OT: Is STEM the big lie

[bearishgurl]

[quote=SK in CV][quote=bearishgurl]
SK, why don’t you leave “border crossing” and your other racist comments out of this discussion? The “border crossing” situation will either get fixed …. or it won’t, but we won’t know until after “We, the People” have spoken. They’re going to be speaking loud and clear in your border state (AZ) as well, so stay tuned.[/quote]

LOL! it’s going to get fixed? With a wall? By a president with a rodent on his head?[/quote]Umm, it’s entirely possible that your peeps in AZ may decide that that’s what they want. Time will tell.

https://www.texastribune.org/2016/03/30/border-patrol-union-endorses-trump-president/

[bearishgurl]

[quote=SK in CV][quote=bearishgurl]The vast majority of people who sign up for coverage on the exchanges DO take a subsidy. Why would anyone go thru all those layers of BS just to have a healthplan if they weren’t going to get a subsidy?

[/quote]

Because they want and need insurance. And believe it or not, in some markets, there are very decent choices at identical rates as are available outside the exchange. I bought insurance on the exchange with no subsidy for almost a year. My wife purchased insurance on a different state exchange for almost 2 years with no subsidy. Neither of us ever had to enter any income data.

I did the same thing for my daughter on the CA exchange last year for the 3 months she was without insurance between school and her job starting. No income entered. And guess what? with her return she got a premium tax credit. It’s possible that just looking at her tax return, the state of California would have liked to push her into medi-cal, but they never got the chance. And they would have been wrong in doing so. But I never had to fight the fight.

Not everyone who purchases insurance through state and federal exchange receive subsidies.[/quote]Yes, SK, I have checked out your suggestion, above, with a CC enrolled agent-navigator who works out with me, which you made earlier to me on the election thread. If, God forbid, I am forced to continue my CC marketplace PPO into 2017, I am going to do exactly what you have suggested here during opening enrollment this fall. I will drop my request for a subsidy (I get a monthly healthcare allowance from my retirement assn and my subsidy is small, anyway). If I receive a premium tax credit in 2018 (and I should), then so be it. That will be great! This is far preferable than worrying about whether I actually have any coverage from week to week after having my monthly premiums taken out automatically the 1st of every month.

Here in SD, we don’t yet have “very decent choices at identical rates.” SD County (Region 19) is mostly sewed up with longtime Kaiser (HMO), Sharp (EPO) and Tricare (mostly HMO, some PPO) members, Most of the people I know who have HMO’s/regional EPOs (incl Anthem) like the “system” they are in and never take lengthy “road trips” like I do. Many of them stay in SD County and SoCal and just take staycations and day trips and so Sharp (in SD County only) works out fine for them because they were born here (or moved here as a young child 50-60 years ago) and have family here. However, I am out of state 4-8 weeks per year on the road (mostly visiting family) and need nationwide coverage.

I’d like to see the 6 PPO’s who defected from CA at the end of 2013 come back into SD County and offer competitive plans on the open market (above Bronze level). So far, that hasn’t happened.

If I could have qualified for Tricare for the rest of my life, I would have been on Tricare Standard (a PPO) and would not be having this discussion because I never would have signed up on the state exchange. Tricare Standard has a large network and nationwide coverage for whatever services I want to use (currently administered by UHP).

SK, your daughter’s situation was short term. Had she had to pay 100% of her premium long-term, it could have become cost-prohibitive for her, causing her to request a subsidy (and become inadvertent “prey” for trolling Medi-Cal workers to make “adjustments” to her reported income and bump her down to Medi-Cal behind her back). I understand when you say it would have be wrong to place her on Medi-Cal but she would have been on it a minimum of nine months had she been force-placed into it. Only a County Medi-Cal worker can “release” her from Medi-Cal. The truth is … CC and Medi-Cal don’t care if they made a mistake by bumping someone into Medi-Cal. The burden of proof is on the individual who was force-placed in Medi-Cal to appeal CDHS’ finding that they are “Medi-Cal eligible” or “Magi Medi-Cal eligible.” Your daughter (or any appellant) would have had to appeal the finding all the way to an administrative hearing, where, according to the CA agent/navigator blogs I’ve been reading, the ALJ is ruling nearly 100% on behalf of the appellants. It then typically takes Medi-Cal another 4+ months to adhere to the ALJ ruling and “release” the appellant from the “Medi-Cal vise grip” so they can buy some insurance (marketplace or otherwise). And that’s only with constant prodding by the appellant and/or their agent/navigator! This same appellant’s CC account could easily be hijacked subsequent times (after their ALJ win), causing them to be bumped into Medi-Cal again, with or without their knowledge. The incompetent bureaucrats who run Medi-Cal (and even the “pseudo gubment agency” that is CC) are essentially “immune” from all the egregious mistakes they make with people’s lives! It is disheartening that a lot of “middle class” people who, in good faith, signed up for marketplace plans with subsidies are essentially finding themselves constantly banging their heads against a brick wall to keep their rights from being trampled upon. Most people (esp the English-challenged) don’t have the knowledge or wherewithal to “fight the system” and that’s what CC/Medi-Cal count on to keep as many people OFF marketplace plans and ON the gubment dole, instead (with very, very few providers to choose from … IF ANY, in some locations). CC/MC doesn’t care about that little problem, either.

I’m happy to hear that your daughter landed a job with benefits quickly and I hope she is able to stay employed FT for the duration.

[ucodegen]

[quote=SK in CV][quote=ucodegen]BTW: Name calling is known as a logic fallacy (argumentum ad hominem). [/quote]

Please review your logical fallacies. This wasn’t one. What I did was a straight out insult. There was no logical fallacy involved. Some insults are ad hominem. Some are not. Mine wasn’t. Her lousy opinions stand on their own. They don’t need personal insults to support them. The personal insults were just an extra bonus.[/quote]I am quite aware of the definitions of logic fallacy. If you resort to a personal insult/attack in the process of trying to justify your position, it is an “argumentum ad hominem”. You are attempting to ‘dirty’ the opponent by insult, calling name, etc w/o dealing with the facts at hand. It is like calling someone an idiot, therefore they don’t know what they are talking about — in the process not dealing with the facts of the discussion.

Just because the current political climate seems to feature many logic fallacies (including argumentum ad hominem, guilt by association, etc) does not make the logic valid. While in the political climate, it may be easier for either sides of the isle to resort to these types of attacks, we and democracy are cheapened by them.

[ucodegen]

[quote=SK in CV]But nonetheless, the number of people who signed up for insurance, whether through a federal or state exchange is a precise measurement of the success of the ACA. It’s primary goal was to get people insured. It worked. A higher percentage of the population is insured now than at any other time. Arguing that it’s the fine is just stupid. The fine IS an integral part of the ACA.[/quote] Just because people complied due to the fine does not make it a success. The law did not do what it was intended to do – make medical care more affordable to most of the people affected. It did make it more affordable for a small number but more expensive for a greater number of people. All that the fine do was made people comply because the cost of not complying was higher than the cost of insurance.

[quote=SK in CV]Administrative costs are not higher now. As a matter of law, they’re capped. As part of the law. If you’re referring to providers administrative costs going up, there is no evidence to support the claim.[/quote]
Only the administrative costs on the part of insurance companies are capped. This does not include drug companies, hospitals etc. If you remember, Martin Shkreli basically testified to congress that they created this situation when brought in to testify why he jacked up the price on several of his companies drugs (One of them being a lifesaving AIDS drug that he boosted the price 50x from $13.50 a tablet to $750 – because of insurance, the market would bear it). He was slimy, smirking.. etc but unfortunately he was also correct. He was not convicted for what he did (though it was immoral) He was arrested on fraud due to a different issue.

The cap on administrative costs and limit on the loss ratio can be gamed by the insurance companies. The number is calculated as a percentage of premiums paid. If the underlying costs (hospital/drug etc) go up, the premiums have to go up… and therefore the insurance profits also go up (because their allowable charge is based upon percentage of premiums). This is why Defense contracts are sooo expensive. They are limited to about 8% of costs on profit (I used to work as a Defense Contractor). Yet we still see ridiculous costs on defense items that really should be cheaper.

[SK in CV]

[quote=ucodegen][quote=SK in CV]But nonetheless, the number of people who signed up for insurance, whether through a federal or state exchange is a precise measurement of the success of the ACA. It’s primary goal was to get people insured. It worked. A higher percentage of the population is insured now than at any other time. Arguing that it’s the fine is just stupid. The fine IS an integral part of the ACA.[/quote] Just because people complied due to the fine does not make it a success. The law did not do what it was intended to do – make medical care more affordable to most of the people affected. It did make it more affordable for a small number but more expensive for a greater number of people. All that the fine do was made people comply because the cost of not complying was higher than the cost of insurance.

[/quote]

No. It did not make medical care more expensive for a greater number of people. There is absolutely no evidence to support that claim. (Your personal experience may have been different. Your personal experience however, is not evidence of anything other than your experience.) The cost of medical care has increased since the law was passed, however there is no evidence that these increases are a result of the law. Costs increased before the law was passed. Medical insurance premiums have increased at half the rate of increases in the decade immediately before the law went into effect, and at the slowest rate in almost 3 decades.

[SK in CV]

[quote=ucodegen]
[quote=SK in CV]Administrative costs are not higher now. As a matter of law, they’re capped. As part of the law. If you’re referring to providers administrative costs going up, there is no evidence to support the claim.[/quote]
Only the administrative costs on the part of insurance companies are capped. This does not include drug companies, hospitals etc. If you remember, Martin Shkreli basically testified to congress that they created this situation when brought in to testify why he jacked up the price on several of his companies drugs (One of them being a lifesaving AIDS drug that he boosted the price 50x from $13.50 a tablet to $750 – because of insurance, the market would bear it). He was slimy, smirking.. etc but unfortunately he was also correct. He was not convicted for what he did (though it was immoral) He was arrested on fraud due to a different issue.

The cap on administrative costs and limit on the loss ratio can be gamed by the insurance companies. The number is calculated as a percentage of premiums paid. If the underlying costs (hospital/drug etc) go up, the premiums have to go up… and therefore the insurance profits also go up (because their allowable charge is based upon percentage of premiums). This is why Defense contracts are sooo expensive. They are limited to about 8% of costs on profit (I used to work as a Defense Contractor). Yet we still see ridiculous costs on defense items that really should be cheaper.[/quote]

Is there some evidence that the administrative cost of providing care has gone up? Martin Shkreli’s testimony had absolutely nothing to do with the ACA.

[ucodegen]

[quote=SK in CV]
Is there some evidence that the administrative cost of providing care has gone up? Martin Shkreli’s testimony had absolutely nothing to do with the ACA.[/quote] On the first, talk to doctors who are leaving practice. There is no ‘official’ study that I have found yet, probably because that would be incredibly non-PC. On the second, yes it did.. though he did not tie it directly to the ACA. He was able to increase the price because he knew the ACA would cover it because it was deemed ‘lifesaving’ under the ACA – so insurance must pay, and distribute the cost over the rest of their client base. If insurance was not covering it, people would stop taking it because they could not afford it(morbid/heartless/but true) – so the price would be sensitive to price/demand curves ( as I mentioned, morality was not Shkreli’s strong point ).

This combined with the byzantine and lengthy process to start up production of these drugs (which were mostly off-patent) and to get approval from FDA to produce.. allowed Shkreli to charge what ever he wanted.. until someone else got through the FDA to make the drugs (at least 5 years).

When ever you introduce a unrelated payor aka insurer into a purchase arrangement – it shifts and distorts the price-demand curves. These drugs are life saving, by law must be supplied-(mandated by ACA), there was nothing in the ACA to cap the price on the drugs (charged by the manufacturer) therefore the insurers must cover the price no matter what is charged (per ACA). Shkreli did not directly state the relationship.. but he looked/smirked at the congressmen when questioned about the price increases and literally said that they created the situation. Do you think the congressmen who voted for the ACA, who said that to find out what is in it; we must pass it.. then turn around and say ‘oops’ or admit their screwup(s)?

Currently there is action to work around or try to cap the price by either direct cap action(through mod of ACA), or allow buying back drugs from other markets (ie. Canada) though the drugs are still produced in the US(ironic). I don’t expect the current congress to get anywhere on this.

[ucodegen]

[quote=SK in CV]
No. It did not make medical care more expensive for a greater number of people. There is absolutely no evidence to support that claim. (Your personal experience may have been different. Your personal experience however, is not evidence of anything other than your experience.) The cost of medical care has increased since the law was passed, however there is no evidence that these increases are a result of the law. Costs increased before the law was passed. Medical insurance premiums have increased at half the rate of increases in the decade immediately before the law went into effect, and at the slowest rate in almost 3 decades.[/quote] The costs are still increasing AND if you check the years immediately prior to the implementation of the ACA, you will find that the rate of yearly increase in costs was dropping prior to the ACA. When the ACA was implemented, the rate of increase did not go further down.. though it did not seem to go up. I am pretty certain that the cost tracking does not take into account subsidies – since that appears from a different bucket (often SSDI).

BTW: http://www.slate.com/articles/business/the_bills/2015/07/health_care_premiums_going_up_obamacare_has_been_solidified_but_it_s_failed.html
25% to 36% increase on year is nothing to sneeze at.

Average number of people under subsidy – 87%.
Average subsidy $268/month or 72% of the monthly payment with individuals paying avg $105/mo. Without subsidies, premiums would be 2.5x higher.

[SK in CV]

[quote=ucodegen] The costs are still increasing AND if you check the years immediately prior to the implementation of the ACA, you will find that the rate of yearly increase in costs was dropping prior to the ACA. When the ACA was implemented, the rate of increase did not go further down.. though it did not seem to go up. I am pretty certain that the cost tracking does not take into account subsidies – since that appears from a different bucket (often SSDI).

BTW: http://www.slate.com/articles/business/the_bills/2015/07/health_care_premiums_going_up_obamacare_has_been_solidified_but_it_s_failed.html
25% to 36% increase on year is nothing to sneeze at.

Average number of people under subsidy – 87%.
Average subsidy $268/month or 72% of the monthly payment with individuals paying avg $105/mo. Without subsidies, premiums would be 2.5x higher.[/quote]

I’m not sure where you’re getting your information. It’s wrong. I never said that costs went down. I said the increase in the cost of the average health insurance policy slowed to 1/2 the rate of the years immediately preceding the passage of the law.

The subsidy information you’ve provided is misleading. The percentage only applies to those purchasing qualifying policies on federal and state exchanges. It has nothing to do with employer based plans, where subsidies aren’t available. But beyond that, it has absolutely nothing to do with anything I’ve said.

[SK in CV]

[quote=ucodegen][quote=SK in CV]
Is there some evidence that the administrative cost of providing care has gone up? Martin Shkreli’s testimony had absolutely nothing to do with the ACA.[/quote] On the first, talk to doctors who are leaving practice. There is no ‘official’ study that I have found yet, probably because that would be incredibly non-PC. On the second, yes it did.. though he did not tie it directly to the ACA. He was able to increase the price because he knew the ACA would cover it because it was deemed ‘lifesaving’ under the ACA – so insurance must pay, and distribute the cost over the rest of their client base. If insurance was not covering it, people would stop taking it because they could not afford it(morbid/heartless/but true) – so the price would be sensitive to price/demand curves ( as I mentioned, morality was not Shkreli’s strong point ).

This combined with the byzantine and lengthy process to start up production of these drugs (which were mostly off-patent) and to get approval from FDA to produce.. allowed Shkreli to charge what ever he wanted.. until someone else got through the FDA to make the drugs (at least 5 years).

When ever you introduce a unrelated payor aka insurer into a purchase arrangement – it shifts and distorts the price-demand curves. These drugs are life saving, by law must be supplied-(mandated by ACA), there was nothing in the ACA to cap the price on the drugs (charged by the manufacturer) therefore the insurers must cover the price no matter what is charged (per ACA). Shkreli did not directly state the relationship.. but he looked/smirked at the congressmen when questioned about the price increases and literally said that they created the situation. Do you think the congressmen who voted for the ACA, who said that to find out what is in it; we must pass it.. then turn around and say ‘oops’ or admit their screwup(s)?

Currently there is action to work around or try to cap the price by either direct cap action(through mod of ACA), or allow buying back drugs from other markets (ie. Canada) though the drugs are still produced in the US(ironic). I don’t expect the current congress to get anywhere on this.[/quote]

There are neither official nor unofficial studies that show that doctors are retiring because of the ACA. That’s because there is no evidence that there has been any significant exodus as a result of the law, despite the threats while the law was being negotiated. That’s because it’s been good for doctors. The exact same thing happened almost 55 years ago when medicare was being negotiated. Doctors threatened to retire. And it was the biggest boon to physicians’ income of all time. More people covered by insurance means more paying patients.

Even if it were true (and it’s not), I’m not sure how that directly increases administrative costs.

On the drugs, you’ll have to point to the part of the law that makes drug prices go up. I’ve read the law. Numerous times. I don’t recall ever seeing it.

The ACA did not introduce a new unrelated payer into the system. I’m sure you’re old enough to remember 5 years ago, medical insurance already existed.

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