Author Topic: What comes after the ACA?  (Read 349839 times)

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3600 on: September 30, 2017, 05:00:53 PM »
Malevolence tempered by incompetence.

Mr. Green

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Re: What comes after the ACA?
« Reply #3601 on: September 30, 2017, 10:59:54 PM »
I believe we are witnessing the last gasps of the "old guard." When you suffocate someone they always fight the hardest right before they die. That's what is happening.
uhh...... you're scaring me Mr Green. Let's keep our distances, ok?
I meant that is the body's physiological response to suffocation, not that I suffocate people. Lol
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tyort1

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Re: What comes after the ACA?
« Reply #3602 on: September 30, 2017, 11:16:36 PM »
I believe we are witnessing the last gasps of the "old guard." When you suffocate someone they always fight the hardest right before they die. That's what is happening.
uhh...... you're scaring me Mr Green. Let's keep our distances, ok?
I meant that is the body's physiological response to suffocation, not that I suffocate people. Lol

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Monkey Uncle

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Re: What comes after the ACA?
« Reply #3603 on: October 01, 2017, 04:29:30 AM »
Other than the exchanges, are there any other parts of the ACA that are "failing?"  It seems that all of the consumer protection rules are functioning as designed, and somebody who doesn't qualify for subsidies is able to buy a policy in a competitive market.

I'd say that so far it is not succeeding in controlling costs.  But that has been discussed ad nauseum up-thread.
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Bucksandreds

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Re: What comes after the ACA?
« Reply #3604 on: October 01, 2017, 06:12:37 AM »
Other than the exchanges, are there any other parts of the ACA that are "failing?"  It seems that all of the consumer protection rules are functioning as designed, and somebody who doesn't qualify for subsidies is able to buy a policy in a competitive market.

I'd say that so far it is not succeeding in controlling costs.  But that has been discussed ad nauseum up-thread.

Penalties for not buying insurance should have been equal to the cost of insurance. We'd have millions more healthy people on the exchanges and thus lower prices.  Subsidies should have been extended to higher incomes. ACA should have included more price setting/negotiation to control things like drug costs. When Democrats get back control (hopefully 2020) they'll have the choice to do this or push for full single payer. I think the former is more likely in the short term.

maizeman

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Re: What comes after the ACA?
« Reply #3605 on: October 01, 2017, 11:29:33 AM »
The way they wrote the law ACA penalty for not having health insurance actually is the same as the nationwide average cost for a bronze health insurance plan. The reason so many people pay less than that is that there was another provision which capped the penalty owed as a percent of income, so only a subset of people earn enough money to pay the full penalty.
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Paul der Krake

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Re: What comes after the ACA?
« Reply #3606 on: October 01, 2017, 11:40:23 AM »
Massive increases here in Washington for 2018. Shame, it was one of the few states with quite reasonable rates (compared to the rest of the country).

https://www.seattletimes.com/seattle-news/health/states-health-exchange-rates-to-jump-24/


EnjoyIt

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Re: What comes after the ACA?
« Reply #3607 on: October 01, 2017, 11:45:30 AM »
In the US we pay ~$10,500 per person per year on healthcare.
The US population is $320.1 million in 2016.
Simple math tells us we spend $3,361 trillion on healthcare
The US government expects $3,654 trillion in revenue in 2018 (this includes income tax, social security and medicare, corporate tax, unemployment tax and import tariffs)

I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes. I would love to see everyone in the US have their healthcare covered. I just don't see it possible in our current environment.
« Last Edit: October 01, 2017, 11:49:24 AM by EnjoyIt »

madgeylou

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Re: What comes after the ACA?
« Reply #3608 on: October 01, 2017, 12:53:33 PM »
In the US we pay ~$10,500 per person per year on healthcare.
The US population is $320.1 million in 2016.
Simple math tells us we spend $3,361 trillion on healthcare
The US government expects $3,654 trillion in revenue in 2018 (this includes income tax, social security and medicare, corporate tax, unemployment tax and import tariffs)

I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes. I would love to see everyone in the US have their healthcare covered. I just don't see it possible in our current environment.

There is a huge amount of waste in what we pay now -- and we have worse health outcomes than many countries who spend less. Our system could be streamlined to keep costs in line and provide better outcomes.

Also I don't think anyone is proposing to pay for healthcare out of current revenue. Some portion of what we are spending now would be diverted to single payer or public options.

protostache

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Re: What comes after the ACA?
« Reply #3609 on: October 01, 2017, 12:56:23 PM »
In the US we pay ~$10,500 per person per year on healthcare.
The US population is $320.1 million in 2016.
Simple math tells us we spend $3,361 trillion on healthcare
The US government expects $3,654 trillion in revenue in 2018 (this includes income tax, social security and medicare, corporate tax, unemployment tax and import tariffs)

I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes. I would love to see everyone in the US have their healthcare covered. I just don't see it possible in our current environment.

The math is not that simple. Getting every last person into the insurance pool would bring costs down all by itself, for one thing. Second, single payer is just one of a huge variety of options for universal coverage, many of which don't increase government outlays much. A handful of small changes would get us significantly closer to universal coverage with no major changes to the health care system as a whole:

  • Make the individual mandate significantly stronger stronger. I'm talking wage garnishment and auto enrollment.
  • Get rid of the health insurance tax deduction and the business mandate, discouraging businesses from offering it as a benefit. This would bring in an additional $310 billion per year.
  • Use the $310 billion per year additional tax revenue to extend premium subsidies to a max of 10% of income for any income level, as well as strengthening cost sharing reductions.

These changes and more are detailed in this post on acasignups.net from earlier this year.

sol

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Re: What comes after the ACA?
« Reply #3610 on: October 01, 2017, 01:49:34 PM »
I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes.

You've totally missed the point.  The "massive tax hikes" required to pay for all of that health insurance are already being paid by you and me and everyone else.  We just pay it to for-profit health insurance companies instead.  The taxes would only go up by the same amount that our health insurance costs would go down.  Without a profit motive involved, we'd arguably SAVE money in the process by paying less in increased taxes than we currently pay for health insurance.

It's not like taxes would go up to cover the cost of healthcare and we'd have to find that much more money.  We're already paying for it.  Single payer shouldn't cost one penny more than our current health care system costs. 

So don't fall for that conservative line about how it will cost the government trillions.  They only say that because under the current system, we pay for health insurance with a regressive fixed tax (everybody pays the same regardless of income) and rich people LOVE regressive fixed taxes.  If we went to federal single payer health insurance, total healthcare cost would stay the same (or go down) but rich people would probably pay more than poor people.  That's the real Republican argument against single payer.  Not that it will cost more, but that it will cost the country the same while costing rich people more and poor people less. 

Exflyboy

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Re: What comes after the ACA?
« Reply #3611 on: October 01, 2017, 01:49:59 PM »
In the US we pay ~$10,500 per person per year on healthcare.
The US population is $320.1 million in 2016.
Simple math tells us we spend $3,361 trillion on healthcare
The US government expects $3,654 trillion in revenue in 2018 (this includes income tax, social security and medicare, corporate tax, unemployment tax and import tariffs)

I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes. I would love to see everyone in the US have their healthcare covered. I just don't see it possible in our current environment.

The math is not that simple. Getting every last person into the insurance pool would bring costs down all by itself, for one thing. Second, single payer is just one of a huge variety of options for universal coverage, many of which don't increase government outlays much. A handful of small changes would get us significantly closer to universal coverage with no major changes to the health care system as a whole:

  • Make the individual mandate significantly stronger stronger. I'm talking wage garnishment and auto enrollment.
  • Get rid of the health insurance tax deduction and the business mandate, discouraging businesses from offering it as a benefit. This would bring in an additional $310 billion per year.
  • Use the $310 billion per year additional tax revenue to extend premium subsidies to a max of 10% of income for any income level, as well as strengthening cost sharing reductions.

These changes and more are detailed in this post on acasignups.net from earlier this year.

Waaay less.. In the UK they spend about $3500/person/year. But thats Sociliasm and therefore evil.. They have "death panels" over there don't ya know?

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3612 on: October 01, 2017, 02:54:24 PM »

Jump in 2018 insurance rates on the exchange largely a reflection of Trump/GOP sabotage

http://acasignups.net/2018-rate-hikes

jim555

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Re: What comes after the ACA?
« Reply #3613 on: October 01, 2017, 05:21:30 PM »
We made it to Oct. 1st!  The zombie is temporarily dead. 

I just wanted to add the CSR funding issue makes the Silver plans more expensive.  But the subsidies are hinged to the second lowest cost Silver plan, so it may actually make to non-Silver plans cheaper after the subsidy is applied.  This is why it will cost them more not to fund the CSRs.

Exflyboy

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Re: What comes after the ACA?
« Reply #3614 on: October 01, 2017, 06:24:56 PM »
We made it to Oct. 1st!  The zombie is temporarily dead. 

I just wanted to add the CSR funding issue makes the Silver plans more expensive.  But the subsidies are hinged to the second lowest cost Silver plan, so it may actually make to non-Silver plans cheaper after the subsidy is applied.  This is why it will cost them more not to fund the CSRs.

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protostache

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Re: What comes after the ACA?
« Reply #3615 on: October 01, 2017, 07:07:29 PM »
We made it to Oct. 1st!  The zombie is temporarily dead. 

I just wanted to add the CSR funding issue makes the Silver plans more expensive.  But the subsidies are hinged to the second lowest cost Silver plan, so it may actually make to non-Silver plans cheaper after the subsidy is applied.  This is why it will cost them more not to fund the CSRs.

Not just after subsidies. In some rating areas in some states the full freight cost of a Silver plan is equal to or more than a gold plan. I know in my area of Michigan it’s going to be a tough call between a higher deductible HSA Silver plan and a lower deductible gold plan because they’ll be only a few dollars apart.

EnjoyIt

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Re: What comes after the ACA?
« Reply #3616 on: October 01, 2017, 07:51:54 PM »
I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes.

You've totally missed the point.  The "massive tax hikes" required to pay for all of that health insurance are already being paid by you and me and everyone else.  We just pay it to for-profit health insurance companies instead.  The taxes would only go up by the same amount that our health insurance costs would go down.  Without a profit motive involved, we'd arguably SAVE money in the process by paying less in increased taxes than we currently pay for health insurance.

It's not like taxes would go up to cover the cost of healthcare and we'd have to find that much more money.  We're already paying for it.  Single payer shouldn't cost one penny more than our current health care system costs. 

So don't fall for that conservative line about how it will cost the government trillions.  They only say that because under the current system, we pay for health insurance with a regressive fixed tax (everybody pays the same regardless of income) and rich people LOVE regressive fixed taxes.  If we went to federal single payer health insurance, total healthcare cost would stay the same (or go down) but rich people would probably pay more than poor people.  That's the real Republican argument against single payer.  Not that it will cost more, but that it will cost the country the same while costing rich people more and poor people less.

A few points on your comment:
1) Yes I agree that we are currently paying that amount so if we convert it from paying insurance premiums and deductibles to taxes it should technically make no difference in the final amount paid. Except, those who make enough money will find their taxes go up not just to cover their own $10.5k/yr, but also their families.  So a family of 4 would see their taxes go up by $42k/yr right?  Then the healthcare cost of those who can't afford their share of $10.5k/yr.  If a large portion of the country will be paying nothing or a tiny fraction of that $10.5k, then Sol, how much will you and I have to cover? Will this same higher income upper middle class family have to shell out $50-$60k/yr to cover those costs?  I honestly don't know the answer to this math problem, but it does concern me. 

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

3) There will be some savings in regards to decreased paperwork since healthcare providers will have to deal with only 1 payer.  I have no way of calculating those savings, but I'm sure they are not insignificant.

4) We can also assume that those who currently pay out of pocket or have high deductibles may utilize more health resources since everything will be fully covered by the government and expenditures would likely go up.

5) Will expenditures in total go up or go down I believe is very tough to predict based on just those simple points.

6) If all 320 million people are covered by the government, will the government be more or less efficient than the private sector? It depends.  Medicare seams to be relatively efficient based on the number they claim (There is a whole discussing how they neglect to calculate the inefficiencies they force unto the hospitals, offices and health care providers but that is a whole other topic.) Can they be more efficient than the private sector and will they be able to continue that when responsible for the entire US?

So once again Sol, I seam to agree with some of your points, but it does lead to more questions.

JLee

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Re: What comes after the ACA?
« Reply #3617 on: October 02, 2017, 09:00:33 PM »
I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes.

You've totally missed the point.  The "massive tax hikes" required to pay for all of that health insurance are already being paid by you and me and everyone else.  We just pay it to for-profit health insurance companies instead.  The taxes would only go up by the same amount that our health insurance costs would go down.  Without a profit motive involved, we'd arguably SAVE money in the process by paying less in increased taxes than we currently pay for health insurance.

It's not like taxes would go up to cover the cost of healthcare and we'd have to find that much more money.  We're already paying for it.  Single payer shouldn't cost one penny more than our current health care system costs. 

So don't fall for that conservative line about how it will cost the government trillions.  They only say that because under the current system, we pay for health insurance with a regressive fixed tax (everybody pays the same regardless of income) and rich people LOVE regressive fixed taxes.  If we went to federal single payer health insurance, total healthcare cost would stay the same (or go down) but rich people would probably pay more than poor people.  That's the real Republican argument against single payer.  Not that it will cost more, but that it will cost the country the same while costing rich people more and poor people less.

A few points on your comment:
1) Yes I agree that we are currently paying that amount so if we convert it from paying insurance premiums and deductibles to taxes it should technically make no difference in the final amount paid. Except, those who make enough money will find their taxes go up not just to cover their own $10.5k/yr, but also their families.  So a family of 4 would see their taxes go up by $42k/yr right?  Then the healthcare cost of those who can't afford their share of $10.5k/yr.  If a large portion of the country will be paying nothing or a tiny fraction of that $10.5k, then Sol, how much will you and I have to cover? Will this same higher income upper middle class family have to shell out $50-$60k/yr to cover those costs?  I honestly don't know the answer to this math problem, but it does concern me. 

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

3) There will be some savings in regards to decreased paperwork since healthcare providers will have to deal with only 1 payer.  I have no way of calculating those savings, but I'm sure they are not insignificant.

4) We can also assume that those who currently pay out of pocket or have high deductibles may utilize more health resources since everything will be fully covered by the government and expenditures would likely go up.

5) Will expenditures in total go up or go down I believe is very tough to predict based on just those simple points.

6) If all 320 million people are covered by the government, will the government be more or less efficient than the private sector? It depends.  Medicare seams to be relatively efficient based on the number they claim (There is a whole discussing how they neglect to calculate the inefficiencies they force unto the hospitals, offices and health care providers but that is a whole other topic.) Can they be more efficient than the private sector and will they be able to continue that when responsible for the entire US?

So once again Sol, I seam to agree with some of your points, but it does lead to more questions.

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Re: 4) Or, people with access to preventative health care might catch problems earlier and end up saving the entire health care system money in the end -
 Further info.

DeanHedlund

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Re: What comes after the ACA?
« Reply #3618 on: October 02, 2017, 10:09:08 PM »

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.
Completely agree. I have no kids but pay a lot.

I think people act like this is an uncharted territory and USA is the first to do this. Oh the sky is falling, the sky is falling. Use fear, because it works for many people.

Exflyboy

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Re: What comes after the ACA?
« Reply #3619 on: October 02, 2017, 10:40:38 PM »

Jump in 2018 insurance rates on the exchange largely a reflection of Trump/GOP sabotage

http://acasignups.net/2018-rate-hikes

Not sure I understand this. The chart shows the full weighted increase in Oregon is to be 15.7%.

I just got a letter from my insurance company saying my unsubsidised rate is going from $847 up to $1102.. i.e a 30% increase!!!!!

Like Holy shit!

sol

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Re: What comes after the ACA?
« Reply #3620 on: October 02, 2017, 10:47:44 PM »
Like Holy shit!

Are you paying the unsubsidized rate?  If not, then this doesn't impact you at all.  If you are, then it sounds like it's time to let that free market go to work, and you need to shop for different insurance.

Exflyboy

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Re: What comes after the ACA?
« Reply #3621 on: October 02, 2017, 11:02:31 PM »
Nope getting a significant subsidy which they say will be the same amount next year.. if thats true then I get to pay the full 30%.. for the Bronze HSA plan.

I.e 2017.. cost = $847, subsidy $811.. Net cost $36

2018 .. From Providence, Cost = $1102, subsidy $811, net cost $291.

Not the end of the world but Providence is telling me the subsidy will be the same (assuming the same level of income and I assume the our ages increased by 1 year).

The new plan also has less coverage for out of network.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3622 on: October 03, 2017, 06:28:29 AM »
Nope getting a significant subsidy which they say will be the same amount next year.. if thats true then I get to pay the full 30%.. for the Bronze HSA plan.

I.e 2017.. cost = $847, subsidy $811.. Net cost $36

2018 .. From Providence, Cost = $1102, subsidy $811, net cost $291.

Not the end of the world but Providence is telling me the subsidy will be the same (assuming the same level of income and I assume the our ages increased by 1 year).

The new plan also has less coverage for out of network.

 I would think that your subsidy would go up. It should be based on the cost of the second cheapest silver plan. Presumably that silver plan has gone up in price. And if your income stays the same then your subsidy should go up such that only a certain percentage of your income would go toward paying for the insurance.

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Re: What comes after the ACA?
« Reply #3623 on: October 03, 2017, 06:51:41 AM »
2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

Private health insurers are huge companies with very good accountants. Just like you or I would do with our income tax, they can successfully minimize their profit on paper while still stashing it away in investments/facilities, especially with the heavy incentive to do so that the profit cap provides. Recently the small local health insurer my work uses went out of business - the problem, as I understand it, was that they were excessively profitable, and subsequently were forced to pay compensation to another firm that wasn't profitable, a demand that effectively put them out of business. The "non-profitable" firm was BlueCross BlueShield. I find it very hard to believe that company is not profitable.

Let's also consider the huge costs of legal action between insurers. We all pay for that via premiums, and it would be absolutely unnecessary in a single-payer system.

former player

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Re: What comes after the ACA?
« Reply #3624 on: October 03, 2017, 07:05:06 AM »
2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

Private health insurers are huge companies with very good accountants. Just like you or I would do with our income tax, they can successfully minimize their profit on paper while still stashing it away in investments/facilities, especially with the heavy incentive to do so that the profit cap provides. Recently the small local health insurer my work uses went out of business - the problem, as I understand it, was that they were excessively profitable, and subsequently were forced to pay compensation to another firm that wasn't profitable, a demand that effectively put them out of business. The "non-profitable" firm was BlueCross BlueShield. I find it very hard to believe that company is not profitable.

Let's also consider the huge costs of legal action between insurers. We all pay for that via premiums, and it would be absolutely unnecessary in a single-payer system.
BiB: huh?

(I suspect that you don't have a free market health system in the USA at all, you have a "deliberately rigged to profit the people who give politicians the most money" health system.
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protostache

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Re: What comes after the ACA?
« Reply #3625 on: October 03, 2017, 07:19:41 AM »
2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

Private health insurers are huge companies with very good accountants. Just like you or I would do with our income tax, they can successfully minimize their profit on paper while still stashing it away in investments/facilities, especially with the heavy incentive to do so that the profit cap provides. Recently the small local health insurer my work uses went out of business - the problem, as I understand it, was that they were excessively profitable, and subsequently were forced to pay compensation to another firm that wasn't profitable, a demand that effectively put them out of business. The "non-profitable" firm was BlueCross BlueShield. I find it very hard to believe that company is not profitable.

Let's also consider the huge costs of legal action between insurers. We all pay for that via premiums, and it would be absolutely unnecessary in a single-payer system.
BiB: huh?

(I suspect that you don't have a free market health system in the USA at all, you have a "deliberately rigged to profit the people who give politicians the most money" health system.

What Ocelot is talking about doesn't have anything to do with profitability, it has to do with the "medical loss ratio", which is how much the insurance company pays out for claims. Two programs in ACA transfer funds from plans with low claims to plans with high claims, the "Risk Adjustment" and "Risk Corridor" programs detailed in this helpful explainer. The risk corridor program caused a lot of problems because Senate GOP leadership successfully blocked federal payments into the program which in turn caused many smaller insurance companies to fail due to inaccurate rate setting in the first few years.

The whole idea that an 80% medical loss ratio means your insurance company's profit margin must be 20% is farcical. If they're paying out 80% to providers, then 20% is their gross margin. From that they pay the salaries of everyone involved including customer service, actuaries, and management. They also pay for all of the IT that supports payments sloshing around. They also have to, as Ocelot mentioned, potentially pay into the risk adjustment programs. Insurance company net profit on health insurance, at least for the big players, is like 2-3%. It's basically the same margin as Kroger.

Please don't take the above as me defending the insurance companies or the current system in the US. I am 100% in favor of universal coverage either directly provided by the government or mediated through tightly regulated payers.

maizeman

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Re: What comes after the ACA?
« Reply #3626 on: October 03, 2017, 07:27:40 AM »
Nope getting a significant subsidy which they say will be the same amount next year.. if thats true then I get to pay the full 30%.. for the Bronze HSA plan.

I.e 2017.. cost = $847, subsidy $811.. Net cost $36

2018 .. From Providence, Cost = $1102, subsidy $811, net cost $291.

Not the end of the world but Providence is telling me the subsidy will be the same (assuming the same level of income and I assume the our ages increased by 1 year).

The new plan also has less coverage for out of network.

 I would think that your subsidy would go up. It should be based on the cost of the second cheapest silver plan. Presumably that silver plan has gone up in price. And if your income stays the same then your subsidy should go up such that only a certain percentage of your income would go toward paying for the insurance.

Agreed. My guess is that because they don't have your income for this year (and may not know the second cheapest silver plan for your region yet), the script for creating this form letter was designed to just use the subsidy amount from the previous year for all subscribers.
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jim555

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Re: What comes after the ACA?
« Reply #3627 on: October 03, 2017, 07:35:10 AM »
New York is still keeping the Essential Plans for 2018 despite the CSR funding question. 
Premium remains at $20 for the 150-200 FPL group, and $0 for the 138-150 FPL group.

The weighted average for the QHPs is a 14.5% increase.

farmecologist

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Re: What comes after the ACA?
« Reply #3628 on: October 03, 2017, 08:36:12 AM »

For what it's worth...at least some states are doing the best they can to attempt to 'fix' the current situation :

  http://www.twincities.com/2017/10/02/minnesota-health-insurance-rates-stay-stable-or-even-drop-for-2018/

I'm sure there are plenty of holes that can be blown in this...but at least it is not a 100% gloom and doom story like we almost always hear about here.


protostache

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Re: What comes after the ACA?
« Reply #3629 on: October 03, 2017, 08:44:03 AM »

For what it's worth...at least some states are doing the best they can to attempt to 'fix' the current situation :

  http://www.twincities.com/2017/10/02/minnesota-health-insurance-rates-stay-stable-or-even-drop-for-2018/

I'm sure there are plenty of holes that can be blown in this...but at least it is not a 100% gloom and doom story like we almost always hear about here.

That article doesn't mention the bit where CMS approved the 1332 waiver necessary to implement the reinsurance program and simultaneously discontinued funding for Minnesota's Basic Health Program, something that they repeatedly promised they wouldn't do. Minnesota is worse off as a whole for implementing that program because of HHS/CMS sabotage.

Quote
CMS is effectively stealing $369 million from MinnesotaCare enrollees, giving $208 million of it to unsubsidized MNsure enrollees and...pocketing the $161 million difference?

Put yet another way, CMS just screwed Minnesota residents earning 138% - 200% of the federal poverty line ($16,000 - $24,000/year) in order to help out those earning over 400% FPL ($48,000/yr +). Certainly that help is needed, but it shouldn't have been done by hurting those lower down the income chain.

http://acasignups.net/17/10/03/update-minnesota-avg-rate-drop-2018-thanks-troubled-reinsurance-program

Bucksandreds

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Re: What comes after the ACA?
« Reply #3630 on: October 03, 2017, 08:51:40 AM »
I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes.

You've totally missed the point.  The "massive tax hikes" required to pay for all of that health insurance are already being paid by you and me and everyone else.  We just pay it to for-profit health insurance companies instead.  The taxes would only go up by the same amount that our health insurance costs would go down.  Without a profit motive involved, we'd arguably SAVE money in the process by paying less in increased taxes than we currently pay for health insurance.

It's not like taxes would go up to cover the cost of healthcare and we'd have to find that much more money.  We're already paying for it.  Single payer shouldn't cost one penny more than our current health care system costs. 

So don't fall for that conservative line about how it will cost the government trillions.  They only say that because under the current system, we pay for health insurance with a regressive fixed tax (everybody pays the same regardless of income) and rich people LOVE regressive fixed taxes.  If we went to federal single payer health insurance, total healthcare cost would stay the same (or go down) but rich people would probably pay more than poor people.  That's the real Republican argument against single payer.  Not that it will cost more, but that it will cost the country the same while costing rich people more and poor people less.

A few points on your comment:
1) Yes I agree that we are currently paying that amount so if we convert it from paying insurance premiums and deductibles to taxes it should technically make no difference in the final amount paid. Except, those who make enough money will find their taxes go up not just to cover their own $10.5k/yr, but also their families.  So a family of 4 would see their taxes go up by $42k/yr right?  Then the healthcare cost of those who can't afford their share of $10.5k/yr.  If a large portion of the country will be paying nothing or a tiny fraction of that $10.5k, then Sol, how much will you and I have to cover? Will this same higher income upper middle class family have to shell out $50-$60k/yr to cover those costs?  I honestly don't know the answer to this math problem, but it does concern me. 

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

3) There will be some savings in regards to decreased paperwork since healthcare providers will have to deal with only 1 payer.  I have no way of calculating those savings, but I'm sure they are not insignificant.

4) We can also assume that those who currently pay out of pocket or have high deductibles may utilize more health resources since everything will be fully covered by the government and expenditures would likely go up.

5) Will expenditures in total go up or go down I believe is very tough to predict based on just those simple points.

6) If all 320 million people are covered by the government, will the government be more or less efficient than the private sector? It depends.  Medicare seams to be relatively efficient based on the number they claim (There is a whole discussing how they neglect to calculate the inefficiencies they force unto the hospitals, offices and health care providers but that is a whole other topic.) Can they be more efficient than the private sector and will they be able to continue that when responsible for the entire US?

So once again Sol, I seam to agree with some of your points, but it does lead to more questions.

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Re: 4) Or, people with access to preventative health care might catch problems earlier and end up saving the entire health care system money in the end -
 Further info.

Arguing with the nonsense spewed by the far right gives it legitimacy. Let's let the adults converse about real health care solutions and do our best to ignore the nonsense.

mm1970

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Re: What comes after the ACA?
« Reply #3631 on: October 03, 2017, 10:34:28 AM »

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.
Completely agree. I have no kids but pay a lot.

I think people act like this is an uncharted territory and USA is the first to do this. Oh the sky is falling, the sky is falling. Use fear, because it works for many people.
Property taxes funding schools is a bit different.

When you fund your schools, you aren't actually paying for someone else's kids to go to school.  You are, but in reality you have to think about it as "paying back for your own public education".

I had a convo on a walk once with a rather conservative woman.  She grew up in my neighborhood and went to the school down the street from me.  But then she went on a rant that she should get a discount on her property taxes because she didn't have children.

Now, this woman was probably in her late 50's or early 60's.

My response:
- This is California.  Prop 13 already insures that you get a discount on your property taxes because you bought your house decades ago.
- You are repaying society for your own education.
- (I didn't even mention the benefits to society from having an educated populace).

My quick math tells me that on average, our district spends $7000 per student per year.
So, for her education, that is $7000x13 = $91,000.  She's married, so double that to add her husband.

Based on that, on Prop 13 capping her prop taxes, and the percentage of property taxes that go to the schools, I estimated that it will take her 75 years until she has paid back the cost of schooling for her and her husband.

So yeah, if you want a discount on prop taxes after 75 years, sure!

Inaya

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Re: What comes after the ACA?
« Reply #3632 on: October 03, 2017, 12:35:28 PM »

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.
Completely agree. I have no kids but pay a lot.

I think people act like this is an uncharted territory and USA is the first to do this. Oh the sky is falling, the sky is falling. Use fear, because it works for many people.
Property taxes funding schools is a bit different.

When you fund your schools, you aren't actually paying for someone else's kids to go to school.  You are, but in reality you have to think about it as "paying back for your own public education".


But when your taxes go toward healthcare, aren't you really just pre-paying for your own healthcare? Everyone needs it eventually.
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mm1970

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Re: What comes after the ACA?
« Reply #3633 on: October 03, 2017, 05:35:19 PM »

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.
Completely agree. I have no kids but pay a lot.

I think people act like this is an uncharted territory and USA is the first to do this. Oh the sky is falling, the sky is falling. Use fear, because it works for many people.
Property taxes funding schools is a bit different.

When you fund your schools, you aren't actually paying for someone else's kids to go to school.  You are, but in reality you have to think about it as "paying back for your own public education".


But when your taxes go toward healthcare, aren't you really just pre-paying for your own healthcare? Everyone needs it eventually.
Yes, really.  That's a very good way of looking at it. 

JLee

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Re: What comes after the ACA?
« Reply #3634 on: October 03, 2017, 06:48:55 PM »

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.
Completely agree. I have no kids but pay a lot.

I think people act like this is an uncharted territory and USA is the first to do this. Oh the sky is falling, the sky is falling. Use fear, because it works for many people.
Property taxes funding schools is a bit different.

When you fund your schools, you aren't actually paying for someone else's kids to go to school.  You are, but in reality you have to think about it as "paying back for your own public education".

I had a convo on a walk once with a rather conservative woman.  She grew up in my neighborhood and went to the school down the street from me.  But then she went on a rant that she should get a discount on her property taxes because she didn't have children.

Now, this woman was probably in her late 50's or early 60's.

My response:
- This is California.  Prop 13 already insures that you get a discount on your property taxes because you bought your house decades ago.
- You are repaying society for your own education.
- (I didn't even mention the benefits to society from having an educated populace).

My quick math tells me that on average, our district spends $7000 per student per year.
So, for her education, that is $7000x13 = $91,000.  She's married, so double that to add her husband.

Based on that, on Prop 13 capping her prop taxes, and the percentage of property taxes that go to the schools, I estimated that it will take her 75 years until she has paid back the cost of schooling for her and her husband.

So yeah, if you want a discount on prop taxes after 75 years, sure!

That's all well and good, but I was homeschooled. Sooooooooo....what am I paying back, exactly?

You're correct - society benefits from having an educated populace, much as society benefits from having a healthy populace.  Do you see where I'm going here?
« Last Edit: October 03, 2017, 06:51:00 PM by JLee »

EnjoyIt

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Re: What comes after the ACA?
« Reply #3635 on: October 03, 2017, 10:10:00 PM »
I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes.

You've totally missed the point.  The "massive tax hikes" required to pay for all of that health insurance are already being paid by you and me and everyone else.  We just pay it to for-profit health insurance companies instead.  The taxes would only go up by the same amount that our health insurance costs would go down.  Without a profit motive involved, we'd arguably SAVE money in the process by paying less in increased taxes than we currently pay for health insurance.

It's not like taxes would go up to cover the cost of healthcare and we'd have to find that much more money.  We're already paying for it.  Single payer shouldn't cost one penny more than our current health care system costs. 

So don't fall for that conservative line about how it will cost the government trillions.  They only say that because under the current system, we pay for health insurance with a regressive fixed tax (everybody pays the same regardless of income) and rich people LOVE regressive fixed taxes.  If we went to federal single payer health insurance, total healthcare cost would stay the same (or go down) but rich people would probably pay more than poor people.  That's the real Republican argument against single payer.  Not that it will cost more, but that it will cost the country the same while costing rich people more and poor people less.

A few points on your comment:
1) Yes I agree that we are currently paying that amount so if we convert it from paying insurance premiums and deductibles to taxes it should technically make no difference in the final amount paid. Except, those who make enough money will find their taxes go up not just to cover their own $10.5k/yr, but also their families.  So a family of 4 would see their taxes go up by $42k/yr right?  Then the healthcare cost of those who can't afford their share of $10.5k/yr.  If a large portion of the country will be paying nothing or a tiny fraction of that $10.5k, then Sol, how much will you and I have to cover? Will this same higher income upper middle class family have to shell out $50-$60k/yr to cover those costs?  I honestly don't know the answer to this math problem, but it does concern me. 

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

3) There will be some savings in regards to decreased paperwork since healthcare providers will have to deal with only 1 payer.  I have no way of calculating those savings, but I'm sure they are not insignificant.

4) We can also assume that those who currently pay out of pocket or have high deductibles may utilize more health resources since everything will be fully covered by the government and expenditures would likely go up.

5) Will expenditures in total go up or go down I believe is very tough to predict based on just those simple points.

6) If all 320 million people are covered by the government, will the government be more or less efficient than the private sector? It depends.  Medicare seams to be relatively efficient based on the number they claim (There is a whole discussing how they neglect to calculate the inefficiencies they force unto the hospitals, offices and health care providers but that is a whole other topic.) Can they be more efficient than the private sector and will they be able to continue that when responsible for the entire US?

So once again Sol, I seam to agree with some of your points, but it does lead to more questions.

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Re: 4) Or, people with access to preventative health care might catch problems earlier and end up saving the entire health care system money in the end -
 Further info.

I do not disagree with either of your comments. I have no problem paying my fair share of taxes and have no problem paying extra to make sure people who can't afford healthcare can have their acute and chronic diseases treated.  I do wonder what the real cost of healthcare would be if we went to a fully government funded system?  Will it increase, decrease or stay the same? I would hope despite some of my listed items, the cost of providing healthcare would go down as a whole.  But by how much?  Even getting healthcare costs down to $8k/person/year is still very expensive. How are we as a country going to pay for it? The general proposition is to increase taxes by what we are currently paying for private healthcare. We assume that those who are subsidized will continue to pay nothing or very little based on their income while those families who don't qualify for subsidies will have to pay more.  If healthcare cost will go down to $8k/person/year then a family of 4 will have to pay $32k/yr for their share as well as cover the subsidies for those who can't afford it. How much more? Am I wrong that for example a family of 4 making $120k/yr would be forking over a significant chunk of their paycheck in this model? 

I will admit I am no expert on what a conversion to a public health plan will look like and interested in seeing how we will fund it. I'm willing to accept my logic above is wrong but would love to understand why/how. I think our biggest issue compared to other countries who have successfully created social healthcare is that they pay half of what the US pays and getting better results.

JLee

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Re: What comes after the ACA?
« Reply #3636 on: October 03, 2017, 10:34:47 PM »
I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes.

You've totally missed the point.  The "massive tax hikes" required to pay for all of that health insurance are already being paid by you and me and everyone else.  We just pay it to for-profit health insurance companies instead.  The taxes would only go up by the same amount that our health insurance costs would go down.  Without a profit motive involved, we'd arguably SAVE money in the process by paying less in increased taxes than we currently pay for health insurance.

It's not like taxes would go up to cover the cost of healthcare and we'd have to find that much more money.  We're already paying for it.  Single payer shouldn't cost one penny more than our current health care system costs. 

So don't fall for that conservative line about how it will cost the government trillions.  They only say that because under the current system, we pay for health insurance with a regressive fixed tax (everybody pays the same regardless of income) and rich people LOVE regressive fixed taxes.  If we went to federal single payer health insurance, total healthcare cost would stay the same (or go down) but rich people would probably pay more than poor people.  That's the real Republican argument against single payer.  Not that it will cost more, but that it will cost the country the same while costing rich people more and poor people less.

A few points on your comment:
1) Yes I agree that we are currently paying that amount so if we convert it from paying insurance premiums and deductibles to taxes it should technically make no difference in the final amount paid. Except, those who make enough money will find their taxes go up not just to cover their own $10.5k/yr, but also their families.  So a family of 4 would see their taxes go up by $42k/yr right?  Then the healthcare cost of those who can't afford their share of $10.5k/yr.  If a large portion of the country will be paying nothing or a tiny fraction of that $10.5k, then Sol, how much will you and I have to cover? Will this same higher income upper middle class family have to shell out $50-$60k/yr to cover those costs?  I honestly don't know the answer to this math problem, but it does concern me. 

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

3) There will be some savings in regards to decreased paperwork since healthcare providers will have to deal with only 1 payer.  I have no way of calculating those savings, but I'm sure they are not insignificant.

4) We can also assume that those who currently pay out of pocket or have high deductibles may utilize more health resources since everything will be fully covered by the government and expenditures would likely go up.

5) Will expenditures in total go up or go down I believe is very tough to predict based on just those simple points.

6) If all 320 million people are covered by the government, will the government be more or less efficient than the private sector? It depends.  Medicare seams to be relatively efficient based on the number they claim (There is a whole discussing how they neglect to calculate the inefficiencies they force unto the hospitals, offices and health care providers but that is a whole other topic.) Can they be more efficient than the private sector and will they be able to continue that when responsible for the entire US?

So once again Sol, I seam to agree with some of your points, but it does lead to more questions.

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Re: 4) Or, people with access to preventative health care might catch problems earlier and end up saving the entire health care system money in the end -
 Further info.

I do not disagree with either of your comments. I have no problem paying my fair share of taxes and have no problem paying extra to make sure people who can't afford healthcare can have their acute and chronic diseases treated.  I do wonder what the real cost of healthcare would be if we went to a fully government funded system?  Will it increase, decrease or stay the same? I would hope despite some of my listed items, the cost of providing healthcare would go down as a whole.  But by how much? Even getting healthcare costs down to $8k/person/year is still very expensive. How are we as a country going to pay for it? The general proposition is to increase taxes by what we are currently paying for private healthcare. We assume that those who are subsidized will continue to pay nothing or very little based on their income while those families who don't qualify for subsidies will have to pay more.  If healthcare cost will go down to $8k/person/year then a family of 4 will have to pay $32k/yr for their share as well as cover the subsidies for those who can't afford it. How much more? Am I wrong that for example a family of 4 making $120k/yr would be forking over a significant chunk of their paycheck in this model? 

I will admit I am no expert on what a conversion to a public health plan will look like and interested in seeing how we will fund it. I'm willing to accept my logic above is wrong but would love to understand why/how. I think our biggest issue compared to other countries who have successfully created social healthcare is that they pay half of what the US pays and getting better results.

We are already paying for it.

EnjoyIt

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Re: What comes after the ACA?
« Reply #3637 on: October 03, 2017, 11:05:06 PM »
Who is "we?"  Currently we (My wife and I) pay our medicare tax, our insurance premiums, and any healthcare we incur which so far has been below our yearly deductible. Last couple of years, roughly our family spent $13k/yr which is pretty damn low since we are young and healthy.  How much more will we have to pay to help cover the rest of the US?  Maybe I am just not getting the math.  I'm sure you will agree that we will have to pay more.  How much more?

If the cost of healthcare on average is $10,500/person we are definitely underpaying our share of the average.  Someone else must be covering our share as well as covering all those people who pay less or nothing at all. Who are these people? I have to be missing something, what is it?

JLee

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Re: What comes after the ACA?
« Reply #3638 on: October 03, 2017, 11:45:52 PM »
Who is "we?"  Currently we (My wife and I) pay our medicare tax, our insurance premiums, and any healthcare we incur which so far has been below our yearly deductible. Last couple of years, roughly our family spent $13k/yr which is pretty damn low since we are young and healthy.  How much more will we have to pay to help cover the rest of the US?  Maybe I am just not getting the math. I'm sure you will agree that we will have to pay more.  How much more?

If the cost of healthcare on average is $10,500/person we are definitely underpaying our share of the average.  Someone else must be covering our share as well as covering all those people who pay less or nothing at all. Who are these people? I have to be missing something, what is it?

Why are you sure of this?  The fundamental problem is we, as a collective nation, spend FAR more money than should be necessary on health care. If we lower what we pay as a collective, why do you insist that individual costs are going to skyrocket?

US Health Care Spending: Who Pays?
« Last Edit: October 03, 2017, 11:50:25 PM by JLee »

Paul der Krake

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Re: What comes after the ACA?
« Reply #3639 on: October 04, 2017, 12:02:55 AM »
It's pretty simple: public health spending comes from your taxes. As a high earner, you, EnjoyIt, pay a disproportionately large share of all Medicare, Medicaid, and the funny accounting that goes on when hospitals write off unpaid bills.

Mr Mark

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Re: What comes after the ACA?
« Reply #3640 on: October 04, 2017, 03:54:18 AM »
There are many ways so-called single payer could work. It could be a gov regulated (and paid) super basic catastrophic style plan with some thresholds before it pays, waitlists for non critical treatments and capped copays. If people want higher levels of coverage they can purchase in the market.
Mr. Mark

Ocelot

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Re: What comes after the ACA?
« Reply #3641 on: October 04, 2017, 06:13:54 AM »
Who is "we?"  Currently we (My wife and I) pay our medicare tax, our insurance premiums, and any healthcare we incur which so far has been below our yearly deductible. Last couple of years, roughly our family spent $13k/yr which is pretty damn low since we are young and healthy.  How much more will we have to pay to help cover the rest of the US?  Maybe I am just not getting the math.  I'm sure you will agree that we will have to pay more.  How much more?

If the cost of healthcare on average is $10,500/person we are definitely underpaying our share of the average.  Someone else must be covering our share as well as covering all those people who pay less or nothing at all. Who are these people? I have to be missing something, what is it?

Don't forget you are also paying through your general taxes, thanks to the very generous tax breaks given to employer-provided healthcare spending, which adds up to a huge amount of lost revenue that must be made up somewhere. Also remember that everybody pays to offset those tax breaks while not everybody is lucky enough to have the benefit of health insurance via their employer, ironically meaning that poorer people are in a way paying for a benefit that mostly only middleclass and up enjoys.


Ocelot

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Re: What comes after the ACA?
« Reply #3642 on: October 04, 2017, 06:14:42 AM »
2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

Private health insurers are huge companies with very good accountants. Just like you or I would do with our income tax, they can successfully minimize their profit on paper while still stashing it away in investments/facilities, especially with the heavy incentive to do so that the profit cap provides. Recently the small local health insurer my work uses went out of business - the problem, as I understand it, was that they were excessively profitable, and subsequently were forced to pay compensation to another firm that wasn't profitable, a demand that effectively put them out of business. The "non-profitable" firm was BlueCross BlueShield. I find it very hard to believe that company is not profitable.

Let's also consider the huge costs of legal action between insurers. We all pay for that via premiums, and it would be absolutely unnecessary in a single-payer system.
BiB: huh?

(I suspect that you don't have a free market health system in the USA at all, you have a "deliberately rigged to profit the people who give politicians the most money" health system.

What Ocelot is talking about doesn't have anything to do with profitability, it has to do with the "medical loss ratio", which is how much the insurance company pays out for claims. Two programs in ACA transfer funds from plans with low claims to plans with high claims, the "Risk Adjustment" and "Risk Corridor" programs detailed in this helpful explainer. The risk corridor program caused a lot of problems because Senate GOP leadership successfully blocked federal payments into the program which in turn caused many smaller insurance companies to fail due to inaccurate rate setting in the first few years.

The whole idea that an 80% medical loss ratio means your insurance company's profit margin must be 20% is farcical. If they're paying out 80% to providers, then 20% is their gross margin. From that they pay the salaries of everyone involved including customer service, actuaries, and management. They also pay for all of the IT that supports payments sloshing around. They also have to, as Ocelot mentioned, potentially pay into the risk adjustment programs. Insurance company net profit on health insurance, at least for the big players, is like 2-3%. It's basically the same margin as Kroger.

Please don't take the above as me defending the insurance companies or the current system in the US. I am 100% in favor of universal coverage either directly provided by the government or mediated through tightly regulated payers.

Thanks for the explanation.

talltexan

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Re: What comes after the ACA?
« Reply #3643 on: October 06, 2017, 08:34:05 AM »
Various media sources (through interviews with former ACA administrator Andy Slavitt) are now touting something called "Synthetic Repeal". It basically refers to undercutting the law through

1. Executive Orders that allow insurers to offer "barebones" health insurance plans across state lines, (I recognize that this might actually benefit a lot of people who are Mustachians)
2. Budgets that shrink Medicaid and deny resources to insurers in the exchanges, and
3. Sabatoge of the ACA through website downtime, lack of advertising, etc., to shrink the total risk pool

Without demonstrating the consensus of elected officials against this law, it will basically be a programme of actions through which the President and Congress are able to make Health Coverage much less accessible to poor and those with pre-existing conditions, while allowing them the ability to campaign in 2018 by claiming that ACA was flawed from the start, and--but for a few Centrist Republican holdouts--we could have fixed it and avoided the mess that we're now in.

Exflyboy

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Re: What comes after the ACA?
« Reply #3644 on: October 06, 2017, 10:03:36 AM »
In other words .. Act like assholes!

OurTown

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Re: What comes after the ACA?
« Reply #3645 on: October 06, 2017, 11:22:05 AM »
In other words .. Act like assholes!

I don't think they are acting.

nereo

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Re: What comes after the ACA?
« Reply #3646 on: October 06, 2017, 04:33:00 PM »
Well since repeal hasn't worked the GOP is plowing ahead with the 'sabotage' strategy:

GOP cuts federal support for ACA enrollment

GOP widens definition for which employers can deny coverage of birth control under their health care plan.


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Exflyboy

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Re: What comes after the ACA?
« Reply #3647 on: October 06, 2017, 05:39:49 PM »
From that article..

“The American people know a bad deal when they see one, and many won’t be convinced to sign up for ‘Washington-knows-best’ health coverage that they can’t afford.”

Umm.... If your a total Dump F GOP voter, no I don't think you do know a bad deal when you see one!

nereo

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Re: What comes after the ACA?
« Reply #3648 on: October 06, 2017, 06:00:19 PM »
From that article..

“The American people know a bad deal when they see one, and many won’t be convinced to sign up for ‘Washington-knows-best’ health coverage that they can’t afford.”

Umm.... If your a total Dump F GOP voter, no I don't think you do know a bad deal when you see one!

For context it's important to cite who was speaking - in this case the HSS spokesman Matt Lloyd via email.
Amazing. The spokesman for the very federal bureau that is supposed to be overseeing the ACA is publicly trashing it instead.
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Monkey Uncle

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Re: What comes after the ACA?
« Reply #3649 on: October 08, 2017, 04:23:01 AM »
Apparently there is an E.O. in the works to allow individuals to form associations to purchase group health insurance. 

http://www.msn.com/en-us/news/politics/trump-poised-to-sign-order-opening-new-paths-to-health-insurance/ar-AAt34K9

It isn't clear from the article whether the plans would have to meet ACA exchange plan standards.  If not, such plans could skim off the healthy people who don't qualify for subsidies.  Perhaps an opportunity for higher income early retirees to reduce their insurance costs, but likely not for typical mustachian FIREees with low taxable incomes.
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