3 ms·

I think that is very much setting the wrong bar. This sounds awful and cynical, but you have to compare the deaths the website might lead to, to the estimated

I think that is very much setting the wrong bar. This sounds awful and cynical, but you have to compare the deaths the website might lead to, to the estimated counterfactual - how many would die in the status quo. The ACA prohibits "pre-existing condition" rejections, and it also prohibits "annual and lifetime maximums" (where the insurance companies say, "Oops, looks like we already paid out a million bucks on your cancer, you're on your own now!") And there's also the expanded Medicaid. So you have to factor in the lives that will be saved by the law.

hga 13y ago
Indeed. Although I'll note the not all plans really eliminate maximums, some require 20-30% (from what I've seen) copays after you max out your deductible. People are going to be trying to figure this out for a long time (even if the ACA gets terminated with extreme prejudice in a few years). There are a LOT of factors: The cost of guaranteed issue and community ratings is huge price increases for the under 50 set to subsidize the inherently more expensive 50-64 set (or so I've read, but I'm sure its roughly true). A lot of people are losing the ability to work more than 29 hours at one place, or are just plain getting fired because they now cost more than they can produce, and that loss of wealth will have significant effects. Heck, the #1 piece of advice to get more subsidies is to make less money. Then we get into the messy dynamic effects, where "Europe" is the object lesson: due to the changed game, a bunch of companies are not going to be founded or make it, or fail ... and in the longer term people are going to notice that there's no scenario where being married doesn't result in higher costs. Accounting for the effects of the latter is supremely difficult. And then there's the argument this with all else Obama et. al. are doing (most certainly including the eGOP) is moving the US rapidly to failed nation status. It's hardly beyond the realm of possibility that will kill 10s of millions. If it denies me the medications I need to live, I'll be one of them.... ADDED: now that you've labeled me as dishonest (e.g. for not wanting to provide health care for illegal aliens (which, yes, is a harsh position)), I'm not sure there's much point in continuing to discuss this. But also add the effects of reduced medical innovation. Starting with the 2.3% excise tax on medical devices, which we know from the history of "socialized medicine" will continue. One reason health care is so expensive in the US is that we pay nearly all the burden of new drug development.... If we manage to curtail the already feeble new antibiotic development efforts the results world wide will be measured in ... biblical proportions.
- tunesmith 13y ago
  Just to respond to your first sentence. All ACA plans have a "coinsurance maximum". Meaning, you pay your deductible. Then you pay your 20%-30% coinsurance. And then when you reach your coinsurance maximum, your health insurance pays 100% of your health care costs. The coinsurance maximum varies with the plan but they're not very high. Mine is around $3500, and the biggest I've seen is $12,500 for "out of network care". On top of that, "annual/lifetime maximums" (where the insurance company STOPS paying for your care after a certain amount) are prohibited. And that is different than before. The upshot is that everyone on a health insurance plan truly has an out-of-pocket maximum now. (There's always the chance that I have missed something here, but this understanding is consistent with the intent of the law.) I'm in my low 40's and my premium went down over 20%. I think the premium increases for people are also very much about the improved quality level of the plans, and some of that quality increase is "hidden" due to the old plans having lots of against-the-patient "tricks" that are now outlawed. BTW, you have referred to my other comment a couple of times now. I am not saying it is dishonest to not want to provide health care for undocumented immigrants. I am saying that is intellectually dishonest to have that position, and simultaneously criticize Obamacare for not covering that number of uncovered patients. I believe that if someone criticizes a problem, it is their responsibility to also be in favor of the solution. That's a basic value in rational discourse/dialectic.
  - hga 13y ago
    I'm covered by Medicare so I don't know these details; I do agree it would be insane to have unlimited coinsurance, and a little research shows that it's capped through the out-of-pocket maximum. Which in the Humana plan I just looked includes the larger deductable. WRT to dishonesty, "e.g." -> for example, illegal aliens aren't the only ones included, just the most clear cut and harshest example for me; trust me, you're labeling me as dishonest.

hga 13y ago

Indeed. Although I'll note the not all plans really eliminate maximums, some require 20-30% (from what I've seen) copays after you max out your deductible. People are going to be trying to figure this out for a long time (even if the ACA gets terminated with extreme prejudice in a few years). There are a LOT of factors: The cost of guaranteed issue and community ratings is huge price increases for the under 50 set to subsidize the inherently more expensive 50-64 set (or so I've read, but I'm sure its roughly true). A lot of people are losing the ability to work more than 29 hours at one place, or are just plain getting fired because they now cost more than they can produce, and that loss of wealth will have significant effects. Heck, the #1 piece of advice to get more subsidies is to make less money. Then we get into the messy dynamic effects, where "Europe" is the object lesson: due to the changed game, a bunch of companies are not going to be founded or make it, or fail ... and in the longer term people are going to notice that there's no scenario where being married doesn't result in higher costs. Accounting for the effects of the latter is supremely difficult. And then there's the argument this with all else Obama et. al. are doing (most certainly including the eGOP) is moving the US rapidly to failed nation status. It's hardly beyond the realm of possibility that will kill 10s of millions. If it denies me the medications I need to live, I'll be one of them.... ADDED: now that you've labeled me as dishonest (e.g. for not wanting to provide health care for illegal aliens (which, yes, is a harsh position)), I'm not sure there's much point in continuing to discuss this. But also add the effects of reduced medical innovation. Starting with the 2.3% excise tax on medical devices, which we know from the history of "socialized medicine" will continue. One reason health care is so expensive in the US is that we pay nearly all the burden of new drug development.... If we manage to curtail the already feeble new antibiotic development efforts the results world wide will be measured in ... biblical proportions.

tunesmith 13y ago
Just to respond to your first sentence. All ACA plans have a "coinsurance maximum". Meaning, you pay your deductible. Then you pay your 20%-30% coinsurance. And then when you reach your coinsurance maximum, your health insurance pays 100% of your health care costs. The coinsurance maximum varies with the plan but they're not very high. Mine is around $3500, and the biggest I've seen is $12,500 for "out of network care". On top of that, "annual/lifetime maximums" (where the insurance company STOPS paying for your care after a certain amount) are prohibited. And that is different than before. The upshot is that everyone on a health insurance plan truly has an out-of-pocket maximum now. (There's always the chance that I have missed something here, but this understanding is consistent with the intent of the law.) I'm in my low 40's and my premium went down over 20%. I think the premium increases for people are also very much about the improved quality level of the plans, and some of that quality increase is "hidden" due to the old plans having lots of against-the-patient "tricks" that are now outlawed. BTW, you have referred to my other comment a couple of times now. I am not saying it is dishonest to not want to provide health care for undocumented immigrants. I am saying that is intellectually dishonest to have that position, and simultaneously criticize Obamacare for not covering that number of uncovered patients. I believe that if someone criticizes a problem, it is their responsibility to also be in favor of the solution. That's a basic value in rational discourse/dialectic.
- hga 13y ago
  I'm covered by Medicare so I don't know these details; I do agree it would be insane to have unlimited coinsurance, and a little research shows that it's capped through the out-of-pocket maximum. Which in the Humana plan I just looked includes the larger deductable. WRT to dishonesty, "e.g." -> for example, illegal aliens aren't the only ones included, just the most clear cut and harshest example for me; trust me, you're labeling me as dishonest.