The Epic Boondoggle Many Predicted?

[Birdstrike]

The CBO [Congressional Budget Office] projects that under Obamacare over the next decade, the number of uninsured will never fall below 30 million. Despite Obamacare’s mix of requirements, mandates, subsidies, and penalties, the CBO projects that the law will never be able to decrease the number of uninsured below 11 percent of the population.

http://www.weeklystandard.com/blogs...care-never-falls-below-30-million_733740.html


Now, as implementation approaches, CBO has released projections for...the first actual decade of Obamacare — and the gross cost projection is $1.8 trillion.

http://washingtonexaminer.com/cbo-o...-1.8-trillion-in-first-decade/article/2529655


We're going to pay $1,800,000,000,000 to have 30,000,000 people still uninsured? What in G-d's name will be the solution for this solution? Oh, wait. I know. Higher taxes on us, lower payments to us. More burdensome regulations and decreased efficiency forced upon us. Less autonomy for us. High costs for our own families insurance. And zero protection from lawsuits. To still have 30 million people uninsured at the cost of $1.8 Trillion? Wow, I'm really afraid to see what Obamacare 2.0 brings.

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[Chip N Sawbones]

If this is true Obamacare won't even be insuring half of the current uninsured population. I couldn't find a more recent number, but in 2010 there were about 50 million people without health insurance. That means that Obamacare will be spending trillions to insure about 20 million people, many of whom hate the idea of being forced to buy health insurance just as much as I do. I've never seen a reason to go spend thousands on insurance when I almost never get sick. Since I left my parents' home thirteen years ago I've spent a grand total of about $900 on medical expenses. Most of that was getting various splinters pulled out of my eyeballs. Even if I spend $900 on insurance premiums for a year, it'll only buy a high-deductible plan that doesn't help me much more than EMTALA does now. Thanks for nothing, Obama.

 

[FSU2013]

.

 

[henge]

We're going to pay $1,800,000,000,000 to have 30,000,000 people still uninsured? .

Without Obamacare your CBO cite says 56,000,000 would be uninsured, so Obamacare is reducing the number of uninsured by 25,000,000. Your $1.8T reference is to the aggregate cost over 10 years, which is not very useful. Using the $250B per year gross cost (which is the highest annual cost shown on the CBO report), if Obamacare only was intended to reduce the number of uninsured, it would work out to $10,000 per year, per person who ceased to be uninsured.

But of course, Obamacare does not just reduce the number of uninsured. It also limits the amount low and middle income people can be required to pay for insurance, and so gives them a boost (I imagine you consider this blatant socialism; oh well, I look at the tobacco subsidies Sen. McConnell is protecting as blatant socialism, so I guess it depends on your point of view).

It also requires free riders to pay for the health care system they benefit from. Given the large role medical bills play in bankruptcies, it is clear that many people free ride, get health care, then go bankrupt, causing others to bear the cost of their care. Obamacare ends this free rider socialism, which was one of the attractions the Heritage and the Republicans touted when they backed insurance mandates in the 1990s.

Most importantly, in my opinion, it makes it possible for individuals with pre-existing conditions to get health insurance at community rates, instead of being denied coverage altogether (if HIPAA is not applicable) or are charged outrageous rates (even when HIPAA applies). That has enormous value to me, and to millions of others who have, or who have family members with major health problems. As employers get out of the insurance business, something that will happen with or without Obamacare and which would be accelerated by the Reps' plans to make employer-paid health insurance premiums taxable to employees, this will become even more important.

Cantor tried to get the House to expand the catastrophic coverage plan that exists in transitionary form, and the Reps rejected that, and they'll reject anything else that involves spending. As far as I can tell, Obamacare is the only game in town that provides a mechanism for unhealthy people to get insurance at reasonable rates.

 

[Birdstrike]

Without Obamacare your CBO cite says 56,000,000 would be uninsured, so Obamacare is reducing the number of uninsured by 25,000,000. Your $1.8T reference is to the aggregate cost over 10 years, which is not very useful. Using the $250B per year gross cost (which is the highest annual cost shown on the CBO report), if Obamacare only was intended to reduce the number of uninsured, it would work out to $10,000 per year, per person who ceased to be uninsured.

But of course, Obamacare does not just reduce the number of uninsured. It also limits the amount low and middle income people can be required to pay for insurance, and so gives them a boost (I imagine you consider this blatant socialism; oh well, I look at the tobacco subsidies Sen. McConnell is protecting as blatant socialism, so I guess it depends on your point of view).

It also requires free riders to pay for the health care system they benefit from. Given the large role medical bills play in bankruptcies, it is clear that many people free ride, get health care, then go bankrupt, causing others to bear the cost of their care. Obamacare ends this free rider socialism, which was one of the attractions the Heritage and the Republicans touted when they backed insurance mandates in the 1990s.

Most importantly, in my opinion, it makes it possible for individuals with pre-existing conditions to get health insurance at community rates, instead of being denied coverage altogether (if HIPAA is not applicable) or are charged outrageous rates (even when HIPAA applies). That has enormous value to me, and to millions of others who have, or who have family members with major health problems. As employers get out of the insurance business, something that will happen with or without Obamacare and which would be accelerated by the Reps' plans to make employer-paid health insurance premiums taxable to employees, this will become even more important.

Cantor tried to get the House to expand the catastrophic coverage plan that exists in transitionary form, and the Reps rejected that, and they'll reject anything else that involves spending. As far as I can tell, Obamacare is the only game in town that provides a mechanism for unhealthy people to get insurance at reasonable rates.

I couldn't care less about Mitch McConnell, Eric Cantor or the warring political parties which are both bought off, and corrupt.

No, Obamacare is not socialism. It's much messier, much more costly, and is without any pretense of even providing universal coverage.

The "Public Option" or Medicare-for-all (which I was not in favor of at the time, either) would have been better than this costly and epic disaster that is brewing, that will do little other than shift people to Medicaid, subsidize private insurance and fine, but not insure, the majority of the uninsured (30 out of 50 million). Although, impossibly costly, at least that would've covered everyone.

I think this train is just headed right off the cliff.

 

[deleted547339]

Without Obamacare your CBO cite says 56,000,000 would be uninsured, so Obamacare is reducing the number of uninsured by 25,000,000. Your $1.8T reference is to the aggregate cost over 10 years, which is not very useful. Using the $250B per year gross cost (which is the highest annual cost shown on the CBO report), if Obamacare only was intended to reduce the number of uninsured, it would work out to $10,000 per year, per person who ceased to be uninsured.

But of course, Obamacare does not just reduce the number of uninsured. It also limits the amount low and middle income people can be required to pay for insurance, and so gives them a boost (I imagine you consider this blatant socialism; oh well, I look at the tobacco subsidies Sen. McConnell is protecting as blatant socialism, so I guess it depends on your point of view).

It also requires free riders to pay for the health care system they benefit from. Given the large role medical bills play in bankruptcies, it is clear that many people free ride, get health care, then go bankrupt, causing others to bear the cost of their care. Obamacare ends this free rider socialism, which was one of the attractions the Heritage and the Republicans touted when they backed insurance mandates in the 1990s.

Most importantly, in my opinion, it makes it possible for individuals with pre-existing conditions to get health insurance at community rates, instead of being denied coverage altogether (if HIPAA is not applicable) or are charged outrageous rates (even when HIPAA applies). That has enormous value to me, and to millions of others who have, or who have family members with major health problems. As employers get out of the insurance business, something that will happen with or without Obamacare and which would be accelerated by the Reps' plans to make employer-paid health insurance premiums taxable to employees, this will become even more important.

Cantor tried to get the House to expand the catastrophic coverage plan that exists in transitionary form, and the Reps rejected that, and they'll reject anything else that involves spending. As far as I can tell, Obamacare is the only game in town that provides a mechanism for unhealthy people to get insurance at reasonable rates.

It's all about smoke and mirrors and shifting tax burdens.

 

[henge]

It's all about smoke and mirrors and shifting tax burdens.

Insightful. Is providing coverage to 25 million people smoke or mirrors? what about allowing people with pre-existing conditions to get insurance?

 

[henge]

I couldn't care less about Mitch McConnell, Eric Cantor or the warring political parties which are both bought off, and corrupt.

No, Obamacare is not socialism. It's much messier, much more costly, and is without any pretense of even providing universal coverage.

The "Public Option" or Medicare-for-all (which I was not in favor of at the time, either) would have been better than this costly and epic disaster that is brewing, that will do little other than shift people to Medicaid, subsidize private insurance and fine, but not insure, the majority of the uninsured (30 out of 50 million). Although, impossibly costly, at least that would've covered everyone.

I think this train is just headed right off the cliff.

Hypothetically, if Obamacare DID provide for universal coverage at $10k a person per year, would you support it? What about at $5k a person; $1k a person? What value do you put on allowing unhealthy people to buy their own insurance? What about stopping free riders? Any value there? Or do you simply reject any approach which would result in taxes?

 

[docB]

Insightful. Is providing coverage to 25 million people smoke or mirrors? what about allowing people with pre-existing conditions to get insurance?

When you force insurers to underwrite people with preexisting conditions it's not insurance. The concept of insurance is predicated on a few assumptions. One is that it's a contract entered into voluntarily by both parties, the insured because they would rather pay premiums than bear the potential cost of an event and the insurer because they know that if their actuaries are good enough they can set rates to take in more than they pay out. Another is that they will be able to manipulate either the rates or the pool of insureds to make sure they are profitable.

Once you set rate limits and require an insurer to accept more risk than that rate will cover it is just cost transferring and hence smoke and mirrors in the economic sense. It can be argued that this is a good thing to do but it's not different than putting everyone with a preexisting condition on Medicaid or any other cost transfer or risk pooling scheme.

As for your example about tobacco subsidies that isn't socialism. It's pork or special interest provision or even outright graft but not socialism.

 

[deleted547339]

Insightful. Is providing coverage to 25 million people smoke or mirrors? what about allowing people with pre-existing conditions to get insurance?

Yes.

 

[beakerdan]

When you force insurers to underwrite people with preexisting conditions it's not insurance. The concept of insurance is predicated on a few assumptions. One is that it's a contract entered into voluntarily by both parties, the insured because they would rather pay premiums than bear the potential cost of an event and the insurer because they know that if their actuaries are good enough they can set rates to take in more than they pay out. Another is that they will be able to manipulate either the rates or the pool of insureds to make sure they are profitable.

Once you set rate limits and require an insurer to accept more risk than that rate will cover it is just cost transferring and hence smoke and mirrors in the economic sense. It can be argued that this is a good thing to do but it's not different than putting everyone with a preexisting condition on Medicaid or any other cost transfer or risk pooling scheme.

As for your example about tobacco subsidies that isn't socialism. It's pork or special interest provision or even outright graft but not socialism.

One of the big problems that causes this is the "health insurance as a benefit for employment". Because then any time a person switches jobs, they're going to be switching insurance companies, and then they're going to fall into trouble with the 'pre-existing condition' problem. They/their employer paid Company A (old job) to take on the risk that they'd acquire that condition, and now they want Company B (new job) to pay out for it.

 

[RustedFox]

As a guy with a "pre-existing condition", I gotta weigh-in on this.

We, the 'uninsurable', still want the ability to... (gasp)... SEE A DOCTOR.

We come with money. We are aware of the costs that we will incur. We still want to pay a fair share for our care. The problem is... all too often... the gambit is:

"No insurance ?" .... "No, we won't see you."

Period.

That's it. We're effectively kept out of care (except for the EMTALA-deigned care), and even then, it doesn't really get the job done. Its like "health insurance" is the bouncer outside of the bar that serves "care".

Its pathetic.

Right now, I'm dependent upon my medication. My immune system has declared war on (whatever part of my body). Through no fault of my own. If I go without health insurance... that's it... I'm going to pay (yep, I math-ed it out).... 3K/month for prescriptions alone. I can't "afford" to take a month "off" my meds. I might die. I really, might, die.

 

[docB]

I'm not saying we shouldn't provide access to care for those with preexisting conditions. I too have them and have been uninsurable.

I am saying that to provide affordable care to them in the current paradigm can only happen with transfer of cost from the sick to the well. It isn't "insurance" in the real sense although it would be "coverage."

For example I am now covered by an employer group plan. My condition is covered by my healthier colleagues.

 

[Zanegray]

Its like "health insurance" is the bouncer outside of the bar that serves "care".

Its pathetic. .

This. How did we get to the point that insurance = care? And more importantly, how do we get out of it?

There was recently an article about a fam med guy in CA that went to a cash only practice. Got rid of the overhead, posts his prices, cut them by 1/3 and is doing better than before. And... he can decide when someone needs a break to give it to them - something that is difficult or "illegal" with the current system and medicare as a payor.

 

[henge]

When you force insurers to underwrite people with preexisting conditions it's not insurance. The concept of insurance is predicated on a few assumptions. One is that it's a contract entered into voluntarily by both parties, the insured because they would rather pay premiums than bear the potential cost of an event and the insurer because they know that if their actuaries are good enough they can set rates to take in more than they pay out. Another is that they will be able to manipulate either the rates or the pool of insureds to make sure they are profitable.

Once you set rate limits and require an insurer to accept more risk than that rate will cover it is just cost transferring and hence smoke and mirrors in the economic sense. It can be argued that this is a good thing to do but it's not different than putting everyone with a preexisting condition on Medicaid or any other cost transfer or risk pooling scheme.

I disagree. There is no reason insurance and cost transference have to be mutually exclusive. Insurance involves risk transfer and risk distribution. Risk transfer and risk distribution don't cease to occur simply because they are coupled with cost transference. An individual with cancer can transfer his risk of health costs to an insurer, and that insurer, who might be insuring 10,000 people with cancer and a million without it, can spread that risk among all of its insureds. Is there cost transfer if the cancer patients covered? Yes. Is there risk transfer and risk distribution? Yes. It is not smoke and mirrors, it is insurance, with cost transference built in. And, I am one who would argue that is a good thing to do.

 

[TallScrubs]

As a guy with a "pre-existing condition", I gotta weigh-in on this.

We, the 'uninsurable', still want the ability to... (gasp)... SEE A DOCTOR.

We come with money. We are aware of the costs that we will incur. We still want to pay a fair share for our care. The problem is... all too often... the gambit is:

"No insurance ?" .... "No, we won't see you."

Period.

That's it. We're effectively kept out of care (except for the EMTALA-deigned care), and even then, it doesn't really get the job done. Its like "health insurance" is the bouncer outside of the bar that serves "care".

Its pathetic.

Right now, I'm dependent upon my medication. My immune system has declared war on (whatever part of my body). Through no fault of my own. If I go without health insurance... that's it... I'm going to pay (yep, I math-ed it out).... 3K/month for prescriptions alone. I can't "afford" to take a month "off" my meds. I might die. I really, might, die.

Now I can't stop trying to think of what you have........

 

[RustedFox]

Now I can't stop trying to think of what you have........

Stay healthy.

 

[henge]

As a guy with a "pre-existing condition", I gotta weigh-in on this .... Right now, I'm dependent upon my medication. My immune system has declared war on (whatever part of my body). Through no fault of my own. If I go without health insurance... that's it... I'm going to pay (yep, I math-ed it out).... 3K/month for prescriptions alone. I can't "afford" to take a month "off" my meds. I might die. I really, might, die.

205 days until community rating

 

[RustedFox]

205 days until community rating

Huh?


EDIT: Nevermind. I read "community reading". That's what happens when you have your attention divided too many ways at once.

 

[docB]

I disagree. There is no reason insurance and cost transference have to be mutually exclusive. Insurance involves risk transfer and risk distribution. Risk transfer and risk distribution don't cease to occur simply because they are coupled with cost transference. An individual with cancer can transfer his risk of health costs to an insurer, and that insurer, who might be insuring 10,000 people with cancer and a million without it, can spread that risk among all of its insureds. Is there cost transfer if the cancer patients covered? Yes. Is there risk transfer and risk distribution? Yes. It is not smoke and mirrors, it is insurance, with cost transference built in. And, I am one who would argue that is a good thing to do.

But no insurer would willingly take on a cancer patient. They would have to be forced. Consequently it's not an insurance agreement entered into by two parties willingly. It's something else.

Look at car insurance. The market is skewed by the legal requirement to carry liability coverage. Consequently liability insurance is relatively expensive. The other stuff like collision, towing, rental car coverage is not required so it's relatively cheap if you decide to buy it.

Anytime the insurance market is altered by laws or regulations it quits being two parties making a business decision about what they think is in their best interest in terms of risk tolerance and becomes something else.

 

[henge]

But no insurer would willingly take on a cancer patient. They would have to be forced. Consequently it's not an insurance agreement entered into by two parties willingly. It's something else.

Look at car insurance. The market is skewed by the legal requirement to carry liability coverage. Consequently liability insurance is relatively expensive. The other stuff like collision, towing, rental car coverage is not required so it's relatively cheap if you decide to buy it.

Anytime the insurance market is altered by laws or regulations it quits being two parties making a business decision about what they think is in their best interest in terms of risk tolerance and becomes something else.

You've chosen to define insurance as something that cannot involve government intervention, but, aside for the fact that virtually all existing insurance markets are heavily regulated, whether there is government intervention has nothing to do with whether there is risk transfer and risk distribution, which are the characteristics that define insurance. Insurers will issue insurance to cancer patients if it is a condition of them issuing policies to non-cancer patients. If you choose to call that force, go ahead, but it has no impact on whether the policies transfer and distribute risk and are therefore insurance.

Compare these two scenarios.

Scenario 1. Healthy person buys policy for $4000, which is his risk adjusted price, so insurer is willing to issue it. Unhealthy person buys policy for $10,000, which is his risk adjusted price, so insurer is willing to issue it. Government taxes healthy person $3000 and gives the $3000 to unhealthy person. End result: healthy person is out of pocket $7000, unhealthy person is out of pocket $7000, insurance company has voluntarily issued two policies for $14,000, which is its aggregate risk adjusted price.

Scenario 2: Healthy person pays $7000 for policy, which is $3000 above his risk adjusted price. Unhealthy person pays $7000 for policy, which is $3000 below his risk adjusted price; the insurer issues the policy because unless it does so, it will not be allowed to issue the very profitable policy to healthy person. End result: healthy person is out of pocket $7000, unhealthy person is out of pocket $7000, insurance company has voluntarily issued two policies for $14,000, which is its aggregate risk adjusted price.

The results are identical, yet because the scenario 2 requires the insurance company to issue policies, you say it is not insurance. Both scenarios are insurance, coupled with a transfer. You may object to the transfer from the healthy to the unhealthy person on political grounds, but that does not change the nature of the underlying arrangement.

In addition, your car insurance analogy has it exactly backward. Towing and other services are cheap not because they are elective, but rather because the cost and risk is low. When coverage is elective, those people who are most likely to need the services purchase coverage, while those who aren't likely to need them don't. This is called adverse selection and it has been a central component of insurance analysis for literally centuries.

 

[NOsaintsfan]

You've chosen to define insurance as something that cannot involve government intervention, but, aside for the fact that virtually all existing insurance markets are heavily regulated, whether there is government intervention has nothing to do with whether there is risk transfer and risk distribution, which are the characteristics that define insurance. Insurers will issue insurance to cancer patients if it is a condition of them issuing policies to non-cancer patients. If you choose to call that force, go ahead, but it has no impact on whether the policies transfer and distribute risk and are therefore insurance.

Compare these two scenarios.

Scenario 1. Healthy person buys policy for $4000, which is his risk adjusted price, so insurer is willing to issue it. Unhealthy person buys policy for $10,000, which is his risk adjusted price, so insurer is willing to issue it. Government taxes healthy person $3000 and gives the $3000 to unhealthy person. End result: healthy person is out of pocket $7000, unhealthy person is out of pocket $7000, insurance company has voluntarily issued two policies for $14,000, which is its aggregate risk adjusted price.

Scenario 2: Healthy person pays $7000 for policy, which is $3000 above his risk adjusted price. Unhealthy person pays $7000 for policy, which is $3000 below his risk adjusted price; the insurer issues the policy because unless it does so, it will not be allowed to issue the very profitable policy to healthy person. End result: healthy person is out of pocket $7000, unhealthy person is out of pocket $7000, insurance company has voluntarily issued two policies for $14,000, which is its aggregate risk adjusted price.

The results are identical, yet because the scenario 2 requires the insurance company to issue policies, you say it is not insurance. Both scenarios are insurance, coupled with a transfer. You may object to the transfer from the healthy to the unhealthy person on political grounds, but that does not change the nature of the underlying arrangement.

In addition, your car insurance analogy has it exactly backward. Towing and other services are cheap not because they are elective, but rather because the cost and risk is low. When coverage is elective, those people who are most likely to need the services purchase coverage, while those who aren't likely to need them don't. This is called adverse selection and it has been a central component of insurance analysis for literally centuries.

Your not taking into account the overall effects of the market.

The next few years will be very interesting because no one (insurance consumers) really knows how this whole thing will play out. I'm talking about how it will effect insurance premiums.

In your fantasy scenario (which is very likely) healthy people will be paying ever increasing costs to keep insurance. Their is a point at which many people will say to heck with it and go into medicare.

My crystal ball tells me this is exactly what's going to happen. Thing is I think the advocates of Obamacare knew it all along (their not stupid).

What they really wanted was a single payer system, they could have got that (remember that had control of both house and senate) but they knew that the American public wasn't supportive of that. So what did they do? They created a system that will drive most insurance companies out of business w/in ~10yrs or so. This will FORCE the government to step in and "SAVE" the American public with a single payer system.

If you think I'm dreaming up some conspiracy then apply a little deductive reasoning.

The scenario you outlined above is not sustainable, and will collapse. If you don't see that then learn more about business. Or don't take my word for it, listen to the president and his political allies in their own words......

http://www.youtube.com/watch?v=8_xwnVLC-YQ

http://www.youtube.com/watch?v=fpAyan1fXCE

Now to be clear, I think that providing "coverage" for everyone is a good thing. What I don't like is that their isn't a real honest discussion about cost. I also don't like the deceptive way it is coming about.

If a single payer system is what you want, then say that and lets debate it. Be prepared to defend your position. If a single payer system is truly the way to go then it will stand up to scrutiny.

This back door stuff and deception leaves a bad taste in my mouth, even if I'm in principle for the idea of medical access for all.

 

[Birdstrike]

The next few years will be very interesting because no one (insurance consumers) really knows how this whole thing will play out. I'm talking about how it will effect insurance premiums.

Actually, plenty of people know how it will effect insurance premiums. You have 1.8 Trillion more dollars infused into the economy over the next 10 years. It's basic Econ 101: more dollars chasing good and services = price inflation = higher prices.

There never was a Holy Grail, that could produce more insurance policies, and more healthcare, for more people, for less money. Those who made an honest, informed assessment of the law knew this, and still know it.

Say what you want about Obamacare good or bad, like it or not, needed or not needed, costs and expenditures will go up. They will go up BIG.

Don't take it from me. Read this article from 2009, regarding Senator Max Baucus who almost single handedly made Obamacare happen in the Senate, "according to OpenSecrets.org, over his career he has taken donations from:

* The Insurance Industry: $1,170,313
* Health Professionals: $1,016,276
* Pharmaceuticals/Health Products Industry: $734,605
* Hospitals/Nursing Homes: $541,891
* Health Services/HMOs: $439,700

Baucus has shown his bias and should be removed from leading the health care reform effort by the Democratic Party leadership.

That is a grand total of $3,902,785."

https://www.commondreams.org/view/2009/05/31-4

In California, premiums are already soaring:

http://www.forbes.com/sites/peterfe...-insurance-premiums-are-soaring-this-is-fact/

Out of pocket costs will increase especially for the young:

http://www.economicpolicyjournal.com/2013/06/insurance-analysts-obamacare-to.html?m=1

And last, but not least, Max Baucus himself (now retiring), who even possibly more than Obama made Obamacare happen, now is worried the implementation of Obamacare may turn into a "train wreck."

http://m.us.wsj.com/articles/a/SB10001424127887324874204578441032081716170?mg=reno64-wsj


On the flip side....what is in general a boondoggle, will be a boon for others. Position yourself in some way with those enities that will profit and profit mightly from this train wreck such as: EMR software companies, the government, an insurance company, the IRS, temp staffing companies, India outsourcing companies or administration and it may be a boon for you, too. It's our New Normal. Welcome to Boondoggleville.

 

[NOsaintsfan]

Actually, plenty of people know how it will effect insurance premiums. You have 1.8 Trillion more dollars infused into the economy over the next 10 years. It's basic Econ 101: more dollars chasing good and services = price inflation = higher prices.

There never was a Holy Grail, that could produce more insurance policies, and more healthcare, for more people, for less money. Those who made an honest, informed assessment of the law knew this, and still know it.

Say what you want about Obamacare good or bad, like it or not, needed or not needed, costs and expenditures will go up. They will go up BIG.

Don't take it from me. Read this article from 2009, regarding Senator Max Baucus who almost single handedly made Obamacare happen in the Senate, "according to OpenSecrets.org, over his career he has taken donations from:

* The Insurance Industry: $1,170,313
* Health Professionals: $1,016,276
* Pharmaceuticals/Health Products Industry: $734,605
* Hospitals/Nursing Homes: $541,891
* Health Services/HMOs: $439,700

Baucus has shown his bias and should be removed from leading the health care reform effort by the Democratic Party leadership.

That is a grand total of $3,902,785."

https://www.commondreams.org/view/2009/05/31-4

In California, premiums are already soaring:

http://www.forbes.com/sites/peterfe...-insurance-premiums-are-soaring-this-is-fact/

Out of pocket costs will increase especially for the young:

http://www.economicpolicyjournal.com/2013/06/insurance-analysts-obamacare-to.html?m=1

And last, but not least, Max Baucus himself (now retiring), who even possibly more than Obama made Obamacare happen, now is worried the implementation of Obamacare may turn into a "train wreck."

http://m.us.wsj.com/articles/a/SB10001424127887324874204578441032081716170?mg=reno64-wsj


On the flip side....what is in general a boondoggle, will be a boon for others. Position yourself in some way with those enities that will profit and profit mightly from this train wreck such as: EMR software companies, the government, an insurance company, the IRS, temp staffing companies or administration and it may be a boon for you, too. It's our New Normal. Welcome to Boondoggleville.

I completely agree that informed people know what this will do to insurance premiums. I was referring to the US as a whole.

If the majority of Americans realized that Obamacare would lead to a collapse of the medical insurance industry as we know it, and end up bringing us to a single payer (government) system their would be even less support. Support for Obama care is already low according to current polling data.

http://www.realclearpolitics.com/epolls/other/obama_and_democrats_health_care_plan-1130.html

 

[henge]

Your not taking into account the overall effects of the market.

The next few years will be very interesting because no one (insurance consumers) really knows how this whole thing will play out. I'm talking about how it will effect insurance premiums.

In your fantasy scenario (which is very likely) healthy people will be paying ever increasing costs to keep insurance. Their is a point at which many people will say to heck with it and go into medicare.

My crystal ball tells me this is exactly what's going to happen. Thing is I think the advocates of Obamacare knew it all along (their not stupid).

What they really wanted was a single payer system, they could have got that (remember that had control of both house and senate) but they knew that the American public wasn't supportive of that. So what did they do? They created a system that will drive most insurance companies out of business w/in ~10yrs or so. This will FORCE the government to step in and "SAVE" the American public with a single payer system.

If you think I'm dreaming up some conspiracy then apply a little deductive reasoning.

The scenario you outlined above is not sustainable, and will collapse. If you don't see that then learn more about business. Or don't take my word for it, listen to the president and his political allies in their own words......

http://www.youtube.com/watch?v=8_xwnVLC-YQ

http://www.youtube.com/watch?v=fpAyan1fXCE

Now to be clear, I think that providing "coverage" for everyone is a good thing. What I don't like is that their isn't a real honest discussion about cost. I also don't like the deceptive way it is coming about.

If a single payer system is what you want, then say that and lets debate it. Be prepared to defend your position. If a single payer system is truly the way to go then it will stand up to scrutiny.

This back door stuff and deception leaves a bad taste in my mouth, even if I'm in principle for the idea of medical access for all.

My post you're quoting was in response to another person's post about whether the insurance offered by insurance companies under the ACA was insurance, and I was not attempting to address the overall market matters which you address.

As for the debate about costs and the system collapsing, there have in fact been many analyses of the future of ACA, by CBO and many, many think tanks and scholars. So, it's not like there is some conspiracy of silence (though there was a lot of screaming about Death Panels and socialism form one side of the aisle that did tend to stifle honest discussion). A google search for 'Obamacare and cost estimates' generated 753,000 hits; when I limit it to Jan 20, 2009-March 23, 2010, there are still a ton of hits. In short, there is a lot out there.

As for debating the future of the system, which you predict will collapse in ~10 years, it helps to remember we are not re-inventing the wheel here, as every other advanced country in the world has universal (or near universal) health care.

There are four other countries that currently operate individual insurance mandate health care financing systems: Australia, Japan, Netherlands and Switzerland. The Australian system began in 1984; the Japanese system has been operating since 1961; the Dutch system since 2006; the Swiss system since 1996. All of those countries spend less on healthcare than does the US; all have good health outcomes; Australia, Netherlands and Switzerland all have AAA credit ratings from S&P (Japan is AA-, the US is AA+). In other words, individual mandate systems have proven sustainable.

Now, in the spirit of the honest discussion you crave, does the fact that there are individual mandate systems that have lasted 52, 19 and 17 years suggest to you that individual mandate systems are not, in fact, doomed to fail within 10 years? If not, why not?

As for your ad hominen attack, that "if you don't see that [the system will collapse] then learn more about business," I'll only say it is wildly presumptuous of you to assume I don't know much about business, or to suggest that you know more than I.You know next to nothing about my background (hint, I'm not a 20 year old college kid).

 

[Birdstrike]

I completely agree that informed people know what this will do to insurance premiums. I was referring to the US as a whole.

If the majority of Americans realized that Obamacare would lead to a collapse of the medical insurance industry as we know it, and end up bringing us to a single payer (government) system their would be even less support. Support for Obama care is already low according to current polling data.

http://www.realclearpolitics.com/epolls/other/obama_and_democrats_health_care_plan-1130.html

Obamacare is going to be a boon to insurance companies. Click on the link in my last post above. Collapse of insurance industry bringing single payer? No one is even talking about that now. That will never happen. Obamacare does the exact opposite. It requires people to buy insurance. People were worried about the collapse of the private insurance maket if the Public Option came about (ie, Medicare for all), but not now. In fact, the insurance industry played a large role in killing the public option. They are very happy with Obamacare as it stands. Heck, Obamacare even sets up insurance exchanges, helping people find insurance to buy.

 

[henge]

Actually, plenty of people know how it will effect insurance premiums. You have 1.8 Trillion more dollars infused into the economy over the next 10 years. It's basic Econ 101: more dollars chasing good and services = price inflation = higher prices.

There never was a Holy Grail, that could produce more insurance policies, and more healthcare, for more people, for less money. Those who made an honest, informed assessment of the law knew this, and still know it.

Say what you want about Obamacare good or bad, like it or not, needed or not needed, costs and expenditures will go up. They will go up BIG.

Don't take it from me. Read this article from 2009, regarding Senator Max Baucus who almost single handedly made Obamacare happen in the Senate, "according to OpenSecrets.org, over his career he has taken donations from:

* The Insurance Industry: $1,170,313
* Health Professionals: $1,016,276
* Pharmaceuticals/Health Products Industry: $734,605
* Hospitals/Nursing Homes: $541,891
* Health Services/HMOs: $439,700

Baucus has shown his bias and should be removed from leading the health care reform effort by the Democratic Party leadership.

That is a grand total of $3,902,785."

https://www.commondreams.org/view/2009/05/31-4

In California, premiums are already soaring:

http://www.forbes.com/sites/peterfe...-insurance-premiums-are-soaring-this-is-fact/

Out of pocket costs will increase especially for the young:

http://www.economicpolicyjournal.com/2013/06/insurance-analysts-obamacare-to.html?m=1

And last, but not least, Max Baucus himself (now retiring), who even possibly more than Obama made Obamacare happen, now is worried the implementation of Obamacare may turn into a "train wreck."

http://m.us.wsj.com/articles/a/SB10001424127887324874204578441032081716170?mg=reno64-wsj


On the flip side....what is in general a boondoggle, will be a boon for others. Position yourself in some way with those enities that will profit and profit mightly from this train wreck such as: EMR software companies, the government, an insurance company, the IRS, temp staffing companies, India outsourcing companies or administration and it may be a boon for you, too. It's our New Normal. Welcome to Boondoggleville.

$1.8T/10years=$180B/year. Current healthcare spending=$2.7T/year. $180B/$2.7T=6.7%. That's about the same as the rate at which health care spending has been increasing each year (though CBO has just reduced the projected Medicare growth rate). So, again putting the big $1.8T number in context, it's a lot less daunting. Moreover, the $1.8T is the gross number, without offsets due to reductions in uncompensated care incurred by hospitals (currently hospitals receive little from uninsured poor or free riders, but they still provide the care and incur the expenses; after ACA, the payments they get for that will count toward the $1.8T), planned reductions in MC and reduced spending by private plans (thru, e.g., taxes on Cadillac plans).

The Forbes article is a terrible hatchet job (and evidence of the lack of serious discussion NOSaintsfan deplores): 1) The insurance website the author cites quotes teaser rates available for the first year of coverage only; 2) ~25% of people would not meet the underwriting standards for the quoted policies; 3) the article (in original form) never mentions that most insureds will get subsidies to pay premiums; 4) the article ignores that groups other than young, healthy men will have much lower rate increases, or even rate decreases. Oddly, the author acts as if he has found something new and unexpected, some secret hidden flaw. In fact, it was well known that premiums for young healthy men would go up, since: a) ACA eliminates gender as a factor in rate setting and young women cost more to insure than young men, b) the permitted disparity between young and old is limited to 3:1, even though historically it has cost about 5 times as much to insure the oldest under 65s as the youngest over 18s, and c) unhealthy people cannot be charged higher premiums. Treating healthy 26 year old men as representative of the population as a whole is very misleading.

 

[henge]

Don't take it from me. Read this article from 2009, regarding Senator Max Baucus who almost single handedly made Obamacare happen in the Senate, "according to OpenSecrets.org, over his career he has taken donations from:

* The Insurance Industry: $1,170,313
* Health Professionals: $1,016,276
* Pharmaceuticals/Health Products Industry: $734,605
* Hospitals/Nursing Homes: $541,891
* Health Services/HMOs: $439,700

Baucus has shown his bias and should be removed from leading the health care reform effort by the Democratic Party leadership.

That is a grand total of $3,902,785."

https://www.commondreams.org/view/2009/05/31-4

So Baucus took in $3.9M over his (then) 31 year Senate career, or about $125,000 per year, including both election and non-election years. Looks like a piker compared to the Rep's Senate leader.

3 of McConnell's top 5 donors in 2012 were healthcare businesses: Kindred Health, Humana, and Blue Cross. Those 3 donated a total of ~$240,000-- and remember that's just in one non-election year (for McConnell) and just from those three donors, ignoring those donors further down the list. So, I guess McConnell should recuse himself from attempts to repeal ACA, since he has also revealed his bias.
http://www.opensecrets.org/politicians/contrib.php?cycle=2012&type=C&cid=n00003389&newMem=N&recs=20

 

[henge]

Heck, Obamacare even sets up insurance exchanges, helping people find insurance to buy.

Why yes, one might even say the exchanges are a centerpiece of the ACA. And you think on-line markets where people can easily compare the prices of competing products are evil because...?

 

[NOsaintsfan]

My post you're quoting was in response to another person's post about whether the insurance offered by insurance companies under the ACA was insurance, and I was not attempting to address the overall market matters which you address.

As for the debate about costs and the system collapsing, there have in fact been many analyses of the future of ACA, by CBO and many, many think tanks and scholars. So, it's not like there is some conspiracy of silence (though there was a lot of screaming about Death Panels and socialism form one side of the aisle that did tend to stifle honest discussion). A google search for 'Obamacare and cost estimates' generated 753,000 hits; when I limit it to Jan 20, 2009-March 23, 2010, there are still a ton of hits. In short, there is a lot out there.

As for debating the future of the system, which you predict will collapse in ~10 years, it helps to remember we are not re-inventing the wheel here, as every other advanced country in the world has universal (or near universal) health care.

There are four other countries that currently operate individual insurance mandate health care financing systems: Australia, Japan, Netherlands and Switzerland. The Australian system began in 1984; the Japanese system has been operating since 1961; the Dutch system since 2006; the Swiss system since 1996. All of those countries spend less on healthcare than does the US; all have good health outcomes; Australia, Netherlands and Switzerland all have AAA credit ratings from S&P (Japan is AA-, the US is AA+). In other words, individual mandate systems have proven sustainable.

Now, in the spirit of the honest discussion you crave, does the fact that there are individual mandate systems that have lasted 52, 19 and 17 years suggest to you that individual mandate systems are not, in fact, doomed to fail within 10 years? If not, why not?

As for your ad hominen attack, that "if you don't see that [the system will collapse] then learn more about business," I'll only say it is wildly presumptuous of you to assume I don't know much about business, or to suggest that you know more than I.You know next to nothing about my background (hint, I'm not a 20 year old college kid).

Actually I would disagree that their was any sort of honest debate in regard to the ACA. The ACA was pushed through in 2-3 days with then speaker of the house Nancy Pelosi famously saying "We have to hurry and pass the bill so we can read it and find out what's in it"

Most of the analysis that has been done was post passage of the bill. That's not my view of open and honest debate.

As for the collapse of private insurance, I wrote that it will collapse the system as we know it. I don't know much about all the countries you listed but I know a little about Australia.

What they have there is very different from the private insurance market we have here.

Only ~50% of people in Australia choose to buy private insurance. Fairly comprehensive government medical services are provided for ALL and the private insurance companies only pay for services above and beyond what the government provides.

Some of the most common reasons for purchasing private insurance in Australia include:

"•In the 2004-05 NHS the most commonly reported reasons for having private health insurance were security/protection or peace of mind (43% of those with private health insurance), shorter wait for treatment or concern over public hospital waiting lists (23%),and having always had it, parents pay for it, or as a condition of their job (23%).

[The death panel distraction you mentioned might not be so crazy, and again I think it should be part of the valid discussion, obviously not everyone agrees.]

•Almost two thirds (64%) of those without private health insurance reported not insuring because they could not afford it or it was too expensive (an increase of five percentage points from 2001). This was the most commonly reported reason for not having private health insurance across all age groups and income groups."

The above was taken directly from the Australian Bureau of Statistics web site, the links are below.



This is very different from what we have here. If the US goes from our current system to that I would defiantly call that a COLLAPSE of our current system.

Obamacare puts us on a path to precisely what Australia has, to me this is obvious and again I'm not sure how anyone can not see that.

As I stated above a system like Australia has might not be a bad thing at all. I am in favor of access to healthcare for all. I do however disagree with they way its been "sold" to the public.

I think that through Obamacare the government is trying to shift our healthcare delivery to something similar to Australia, however that is not how its been presented.

http://www.abs.gov.au/ausstats/[email protected]/mf/4815.0.55.001

http://www.privatehealth.gov.au/healthinsurance/whatiscovered/

 

[NOsaintsfan]

Obamacare is going to be a boon to insurance companies. Click on the link in my last post above. Collapse of insurance industry bringing single payer? No one is even talking about that now. That will never happen. Obamacare does the exact opposite. It requires people to buy insurance. People were worried about the collapse of the private insurance maket if the Public Option came about (ie, Medicare for all), but not now. In fact, the insurance industry played a large role in killing the public option. They are very happy with Obamacare as it stands. Heck, Obamacare even sets up insurance exchanges, helping people find insurance to buy.

The WSJ article supports my assertion. It claims that 30-40 million people will pay significantly higher insurance premiums, some over 100% higher.

My fear is that not everyone will be able to afford this. It may take time but I think more and more people will chose medicade, simply due to cost.

This will lead to a lot fewer people buying private insurance. See my post above to reference how I feel this will cause a "collapse" of our current system.

Its just my opinion and I certainly could be wrong, but if "no one is talking about this" then they should be.

Do I think insurance companies will still exist in 10-15 years? Yes. However I think that who their "customers" are will be different and that the insurance market as we know it now will be very different.

This may lead to increased profits for some insurance companies, I find it hard to imagine that some (maybe a lot) will not go out of business. At the very least I see their business model changing quite a bit.

 

[henge]

Actually I would disagree that their was any sort of honest debate in regard to the ACA. The ACA was pushed through in 2-3 days with then speaker of the house Nancy Pelosi famously saying "We have to hurry and pass the bill so we can read it and find out what's in it"

The precursor to PPACA was introduced in the House on 9-17-09; passed by the House 10-8-09; passed by the Senate 12-24-09; House agreed to Senate amendment 3-20-09. http://en.wikipedia.org/wiki/Ppaca So, over 6 months passed between the time the first bill was passed and the final version was passed by the House, and almost 3 months passed between the date the Senate passed the ultimate bill and the House voted on that exact bill (Kennedy's death and Brown's election negating the possibility of going back to the Senate to conference). And, of course, time was spent drafting and arguing before the first bill was passed.

In addition, besides the plans in operation in other countries (and, of course, in Massachusetts) there were several prior attempts in earlier Congresses to pass universal health care based on the individual mandate model, so this was not exactly virgin territory. See http://healthcarereform.procon.org/view.resource.php?resourceID=004182

Most of the analysis that has been done was post passage of the bill. That's not my view of open and honest debate.

Maybe most was, but there was still a lot pre-passage discussion. Seriously, google "obamacare cost estimates" with a date restriction of 1/20/2009 to 3/20/2010. There's a lot there, some complaining about the lack of cost estimates, but lots of folks taking a whack at costs.

And as it became clear that no Reps were going to vote for ACA, it's not clear who its supporters would debate the fine points of cost with on the Hill. Really, do you think it would have made one bit of difference to the Reps if ACA was projected to cost $1T, $1.5T or $2T, or to be budget neutral, or to increase the deficit by $100B, or decrease the deficit by $100B? The Reps would have rejected the projections as being rubbish (just consider their reaction to the recent CBO projections that show the rate of MC spending decreasing) and kept assaulting anyhow. It would have been a debate with the deaf.

As for the collapse of private insurance, I wrote that it will collapse the system as we know it. I don't know much about all the countries you listed but I know a little about Australia.

What they have there is very different from the private insurance market we have here.

Only ~50% of people in Australia choose to buy private insurance.

Maybe not as different as you believe, and not in the way you believe. Only about 10% of Americans buy insurance on the individual health insurance market in the US, and 31% get their insurance from the government (MC, MA, Vets, military) (there is some overlap). http://en.wikipedia.org/wiki/Health_insurance_in_the_United_States Even if half the uninsured get individual insurance, it will still be a small number. The bigger difference is not with government provided insurance, but the fact that in the US employers provide about half of the coverage. Employers have always been subject to group rating rules which prevent them from excluding individuals with health problems. Obviously working people tend to be healthier than non-working people, but employers have for decades dealt with what is, effectively, community risk rating.

Neither of us is an expert in the health policy of Australia (or Japan, Netherlands, or Switzerland), but it looks like Australia basically has an individual mandate with a public option, which was discussed in the lead up to ACA. (Again, google it, and you get many, many hits, even time restricted).

Interestingly, the Australian site you reference indicates that private insurance coverage has increased, from 38% in 1998 to 51% in 2006 (due to some rebate changes apparently), so I'm not sure Australia is your best example of government policy sneaking in a Trojan Horse to effect the collapse of the private health insurance industry.

Still, maybe we will end up with an Australian system, and if a private insurance system with a public option is what you meant when you said the insurance market would be destroyed, I'd certainly prefer that to the current-pre-ACA system where those with poor health cannot get insurance at reasonable rates.

 

[NOsaintsfan]

What was Ms. Pelosi talking about then? I remember that there were a number of amendments to the bill and that its passage pushed through.

Maybe I remember the president saying this:
"The public will have 5 days to read any bill that lands on my desk so that you know what's in it"

http://www.youtube.com/watch?v=o5t8GdxFYBU

I know you cant expect any politician to actually do what they say they will do, but I remember him saying that so maybe that's why I feel that the ACA was rushed.

Also keep in mind that one key detail you left out about the private insurance market in Australia is that they (insurance companies) only have to pay for services that the government doesn't provide. A lot of this is elective procedures. So when a person with private insurance in Oz goes to the emergency room their private insurance doesn't pick up the whole cost of that visit, they only pay for what the government doesn't allow for.

This seems a lot different that the way your portraying insurance in Australia.

Again this may not be a bad thing. I just wish the government was a little more transparent about what they are trying to do.

 

[henge]

What was Ms. Pelosi talking about then? I remember that there were a number of amendments to the bill and that its passage pushed through.

Maybe I remember the president saying this:
"The public will have 5 days to read any bill that lands on my desk so that you know what's in it"

http://www.youtube.com/watch?v=o5t8GdxFYBU

I know you cant expect any politician to actually do what they say they will do, but I remember him saying that so maybe that's why I feel that the ACA was rushed.

Also keep in mind that one key detail you left out about the private insurance market in Australia is that they (insurance companies) only have to pay for services that the government doesn't provide. A lot of this is elective procedures. So when a person with private insurance in Oz goes to the emergency room their private insurance doesn't pick up the whole cost of that visit, they only pay for what the government doesn't allow for.

This seems a lot different that the way your portraying insurance in Australia.

Again this may not be a bad thing. I just wish the government was a little more transparent about what they are trying to do.

Not sure what Pelosi meant. Maybe she meant there was not going to be much formal debate on the floor. The election of Brown changed the dynamic a lot. The Dems were worried that spending more time on ACA would drag them down even more.

I don't know the intricasies of Australian health insurance, and did not mean to suggest I did. My initial point, when citing Australia, Japan, Netherlands and Switz, was merely that these types of individual mandate plans have been around a while, and they've worked reasonably well. There are of course differences among the countries and their health care systems, but the success of these plans elsewhere is reason for optimism. It's frustrating when you debate ACA, and the anti-ACA folks act like universal care is something out of Mars. It's not; it's the norm internationally, and we can make it work here.

Nice debating with you.

 

[Birdstrike]

(Double post)

 

[Birdstrike]

Not sure what Pelosi meant. Maybe she meant there was not going to be much formal debate on the floor. The election of Brown changed the dynamic a lot. The Dems were worried that spending more time on ACA would drag them down even more.

I don't know the intricasies of Australian health insurance, and did not mean to suggest I did. My initial point, when citing Australia, Japan, Netherlands and Switz, was merely that these types of individual mandate plans have been around a while, and they've worked reasonably well. There are of course differences among the countries and their health care systems, but the success of these plans elsewhere is reason for optimism. It's frustrating when you debate ACA, and the anti-ACA folks act like universal care is something out of Mars. It's not; it's the norm internationally, and we can make it work here.

Nice debating with you.

Universal care? In the USA? Not with the ACA. That's the whole point of this thread. Please re-read the OP. We've come full circle.

 

[NOsaintsfan]

Nice debating with you.

Likewise

 

[NOsaintsfan]

Universal care? In the USA? Not with the ACA. That's the whole point of this thread. Please re-read the OP. We've come full circle.

Kinda my feeling, the government pushed through something when they really wanted something else (universal care) and what we are stuck with is an impending nightmare.

I hope I'm wrong, but my gut tells me I'm not. We'll see.

 

[Arcan57]

Kinda my feeling, the government pushed through something when they really wanted something else (universal care) and what we are stuck with is an impending nightmare.

I hope I'm wrong, but my gut tells me I'm not. We'll see.

Nobody really wanted the current form of the ACA but it was the only one that was going to pass. However, I think the ACA is going to get blamed for a lot of the things that were well into motion before it was passed. Low deductible, non-restrictive plans were already becoming too expensive for most of the population prior to the ACA passing. The path in front of us on our prior course was surging numbers of uninsured and the majority of insured having catastrophic only care. The path before us now is a split into a Medicaid funded public system and a private (cash/high premium insurance) for the wealthy. Figure out which market you're going to go for now, since the skill set is going to be pretty different to be successful between the two (look to the academic plastic surgeons for an example of mixing the two populations with at least some success). I don't think that the pharma side of spending is sustainable in either model, but it will be at least 10+ years before popular thinking overcomes drug company money in the legislature. The threat of stifling innovation has been proven sufficient to hide the fact that the innovation is usually just "me-too" drugs.

 

[NOsaintsfan]

Nobody really wanted the current form of the ACA but it was the only one that was going to pass. However, I think the ACA is going to get blamed for a lot of the things that were well into motion before it was passed. Low deductible, non-restrictive plans were already becoming too expensive for most of the population prior to the ACA passing. The path in front of us on our prior course was surging numbers of uninsured and the majority of insured having catastrophic only care. The path before us now is a split into a Medicaid funded public system and a private (cash/high premium insurance) for the wealthy. Figure out which market you're going to go for now, since the skill set is going to be pretty different to be successful between the two (look to the academic plastic surgeons for an example of mixing the two populations with at least some success). I don't think that the pharma side of spending is sustainable in either model, but it will be at least 10+ years before popular thinking overcomes drug company money in the legislature. The threat of stifling innovation has been proven sufficient to hide the fact that the innovation is usually just "me-too" drugs.

I don't doubt one bit that the current (pre ACA) system was unsubstainable something needed to be done.

What I am confused by is why didn't Congress just pass a single payer system. We all know that's what the democrats wanted. Democrats had the house, senate and White House they could have passed anything they wanted to. People say well the ACA was the only thing they could get through so that's why they did it. I say bull, the ACA passed with 0 republican votes in the house. The Dems could have passed anything.

Maybe they were afraid that if they passed a single payer system the backlash would have been even worse than it was in 2010, who knows.

I'm not even saying I'm necessarily for a single payer, but the whole thing just stinks to high heaven to me.

I think they were playin games, but that's just me.

 

[Arcan57]

I don't doubt one bit that the current (pre ACA) system was unsubstainable something needed to be done.

What I am confused by is why didn't Congress just pass a single payer system. We all know that's what the democrats wanted. Democrats had the house, senate and White House they could have passed anything they wanted to. People say well the ACA was the only thing they could get through so that's why they did it. I say bull, the ACA passed with 0 republican votes in the house. The Dems could have passed anything.

Maybe they were afraid that if they passed a single payer system the backlash would have been even worse than it was in 2010, who knows.

I'm not even saying I'm necessarily for a single payer, but the whole thing just stinks to high heaven to me.

I think they were playin games, but that's just me.

Whatever single payor system was picked would have had problems and shortcomings that would take years to fix (if fixable at all). The next election would have resulted in everyone getting voted out of office.

 

[henge]

Universal care? In the USA? Not with the ACA. That's the whole point of this thread. Please re-read the OP. We've come full circle.

Per CBO, under ACA, there will be 31M uninsured in 2023, out of a population of 341M, for an uninsurance rate of ~9%.

Who will be uninsured?

About 3M of those will be uninsured due to the refusal of States to expand Medicaid, as contemplated by ACA (but struck down by SCOTUS. http://www.cbo.gov/publication/43472

A much larger group of uninsured will be undocumented aliens. According to the Urban Inst, illegal aliens will comprise 26% of the uninsured after ACA, or abot 8M. http://www.lifehealthpro.com/2012/06/19/millions-will-still-go-without-insurance-if-ppaca?t=individual-health Other estimates are comparable: 6.7M undocumented aliens in the US lacked health insurance. http://www.commonwealthfund.org/~/m...hlt_care_undocumented_migrants_intl_brief.pdf The conservative Cato Institute estimates that about one-third of the uninsured, say 10M, will be illegal immigrants. http://www.intellectualtakeout.org/library/chart-graph/number-uninsured-under-ppaca So, 8M of the uninsured will be illegal aliens, a group expressly excluded for political purposes.

The biggest group, comprising 36% (11M) of the total per Urban Inst, will be people who qualify for Medicaid, but fail to apply and obtain coverage.

Others uninsured will fall into exemptions for for religious beliefs (probably in the 100,000s, not millions, but I'm just guessing), the exemption for American Indians and a few other exemptions. I could not find projected numbers for those groups, but note that about 1.8M Indians use the IHS http://en.wikipedia.org/wiki/Indian_Health_Service, and presumably some of them will not get insurance.

So, I'd guesstimate that close to half of the 9% of the population who will be uninsured will be uninsured because of the refusal of States to expand Medicaid (3M), because they are undocumented aliens (~8M) or they are exempted from the mandate because they have religious objection or are American Indians. So, maybe 5%+ will uninsured for other reasons--they choose to free ride, they can't afford a policy even with subsidies, they don't understand options, especially Medicaid availability.

The simplest way to reduce the rate of uninsurance would be for states to expand Medicaid and to allow undocumented aliens to get coverage thru the exchanges. But of course, that won't happen for political reasons. Increased outreach to encourage poor people to sign up for Medicaid would also help a lot, but, again, there is little appetite to incur the expense that would entail.

What do you say Birdstrike, you going to champion Medicaid expansion and extension of coverage to uninsured illegal aliens?

BTW, Japan and the Netherlands, which also both have an individual mandate systems, have uninsurance rates of 10% and 1.5%respectively, so the US is on the high side, with its numbers blown up due to political factors (refusal to expand Medicaid and animus to illegal aliens).

And finally, as discussed in earlier posts, ACA does more than just reduce uninsurance; it also makes it possible for unhealthy people to buy insurance at community rates, it subsidizes policies for poor and middle income families, and it makes free riders pay a share of the cost of the health care system they benefit from. All of those are good things, in my view.

 

[NOsaintsfan]

Per CBO, under ACA, there will be 31M uninsured in 2023, out of a population of 341M, for an uninsurance rate of ~9%.

Who will be uninsured?

About 3M of those will be uninsured due to the refusal of States to expand Medicaid, as contemplated by ACA (but struck down by SCOTUS. http://www.cbo.gov/publication/43472

A much larger group of uninsured will be undocumented aliens. As of 2007, about 6.7M undocumented aliens in the US lacked health insurance. http://www.commonwealthfund.org/~/m...hlt_care_undocumented_migrants_intl_brief.pdf The conservative Cato Institute estimates that about one-third of the uninsured, say 10M, will be illegal immigrants. http://www.intellectualtakeout.org/library/chart-graph/number-uninsured-under-ppaca So, somewhere between 6.7M and 10M uninsured will be illegal aliens, a group expressly excluded for political purposes.

Others uninsured will fall into exemptions for for religious beliefs, the exemption for American Indians and a few other exemptions. I could not find projected numbers for those groups.

So, I'd guesstimate that close to half of the 9% of the population who will be uninsured will be uninsured because of the refusal of States to expand Medicaid (3M), because they are undocumented aliens (6.7M-10M) or they are exempted from the mandate because they have religious objection or are American Indians. So, maybe 5% will uninsured for other reasons--they choose to free ride, they can't afford a policy even with subsidies, they don't understand options.

The simplest way to reduce the rate of uninsurance would be for states to expand Medicaid and to allow undocumented aliens to get coverage thru the exchanges. But of course, that won't happen for political reasons.

What do you say Birdstrike, you going to champion Medicaid expansion and extension of coverage to uninsured illegal aliens?

BTW, Japan and the Netherlands, which also both have an individual mandate systems, have uninsurance rates of 10% and 1.5%respectively, so the US is on the high side, with its numbers blown up due to political factors (refusal to expand Medicaid and animus to illegal aliens).

And finally, as discussed inearlier posts, ACA does more than just reduce uninsurance; it also makes it possible for unhealthy people to buy insurance at community rates, it subsidizes policies for poor and middle income families, and it makes free riders pay a share of the cost of the health care system they benefit from. All of those are good things, in my view.

Just as an add on, we all know that this whole issue is highly political.

With that said I know that some states have refused to expand Medicade because the funding for the expansion from the Feds is only temporary.

Sataes are given money to find the expansion for 2yrs (? Maybe 3) but then it's up to the state to come up with the funding from state budgets.

For most states this will comprise a significant amount of the overall state budget. For many states the cost will be prohibitive (20-40% of budget).

Where are they going to come up with future money? The pie is only so big.

Other services will have to be cut and taxes will have to rise.

Government doesn't "make" money. The only way they get any money is by taking it from people.

It will be interesting to see how states adapt.

 

[henge]

With that said I know that some states have refused to expand Medicade because the funding for the expansion from the Feds is only temporary.

Sataes are given money to find the expansion for 2yrs (? Maybe 3) but then it's up to the state to come up with the funding from state budgets.

For most states this will comprise a significant amount of the overall state budget. For many states the cost will be prohibitive (20-40% of budget).

Where are they going to come up with future money? The pie is only so big.

Coverage for the newly eligible adults will be fully funded by the federal government for three years, beginning in 2014, phasing down to 90% by 2020. http://www.medicaid.gov/AffordableCareAct/Provisions/Financing.html

I can't do the economic multipliers, but I have to believe that if the Feds pump $9 into a state's economy, the additional economic activity generated by that--i.e., hospitals and other providers get $9 more revenue, use it to hire staff who then pay taxes on their earnings and purchases, new MA patients spend money that would otherwise be spent on non-taxable healthcare on other taxable purchases, fewer of the new MA patients go bankrupt (and there is definitely a big saving to be had on bankruptcy), so creditors save on defaults and can lend more, etc.-- would produce a fair chunk of the $1 the State eventually needs to come up with. I mean, 9:1, where else can a State get that sort of multiplier?

 

[NOsaintsfan]

Thanks for the funding clarification. I agree additional spending will add to the economic output of the states but at the same time not really. The effects will be interesting to track.

I say not really because the federal money being spent is not "new" money from economic growth and expansion. Any federal money spent is money taken out of the economy. Not added to economic output. This is because federal money is confiscated from individuals and not "earned" through production. Government spending doesn't grow the pie so to speak.

So when you keep this in mind it's easy to see that while government investment can help spur new economic growth, government spending never directly grows the economy. If done correctly government investment can "seed" new business that will lead to economic growth, but their is a fine line that must be navigated. Overspending by government can depress the economy due to lost economic potential.

The above is a generality about government spending and not specifically aimed at the impact of health at healthcare expendature obviously theirs alot more to the subject of government spending.

 

[Arcan57]

Thanks for the funding clarification. I agree additional spending will add to the economic output of the states but at the same time not really. The effects will be interesting to track.

I say not really because the federal money being spent is not "new" money from economic growth and expansion. Any federal money spent is money taken out of the economy. Not added to economic output. This is because federal money is confiscated from individuals and not "earned" through production. Government spending doesn't grow the pie so to speak.

So when you keep this in mind it's easy to see that while government investment can help spur new economic growth, government spending never directly grows the economy. If done correctly government investment can "seed" new business that will lead to economic growth, but their is a fine line that must be navigated. Overspending by government can depress the economy due to lost economic potential.

The above is a generality about government spending and not specifically aimed at the impact of health at healthcare expendature obviously theirs alot more to the subject of government spending.

Counting only direct effects when deciding the wisdom of government expenditures is so reductionist as to be absurd.

 

[henge]

We are well beyond the scope of this thread so I'll limit my response.

First, the States that are not expanding MA are still taxed to finance the expansion in other states, so they get all of the cost and none of the benefit.

Second, many, many economists believe that government spending can, in fact, grow an economy when interest rates have fallen against the so-called 'zero bound,' since in such circumstances (which applied in the Great Depression and now), in order for private investment markets to reach an equilibrium of supply and demand, interest rates would have to fall below zero (which cannot happen since rather than lend at negative rates, potential lenders will simply hold cash--which, based on the massive cash reserves held by private banks and corporations, may have happened).

Third, some government spending grows segments of the economy that are ignored by the private because of market failures, such as high transaction costs and externalities. For example, transaction costs make private ownership of non-limited access roads impractical, so no government no roads, and education produces economic benefit which is not captured by the student, and so the student would underinvest in education if left unsubsidized.Government spending in those cases clearly adds to the economy.

Fourth, markets tend to overvalue that which can be readily converted into money, which leaves many sorts of economic good undervalued. For example, a person is certainly better off if his health is improved, but unless that improvement results in enhanced earnings capacity, it probably won't show up in the GDP stats. But that does not mean it didn't happen, or that it is important. Sometimes there is no way an individual's health can be improved without the government stepping in. Those government steps improve welfare even if they don't add to GDP.

But I digress...

 

[NOsaintsfan]

Agreed, government spending CAN grow the economy. In addition I agree that government is necessary and some of the spending that goes along with it.

That being said the government has a horrible track record of being "good stewards" with my/our money.

Much of government spending is wasteful plain and simple. I'm sure I don't have come up with the countless examples of government inefficiency and waste to convince you of that. If you want somewhere to look for a myriad of examples just look at military, I'll leave it at that.

The above is why there is an inherent skepticism of government by some people and a reluctance by others to turn over something as big and costly as providing for the nations healthcare solely to the government.

I realize that most countries do just that but we're not most countries.

 

[docB]

You've chosen to define insurance as something that cannot involve government intervention, but, aside for the fact that virtually all existing insurance markets are heavily regulated, whether there is government intervention has nothing to do with whether there is risk transfer and risk distribution, which are the characteristics that define insurance. Insurers will issue insurance to cancer patients if it is a condition of them issuing policies to non-cancer patients. If you choose to call that force, go ahead, but it has no impact on whether the policies transfer and distribute risk and are therefore insurance.

Compare these two scenarios.

Scenario 1. Healthy person buys policy for $4000, which is his risk adjusted price, so insurer is willing to issue it. Unhealthy person buys policy for $10,000, which is his risk adjusted price, so insurer is willing to issue it. Government taxes healthy person $3000 and gives the $3000 to unhealthy person. End result: healthy person is out of pocket $7000, unhealthy person is out of pocket $7000, insurance company has voluntarily issued two policies for $14,000, which is its aggregate risk adjusted price.

Scenario 2: Healthy person pays $7000 for policy, which is $3000 above his risk adjusted price. Unhealthy person pays $7000 for policy, which is $3000 below his risk adjusted price; the insurer issues the policy because unless it does so, it will not be allowed to issue the very profitable policy to healthy person. End result: healthy person is out of pocket $7000, unhealthy person is out of pocket $7000, insurance company has voluntarily issued two policies for $14,000, which is its aggregate risk adjusted price.

The results are identical, yet because the scenario 2 requires the insurance company to issue policies, you say it is not insurance. Both scenarios are insurance, coupled with a transfer. You may object to the transfer from the healthy to the unhealthy person on political grounds, but that does not change the nature of the underlying arrangement.

In addition, your car insurance analogy has it exactly backward. Towing and other services are cheap not because they are elective, but rather because the cost and risk is low. When coverage is elective, those people who are most likely to need the services purchase coverage, while those who aren't likely to need them don't. This is called adverse selection and it has been a central component of insurance analysis for literally centuries.

You are correct in that we have different definitions of "insurance." To me it does mean a willing arrangement that takes place at market prices. Once you distort the market forces you are really talking about "coverage" rather than "insurance." The difference is that in the insurance model you get what you pay for. In the coverage model you may get more or you may get less depending on who the regulators favor at any given time.

Your scenario #2 is interesting. You use as an example an insurance company that is forced to issue a money losing policy to maintain the privilege of existing in an industry where it can issue profitable policies. You also say they are doing this willingly. That's basically how EMTALA works. We are forced to provide free care in order to exist in the industry. We are all well aware of the bizarre situations and waste created by EMTALA not to mention the waste created by Medicare and Medicaid. And we have to charge transfer rates to exist.

This has the political benefit of hiding expenses. I would prefer we allow the market to drive costs but since we won't do that I'd prefer we actually tax the difference rather than launder those costs through unfunded mandates. If the politicians are going to vote everyone higher expenses then they should own it.

Your comment about car insurance seems off. If the only people who buy a service are those who will likely use it then costs go up. For example if 100 people buy towing insurance for every one who uses it you can charge 1/100th of a tow bill and break even. If 99/100 who buy it use it you have to charge 99% of a tow bill to break even. You are correct that the costs of towing and even collision are lower than liability which makes apples to apples difficult. It is true that the requirement for everyone to have liability insurance has driven costs up because there is a huge industry devoted to suing insurers. If liability insurance were less common the personal injury industry would be less robust.

We are well beyond the scope of this thread so I'll limit my response.

First, the States that are not expanding MA are still taxed to finance the expansion in other states, so they get all of the cost and none of the benefit.

Second, many, many economists believe that government spending can, in fact, grow an economy when interest rates have fallen against the so-called 'zero bound,' since in such circumstances (which applied in the Great Depression and now), in order for private investment markets to reach an equilibrium of supply and demand, interest rates would have to fall below zero (which cannot happen since rather than lend at negative rates, potential lenders will simply hold cash--which, based on the massive cash reserves held by private banks and corporations, may have happened).

Third, some government spending grows segments of the economy that are ignored by the private because of market failures, such as high transaction costs and externalities. For example, transaction costs make private ownership of non-limited access roads impractical, so no government no roads, and education produces economic benefit which is not captured by the student, and so the student would underinvest in education if left unsubsidized.Government spending in those cases clearly adds to the economy.

Few other than staunch libertarians argue against the government provided infrastructure such as roads. But we have moved to the point where they "provide" lots of other commodities such as education and healthcare. Some modern types of infrastructure do much better without government interference such as cellular and electronic networks.

Fourth, markets tend to overvalue that which can be readily converted into money, which leaves many sorts of economic good undervalued. For example, a person is certainly better off if his health is improved, but unless that improvement results in enhanced earnings capacity, it probably won't show up in the GDP stats. But that does not mean it didn't happen, or that it is important. Sometimes there is no way an individual's health can be improved without the government stepping in. Those government steps improve welfare even if they don't add to GDP.

But I digress...

Improvements in health are supposed to show up directly in GDP due to the population's increased productivity. At least that's what we're told when the converse decreases in GDP due to poor health are trotted out as arguments for socialized care.

The idea that the only way some individuals can get healthier is through government intervention may be true in our current situation but it is chilling nonetheless.

 

[Old_Mil]

I expect that the number of uninsured will actually go up. My step daughter is a teller at a bank; next year they are dropping coverage for their employees.

In the end, obamacare will be.about what most government programs are about...increasing power and control.

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