Author Topic: What comes after the ACA?  (Read 243288 times)

zing12

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Re: What comes after the ACA?
« Reply #2200 on: May 06, 2017, 12:32:06 PM »
We need some kind of medical-tourism-insurance plan. High deductible, catastrophic, covers the cost of going abroad for medical care. boycott US system entirely, at least for anything big.
« Last Edit: May 06, 2017, 12:43:01 PM by zing12 »

NaturallyHappier

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Re: What comes after the ACA?
« Reply #2201 on: May 06, 2017, 06:58:38 PM »
The provision in this bill that allows states to get exemptions from the pre-existing condition guarantee will absolutely destroy the entire insurance marketplace.

Think about how this would work.  Red states will ask for exemptions from the Obamacare rule and blue states will not.  People who get sick in red states will immediately be unable to afford health insurance in their own state, but will still be guaranteed coverage in their neighboring blue state.  Sick people will flock to blue states, driving up their coverage costs while reducing costs for healthy folks back in the red states by leaving their risk pool at the first sign of trouble.

End result: insurance gets cheaper and cheaper over time in red states, as long as you don't have to use it.  Insurance gets more and more expensive over time in blue states, which will have to suck up all of the country's sickest people who can't get insurance anywhere else.

It's the same number of people buying the same total amount of healthcare, but the PEC exemption provision effectively bifurcates the market into a healthy pool of conservatives that gets cheap useless insurance, and an unhealthy pool for everyone else that gets guaranteed coverage paid for only by liberals.  The red state insurance becomes craptastic coverage, and the blue state insurance is guaranteed a death spiral.

Who thought up this genius idea?

The guys from the red states!

JLee

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Re: What comes after the ACA?
« Reply #2202 on: May 07, 2017, 04:14:38 PM »
One aspect the AHCA probably will bring back is bare-bones plans with very high deductibles... the sort of thing that is very bad for the broader public that a responsible mustachian nearing FI/RE should be able to handle.
Does everyone forget pre ACA we could get catastrophic coverage.  And self insure.  I see those plans coming back with the mandate gone. 

Right.  Not only that, but many(most) states preACA had some type of income based coverage that filled the gaps between medicaid and median household incomes.  If your home state does not provided something, geographic arbitrage is always a reasonable possibility, many folks talk about FIRE'ing to different areas for purposes of reduced housing costs.  Why would healthcare be different?. 

Speaking of geographic arbitrage, this may come as a surprise, but many (most) healthcare conditions do not require immediate & emergent treatment.  Many developing countries provide Western style care at a much lower cost.   

Let's assume a horrible case...  Say you suddenly have excruciating chest pain, go to the ER and they diagnosis a STEMI (common life threatening heart attack).  You are completely uninsured!  You're quickly carted of the the cardiac cath lab where a very expensive cardiologist places two stents in your LAD which had 85% blockage, effectively saving your life.  Now you need a day to recover in the hospital and are place on two or three new medications which you must take or virtually guarantee re-occurrence.  How much will this life-saving emergent procedure cost?
Source
Quote
Look for separate charges from the hospital, doctors and laboratory. For patients without health insurance, total costs are typically $11,000-$41,000 or more, depending on the type of stent and length of hospital stay. Legacy Health, an operator of hospitals and clinics in Portland, OR, charges $11,298-$36,221 for an average heart stent placement surgery; the company reported an average charge of $36,221. At Aurora Sinai Medical Center[2] in Wisconsin, placement of one cardiac stent that is coated with long-release medication to prevent scar tissue from reclogging the artery carries a median hospital charge of $41,228, according estimates from the Wisconsin Hospital Association.
Plus a couple grand in meds over the next year or so.

Sucks, yes!  End of a Mustachian FIRE?  Doubtful.

It's the unsubsidized  insurance premiums after something like this that are FIRE killers.  Chronic conditions are more expensive due to reoccurring cost, but in these cases geographic arbitrage should be considered.

That's the real problem, IMO.

The United States has the most expensive health care in the world by a dramatic margin - without a corresponding improvement in care.

Until the health care system ceases to be a for-profit industry, we will constantly be plagued by problems.

sol

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Re: What comes after the ACA?
« Reply #2203 on: May 07, 2017, 04:59:21 PM »
Until the health care system ceases to be a for-profit industry, we will constantly be plagued by problems.

I'd like to believe that we can keep for-profit health care, and for-profit health insurance.

We just can't have them be ONLY for-profit, as the only option.  There clearly needs to be some basic level of healthcare coverage available to everyone, regardless of income, and paid for with taxes.  This is how we handle disability and old-age insurance, for example.  Everyone pays a percentage of their income.  Everyone is covered.  And if you want MORE disability insurance, or MORE old-age insurance, you are free to seek out those products on the for-profit market to supplement the minimum coverage the government provides to everyone.

This is such an easy fix for so many other things that people need.  Why is this one so hard?

former player

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Re: What comes after the ACA?
« Reply #2204 on: May 07, 2017, 05:02:17 PM »
My understanding is that Medicaid pays the bills for the poor elderly in nursing homes.  What happens if the cuts to Medicaid mean that those bills can no longer be paid by Medicaid?

ETA apparently about 62% of nursing home bills in the USA are paid by Medicaid.  How can that be capped/limited?  Nursing homes go bankrupt?  Sick old people get dumped on the streets?
« Last Edit: May 07, 2017, 05:10:32 PM by former player »
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BeanCounter

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Re: What comes after the ACA?
« Reply #2205 on: May 07, 2017, 05:29:33 PM »
Until the health care system ceases to be a for-profit industry, we will constantly be plagued by problems.

I'd like to believe that we can keep for-profit health care, and for-profit health insurance.

We just can't have them be ONLY for-profit, as the only option.  There clearly needs to be some basic level of healthcare coverage available to everyone, regardless of income, and paid for with taxes.  This is how we handle disability and old-age insurance, for example.  Everyone pays a percentage of their income.  Everyone is covered.  And if you want MORE disability insurance, or MORE old-age insurance, you are free to seek out those products on the for-profit market to supplement the minimum coverage the government provides to everyone.

This is such an easy fix for so many other things that people need.  Why is this one so hard?
Yes! Yes! And Yes!
I would gladly pay more taxes if it gave me access to Medicare at any age. It's not hard. The system is already built, they just need to expand it. The answer is right there in front of our faces and it's relatively easy. There are just too many people with selfish interests standing in the way. Makes me so angry.

jim555

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Re: What comes after the ACA?
« Reply #2206 on: May 07, 2017, 05:42:05 PM »
My understanding is that Medicaid pays the bills for the poor elderly in nursing homes.  What happens if the cuts to Medicaid mean that those bills can no longer be paid by Medicaid?

ETA apparently about 62% of nursing home bills in the USA are paid by Medicaid.  How can that be capped/limited?  Nursing homes go bankrupt?  Sick old people get dumped on the streets?
Probably means the states will have to raise taxes to make up the cuts.

radram

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Re: What comes after the ACA?
« Reply #2207 on: May 07, 2017, 05:58:25 PM »
Until the health care system ceases to be a for-profit industry, we will constantly be plagued by problems.

I'd like to believe that we can keep for-profit health care, and for-profit health insurance.

We just can't have them be ONLY for-profit, as the only option.  There clearly needs to be some basic level of healthcare coverage available to everyone, regardless of income, and paid for with taxes.  This is how we handle disability and old-age insurance, for example.  Everyone pays a percentage of their income.  Everyone is covered.  And if you want MORE disability insurance, or MORE old-age insurance, you are free to seek out those products on the for-profit market to supplement the minimum coverage the government provides to everyone.

This is such an easy fix for so many other things that people need.  Why is this one so hard?
Yes! Yes! And Yes!
I would gladly pay more taxes if it gave me access to Medicare at any age. It's not hard. The system is already built, they just need to expand it. The answer is right there in front of our faces and it's relatively easy. There are just too many people with selfish interests standing in the way. Makes me so angry.

You are forgetting that the system in place already covers the WORST,MOST EXPENSIVE POPULATION IT POSSIBLY COULD. Everyone that goes on it, including the "high Risk" pre-existing people will LOWER per person costs, when compared to covering the old population alone.

To me, the answer is beyond right in front of their faces. If you are missing it, you are doing so ON PURPOSE for some other reason. Special interests perhaps?

wenchsenior

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Re: What comes after the ACA?
« Reply #2208 on: May 07, 2017, 06:11:15 PM »
Until the health care system ceases to be a for-profit industry, we will constantly be plagued by problems.

I'd like to believe that we can keep for-profit health care, and for-profit health insurance.

We just can't have them be ONLY for-profit, as the only option.  There clearly needs to be some basic level of healthcare coverage available to everyone, regardless of income, and paid for with taxes.  This is how we handle disability and old-age insurance, for example.  Everyone pays a percentage of their income.  Everyone is covered.  And if you want MORE disability insurance, or MORE old-age insurance, you are free to seek out those products on the for-profit market to supplement the minimum coverage the government provides to everyone.

This is such an easy fix for so many other things that people need.  Why is this one so hard?
Yes! Yes! And Yes!
I would gladly pay more taxes if it gave me access to Medicare at any age. It's not hard. The system is already built, they just need to expand it. The answer is right there in front of our faces and it's relatively easy. There are just too many people with selfish interests standing in the way. Makes me so angry.

You are forgetting that the system in place already covers the WORST,MOST EXPENSIVE POPULATION IT POSSIBLY COULD. Everyone that goes on it, including the "high Risk" pre-existing people will LOWER per person costs, when compared to covering the old population alone.

To me, the answer is beyond right in front of their faces. If you are missing it, you are doing so ON PURPOSE for some other reason. Special interests perhaps?

I suspect that the combo of broadening the Medicare pool to include everyone (including the young and healthy) combined with the government's more powerful ability to negotiate prices would be pretty damn effective at lowering costs. And the private insurance market can continue to operate offering supplemental packages. 

If it weren't for the fact that I know several people whose situations would be devastated by loss of the ACA, I'm almost tempted to root for the passage of the worst monstrosity the GOP can dream up.  I can't imagine that after a few years of it, the majority of voters wouldn't demand something else. And at this point, that something else is pretty much a government option of some sort.

gerardc

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Re: What comes after the ACA?
« Reply #2209 on: May 07, 2017, 11:41:05 PM »
If this bill results in even one 35 year old "early-retiree" Mustachian to keep working for a few more years in their prime to support their health care costs, I'd say mission accomplished. Get back to work, entitled bastards!! instead of preying on the ACA for your own motives under the guise of being empathic to poor people.

JLee

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Re: What comes after the ACA?
« Reply #2210 on: May 07, 2017, 11:42:16 PM »
If this bill results in even one 35 year old "early-retiree" Mustachian to keep working for a few more years in their prime to support their health care costs, I'd say mission accomplished. Get back to work, entitled bastards!! instead of preying on the ACA for your own motives under the guise of being empathic to poor people.

u mad, bro?

Bateaux

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Re: What comes after the ACA?
« Reply #2211 on: May 08, 2017, 02:51:55 AM »
The SOB is just trolling.  Ignore him.
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Monkey Uncle

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Re: What comes after the ACA?
« Reply #2212 on: May 08, 2017, 04:38:55 AM »
Until the health care system ceases to be a for-profit industry, we will constantly be plagued by problems.

I'd like to believe that we can keep for-profit health care, and for-profit health insurance.

We just can't have them be ONLY for-profit, as the only option.  There clearly needs to be some basic level of healthcare coverage available to everyone, regardless of income, and paid for with taxes.  This is how we handle disability and old-age insurance, for example.  Everyone pays a percentage of their income.  Everyone is covered.  And if you want MORE disability insurance, or MORE old-age insurance, you are free to seek out those products on the for-profit market to supplement the minimum coverage the government provides to everyone.

This is such an easy fix for so many other things that people need.  Why is this one so hard?
Yes! Yes! And Yes!
I would gladly pay more taxes if it gave me access to Medicare at any age. It's not hard. The system is already built, they just need to expand it. The answer is right there in front of our faces and it's relatively easy. There are just too many people with selfish interests standing in the way. Makes me so angry.

You are forgetting that the system in place already covers the WORST,MOST EXPENSIVE POPULATION IT POSSIBLY COULD. Everyone that goes on it, including the "high Risk" pre-existing people will LOWER per person costs, when compared to covering the old population alone.

To me, the answer is beyond right in front of their faces. If you are missing it, you are doing so ON PURPOSE for some other reason. Special interests perhaps?

I suspect that the combo of broadening the Medicare pool to include everyone (including the young and healthy) combined with the government's more powerful ability to negotiate prices would be pretty damn effective at lowering costs. And the private insurance market can continue to operate offering supplemental packages. 

If it weren't for the fact that I know several people whose situations would be devastated by loss of the ACA, I'm almost tempted to root for the passage of the worst monstrosity the GOP can dream up.  I can't imagine that after a few years of it, the majority of voters wouldn't demand something else. And at this point, that something else is pretty much a government option of some sort.

What you all are missing is the fact that Paul Ryan and the Freedom Caucus fuckwits would gladly get rid of the old age and disability insurance if they thought they had the votes to do it.  The only reason we have old age and disability insurance is because idiots like them were not in charge during the 1930s and 40s, and they haven't had enough votes to un-do those things since then.  But make no mistake, as soon as they think they have the votes, they will make a run at getting rid of all of the basic underpinnings of the social safety net.  That's why the sensible solution on health care is a non-starter now; because the idiots have had enough votes to block anything sensible for most of the last 25 years.
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Monkey Uncle

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Re: What comes after the ACA?
« Reply #2213 on: May 08, 2017, 05:00:34 AM »
Side note:  Paul Ryan and the Freedom Caucus Fuckwits would be a great name for a punk band.
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nereo

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Re: What comes after the ACA?
« Reply #2214 on: May 08, 2017, 07:35:43 AM »
If this bill results in even one 35 year old "early-retiree" Mustachian to keep working for a few more years in their prime to support their health care costs, I'd say mission accomplished. Get back to work, entitled bastards!! instead of preying on the ACA for your own motives under the guise of being empathic to poor people.
I'm far more concerned about my immediate family than I am for myself.  I'm pretty certain that, whatever the outcome, I'll be ok.  I have assets, cash flow and no pre-existing conditions, and I acknowledge how lucky I am in that regard.
My family members have not been so lucky. BIL has a congenital kidney disease that requires periodic dialysis. He's incredibly bright and just finished his graduate degree - with treatment his condition is manageable. Aunt was in a car crash over a decade ago that crushed her pelvis.  She's as recovered as she's ever going to get but has residual problems from frequent back-spasms to bone spurs. Neither are likely to be able to afford the premiums of comprehensive health care should the AHCA pass under its current form.  I'd wager that the majority of people have similar stories - Kaiser Foundation estimates 52MM Americans under 65 can be labeled as having "pre-existing conditions" of some nature.

Even from an strictly economic standpoint this bill doesn't make much sense to me. The burden of health costs can't simply be ignored - they get worse and ultimately multiply if left untreated.  This burden gets heaped onto family members, the community and very often back onto the broader society itself when conditions become life threatening.
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NESailor

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Re: What comes after the ACA?
« Reply #2215 on: May 08, 2017, 07:57:46 AM »

Yes! Yes! And Yes!
I would gladly pay more taxes if it gave me access to Medicare at any age. It's not hard. The system is already built, they just need to expand it. The answer is right there in front of our faces and it's relatively easy. There are just too many people with selfish interests standing in the way. Makes me so angry.

Spoke with a hospital CFO last week.  I asked him about the payor mix at the hospital given the changes pending in Congress - this was before the vote.  We're in a somewhat rural setting so I was hinting at the possibility of large cuts to federal programs.  Said the mix was healthy.  Then he looked around as if to check if anyone is listening and said: "You know, Medicare is really not that bad of a payor".  I think the body language indicated that he was aware the statement would be considered heresy in some circles.   If an industry insider on the care side honestly accepts Medicare as OK...wtf are we waiting for?

BeanCounter

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Re: What comes after the ACA?
« Reply #2216 on: May 08, 2017, 07:58:27 AM »
If this bill results in even one 35 year old "early-retiree" Mustachian to keep working for a few more years in their prime to support their health care costs, I'd say mission accomplished. Get back to work, entitled bastards!! instead of preying on the ACA for your own motives under the guise of being empathic to poor people.
I'm far more concerned about my immediate family than I am for myself.  I'm pretty certain that, whatever the outcome, I'll be ok.  I have assets, cash flow and no pre-existing conditions, and I acknowledge how lucky I am in that regard.
My family members have not been so lucky. BIL has a congenital kidney disease that requires periodic dialysis. He's incredibly bright and just finished his graduate degree - with treatment his condition is manageable. Aunt was in a car crash over a decade ago that crushed her pelvis.  She's as recovered as she's ever going to get but has residual problems from frequent back-spasms to bone spurs. Neither are likely to be able to afford the premiums of comprehensive health care should the AHCA pass under its current form.  I'd wager that the majority of people have similar stories - Kaiser Foundation estimates 52MM Americans under 65 can be labeled as having "pre-existing conditions" of some nature.

Even from an strictly economic standpoint this bill doesn't make much sense to me. The burden of health costs can't simply be ignored - they get worse and ultimately multiply if left untreated.  This burden gets heaped onto family members, the community and very often back onto the broader society itself when conditions become life threatening.

I think thinking that "whatever the outcome, I'll be okay" is really naïve and flawed thinking.
Lots of folks with no family history, risk factors or preexisting conditions are getting cancer. And there are many cancers that are becoming long term diseases requiring very expensive care. You can easily live with cancer 10 years or more. But if you can't get medical insurance, or your medical plan jacks up the rates until they are unaffordable, or they allow lifetime maxes again, you could exhaust all of your resources fighting your disease.
Your brother in law on the other hand will at some point qualify to be on Medicare because of ESRD. Even if he's not 65. Even if he has other insurance. Once you are in ESRD, requiring frequent dialysis, Medicare takes over. And thank god because commercial plans couldn't afford to pay for it.
This is part of the problem with the system. Medicine has changed and conditions that would have ended a patient's life relatively quickly are now manageable, but very expensive.

BeanCounter

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Re: What comes after the ACA?
« Reply #2217 on: May 08, 2017, 08:07:44 AM »

Yes! Yes! And Yes!
I would gladly pay more taxes if it gave me access to Medicare at any age. It's not hard. The system is already built, they just need to expand it. The answer is right there in front of our faces and it's relatively easy. There are just too many people with selfish interests standing in the way. Makes me so angry.

Spoke with a hospital CFO last week.  I asked him about the payor mix at the hospital given the changes pending in Congress - this was before the vote.  We're in a somewhat rural setting so I was hinting at the possibility of large cuts to federal programs.  Said the mix was healthy.  Then he looked around as if to check if anyone is listening and said: "You know, Medicare is really not that bad of a payor".  I think the body language indicated that he was aware the statement would be considered heresy in some circles.   If an industry insider on the care side honestly accepts Medicare as OK...wtf are we waiting for?

Yep. I have seen it first hand for the last 15 years. Lots of people seem to believe that if we went to Medicare for everyone that hospitals would fold and we wouldn't have enough docs etc. etc. But commercial payors negotiate very, very low rates. And are heavily pushing ACOs, which pushes risks onto the docs and hospital groups. We are already having trouble recruiting PCPs, but that's not because of Medicare rates. There are solutions to this problem too.....guess what America, you do NOT have to be seen by a physician for your sinus infection. A PA or CNP will work just fine.

nereo

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Re: What comes after the ACA?
« Reply #2218 on: May 08, 2017, 08:18:03 AM »
If this bill results in even one 35 year old "early-retiree" Mustachian to keep working for a few more years in their prime to support their health care costs, I'd say mission accomplished. Get back to work, entitled bastards!! instead of preying on the ACA for your own motives under the guise of being empathic to poor people.
I'm far more concerned about my immediate family than I am for myself.  I'm pretty certain that, whatever the outcome, I'll be ok.  I have assets, cash flow and no pre-existing conditions, and I acknowledge how lucky I am in that regard.
My family members have not been so lucky. BIL has a congenital kidney disease that requires periodic dialysis. He's incredibly bright and just finished his graduate degree - with treatment his condition is manageable. Aunt was in a car crash over a decade ago that crushed her pelvis.  She's as recovered as she's ever going to get but has residual problems from frequent back-spasms to bone spurs. Neither are likely to be able to afford the premiums of comprehensive health care should the AHCA pass under its current form.  I'd wager that the majority of people have similar stories - Kaiser Foundation estimates 52MM Americans under 65 can be labeled as having "pre-existing conditions" of some nature.

Even from an strictly economic standpoint this bill doesn't make much sense to me. The burden of health costs can't simply be ignored - they get worse and ultimately multiply if left untreated.  This burden gets heaped onto family members, the community and very often back onto the broader society itself when conditions become life threatening.

I think thinking that "whatever the outcome, I'll be okay" is really naïve and flawed thinking.
Lots of folks with no family history, risk factors or preexisting conditions are getting cancer. And there are many cancers that are becoming long term diseases requiring very expensive care. You can easily live with cancer 10 years or more. But if you can't get medical insurance, or your medical plan jacks up the rates until they are unaffordable, or they allow lifetime maxes again, you could exhaust all of your resources fighting your disease.
Your brother in law on the other hand will at some point qualify to be on Medicare because of ESRD. Even if he's not 65. Even if he has other insurance. Once you are in ESRD, requiring frequent dialysis, Medicare takes over. And thank god because commercial plans couldn't afford to pay for it.
This is part of the problem with the system. Medicine has changed and conditions that would have ended a patient's life relatively quickly are now manageable, but very expensive.

I say "I'll be ok" because I"m an optimist at heart and because I know I've been more fortunate than most.  Growing up ina  medical family I'm keenly aware that I could come down with an expensive condition and that, living long enough, everyone develops cancer.
My response was directed at others who accuse members here of wanting the ACA purely for their own financial benefit. That's simply not true for me.

As for costs within our system, that's a core problem. Our medical system costs more than any developed nation on a per-capita basis, and in most cases the outcomes are only marginally better if at all. Despite this we're still tilting at windmills when it comes to bringing prices down.
It reminds me of our approach to the military - we demand the biggest and most  powerful, damned the ultimate costs.  Something similar can be said about our approach to medicine. We want advanced tests, the highest level of provider (doctors, not CNPs for shots), and expensive 1:1000 treatments for that chance we might eek out a few more months with a low standard of living. And if we don't get it there will be litigation.

Whatever the solution (and I don't pretend to have that nut cracked), shifting medical obligations from society to family/community (and ultimately back to society with delayed care, then medicare) makes no sense ethically or economically.  As you pointed out at some point my BIL will qualify for Medicare - so after shouldering an unwieldly burden for a while it'll get dumped back off to the state care.  He's just one example, though. Ultimately commercial insurance exists to make a profit, and they'll charge a premium on everyone to secure those profits. We'll pay either way.
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Jrr85

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Re: What comes after the ACA?
« Reply #2219 on: May 08, 2017, 12:28:32 PM »
But I really don't understand why young people should be forced to subsidize the cost of richer, older people.  Hell, some of these young people may not even make it to 50, and they are having to pay higher rates so richer, older people can enjoy lower rates?  I mean I get AARP is an advocacy organization, but surely they are a little bit embarrassed by this argument.

People who don't need to utilize (or under utilize) coverage subsidizing those who do is the definition of any insurance.

No, the essence of insurance is that it's a financial product used as a tool to manage risk.  It's only a subsidy scheme when the government prevents normal insurance from being available, like it has done in health insurance. 



 In something like term life, you can just opt out, don't buy the policy, who cares.  However, with medical insurance if you opt out, get sick, and can't pay.  Well... you get the treatment anyway and society as a whole has to pay for you.  This is why healthcare has to change in one of two ways.  A) If you opt out and get sick, you don't get treatment and die.  Is this morally acceptable to most of our country?  or  B) Everyone has to join the risk pool, some will win (if you call getting sick a win), some will lose, but everyone pays their (progressive tax) fair share.

Edit: for clarity

Requiring that everybody join the risk pool doesn't require that poor younger people be forced to subsidize the insurance of richer older people.  The people enjoying the subsidy right now didn't have to spend their twenty's and thirty's subsidizing the insurance of older generations, there's no reason to force poorer younger people to subsidize them. 

If you want to do need-based subsidies, I think everybody can understand that even if they don't agree with it.  I have trouble even understanding why poor people in their twenty's and thirty's (or even middle class or rich people in their twenty's and thirty's) should be forced to richer people just because they are older. 

nereo

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Re: What comes after the ACA?
« Reply #2220 on: May 08, 2017, 01:27:01 PM »
But I really don't understand why young people should be forced to subsidize the cost of richer, older people.  Hell, some of these young people may not even make it to 50, and they are having to pay higher rates so richer, older people can enjoy lower rates?  I mean I get AARP is an advocacy organization, but surely they are a little bit embarrassed by this argument.

People who don't need to utilize (or under utilize) coverage subsidizing those who do is the definition of any insurance.

No, the essence of insurance is that it's a financial product used as a tool to manage risk.  It's only a subsidy scheme when the government prevents normal insurance from being available, like it has done in health insurance. 



 In something like term life, you can just opt out, don't buy the policy, who cares.  However, with medical insurance if you opt out, get sick, and can't pay.  Well... you get the treatment anyway and society as a whole has to pay for you.  This is why healthcare has to change in one of two ways.  A) If you opt out and get sick, you don't get treatment and die.  Is this morally acceptable to most of our country?  or  B) Everyone has to join the risk pool, some will win (if you call getting sick a win), some will lose, but everyone pays their (progressive tax) fair share.

Edit: for clarity

Requiring that everybody join the risk pool doesn't require that poor younger people be forced to subsidize the insurance of richer older people.  The people enjoying the subsidy right now didn't have to spend their twenty's and thirty's subsidizing the insurance of older generations, there's no reason to force poorer younger people to subsidize them. 

If you want to do need-based subsidies, I think everybody can understand that even if they don't agree with it.  I have trouble even understanding why poor people in their twenty's and thirty's (or even middle class or rich people in their twenty's and thirty's) should be forced to richer people just because they are older.
Your argument seems to boil down to this: today's older people weren't subsidizing their parents and grandparents, ergo we cannot expect the present generation to do so.  In effect - 'why should we when they didn't have to'?
i don't find this method of thinking to be very productive. Policies change all the time; today's top earners pay far less into the system as a percentage of their income than previous generations.

The obvious retort is that, with the exception of some unlucky few, almost all young people will grow up to be old people.
An even more nuanced argument is that we pay regardless. If senior citizens cannot afford their health-care premiums to for-profit insurance companies the burden falls to their families, and to the community, and onto community level clinics and hospitals. Without proper treatment small problems grow into big ones - particularly with the elderly.

Personally I don't object to having a means-tested insurance premium cap.  In a very real way that's what Medicaid is, and the largest chunk of the ACA.  If you have limited financial resources you qualify for medicaid.
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Re: What comes after the ACA?
« Reply #2221 on: May 08, 2017, 01:39:05 PM »
But I really don't understand why young people should be forced to subsidize the cost of richer, older people.  Hell, some of these young people may not even make it to 50, and they are having to pay higher rates so richer, older people can enjoy lower rates?  I mean I get AARP is an advocacy organization, but surely they are a little bit embarrassed by this argument.

People who don't need to utilize (or under utilize) coverage subsidizing those who do is the definition of any insurance.

No, the essence of insurance is that it's a financial product used as a tool to manage risk.  It's only a subsidy scheme when the government prevents normal insurance from being available, like it has done in health insurance. 



 In something like term life, you can just opt out, don't buy the policy, who cares.  However, with medical insurance if you opt out, get sick, and can't pay.  Well... you get the treatment anyway and society as a whole has to pay for you.  This is why healthcare has to change in one of two ways.  A) If you opt out and get sick, you don't get treatment and die.  Is this morally acceptable to most of our country?  or  B) Everyone has to join the risk pool, some will win (if you call getting sick a win), some will lose, but everyone pays their (progressive tax) fair share.

Edit: for clarity

Requiring that everybody join the risk pool doesn't require that poor younger people be forced to subsidize the insurance of richer older people.  The people enjoying the subsidy right now didn't have to spend their twenty's and thirty's subsidizing the insurance of older generations, there's no reason to force poorer younger people to subsidize them. 

If you want to do need-based subsidies, I think everybody can understand that even if they don't agree with it.  I have trouble even understanding why poor people in their twenty's and thirty's (or even middle class or rich people in their twenty's and thirty's) should be forced to richer people just because they are older.
Your argument seems to boil down to this: today's older people weren't subsidizing their parents and grandparents, ergo we cannot expect the present generation to do so.  In effect - 'why should we when they didn't have to'?
i don't find this method of thinking to be very productive. Policies change all the time; today's top earners pay far less into the system as a percentage of their income than previous generations.

The obvious retort is that, with the exception of some unlucky few, almost all young people will grow up to be old people.
An even more nuanced argument is that we pay regardless. If senior citizens cannot afford their health-care premiums to for-profit insurance companies the burden falls to their families, and to the community, and onto community level clinics and hospitals. Without proper treatment small problems grow into big ones - particularly with the elderly.

Personally I don't object to having a means-tested insurance premium cap.  In a very real way that's what Medicaid is, and the largest chunk of the ACA.  If you have limited financial resources you qualify for medicaid.

No, my argument boils down to why should poorer younger people be forced to subsidize richer older people.  What principal can you describe that would justify requiring, say, a 28 year old making $60k a year having to subsidize the insurance costs of a 58 year old making $250k per year?  The 58 year is older is not a principal. 

The same argument applies to social security (e.g., why should a minimum wage 25 year old be forced to pay taxes to give money to a multimillionaire retiree), but at least there you have the argument that the retiree paid social security taxes for years.  I don't think that's a very good argument, but I certainly understand it and understand why it would be persuasive to some people.  You don't have that kind of justification for making a 28 year old subsidize a much wealthier 58 year old.

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Re: What comes after the ACA?
« Reply #2222 on: May 08, 2017, 01:49:48 PM »
If you don't want the 25 year old to subsidize the well-off 50 year old, that isn't an argument against government regulation of the system, just an argument about the particular nature of the regulation.  If the rich of whatever age are paying enough in taxes then the subsidy can be from the rich rather than from the 25 year olds.  The problem, apparently, is that the Republicans don't want the rich to pay.
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Re: What comes after the ACA?
« Reply #2223 on: May 08, 2017, 01:51:32 PM »

No, my argument boils down to why should poorer younger people be forced to subsidize richer older people.  What principal can you describe that would justify requiring, say, a 28 year old making $60k a year having to subsidize the insurance costs of a 58 year old making $250k per year?  The 58 year is older is not a principal. 

The same argument applies to social security (e.g., why should a minimum wage 25 year old be forced to pay taxes to give money to a multimillionaire retiree), but at least there you have the argument that the retiree paid social security taxes for years.  I don't think that's a very good argument, but I certainly understand it and understand why it would be persuasive to some people.  You don't have that kind of justification for making a 28 year old subsidize a much wealthier 58 year old.
Ok, I understand your point a bit better now.  As I mentioned earlier, the largest portion of the ACA was medicaid expansion, which is based on financial need. Take that away and you'll have a great deal more poor older individuals in the broader pool. 
I don't disagree that insurance subsidies ought to be means tested so that a 58 year old making $250k/year is paying less than he otherwise would.  AT the same time the AHCA seeks to remove a major source of revenue for health care by eliminating the 'net investment income tax (aka "obamacare tax')'. This was one measure that ensured very high earners weren't be subsidized by very low earners.

Do away with both of these regulations and what are we left with?  Very high income earners who pay less and more low income individuals of all ages kicked off medicaid. The main outcome of the plan is less cost to high income earners and less coverage and coverage assistance for low income people. That seems to be the opposite of what you are arguing against (the hypothetical young poor person subsidizing the richer 58 year old), no?
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Re: What comes after the ACA?
« Reply #2224 on: May 08, 2017, 02:26:45 PM »
If you don't want the 25 year old to subsidize the well-off 50 year old, that isn't an argument against government regulation of the system, just an argument about the particular nature of the regulation.  If the rich of whatever age are paying enough in taxes then the subsidy can be from the rich rather than from the 25 year olds.  The problem, apparently, is that the Republicans don't want the rich to pay.

I wasn't arguing against government regulation, I was pointing out that out of all the arguments for or against Obamacare/Trumpcare/whatever, AARP was making the argument that it's terrible that poor young people would be subsidizing richer older people less (not eliminating the subsidy, just lowing it).  Again, I understand that they're an advocacy organization, but they still have to feel a little stupid making that argument, unless they don't put any thought into it at all.

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Re: What comes after the ACA?
« Reply #2225 on: May 08, 2017, 02:35:12 PM »

No, my argument boils down to why should poorer younger people be forced to subsidize richer older people.  What principal can you describe that would justify requiring, say, a 28 year old making $60k a year having to subsidize the insurance costs of a 58 year old making $250k per year?  The 58 year is older is not a principal. 

The same argument applies to social security (e.g., why should a minimum wage 25 year old be forced to pay taxes to give money to a multimillionaire retiree), but at least there you have the argument that the retiree paid social security taxes for years.  I don't think that's a very good argument, but I certainly understand it and understand why it would be persuasive to some people.  You don't have that kind of justification for making a 28 year old subsidize a much wealthier 58 year old.
Ok, I understand your point a bit better now.  As I mentioned earlier, the largest portion of the ACA was medicaid expansion, which is based on financial need. Take that away and you'll have a great deal more poor older individuals in the broader pool. 
I don't disagree that insurance subsidies ought to be means tested so that a 58 year old making $250k/year is paying less than he otherwise would.  AT the same time the AHCA seeks to remove a major source of revenue for health care by eliminating the 'net investment income tax (aka "obamacare tax')'. This was one measure that ensured very high earners weren't be subsidized by very low earners.

Do away with both of these regulations and what are we left with?  Very high income earners who pay less and more low income individuals of all ages kicked off medicaid. The main outcome of the plan is less cost to high income earners and less coverage and coverage assistance for low income people. That seems to be the opposite of what you are arguing against (the hypothetical young poor person subsidizing the richer 58 year old), no?
Yea, it looks like the context was cut off by the time you jumped into the responses to my comments.  I was really commenting on the dishonesty in the AARP's article (http://www.aarp.org/politics-society/advocacy/info-2017/healthcare-bill-will-increase-premiums.html?intcmp=AE-POL-ADV-EOA2) where it equated reducing (not eliminating) a non-needs based subsidy to older people as somehow a tax on the people receiving the subsidy.   

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Re: What comes after the ACA?
« Reply #2226 on: May 08, 2017, 02:57:07 PM »

No, my argument boils down to why should poorer younger people be forced to subsidize richer older people.  What principal can you describe that would justify requiring, say, a 28 year old making $60k a year having to subsidize the insurance costs of a 58 year old making $250k per year?  The 58 year is older is not a principal. 

The same argument applies to social security (e.g., why should a minimum wage 25 year old be forced to pay taxes to give money to a multimillionaire retiree), but at least there you have the argument that the retiree paid social security taxes for years.  I don't think that's a very good argument, but I certainly understand it and understand why it would be persuasive to some people.  You don't have that kind of justification for making a 28 year old subsidize a much wealthier 58 year old.
Ok, I understand your point a bit better now.  As I mentioned earlier, the largest portion of the ACA was medicaid expansion, which is based on financial need. Take that away and you'll have a great deal more poor older individuals in the broader pool. 
I don't disagree that insurance subsidies ought to be means tested so that a 58 year old making $250k/year is paying less than he otherwise would.  AT the same time the AHCA seeks to remove a major source of revenue for health care by eliminating the 'net investment income tax (aka "obamacare tax')'. This was one measure that ensured very high earners weren't be subsidized by very low earners.

Do away with both of these regulations and what are we left with?  Very high income earners who pay less and more low income individuals of all ages kicked off medicaid. The main outcome of the plan is less cost to high income earners and less coverage and coverage assistance for low income people. That seems to be the opposite of what you are arguing against (the hypothetical young poor person subsidizing the richer 58 year old), no?
Yea, it looks like the context was cut off by the time you jumped into the responses to my comments.  I was really commenting on the dishonesty in the AARP's article (http://www.aarp.org/politics-society/advocacy/info-2017/healthcare-bill-will-increase-premiums.html?intcmp=AE-POL-ADV-EOA2) where it equated reducing (not eliminating) a non-needs based subsidy to older people as somehow a tax on the people receiving the subsidy.   
Thanks for the clarification.  Threaded (and truncated) conversations can be a bit confusing to follow at times.
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Re: What comes after the ACA?
« Reply #2227 on: May 08, 2017, 04:56:43 PM »
If you don't want the 25 year old to subsidize the well-off 50 year old, that isn't an argument against government regulation of the system, just an argument about the particular nature of the regulation.  If the rich of whatever age are paying enough in taxes then the subsidy can be from the rich rather than from the 25 year olds.  The problem, apparently, is that the Republicans don't want the rich to pay.

I wasn't arguing against government regulation, I was pointing out that out of all the arguments for or against Obamacare/Trumpcare/whatever, AARP was making the argument that it's terrible that poor young people would be subsidizing richer older people less (not eliminating the subsidy, just lowing it).  Again, I understand that they're an advocacy organization, but they still have to feel a little stupid making that argument, unless they don't put any thought into it at all.

Yeah, this aspect of the ACA has bothered me as well. Younger people tend to have student loans and lower incomes and less time to have saved than older people, and yet the ACA forces the young to subsidize the old. It does this by limiting the difference in premiums between old and young to a factor of 3. If you charged each age bracket according to actual costs the factor would be something like 4.5-5 instead.

The law already provides tax credits for people of any age to have their premiums limited to an amount that is considered "affordable" based on their income. Why is it necessary to go a step farther and force young people to pay for discounts to the older people who are doing well financially and don't need the tax credits?
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Re: What comes after the ACA?
« Reply #2228 on: May 08, 2017, 08:42:05 PM »
Why is it necessary to go a step farther and force young people to pay for discounts to the older people who are doing well financially and don't need the tax credits?

It isn't necessary, and the ACA doesn't do that.  Older people who don't need the tax credits (okay "premium subsidies") don't get the tax credits.  Only poor people get the tax credits.  Premiums are limited to a percentage of your income, regardless of age.  The young do not pay more to subsidize the old; the rich pay more to subsidize the poor.

But some people will use any divisive tactic they can think of to turn people against each other.  Did you know that inner city black women are having kids left and right to take welfare benefits away from hard working poor white Americans?  Same BS logic.
« Last Edit: May 08, 2017, 11:25:51 PM by sol »

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Re: What comes after the ACA?
« Reply #2229 on: May 08, 2017, 11:11:27 PM »
I had planned my FIRE around getting a subsidy for health care.  I really didn't give a crap who was taxed for the relief I'd receive. With all passive income it was an early retirement dream turn nightmare.
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boarder42

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Re: What comes after the ACA?
« Reply #2230 on: May 09, 2017, 06:15:17 AM »
Why is it necessary to go a step farther and force young people to pay for discounts to the older people who are doing well financially and don't need the tax credits?

It isn't necessary, and the ACA doesn't do that.  Older people who don't need the tax credits (okay "premium subsidies") don't get the tax credits.  Only poor people get the tax credits.  Premiums are limited to a percentage of your income, regardless of age.  The young do not pay more to subsidize the old; the rich pay more to subsidize the poor.

But some people will use any divisive tactic they can think of to turn people against each other.  Did you know that inner city black women are having kids left and right to take welfare benefits away from hard working poor white Americans?  Same BS logic.

this is very self serving.  the real best way to do it would be to account for total assets not income .. which would then discourage saving.  why should someone with 2MM in the bank be getting subsidized, b/c they know how to manipulate their income to make it seem low enough to get the subsidy they dont really need. 

i mean i get it i'm selfish too but i think for the most part you try to come off here as whats best for the people but based on these boards making it income based is a very self serving proposition.  we're all going to have likely piles of money in old age and just b/c we're spending less we dont pay as much into a healthcare system  thats not really right.  - i know we're a small percentage of the total population but not really the best way IMO to handle this. 

on a completely unrelated note warren buffett and his right hand man have both addressed the real issue this week.  the cost.  who they hell cares who pays for it if the costs arent brought back under control.
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Re: What comes after the ACA?
« Reply #2231 on: May 09, 2017, 07:02:06 AM »
Realize first that what we are talking about is not health CARE, but health care INSURANCE offered by private for-profit companies

Now, assuming we reject universal insurance funded through tax revenue*, there are two ends of the spectrum

option 1) everyone pays the same amount, regardless of age, gender, pre-existing conditions or ice-cream preference
option 2) premiums are based entirely on personal history.  Those that are older, female or in poor health pay more, sometimes astronomically so.

Personally I don't like either of these extremes - option 1 is very good if you are old, sick but wealthy, and very bad if you are young and poor. Option 1 is the epitome of the older & rich sticking it to the young and poor.
I'm not a fan of option 2 either because it leaves the old and sick out to dry, and very often those costs just get re-absorbed by family, community, and ultiamtely the system itself (at even higher costs due to late treatment). As a compassionate human I believe we have an ethical obligation to take care of the sick and less fortunate in our society.

Therefore, what we're all discussing is where on the spectrum we'd like to set health-care premiums.  Boarder42 brings up a good point that income is not always the best reflection of ability to pay; total assets (or perhaps investments) might be better. Of course is you are recently retired with $1MM it might seem like you have a lot of assets, but you are counting on that to support you until you die, and I'm certain that a retiree living on $40k/year (4%!) would object to paying several times more for healthcare than someone earning $40k/year but with little savings. It's also highly de-stablizing to change health care costs so dramatically on fixed-income individuals.

Ultimately the question we need to address is where do we set these limits? Medicaid has offered a form of health care to financially needy families.  Where should that threshold be?  Health care for older and sicker people costs more - where should premiums be set for those individuals?
If we can focus on the questions, it might clarify our answers.

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starguru

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Re: What comes after the ACA?
« Reply #2232 on: May 09, 2017, 07:37:02 AM »
I had planned my FIRE around getting a subsidy for health care.  I really didn't give a crap who was taxed for the relief I'd receive. With all passive income it was an early retirement dream turn nightmare.

I personally feel one isn't FI is they require a government handout to survive.   

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Re: What comes after the ACA?
« Reply #2233 on: May 09, 2017, 07:44:44 AM »
I had planned my FIRE around getting a subsidy for health care.  I really didn't give a crap who was taxed for the relief I'd receive. With all passive income it was an early retirement dream turn nightmare.

I personally feel one isn't FI is they require a government handout to survive.
Does the NHS count?  Because none of us UK residents would qualify as FI otherwise.

Oh wait, there's all those taxes I have paid and still pay which go towards the NHS.  Is it still a handout?  Are Medicaid and Medicare handouts to US taxpayers?

Look, we are pretty much all subsidised by someone else at some point and in some way.  Glorious isolation doesn't work, unless perhaps you go for subsistence living in a cabin in Alaska and never come back.
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Re: What comes after the ACA?
« Reply #2234 on: May 09, 2017, 07:56:52 AM »
I had planned my FIRE around getting a subsidy for health care.  I really didn't give a crap who was taxed for the relief I'd receive. With all passive income it was an early retirement dream turn nightmare.

I personally feel one isn't FI is they require a government handout to survive.

Not a handout so much as a system that we all pay into and helps control the out of control escalating costs of medicine and care.  It's not us against them, everyone is in this together and we all need healthcare at some point in our lives.

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Re: What comes after the ACA?
« Reply #2235 on: May 09, 2017, 08:23:51 AM »
Realize first that what we are talking about is not health CARE, but health care INSURANCE offered by private for-profit companies

Now, assuming we reject universal insurance funded through tax revenue*, there are two ends of the spectrum

option 1) everyone pays the same amount, regardless of age, gender, pre-existing conditions or ice-cream preference
option 2) premiums are based entirely on personal history.  Those that are older, female or in poor health pay more, sometimes astronomically so.

Personally I don't like either of these extremes - option 1 is very good if you are old, sick but wealthy, and very bad if you are young and poor. Option 1 is the epitome of the older & rich sticking it to the young and poor.
I'm not a fan of option 2 either because it leaves the old and sick out to dry, and very often those costs just get re-absorbed by family, community, and ultiamtely the system itself (at even higher costs due to late treatment). As a compassionate human I believe we have an ethical obligation to take care of the sick and less fortunate in our society.

Therefore, what we're all discussing is where on the spectrum we'd like to set health-care premiums.  Boarder42 brings up a good point that income is not always the best reflection of ability to pay; total assets (or perhaps investments) might be better. Of course is you are recently retired with $1MM it might seem like you have a lot of assets, but you are counting on that to support you until you die, and I'm certain that a retiree living on $40k/year (4%!) would object to paying several times more for healthcare than someone earning $40k/year but with little savings. It's also highly de-stablizing to change health care costs so dramatically on fixed-income individuals.

Ultimately the question we need to address is where do we set these limits? Medicaid has offered a form of health care to financially needy families.  Where should that threshold be?  Health care for older and sicker people costs more - where should premiums be set for those individuals?
If we can focus on the questions, it might clarify our answers.

i really dont think that solving where the payment comes from solves the real problem it solves the symptom.  if our healthcare costs were more in line with other first world countries this would hardly need to be debated.  but our costs are so extremely high it causes real issues. 

premiums are based on the costs ... and in a for profit insurance game premiums will go up as costs go up and go down as costs go down - if properly regulated.  control cost and everything else could fall into place and make everyone happy. 

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starguru

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What comes after the ACA?
« Reply #2236 on: May 09, 2017, 08:24:37 AM »
I had planned my FIRE around getting a subsidy for health care.  I really didn't give a crap who was taxed for the relief I'd receive. With all passive income it was an early retirement dream turn nightmare.

I personally feel one isn't FI is they require a government handout to survive.

Not a handout so much as a system that we all pay into and helps control the out of control escalating costs of medicine and care.  It's not us against them, everyone is in this together and we all need healthcare at some point in our lives.

Sure, but are you claiming that the ACA did anything to control escalating medical costs, other perhaps the vague notion that if everyone bought insurance prices would somehow go down?

I agree, we are all in this together.  But how we are in this together is the rub, here.  We could (attempt to) control medical costs without the ACA, by changing the nature of how we pay for medical care, or having laws in place for how drug prices get set.  Does anyone find it suspicious that an epipen costs $700 for two uses?  Or that older chemotherapy prices rise to be comparable to the prices of newer treatments?  Or that when you go to the Dr you never know what it's going to cost?   Or that our congress agreed to pay full price for drugs under the medicare system? 

I'd prefer single payer to the mess that the ACA is.   And I stand by the idea that if one requires a handout, they are not FI.  Especially when the subsidy is only available because the supposedly FI individual can play the game where they get their income from a source that is taxed less than the rate at which working schmucks are taxed.  They can fix this issue by just taxing all income at the same marginal rates.   

It's a false equivalence to compare buying a product in a private transaction with a subsidy from a gubment against society's need for things like roads and national defense.  The latter are required by everyone, all the time.  Medical care is only required rarely (i.e. maybe a few times a year) for most people.
« Last Edit: May 09, 2017, 08:39:13 AM by starguru »

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Re: What comes after the ACA?
« Reply #2237 on: May 09, 2017, 08:44:52 AM »
I agree, we are all in this together.  But how we are in this together is the rub, here.  We could (attempt to) control medical costs without the ACA, by changing the nature of how we pay for medical care, or having laws in place for how drug prices get set.  Does anyone find it suspicious that an epipen costs $700 for two uses?  Or that older chemotherapy prices rise to be comparable to the prices of newer treatments?  Or that when you go to the Dr you never know what it's going to cost?   Or that our congress agreed to pay full price for drugs under the medicare system? 

Suspicious?  not at all.  It's free-market capitalism. It's the natural result of allowing for-profit companies to dictate pricing.

Quote
It's a false equivalence to compare buying a product in a private transaction with a subsidy from a gubment against society's need for things like roads and national defense.  The latter are required by everyone, all the time.  Medical care is only required rarely (i.e. maybe a few times a year) for most people.  Especially w
"especially w..."??  I'm what?  You left me hanging here!
I don't believe its fair to say that just because I only need to be seen by a medical professional occasionally that its not equivalent to other societal needs. You could say similar things about fire departments, elementary schools or any other number of things. Individually I rarely need these things (if ever) - collectively we all benefit from having them and we certainly will all use the system at some point.

Quote
And I stand by the idea that if one requires a handout, they are not FI.  Especially when the subsidy is only available because the supposedly FI individual can play the game where they get their income from a source that is taxed less than the rate at which working schmucks are taxed.
That's fine as a philisophical point, but one person's 'loop-hole' is another's tax deduction. I'm counting on paying less in taxes in ER because LT-CP are taxed at less than earned income for most people. Others get tax breaks for taking out obscene amounts in loans (morgage, SL, etc). That reality is there for everyone. Almost half of all people will get more out of SS than they paid in. Military benefits are available regardless of whether you did multiple tours in combat zones or spent all your days repairing engines back on base.  None of that matters so long as we're all governed by the same rules.
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mm1970

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Re: What comes after the ACA?
« Reply #2238 on: May 09, 2017, 09:18:23 AM »
Quote
The same argument applies to social security (e.g., why should a minimum wage 25 year old be forced to pay taxes to give money to a multimillionaire retiree), but at least there you have the argument that the retiree paid social security taxes for years.  I don't think that's a very good argument, but I certainly understand it and understand why it would be persuasive to some people.  You don't have that kind of justification for making a 28 year old subsidize a much wealthier 58 year old.

This confuses me though.  I'm middle-aged.  I've been paying health insurance premiums, and certainly have used less health care than I've paid for, in my 25 years as an adult.

So, in essence, wasn't I subsidizing older/ less healthy people all these years?  The same way that I've been subsidizing poorer drivers?

That's kind of the point of insurance.
Sure, the system is changing a bit, I get that.

I think I'd be really pissed if I paid insurance premiums for 38 years, barely used insurance, then got cancer at 60 or got into a bad car accident and suddenly had my premiums skyrocket "because you are old and sick or old and injured".  That's kind of shitty.

Knaak

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Re: What comes after the ACA?
« Reply #2239 on: May 09, 2017, 09:50:42 AM »
So, in essence, wasn't I subsidizing older/ less healthy people all these years?

Yes, you were subsidizing older/unhealthy people all those years.  Now imagine if you had to subsidize them, plus subsidize healthy older people, by paying an extra 50% higher premiums.  That's what happened when the ACA changed the ratios from 5:1 to 3:1.

Edit: Added bolded part.
« Last Edit: May 09, 2017, 12:31:05 PM by Knaak »

tyort1

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Re: What comes after the ACA?
« Reply #2240 on: May 09, 2017, 10:29:26 AM »
I think I'd be really pissed if I paid insurance premiums for 38 years, barely used insurance, then got cancer at 60 or got into a bad car accident and suddenly had my premiums skyrocket "because you are old and sick or old and injured".  That's kind of shitty.

That will happen in a free market insurance system.  That's how private insurance works.  They are motivated by profit and 60 year old you just became high risk and very expensive. 

Which is why we shouldn't let sociopathic, money motivated companies make these decisions.  It's one thing to revoke someone's driver's insurance.  It's quite another to revoke their cancer treatment.
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mm1970

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Re: What comes after the ACA?
« Reply #2241 on: May 09, 2017, 10:44:24 AM »
So, in essence, wasn't I subsidizing older/ less healthy people all these years?

Yes, you were subsidizing older/unhealthy people all those years.  Now imagine if you had to subsidize them by paying an extra 50% higher premiums.  That's what happened when the ACA changed the ratios from 5:1 to 3:1.

Well, since the premiums were also somewhat based on income...I'm kind of okay paying higher premiums if it means that people can have health affordable health insurance and health care.

The higher premiums now are worth it to me so that my friends with pre-existing conditions can actually GET health insurance and be covered.  It's also sort of a social compact.  If I get old and sick and suddenly broke, what happens?  I'd hope that what happens is that I get health care.  And affordable health care.  Old, sick, poor people.  I'm okay paying more for that.  (Part of it is because I have enough money.  Part of it is because I grew up poor, with no health insurance.  Everything paid out of pocket, including major surgery that took my parents 5 years to pay off.  My family prioritized health care and needs.  We did not, however, go on vacation, have cable TV, etc.)

I haven't had enough coffee today, so I'm not sure I'm explaining well.  It's a fascinating subject, in any event.  I posted a rather snarky comment on FB recently about how we should just eliminate health insurance premium subsidies for all federal employees.  One of my HS friends missed the "snark" and agreed that people should pay their own premiums.  I don't think she did the math, though. Because my estimates would be that her annual health insurance cost would be $10k in premiums, up to $8k out of pocket after that.  For her family of soon-to-be-4.  On her $45,000 annual salary.  Nevermind that both she and her wife have pre-existing conditions and likely would have to pay more than that, were there not an ACA, if they could even get coverage.

Or maybe she did do that math, and prefers my home town method of crowdfunding for chemo.  Pancake breakfasts and spaghetti dinners.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2242 on: May 09, 2017, 10:58:50 AM »
If this bill results in even one 35 year old "early-retiree" Mustachian to keep working for a few more years in their prime to support their health care costs, I'd say mission accomplished. Get back to work, entitled bastards!! instead of preying on the ACA for your own motives under the guise of being empathic to poor people.

It's this kind of thinking that destroys entrepreneurial ventures.
If people have to worry about not having health insurance if they leave a job at a staid megacorp to start a new business, then destroying the ACA will stunt the entrepreneurial spirit and new business formation.
It's the formation of new business that contribute most to economic activity and hiring of new employees.

tyort1

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Re: What comes after the ACA?
« Reply #2243 on: May 09, 2017, 11:01:54 AM »
If this bill results in even one 35 year old "early-retiree" Mustachian to keep working for a few more years in their prime to support their health care costs, I'd say mission accomplished. Get back to work, entitled bastards!! instead of preying on the ACA for your own motives under the guise of being empathic to poor people.

It's this kind of thinking that destroys entrepreneurial ventures.
If people have to worry about not having health insurance if they leave a job at a staid megacorp to start a new business, then destroying the ACA will stunt the entrepreneurial spirit and new business formation.
It's the formation of new business that contribute most to economic activity and hiring of new employees.

That can't be right.  Nothing the gubment ever does, ever improves the economy.  Gubment can't create jobs!!!!  So your analysis must be flawed because CONSTITUTION!!!!!  Libtard.

[Utmost snark]
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nereo

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Re: What comes after the ACA?
« Reply #2244 on: May 09, 2017, 11:06:27 AM »
If this bill results in even one 35 year old "early-retiree" Mustachian to keep working for a few more years in their prime to support their health care costs, I'd say mission accomplished. Get back to work, entitled bastards!! instead of preying on the ACA for your own motives under the guise of being empathic to poor people.

It's this kind of thinking that destroys entrepreneurial ventures.
If people have to worry about not having health insurance if they leave a job at a staid megacorp to start a new business, then destroying the ACA will stunt the entrepreneurial spirit and new business formation.
It's the formation of new business that contribute most to economic activity and hiring of new employees.
Interesting point.  I'm fairly certain if we were to craft a health-care and tax system entirely from scratch, neither party would create a system which relies overwhelmingly on health care being provided by an individual's employer. This made some sense several generations ago when health care costs were relatively modest, worker mobility was low and government could encourage companies to provide health care by relatively small tax breaks.

In today's reality it does exactly what you say- stiffles entrepreneurial ventures and limits the success of small businesses . Health coverage has become an anchor for many employees.
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2245 on: May 09, 2017, 11:20:59 AM »
So, in essence, wasn't I subsidizing older/ less healthy people all these years?

Yes, you were subsidizing older/unhealthy people all those years.  Now imagine if you had to subsidize them by paying an extra 50% higher premiums.  That's what happened when the ACA changed the ratios from 5:1 to 3:1.

But if you're a younger person who wasn't quite so rich in income, you wouldn't be paying so much personally because you would have tax subsidies to offset your insurance premiums.
Or you would have followed the mustachian guide and you would have contributed $18K into your  self-employed 401K (and additional thousands into the employer contribution part of that 401k), and another $3,350 into your Health Savings Account, and another $5500 into your traditional IRA, so that your income would be lower and you would have a lower Adjusted Gross Income on your tax return, so that you would then qualify for those health insurance tax subsidies.

You do realize that if you have employer provided insurance this 5:1 to 3:1 ratio doesn't impact you?
« Last Edit: May 09, 2017, 11:22:43 AM by DavidAnnArbor »

Jrr85

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Re: What comes after the ACA?
« Reply #2246 on: May 09, 2017, 11:35:48 AM »
Quote
The same argument applies to social security (e.g., why should a minimum wage 25 year old be forced to pay taxes to give money to a multimillionaire retiree), but at least there you have the argument that the retiree paid social security taxes for years.  I don't think that's a very good argument, but I certainly understand it and understand why it would be persuasive to some people.  You don't have that kind of justification for making a 28 year old subsidize a much wealthier 58 year old.

This confuses me though.  I'm middle-aged.  I've been paying health insurance premiums, and certainly have used less health care than I've paid for, in my 25 years as an adult.

So, in essence, wasn't I subsidizing older/ less healthy people all these years?  The same way that I've been subsidizing poorer drivers?
  No,  unless you were in an employer provided plan or were in in one of the jurisdictions that already had community rating, you were paying a risk rated cost.  You may have ultimately paid for more insurance that you used in healthcare, in hindsight, but there would have been other people that looked the same as you from an actuarial basis that used more insurance than they paid for, and with it all netted out, the insurance company probably made profits of around 3% of premiums paid.  That's the point of insurance, to spread risk.  Not to force subsidies from one group to another.  If you try to voluntarily have subsidies, people won't by your product because the expected value of the insurance policy becomes too negative so the lower risk people just drop out. 

 
That's kind of the point of insurance.
Sure, the system is changing a bit, I get that.

I think I'd be really pissed if I paid insurance premiums for 38 years, barely used insurance, then got cancer at 60 or got into a bad car accident and suddenly had my premiums skyrocket "because you are old and sick or old and injured".  That's kind of shitty.

The subsidy from young to old is not necessary to prevent that.  All you have to do is limit when people that have maintained continuous coverage can be risk rated for reasons other than age (which would result in a gradual increase in premiums as you age).  The law already did this to an extent before Obamacare, but it needed to be improved in the individual market.   

Knaak

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Re: What comes after the ACA?
« Reply #2247 on: May 09, 2017, 11:36:43 AM »
So, in essence, wasn't I subsidizing older/ less healthy people all these years?

Yes, you were subsidizing older/unhealthy people all those years.  Now imagine if you had to subsidize them by paying an extra 50% higher premiums.  That's what happened when the ACA changed the ratios from 5:1 to 3:1.

Well, since the premiums were also somewhat based on income...I'm kind of okay paying higher premiums if it means that people can have health affordable health insurance and health care.

The higher premiums now are worth it to me so that my friends with pre-existing conditions can actually GET health insurance and be covered.  It's also sort of a social compact.  If I get old and sick and suddenly broke, what happens?  I'd hope that what happens is that I get health care.  And affordable health care.  Old, sick, poor people.  I'm okay paying more for that.  (Part of it is because I have enough money.  Part of it is because I grew up poor, with no health insurance.  Everything paid out of pocket, including major surgery that took my parents 5 years to pay off.  My family prioritized health care and needs.  We did not, however, go on vacation, have cable TV, etc.)

I haven't had enough coffee today, so I'm not sure I'm explaining well.  It's a fascinating subject, in any event.  I posted a rather snarky comment on FB recently about how we should just eliminate health insurance premium subsidies for all federal employees.  One of my HS friends missed the "snark" and agreed that people should pay their own premiums.  I don't think she did the math, though. Because my estimates would be that her annual health insurance cost would be $10k in premiums, up to $8k out of pocket after that.  For her family of soon-to-be-4.  On her $45,000 annual salary.  Nevermind that both she and her wife have pre-existing conditions and likely would have to pay more than that, were there not an ACA, if they could even get coverage.

Or maybe she did do that math, and prefers my home town method of crowdfunding for chemo.  Pancake breakfasts and spaghetti dinners.

Darn it, I deleted part of my response to reword it, then didn't replace it.  I really shouldn't write responses from work.

Let's try this again.  The "Now imagine..." sentence should have been:

Now imagine if you had to subsidize them, plus subsidize healthy older people, by paying an extra 50% higher premiums.

Should a healthy 60-year-old making $150,000/yr receive subsidized premiums at the expense of a healthy 27-year-old making $60,000/yr?

obstinate

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Re: What comes after the ACA?
« Reply #2248 on: May 09, 2017, 11:38:38 AM »
Should a healthy 60-year-old making $150,000/yr receive subsidized premiums at the expense of a healthy 27-year-old making $60,000/yr?
A healthy sixty year old making $150k will not get subsidies because their income is too high. http://www.financialsamurai.com/subsidy-amounts-by-income-limits-for-the-affordable-care-act-obamacare/

Jrr85

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Re: What comes after the ACA?
« Reply #2249 on: May 09, 2017, 11:41:15 AM »
If this bill results in even one 35 year old "early-retiree" Mustachian to keep working for a few more years in their prime to support their health care costs, I'd say mission accomplished. Get back to work, entitled bastards!! instead of preying on the ACA for your own motives under the guise of being empathic to poor people.

It's this kind of thinking that destroys entrepreneurial ventures.
If people have to worry about not having health insurance if they leave a job at a staid megacorp to start a new business, then destroying the ACA will stunt the entrepreneurial spirit and new business formation.
It's the formation of new business that contribute most to economic activity and hiring of new employees.

I doubt it.  Most people that want to start businesses are relatively young and healthy.  Depending on the health of the pool of employees at their employer, they are probably healthier, and so even if they lose the benefit of the favorable tax treatment, it will still probably be roughly the same in costs if not cheaper.  So it's not that they don't start a business because of theprice of health insurance, it's that they don't start a business because they can't stomach the cut in total compensation that would occur to begin with as a result of quitting their job and starting a new business.