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Yes, I understand those points, and I tried to make that clear in my comment, but I guess I failed. More people are insured now, against more risks. I get it.

by hundt 10y ago

Yes, I understand those points, and I tried to make that clear in my comment, but I guess I failed. More people are insured now, against more risks. I get it. My question is, now that we as a society are paying for these extra services (expanded risk pool and reducing the ability of insurers to deny coverage), what is the economic benefit that we expect to get as a result, and have we seen evidence of it yet? I hypothesized three possible benefits, and was wondering which one you expect to see, or if you think we've seen it already. To be clear, this is not an effort to prove that ACA was ineffective. And I didn't say anything about red tape. I'm just trying to understand the economics of the situation, to have a framework for thinking about it beyond "more people have (useful) insurance now." Edit: thinking about it more, I feel like my comment may come off as demanding that you prove the value of the ACA in some objective sense, especially given the thread it is attached to. Sorry if that is the case. I am mostly just trying to understand the mechanisms by which broadening health insurance access improves society. If the answer for you is just "now my family and others like it don't have to live in fear of getting sick" then I don't mean to imply that that is an inadequate reason to be happy about the ACA.

tptacek 10y ago
For the many millions of people who are insured today thanks primarily to the ACA, the economic impact includes: * Access to preventative care that keeps them out of the ER, where the expense of their care is maximized * Financial contribution to their care, rather than the previous expectation that they would simply default on gigantic medical bills or go bankrupt, in either case leaving everyone else in the market to absorb their costs * The availability of guaranteed-issue insurance on the individual market reduces job-lock and, for us in particular, makes it possible to start companies without worrying about how to secure insurance for our families. Health insurance has been a top 5 issue for the founders I've talked to about it (obviously, myself included). The thing you need to remember about risk pools and denial of coverage is that health insurers can't deny health services to people, only insurance coverage. For a variety of reasons, including the fact that insurers have collusive secret pricing deals with health care chains, but also the fact that acute health care is just crazy expensive to provide, almost anyone who doesn't have insurance will simply be bankrupted by medical events without coverage. When that happens, it's not like we don't pay for it; it's just that our insurance companies get to dodge a bullet that we collectively have to take for them.
hundt 10y ago
I can't reply to your comment, so I guess I have to do it here. I feel like you are just listing reasons why having health insurance is good. I know all those reasons. That's not the question I was asking. But I think I probably attached this question to the wrong thread, or have made some other error, because we appear to be talking past each other. Edit to respond to your comment: Yes, maybe it is a dumb question! I don't know. It sounds like your answer to my question is a combination of: (a) denying my premise that we are actually paying more in aggregate for healthcare by saying we were paying for it before with higher service costs. So I guess you believe that the total amount paid for everyone's insurance premiums would have risen just as fast (or faster because of costly emergency room visits) without ACA as they did with it in order to continue covering those hidden costs that are now explicit. (b) fewer medical bankruptcies
- tptacek 10y ago
  Is the answer to your original question just really simple? It might just be: fewer ER visits and fewer medical bankruptcies, both of which were rampant and quietly increasing costs for everyone prior to ACA. The "extra money in the system" is money that was previously being paid surreptitiously in the form of higher costs for services for everyone.

by hundt 10y ago

tptacek 10y ago

For the many millions of people who are insured today thanks primarily to the ACA, the economic impact includes: * Access to preventative care that keeps them out of the ER, where the expense of their care is maximized * Financial contribution to their care, rather than the previous expectation that they would simply default on gigantic medical bills or go bankrupt, in either case leaving everyone else in the market to absorb their costs * The availability of guaranteed-issue insurance on the individual market reduces job-lock and, for us in particular, makes it possible to start companies without worrying about how to secure insurance for our families. Health insurance has been a top 5 issue for the founders I've talked to about it (obviously, myself included). The thing you need to remember about risk pools and denial of coverage is that health insurers can't deny health services to people, only insurance coverage. For a variety of reasons, including the fact that insurers have collusive secret pricing deals with health care chains, but also the fact that acute health care is just crazy expensive to provide, almost anyone who doesn't have insurance will simply be bankrupted by medical events without coverage. When that happens, it's not like we don't pay for it; it's just that our insurance companies get to dodge a bullet that we collectively have to take for them.

hundt 10y ago

I can't reply to your comment, so I guess I have to do it here. I feel like you are just listing reasons why having health insurance is good. I know all those reasons. That's not the question I was asking. But I think I probably attached this question to the wrong thread, or have made some other error, because we appear to be talking past each other. Edit to respond to your comment: Yes, maybe it is a dumb question! I don't know. It sounds like your answer to my question is a combination of: (a) denying my premise that we are actually paying more in aggregate for healthcare by saying we were paying for it before with higher service costs. So I guess you believe that the total amount paid for everyone's insurance premiums would have risen just as fast (or faster because of costly emergency room visits) without ACA as they did with it in order to continue covering those hidden costs that are now explicit. (b) fewer medical bankruptcies

tptacek 10y ago
Is the answer to your original question just really simple? It might just be: fewer ER visits and fewer medical bankruptcies, both of which were rampant and quietly increasing costs for everyone prior to ACA. The "extra money in the system" is money that was previously being paid surreptitiously in the form of higher costs for services for everyone.