I’m not going to respond to all of it, because I think its generally pretty accurate.
But one thing I’ve heard many times (and which I tend to agree with) is that health insurance should be, well, insurance. We don’t expect our car insurance to pay for gas and oil changes, and if it did we would probably see the cost on those things escalate. Moving more people to a model where preventative care is free/cheap, moderate care is cost-sensitive and paid pretty much out-of-pocket, but truly expensive care is covered by insurance may not be the worst outcome in the world.
I do agree that from what I’m seeing a lot of these Bronze plans are pretty shitty (PPOs in particular) in that they won’t really help make standard non-catastrophic care more affordable to anyone other than those that get subsidies to pay almost all of the premiums. And even then the deductibles on some of these plans will still hurt.
He didn’t say that in his response, so the criticism is fair. He should go around with an iPad attached to display the footnotes. It reminds me of Robin Williams doing Buckley in Aladdin explaining the rules.
But even before this stuff there was the realization here that the government couldn’t prevent private companies from changing the rules. The baseless concern, if you remember, that the government was going to get between you and your insurance company, which was used after the baseless concern that the government was going to get between you and your doctor was laid to rest.
There are tons of small business owners out there who don’t have the clout to get a decent plan. My wife is a freelance writer. She makes good money, but she’d be in trouble if she had to buy her own coverage. (She is on mine.) The exchanges are great for people wanting to start small businesses also.
I have very good self control (and a lot of money in the bank.) The government doesn’t. Or, you can say that the extra money could go into good investments like infrastructure or research.
Like I said, I’m in UHC so very good coverage. There are many hospitals near me. Number of places in network would seem to correlate with bigger companies and thus cheaper prices, not the other way around. Insurance isn’t created by mom and pop outfits (or it shouldn’t be, since they won’t be competitive.) Bigger companies have the clout to get better deals, and thus can be cheaper. So I’d be very nervous about signing up with a place with very few partners.
But insurance has value even if you don’t use it. (See life insurance.) The question is whether this perceived benefit plus the cash benefits is > then the cost - the penalty. You don’t have to make the penalty equal to the cost of the cheapest plan to motivate people to sign up.
Can’t disagree with this. I think more people will have health care (which is why medical stocks have gone up) but a single payer system would be much better.
Yes, but the SMB plans are generally in the center of costs compared to the costs that are on the exchange currently. You can get way more expensive (With niftier options) and way cheaper plans (with fewer options). But I think a lot of SMBs will either turn people lose on the exchanges because health care was crippling them or give them an additional subsidy to shop on the exchanges.
In my opinion, if they are going to mandate everyone to have insurance, then we should all get it the same way and every company should give some set monthly amount to pay for that insurance ($150/mo? Whatever makes sense) instead of allowing multiple avenues just trying to go “Look! Look! People covered!”
Oh, so you want to own AND eat your cake. You’ll take your sale savings and stuff it into your savings account instead of helping the economy. Scandalously selfish
I was more concerning myself with the OP saying that “We’ll pay more into the debt for this!” instead of what would likely happen: It disappearing into Medicare/Medicaid/Social Security. The Congress of our fair land loves to spend. I am conservative in this topic. I would prefer if they were more guarded with their cash outlays. The war in Iraq (I admit that Afghanistan wasn’t a stretch for me in terms of “We should probably shoot those guys a couple of times.”) all the way to things like Solyndra are all things I think shouldn’t have happened.
Even the larger companies have cut back who will be covered by certain plans. So to get cheaper rates, you may significantly dampen who you can go see. It’s kind of a bad place to be if you can’t (or barely can) afford the silver plans which is where this sort of thing starts.
The problem is that most people are generally healthy from 18 to 35. If they are in a business setting and making good money, the cheaper insurance rates offered by even SMBs are probably worth it. If they are barely making it at McDonalds, the exchange rates versus how much they bring in is a lot harsher and the entire dynamic changes in terms of how they spend their money.
Medical stocks have gone up because everyone expects a huge influx (estimates of, what, 10 million people by this time next year?) of people with insurance means a huge influx of capital into the medical industry…which investors want some of. It’s the same reason things like Apple stocks get ruthlessly pumped up for a new iPhone. Investors want money.
Which is probably a good thing. Insurance is all about risk pool size, and I’ve seen interviews with small business owners complaining that though they want to insure their employees they can’t because they don’t have enough clout. Being in a big risk pool on an exchange will be cheaper - and everyone wins. It is more efficient.
However some companies may want to attract employees by giving more.
Damn right! If everyone was like me and my wife the economy would be in serious trouble. I get a new car every 15 years if I need one or not.
When my big company got bought by a really big company my insurance coverage improved a lot. Of course we are self insured - I think most big companies are, so this stuff shouldn’t affect them. The big win would be if health care spending stops increasing so steeply. Now it has done this the past few years, but that might be the economy. The various initiatives around making costs more available and encouraging evidence based medicine can really help.
Which means the expected value of having insurance decreases. On the other end Social Security is important because the expect cost for someone who is 90 will be higher than it would be feasible to pay. At 95 my father-in-law’s group insurance cancelled him - because he was the only one still alive in the group. He really, really needed Medicare plan B.
How can Obamacare possibly make health costs lower? Can they just legislate lower prices? or are prices a measure of something far deeper? The only way health care costs will go down is if we return to the system where people pay for what they use. Under the current system, people don’t care how high health care costs are b/c they usually aren’t the one paying for the service.
It wouldn’t be in trouble. We’d just confiscate private deposits like Cyprus did.
Why would you get a car if you didn’t need it?
I completely mistook your meaning. I was talking about big companies offering plans on the exchanges at lower prices by cutting the number of in-plan options. My bad.
My argument is that the ACA-provided plans don’t give enough incentive for people to actually go for it on the lower-end of the scale, except in the minority of cases. Pre-existing conditions and such. As a result, the exchanges will likely be underserving for at least this year and probably next year’s enrollment, also.
The best risk pool is the largest risk pool. By splitting people in to different pools, the insurance companies successfully create a way to change the stakes in their favor and make more money. That inflates the overall cost we pay for health care, which isn’t good for bringing costs down. If they get expert at tweaking the new avenue that might have been created for them, they’ll get driven to obscene profits.
Saying that stocks are going up means that there will be more medical care is kinda…off. It just means that people are hoping they get huge wind falls from the possibility that the ACA strikes gold-encrusted crude oil and makes the investors rich(er).
It sounds like you already had a good plan through your work that your employer pays a large chunk of. Obamacare was never passed for people in your situation.
The single male 35 year old healthy small business owner who was paying for a bare bones plan with no maternity benefits (because, well, he’s male and can’t get pregnant) or contraception (ditto) and paying a decent rate because he is healthy is going to take a big fat hit to his wallet because of the ACA.
It is one more step in government benefits, like I suggested above, that kills most regular Joes.
I’ve seen it my whole life. (And substitute number for inflation or for where you live):
A family in their early to mid 20s. Has a kid. Maybe they made bad decision in life, but we all did, some of us didn’t get caught. They pull in around $24k per year. They qualify for food stamps, medicaid for the kid, earned income tax credit, and the whole bit. Someone screws them out of $50? Take them to court because the government waives the filing fee for indigents. We as taxpayers take care of them because they can’t do it on their own. Fair enough.
Fast forward a few years and Dad gets promoted to assistant manager or manager and now makes $40k per year. He is working hard, doing the right thing, not too hungover when he goes to work. Basically doing what society tells him to do. The result? His income is too high for food stamps, Medicaid, and EITC. His job pays all of his premium but offers nothing for his wife and kid. Since HIS health care is “affordable” get gets nothing for an ACA subsidy. No big tax refund, must pay for health insurance, and someone different screws him out of $100 every other week? The courtroom door is shut because he must pay $90 to file his case. It’s not worth it.
In many, many ways (arguably in every financial way) he is worse off than he was before. He would be better had he not taken the promotion. That is an absolutely terrible entrenched party of society we have that discourages upward mobility from lower middle to middle class. And every single government program seems to favor keeping people from this upward mobility.
I think I’ve seen a stat which said that for some lower middle class people the combination of taxes and decreasing ACA subsidy results in an effective marginal tax rate of about 90%.
But as you indicate, this is a much broader issue than just the ACA. And a big part of the problem is that social programs do not recognize that other social programs are income, for purposes of needs-based testing.
So that a guy who applies for some program who has $20K in gross income is counted as having $20K of income. Another guy who has $10K of income and also receives $10K tax free from various social programs is counted as having $10K of income.
Not a big incentive for a person in that situation to get a job.
There’s also about a dozen more ways it lowers costs in theory.
The exchanges themselves are of course one way. The lower the transaction costs and more perfect the information, the better the free market works. And it doesn’t hurt that insurers are competing for government subsidies.
But there are other cost control efforts too, from IPAB to measures incentivizing moving from fee for service to fee for success. That aspect of Obamacare has been woefully undercovered.
IPAB is for medicare/medicaid only as far as I’m aware. Does it extend into private insurances (the exchange costs) also?
And Fee for Success I’m not sold on. A doctor who is trying to find out what’s wrong with a patient won’t get paid until he hits test 15 and sees that you have EbolaSARS. Is it really fair to penalize him for trying to help?
And the ACA includes other things that also cost more. Not only for the new perks like pre-existing conditions, but things like electronic medical records. Until we see those play out, I’m not sure if the balance will be to “cost savings” or “net zero” or “costs more”.
No, but as the largest players in the market, their influence extends well beyond only their insureds.
I’m not an expert on this, but I have found Atul Gowande’s stuff to be very persuasive.
If EbolaSARS takes 15 tests to determine, then the fee for identifying and treating it would be commensurate. If, on the other hand, only a bad or greedy doctor would run 15 tests, then he shouldn’t get paid for doing them.
Coverage for pre-existing conditions and electronic medical records may well result in lower costs rather than higher costs. But you’re absolutely right that nothing is guaranteed. We’ll have to see how it all plays out.
If you’re in the ambulance and don’t have a choice of what hospital you’re taken to (non patient driven care), you can appeal to your insurance process it as in-network. At my company that doesn’t even need approval from management. If a customer service rep hears about that situation s/he’ll let one of us claims processers know and we’ll reprocess the claim.
Don’t do like one of our members did. He decided to go to an out-of-network provider for outpatient surgery. Wound up owing over $35,000 for out of network deductible and the difference between charge and our allowed amount. It it has been a network provider it would have cost him a few hundred. We’re introducing tiered plans with “extended network” where expensive hospitals still have a contract with us, but you may pay more out of pocket, but for providers without a contract guess who pays the difference between charge and allowed amount in addition to any deductible, and as we all know some billed charges are rather fantastic compared to what insurance companies allow.
Maybe, but that still doesn’t extend cost savings to the private insurance members. It might drive the costs down, but as history has shown, the private insurers that use the medicare reimbursement schedule don’t necessarily reduce costs to the end user(s).
Eh, the problem with this assessment is that not all things are easy to find. What’s the first thing your doctor will think when you show up at his office with puffy eyes, runny nose, and a temperature? Flu, right? Take some tylenol, sleep for a few days and you’re good, right?
Oh, in a few days you aren’t good? Well, it’s probably just sinus/allergy issues. Take a decongestant for a few days.
Oh, STILL not good? Well, hm. Let’s run a bacterial culture to see if you have something nasty. Take some antibiotics for a week.
STILL not good? Well, your test came back clean. Let’s run an XRay. Oh, look. One of your dental fillings has it’s core drilled into your sinus cavity. Let’s surgury that bad boy out of there.
And the doctor only gets paid for one visit? He was going through the stuff that people with that symptom have most common and slowly working towards a solution, not because he’s lazy or greedy, but because it takes time to figure out if a viral or bacterial treatment works. Sadly, no one is Doctor House who figures this stuff out in three days after intense scrutiny.
No. Pre-existing conditions won’t lower medical costs. It’s why everyone stopped coverage for it. You pay out the nose to continuously fund treatment of a PEC. Especially the major ones.
And E-records certainly aren’t going to reduce costs. The P4P stuff that you need to do on them is complex and down right crazy. A medical expert can speak more competently on this, but my old PCP was being asked to convert to EMRs and he had a printout of roughly 3,000 codes that his practice would use just to report to the insurance company what he did. That sort of…fun doesn’t save money. It costs money. Both in training and constant use.
The waiting is because most of those requirements aren’t active, yet. We’ll have to see how they start and then maintain before we know for sure. But I do know that the major pushers of EMRs are insurance companies and most doctors/nurses I used to deal with don’t like the added workload of filling extra spaces on a E-chart out.
Just to follow up: Yes, there is certainly room for abuse, here. The only way to tell, though is to look at the trend. Does the doctor take 12 tests for each and every ailment that ever comes across his door? Or does he usually have single/double visits and only a fraction of his patients are strange tangents like I laid out above?
Medicine is as much art as it is science. New age art. With organs.
I don’t understand the “lower part”. The premiums I saw were higher than what I’m paying now and then heavily subsidized. they also didn’t make sense because the showed a deductible and then total out of pocket expenses. My deductible is from my understanding, the total OOP expense.
These aspect of Obamacare have been heavily overcovered IMO. They are highly speculative. People in the business of predicting healthcare increases don’t take them seriously at this point.
The government doesn’t. Or, you can say that the extra money could go into good investments like infrastructure or research.