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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 i

by 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.
- zedpm 13y ago
  So you think that all the younger, healthy people who either didn't have insurance or had it but paid extremely low premiums aren't going to largely offset the added costs? It's a complex issue and it's hard to find the information to do the math, but it seems like a lot of analyses only take into account the negatives without also accounting for the other side. More expensive people will now be in the risk pool? Less expensive people will also be joining. Further, right now we're all paying for people who get care and don't/can't pay, so we have to make sure we don't double count costs. In the same way, if people previously got coverage via Medicaid but will now have a subsidized insurance plan, we shouldn't double count those expenditures.
  - glenra 13y ago
    > "So you think that all the younger, healthy people who either didn't have insurance or had it but paid extremely low premiums aren't going to largely offset the added costs?" Nope, I don't think that will happen at all. Because: competition. If young people are suddenly paying higher premiums than is actuarially appropriate, competing private firms that happen to mostly serve a lot of young people will have a windfall bonus, which they will in short order find ways to compete away until there aren't any excess profits to be had from the young people to subsidize the old people. Remember how under airline rate regulation, planes tended to fly half-empty and meals were free? Stuff like that. Firms will waste money on really expensive real estate next to universities, on gyms, on salaries of doctors and admins that specialize in young-people problems. Meanwhile firms will do everything they can to subtly discourage old people from joining up and to make the service old people get as mediocre as possible while still staying mostly within the letter of the law. Companies that used to be especially good at providing service to the old (albeit for a higher price) will tend to go broke, being replaced with companies that are really good at getting the laws bent in their favor and cutting corners. The cost to provide care to the young will rise through "improvements" the customers don't value as much as they cost; the cost to provide care to the old will decline through degradation that's not worth the money it saves. (Until eventually 3:1 is actually the correct relative valuation of the service provided.)

by zedpm 13y ago

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.
zedpm 13y ago
So you think that all the younger, healthy people who either didn't have insurance or had it but paid extremely low premiums aren't going to largely offset the added costs? It's a complex issue and it's hard to find the information to do the math, but it seems like a lot of analyses only take into account the negatives without also accounting for the other side. More expensive people will now be in the risk pool? Less expensive people will also be joining. Further, right now we're all paying for people who get care and don't/can't pay, so we have to make sure we don't double count costs. In the same way, if people previously got coverage via Medicaid but will now have a subsidized insurance plan, we shouldn't double count those expenditures.
- glenra 13y ago
  > "So you think that all the younger, healthy people who either didn't have insurance or had it but paid extremely low premiums aren't going to largely offset the added costs?" Nope, I don't think that will happen at all. Because: competition. If young people are suddenly paying higher premiums than is actuarially appropriate, competing private firms that happen to mostly serve a lot of young people will have a windfall bonus, which they will in short order find ways to compete away until there aren't any excess profits to be had from the young people to subsidize the old people. Remember how under airline rate regulation, planes tended to fly half-empty and meals were free? Stuff like that. Firms will waste money on really expensive real estate next to universities, on gyms, on salaries of doctors and admins that specialize in young-people problems. Meanwhile firms will do everything they can to subtly discourage old people from joining up and to make the service old people get as mediocre as possible while still staying mostly within the letter of the law. Companies that used to be especially good at providing service to the old (albeit for a higher price) will tend to go broke, being replaced with companies that are really good at getting the laws bent in their favor and cutting corners. The cost to provide care to the young will rise through "improvements" the customers don't value as much as they cost; the cost to provide care to the old will decline through degradation that's not worth the money it saves. (Until eventually 3:1 is actually the correct relative valuation of the service provided.)