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I disagree with almost every assertion you are making, and I'm not sure I have the time or energy to respond anymore. But let me just say this, the individual m

I disagree with almost every assertion you are making, and I'm not sure I have the time or energy to respond anymore. But let me just say this, the individual market pre-ACA had choice, offered real value, was cheaper, had lower deductibles, and had more doctor choice. So if 3x price increase and huge deductibles was somehow still a net in for you, congrats, but it came at a huge price for a lot of other people, and I'll celebrate the upcoming repeal of the ACA.

tptacek 10y ago
It did none of those things. It was cheaper and had lower deductibles for young families with practically no prior exposure to the health system. But if you were older, or were a woman who had ever seen a reproductive health specialist, or had at any point in your past had an unexplained seizure, or had reported any of a constellation of 10 different symptoms predictive of a future diabetic condition (and so and so forth), the California individual market provided literally no value at all, because you were locked out of it: insurance wasn't available to you outside the group market at any price. It's easy for insurers to provide incredibly cheap premiums when they can exclude broad classes of customers on the suspicion that they will in the future make claims. It's also easy for insurers to provide incredibly cheap premiums when they can quietly impose low annual and lifetime caps on coverage, which they could and did before the ACA. It's also easy for insurers to provide those cheap premiums when they can re-evaluate your coverage and rescind it retroactively when you're diagnosed with a chronic condition, which they could and did before the ACA. My point is simple: you're not comparing apples and oranges. You need to compare the small group market to the post-ACA individual market if you want to compare like with like. The system you're comparing it to now was exploiting consumers; you were a beneficiary of it, I agree, but your benefits came at others expense. More importantly, though, outside the moral dimension: as soon as you got your company off the ground and had to begin providing for employees, you'd have found yourself in the same situation you are now: with annual double digit increases in premiums. Because that's where most of us were prior to the ACA.
- hundt 10y ago
  One thing I wonder about ACA: it seems like the young/healthy who bought their own insurance have had their premiums go way up compared to before (and also they are penalized if they don't buy insurance, so presumably more of them buy it now), and I haven't heard about any large groups of people whose premiums went down. So, more money is going into the system than before. Where is the extra money going? Here are the possibilities I can think of: - Better health outcomes for the previously uninsured or uninsurable. This would be the case if the previously uninsured just didn't get useful medical care before ACA, and now they do. In this case we might see longer life expectancy, increased happiness, or some other improved health care outcome. - Less money out of the pockets of the previously uninsured. This would be the case if the previously uninsured used to get the medical care they needed anyway, but had to pay a lot for it. In this case we might see, for example, fewer medical bankruptcies. - More profits for insurance companies or medical service providers. This could be the case if providers were directly or indirectly subsidizing the previously uninsured when they couldn't pay their bills. (If this is true I'm assuming they didn't simply pass the costs on to the previously insured, because that should have resulted in a lot of people's premiums going down after ACA, and apparently that didn't happen.) Do you have a sense of whether these things have happened, or do you expect them to happen in the future? Or maybe I missed some other possibility.
  - tptacek 10y ago
    You're missing that for a very large collection of new insureds, premiums did go down, from Inf to hundreds of dollars. "The ACA" doesn't charge premiums; insurers do. They increase premiums when actuarial values change. The ACA did two big things to change those values: * It introduced tens of millions of formerly uninsured people to the system; if you were previously uninsured, you're also more likely to be costly to insure (there's a correlation between being stably employed and being healthy, for instance, and the stably employed have always tended to have insurance) * It required insurers to cover without caps or recission and for policies to have minimal actuarial value to customers, all of which were levers that insurers used to lower premiums in exchange for reduced service to customers. To believe that ACA red tape was a primary driver for increased premiums, you have to ignore the ratio of money insurers spend on medical costs versus administrative overhead, which is reported annually. It's hard to see how anything in the ACA could have driven up the cost of an doctors visit or an MRI. And yet that's where the expense is growing: to wit, more people are getting more procedures now that they have coverage.

tptacek 10y ago

It did none of those things. It was cheaper and had lower deductibles for young families with practically no prior exposure to the health system. But if you were older, or were a woman who had ever seen a reproductive health specialist, or had at any point in your past had an unexplained seizure, or had reported any of a constellation of 10 different symptoms predictive of a future diabetic condition (and so and so forth), the California individual market provided literally no value at all, because you were locked out of it: insurance wasn't available to you outside the group market at any price. It's easy for insurers to provide incredibly cheap premiums when they can exclude broad classes of customers on the suspicion that they will in the future make claims. It's also easy for insurers to provide incredibly cheap premiums when they can quietly impose low annual and lifetime caps on coverage, which they could and did before the ACA. It's also easy for insurers to provide those cheap premiums when they can re-evaluate your coverage and rescind it retroactively when you're diagnosed with a chronic condition, which they could and did before the ACA. My point is simple: you're not comparing apples and oranges. You need to compare the small group market to the post-ACA individual market if you want to compare like with like. The system you're comparing it to now was exploiting consumers; you were a beneficiary of it, I agree, but your benefits came at others expense. More importantly, though, outside the moral dimension: as soon as you got your company off the ground and had to begin providing for employees, you'd have found yourself in the same situation you are now: with annual double digit increases in premiums. Because that's where most of us were prior to the ACA.

hundt 10y ago
One thing I wonder about ACA: it seems like the young/healthy who bought their own insurance have had their premiums go way up compared to before (and also they are penalized if they don't buy insurance, so presumably more of them buy it now), and I haven't heard about any large groups of people whose premiums went down. So, more money is going into the system than before. Where is the extra money going? Here are the possibilities I can think of: - Better health outcomes for the previously uninsured or uninsurable. This would be the case if the previously uninsured just didn't get useful medical care before ACA, and now they do. In this case we might see longer life expectancy, increased happiness, or some other improved health care outcome. - Less money out of the pockets of the previously uninsured. This would be the case if the previously uninsured used to get the medical care they needed anyway, but had to pay a lot for it. In this case we might see, for example, fewer medical bankruptcies. - More profits for insurance companies or medical service providers. This could be the case if providers were directly or indirectly subsidizing the previously uninsured when they couldn't pay their bills. (If this is true I'm assuming they didn't simply pass the costs on to the previously insured, because that should have resulted in a lot of people's premiums going down after ACA, and apparently that didn't happen.) Do you have a sense of whether these things have happened, or do you expect them to happen in the future? Or maybe I missed some other possibility.
- tptacek 10y ago
  You're missing that for a very large collection of new insureds, premiums did go down, from Inf to hundreds of dollars. "The ACA" doesn't charge premiums; insurers do. They increase premiums when actuarial values change. The ACA did two big things to change those values: * It introduced tens of millions of formerly uninsured people to the system; if you were previously uninsured, you're also more likely to be costly to insure (there's a correlation between being stably employed and being healthy, for instance, and the stably employed have always tended to have insurance) * It required insurers to cover without caps or recission and for policies to have minimal actuarial value to customers, all of which were levers that insurers used to lower premiums in exchange for reduced service to customers. To believe that ACA red tape was a primary driver for increased premiums, you have to ignore the ratio of money insurers spend on medical costs versus administrative overhead, which is reported annually. It's hard to see how anything in the ACA could have driven up the cost of an doctors visit or an MRI. And yet that's where the expense is growing: to wit, more people are getting more procedures now that they have coverage.