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Everyone knew Obamacare would cause this (or make it worse), but no one could do anything about it because there was no alternative plan acceptable to a large e

by ars 4y ago

Everyone knew Obamacare would cause this (or make it worse), but no one could do anything about it because there was no alternative plan acceptable to a large enough majority. Obamacare dramatically increased deductibles, in the name of providing "coverage" to everyone. What ends up happening is people don't pay the deductive. What should have happened is politicians should have worked on costs, not on payments. They should have worked on dramatically increasing healthcare supply not availability. Trump tried, a bit, by forcing hospitals to release price lists, but I have not seen lower costs as a result. And I don't just criticize, I have two ideas to help: 1: Encourage capitation[1] - people should pay a fixed amount that covers everything* no exclusions, no co-pays, or anything else. Care is gated by lower cost professionals who escalate to higher cost general practitioners, and then specialists, as needed. The Doctors are paid a fixed salary that does not depend on how many people they see or how many procedures they do. 2: Gut employer healthcare. Just give everyone cash (in a tax controlled way) that can only pay for healthcare. In a two person household they can pool the cash and it should be enough to pay for coverage, with complete competition. People with lower income would automatically receive subsidies that would help. 3: No more special Medicare coverage - it would be routed via the identical path that others use, except the subsidy is higher. I've helped people on Medicare - the government coverage is terrible, the only good coverage is Medicare Advantage which is private care paid for by the government, which works well. [1]: https://en.wikipedia.org/wiki/Capitation_(healthcare) https://en.wikipedia.org/wiki/Capitation_(healthcare)

runnerup 4y ago
> Obamacare dramatically increased deductibles, in the name of providing "coverage" to everyone. What ends up happening is people don't pay the deductive. I don't understand this. Are you saying everyone just lets the bills for the deductible go to debt collections?
- netdoll 4y ago
  I've heard it often remarked in my circles (wryly and bitterly) that "bankruptcy and gofundme are the American health care plans of choice". So yes, it would seem that for a lot of stuff the plan is just to let it go to collections and then default for as long as you can get away with it. (n.b. I have some relatively significant physical health issues, so if I can't afford medical tourism and/or get on an absurdly good plan before I'm 26, I may end up being forced into a strategy like this)
- ars 4y ago
  > just lets the bills for the deductible go to debt collections? Yes. Nothing happens as a result. They mail letters, and try to call, and that's about it. It doesn't even hurt credit scores, since they exclude medical debt.
lotsofpulp 4y ago
> Obamacare dramatically increased deductibles, in the name of providing "coverage" to everyone. What ends up happening is people don't pay the deductive. What does this mean? The Affordable Care Act did not directly increase deductibles. It even provided huge subsidies from the young and healthy to the poor and old via age rating factors, restricting of pricing criteria (removal of pre existing conditions exclusions), and implementation of out of pocket maximums. > 2: Gut employer healthcare. Just give everyone cash (in a tax controlled way) that can only pay for healthcare. In a two person household they can pool the cash and it should be enough to pay for coverage, with complete competition. People with lower income would automatically receive subsidies that would help. This was a non starter during Affordable Care Act negotiations due to upper middle class people being up in arms about their premiums going up due to being in the same risk pool as poorer and sicker people.
- ars 4y ago
  > The Affordable Care Act did not directly increase deductibles. My deductible before the ACA was around $500 before, and around $4000 after. In one year it changed that much. Other people I've spoken with had the same experience. > It even provided huge subsidies from the young and healthy to the poor Only to people not in employee health care plans, which always have high deductibles. > about their premiums going up due to being in the same risk pool as poorer and sicker people. I'm not seeing the connection. People can buy whatever plan they want, receiving the money in cash doesn't force people into any particular risk pool. Not to mention the ACA majorly combined pools, and in fact did cause premiums to go up for this exact reason.
  - lotsofpulp 4y ago
    > My deductible before the ACA was around $500 before, and around $4000 after. In one year it changed that much. Other people I've spoken with had the same experience. I meant the deductible increase was not a statutory part of ACA, but an inevitable part due to the drastic increase in benefits (all preventative care, all medicines assuming there was efficacy data, out of pocket maximum instead of benefit maximum). Before ACA, insurance could deny you healthcare easily. After ACA, they had to provide the benefit, even if the medicine cost $1M per month, and the insurance company could not choose to drop you as an insured. > Only to people not in employee health care plans, which always have high deductibles. As far as I know, this applies to all ACA compliant health plans, even ones that employers subsidize: https://www.healthcare.gov/how-plans-set-your-premiums https://www.healthcare.gov/how-plans-set-your-premiums > I'm not seeing the connection. People can buy whatever plan they want, receiving the money in cash doesn't force people into any particular risk pool. Not to mention the ACA majorly combined pools, and in fact did cause premiums to go up for this exact reason. Being part of an employer subsidized insurance plan’s risk pool can result in you being in a better risk pool than the public ones on healthcare.gov. For example, white collar businesses with lots of young, healthy employees like law firms and tech companies.

by ars 4y ago

runnerup 4y ago

> Obamacare dramatically increased deductibles, in the name of providing "coverage" to everyone. What ends up happening is people don't pay the deductive. I don't understand this. Are you saying everyone just lets the bills for the deductible go to debt collections?

netdoll 4y ago
I've heard it often remarked in my circles (wryly and bitterly) that "bankruptcy and gofundme are the American health care plans of choice". So yes, it would seem that for a lot of stuff the plan is just to let it go to collections and then default for as long as you can get away with it. (n.b. I have some relatively significant physical health issues, so if I can't afford medical tourism and/or get on an absurdly good plan before I'm 26, I may end up being forced into a strategy like this)
ars 4y ago
> just lets the bills for the deductible go to debt collections? Yes. Nothing happens as a result. They mail letters, and try to call, and that's about it. It doesn't even hurt credit scores, since they exclude medical debt.

lotsofpulp 4y ago

> Obamacare dramatically increased deductibles, in the name of providing "coverage" to everyone. What ends up happening is people don't pay the deductive. What does this mean? The Affordable Care Act did not directly increase deductibles. It even provided huge subsidies from the young and healthy to the poor and old via age rating factors, restricting of pricing criteria (removal of pre existing conditions exclusions), and implementation of out of pocket maximums. > 2: Gut employer healthcare. Just give everyone cash (in a tax controlled way) that can only pay for healthcare. In a two person household they can pool the cash and it should be enough to pay for coverage, with complete competition. People with lower income would automatically receive subsidies that would help. This was a non starter during Affordable Care Act negotiations due to upper middle class people being up in arms about their premiums going up due to being in the same risk pool as poorer and sicker people.

ars 4y ago
> The Affordable Care Act did not directly increase deductibles. My deductible before the ACA was around $500 before, and around $4000 after. In one year it changed that much. Other people I've spoken with had the same experience. > It even provided huge subsidies from the young and healthy to the poor Only to people not in employee health care plans, which always have high deductibles. > about their premiums going up due to being in the same risk pool as poorer and sicker people. I'm not seeing the connection. People can buy whatever plan they want, receiving the money in cash doesn't force people into any particular risk pool. Not to mention the ACA majorly combined pools, and in fact did cause premiums to go up for this exact reason.
- lotsofpulp 4y ago
  > My deductible before the ACA was around $500 before, and around $4000 after. In one year it changed that much. Other people I've spoken with had the same experience. I meant the deductible increase was not a statutory part of ACA, but an inevitable part due to the drastic increase in benefits (all preventative care, all medicines assuming there was efficacy data, out of pocket maximum instead of benefit maximum). Before ACA, insurance could deny you healthcare easily. After ACA, they had to provide the benefit, even if the medicine cost $1M per month, and the insurance company could not choose to drop you as an insured. > Only to people not in employee health care plans, which always have high deductibles. As far as I know, this applies to all ACA compliant health plans, even ones that employers subsidize: https://www.healthcare.gov/how-plans-set-your-premiums https://www.healthcare.gov/how-plans-set-your-premiums > I'm not seeing the connection. People can buy whatever plan they want, receiving the money in cash doesn't force people into any particular risk pool. Not to mention the ACA majorly combined pools, and in fact did cause premiums to go up for this exact reason. Being part of an employer subsidized insurance plan’s risk pool can result in you being in a better risk pool than the public ones on healthcare.gov. For example, white collar businesses with lots of young, healthy employees like law firms and tech companies.