6 ms·

Obamacare only reduced the growth of healthcare costs, it did not stop the growth. The approach that most democrats believe would reduce cost is single payer or

Obamacare only reduced the growth of healthcare costs, it did not stop the growth. The approach that most democrats believe would reduce cost is single payer or Medicaid for all.

0xbear 9y ago
As far as I can tell by looking at my premiums, it actually significantly sped up the growth of costs. I don't know how anyone could argue otherwise with a straight face.
- tptacek 9y ago
  That's not the cost we're measuring! We're measuring cost on the macro scale, in terms of the percentage of the economy spent on health care and, in particular, the percentage of the federal budget spent on health care entitlements. That's the cost curve we're talking about bending, because the pre-ACA projections were literally prima facie untenable. Any number of effective cost-saving measures could be passed that would have the effect of increasing your premiums.
  - KekDemaga 9y ago
    Unfortunately for the DNC, the costs many voters were measuring last November wasn't healthcare spending compared to GDP it was actual out of pocket costs that have risen dramatically for many working class Americans.
    - tptacek 9y ago
      Can you cite a source for that claim?
      - KekDemaga 9y ago
        You need a source for "people care more about their family budgets than percentages of GDP spent on healthcare"? Take a look on how the middle class voted last election. As for the increase premiums are up 25% in 2017 alone. At the same time deductibles are also rising, its much more money for much less coverage if you are unlucky enough to make over 50k a year or so. http://fortune.com/2016/10/25/obamacare-insurance-premiums-2017-healthcare/ http://fortune.com/2016/10/25/obamacare-insurance-premiums-2...
        tptacek 9y ago
        No, I need a source for "the rate of cost increase is steeper under the ACA than it was prior to the ACA".
        KekDemaga 9y ago
        "enrollment-weighted premiums in the individual health insurance market increased by 24.4 percent beyond what they would have had they simply followed trends" https://www.brookings.edu/wp-content/uploads/2016/07/Fall2014BPEA_Kowalski.pdf https://www.brookings.edu/wp-content/uploads/2016/07/Fall201...
        pcwalton 9y ago
        The very next two sentences: "The observed premium increase reflects unsubsidized premiums. Insurers receive the full premiums each month, regardless of whether they are paid by the individual or the federal government (IRS 2014). Thus, although the data reflect premiums received by insurers, individuals likely faced smaller changes in premiums after taking the subsidy into account." It's remarkable that premiums didn't rise more under the ACA, despite how many new previously-uninsurable people were covered.
  - 0xbear 9y ago
    You can measure whatever you like, but my costs have gone up nearly threefold and my plan is worse now than it used to be. I'm not interested in solving world peace here. I just want to understand why insuring a relatively healthy family of three under a very high deductible plan costs $1700/mo, and why is it now illegal to not go along with this ridiculous rip off.
    - tptacek 9y ago
      Your plan was already going up before the ACA was proposed, even if you were in medium or large group markets. (My firm offered health insurance to employees in California, New York, and Illinois from ~2006-2012.) Family health insurance on the group market was something like 1100-1200 pre-ACA. If you're paying for your own insurance, you're in the individual market, which is significantly more expensive, and what you're seeing is, in part, the market absorbing the cost of guaranteed issue, something we decisively did not have before the ACA, when health insurers could lock people out of coverage on suspicion of a medical condition, and later rescind care. Pre-ACA and post-ACA insurance is for that reason also not an apples-apples comparison.
      - chrishynes 9y ago
        Yep, prices were rising before ACA and continued to rise thereafter. I'm not sure on the rate of increase, but the absolute levels are getting to the impossible. Regardless of the cause, it's extremely frustrating to be hit with such a large monthly bill for rather poor coverage. I'm not quite as bad off as 0xbear, but we're at $1550/mo for a family of three for much crappier coverage than we had a few years back. Here in Phoenix we've seen double digit increases every year for years, and are down to a single provider on the individual market. Paying $18k/yr before you even use a plan is insane. Use it at all and you're looking at $20 or 25k total, with coverage limits not really kicking in to stop the bleeding until you've shelled out 30k or so. Somebody making $80k/yr just hits the subsidy payout and is spending 20-40% of income on health care. Unsustainable. Argue the whys all you want, these sky high rates have to change.
        9y ago
- dankohn1 9y ago
  Because premium growth actually has slowed since Obamacare was passed: http://www.factcheck.org/2015/02/slower-premium-growth-under-obama/ http://www.factcheck.org/2015/02/slower-premium-growth-under...
  - tptacek 9y ago
    ... and this underplays the effect, because the plans being sold under the ACA have a higher cost basis for insurers than pre-ACA plans do. You can easily observe this for yourself if you're in a major insurance market by calling up an insurer and asking for prices on non-ACA-compliant plans, which are still sold.
  - 0xbear 9y ago
    Of course they do. Raise the deductible 5-10x and you can claim some pretty interesting "premium reduction" numbers.
    - tptacek 9y ago
      Deductibles haven't 5x'd (let alone 10x'd) under the ACA, which, for what it's worth, caps deductibles. Before Blue Cross made it annoying to do this, we did the standard HSA+HDHP plan (most young families should HSA+HDHP), and it was a little annoying getting a bronze plan from BCBS with a deductible high enough to qualify as an HDHP for our HSA.
      - somecontext 9y ago
        For some context, the Kaiser family foundation's 2016 Employer health benefits survey available at http://www.kff.org/report-section/ehbs-2016-summary-of-findings/ http://www.kff.org/report-section/ehbs-2016-summary-of-findi... suggests that the average in-network deductible for a single worker has increased from $917/year in 2010 (when the ACA was passed) to $1,478/year in 2016 -- not adjusted for inflation. While more people are using high-deductible plans, the growth in any specific plan type (eg, HMO) is about the same. Without adjusting for inflation, this growth is ~60% growth in 6 years, or a doubling time of ~9 years. After adjusting, it's more like 40% over the same 6 years or a doubling time of ~12 years.
- neuronexmachina 9y ago
  If you're curious, the non-partisan KFF has pretty comprehensive data on how average premiums for single and family coveraged have changed from 1999-2016. The increase is pretty darn linear: http://www.kff.org/report-section/ehbs-2016-section-one-cost-of-health-insurance/ http://www.kff.org/report-section/ehbs-2016-section-one-cost...
- dboreham 9y ago
  There are a couple of forces at work: 1. Medical folks charge more over time, for...reasons. 2. Previously insurance could be sold tailored to the customer's ability to pay; but that insurance didn't actually cover many useful things and had a low cap (hence was almost worthless). ACA disallowed that and made insurance industry offer policies that cover the stuff a regular person needs covered. So you could have the impression that you had "cheap insurance" as long as you never need to have significant healthcare paid for.
  - kobeya 9y ago
    I made significant use of my healthcare pre-ACA ($30k-$50k charges before insurance). All of it was in-network, covered, and a small annual premium. The very year ACA took effect my health plan was canceled, my doctor went off-network, my new plan had 3x the annual premium and has grown 30% year over year, as have deductibles, and I fight tooth and nail every single charge to make sure it is in network and covered. Yes, one anecdote is not data. But there is no more validity to the politician's lie that I can "keep my health plan, keep my doctor, and health care costs will go down."
    - chrishynes 9y ago
      "The very year ACA took effect my health plan was canceled, my doctor went off-network, my new plan had 3x the annual premium and has grown 30% year over year, and I fight tooth and nail every single charge to make sure it is in network and covered." Same here, and I hear the same exact story from most people I talk to. Plans dropped, premiums skyrocketing. Here in Phoenix we've got a single insurer left, and we'll see if we have anybody next year. What I haven't seen is stories of average joes who were substantially helped by ACA. Sure, if you didn't have coverage before by cost or pre-existing condition, or get subsidies now, maybe you're happier. But the vast middle class, not so much.
      - drewbuschhorn 9y ago
        Post ACA I'm able to get my wife insured (congenital heart issue fixed forever at 14, still used to deny her coverage at 27), and my premiums dropped. We're rather firmly middle class, pretty sure I didn't qualify for any health subsidies, I think student loan deduction and mortgage were it. So there's a face for you, 32 year old, healthy, middle class, white woman who likes cats, rides horses, and has a pet bearded dragon who she talks to in a baby voice can get regular cancer screenings because of ACA.
mcv 9y ago
I recently read that while 80% of Democratic voters support single payer, their members of Congress prefer something that keeps insurance companies in the loop snd profits high for the medical industry. Presumably because of donations. If that's the case, then the difference between Democrats and Republicans is that the Dems want to insure the poor while still ensuring high profits for the industry, while the Republicans want to screw the poor while ensuring high profits for the industry. They differ on one very important issue, but are still mostly the same. Actually reducing medical costs requires a far more thorough overhaul of the system.

Obamacare only reduced the growth of healthcare costs, it did not stop the growth. The approach that most democrats believe would reduce cost is single payer or Medicaid for all.

0xbear 9y ago

As far as I can tell by looking at my premiums, it actually significantly sped up the growth of costs. I don't know how anyone could argue otherwise with a straight face.

tptacek 9y ago
That's not the cost we're measuring! We're measuring cost on the macro scale, in terms of the percentage of the economy spent on health care and, in particular, the percentage of the federal budget spent on health care entitlements. That's the cost curve we're talking about bending, because the pre-ACA projections were literally prima facie untenable. Any number of effective cost-saving measures could be passed that would have the effect of increasing your premiums.
- KekDemaga 9y ago
  Unfortunately for the DNC, the costs many voters were measuring last November wasn't healthcare spending compared to GDP it was actual out of pocket costs that have risen dramatically for many working class Americans.
  - tptacek 9y ago
    Can you cite a source for that claim?
    - KekDemaga 9y ago
      You need a source for "people care more about their family budgets than percentages of GDP spent on healthcare"? Take a look on how the middle class voted last election. As for the increase premiums are up 25% in 2017 alone. At the same time deductibles are also rising, its much more money for much less coverage if you are unlucky enough to make over 50k a year or so. http://fortune.com/2016/10/25/obamacare-insurance-premiums-2017-healthcare/ http://fortune.com/2016/10/25/obamacare-insurance-premiums-2...
      - tptacek 9y ago
        No, I need a source for "the rate of cost increase is steeper under the ACA than it was prior to the ACA".
        KekDemaga 9y ago
        "enrollment-weighted premiums in the individual health insurance market increased by 24.4 percent beyond what they would have had they simply followed trends" https://www.brookings.edu/wp-content/uploads/2016/07/Fall2014BPEA_Kowalski.pdf https://www.brookings.edu/wp-content/uploads/2016/07/Fall201...
        pcwalton 9y ago
        The very next two sentences: "The observed premium increase reflects unsubsidized premiums. Insurers receive the full premiums each month, regardless of whether they are paid by the individual or the federal government (IRS 2014). Thus, although the data reflect premiums received by insurers, individuals likely faced smaller changes in premiums after taking the subsidy into account." It's remarkable that premiums didn't rise more under the ACA, despite how many new previously-uninsurable people were covered.
- 0xbear 9y ago
  You can measure whatever you like, but my costs have gone up nearly threefold and my plan is worse now than it used to be. I'm not interested in solving world peace here. I just want to understand why insuring a relatively healthy family of three under a very high deductible plan costs $1700/mo, and why is it now illegal to not go along with this ridiculous rip off.
  - tptacek 9y ago
    Your plan was already going up before the ACA was proposed, even if you were in medium or large group markets. (My firm offered health insurance to employees in California, New York, and Illinois from ~2006-2012.) Family health insurance on the group market was something like 1100-1200 pre-ACA. If you're paying for your own insurance, you're in the individual market, which is significantly more expensive, and what you're seeing is, in part, the market absorbing the cost of guaranteed issue, something we decisively did not have before the ACA, when health insurers could lock people out of coverage on suspicion of a medical condition, and later rescind care. Pre-ACA and post-ACA insurance is for that reason also not an apples-apples comparison.
    - chrishynes 9y ago
      Yep, prices were rising before ACA and continued to rise thereafter. I'm not sure on the rate of increase, but the absolute levels are getting to the impossible. Regardless of the cause, it's extremely frustrating to be hit with such a large monthly bill for rather poor coverage. I'm not quite as bad off as 0xbear, but we're at $1550/mo for a family of three for much crappier coverage than we had a few years back. Here in Phoenix we've seen double digit increases every year for years, and are down to a single provider on the individual market. Paying $18k/yr before you even use a plan is insane. Use it at all and you're looking at $20 or 25k total, with coverage limits not really kicking in to stop the bleeding until you've shelled out 30k or so. Somebody making $80k/yr just hits the subsidy payout and is spending 20-40% of income on health care. Unsustainable. Argue the whys all you want, these sky high rates have to change.
      - 9y ago
dankohn1 9y ago
Because premium growth actually has slowed since Obamacare was passed: http://www.factcheck.org/2015/02/slower-premium-growth-under-obama/ http://www.factcheck.org/2015/02/slower-premium-growth-under...
- tptacek 9y ago
  ... and this underplays the effect, because the plans being sold under the ACA have a higher cost basis for insurers than pre-ACA plans do. You can easily observe this for yourself if you're in a major insurance market by calling up an insurer and asking for prices on non-ACA-compliant plans, which are still sold.
- 0xbear 9y ago
  Of course they do. Raise the deductible 5-10x and you can claim some pretty interesting "premium reduction" numbers.
  - tptacek 9y ago
    Deductibles haven't 5x'd (let alone 10x'd) under the ACA, which, for what it's worth, caps deductibles. Before Blue Cross made it annoying to do this, we did the standard HSA+HDHP plan (most young families should HSA+HDHP), and it was a little annoying getting a bronze plan from BCBS with a deductible high enough to qualify as an HDHP for our HSA.
    - somecontext 9y ago
      For some context, the Kaiser family foundation's 2016 Employer health benefits survey available at http://www.kff.org/report-section/ehbs-2016-summary-of-findings/ http://www.kff.org/report-section/ehbs-2016-summary-of-findi... suggests that the average in-network deductible for a single worker has increased from $917/year in 2010 (when the ACA was passed) to $1,478/year in 2016 -- not adjusted for inflation. While more people are using high-deductible plans, the growth in any specific plan type (eg, HMO) is about the same. Without adjusting for inflation, this growth is ~60% growth in 6 years, or a doubling time of ~9 years. After adjusting, it's more like 40% over the same 6 years or a doubling time of ~12 years.
neuronexmachina 9y ago
If you're curious, the non-partisan KFF has pretty comprehensive data on how average premiums for single and family coveraged have changed from 1999-2016. The increase is pretty darn linear: http://www.kff.org/report-section/ehbs-2016-section-one-cost-of-health-insurance/ http://www.kff.org/report-section/ehbs-2016-section-one-cost...
dboreham 9y ago
There are a couple of forces at work: 1. Medical folks charge more over time, for...reasons. 2. Previously insurance could be sold tailored to the customer's ability to pay; but that insurance didn't actually cover many useful things and had a low cap (hence was almost worthless). ACA disallowed that and made insurance industry offer policies that cover the stuff a regular person needs covered. So you could have the impression that you had "cheap insurance" as long as you never need to have significant healthcare paid for.
- kobeya 9y ago
  I made significant use of my healthcare pre-ACA ($30k-$50k charges before insurance). All of it was in-network, covered, and a small annual premium. The very year ACA took effect my health plan was canceled, my doctor went off-network, my new plan had 3x the annual premium and has grown 30% year over year, as have deductibles, and I fight tooth and nail every single charge to make sure it is in network and covered. Yes, one anecdote is not data. But there is no more validity to the politician's lie that I can "keep my health plan, keep my doctor, and health care costs will go down."
  - chrishynes 9y ago
    "The very year ACA took effect my health plan was canceled, my doctor went off-network, my new plan had 3x the annual premium and has grown 30% year over year, and I fight tooth and nail every single charge to make sure it is in network and covered." Same here, and I hear the same exact story from most people I talk to. Plans dropped, premiums skyrocketing. Here in Phoenix we've got a single insurer left, and we'll see if we have anybody next year. What I haven't seen is stories of average joes who were substantially helped by ACA. Sure, if you didn't have coverage before by cost or pre-existing condition, or get subsidies now, maybe you're happier. But the vast middle class, not so much.
    - drewbuschhorn 9y ago
      Post ACA I'm able to get my wife insured (congenital heart issue fixed forever at 14, still used to deny her coverage at 27), and my premiums dropped. We're rather firmly middle class, pretty sure I didn't qualify for any health subsidies, I think student loan deduction and mortgage were it. So there's a face for you, 32 year old, healthy, middle class, white woman who likes cats, rides horses, and has a pet bearded dragon who she talks to in a baby voice can get regular cancer screenings because of ACA.

mcv 9y ago

I recently read that while 80% of Democratic voters support single payer, their members of Congress prefer something that keeps insurance companies in the loop snd profits high for the medical industry. Presumably because of donations. If that's the case, then the difference between Democrats and Republicans is that the Dems want to insure the poor while still ensuring high profits for the industry, while the Republicans want to screw the poor while ensuring high profits for the industry. They differ on one very important issue, but are still mostly the same. Actually reducing medical costs requires a far more thorough overhaul of the system.