6 ms·

Apparently addressing a quasi-free-rider issue with health insurance (those folks who pay almost nothing but still get coverage) is a bad thing. I mean, yeah, i

by zedpm 13y ago

Apparently addressing a quasi-free-rider issue with health insurance (those folks who pay almost nothing but still get coverage) is a bad thing. I mean, yeah, it's a bad thing for them, in the same way that it's bad whenever someone has to contribute to society to any meaningful degree. These complaints about an individual's premium going up massively (e.g. 100%) under ACA appear to be mostly the result of extremely limited plans being phased out and replaced with more comprehensive ones. That is, the old cheap plan barely covered anything but technically qualified as insurance. The new, more expensive plan that's the minimum includes much more broad coverage. Part of tackling extremely high costs for health care is having more things covered so providers don't have to write them off; currently people with little or no insurance coverage get care and stick the rest of us with the costs. The idea here is to expand the coverage so those folks who used to have pseudo-insurance that didn't actually cover much would have proper coverage (which costs more than the skimpy plan they previously had). It is a pain and a burden for some people? Sure, just like everything else in life. Policies change all the time and there are always winners and losers; the best policy in the world ends up impacting someone negatively. Discussing issues like adults means understanding this and not simply ignoring the good and the sensible so we can shriek and moan about the bad bits.

hga 13y ago
Were plans that didn't cover your children through age 26 "pseudo-insurance"??? I've read there's around 10 things including that clearly indefensible one mandated; perhaps these are on top of the now outlawed high deductible major medical true insurance plans that I've bought in times past. Without going through the entire list your thesis is a also indefensible. And then there's stuff like the 2.3% excise tax on medical devices. You can't deny that that doesn't raise costs across the board. Another thing I wonder about: somewhere on the net there's a general tools for looking at Obamacare policy costs. Someone ran a bunch of scenarios on it and he found that there was not a single one where being married wasn't more expensive that living together.... Anyway, you may say this is better, and it could be a legitimately debatable point, but it ignores one of the major points the article makes: "But the laws’ supporters and enforcers don’t want you to know that, because it would violate the President’s incessantly repeated promise that nothing would change for the people that Obamacare doesn’t directly help. If you shop for Obamacare-based coverage without knowing if you qualify for subsidies, you might be discouraged by the law’s steep costs." The Obamacare that was sold to the public was a lie. It's hard to see how lying to take control of 1/6th of the economy is going to end well, no matter how much the site can disguise it for some people. We're already getting some delightful gems like http://www.mercurynews.com/nation-world/ci_24248486/obamacares-winners-and-losers-bay-area http://www.mercurynews.com/nation-world/ci_24248486/obamacar... ""I was laughing at Boehner -- until the mail came today," Waschura said, referring to House Speaker John Boehner, who is leading the Republican charge to defund Obamacare. "I really don't like the Republican tactics, but at least now I can understand why they are so pissed about this. When you take $10,000 out of my family's pocket each year, that's otherwise disposable income or retirement savings that will not be going into our local economy." Both Vinson and Waschura have adjusted gross incomes greater than four times the federal poverty level -- the cutoff for a tax credit. And while both said they anticipated their rates would go up, they didn't realize they would rise so much. "Of course, I want people to have health care," Vinson said. "I just didn't realize I would be the one who was going to pay for it personally.""
- zedpm 13y ago
  Undoubtedly it's a hard problem, and as I noted, some people come out worse under ACA; some come out better. It's unfortunate that people who truly don't want insurance are obligated to purchase it, but it's not clear how to avoid that without having a system collapse due to free-riders. Your point about Obama's promise that nothing would change for people who aren't directly helped has some validity to it. People who had very minimal plans and were happy with those are forced into more extensive (and expensive) plans; that's clearly true. What he should have said was that nothing has to change for people who already have insurance plans that meet the minimum standard (which is a lot of us). As for the linked article, it clearly illustrates that, as with every other policy in the history of the world, there are winners and losers. Waschura's case would seem to be an outlier.
  - glenra 13y ago
    > What he should have said was that nothing has to change for people who already have insurance plans that meet the minimum standard (which is a lot of us). Nah, that wouldn't have been true either. All insurance plans got more expensive to maintain under the hood due to things like the 3:1 pricing restriction. As a result, some people whose plans "met the minimum" in terms of what they covered are losing coverage because their employers can't afford it any more. Employers are dropping domestic partner coverage and forcing part-timers who would have been covered to drop their hours so they aren't anymore - that stuff would even affect people who had plans that "meet the minimum" in terms of benefits. > Waschura's case would seem to be an outlier. The 3:1 restriction makes healthcare plans significantly more expensive for pretty much anybody under 50. If you're under 50, relatively healthy, and making enough that the subsidies don't seriously kick in, you're probably in the same boat as Waschura (though the specific numbers will vary). Which is a hell of a lot of people, not just a few "outliers".
    - hga 13y ago
      That's very interesting, it suggests a lot of this is to cover the definitely expensive age 50-64 year old window, after which Medicare kicks in. And, yeah, we should not forget all those who are losing family or 30+ hours/week coverage, the stories about them are legion.
vinceguidry 13y ago
I don't see it as so much a free-rider issue because health care costs in this country are ridiculously, astronomically high, and the reason is definitely not the free-riders, it's the greedy-ass corporations being deliberately obtuse about pricing so as to extract as much cash from the system as they can before we shut them down. We have a free-rider 'problem' here because of the disgusting prices. I'd gladly buy health care coverage (which I'd never use) if it were about as cheap as my car insurance.
- hga 13y ago
  Ummm, since a bit after WWII every emergency room in the country has had to accept and treat anyone who walks in their door (yeah, sometimes games are played to try to shift a patient to another one, but they still end up getting treated somewhere). If you don't call the patients who do that without any coverage "free riders", I'm not sure what to say. And obviously this is why we don't have very many horror stories of people denied treatment. CMS claims otherwise, but there are convincing analyses that Medicare overall shifts costs to others. And what about the rest of the world forcing drug companies to sell their products as a bit about cost? Our market pays for nearly all new drug development costs ... which of course many want to "fix".
  - glenra 13y ago
    > If you don't call the patients who do that without any coverage "free riders", I'm not sure what to say. Surely some people walk in the door without coverage and then - here's a shock - pay their bill later. You know, with actual money. Possibly after a bit of negotiation, but still...
    - hga 13y ago
      But we also know there are a lot of people who never pay, and never intend to/can't pay; a moment with Google will find things like ((http://www.pantagraph.com/news/national/trauma-in-the-er-who-pays-for-the-uninsured/article_43f6f99e-bae9-11e1-bece-001a4bcf887a.html http://www.pantagraph.com/news/national/trauma-in-the-er-who...): "Nationwide, the uninsured account for nearly a fifth of emergency department visits. [...] Last year, MedStar Washington reported delivering $107.2 million in care for which it was not reimbursed. Nationwide, the total amount of uncompensated care provided to the uninsured reached an estimated $56 billion in 2008, according to one study." And there a very few extreme outliers who make more than a hundred visits a year. Anyway, my point stands, I can trivially point to one major class of free riders, which deflates wild claims that it's all the fault of greedy corporations.
greenyoda 13y ago
"Apparently addressing a quasi-free-rider issue with health insurance (those folks who pay almost nothing but still get coverage) is a bad thing." Those folks who paid almost nothing but still got coverage were healthy, young people, who have many fewer costly medical problems than older people. You can be sure that they paid enough in premiums for the insurance companies to make a profit on them (on average) after paying for their medical expenses, since insurance companies are for-profit businesses that don't like to lose money. The fact that they were only paying their own way and not subsidizing someone else's insurance rates by overpaying for their own coverage doesn't sound like a "free ride" to me. Consider car insurance: Should middle-aged drivers with clean driving records (who pay the lowest rates) pay higher rates so that teenagers, who get into more accidents, can have more affordable rates? Or should the rates be proportional to the amount the insurance company has to pay out for a particular group of drivers? If "health insurance" is really insurance against a predictable set of risks, why should it be different from auto insurance?

by zedpm 13y ago

hga 13y ago

Were plans that didn't cover your children through age 26 "pseudo-insurance"??? I've read there's around 10 things including that clearly indefensible one mandated; perhaps these are on top of the now outlawed high deductible major medical true insurance plans that I've bought in times past. Without going through the entire list your thesis is a also indefensible. And then there's stuff like the 2.3% excise tax on medical devices. You can't deny that that doesn't raise costs across the board. Another thing I wonder about: somewhere on the net there's a general tools for looking at Obamacare policy costs. Someone ran a bunch of scenarios on it and he found that there was not a single one where being married wasn't more expensive that living together.... Anyway, you may say this is better, and it could be a legitimately debatable point, but it ignores one of the major points the article makes: "But the laws’ supporters and enforcers don’t want you to know that, because it would violate the President’s incessantly repeated promise that nothing would change for the people that Obamacare doesn’t directly help. If you shop for Obamacare-based coverage without knowing if you qualify for subsidies, you might be discouraged by the law’s steep costs." The Obamacare that was sold to the public was a lie. It's hard to see how lying to take control of 1/6th of the economy is going to end well, no matter how much the site can disguise it for some people. We're already getting some delightful gems like http://www.mercurynews.com/nation-world/ci_24248486/obamacares-winners-and-losers-bay-area http://www.mercurynews.com/nation-world/ci_24248486/obamacar... ""I was laughing at Boehner -- until the mail came today," Waschura said, referring to House Speaker John Boehner, who is leading the Republican charge to defund Obamacare. "I really don't like the Republican tactics, but at least now I can understand why they are so pissed about this. When you take $10,000 out of my family's pocket each year, that's otherwise disposable income or retirement savings that will not be going into our local economy." Both Vinson and Waschura have adjusted gross incomes greater than four times the federal poverty level -- the cutoff for a tax credit. And while both said they anticipated their rates would go up, they didn't realize they would rise so much. "Of course, I want people to have health care," Vinson said. "I just didn't realize I would be the one who was going to pay for it personally.""

zedpm 13y ago
Undoubtedly it's a hard problem, and as I noted, some people come out worse under ACA; some come out better. It's unfortunate that people who truly don't want insurance are obligated to purchase it, but it's not clear how to avoid that without having a system collapse due to free-riders. Your point about Obama's promise that nothing would change for people who aren't directly helped has some validity to it. People who had very minimal plans and were happy with those are forced into more extensive (and expensive) plans; that's clearly true. What he should have said was that nothing has to change for people who already have insurance plans that meet the minimum standard (which is a lot of us). As for the linked article, it clearly illustrates that, as with every other policy in the history of the world, there are winners and losers. Waschura's case would seem to be an outlier.
- glenra 13y ago
  > What he should have said was that nothing has to change for people who already have insurance plans that meet the minimum standard (which is a lot of us). Nah, that wouldn't have been true either. All insurance plans got more expensive to maintain under the hood due to things like the 3:1 pricing restriction. As a result, some people whose plans "met the minimum" in terms of what they covered are losing coverage because their employers can't afford it any more. Employers are dropping domestic partner coverage and forcing part-timers who would have been covered to drop their hours so they aren't anymore - that stuff would even affect people who had plans that "meet the minimum" in terms of benefits. > Waschura's case would seem to be an outlier. The 3:1 restriction makes healthcare plans significantly more expensive for pretty much anybody under 50. If you're under 50, relatively healthy, and making enough that the subsidies don't seriously kick in, you're probably in the same boat as Waschura (though the specific numbers will vary). Which is a hell of a lot of people, not just a few "outliers".
  - hga 13y ago
    That's very interesting, it suggests a lot of this is to cover the definitely expensive age 50-64 year old window, after which Medicare kicks in. And, yeah, we should not forget all those who are losing family or 30+ hours/week coverage, the stories about them are legion.

vinceguidry 13y ago

I don't see it as so much a free-rider issue because health care costs in this country are ridiculously, astronomically high, and the reason is definitely not the free-riders, it's the greedy-ass corporations being deliberately obtuse about pricing so as to extract as much cash from the system as they can before we shut them down. We have a free-rider 'problem' here because of the disgusting prices. I'd gladly buy health care coverage (which I'd never use) if it were about as cheap as my car insurance.

hga 13y ago
Ummm, since a bit after WWII every emergency room in the country has had to accept and treat anyone who walks in their door (yeah, sometimes games are played to try to shift a patient to another one, but they still end up getting treated somewhere). If you don't call the patients who do that without any coverage "free riders", I'm not sure what to say. And obviously this is why we don't have very many horror stories of people denied treatment. CMS claims otherwise, but there are convincing analyses that Medicare overall shifts costs to others. And what about the rest of the world forcing drug companies to sell their products as a bit about cost? Our market pays for nearly all new drug development costs ... which of course many want to "fix".
- glenra 13y ago
  > If you don't call the patients who do that without any coverage "free riders", I'm not sure what to say. Surely some people walk in the door without coverage and then - here's a shock - pay their bill later. You know, with actual money. Possibly after a bit of negotiation, but still...
  - hga 13y ago
    But we also know there are a lot of people who never pay, and never intend to/can't pay; a moment with Google will find things like ((http://www.pantagraph.com/news/national/trauma-in-the-er-who-pays-for-the-uninsured/article_43f6f99e-bae9-11e1-bece-001a4bcf887a.html http://www.pantagraph.com/news/national/trauma-in-the-er-who...): "Nationwide, the uninsured account for nearly a fifth of emergency department visits. [...] Last year, MedStar Washington reported delivering $107.2 million in care for which it was not reimbursed. Nationwide, the total amount of uncompensated care provided to the uninsured reached an estimated $56 billion in 2008, according to one study." And there a very few extreme outliers who make more than a hundred visits a year. Anyway, my point stands, I can trivially point to one major class of free riders, which deflates wild claims that it's all the fault of greedy corporations.

greenyoda 13y ago

"Apparently addressing a quasi-free-rider issue with health insurance (those folks who pay almost nothing but still get coverage) is a bad thing." Those folks who paid almost nothing but still got coverage were healthy, young people, who have many fewer costly medical problems than older people. You can be sure that they paid enough in premiums for the insurance companies to make a profit on them (on average) after paying for their medical expenses, since insurance companies are for-profit businesses that don't like to lose money. The fact that they were only paying their own way and not subsidizing someone else's insurance rates by overpaying for their own coverage doesn't sound like a "free ride" to me. Consider car insurance: Should middle-aged drivers with clean driving records (who pay the lowest rates) pay higher rates so that teenagers, who get into more accidents, can have more affordable rates? Or should the rates be proportional to the amount the insurance company has to pay out for a particular group of drivers? If "health insurance" is really insurance against a predictable set of risks, why should it be different from auto insurance?