually costs in the $30 range, but is one of my go-to books for ideas on how to position copy. Almost every successful kopywriter will know this book.BOOK 4.) Also, check out Ogilvy on Advertising by David Ogilvy (great for traditional advertising advice as well)Your Next Steps To Becoming A Copywriter:I showed above in this post some good things to do first:Read the copywriting books I recommended above.Making a simple copywriting portfolio.Put yourself out there.Well my young friend, I hope this answers your question!-N

★★★In essence, an OK budget.The good:No increase in passenger fare: Considering that the passenger fares were hiked less than a year ago by 15%, this is a welcome move. Introduction of health and security helplines (138 for helpline; 182 for security): Much needed. However, this will only be successful if the implementation is swift and reliable.Focus on cleanliness: New toilets at 650 additional stations, introduction of bio-toilets, introduction of the "swachch rail scheme", creation of a new department to take care of cleanliness in trains and stations.One thing missed out here seems to be the lack of any actions against people found littering on stations. There needs to be a mechanism in place where people indulging in such can be reported by fellow passengers and appropriately fined. Also, a future addition would be to have a "littering history" wherein every offence is recorded against the person's PAN number and subsequent ones are dealt with more strictly.Cameras for women safety: One of the burning issues in India is women safety. Introduction of the CCTV pilot scheme will definitely help.Increased speed: 9 long-route corridors will now run trains at higher speed to make travel between major cities like Mumbai, Delhi, Kolkata shorter"5 minute ticket" scheme: For people travelling ad-hoc. However, I am not sure how effective it would be, considering that Indian railways suffer from a dearth of capacity on all major routes.SMS alert system: To communicate arrivals and departures and also change in timings. Welcome move. After the recent successful upgradation of the IRCTC website, it is clear that the ministry has teh technology and the resources to handle this.The bad:No new trains: Everyone knows that Indian railways has a dearth of capacity. There are around 7000 passengers trains that run daily. And they carry 14 mn passengers. That comes to about 2000 passengers per train. Considering 25 coaches and 72 seats per coach, the capacity per train is 1800. Hence, demand = 111% capacity. This does not even consider the variation in demand across regions and seasons. Most major stations have issues of non-availability of tickets. Most major trains get filled a few hours after reservations startExtending the ticket booking window to 4 months (120 days): I mean, seriously? Who makes plans 4 months in advance? The ministry should have made provisions for tiered booking (phase 1: 4 months before journey, phase 2: 3 months, phase 3: 1 month, phase 4: 2 weeks, phase 5: tatkal). This would ensure that tickets are available throughout. Plus, they should have tweaked the "(dis)incentive" structure to discourage whimsical bookings. People book tickets even if the plans are not confirmed because the cancellation charges are nominal. This causes problems to others and such cancelled tickets are only available a couple of days before the journey. A tiered cancellation policy is needed.The ignored:Nothing on cancellations and over-booking: See "The bad #2"No respite from agents and middle-men: More than 50% of the tickets are "reserved" for agents and dalals who charge a hefty premium. This adds to the issue of non-availability and is unfair towards the financially under-privileged.Silence on improving the operational efficiency of trains: Again nothing. No reorganization, no re-allotment of trains from routes with less traffic to ones with more. No plan to tackle the issue of ticketless travel in sleeper class:

I can't say whether you would be contractually obligated. It's a very good idea to complete the survey and send it in as the carrier may put claims processing on hold for you until it receives your updated information. This means your providers won't get paid and when they don't get paid it's you they will be looking for.The insurance company sends these questionnaires because when someone has more than one form of insurance the different carriers take on roles — primary, secondary, tertiary, etc. The primary carrier pays first according to the terms of the policy. The secondary company will pay second, but they will only consider what's left after the primary pays.For example, let's say your ER visit was $2000. Your deductible is $1000 with the primary carrier and the primary insurance pays $1000.Your deductible with the secondary insurance is only $500. The secondary carrier is now looking at a bill for $1000. They pay $500.In the end, you paid $500, primary paid $1000, and secondary paid $500.If you only gave the provider information on your secondary insurance, they would be billed that while $2000 (as the ER wouldn't know about your other coverage). The secondary carrier, knowing they're second, will insist it's sent to the primary carrier for payment first.If they don't know there's a primary carrier, this becomes a very different financial situation for them — instead of $500, they pay $1500! That's your full bill less the $500 you pay out of pocket.Not knowing about the primary carrier just cost the secondary insurance an additional $1000.It's for this reason that they keep sending you questionnaires, and for this reason that they could hold off on processing your claims if you don't respond. In the end their goal is to save as much money as possible by making sure that they don't pay anything for which they aren't liable.

This is a very complicated question because the VA is not a homogenous organization. I have worked in 3 VAs in 2 states and they are quite different:In general, I think the care at our academic VA was good because it was staffed by residents and professors who worked outside of the VA as well. The patients certainly had to wait and the VA staff (not the doctors) are notorious about working exactly 8 hours per day, and "working" needs to be taken with a grain of salt. Also the staff members who everyone else knew were useless could not be fired because the union would defend them at all costs. We did have a problem with things that were slightly out of the ordinary not being covered by the VA but luckily for our veterans the university hospital was the county hospital so they took care of emergencies. But the veterans always got their medicines and their surgeries. They had to wait but not as long as my uncle is waiting in Canada. At one point there was an 8 month wait to get cataract surgery, and an 18 month wait to get non-urgent oculoplastic surgery. We got that down to less than 1 month which is comparable to private practice in the area. I heard since I left the administration has really gone downhill and an optometrist is now in charge of the ophthalmology department. This is negatively affecting care. The outside VAs and VA clinics that would refer us patients really could not handle much in terms of urgent care or complex care. The doctors usually only worked at the VA and there were no residents. This in my opinion led to substandard care. We would routinely get patients from smaller VAs or satellite clinics that were grossly mismanaged. So it depends on the specific VA you are talking about. And the specific department. But yes the system is grossly overloaded. There is not enough staff, they don't work as hard as people in private practice. But all of my patients received excellent care. The problem in the news about wait times killing people, I could definitely see that happening. I have no idea how people ended up in my clinic but very few people had mild disease. They almost always had severe pathology, which means that somewhere along the way, they were not seen soon enough. The problem is that it takes an act of congress to get anything done to change the system (literally). If I were in charge I would evaluate every VA and if necessary close and restaff every single one. I would replace the antiquated electronic medical record system they have with one that can communicate with the rest of the  VAs across the country. I would hire many more staff and increase the number of skilled nursing facilities.

Trump and the actions of his administration speak loudly. I will let you, the reader, come to your own conclusion on what to believe Trump’s true stance on transgender equality is.What Trump said:President Donald Trump said he was a different kind of Republican. As someone from liberal New York, he signaled that he would be the person to finally move his political party on LGBTQ issues. He held up a Pride flag at a campaign event, and he said the key acronym (“L, G, B, T … Q”) at the 2016 Republican convention.Source: Trump promised to be LGBTQ-friendly. His first year in office proved it was a giant con.What Trump has done:Below you will find a timeline of “approved discriminations” put in place by the Trump administration. Please visit: The Discrimination Administration the source for this information.Anti-Transgender and Anti-LGBT ActionsMarch 13, 2019: The Department of Defense laid out its plans for implementing its ban on transgender troops, giving an official implementation date of April 12.January 23, 2019: The Department of Health & Human Services' Office of Civil Rights granted an exemption to adoption and foster care agencies in South Carolina, allowing religiously-affiliated services to discriminate against current and aspiring LGBTQ caregivers.November 23, 2018: The U.S. Office of Personnel Management (OPM) erased critical guidance that helped federal agency managers understand how to support transgender federal workers and respect their rights, replacing clear and specific guidance reflecting applicable law and regulations with vaguely worded guidance hostile to transgender workers. While this guidance change did not change the rights of transgender federal workers under applicable law, regulations, Executive Orders, and case law, it is likely to cause confusion and promote discrimination within the nation's largest employer.August 10, 2018: The Department of Labor released a new directive for Office of Federal Contract Compliance Programs (OFCCP) staff encouraging them to grant broad religious exemptions to federal contractors with religious-based objections to complying with nondiscrimination laws. It also deleted material from an OFCCP FAQ on LGBT nondiscrimination protections that previously clarified the limited scope of allowable religious exemptions.June 11, 2018: Attorney General Jeff Sessions ruled that the federal government would no longer recognized gang violence or domestic violence as grounds for asylum, adopting a legal interpretation that could lead to rejecting most LGBT asylum-seekers.May 11, 2018: The Bureau of Prisons in the Department of Justice adopted an illegal policy of almost entirely housing transgender people in federal prison facilities that match their sex assigned at birth, rolling back existing protections.March 23, 2018: The Trump Administration announced an implementation plan for its discriminatory ban on transgender military service members.February 18, 2018: The Department of Education announced it will summarily dismiss complaints from transgender students involving exclusion from school facilities and other claims based solely on gender identity discrimination.January 26, 2018: The Department of Health and Human Services proposed a rule that encourages medical providers to use religious grounds to deny treatment to transgender people, people who need reproductive care, and others.January 18, 2018: The Department of Health and Human Services' Office of Civil Rights opened a "Conscience and Religious Freedom Division" that will promote discrimination by health care providers who can cite religious or moral reasons for denying care.December 14, 2017: Staff at the Centers for Disease Control and Prevention were instructed not to use the words “transgender,” “vulnerable,” “entitlement,” “diversity,” “fetus,” “evidence-based,” and “science-based” in official documents.October 6, 2017: The Justice Department released a sweeping "license to discriminate" allowing federal agencies, government contractors, government grantees, and even private businesses to engage in illegal discrimination, as long as they can cite religious reasons for doing so.October 5, 2017: The Justice Department released a memo instructing Department of Justice attorneys to take the legal position that federal law does not protect transgender workers from discrimination.September 7, 2017: The Justice Department filed a legal brief on behalf of the United States in the U.S. Supreme Court, arguing for a constitutional right for businesses to discriminate on the basis of sexual orientation and, implicitly, gender identity.August 25, 2017: President Trump released a memo directing Defense Department to move forward with developing a plan to discharge transgender military service members and to maintain a ban on recruitment.July 26, 2017: President Trump announced, via Twitter, that "the United States Government will not accept or allow Transgender individuals to serve in any capacity in the U.S. Military."July 26, 2017: The Justice Department filed a legal brief on behalf of the United States in the U.S. Court of Appeals for the Second Circuit, arguing that the 1964 Civil Rights Act does not prohibit discrimination based on sexual orientation or, implicitly, gender identity.June 14, 2017: The Department of Education withdrew its finding that an Ohio school district discriminated against a transgender girl. The Department gave no explanation for withdrawing the finding, which a federal judge upheld.May 2, 2017: The Department of Health and Human Services (HHS) announced a plan to roll back regulations interpreting the Affordable Care Act’s nondiscrimination provisions to protect transgender people.April 14, 2017: The Justice Department abandoned its historic lawsuit challenging North Carolina’s anti-transgender law. It did so after North Carolina replaced HB2 with a different anti-transgender law known as “HB 2.0.”April 4, 2017: The Departments of Justice and Labor cancelled quarterly conference calls with LGBT organizations; on these calls, which had happened for years, government attorneys shared information on employment laws and cases.March 31, 2017: The Justice Department announced it would review (and likely seek to scale back) numerous civil rights settlement agreements with police departments. These settlements were put in places where police departments were determined to be engaging in discriminatory and abusive policing, including racial and other profiling. Many of these agreements include critical protections for LGBT people.March 2017: The Department of Housing and Urban Development (HUD) removed links to four key resource documents from its website, which informed emergency shelters on best practices for serving transgender people facing homelessness and complying with HUD regulations.March 28, 2017: The Census Bureau retracted a proposal to collect demographic information on LGBT people in the 2020 Census.March 24, 2017: The Justice Department cancelled a long-planned National Institute of Corrections broadcast on “Transgender Persons in Custody: The Legal Landscape.”March 13, 2017: The Department of Health and Human Services (HHS) announced that its national survey of older adults, and the services they need, would no longer collect information on LGBT participants. HHS initially falsely claimed in its Federal Register announcement that it was making “no changes” to the survey.March 13, 2017: The State Department announced the official U.S. delegation to the UN’s 61st annual Commission on the Status of Women conference would include two outspoken anti-LGBT organizations, including a representative of the Center for Family and Human Rights (C-FAM): an organization designated as a hate group by the Southern Poverty Law Center.March 10, 2017: The Department of Housing and Urban Development (HUD) announced it would withdraw two important agency-proposed policies designed to protect LGBT people experiencing homelessness. One proposed policy would have required HUD-funded emergency shelters to put up a poster or "notice" to residents of their right to be free from anti-LGBT discrimination under HUD regulations.The other announced a survey to evaluate the impact of the LGBTQ Youth Homelessness Prevention Initiative, implemented by HUD and other agencies over the last three years. This multi-year project should be evaluated, and with this withdrawal, we may never learn what worked best in the project to help homeless LGBTQ youth.March 8, 2017: Department of Health and Human Services (HHS) removed demographic questions about LGBT people that Centers for Independent Living must fill out each year in their Annual Program Performance Report. This report helps HHS evaluate programs that serve people with disabilities.March 2, 2017: The Department of Justice abandoned its request for a preliminary injunction against North Carolina’s anti-transgender House Bill 2, which prevented North Carolina from enforcing HB 2. This was an early sign that the Administration was giving up defending trans people (later, on April 14, it withdrew the lawsuit completely).March 1, 2017: The Department of Justice took the highly unusual step of declining to appeal a nationwide preliminary court order temporarily halting enforcement of the Affordable Care Act’s nondiscrimination protections for transgender people. The injunction prevents HHS from taking any action to enforce transgender people's rights from health care discrimination.February 22, 2017, 2017: The Departments of Justice and Education withdrew landmark 2016 guidance explaining how schools must protect transgender students under the federal Title IX law.

Original Question: Can we 'Quorans' come up with solutions to the U.S. Healthcare crisis and hopefully provide inexpensive medical care solutions?How many times have I answered this, discussed this, explained this? Here are some of my posts and answers from recently. First, a recent (this week) comment I made is key to everything that follows.[I]nsurance is not medicine. Insurance is access. If the costs are too high and those cost drivers aren't addressed we are doomed. (Your humble Quoran)Universal Health Care…coming soon? by Tom Byron on Byron's BlogHere are a few of the key points recently which will solve this “matter”Agree to all revisions in a bipartisan manner. Include congress on the plan, no special exemption for the few, the partisan, the privileged.Congressional exemption from some Republican health plan cuts again in place With hours to go before the latest vote on repealing and replacing the Affordable Care Act, it appears members of Congress and their staff would be exempt from losing some popular provisions of the health coverage available under Obamacare, as it is popularly known.2. Allow policy holders to keep their insurance when they move from state to state. Allow insurers to compete for their business.3. Allow ony for catastrophic and wellness coverage for the poor. Prevention is a great idea and should help keep the few 5% from incurring 50% of health care costs.5% of Americans Made Up 50% of U.S. Health Care Spending When it comes to America's spiraling health care costs, the country's problems begin with the 5%. In 2008 and 2009, 5% of Americans were responsible for nearly half of the country's medical spending.Of course, health care has its own 1% crisis. In 2009, the top 1% of patients accounted for 21.8% of expenditures.The figures are from a new study by the Department of Health and Human Services, which examined how different U.S. demographics contributed to medical costs. It looked at the $1.26 trillion spent by civilian, non-institutionalized Americans each year on health care.The top 5% of spenders paid an annual average of $35,829 in doctors' bills. By comparison, the bottom half paid an average $232 and made up about 3% of total costs.House members on Thursday will vote on the latest iteration of the Republican-backed bill, the American Health Care Act, in another attempt to overhaul the U.S. health care system. As of Wednesday night, an amendment included in the bill would allow states to waive certain Obamacare requirements, including coverage for pre-existing conditions, maternity care and mental health care. However, members of Congress and their staff, who are currently required to buy insurance through the marketplace just like every other Obamacare enrollee, would not be affected by these changes, Vox reported.4. Stop the practice of practicing defensive medicine to keep from being sued. Excessive tests to “CYA” if the doctor doesn't immediately figure out the exact problem, and has an “ambulence-chaser” calling him. The English System, loser pays would help reduce this situation.5. Allow plans that fit the policy holder’s needs, not “one size fits all”. This is why the mandate was created. Force people who don’t need/want certain coverage based on age, sex, etc—everyone doesn't need the same coverage.Original Question: As of 2016, should the Affordable Care Act be judged a success or a failure and why?Preface: I've written 59 answers here on Obamacare (Patient Protection and Affordable Care Act) and you may link there for more of my many discussions. I will reference a few of these in my answer here.First let’s examine (a) what we were promised. Then let's see (b) what the impact on delivery of the Affordable Care Act (ACA) has been. Finally let’s examine (c) where is ACA today in August 2016 and (d) How ACA is projected to be in the future.As we examine this, I will give you a question to ponder in the back of your mind as I make my case. Have you, or do you know someone who has heard, “I'm sorry, we don't take that insurance (card) anymore.” My doctor is going to retire earlier than she wants to because of all the unnecessary paperwork she is mandated to fill out. She specifically says, “It's that Obama Care!” It cuts into her and her staff’s time interacting with patients and the churn of her patients.Finally, before I outline my thesis: Why are we still debating this brave new world of health care delivery? It has a large group who hate it and another group who love it. It was signed into law six years ago, back in Mar. 2010. Isn't insurance meant to spread risk?(a) What we were promised?We were promised (37 times) specifically, that we could keep our Doctor. We could also keep our plan we had. This was based on a lie and repeated as a lie to move forward. We would see a bending of the cost curve; you will save $2500 per year on premiums. That has not happened yet either.Tom Byron's answer to What are the biggest misconceptions about Obamacare? (1) That you can keep your insurance if it meets Essential Health Benefits (EHB) level and you had it before the law was passed and it has not changed at all). My take on the reasons (behind the reasons) for Obama Care. by Tom Byron on Byron's Blog(2) It will cover millions of uninsured, but we all thought that our insurance we were paying for we could keep. It was sold to provide the 40 million who did not have insurance, to have insurance. We were not told about (1) above.From the Huffington Post (not FoxNews) this Sept. 23, 2013 article is scary as hell. Does anyone believe that 80% of the insured will have nothing to worry about?If you're one of the roughly 80 percent of Americans who already has health insurance through an employer or is enrolled in a government program like Medicare, the answer is: probably nothing.For nearly everyone else -- the 170.9 million people covered by employers and the 101.5 million enrolled in government health programs -- the ballyhooed launch of the Obamacare exchanges will mean little, according to health care, consumer and business experts."If you have employer coverage now, do not worry," said Lynn Quincy, a senior policy analyst at Consumers Union in Washington who specializes in health care issues. "If you're on Medicare now, please don't worry," she said.http://m.huffpost.com/us/entry/3...(3) It would be as easy as going to Expedia and booking a flight. We did not know that they didn't know how difficult designing a complex system of verifications, and subsidies from other agencies would be.(4) We did not realize how many people would be routed in to Medicaid. How will this bend the cost curve down and "won't add a dime" to costs according to President Obama?Nine out of 10 new Obamacare enrollees have signed up for Medicaid, the Washington Post reports, compared to only "a trickle of sign-ups for private insurance." Health & Science - philly.com...(5) We did not know that the insurance companies would be compensated if they lost money. Risk corridors. PPACA the next shoe to drop. by Tom Byron on Byron's Blog(6) We were not told (originally) that millions would be dropped, or policies cancelled, due to EHBs, though we were warned. These people regularly get cancellation notices, except (a) they didn't see this coming, (b) they are now under mandate to switch and use a mostly inefficient web site.(7) Most people did not know that special interests would get waivers and delays in the implementation of the ACA. http://m.nationalreview.com/arti...(8) Most people thought they were immune from all this churn and mess with insurance, "I have a good policy with Delta Airlines, company provided. I am exempt." Not so fast, Delta sees a $100 million additional in expenses and may dump their employees into the exchanges. August 2013 - RedState...(9) Most people did not realize that a normal work week would change to 29 1/2 hours, due to ACA. 77% of the Obama jobs created are full or part time. Read here for the shocking answer. Breaking news from around the globe: U.S. news, politics, world, health, finance, video, science, technology, live news stream...This week, in August, 2016, we see that the insurance giant Aetna is pulling out of many insurance markets. They have a fiduciary responsibility to shareholders to maximize their profits. They project worse losses in the future after recent signNow loses. Less competition drives up costs. This is the death spiral that has been predicted. Now it has become even more real. As insurers exit the market and competition disappears, costs will only rise.(b) What is the impact on delivery of the Affordable Care Act (ACA)?There was no Republican support in passing this law. Those in the heat of this partisan battle saw what was happening. In spite of harsh criticism and much ballyhooing by Democrats they said the system being created would implode like a Stellar Supernova. So far, we are on schedule for that prediction.The bailout mechanism was placed in the law to prevent this collapse. It was labeled “risk corridor”, also known in the military as an ejection seat. Catastrophe coming up—bail out! The insurers were to be reimbursed for losses. This section was later deleted, the losses arose, they are bailing out.How many enrollees were predicted and how many are now covered. That's an interesting way to show great results. But is it an accurate result, as I mentioned earlier, insurance is about spreading risk. Under ACA the result is pseudo-wealth redistribution in the form of “free” health care.Today, after more than 6 years, you have too many elderly, sick and previously uninsured people. The young and healthy would rather pay the penalty for not being insured. Odd this is so great that for the first time you are penalized for not buying something. Odd?!How Many People Has Obamacare Really Insured? (2015) far, even if you accept the most optimistic math, Obamacare is hardly the unmitigated success that its many apostles proclaim. Whatever minimal gains in the level of commercial coverage that’s been achieved has come at a huge fiscal expense. This is not to mention the massive growth in costly and restrictive regulation.This why Aetna and others facing the difficulty of writing policies with 30% or higher premiums; the risks aren't being spread by sound Actuarial Analysis. For some graphs and charts to explain profits and losses in different markets, with and without competition.(c) Where is ACA today in August 2016?ACA is first and foremost a powerful campaign topic. Democrats want to make health care like VA care. Republicans want to repeal and replace—after several dozen attempts. Why repeal a failed program instead of expanding it? Some labor statistics show why.We have the lowest worker participation rate in many decades. 300.000 INDICATORS FROM 196 COUNTRIESCombined with an increase in part time work, this is not a benefit for the working class. Part time work is directly tied to ACA regulations forcing employers to provide health care or reduce employees hours. That is a no brainier, just like paying $15.00 minimum wage and reducing staff and automating staff.This is a new Applebee employee, a tablet!(d) How ACA is projected to be in the future?There are two schools of thought:(Mar. 2016) The Obama Health Care Legacy: More Coverage and Less Spending(Feb 2016) CBO: Obamacare Costs to Increase in 2016 As Millions More Get Subsidized InsuranceWhat is certain that ACA depends on which party is elected. This will be driven by the reporting of the November 2016 ACA premiums, state by state.Here is what may drive the election, in part, these new rates which have yet to be made public widely.Obamacare's November surprise Indeed, Republicans are already pouncing on UnitedHealth's decision as proof the law is unworkable. “You’re seeing the beginning of the so-called insurance death spiral," Sen. John Barrasso (R-Wyo.) said last week.Democrats say they will mount a vigorous defense of a law that has provided 20 million people with coverage — and point to Republicans' failure to propose any coherent alternative to Obamacare.Conclusion: I would judge it a failed but noble attempt. Universal health care may be the solution, but there are easier and less expensive ways. The government is never the least expensive not the easiest. They pick winners and losers, whereas a free market system allows the better ideas to compete and win. The discussion on how to accomplish this goal has been laid out. More details will follow depending on who is elected President in November, 2016.Obamacare's November surprise The last thing Democrats want to contend with just a week before the 2016 presidential election is an outcry over double-digit insurance hikes as millions of Americans begin signing up for Obamacare.But that looks increasingly likely as health plans socked by Obamacare losses look to regain their financial footing by raising rates.Read more: Obamacare's November surpriseUniversal Health Care…coming soon? by Tom Byron on Byron's Blog