I was quoted $1400 per month with a $5000 deductible for an individual policy before Obamacare. For a much better policy under Obamacare ($750 deductible, $1500 maximum out of pocket) I pay $106 with the tax credit. Without the tax credit, the premium is $592, less than half of what was available on the free market, pre-Obamacare. So in my case, you are wrong.
Interesting theory. Can you point to a regulation that determines compliance that was not evident from the statutory language? And what percentage of cancelled plans were noncompliant only with a regulation and not the plain statutory language?
Well then I see why you like it. I’m guessing you have pre-existing conditions that drove up your insurance cost. Good for you.
Do you see why I don’t feel the same way? (Well, one of the reasons.)
It’s a step in the right direction. But really, grandfathering all plans is also an easy fix. There are more than enough uninsured to make the exchanges viable, assuming they want to sign up. It’s unnecessary to take people’s existing arrangements away.
One would be the contraception mandate. Nothing in the law required free contraception, and in fact the regulation may violate other federal law. That was before the election, but well after 2010(I believe it was issued in summer 2012).
But sure, if you really want to enforce the fine print, you could write a law limiting grandfathered plans to only those plans that were compliant with the law AT THE TIME they were sold.
That’s what grandfathering means to me. But if you are talking about new people entering the market, those policies are going away, because they cost the economy too much when they fail to cover expenses and drive the patient into a medical bankruptcy. Grandfather existing policies, ban new non-compliant policies. That achieves the best coverage for the most people. I am not concerned that it isn’t perfect for everyone, so long as it is better for more people than the pre-Obamacare disaster.
I thought this would be a hijack but since this is about the lies in Obamacare let’s throw out a new one: it will reduce healthcare costs. How will it do that? By making sure 80% of the premiums go to health care cost. Whether that is as an individual or in the aggregate I don’t know but I guess the idea is that if I spend $1200 in premiums and only use $800 in healthcare coverage that the insurance company owes me $200 at the end of the year. Except is it me as an individual or does the insurance company take all of its customers and do average premium - 1.25 x medical costs? So is average premium is $1500 and average medical costs are $800 then everyone gets a $500 rebate because if so then that is all sorts of fucked up.
Except there is nothing that controls healthcare prices. Prices are not linked to cost but instead made up because the numbers sound good. Are my 80% costs the inflated ones that non-insured people pay or the reduced ones the insurance company negotiates? Ultimately, what encourages the insurance company to reduce medical cost (which they don’t really control anyways) rather than just saying estimated cost x 1.25 = annual premium.
So did Obama lie when he said ACA would reduce health care costs?
This is incorrect. There are dozens of statutory mechanisms designed to affect healthcare prices as distinct from insurance prices.
Who pays when a patient declares a medical bankruptcy and defaults on a large hospital bill? Those costs get passed on to patients and their insurance companies who are paying. More people covered by health insurance means fewer defaults, and lower costs passed on to consumers means controlling health care costs.
No, it just means those costs are paid by other means. The costs exist regardless of whether they are paid or not.
As for the grandfathering, given the nature of the President’s promise, make it simple: all plans that existed up until say, right now, are grandfathered.
Do you have a link to those? Not that I don’t believe you but all I’ve seen so far is
- Pass ACA
- Lower health care costs
Yeah, it’s a shame this aspect hasn’t gotten more attention. Here’s an incomplete list:
Tax the drivers of cost inflation that don’t significantly affect the quality of care (as we all know, you get less of what you tax, and so the taxes to pay for the ACA are targeted toward drivers of cost that don’t substantially improve outcomes–namely, medical devices and insurance plans that lack consumer incentives to shop for care)
Preventative care (keeping diabetes in check, say, saves a lot of money compared to failing to keep it in check, and the ACA improves this aspect in many ways, including by eliminating co-pays for such prevention, expanding the number of people with coverage, offering grants for wellness programs for small employers, and offering grants for fighting specific expensive diseases, like Diabetes and tobacco addiction–these costs inflate the cost of care overall because the costs of unprevented simple illnesses are usually the costs the providers have to eat and pass on to everyone else)
Make Medicare/Medicaid payments for efficient, the biggest demand-side part of the price equation (much of the ACA is targeted at using the 800lb. gorilla that is Medicare to get providers to provide care more efficiently, this includes the Independent Payment Advisory Board based on the 20-year Dartmouth study of cost inefficiencies whose recommendation Congress must either accept or enact policies that achieve equivalent savings, and it also includes things like modifying hospital payments to be based on the dollar value of each hospital’s percentage of potentially preventable Medicare readmissions, making the bidding process more competitive, provides better incentives for quality of outcomes as opposed to number of services, )
Accountable Care Organizations (ACOs) (the ACA set up 32 pilot programs which incorporate pretty much every idea about how to control costs and studies them on an experimental basis for eventual incorporation into Medicare (or market adoption since they, you know, lower costs—so far, all of the 32 health systems in the so-called Pioneer Accountable Care Organization (PACO) program improved patient care on quality measures and 18 did so while lowering costs)
Tort Reform Experiments (funding for state-level pilot programs aimed at reducing defensive medicine–among the things they have already funded are measures related to apologies issued by doctors that are then inadmissible in court)
Comparative effectiveness research (funding for figuring out what procedures work and which don’t, which by most estimates saves more health care dollars than it costs)
This link has an even better summary than those, actually: http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf
Without the government handout, the deductible on your policy is not $750 and the maximum out of pocket is not $1500.
Richard, thanks for that list. You left out the best one though, IPAB. That’s the big cost saver, if it’s given teeth. The rest may or may not work. CBO didn’t give the bill much credit for cost savings in the 10-year window.
A big part of our problem is that things in the social and economic sciences are very difficult to demonstrate without installing. You pretty much have to do them to find out if they work or not. Not like in the “hard” sciences like physics, you can take the two balls up the tower, drop them, and show instantly that they hit the ground at the same time. The facts of those studies can be proven to such a degree as to convince any reasonable person, however resistant they may be.
Over many years, the evidence has accumulated, all over the world the “socialized medicine” model works, works well, and continues to work well. Nations without anything near our level of money and power take care of their citizens to a degree that makes them wonder WTF is the matter with us: they do it, and its difficult because they don’t have what we have, we could do it much more easily, and we flat refuse to. They don’t get it. I don’t blame them.
So, can anyone just tell me, in terms that can be clearly defined, why that should be so? Can anyone tell me why what works in Canada, Mexico, Sweden, Germany and so on and so forth, won’t work for us? Without invoking some vague metaphysics or magical unrealism like “American exceptionalism”? Just tell me how they can do it and we can’t. Are they smarter than us, have more resources, have more willpower? The footprints on the Moon are American footprints, we can’t do this?
Tell me why.
So what?
They all work if you define the goal as “everyone gets a basic level of care”. A socialized food program would be successful in exactly the same way, if we defined success as “everyone gets a basic diet”. But which method is better for achieving that goal without collateral damage? Would it be better to have all food production be handled by the government and everyone gets what the government judges that they need? Or would it be better to have competition in the food industry, with most consumers buying as much or as little as they want, while the poorest get financial assistance(food stamps)?
And that there is the difference between single payer and multi-payer, and why multi-payer is superior.
That one word “basic” is supporting a lot of the weight in your argument, but seems a mite thin on definition. You could start there, tell us what that means.
Then we can get around to the “apples to orangutans” comparison between food and medical care, where one is a physical commodity, and the other is more a matter of applied skills.
But lets start easy, even a journey of a thousand miles begins with a single stumble… Define “basic medical care”. Please proceed, adaher.
Basic medical care defines all medical care that can be provided to all citizens of a state without bankrupting the nation. In other words, everyone who needs chemo can have chemo, but not proton beam therapy. You only get that with cash or supplemental insurance. Same goes for $20,000 drugs like Herceptin. No country can afford to give it to every patient who could use it. So those will not be “basic care”.