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The ACA increases the opportunities for young people and people with chronic illnesses. By distributing those costs, healthy individuals pay more in premiums, w

The ACA increases the opportunities for young people and people with chronic illnesses. By distributing those costs, healthy individuals pay more in premiums, which limit their opportunities. If we are optimizating for overall economic productivity, far more people benefit from not having the ACA.

bduerst 10y ago
Not when you factor in more insured people means less expensive medical costs - i.e. more preventative care and less emergency room visits.
- Amezarak 10y ago
  I'm not sure it is or will work that way, in practice - the more preventative care, less emergency room part, anyway. The total cost of my health insurance premiums is about 20k/year; some of this is subsidized by my employer. I have a $4500 deductible. The insurance does not pay for anything, outside of preventative care, until I've paid $4500. After that, they contribute 80% up to some number, $7500 I think, and then they contribute 100% until the end of the calendar year. Because I have such a high deductible, and due to the opacity of medical billing, I am not going to the doctor unless I'm pretty sure that not going to the doctor means I'm going to be put out of work or going to die. "Preventative" care is defined very strictly: you get a physical. For example, "preventing" the development of pneumonia by treating your respiratory illness early does not count as preventative care. The best I can do is squirrel away what I can in my HSA...but that's one health catastrophe from being blown away. God forbid I come down with any kind of chronic illness that lasts longer than the calendar year. That said, for the poor population, this is definitely true - Medicaid is a dream compared to private insurance. At least in my state, if you're on Medicaid, you don't even see medical bills. It's really lamentable the states were allowed to turn down the Medicaid expansion - the expansion of public health insurance was the best part of the ACA, in my opinion, and the most regrettable part of the bill is that the public option is not available to everyone.
  - bduerst 10y ago
    >The total cost of my health insurance premiums is about 20k/year; That doesn't sound right - What is your maximum out of pocket?
    - Amezarak 10y ago
      About $7500. I would be surprised if your costs are radically different - be sure to account for any employer or government subsidy for health insurance premiums. Also, those numbers include only in-network providers. If I am given out-of-network care - which isn't always under my control - then I could potentially be on the hook for tens of thousands more dollars.
      - bduerst 10y ago
        But the concept of in-network and out-of-network coverage isn't a new to the ACA, or that different. There are plans with national network coverages - so why are you going out of network?
        Amezarak 10y ago
        I wouldn't deliberately, but there are plenty of situations where someone might inadvertently be given out-of-network care. - An out-of-network providers gives you medical attention at an in-provider facility - maybe your ER doctor, surprise, is not in-network, even though the hospital is in-network. [1] [2] [3] - Maybe you have a medical emergency and the closest facility at the time is out-of-network. (In some states and with some insurers under some circumstances, you can get them to pay the difference for emergency out-of-network care.) The biggest risk factor is the "normal" <= $7500 medical bill from an in-network provider, but inadvertent out-of-network care is still something you have to be concerned about. Also, I'm not sure if I'm reading you right, but "in-network" does not necessarily have anything to do with geography - sure, there exist in-network providers for my insurance throughout the country, but the second-closest hospital to me is still out-of-network. [1] http://justcareusa.org/beware-of-out-of-network-er-bills/ http://justcareusa.org/beware-of-out-of-network-er-bills/ [2] http://www.consumerreports.org/cro/news/2014/10/protect-yourself-from-surprise-out-of-network-medical-bills/index.htm http://www.consumerreports.org/cro/news/2014/10/protect-your... [3] http://www.realclearhealth.com/articles/2017/01/09/in_through_the_out_door_a_comprehensive_look_at_surprise_medical_bills__110368.html http://www.realclearhealth.com/articles/2017/01/09/in_throug... EDIT: The HN backoff must be crazy high - 40 minutes later, and I still can't post, and I'll be offline the rest of the day. Because the ACA didn't fix it. From my perspective, it was largely a giveaway to private insurance companies with some fortunate side effects. The total cost for my health insurance premiums are 20k a year. My in-network deductible is $4500. My in-network out of pocket is $7500. My out-of-network out of pocket is $20k. Those are not hypotheticals, and because of those costs, I avoid medical care unless it is absolutely necessary. I'm afraid we're getting into the weeds - my main point is that the ACA's preventative care provisions are really quite weak and don't mean what we might think they'd mean; the preponderance of high deductibles and out-of-pocket maximums mean that people will continue to avoid getting prompt medical care until their condition becomes serious. The preventative benefit, mainly, is that everyone gets a yearly physical and a few other narrow types of preventative care.
- chimeracoder 10y ago
  > Not when you factor in more insured people means less expensive medical costs - i.e. more preventative care and less emergency room visits. Well, you can make the argument for preventive care on medical grounds or even moral ones, but you can't say it actually saves money. When people have access to preventive care, they also tend to consume more, which means greater costs (although better overall care)[0]. This has borne out with the ACA[1], as the data shows that preventive costs increased faster than chronic and acute care costs dropped, by a very significant margin. [0] https://prescriptions.blogs.nytimes.com/2009/09/03/when-preventive-care-costs-more/ https://prescriptions.blogs.nytimes.com/2009/09/03/when-prev... [1] https://www.nytimes.com/2015/08/06/upshot/no-giving-more-people-health-insurance-doesnt-save-money.html https://www.nytimes.com/2015/08/06/upshot/no-giving-more-peo...
  - lsiebert 10y ago
    I'm not sure to what extent that factors in productivity improvements from workers with better health though, in terms of overall economic activity and GDP.
  - bduerst 10y ago
    You should really read articles before you cite them, because neither use data after 2014, when the ACA provisions took effect. The ACA report last month shows the opposite of what you're saying, that oupatient costs have dropped more than inpatient costs have risen, and that medical prices have not risen more than inflation. Page 58+ here: https://www.whitehouse.gov/sites/default/files/page/files/20161213_cea_record_healh_care_reform.pdf https://www.whitehouse.gov/sites/default/files/page/files/20...
    - chimeracoder 10y ago
      > The ACA report last month shows the opposite of what you're saying, that oupatient costs have dropped more than inpatient costs have risen That's not actually the opposite of what I said. Outpatient vs. inpatient isn't the same comparison as preventive vs. responsive care. You're comparing apples and oranges. > You should really read articles before you cite them From the Hacker News guidelines: > Avoid gratuitous negativity.... Please don't insinuate that someone hasn't read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that."
DoodleBuggy 10y ago
Are you volunteering to give up your health insurance to test your theory?
beat 10y ago
Virtually all economic growth comes from small businesses and startups. If we're "optimizing for overall economic productivity", we should be bending over backwards as a society to make it as easy as possible to start businesses! The existing employer-provided model strongly discriminates against small businesses and startups. Providing insurance to employees is both a cost and a bureaucratic overhead. Big corporations have much more negotiating power and can get better prices than small businesses. They have much more staff and can afford dedicated HR staff to deal with insurance. Moreover, in the case of expensive or catastrophic coverage, society is picking up those costs anyway (or alternately, just letting people die). Your premiums then go to cover the costs of people who wound up declaring bankruptcy. And no insurance (or bad insurance) cuts into preventative care that can detect problems early, when they're much cheaper to treat. I support the ACA (or better yet, much more socialized models) because I want to optimize for overall economic productivity.
- phamilton 10y ago
  My point is that for the median entrepreneur or small business owner, the ACA made it harder. Increases in premiums are not trivial. I agree an employer based model does discriminate against startups, but my point is that the ACA also makes it harder for the median entrepreneur to succeed. The fact that the fringe cases can start companies does not to me justify the drain on all other entrepreneurs.
pavlov 10y ago
Distributing cost will improve economic vitality if it removes critical obstacles for others while not substantially impacting the opportunities available to the rest. Without ACA, a software engineer with a chronic illness wouldn't be able to start a business. Meanwhile, a healthy software engineer will start a business regardless of ACA because a minor difference in healthcare premiums is not material to that decision.
antaviana 10y ago
Hear, hear! Moreover, if we somehow create a law to limit people's age so that they die at 40 (obviously without any kind of pain), the premiums would be really affordable for those who really deserve it because at 40 is when health costs for even healthy people begin to ramp up.
- richieb 10y ago
  Actually the health cost really ramp up when 20 or 30 somethings start having kids.
thyrsus 10y ago
Or, as Alan Grayson described the GOP plan: * don't get sick; otherwise * die quickly
astrodust 10y ago
You really don't understand how insurance works, do you? People pay into a pool and if one day they too become ill they'll need to draw on that. Prior to the ACA it was in the best interest of insurers to simply eject all the "sick" people from the pool. What use is insurance if when you really need it they cut you off? This hurts everyone. It's not about paying more in premiums. It's about insurance that sticks around when the shit hits the fan.

bduerst 10y ago

Not when you factor in more insured people means less expensive medical costs - i.e. more preventative care and less emergency room visits.

Amezarak 10y ago
I'm not sure it is or will work that way, in practice - the more preventative care, less emergency room part, anyway. The total cost of my health insurance premiums is about 20k/year; some of this is subsidized by my employer. I have a $4500 deductible. The insurance does not pay for anything, outside of preventative care, until I've paid $4500. After that, they contribute 80% up to some number, $7500 I think, and then they contribute 100% until the end of the calendar year. Because I have such a high deductible, and due to the opacity of medical billing, I am not going to the doctor unless I'm pretty sure that not going to the doctor means I'm going to be put out of work or going to die. "Preventative" care is defined very strictly: you get a physical. For example, "preventing" the development of pneumonia by treating your respiratory illness early does not count as preventative care. The best I can do is squirrel away what I can in my HSA...but that's one health catastrophe from being blown away. God forbid I come down with any kind of chronic illness that lasts longer than the calendar year. That said, for the poor population, this is definitely true - Medicaid is a dream compared to private insurance. At least in my state, if you're on Medicaid, you don't even see medical bills. It's really lamentable the states were allowed to turn down the Medicaid expansion - the expansion of public health insurance was the best part of the ACA, in my opinion, and the most regrettable part of the bill is that the public option is not available to everyone.
- bduerst 10y ago
  >The total cost of my health insurance premiums is about 20k/year; That doesn't sound right - What is your maximum out of pocket?
  - Amezarak 10y ago
    About $7500. I would be surprised if your costs are radically different - be sure to account for any employer or government subsidy for health insurance premiums. Also, those numbers include only in-network providers. If I am given out-of-network care - which isn't always under my control - then I could potentially be on the hook for tens of thousands more dollars.
    - bduerst 10y ago
      But the concept of in-network and out-of-network coverage isn't a new to the ACA, or that different. There are plans with national network coverages - so why are you going out of network?
      - Amezarak 10y ago
        I wouldn't deliberately, but there are plenty of situations where someone might inadvertently be given out-of-network care. - An out-of-network providers gives you medical attention at an in-provider facility - maybe your ER doctor, surprise, is not in-network, even though the hospital is in-network. [1] [2] [3] - Maybe you have a medical emergency and the closest facility at the time is out-of-network. (In some states and with some insurers under some circumstances, you can get them to pay the difference for emergency out-of-network care.) The biggest risk factor is the "normal" <= $7500 medical bill from an in-network provider, but inadvertent out-of-network care is still something you have to be concerned about. Also, I'm not sure if I'm reading you right, but "in-network" does not necessarily have anything to do with geography - sure, there exist in-network providers for my insurance throughout the country, but the second-closest hospital to me is still out-of-network. [1] http://justcareusa.org/beware-of-out-of-network-er-bills/ http://justcareusa.org/beware-of-out-of-network-er-bills/ [2] http://www.consumerreports.org/cro/news/2014/10/protect-yourself-from-surprise-out-of-network-medical-bills/index.htm http://www.consumerreports.org/cro/news/2014/10/protect-your... [3] http://www.realclearhealth.com/articles/2017/01/09/in_through_the_out_door_a_comprehensive_look_at_surprise_medical_bills__110368.html http://www.realclearhealth.com/articles/2017/01/09/in_throug... EDIT: The HN backoff must be crazy high - 40 minutes later, and I still can't post, and I'll be offline the rest of the day. Because the ACA didn't fix it. From my perspective, it was largely a giveaway to private insurance companies with some fortunate side effects. The total cost for my health insurance premiums are 20k a year. My in-network deductible is $4500. My in-network out of pocket is $7500. My out-of-network out of pocket is $20k. Those are not hypotheticals, and because of those costs, I avoid medical care unless it is absolutely necessary. I'm afraid we're getting into the weeds - my main point is that the ACA's preventative care provisions are really quite weak and don't mean what we might think they'd mean; the preponderance of high deductibles and out-of-pocket maximums mean that people will continue to avoid getting prompt medical care until their condition becomes serious. The preventative benefit, mainly, is that everyone gets a yearly physical and a few other narrow types of preventative care.
chimeracoder 10y ago
> Not when you factor in more insured people means less expensive medical costs - i.e. more preventative care and less emergency room visits. Well, you can make the argument for preventive care on medical grounds or even moral ones, but you can't say it actually saves money. When people have access to preventive care, they also tend to consume more, which means greater costs (although better overall care)[0]. This has borne out with the ACA[1], as the data shows that preventive costs increased faster than chronic and acute care costs dropped, by a very significant margin. [0] https://prescriptions.blogs.nytimes.com/2009/09/03/when-preventive-care-costs-more/ https://prescriptions.blogs.nytimes.com/2009/09/03/when-prev... [1] https://www.nytimes.com/2015/08/06/upshot/no-giving-more-people-health-insurance-doesnt-save-money.html https://www.nytimes.com/2015/08/06/upshot/no-giving-more-peo...
- lsiebert 10y ago
  I'm not sure to what extent that factors in productivity improvements from workers with better health though, in terms of overall economic activity and GDP.
- bduerst 10y ago
  You should really read articles before you cite them, because neither use data after 2014, when the ACA provisions took effect. The ACA report last month shows the opposite of what you're saying, that oupatient costs have dropped more than inpatient costs have risen, and that medical prices have not risen more than inflation. Page 58+ here: https://www.whitehouse.gov/sites/default/files/page/files/20161213_cea_record_healh_care_reform.pdf https://www.whitehouse.gov/sites/default/files/page/files/20...
  - chimeracoder 10y ago
    > The ACA report last month shows the opposite of what you're saying, that oupatient costs have dropped more than inpatient costs have risen That's not actually the opposite of what I said. Outpatient vs. inpatient isn't the same comparison as preventive vs. responsive care. You're comparing apples and oranges. > You should really read articles before you cite them From the Hacker News guidelines: > Avoid gratuitous negativity.... Please don't insinuate that someone hasn't read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that."

DoodleBuggy 10y ago

Are you volunteering to give up your health insurance to test your theory?

beat 10y ago

Virtually all economic growth comes from small businesses and startups. If we're "optimizing for overall economic productivity", we should be bending over backwards as a society to make it as easy as possible to start businesses! The existing employer-provided model strongly discriminates against small businesses and startups. Providing insurance to employees is both a cost and a bureaucratic overhead. Big corporations have much more negotiating power and can get better prices than small businesses. They have much more staff and can afford dedicated HR staff to deal with insurance. Moreover, in the case of expensive or catastrophic coverage, society is picking up those costs anyway (or alternately, just letting people die). Your premiums then go to cover the costs of people who wound up declaring bankruptcy. And no insurance (or bad insurance) cuts into preventative care that can detect problems early, when they're much cheaper to treat. I support the ACA (or better yet, much more socialized models) because I want to optimize for overall economic productivity.

phamilton 10y ago
My point is that for the median entrepreneur or small business owner, the ACA made it harder. Increases in premiums are not trivial. I agree an employer based model does discriminate against startups, but my point is that the ACA also makes it harder for the median entrepreneur to succeed. The fact that the fringe cases can start companies does not to me justify the drain on all other entrepreneurs.

pavlov 10y ago

Distributing cost will improve economic vitality if it removes critical obstacles for others while not substantially impacting the opportunities available to the rest. Without ACA, a software engineer with a chronic illness wouldn't be able to start a business. Meanwhile, a healthy software engineer will start a business regardless of ACA because a minor difference in healthcare premiums is not material to that decision.

antaviana 10y ago

Hear, hear! Moreover, if we somehow create a law to limit people's age so that they die at 40 (obviously without any kind of pain), the premiums would be really affordable for those who really deserve it because at 40 is when health costs for even healthy people begin to ramp up.

richieb 10y ago
Actually the health cost really ramp up when 20 or 30 somethings start having kids.

thyrsus 10y ago

Or, as Alan Grayson described the GOP plan: * don't get sick; otherwise * die quickly

astrodust 10y ago

You really don't understand how insurance works, do you? People pay into a pool and if one day they too become ill they'll need to draw on that. Prior to the ACA it was in the best interest of insurers to simply eject all the "sick" people from the pool. What use is insurance if when you really need it they cut you off? This hurts everyone. It's not about paying more in premiums. It's about insurance that sticks around when the shit hits the fan.