OT: Best Discussion yet on Obamacare IMO: Nixon

[joec]

SDR, I agree with you that you were lied to when Obama said people can keep the coverage that they wanted. There’s enough heat on the prez that he obviously said such terms enough that enough people felt that was true.

My point was that sure, you can make the call as to what coverage you needed, etc…but at the end of the day, I really doubt you or anyone can know exactly all future ailments that come up. Not covered for prostate cancer? Well, I guess you are on the train to death then or cough up a few mil to try to treat it with chemo and whatever meds are needed.

Oh, your father had heart disease, we’ll just exclude that as well and give you the plan without heart disease coverage.

Again, it’s nice to think we’re so smart with our finances that we can pay for all our medical ailments. But seriously, after seeing a 400k bill, I think nearly EVERYONE, will be in a shit of hurt trying to pay or renegotiate that type of bill. Also, maybe it isn’t you, maybe a parent or son gets a massive bill…do you really want to put your own finances to help out?

Like a few others have said, I’m ok with knowing that I would be covered than to fly blind. Sorta like if you bought home owners insurance, but they specifically exclude fire in San Diego…but you didn’t see it, is this good for everyone if everyone else still has to pay?

Back to maybe what you are arguing, yes, you got royally fucked and lied to by Obama and you are right to get pissed off and curse/swear and everything, too bad so many other people in the US sucks in terms of taking care of their own health and have no money/broke/etc…

…and everyone else has to pay for their poor lifestyle choices.

[scaredyclassic]

I have to pee at 415 am. I hope that’s covered.

[EconProf]

My son is a single, healthy 30-year old. He has always bought inexpensive health insurance on his own with a high deductible. He pays the first $2000 per year of any medical expenses and 20% of anything over that amount. Very cheap because at his age the insurance company has little risk and competition with other insurance companies forces them to price it low. Also, he shops around when he needs medical service, offers to pay up front, and gets huge discounts when the provider realizes they don’t have to deal with insurance paperwork. In other words, he is dealing in the private sector he has found the right solution for his situation, and puts no burden on others to subsidize his medical needs.
Now, under Obamacare, he will see his costs double or triple because he will have to pay for older, less healthy people. The government is imposing a one-size-fits-all plan upon us rather than letting us pick and chose what best fits our situation. The result is hidden subsidies to some and hidden costs to others. For all you Piggs under 40, and especially those under 30, the coming rate shock will be a wakeup call. Interestingly, the under 30 year olds were those who most likely voted for Obama.

[ocrenter]

[quote=EconProf]My son is a single, healthy 30-year old. He has always bought inexpensive health insurance on his own with a high deductible. He pays the first $2000 per year of any medical expenses and 20% of anything over that amount. Very cheap because at his age the insurance company has little risk and competition with other insurance companies forces them to price it low. Also, he shops around when he needs medical service, offers to pay up front, and gets huge discounts when the provider realizes they don’t have to deal with insurance paperwork. In other words, he is dealing in the private sector he has found the right solution for his situation, and puts no burden on others to subsidize his medical needs.
Now, under Obamacare, he will see his costs double or triple because he will have to pay for older, less healthy people. The government is imposing a one-size-fits-all plan upon us rather than letting us pick and chose what best fits our situation. The result is hidden subsidies to some and hidden costs to others. For all you Piggs under 40, and especially those under 30, the coming rate shock will be a wakeup call. Interestingly, the under 30 year olds were those who most likely voted for Obama.[/quote]

But isn’t this the main idea behind all insurance scheme? Essentially the majority of non-users or minimal users are subsidizing the “superusers”. Aka shared risk. Is shared risk really capitalistic? No. Actually, once you are within an insurance system, it is very communistic. The choices a user makes once they have insurance are no longer driven by market forces because everything is well subsidized. And because it is fully subsidized by your fellow insured, you can pick from whatever care you like. But here’s the rub: doctors are incentivized to recommend the MOST. Therefore, a twisted knee turns into a MRI and a visit to the orthopedic specialist. Because you now have insurance, you are buffered against market forces and therefore, you go along with the recommendations. Which ultimately drive up the cost.

This system will therefore drive up cost even without having superusers in the game, because the doctors are making capitalistic recommendations but the patients are shielded from market forces by having the insurance pay for all of the recommendations.

This system will therefore collapse on it’s own weight IF superusers are included. This is why all medical insurance companies work so hard to remove superusers from their system.

So let’s look at the system in place before Obamacare. They excluded the superusers, but year after year the insurance rate continued to go up at rediculous levels. The ones that need healthcare were denied care, and the rest of us got more care then we really needed. The end result is IF you are unfortunate enough to become a superuser, plan on filing for BK even if you have insurance.

Obamacare at least tries to rectify this by forcing acceptance of the superusers back into the system, but he needed the nonusers like your son to buy into the program as well, otherwise, like I said before, the systems was already barely afloat and would collapse if they take in those that need the most care.

Why Obamacare won’t work? Because it doesn’t address the fundamental problem of doctors incentivized to recommend the most possible care and the patients agreeing to them because they are shielded from paying the true market price of those recommendations.

The only way out is get out of this hydrid system of capitalistic providers and communistic consumers. Which as you can see, only serve to drive up cost to no end without serving people that need it the most.

We have two options, full blown socialist model of single payer. You get the doctors out of the game of incentives for doing more for more profit. They are the main cost drivers under the current system. Remember, the same doctor without the kickback from his radiologist and orthopedic buddies will likely just recommend some icing and course of high dose ibuprofen for that twisted knee instead of the MRI and a visit to orthopedics. The single payer has the power of monopoly to set how much they are willing to pay for supplies and drugs, cost can then come down..with the cost controlled, we can take care of our superusers.

Our other option is a fully capitalistic model. The government completely get out of the game of health care. Superusers should just move out of the country and if you can’t pay, you are refused service, period. This model does work, see China and Mexico and Thailand. The healthcare cost for these countries are very minimal.

But that’s really the two choices we got, anything in between really is just a big FAIL.

[spdrun]

I’m early-30s and my rates aren’t going up a lot next year. Thing is that NY has had community rating for a few decades now, so the “Obamacare” model already exists here on paper.

[Jazzman]

[quote=ocrenter]
But isn’t this the main idea behind all insurance scheme? Essentially the majority of non-users or minimal users are subsidizing the “superusers”. Aka shared risk.
That is correct, but the term “superuser” has negative connotations. You can be the same risk profile as someone else but through misfortune be a so-called “superuser.” I’m not a scientist, but I believe genome mapping hasn’t quite developed to the stage where the risk of all diseases can be predetermined. And then there’s accidents.
…doctors are incentivized to recommend the MOST. Therefore, a twisted knee turns into a MRI and a visit to the orthopedic specialist. Which ultimately drive up the cost.
Doctors should be rewarded for preventive practices and results thereof. It has proven effective in other systems.

This system will therefore collapse on it’s own weight IF superusers are included. This is why all medical insurance companies work so hard to remove superusers from their system.
I think it fair to say that remains to be seen. Presumably, actuarial calculations took that into account.

…[I]F you are unfortunate enough to become a superuser, plan on filing for BK even if you have insurance.

Obamacare at least tries to rectify this by forcing acceptance of the superusers back into the system, but he needed the nonusers like your son to buy into the program as well, otherwise, like I said before, the systems was already barely afloat and would collapse if they take in those that need the most care.
Bankruptcy insurance seems a fitting description of some insurance policies. Each generation will be dependent on the next generation so everything evens out. Isn’t social security funded similarly?

We have two options, full blown socialist model of single payer. You get the doctors out of the game of incentives for doing more for more profit. They are the main cost drivers under the current system. Remember, the same doctor without the kickback from his radiologist and orthopedic buddies will likely just recommend some icing and course of high dose ibuprofen for that twisted knee instead of the MRI and a visit to orthopedics. The single payer has the power of monopoly to set how much they are willing to pay for supplies and drugs, cost can then come down..with the cost controlled, we can take care of our superusers.
I don’t agree with the ideological frameworks being used but agree in principle with the costs and incentives argument.

Our other option is a fully capitalistic model. The government completely get out of the game of health care. Superusers should just move out of the country and if you can’t pay, you are refused service, period. This model does work, see China and Mexico and Thailand. The healthcare cost for these countries are very minimal.

But that’s really the two choices we got, anything in between really is just a big FAIL.
I’m guessing the second option is a rhetorical suggestion.

Drug companies, training, medical equipment companies, bureaucracy, duplication, litigation, and research must also contribute significantly to the cost of insurance. This is not just about insurance. The core of the problem is costs, so why not apply reductionist principles and surgically remove the tumor as opposed to applying palliatives. In other words, treat the disease, not the symptoms.

[/quote]

[Jazzman]

[quote=EconProf]My son is a single, healthy 30-year old. He has always bought inexpensive health insurance on his own with a high deductible. He pays the first $2000 per year of any medical expenses and 20% of anything over that amount. Very cheap because at his age the insurance company has little risk and competition with other insurance companies forces them to price it low. Also, he shops around when he needs medical service, offers to pay up front, and gets huge discounts when the provider realizes they don’t have to deal with insurance paperwork. In other words, he is dealing in the private sector he has found the right solution for his situation, and puts no burden on others to subsidize his medical needs.
Now, under Obamacare, he will see his costs double or triple because he will have to pay for older, less healthy people. The government is imposing a one-size-fits-all plan upon us rather than letting us pick and chose what best fits our situation. The result is hidden subsidies to some and hidden costs to others. For all you Piggs under 40, and especially those under 30, the coming rate shock will be a wakeup call. Interestingly, the under 30 year olds were those who most likely voted for Obama.[/quote]
Supposing your son falls ill (God forbid) when he is older. Won’t he be thankful the next generation is subsidizing him?

[CA renter]

[quote=EconProf]My son is a single, healthy 30-year old. He has always bought inexpensive health insurance on his own with a high deductible. He pays the first $2000 per year of any medical expenses and 20% of anything over that amount. Very cheap because at his age the insurance company has little risk and competition with other insurance companies forces them to price it low. Also, he shops around when he needs medical service, offers to pay up front, and gets huge discounts when the provider realizes they don’t have to deal with insurance paperwork. In other words, he is dealing in the private sector he has found the right solution for his situation, and puts no burden on others to subsidize his medical needs.
Now, under Obamacare, he will see his costs double or triple because he will have to pay for older, less healthy people. The government is imposing a one-size-fits-all plan upon us rather than letting us pick and chose what best fits our situation. The result is hidden subsidies to some and hidden costs to others. For all you Piggs under 40, and especially those under 30, the coming rate shock will be a wakeup call. Interestingly, the under 30 year olds were those who most likely voted for Obama.[/quote]

Your son is lucky that he’s healthy and is able to get cheap insurance. For many his age, even though they’ve lived healthy lifestyles, this is not possible because they were some of the unlucky ones. Cancer, MS, various genetic diseases and abnormalities, etc. are indiscriminate. I know a handful of VERY health conscious people who had life-threatening medical issues at fairly young ages (cancer, strokes, heart attacks). It was 100% random and had nothing at all to do with their lifestyles.

While your son might be subsidizing the older today, in a couple of short decades, younger people will be subsidizing him. As OCR noted, this is the very essence of insurance. If you want a system that is completely without subsidies, there would be no insurance market at all.

Also, I’ve often gone as a cash patient, and was never able to get the same discount that my insurer was able to get. Many doctors won’t offer a cash discount under any circumstances.

[CA renter]

Another thing that I find interesting is that in countries with socialized medicine, the governments tend to be more diligent in other areas that affect health. Many toxic chemicals and additives are banned in places where there is socialized medicine, while in the US, we are constantly being fed a steady stream of carcinogens and other harmful substances — in our water supplies, food packaging, certain pesticides and herbicides, GMOs that aren’t labeled, personal care products, etc.

Could it be that since our govt has no incentive to maintain a healthy population — one might argue that some of their biggest contributors ensure that these chemicals remain in our system — we are being exposed to more toxic substances?

Personally, I want a healthcare system (a total society, as a matter of fact) that puts a person’s health as a top priority, not profits. In a for-profit healthcare system, the ideal patient is one who is chronically ill and who needs to take multiple medications and have multiple medical interventions and screenings for life. With the major conflicts of interest inherent in a for-profit system, it’s bound to be the most expensive system leading to the sickest population. And, lo and behold, that’s exactly what we’ve got under the current system relative to other developed nations with socialized medicine.

[Anonymous]

Anyone who claims that they actually understand what they are getting from their health insurance policy is suffering a severe case of hubris.

I doubt that most attorneys who specialize in health insurance even understand their own policies completely.

Healthcare is the ultimate example of economic information asymmetry.

Before ACA, lots of people were paying health insurance premiums.

Far fewer actually had insurance.

[ocrenter]

[quote=harvey]Anyone who claims that they actually understand what they are getting from their health insurance policy is suffering a severe case of hubris.

I doubt that most attorneys who specialize in health insurance even understand their own policies completely.

Healthcare is the ultimate example of economic information asymmetry.

Before ACA, lots of people were paying health insurance premiums.

Far fewer actually had insurance.[/quote]

+1

That’s why even with “insurance”, if you are unlucky enough to become a superuser, the insurance companies would do their very best to get rid of you. Because their actuaries told them so.

[joec]

Agree with a lot of the recent posts. I’m probably one of the healthiest people I know. Never broke a bone, never got sick or missed work “once” since my last job after about 15 years of work. Rarely see the doctor if ever…All that said, things change or will change within 10-20 years for many folks.

In regards to your son, like some examples, if this plays out and he eventually gets married, has kids, spouse, etc…this law would help him immensely. Maternity/Neonatal care alone could probably be impossible to get even for people who are willing to pay. I know since for me, I looked…It was expensive, only 1 option in CA previously and crappy.

This sorta like reminds me of working at startups. When I was single and put in the long long hours, there were parents who had to leave early to pick up their kids, go to pta meetings, etc…

You don’t think too much about it because eventually, that could be you (which it is now for me). In a company, you don’t feel as bad maybe since they are a friend/co-worker, but in the US of A, we just naturally dislike the poor/sick slob I guess and don’t want to subsidize the next guy even though in 10 years, we’re that next guy.

It’d be interesting to see how all this plays out in 5-10 years. It’s not perfect, but unlike car insurance, health care is sorta required or people, like now just use emergency rooms and we all still pay.

Someone brought up the interesting point that even though we already excluded all the sickly people with the current insurance situation, the costs was still soaring.

I’m glad that at least something is being tried.

Isn’t Romney’s health care for all in Mass working out pretty well actually?

[ocrenter]

[quote=Jazzman]
That is correct, but the term “superuser” has negative connotations. You can be the same risk profile as someone else but through misfortune be a so-called “superuser.” I’m not a scientist, but I believe genome mapping hasn’t quite developed to the stage where the risk of all diseases can be predetermined. And then there’s accidents.

Doctors should be rewarded for preventive practices and results thereof. It has proven effective in other systems.

I think it fair to say that remains to be seen. Presumably, actuarial calculations took that into account.

Bankruptcy insurance seems a fitting description of some insurance policies. Each generation will be dependent on the next generation so everything evens out. Isn’t social security funded similarly?

I don’t agree with the ideological frameworks being used but agree in principle with the costs and incentives argument.

I’m guessing the second option is a rhetorical suggestion.

Drug companies, training, medical equipment companies, bureaucracy, duplication, litigation, and research must also contribute significantly to the cost of insurance. This is not just about insurance. The core of the problem is costs, so why not apply reductionist principles and surgically remove the tumor as opposed to applying palliatives. In other words, treat the disease, not the symptoms.
[/quote]

You’re right, superuser does have a negative connotation. I used it because I purposely wanted to dehumanize everything and spin this into a pure cost-wise analysis. And to point out what would truly be the best option if our purpose is to save dollars as well as to include as many of our citizenry as possible.

Doctors have been rewarded with preventive care awards. Most plans have a P4P system (pay for performance) system in place. But old habits die hard. And remember, a primary can make far more seeing 40 patients then 20 patients. And when you see 40 patients, it is FAR EASIER to send the twisted knee for the MRI and the ortho consult. Also keep in mind that a lot of PPO plans allow for self referrals. Which means a guy with heart burn may self refer to a cardiologist first, gets the EKG and the treadmill plus a CT coronary. After the “million dollar” workup, then referred to GI who then does a scope and put him on Nexium (the most expensive option but the rep was in with a free lunch earlier in the day.) Bottomline, without a gatekeeper doc who’s given sufficient time and compensation who’s also monitored on his/her prescription patterns and referrals and imagings, the system’s default is to spend as much as possible.

Funny you termed it bankruptcy insurance. I like that. except in a lot of cases as someone becomes a “superuser”, they also end up getting laid off or fired because of the reduced productivity, which means their insurance then disappears. This is why it is SO AWFUL to link health insurance to work. Again, by linking insurance to work, you are selecting for patients that are healthy enough to work. and when someone is no longer healthy enough to do so, there goes the insurance as well.

The completely capitalistic model was somewhat rhetorical, except to point out that we do not have a RIGHT to be treated, even if you are having crushing chest pain in front of the ER doors. We have a guaranteed right to bear arms, but the Founding Fathers did not grant a RIGHT for a pregnant woman to be delivered in a clean hospital bed with trained professionals. So if the population of this country decides they are willing to stomach seeing people turned away at the ER and die on the streets, we CAN do that.

[Jazzman]

Do you work in healthcare OCR?

[SD Realtor]

Harvey I don’t quite agree with your assessment. For several years my family had a very high deductible plan and we had a very good understanding of that plan. For many of those years we never reached the point where the plan paid for anything but in one of those years we did and everything actually worked out okay.

So your implication is that basically most people understand the plan that they are paying premiums for?

[Author]

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