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First, that distortion already took place. Providers and insurers have spent the last two decades colluding on pricing and process in ways that transformed Blue

First, that distortion already took place. Providers and insurers have spent the last two decades colluding on pricing and process in ways that transformed Blue Cross from an insurer to a poorly-regulated utility. The health care bill takes this to a whole new level, and then sets it in stone. Insurance and health care delivery was already a mess in the U.S. But prior to this bill, we might have evolved or legislated some solution that was not a stupendous giveaway to Blue Cross and Aetna. Too late now. They will never give up the privileges they get today. They get to be toll collectors on our outrageously overpriced health care system forever. Meanwhile, I read articles with people celebrating because they think this bill protects them from the health insurance industry. It's all just too depressing.

tptacek 17y ago
I agree with your sentiment. But from what I can tell, the likelihood that we were ever going to disentangle the insurers from the system was nil. It would have taken a climactic reshaping of health care, like single-payer. When I look at the well-intentioned reform ideas coming from the opposition, I see things like "deregulate and sell across state lines". These ideas don't weaken the grip of BCBS and Aetna; they encourage consolidation and push us further in the direction of the Citigroup-izing of health insurance. What's on the table will, on paper at least, ensure that startup entrepreneurs like me can actually buy insurance on the private market. We didn't have that ability before, at all. That's a win, from what I can see. Would I prefer not to have BCBS and United be the vehicles for that win? Of course. But what does that have to do with anything?
- mattchew 17y ago
  You're right, we probably weren't going to disentangle the insurers. That is not an argument for handing them the keys to the nation for the sake of "doing something". Doing nothing would have been better. At a guess, doing nothing would have resulted in attempts to reform at the state level, like Massachusetts. I'd have preferred that outcome by a long way. What's on the table will, on paper at least, ensure that startup entrepreneurs like me can actually buy insurance on the private market. We didn't have that ability before, at all. That's a win, from what I can see. I do not have employer provided insurance. I buy private insurance on the market today. It costs me about $6000 a year to insure my family of four. I expect the cost of insurance, post-reform, to converge on the national average, which is around $13000. That's a loss of $7000 a year for us. Maybe somewhat less because of subsidies (we won't get much there). Maybe more, if the cost of insurance rises post-reform as it did in Massachusetts under their similar reform. It is not out of the question that we will actually give up health insurance altogether and pay the penalty instead. This would not be a win for us. If you aren't able to get individual coverage for around $6000/year now (national average), and would like to, then this bill will indeed be a win for you. Of course, if you don't like the coverage you get at that price, pay it anyway or get fined. This is getting too long, but does it seem thinkable to you that this reform might accelerate the increase in health care costs? I think it quite likely myself. If it does, too bad for everyone. We're locked in now.
  - tptacek 17y ago
    It would have cost $14,000 to insure my family of four (adults in our 30s, kids in single-digits, no pre-existing conditions). I say "would have" because dollar figures didn't come into it: we were flatly denied coverage, first for our daughter, who had been hospitalized several years earlier for a freak seizure, and then for my wife. (Note: we tried to obtain coverage ourselves, using the Internet and a telephone. When that failed, we worked with an insurance broker friend of the family. Neither worked.) There was no dollar amount that would have bought us private insurance. We got around it first by getting Erin a job that offered group coverage, and then by setting up group health insurance at Matasano. I'm happy to say we now subsidize coverage for all our employees. The numbers are a red herring. COBRA vs. private health insurance costs are not the issue that should be scaring entrepreneurs. The possibility of getting stranded with no possible coverage option is what should be scaring them.
    - mattchew 17y ago
      The numbers are a red herring. COBRA vs. private health insurance costs are not the issue that should be scaring entrepreneurs. Thousands of dollars a year in new expenses is not a red herring and is plenty scary. It's not what's important to you, but it is going to be important to a lot of other people. People who have chosen catastrophic coverage, or who chose to go without health insurance to save money are going to get hit hard by this bill. My guess is a disproportionate number of self-employed people fall into this category. People will go out of business because of this bill.
      - tptacek 17y ago
        I don't think you're correct. I've read the Senate bill, though perhaps not as carefully as you have. I don't see where it says high-deductable plans don't qualify as health insurance for the purpose of satisfying the mandate. I don't care about the people who choose to go without health insurance to save money. I wind up paying for them when they get hit by a car, when their appendix bursts, when they have a freak aneuryism, or when they fall down their stairs. The same arguments suggest that people who drive infrequently and carefully should be allowed to forgo car insurance. After all, you can always sue them when something goes wrong with their plan!

tptacek 17y ago

I agree with your sentiment. But from what I can tell, the likelihood that we were ever going to disentangle the insurers from the system was nil. It would have taken a climactic reshaping of health care, like single-payer. When I look at the well-intentioned reform ideas coming from the opposition, I see things like "deregulate and sell across state lines". These ideas don't weaken the grip of BCBS and Aetna; they encourage consolidation and push us further in the direction of the Citigroup-izing of health insurance. What's on the table will, on paper at least, ensure that startup entrepreneurs like me can actually buy insurance on the private market. We didn't have that ability before, at all. That's a win, from what I can see. Would I prefer not to have BCBS and United be the vehicles for that win? Of course. But what does that have to do with anything?

mattchew 17y ago
You're right, we probably weren't going to disentangle the insurers. That is not an argument for handing them the keys to the nation for the sake of "doing something". Doing nothing would have been better. At a guess, doing nothing would have resulted in attempts to reform at the state level, like Massachusetts. I'd have preferred that outcome by a long way. What's on the table will, on paper at least, ensure that startup entrepreneurs like me can actually buy insurance on the private market. We didn't have that ability before, at all. That's a win, from what I can see. I do not have employer provided insurance. I buy private insurance on the market today. It costs me about $6000 a year to insure my family of four. I expect the cost of insurance, post-reform, to converge on the national average, which is around $13000. That's a loss of $7000 a year for us. Maybe somewhat less because of subsidies (we won't get much there). Maybe more, if the cost of insurance rises post-reform as it did in Massachusetts under their similar reform. It is not out of the question that we will actually give up health insurance altogether and pay the penalty instead. This would not be a win for us. If you aren't able to get individual coverage for around $6000/year now (national average), and would like to, then this bill will indeed be a win for you. Of course, if you don't like the coverage you get at that price, pay it anyway or get fined. This is getting too long, but does it seem thinkable to you that this reform might accelerate the increase in health care costs? I think it quite likely myself. If it does, too bad for everyone. We're locked in now.
- tptacek 17y ago
  It would have cost $14,000 to insure my family of four (adults in our 30s, kids in single-digits, no pre-existing conditions). I say "would have" because dollar figures didn't come into it: we were flatly denied coverage, first for our daughter, who had been hospitalized several years earlier for a freak seizure, and then for my wife. (Note: we tried to obtain coverage ourselves, using the Internet and a telephone. When that failed, we worked with an insurance broker friend of the family. Neither worked.) There was no dollar amount that would have bought us private insurance. We got around it first by getting Erin a job that offered group coverage, and then by setting up group health insurance at Matasano. I'm happy to say we now subsidize coverage for all our employees. The numbers are a red herring. COBRA vs. private health insurance costs are not the issue that should be scaring entrepreneurs. The possibility of getting stranded with no possible coverage option is what should be scaring them.
  - mattchew 17y ago
    The numbers are a red herring. COBRA vs. private health insurance costs are not the issue that should be scaring entrepreneurs. Thousands of dollars a year in new expenses is not a red herring and is plenty scary. It's not what's important to you, but it is going to be important to a lot of other people. People who have chosen catastrophic coverage, or who chose to go without health insurance to save money are going to get hit hard by this bill. My guess is a disproportionate number of self-employed people fall into this category. People will go out of business because of this bill.
    - tptacek 17y ago
      I don't think you're correct. I've read the Senate bill, though perhaps not as carefully as you have. I don't see where it says high-deductable plans don't qualify as health insurance for the purpose of satisfying the mandate. I don't care about the people who choose to go without health insurance to save money. I wind up paying for them when they get hit by a car, when their appendix bursts, when they have a freak aneuryism, or when they fall down their stairs. The same arguments suggest that people who drive infrequently and carefully should be allowed to forgo car insurance. After all, you can always sue them when something goes wrong with their plan!