14 ms·

> I don't think they will throw out the good parts You are mistaken. The good parts, like covering pre-existing conditions is exactly what causes your insuranc

by vinhboy 10y ago

> I don't think they will throw out the good parts You are mistaken. The good parts, like covering pre-existing conditions is exactly what causes your insurance to go up. It's basic economics. The Republicans do not have a plan to fix that. If there was a way to fix it, don't you think it would already be implemented? You think they're purposefully keeping your rates high just to fuck with you? Not to mention suffer all the political fallout of it? Don't forget. Obamacare is the Republican plan. This repeal and objection to Obamacare is all politics, not an attempt to fix a broken system.

JustSomeNobody 10y ago
What makes your insurance go up is the fact that insurance companies are beholden to investors and not the people they insure. They must exceed each and every last quarter or they take a hit.
- maxerickson 10y ago
  Many insurers are private non profits, often owned by the people they insure. Here's one with 8 million members: https://www.bcbsil.com/company-info/who-we-are https://www.bcbsil.com/company-info/who-we-are
deleted 10y ago
[deleted]
nugget 10y ago
Everyone knows how to fix the problem in the short/medium term. The solution is money. Specifically, money from the Federal Government. The real behind-the-scenes debate in DC this month is about, first, the best mechanism to transfer funds (direct subsidies, state subsidies, Federal reinsurance pool for the sickest cases, etc ... each of which create distinct winners and losers whose lobbyists are currently out in force), and second, how much of an annual budget deficit the fiscal-hawk Republicans (now led by Rand Paul) are willing to tolerate. The longer-term solutions have much more to do with diet, lifestyle management, and other behavioral health issues than with access to providers and drugs (e.g. look up how much of last year's medicaid/medicare budget was spent on type 2 diabetes treatment alone). Unfortunately it doesn't seem like we can tackle these issues at scale until after the current debate on affordable universal access to care is settled.
- belovedeagle 10y ago
  > Specifically, money from the Federal Government. Excuse me? What money? The government does not generate net positive economic benefit, and therefore has no [real] money. You might be confused and talking about "taxpayer money" — but then why bother with the gov't at all, why not just say your plan amounts to "we should increase healthcare costs so we're, you know, throwing more money at the problem".
  - the_gastropod 10y ago
    I think the point is that currently there's a profit motive for healthcare. There's no incentive to promote _health_. By putting the federal government (a proxy for the U.S. citizenry itself) in charge of healthcare, the incentives for maximizing health (minimizing sickness / our tax burden for healthcare) become clear.
    - belovedeagle 10y ago
      There's also a profit motive in food production, should we move to single-payer for that (hint: this means breadlines)? There's also a profit motive in housing; single-payer? Mobile phones? Internet access? Entertainment?
      - deleted 10y ago
        [deleted]
      - sjwright 10y ago
        Oh if only it were that easy. The competition in those other markets is much stronger and has proven to be reasonably efficient. Healthcare is different because consumers often don't know what anything ought to cost, rarely in a position to shop around, and will never be able to afford some big ticket items without insurance regardless. And the economic consequences are non-obvious. For example, many conditions are much cheaper to treat if caught early; if access to a doctor has an inconvenient cost attached, overall costs go up. The ability to see a doctor for cheap – ideally free – is the most effective way to lower the risk of expensive procedures in the future.
smnrchrds 10y ago
Seconded. ACA puts a cap on the profits of insurers. They are not just increasing the premiums and pocketing the difference. Most, if not all of the difference is going towards medical care by law. "MLR measures the share of health care premium dollars spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if an insurer collects $100,000 in premiums and spends $85,000 on medical care, the MLR is 85%. In general, the higher the MLR, the more value a policyholder receives for his or her premium dollar. The ACA requires an annual, minimum 80% MLR for individual and small group insurance plans, and an annual, minimum 85% MLR for large group plans." [1] Source: https://fas.org/sgp/crs/misc/R42735.pdf https://fas.org/sgp/crs/misc/R42735.pdf
- jrs235 10y ago
  So insurance is bounded by cost plus pricing now. They have no problem if actual health care costs go up, their bottom line profits go up too! The insurance companies interests are now misaligned. Yeah they want to keep costs down to increase their spread, but if the spread is limited and allowed now they have no problem if hospitals charge $200 for what was a $100 procedure last year because $30 is more than $15 and they'll just increase premiums!
  - phil21 10y ago
    I never understood why this is not glaringly obvious before anyone implements such a plan. Or maybe it was and this was intended? Seems just as likely at this point. I mean, this is a constant joke in professional circles. If you are hourly billing and you can use your shitty talent to create something in 8 hours that your good talent would create in 1 - it's usually economically beneficial to have the worse employees do the work as it's more profitable overall. Up until the point where you lose the customer - but in this case that's not a concern.
    - will_pseudonym 10y ago
      It's right up there with excess taxes on gambling and tobacco. Governments become dependent on those excesses and are disincentivized to decrease the activities they're ostensibly trying to lower.
virmundi 10y ago
I grant that this is particular to ski towns, but it is still a good example of risk pool size [1]. I think the costs will go down when the whole nation is the risk pool, rather than state or smaller pools. To me this makes sense in that, as a Union, Americans migrate for pleasure throughout the States. This means that fundamentally the pool should be the whole country under the Commerce Clause (interstate trading definitionally going on). I know that adding infirmed people increases costs. The trouble is that the health insurance system of the US is not focused on individuals managing their own health insurance costs. Most Americans get their health insurance from their employers. This makes the ACA markets problematic because the limited risk pools above are further limited by the people utilizing the markets. Does this mean that the US should ban company sponsored health insurance? Maybe. I don't know. What I do know is that the Democrats tried to stifle debate and thought on the bill. It went so far as Pelosi saying you can only know what's in the bill once you pass it [2]. Overhauling the risk pool will be huge. That's probably in the realm of repeal and replace. What I doubt we'll see, since it would probably destroy the Republicans in two years, is the total gutting of the ACA and the meaningful, unstable gap. The people wouldn't like it, nor would the business community. 1 - http://www.npr.org/sections/health-shots/2014/05/05/309826958/colorado-redraws-insurance-map-to-cut-sky-high-ski-town-rates http://www.npr.org/sections/health-shots/2014/05/05/30982695... 2 - https://www.youtube.com/watch?v=hV-05TLiiLU https://www.youtube.com/watch?v=hV-05TLiiLU
- dnautics 10y ago
  > I think the costs will go down when the whole nation is the risk pool. I think this is a justifiably correct presumption if you assume that costs are normally distributed. Are healthcare costs and risks normally distributed? We had this problem where the cost of financial risk was assumed to be normally distributed and we built a lot of policy on that, including pooling financial entities into bigger and bigger codependent pools, but everyone seemed to have forgotten the known-for-centuries-fact that financial risk has infinite variance. Of course it turned out okay after we bailed out a bunch of rich people.
pdog 10y ago
> If there was a way to fix it, don't you think it would already be implemented? No... The way to "fix" the exorbitant cost of healthcare is to allow young and/or healthy people to sign up for the bare minimum: a dirt-cheap catastrophic plan that covers the absolute basics and prevents personal bankruptcy. Unfortunately, this hasn't been done.
- yequalsx 10y ago
  Healthcare economics in the U.S. is sufficiently complicated that it defies any simple fix other than saying implement what country X is doing. However, given the massive amount of profit being generated in the system that's not likely to happen in the foreseeable future. Your fix is almost certainly not "the way to fix the exorbitant cost(s).."
  - pdog 10y ago
    There are primarily three reasons why healthcare is so expensive in the United States. The first is because the administrative costs are much higher than in other developed countries (about 25 percent). The second is because the U.S. spends much more than other developed countries for the same things (e.g., drugs, doctors, medical equipment, services). The third is because people in the U.S. receive more medical care than people do in other developed countries (for example, they're much more likely to get expensive surgeries). A cheap, catastrophic insurance coverage plan for young, healthy people addresses all three of these reasons.
    - yequalsx 10y ago
      The field of healthcare economics is a complex one. I think simplistic analysis is not sufficient.
    - gnaritas 10y ago
      > A cheap, catastrophic insurance coverage plan for young, healthy people addresses all three of these reasons. No it doesn't. This is insurance, if the young healthy people aren't paying more than a bare minimum, there isn't enough money to cover the sick. You can't mandate care must be given and allow those unlikely to get sick to barely contribute, that's not the purpose of insurance which is to spread the cost and risk across the whole pool. What you propose does nothing to solve the actual problem, providing care for those who actually need it.
slg 10y ago
>The good parts, like covering pre-existing conditions is exactly what causes your insurance to go up. It's basic economics. It is really as simple as that. Could you imagine a system in which car insurance wasn't mandated but car insurance companies were required to repair your car regardless of its preexisting condition? No smart person would preemptively buy insurance. You just wait until your get into an accident and then bring the already damaged car to the insurance company and demand a policy to repair it. No insurance company can work like that. Insurance only works when the costs of the most expensive customers are shared among the cheapest customers. You need incentives to encourage the cheap customers to sign up or the whole system falls apart. Rejecting preexisting conditions is the old capitalist way of incentivizing people, but as soon as that is prohibited nearly all incentives disappear for a healthy person to buy into the system.
- Judson 10y ago
  Taking it a step further, I would argue that it ceases to be an 'insurance' product if allowed to purchase after the insured event has passed. Our failure to find a non-insurance 'hammer' with which to hit all of the health 'nails' is a larger issue.
  - chimeracoder 10y ago
    > Taking it a step further, I would argue that it ceases to be an 'insurance' product if allowed to purchase after the insured event has passed. You can offer insurance against an event that has already occurred, but the insured price will always be slightly higher than the uninsured price. One could call that insurance, but it'd be a degenerate case, so at that point it's more of a word puzzle than a real question. > Our failure to find a non-insurance 'hammer' with which to hit all of the health 'nails' is a larger issue. Exactly - the problem is that people talk about health insurance like it's supposed to solve the problems that a wealth redistribution program would. Except, insurance is not a wealth redistribution mechanism - it has a completely different goal - and trying to turn it into one just results into the worst of all worlds (expensive and ineffective at achieving either goal).
hackerboos 10y ago
>Don't forget. Obamacare is the Republican plan. This repeal and objection to Obamacare is all politics, not an attempt to fix a broken system. Some context for people who don't know about this: http://www.npr.org/sections/itsallpolitics/2015/10/23/451200436/mitt-romney-finally-takes-credit-for-obamacare http://www.npr.org/sections/itsallpolitics/2015/10/23/451200...
zaroth 10y ago
The cost is directly a reflection of the risk pool and coverage. Now think about who is buying ACA plans off the marketplace. First, it's almost entirely people eligible for subsidies (86%) since the plans are cost prohibitive without them. Second, it's people who didn't previously have or couldn't get insurance, unemployed, or who aren't offered insurance through work. You can see immediately the problem... ACA subscribers will overwhelmingly be high-cost subscribers. There aren't any healthy subscribers to ACA because healthy Americans are working and get their insurance through their employer and therefore aren't eligible for subsidies and have no reason to look at the high-cost exchanges. The ACA is effectively cornering the market for super-high risk pool, and premiums on ACA markets will continue to rise to reflect it. If the subsidies were available regardless of availability of a so-called "affordable" employer sponsored plan, and if they employer's contribution could be taken by an employee and applied to an ACA plan in addition to subsidies, it would fix this all in an instant. Suddenly healthy Americans would be shopping on the exchanges, fundamentally altering the risk pool and drive down premiums for everyone.
- JohnTHaller 10y ago
  You're leaving out all of us healthy Americans that do consulting, run our own small businesses, or participate in the "gig" economy who were buying overpriced private insurance before.
  - zaroth 10y ago
    Only 7% of Americans get their health insurance through non-group coverage, according to Kaiser [1] It's not nearly enough to counter-balance to huge influx of high risk subscribers. You're being hung out to dry with the high risk pool, which is why your costs have skyrocketed. "Most people are healthy most of the time, and as a consequence, health care expenditures are heavily concentrated in a small share of the population: about 50 percent of the health care spending in a given year by those below age 65 is attributable to just 5 percent of the nonelderly population. The lowest spending half of the population accounts for only about 3.5 percent of health care spending in a year." [2] If you want to fix ACA, you have to fix the risk pool. So what's the best way to get healthy people signing up for ACA in droves? Imagine if you could take your employer contribution, and legally apply it to any plan of your choosing. As-in, sure the employer could arrange a group plan for the office, and you could take it or leave it, but you got to apply the exact same employer-contributed dollars to any plan you chose if you wanted. Then on top of that, if you could get ACA income-based subsidies, regardless of the amount of the employer cost-share. Because, why on earth should you get less subsidy at the exact same income level, just because you have an employer who is also good enough to contribute?! That's just penalizing employers for contributing. Employer contributions would be an add-back to MAGI for purpose of calculating the subsidy, but nothing more. Currently, today, the meagerest employee contribution will disqualify an employee from all subsidies altogether, almost regardless of income. So-called "affordable" employer-sponsored coverage disqualifies an employee from all subsidies, is defined as an employee share of less than ~10% of household income for an individual plan. WTF?!) What you would end up with is some extremely cheap plans which a lot of very health workers would flock to. The Fed would pay out significantly more in overall subsidies, but the payment of subsidies would be significantly more fair because it would not penalize an employee for working for an employer who is actually willing to contribute to a share of health costs. In practice, it would in quick order eviscerate the group market for employer-chosen plans, and see employees taking proper responsibility for choosing their own plans for themselves, while still preserving the ability for employers to share in health care costs with tax-advantaged dollars. It would save millions of small/medium sized businesses the arduous task of trying to negotiate group health plans for their employers evey single year. But most of all, it would fix the risk pool by getting everyone across America actually buying through the marketplace, and not the skewed microcosm we have now. Early on after ACA passing, I think it was Zenefits was actually trying to sell employers on paying employees to purchased their own plans on ACA marketplaces years ago, until the IRS shut it down. But it was an extremely appealing model at the time. [1] - http://kff.org/other/state-indicator/total-population/?currentTimeframe=0 http://kff.org/other/state-indicator/total-population/?curre... [2] - http://healthaffairs.org/blog/2016/03/15/dont-let-the-talking-points-fool-you-its-all-about-the-risk-pool/ http://healthaffairs.org/blog/2016/03/15/dont-let-the-talkin...
virmundi 10y ago
> Don't forget. Obamacare is the Republican plan. Kinda, sorta, not really [1]. 1 - http://www.politifact.com/punditfact/statements/2013/nov/15/ellen-qualls/aca-gop-health-care-plan-1993/ http://www.politifact.com/punditfact/statements/2013/nov/15/...
- acdha 10y ago
  That's referring to one specific piece of legislation. You're leaving out the core idea coming from Heritage (mostly true: http://www.politifact.com/truth-o-meter/statements/2010/apr/01/barack-obama/obama-says-heritage-foundation-source-health-excha/ http://www.politifact.com/truth-o-meter/statements/2010/apr/...) and the influence of Massachusetts's state system (https://www.google.com/amp/boston.cbslocal.com/2013/11/13/romneycare-vs-obamacare-key-similarities-differences/amp/ https://www.google.com/amp/boston.cbslocal.com/2013/11/13/ro...) which was itself based on the same proposal (http://www.forbes.com/sites/theapothecary/2011/10/20/how-a-conservative-think-tank-invented-the-individual-mandate/ http://www.forbes.com/sites/theapothecary/2011/10/20/how-a-c...). This was the Republican proposal until Obama took them up on it. Anyone who remembers poor Mitt Romney having to bend himself into logical contortions during the presidential campaign knows that: it was his signature achievement as governor, previously praised by many in his party when advocating against single-payer systems, and suddenly so politically incorrect within his own party that he felt obligated to attack it or invent incredibly fine distinctions to say the ACA was different.
vlunkr 10y ago
If we could lower the cost of health care in the first place, that would help. We need price transparency, and to fix patent laws so crooked big pharma companies can't charge outrageous prices. Having the govt foot the bill on all this stuff is just feeding into these problems. I know people that buy medicine in Mexico because it's so much cheaper there. Or people will fly to other countries for sugeries because it doesn't cost them their annual salary. Maybe our health care system here is better, but what good is it if we can't even pay for it? The "affordable care" act doesn't make care affordable. It just pays your bill.
mcguire 10y ago
"The good parts, like covering pre-existing conditions is exactly what causes your insurance to go up." True story: Pre-ACA, I had never been without insurance. I also have asthma. Never been a problem. No pre-existing condition issues. Then, I became a contractor and had to pay for my own insurance. The insurance refused to pay for anything asthma related. Fine; I was making enough to pay for the hideously expensive inhalers (think an epi-pen ever couple of months), but with those, the asthma was well controlled. Then I left that position and became a regular employee with employer provided insurance. Suddenly, no pre-existing condition limit. Weird.
TrevorJ 10y ago
> Obamacare is the Republican plan. Which is why it's named after Reagan.

by vinhboy 10y ago

JustSomeNobody 10y ago

What makes your insurance go up is the fact that insurance companies are beholden to investors and not the people they insure. They must exceed each and every last quarter or they take a hit.

maxerickson 10y ago
Many insurers are private non profits, often owned by the people they insure. Here's one with 8 million members: https://www.bcbsil.com/company-info/who-we-are https://www.bcbsil.com/company-info/who-we-are

deleted 10y ago

[deleted]

nugget 10y ago

Everyone knows how to fix the problem in the short/medium term. The solution is money. Specifically, money from the Federal Government. The real behind-the-scenes debate in DC this month is about, first, the best mechanism to transfer funds (direct subsidies, state subsidies, Federal reinsurance pool for the sickest cases, etc ... each of which create distinct winners and losers whose lobbyists are currently out in force), and second, how much of an annual budget deficit the fiscal-hawk Republicans (now led by Rand Paul) are willing to tolerate. The longer-term solutions have much more to do with diet, lifestyle management, and other behavioral health issues than with access to providers and drugs (e.g. look up how much of last year's medicaid/medicare budget was spent on type 2 diabetes treatment alone). Unfortunately it doesn't seem like we can tackle these issues at scale until after the current debate on affordable universal access to care is settled.

belovedeagle 10y ago
> Specifically, money from the Federal Government. Excuse me? What money? The government does not generate net positive economic benefit, and therefore has no [real] money. You might be confused and talking about "taxpayer money" — but then why bother with the gov't at all, why not just say your plan amounts to "we should increase healthcare costs so we're, you know, throwing more money at the problem".
- the_gastropod 10y ago
  I think the point is that currently there's a profit motive for healthcare. There's no incentive to promote _health_. By putting the federal government (a proxy for the U.S. citizenry itself) in charge of healthcare, the incentives for maximizing health (minimizing sickness / our tax burden for healthcare) become clear.
  - belovedeagle 10y ago
    There's also a profit motive in food production, should we move to single-payer for that (hint: this means breadlines)? There's also a profit motive in housing; single-payer? Mobile phones? Internet access? Entertainment?
    - deleted 10y ago
      [deleted]
    - sjwright 10y ago
      Oh if only it were that easy. The competition in those other markets is much stronger and has proven to be reasonably efficient. Healthcare is different because consumers often don't know what anything ought to cost, rarely in a position to shop around, and will never be able to afford some big ticket items without insurance regardless. And the economic consequences are non-obvious. For example, many conditions are much cheaper to treat if caught early; if access to a doctor has an inconvenient cost attached, overall costs go up. The ability to see a doctor for cheap – ideally free – is the most effective way to lower the risk of expensive procedures in the future.

smnrchrds 10y ago

Seconded. ACA puts a cap on the profits of insurers. They are not just increasing the premiums and pocketing the difference. Most, if not all of the difference is going towards medical care by law. "MLR measures the share of health care premium dollars spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if an insurer collects $100,000 in premiums and spends $85,000 on medical care, the MLR is 85%. In general, the higher the MLR, the more value a policyholder receives for his or her premium dollar. The ACA requires an annual, minimum 80% MLR for individual and small group insurance plans, and an annual, minimum 85% MLR for large group plans." [1] Source: https://fas.org/sgp/crs/misc/R42735.pdf https://fas.org/sgp/crs/misc/R42735.pdf

jrs235 10y ago
So insurance is bounded by cost plus pricing now. They have no problem if actual health care costs go up, their bottom line profits go up too! The insurance companies interests are now misaligned. Yeah they want to keep costs down to increase their spread, but if the spread is limited and allowed now they have no problem if hospitals charge $200 for what was a $100 procedure last year because $30 is more than $15 and they'll just increase premiums!
- phil21 10y ago
  I never understood why this is not glaringly obvious before anyone implements such a plan. Or maybe it was and this was intended? Seems just as likely at this point. I mean, this is a constant joke in professional circles. If you are hourly billing and you can use your shitty talent to create something in 8 hours that your good talent would create in 1 - it's usually economically beneficial to have the worse employees do the work as it's more profitable overall. Up until the point where you lose the customer - but in this case that's not a concern.
  - will_pseudonym 10y ago
    It's right up there with excess taxes on gambling and tobacco. Governments become dependent on those excesses and are disincentivized to decrease the activities they're ostensibly trying to lower.

virmundi 10y ago

I grant that this is particular to ski towns, but it is still a good example of risk pool size [1]. I think the costs will go down when the whole nation is the risk pool, rather than state or smaller pools. To me this makes sense in that, as a Union, Americans migrate for pleasure throughout the States. This means that fundamentally the pool should be the whole country under the Commerce Clause (interstate trading definitionally going on). I know that adding infirmed people increases costs. The trouble is that the health insurance system of the US is not focused on individuals managing their own health insurance costs. Most Americans get their health insurance from their employers. This makes the ACA markets problematic because the limited risk pools above are further limited by the people utilizing the markets. Does this mean that the US should ban company sponsored health insurance? Maybe. I don't know. What I do know is that the Democrats tried to stifle debate and thought on the bill. It went so far as Pelosi saying you can only know what's in the bill once you pass it [2]. Overhauling the risk pool will be huge. That's probably in the realm of repeal and replace. What I doubt we'll see, since it would probably destroy the Republicans in two years, is the total gutting of the ACA and the meaningful, unstable gap. The people wouldn't like it, nor would the business community. 1 - http://www.npr.org/sections/health-shots/2014/05/05/309826958/colorado-redraws-insurance-map-to-cut-sky-high-ski-town-rates http://www.npr.org/sections/health-shots/2014/05/05/30982695... 2 - https://www.youtube.com/watch?v=hV-05TLiiLU https://www.youtube.com/watch?v=hV-05TLiiLU

dnautics 10y ago
> I think the costs will go down when the whole nation is the risk pool. I think this is a justifiably correct presumption if you assume that costs are normally distributed. Are healthcare costs and risks normally distributed? We had this problem where the cost of financial risk was assumed to be normally distributed and we built a lot of policy on that, including pooling financial entities into bigger and bigger codependent pools, but everyone seemed to have forgotten the known-for-centuries-fact that financial risk has infinite variance. Of course it turned out okay after we bailed out a bunch of rich people.

pdog 10y ago

> If there was a way to fix it, don't you think it would already be implemented? No... The way to "fix" the exorbitant cost of healthcare is to allow young and/or healthy people to sign up for the bare minimum: a dirt-cheap catastrophic plan that covers the absolute basics and prevents personal bankruptcy. Unfortunately, this hasn't been done.

yequalsx 10y ago
Healthcare economics in the U.S. is sufficiently complicated that it defies any simple fix other than saying implement what country X is doing. However, given the massive amount of profit being generated in the system that's not likely to happen in the foreseeable future. Your fix is almost certainly not "the way to fix the exorbitant cost(s).."
- pdog 10y ago
  There are primarily three reasons why healthcare is so expensive in the United States. The first is because the administrative costs are much higher than in other developed countries (about 25 percent). The second is because the U.S. spends much more than other developed countries for the same things (e.g., drugs, doctors, medical equipment, services). The third is because people in the U.S. receive more medical care than people do in other developed countries (for example, they're much more likely to get expensive surgeries). A cheap, catastrophic insurance coverage plan for young, healthy people addresses all three of these reasons.
  - yequalsx 10y ago
    The field of healthcare economics is a complex one. I think simplistic analysis is not sufficient.
  - gnaritas 10y ago
    > A cheap, catastrophic insurance coverage plan for young, healthy people addresses all three of these reasons. No it doesn't. This is insurance, if the young healthy people aren't paying more than a bare minimum, there isn't enough money to cover the sick. You can't mandate care must be given and allow those unlikely to get sick to barely contribute, that's not the purpose of insurance which is to spread the cost and risk across the whole pool. What you propose does nothing to solve the actual problem, providing care for those who actually need it.

slg 10y ago

>The good parts, like covering pre-existing conditions is exactly what causes your insurance to go up. It's basic economics. It is really as simple as that. Could you imagine a system in which car insurance wasn't mandated but car insurance companies were required to repair your car regardless of its preexisting condition? No smart person would preemptively buy insurance. You just wait until your get into an accident and then bring the already damaged car to the insurance company and demand a policy to repair it. No insurance company can work like that. Insurance only works when the costs of the most expensive customers are shared among the cheapest customers. You need incentives to encourage the cheap customers to sign up or the whole system falls apart. Rejecting preexisting conditions is the old capitalist way of incentivizing people, but as soon as that is prohibited nearly all incentives disappear for a healthy person to buy into the system.

Judson 10y ago
Taking it a step further, I would argue that it ceases to be an 'insurance' product if allowed to purchase after the insured event has passed. Our failure to find a non-insurance 'hammer' with which to hit all of the health 'nails' is a larger issue.
- chimeracoder 10y ago
  > Taking it a step further, I would argue that it ceases to be an 'insurance' product if allowed to purchase after the insured event has passed. You can offer insurance against an event that has already occurred, but the insured price will always be slightly higher than the uninsured price. One could call that insurance, but it'd be a degenerate case, so at that point it's more of a word puzzle than a real question. > Our failure to find a non-insurance 'hammer' with which to hit all of the health 'nails' is a larger issue. Exactly - the problem is that people talk about health insurance like it's supposed to solve the problems that a wealth redistribution program would. Except, insurance is not a wealth redistribution mechanism - it has a completely different goal - and trying to turn it into one just results into the worst of all worlds (expensive and ineffective at achieving either goal).

hackerboos 10y ago

>Don't forget. Obamacare is the Republican plan. This repeal and objection to Obamacare is all politics, not an attempt to fix a broken system. Some context for people who don't know about this: http://www.npr.org/sections/itsallpolitics/2015/10/23/451200436/mitt-romney-finally-takes-credit-for-obamacare http://www.npr.org/sections/itsallpolitics/2015/10/23/451200...

zaroth 10y ago

The cost is directly a reflection of the risk pool and coverage. Now think about who is buying ACA plans off the marketplace. First, it's almost entirely people eligible for subsidies (86%) since the plans are cost prohibitive without them. Second, it's people who didn't previously have or couldn't get insurance, unemployed, or who aren't offered insurance through work. You can see immediately the problem... ACA subscribers will overwhelmingly be high-cost subscribers. There aren't any healthy subscribers to ACA because healthy Americans are working and get their insurance through their employer and therefore aren't eligible for subsidies and have no reason to look at the high-cost exchanges. The ACA is effectively cornering the market for super-high risk pool, and premiums on ACA markets will continue to rise to reflect it. If the subsidies were available regardless of availability of a so-called "affordable" employer sponsored plan, and if they employer's contribution could be taken by an employee and applied to an ACA plan in addition to subsidies, it would fix this all in an instant. Suddenly healthy Americans would be shopping on the exchanges, fundamentally altering the risk pool and drive down premiums for everyone.

JohnTHaller 10y ago
You're leaving out all of us healthy Americans that do consulting, run our own small businesses, or participate in the "gig" economy who were buying overpriced private insurance before.
- zaroth 10y ago
  Only 7% of Americans get their health insurance through non-group coverage, according to Kaiser [1] It's not nearly enough to counter-balance to huge influx of high risk subscribers. You're being hung out to dry with the high risk pool, which is why your costs have skyrocketed. "Most people are healthy most of the time, and as a consequence, health care expenditures are heavily concentrated in a small share of the population: about 50 percent of the health care spending in a given year by those below age 65 is attributable to just 5 percent of the nonelderly population. The lowest spending half of the population accounts for only about 3.5 percent of health care spending in a year." [2] If you want to fix ACA, you have to fix the risk pool. So what's the best way to get healthy people signing up for ACA in droves? Imagine if you could take your employer contribution, and legally apply it to any plan of your choosing. As-in, sure the employer could arrange a group plan for the office, and you could take it or leave it, but you got to apply the exact same employer-contributed dollars to any plan you chose if you wanted. Then on top of that, if you could get ACA income-based subsidies, regardless of the amount of the employer cost-share. Because, why on earth should you get less subsidy at the exact same income level, just because you have an employer who is also good enough to contribute?! That's just penalizing employers for contributing. Employer contributions would be an add-back to MAGI for purpose of calculating the subsidy, but nothing more. Currently, today, the meagerest employee contribution will disqualify an employee from all subsidies altogether, almost regardless of income. So-called "affordable" employer-sponsored coverage disqualifies an employee from all subsidies, is defined as an employee share of less than ~10% of household income for an individual plan. WTF?!) What you would end up with is some extremely cheap plans which a lot of very health workers would flock to. The Fed would pay out significantly more in overall subsidies, but the payment of subsidies would be significantly more fair because it would not penalize an employee for working for an employer who is actually willing to contribute to a share of health costs. In practice, it would in quick order eviscerate the group market for employer-chosen plans, and see employees taking proper responsibility for choosing their own plans for themselves, while still preserving the ability for employers to share in health care costs with tax-advantaged dollars. It would save millions of small/medium sized businesses the arduous task of trying to negotiate group health plans for their employers evey single year. But most of all, it would fix the risk pool by getting everyone across America actually buying through the marketplace, and not the skewed microcosm we have now. Early on after ACA passing, I think it was Zenefits was actually trying to sell employers on paying employees to purchased their own plans on ACA marketplaces years ago, until the IRS shut it down. But it was an extremely appealing model at the time. [1] - http://kff.org/other/state-indicator/total-population/?currentTimeframe=0 http://kff.org/other/state-indicator/total-population/?curre... [2] - http://healthaffairs.org/blog/2016/03/15/dont-let-the-talking-points-fool-you-its-all-about-the-risk-pool/ http://healthaffairs.org/blog/2016/03/15/dont-let-the-talkin...

virmundi 10y ago

> Don't forget. Obamacare is the Republican plan. Kinda, sorta, not really [1]. 1 - http://www.politifact.com/punditfact/statements/2013/nov/15/ellen-qualls/aca-gop-health-care-plan-1993/ http://www.politifact.com/punditfact/statements/2013/nov/15/...

acdha 10y ago
That's referring to one specific piece of legislation. You're leaving out the core idea coming from Heritage (mostly true: http://www.politifact.com/truth-o-meter/statements/2010/apr/01/barack-obama/obama-says-heritage-foundation-source-health-excha/ http://www.politifact.com/truth-o-meter/statements/2010/apr/...) and the influence of Massachusetts's state system (https://www.google.com/amp/boston.cbslocal.com/2013/11/13/romneycare-vs-obamacare-key-similarities-differences/amp/ https://www.google.com/amp/boston.cbslocal.com/2013/11/13/ro...) which was itself based on the same proposal (http://www.forbes.com/sites/theapothecary/2011/10/20/how-a-conservative-think-tank-invented-the-individual-mandate/ http://www.forbes.com/sites/theapothecary/2011/10/20/how-a-c...). This was the Republican proposal until Obama took them up on it. Anyone who remembers poor Mitt Romney having to bend himself into logical contortions during the presidential campaign knows that: it was his signature achievement as governor, previously praised by many in his party when advocating against single-payer systems, and suddenly so politically incorrect within his own party that he felt obligated to attack it or invent incredibly fine distinctions to say the ACA was different.

vlunkr 10y ago

If we could lower the cost of health care in the first place, that would help. We need price transparency, and to fix patent laws so crooked big pharma companies can't charge outrageous prices. Having the govt foot the bill on all this stuff is just feeding into these problems. I know people that buy medicine in Mexico because it's so much cheaper there. Or people will fly to other countries for sugeries because it doesn't cost them their annual salary. Maybe our health care system here is better, but what good is it if we can't even pay for it? The "affordable care" act doesn't make care affordable. It just pays your bill.

mcguire 10y ago

"The good parts, like covering pre-existing conditions is exactly what causes your insurance to go up." True story: Pre-ACA, I had never been without insurance. I also have asthma. Never been a problem. No pre-existing condition issues. Then, I became a contractor and had to pay for my own insurance. The insurance refused to pay for anything asthma related. Fine; I was making enough to pay for the hideously expensive inhalers (think an epi-pen ever couple of months), but with those, the asthma was well controlled. Then I left that position and became a regular employee with employer provided insurance. Suddenly, no pre-existing condition limit. Weird.

TrevorJ 10y ago

> Obamacare is the Republican plan. Which is why it's named after Reagan.