7 ms·

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

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!
- lrm242 17y ago
  And now we will wind up paying for you because your family has medical issues and couldn't previously get covered. The burden has simply been shifted. Good? Bad? Shrug, depends on which side of the line you sit on. I sit on the side of the line that favors less and smaller federal government. One of the beautiful results of the power we give to States to govern is that as a country we end up with 50 solutions. Our diverse populous can then choose which one fits best with their ideals and personal circumstances--and we get this while still maintaining ourselves as a cohesive country. Unfortunately, this time the government has chosen to white wall a solution across all citizens rather than to let the fundamental action of our country (States rights) do the work which would have resulted in a better solution, IMO.
  - tptacek 17y ago
    In one set of circumstances, a family that could not obtain coverage now can, and contributes premium payments every months to compensate for that coverage. In the other set of circumstances, the family can't obtain coverage. Something bad happens. Now, instead of having insurance cover it, they go bankrupt. We are all still paying the bills. The only difference that I can see is that in this set of circumstances, the family (a) didn't pay insurance premiums, and (b) was driven into bankruptcy. What's the win you see in the second scenario?
    - lrm242 17y ago
      To perform this analysis you must further explore the true costs of the first scenario.
- mattchew 17y ago
  I have not heard that catastrophic coverage is banned by the bill, but the end of this sort of insurance is implied because of adverse selection. Either "insurers cannot refuse coverage" will have exceptions, or reduced cost/reduced benefit programs have to go. Maybe it will take a year or two before the "quality standards" get enacted, but I can't see it not happening. 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. People go without health insurance because it is incredibly expensive. For a lot of people it is a crappy deal, or just flat out unaffordable. It is interesting how people who thought they couldn't afford health insurance used to be portrayed as victims. Now they're the bad guys, they broke the system for everyone else, and you don't need to care about them. What a difference two years makes.
  - tptacek 17y ago
    I don't understand how your logic follows. There are no rules in the Senate bill that cap premiums, or establish floors for the premiums of high deductable insurance. Won't adverse selection drive down the cost of high-deductable insurance as it becomes a proxy for "insurance for 20-30 year olds unlikely to make claims"? If you can afford health insurance, and health insurance is available to you, and you decide not to buy it because you're 25 and you don't think you'll need it, you don't deserve my sympathy. If you can't afford health insurance, you deserve whatever we can do to make health insurance affordable to you. Please don't try to drag me into identity politics. This isn't a "rich vs. poor" issue.
    - mattchew 17y ago
      If the rule is cannot deny coverage, high risk people will buy the cheap policy and then switch when they need the expensive benefits. For that matter low risk people will switch if they roll snake-eyes and need to schedule something expensive like reconstructive surgery. This is essentially the same adverse selection logic that justifies the mandate. * People choosing to buy or not buy insurance has gotten reframed, and I find it interesting to see how effectively the switch took place. In 2008, your hypothetical 25 year old would have been portrayed as a victim, if anything. Screwed over by the greedy health insurance companies who make it impossible to get decent coverage at a reasonable price. In 2010, he's the bad guy. It's his fault the system is broken. He is morally obligated to buy that health insurance now, and if he argues that he's getting a crappy deal for what he is paying, it's him who is being selfish and greedy. There are certainly identity politics tangled up in health care reform, but I was talking about the reframing of an issue and fickle public opinion.

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!

lrm242 17y ago
And now we will wind up paying for you because your family has medical issues and couldn't previously get covered. The burden has simply been shifted. Good? Bad? Shrug, depends on which side of the line you sit on. I sit on the side of the line that favors less and smaller federal government. One of the beautiful results of the power we give to States to govern is that as a country we end up with 50 solutions. Our diverse populous can then choose which one fits best with their ideals and personal circumstances--and we get this while still maintaining ourselves as a cohesive country. Unfortunately, this time the government has chosen to white wall a solution across all citizens rather than to let the fundamental action of our country (States rights) do the work which would have resulted in a better solution, IMO.
- tptacek 17y ago
  In one set of circumstances, a family that could not obtain coverage now can, and contributes premium payments every months to compensate for that coverage. In the other set of circumstances, the family can't obtain coverage. Something bad happens. Now, instead of having insurance cover it, they go bankrupt. We are all still paying the bills. The only difference that I can see is that in this set of circumstances, the family (a) didn't pay insurance premiums, and (b) was driven into bankruptcy. What's the win you see in the second scenario?
  - lrm242 17y ago
    To perform this analysis you must further explore the true costs of the first scenario.
mattchew 17y ago
I have not heard that catastrophic coverage is banned by the bill, but the end of this sort of insurance is implied because of adverse selection. Either "insurers cannot refuse coverage" will have exceptions, or reduced cost/reduced benefit programs have to go. Maybe it will take a year or two before the "quality standards" get enacted, but I can't see it not happening. 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. People go without health insurance because it is incredibly expensive. For a lot of people it is a crappy deal, or just flat out unaffordable. It is interesting how people who thought they couldn't afford health insurance used to be portrayed as victims. Now they're the bad guys, they broke the system for everyone else, and you don't need to care about them. What a difference two years makes.
- tptacek 17y ago
  I don't understand how your logic follows. There are no rules in the Senate bill that cap premiums, or establish floors for the premiums of high deductable insurance. Won't adverse selection drive down the cost of high-deductable insurance as it becomes a proxy for "insurance for 20-30 year olds unlikely to make claims"? If you can afford health insurance, and health insurance is available to you, and you decide not to buy it because you're 25 and you don't think you'll need it, you don't deserve my sympathy. If you can't afford health insurance, you deserve whatever we can do to make health insurance affordable to you. Please don't try to drag me into identity politics. This isn't a "rich vs. poor" issue.
  - mattchew 17y ago
    If the rule is cannot deny coverage, high risk people will buy the cheap policy and then switch when they need the expensive benefits. For that matter low risk people will switch if they roll snake-eyes and need to schedule something expensive like reconstructive surgery. This is essentially the same adverse selection logic that justifies the mandate. * People choosing to buy or not buy insurance has gotten reframed, and I find it interesting to see how effectively the switch took place. In 2008, your hypothetical 25 year old would have been portrayed as a victim, if anything. Screwed over by the greedy health insurance companies who make it impossible to get decent coverage at a reasonable price. In 2010, he's the bad guy. It's his fault the system is broken. He is morally obligated to buy that health insurance now, and if he argues that he's getting a crappy deal for what he is paying, it's him who is being selfish and greedy. There are certainly identity politics tangled up in health care reform, but I was talking about the reframing of an issue and fickle public opinion.