The obamacare trainwreck

Would that be like getting fire insurance after your house burned down?

 

Yes, me too. Surprisingly, he has not come back in a while. Would be interesting to see if he still has his beliefs.

 

I've seen a meme going around on Facebook blaming it on insurance carrier CEO pay, which is laughable since as much as they get paid, it's not even a drop in the bucket. I've heard some liberal commentators blame it on the penalty being too low. He'd probably latch onto one of those arguments.

 

I remember those conversations with hornpharmd too. I was a newbie around here, and just lurking, but I honestly thought to myself, "there is no way he is actually in the medical field if he believes this program has a chance in hell to work". I don't know the man, but his arguments made absolutely no sense.
Really, anyone with half a brain should have seen the writing on the wall that this would be an epic fail, but especially those of us with friends or family involved in health care knew exactly what would happen.

The funny thing is, all my liberal friends who were cheering the fact that "everyone can now have insurance" are wealthy and wouldn't touch Obamacare with a 10 foot pole. They pay out of pocket when they need to see a physician, or, they are covered by their employer. I know only one person who signed up for it, and it almost bankrupted the family. There is no way they will be able to afford the increase.
Hillary is gunning for a single payer system. All that will do is allow the rich the ability to retain concierge physicians while the rest of the poor schmoes are regulated to the bottom of the heap MDs who will see these patients for little reimbursement. It just won't ever work. We have too many people who are poor, or irresponsible, or too healthy to ever make this work.
We ain't Switzerland, or even Canada.

 

"We ain't Switzerland, or even Canada."

But why aren't we? I guess that's the question. Why can't we make a single-payer system work here? I'm genuinely interested in your response. I have insurance through my company and always have (since 1982 with various employers over the years) but I'm still curious about the system and what prevents something being installed that would allow those without a traditional career in corporate America to obtain affordable insurance.

I like two main pillars of the current law; 1) Being able to keep my children on my plan until they are 26 and 2) portability/pre-existing conditions

 

this is some funny ****

from Mar 2014

 

from Oct 2013

 

Good question. To answer, there are three principles that require understanding:

1-all resources to be allocated are scarce
2-individuals do not have the same values, and make decisions based on their own perceived or actual incentives and constraints
3-The cost of anything is the tradeoff of foregoing something else, and the tradeoff is measured by ever changing prices paid and received for the good or service desired/provided and foregone

There could be a centrally controlled system installed that provided "affordable care", but not "quality care". Until there is an infinite amount of medical care available, the free will of individuals -doctors and patients- will determine how the scarce resources are allocated via supply and demand. Interjecting a centralized decision maker (i.e. a "single payer") into the system will begin to favor (bias) a provider, or a patient, or a group of providers, or a group of patients. Such bias begins to change how individuals normally act in a value driven, price determined system of allocation.

The pricing mechanism is the most efficient mechanism to allocate scarce resources.
Single payer systems typically pay the same rate to providers for a given procedure based on some bureaucrat's idea of the "correct amount". Doctors may not like the amounts being paid, so they quit offering the procedure or treatment and instead decide to concentrate on another area of healthcare, or spend more time fishing, or start becoming day traders, etc., and patient waiting lists begin to grow. These systems then start prioritizing patients based on another bureaucrat's idea of medical need. Those at the bottom of the list begin to search outside of the system, subject to their own constraints and incentives, for medical care.

Everyone likes the two aspects of the current law (no pre-existing condition exclusions, and keeping members of household under your plan until they are 26). The former aspect costs a huge amount of money, so the act of liking something won't make it affordable.

As an aside, one of the dumbest aspects of the ACA, and there are many sorry aspects to the law, is the requirement that insurance companies must pay 80 or 85% of their revenues for health care. Think about it; if I make $20 profit on $100 of revenue, it would be wise to let costs escalate so that I could make $40 of profit on $200 of revenue for the same procedure. In other words, I want costs to increase so I can charge more and make a greater profit.

 

Of course, most of these central planners don't think about unintended consequences of stupid rules like this.

 

Or, considering some of the lobbying that goes on, they KNEW that it was the expected consequence and wrote it and passed it anyway...

 

Also a likely possibility.

 

Thanks for the comprehensive response. There is something I may have missed in all the hype and discussion when the ACA was being enacted: Covered employees such as myself (Fortune 500 company) have company subsidized premiums. If I recall, it may be as much as 80% (we do self-ensure). We do have slight increases in premiums/deductibles/co-pays etc every year but in general my total compensation package includes this subsidy and it is a huge benefit when comparing to someone who must pay 100% (not counting those who are subsidized by the government under ACA guidelines) is it not? It seems the premium costs are not comparable between myself and an ACA enrollee.

This is where the hard-core old man yelling at the kids to get off the lawn conservative point of view kicks in; I earned that subsidy from my company; ACA enrollees did not earn anything, they just have a "right". But then again, is it a right? Won't they be TAXED if they don't enroll?

That may not be the way to look at it but I know that I put in my time here. LONG HOURS. Year after year. I earned it. No doubt about it.

And now I'm going to get a pay cut because the Social Security wage ceiling is projected to bump up from $118K to $127K (rounding)...

 

Before Obamacare IIRC 45 states already had laws giving coverage to children depending on state to age 23,24 and in a few states age 29. Penn I think had it until 28 or 29. Nj may have been another.
So for many that was not a huge advantage. Texas IIRC was 24.

what is kinda interesting is how many people now eligible for subsidies have not signed up.
What also should be noted is how many states now only have one provider due to other providers leaving those states.
There were several alternative plans offered by the GOP before Obamacare was rammed down our throats and many GOP congresspeople tried to work to get some things changed in Obamacare.
Hopefully either Obamacare will be scrapped and a new more workable system put in place or Obamacare can be revamped to take out the more onerous provisions that have put it on the path to fail.

 

1) No pre-existing condition exclusion
2) The ability to cover your children up to X age (26 seems to cover the time needed for a college education along with maybe a gap year two as needed to work or get their head straight)
3) Subsidized premiums similar to what Fortune 500 companies provide
4) Incentives/penalties to buy into the system as we need "healthy" enrollees to cover the ponzi scheme
5) Elimination of the insurance companies (cut out the profit required by the middle man)
6) Savings from current uninsured debt eaten by local hospitals (Is this real? Are these savings possible to capture?). I work for a utility company and we have to defend our expenses in a rate case. The interesting thing is that any savings we achieve through our own efforts could end up being refunded back to the customer in the form of lower rates in the long run. Of course nobody ever sees a lower utility bill but there are savings/cost efficiencies imbedded in the rate request (the rate of increase is not as high as it would be). This type of thing would be necessary for hospitals. They would have to prove how much bad debt they were passing along. But is this truly possible?

What else? Maybe this is WAY too simplistic but you have to sketch something out.

 

To me, it's not that they are stupid; it's that they are cynical and Machiavellians. The political factor is overwhelming. They want to "help" those in need. Please note that I do believe there are good-hearted people involved in the ACA effort, but the activist mentality doesn't care about "unintended consequences." They figure it will be absorbed by those who they believe steal money from the poor.

 

You're right. The rules are stupid, but the central planners usually know what they're doing.

 

Of course, we must stipulate that there is stupidity involved in virtually every human endeavor so I'm not trying to totally discount that factor. But I think they have that "mandate from God" or whatever is driving them that enables them to gloss over mistakes and outright lies. They wanted a beach-head. They established the "Facts On The Ground" and now any change will be met with the highly effective retort of, "You are taking away insurance from families." You can't win once they have established their position. That is the Machiavellian effect.

You see, to "them" whoever "them" may be, it's all's fair in love and war. There is no good faith. There is no real care about what happens to the golden goose (our economy). It's that the rich plunder everyone so the only way to fight back is to use government power to force their way into the game. And it may be they are right on many levels. There is no trust and no time for them to wait for "the rich" to be generous. So they do what they have to do.

Then you have the, "Who gets the credit for helping the uninsured" effect. That is the political problem of not being able to compromise. It creates the "Party of No" image.

 

Premium costs are determined by actuaries and competitive forces. You are part of a large group that can be "sorted and labeled", and actuaries will be able to distinguish your group from the general population. Being part of a large group reduces "uncertainty", and the entire business world (and most social endeavors) are concentrating their everyday efforts on reducing uncertainty. In other words, a large group's losses (i.e. medical expenses) are more predictable than the medical costs of an individual purchaser under the ACA. Therefore, the cost for an individual purchaser will normally be higher.

Yes, subject to income levels, those individuals that do not purchase health insurance will be taxed under the ACA. If your employer quits offering you and the rest of your company's employees insurance, they too will be taxed for every employee they have (this is for employers with 50 or more employees). Then you will also be taxed individually if you don't purchase your own health insurance.

It is important to separate "government subsidies" from "private sector subsidies" when you examine subsidies. Your employer subsidizes your health care insurance to stay competitive with other employers in the marketplace. Government subsidies are exacted from other citizens to pay for someone's idea of what "society" should do.

 

How about we go with the old "free market". I like freedom to buy or sell according to my beliefs and desires. I would be willing to pay some amount to help the handicapped, elderly, and orphans, but it would be subject to revenues = expenses plus the cost of a professional manager incentivized to keep costs down.

 

I have a question and hopefully someone can answer. I'll admit I don't understand everything about Obamacare. But I do know it sucks from top to bottom. Anyone here that has read my story with my experience of dealing with the Obamacare knows why I feel the way I do. My question is: I notice each state is expecting higher but different percentages in premium hikes. Why are they different from state to state? It's seems like the Red states like Arizona & Oklahoma are expecting over 100% hikes in their premiums. And states like Texas will be hit harder than most states. So maybe I'm bring something up that is easily explained, but it appears the Red states as a whole are getting a lot higher. The biggest blue states are only expecting a small hike such as California and NY. Is this just a coincidence or is their truly something logical about why this is happening?

 

Blue states generally are more populous?

 

So that should help Texas be in the area of the lower % of premium hikes?

 

I can come up with a rationale, but I'll readily admit that I'm completely pulling this out of my ***, so I'd pretty much give it no deference at all and wouldn't get upset if someone told me I was full of crap.

Nevertheless, many of the red states haven't expanded Medicaid. It's possible that a significant number of those people who aren't Medicaid eligible (but would be in blue states) are buying into private Obamacare plans (perhaps with subsidies). If that's true and if those patients are disproportionately high-risk, then the private insurance markets in those states is having to insure an overall higher-risk pool of insureds. Accordingly, any spike in insurance rates could be higher. It also doesn't help that red states tend to have higher obesity rates. Anyway, that's the best I can do.

 

The worst is yet to come. As bundled payments for certain diagnosis grow, you will see more and more doctors leave medicine or move to concierge care. You will also see non compliant patients get less treatment options because providers will avoid spending money on them. They will try to avoid penalties associated with re-admission. This will particularly affect obese patients, tobacco users and other risky patients.

 

What Theo said is true. And the Medicaid portion taken and/or rejected by some states plays a roll in the cost increases most certainly.

 

Well I have a question on the expansion of Medicaid. IIRC the expansion wanted by bo took two forms, one to cover parents of children already eligible for Medicaid/chips whose income was and the other to provide Medicaid to % of poverty level
and non disabled non elderly people with no dependents whose income was % of pretty level.
The group of parents with children already covered is pretty small but the group of non disabled non elderly adults with no children is pretty big.
another question
People on SS have to pay part of that SS for medicare why shouldn't non disabled non elderly people with no children whose income is 133% of poverty level not have to pay the same amount for obamacare

 

Obama gave an interview to Vox (go figure)
He was asked about Obamacare
He more or less said Americans were too stupid to like Obamacare

At least he is consistent -- everything the people of the country do not like about him or his policies is their fault, not his or his policies.