What comes after the ACA?

[Quidnon?]

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.

Yes!  Yes!  That's it exactly!  And that is my complaint with Obamacare.  It has regulated such a high minimum standard of benefits, in order to be called "health insurance" in any legal context, that I can no longer actually buy real insurance in this field; at least not without also paying a tax penalty for not having official health insurance.  I'm relatively healthy for my age, with no major issues; and I have enough money between my HSA and other funds that I could take quite a hard hit.  But without true catastrophic and/or hospitalization insurance, I cannot be certain that I could absorb any hit that life could throw at me, regardless of the odds that I'll be hit at all.  I should have the right to buy whatever insurance I believe is right for myself, and self-insure to whatever level I am comfortable with financially, without special tax consequences and without being compelled to support the choices of others.

You've taken my quote out of context, Quidnon?. I was responding to your claim that the median emergency visit was (in 2013) about $1,200 - and therefore a trip to the ER is not a financial doomsday.

Did I?  Well, that's interesting, particularly since you just attributed a claim or quote to me that I did not make.  I do not have an opinion on the average cost of an ER trip, and I don't consider it particularly important anyway.

My point was that you don't insure against the median event, but the extremes.
As an example, take car insurance. I'm certain most accidents are minor fender-benders with no injuries and cosmetic damage.  Yet I carry insurance not to cover these likely events (which I could easily do out of pocket) but for the more rare but exponentially more costly major injury/accidents.

And I was agreeing with you, so I don't think that I was taking your quote out of context.

  Like with the ACA, car insurance covers a wide range of things including damaging property, emergency transport, salary compensation, etc.  All of these are unlikely to be needed by me individually, but will be used across the pool of people who ride in cars. 

Comprehensive insurance does, but it doesn't exist to protect you, it exists to protect the provider of your car loan from you.  So the part that is insurance for your direct benefit is the liability portion; which exists to protect you from a catastrophic loss due to harm you might cause to other drivers.  You can get comprehensive auto insurance on your paid for car as well, but it doesn't make sense unless your vehicle is particularly valuable or rare.  Not exactly a apples to apples comparison, since you are expected to pay the premiums on the insurance that protects your loan company's underwritten asset, the loan. 

I would not characterize the ACA as having an incredibly high minimum standard of benefits.  It doesn't cover a wide range of things, including dental and vision, and my unofficial survey of people I know indicate that most of them have both teeth and eyes. The requirements are fairly low overall for a population. What you seem to be objecting to is that you as an individual are required to have coverage for things that you are unlikely to use. Laws, however, are concerned with the population at large.

That's just one objection, but yes.  I'm unlikely to require a free mammogram, and it's discriminatory to me to force me to pay the premium that would pay for that.  I find it amazing that insurance companies can't manage to turn a profit under these conditions, even with the extra regulatory burdens.

[Quidnon?]

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.

Yes!  Yes!  That's it exactly!  And that is my complaint with Obamacare.  It has regulated such a high minimum standard of benefits, in order to be called "health insurance" in any legal context, that I can no longer actually buy real insurance in this field; at least not without also paying a tax penalty for not having official health insurance.  I'm relatively healthy for my age, with no major issues; and I have enough money between my HSA and other funds that I could take quite a hard hit.  But without true catastrophic and/or hospitalization insurance, I cannot be certain that I could absorb any hit that life could throw at me, regardless of the odds that I'll be hit at all.  I should have the right to buy whatever insurance I believe is right for myself, and self-insure to whatever level I am comfortable with financially, without special tax consequences and without being compelled to support the choices of others.

However, I am reminded of a lowly paid employee we used to have here, who claimed he couldn't afford our employer-sponsored health insurance, whose wife had a stroke and since they had no coverage, I had to fill out papers for him to receive medical assistance.  YOU may have the funds to take care of yourself should you have a catastrophic event, but you are not typical.  Most people would not be able to pay for it if they had no insurance and would either go bankrupt or lose their homes and other assets in order to pay the whopping medical bills they were not prepared for.

Of course I'm not typical.  That's an argument for what?  Because I'm not typical, I have to pay more for insurance than I believe that I require, because you know better than I?  Because I'm both lucky and I planned better than most?  I am aware that I'm not typical, but I don't consider that to be cause to force me to pay for more than I require and tax me more in order to subsidize the problems of other people.

[nereo]

My apologies Quidnon? - it was actually Greenback who made the original statement about the median ER visit being 'only' $1200 and how that wasn't a financial death sentence.  That was sloppy thread-following of me.
I do maintain that it's appropriate for both laws and insurance to pertain to what the group needs as opposed to the individual.  As a male I'm unlikely to need a mammogram but then again my wife is (i hope) unlikely to need a prostate exam. No one needs everything, but it is useful at the population level.

[Quidnon?]

My apologies Quidnon? - it was actually Greenback who made the original statement about the median ER visit being 'only' $1200 and how that wasn't a financial death sentence.  That was sloppy thread-following of me.
I do maintain that it's appropriate for both laws and insurance to pertain to what the group needs as opposed to the individual.  As a male I'm unlikely to need a mammogram but then again my wife is (i hope) unlikely to need a prostate exam. No one needs everything, but it is useful at the population level.

That's debatable, and obviously I disagree.  I think that regulated "free" services (because we all know there is no such thing as free) sets up some unpredictable, and often negative, incentives.  To start with, it encourages over use of such services, even if there is a limit.  Because there is no evidence, as an example, that an annual checkup is ideal.  My own doctor, whom I pay in cash, has admitted to me that for most healthy people annually is too often; perhaps 18 to 24 months; but then every 12 months is likely not often enough for monitoring a known chronic problem, or for most over about age 65.  But that is just one example, because I think that most people would be better off if all of society expected them to pay for the regular and moderately common or cheap services needed, and no one had an expectation that they would be able to avoid those smaller, regular expenses; because the insurance part (that limits risk of extreme circumstances) would be much cheaper and much more accessible for the majority.  It's similar to a right to food, I don't believe in that either.  It's not important that it is necessary to life, or that it costs more money for quality, you don't have a right to it just because you are alive and need it.

[RentSeeking]

And I think that it's a bit of a stretch to claim that The Heritage Foundation is  actually conservative.

This is almost, but not quite, as hilarious as Rex Tillerson claiming under oath today that he is "not aware of anything the fossil fuel industry gets that [he] would characterize as a subsidy."

[Quidnon?]

And I think that it's a bit of a stretch to claim that The Heritage Foundation is  actually conservative.

This is almost, but not quite, as hilarious as Rex Tillerson claiming under oath today that he is "not aware of anything the fossil fuel industry gets that [he] would characterize as a subsidy."

Well, I'm the self-identified, non-Republican, conservative here; and I don't consider them conservative.  More neo-con-ish.

[nereo]

That's debatable, and obviously I disagree.  I think that regulated "free" services (because we all know there is no such thing as free) sets up some unpredictable, and often negative, incentives.  To start with, it encourages over use of such services, even if there is a limit.  Because there is no evidence, as an example, that an annual checkup is ideal.  My own doctor, whom I pay in cash, has admitted to me that for most healthy people annually is too often; perhaps 18 to 24 months; but then every 12 months is likely not often enough for monitoring a known chronic problem, or for most over about age 65.  But that is just one example, because I think that most people would be better off if all of society expected them to pay for the regular and moderately common or cheap services needed, and no one had an expectation that they would be able to avoid those smaller, regular expenses; because the insurance part (that limits risk of extreme circumstances) would be much cheaper and much more accessible for the majority.  It's similar to a right to food, I don't believe in that either.  It's not important that it is necessary to life, or that it costs more money for quality, you don't have a right to it just because you are alive and need it.

Yes, we seem to disagree, and that's ok.  Sometimes rational people won't see eye-to-eye on certain issues. My take is that a society has a moral obligation to take care of its people, and the wealthier the society the more obligation it has. Whether that's considered an 'unalienable right' I suppose we could debate, but I think its something we *should* do regardless.
However, I've lived for the past several years in a place that has mandatory single-payer health care, and I see how it can go wrong adn I do see some of the problems you describe (namely overuse). My FIL (a physician in New England) likes to say that if htye just started charging $5 for parking it would eliminate many of the unnecessary visits by those that have zero co-pay. Similarly I would support a program that  allowed for annual checkups but charged a nominal sum (say $15 per visit, but $0 if you were unemployed/underemployed). Regarding frequency, it's true that many healthy individuals do not need a checkup every year, but others with chronic conditions need more frequent visits; such decisions should be between the patient and doctor, not legislation.
Such are my opinons - we may never agree but that's where I'm coming from.

[rtrnow]

And I think that it's a bit of a stretch to claim that The Heritage Foundation is  actually conservative.

This is almost, but not quite, as hilarious as Rex Tillerson claiming under oath today that he is "not aware of anything the fossil fuel industry gets that [he] would characterize as a subsidy."

Well, I'm the self-identified, non-Republican, conservative here; and I don't consider them conservative.  More neo-con-ish.

You also posted a link to thenewamerican. So you obviously don't know how to evaluate an actual news source.

[farmecologist]

No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

[nereo]

No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   

Worth noting that the Supreme Court recognized that health care is unique insofar that virtually no one can avoid it over the course of his or her life.

[coppertop]

No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

[GuitarStv]

No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

Last December my best friend collapsed out of the blue and went to the ER.  He's 36, not a heavy drinker, in good shape (plays soccer and works out regularly), doesn't smoke, and has no family history of disease.  Turns out he had stage 4 lung cancer.  We live in Canada, so I don't know what the cost of a month and a half in intensive care, several ambulance rides, multiple surgeries, home care with an oxygen tank and daily O2 readings, radiation therapy, and the piles upon piles of pills would have cost him in total.

At the moment he is mostly stabilized and is on some trial experimental drugs.  Those pills cost just under 100,000$ a month, (I know because they're experimental and are not covered by Canada's health care plan).  He will likely be on them for the rest of his life.  Medical expenses are real, and they can hit anybody.

[boarder42]

No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

Yes and that is the arguemnt quindon etc are making ... i should have a right to choose to be on a high deductible plan - 6850 is a drop in the bucket to those of us around here who are saving properly.  if you have your HSA that 6850 is really only 40% of that or 4110 out of pocket using those funds. 

i think pre existing conditions should be covered but i also think we each have a right to choose to be on catostrophic plans basically like homeowners insurance.  i dont need insurance against 5k dollar issues i need insurance against 100k dollar issues. 

Yes the avg american doesnt save and invest like us folk around here, and most americans carry low deductible home insurance etc.

covering people is an issue but the biggest issue still is cost transparency.  You can shop for an ER by being prepared.  Just like with work insurance you know which hospitals are in your network by you.  the same thought could be applied to finding the best service lowest cost ER by you if costs were presented open for everyone to see ahead of time you could know which hosipital you'd like to use in an ER event.

[boarder42]

No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

Last December my best friend collapsed out of the blue and went to the ER.  He's 36, not a heavy drinker, in good shape (plays soccer and works out regularly), doesn't smoke, and has no family history of disease.  Turns out he had stage 4 lung cancer.  We live in Canada, so I don't know what the cost of a month and a half in intensive care, several ambulance rides, multiple surgeries, home care with an oxygen tank and daily O2 readings, radiation therapy, and the piles upon piles of pills would have cost him in total.

At the moment he is mostly stabilized and is on some trial experimental drugs.  Those pills cost just under 100,000$ a month, (I know because they're experimental and are not covered by Canada's health care plan).  He will likely be on them for the rest of his life.  Medical expenses are real, and they can hit anybody.

So here is an example of the rich funding the poor. 

these are trial and experimental drugs some company has invested a lot of time and energy coming up with. 10 years ago your friend may have died.  Think of this like a tesla costing 130k can everyone buy that no is everyone entitled to it no.  but the model 3 will be rolling off assembly lines this year and in 5 years the general public can afford it. 

We cant save everyone with the latest and greatest most expensive technology that has been created right when it comes out.  future generations will benefit.  just like we have from great reduction and many helathcare system improvements of those who came before us.

[nereo]

covering people is an issue but the biggest issue still is cost transparency.  You can shop for an ER by being prepared.  Just like with work insurance you know which hospitals are in your network by you.  the same thought could be applied to finding the best service lowest cost ER by you if costs were presented open for everyone to see ahead of time you could know which hosipital you'd like to use in an ER event.

I agree that transparency is a very big issue.  So too is the extreme differences in cost for similar services. 
But almost by definition an ER visit will be unplanned.  Certainly you can inquire ahead of time about various costs at different facilities, but you don't always get to choose in the moment and the almost infinite permutations of emergencies makes it virtually impossible to know where you should go in advance.  Will it be a punctured lung or a bypass? Stroke or pneumonia? You need to know the treatment first before choosing the best ER, and even a physician can't determination until there's a thorough examination and preliminary tests are run. Compounding this is that you'll never know *where* you will be when you need care.

Its never sat well with me that a common procedure, like taking x-rays and setting a simple fracture can vary by 3x or more between facilities less than 20 miles apart. Medicaid has tried to deal with this for decades by having a reimbursement schedule for every proceedure hey can think of (there are literally thousands and all involve using the correct coding), but it's ornerous and ultimately results in certain hospitals losing money on certain proceedures, while others turn a profit.. all of which is completely unknown to the patients and even to most doctors.

[Rezdent]

covering people is an issue but the biggest issue still is cost transparency.  You can shop for an ER by being prepared.  Just like with work insurance you know which hospitals are in your network by you.  the same thought could be applied to finding the best service lowest cost ER by you if costs were presented open for everyone to see ahead of time you could know which hosipital you'd like to use in an ER event.

I agree that transparency is a very big issue.  So too is the extreme differences in cost for similar services. 
But almost by definition an ER visit will be unplanned.  Certainly you can inquire ahead of time about various costs at different facilities, but you don't always get to choose in the moment and the almost infinite permutations of emergencies makes it virtually impossible to know where you should go in advance.  Will it be a punctured lung or a bypass? Stroke or pneumonia? You need to know the treatment first before choosing the best ER, and even a physician can't determination until there's a thorough examination and preliminary tests are run. Compounding this is that you'll never know *where* you will be when you need care.

Its never sat well with me that a common procedure, like taking x-rays and setting a simple fracture can vary by 3x or more between facilities less than 20 miles apart. Medicaid has tried to deal with this for decades by having a reimbursement schedule for every proceedure hey can think of (there are literally thousands and all involve using the correct coding), but it's ornerous and ultimately results in certain hospitals losing money on certain proceedures, while others turn a profit.. all of which is completely unknown to the patients and even to most doctors.

+1

We absolutely need transparency.  We also need some regulation for those situations where transparency can't help.

ER visits are one place where you could identify a choice and not get it for any of various reasons.  You could be unconscious, or the paramedics might not agree with you, or that ER is full...

I had a neck injury.  Strapped to a Backboard, neck brace and Styrofoam stabilizer shoved in my mouth.
The paramedics transported me to their ER choice even while acknowledging they understood my requests through that foam for a different ER.  They told me no, not hospital Y; they were taking me to hospital X, and I just needed to relax and be quiet because my blood pressure appeared to be going up really fast.
Ha! Just choose an ER...

[CBnCO]

I always find the healthcare debate fascinating. First, I think we all have the responsibility to take care of ourselves. Exercise, eating healthy, etc. In fact, I think we should start, instead of with arguing over the price of pharmaceuticals, with health and nutrition education in schools. It really should be one of the most important subjects in the public curriculum. Not one of the proposals I've seen allocates increased spending to health education; so, instead, most get their health education from Mountain Dew and Doritos commercials.

Further, it's not like the Earth is hurting for people. In fact, we are pretty much wreaking havoc on the planet and really shouldn't aspire to increase our populations. I've also seen somewhere that we spend around 50% of our healthcare dollars on "end of life care" and maybe this is something we should consider. I'm thinking we get people educated on how to be healthy, we unhook terminal patients from machines and pills and give them palliative care, and sprinkle in some market based competition and we would see significant improvements. Unfortunately, this is not a debate about what's best for the people, the country, the environment; but, one between the pharmas, insurance companies, politicians, hospitals, etc..in essence $$$..I'm off the eat a salad and do some push-ups!

[Gin1984]

No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

Yes and that is the arguemnt quindon etc are making ... i should have a right to choose to be on a high deductible plan - 6850 is a drop in the bucket to those of us around here who are saving properly.  if you have your HSA that 6850 is really only 40% of that or 4110 out of pocket using those funds. 

i think pre existing conditions should be covered but i also think we each have a right to choose to be on catostrophic plans basically like homeowners insurance.  i dont need insurance against 5k dollar issues i need insurance against 100k dollar issues. 

Yes the avg american doesnt save and invest like us folk around here, and most americans carry low deductible home insurance etc.

covering people is an issue but the biggest issue still is cost transparency. You can shop for an ER by being prepared. Just like with work insurance you know which hospitals are in your network by you.  the same thought could be applied to finding the best service lowest cost ER by you if costs were presented open for everyone to see ahead of time you could know which hosipital you'd like to use in an ER event.

LOL, tried that, did not work.  No one could tell me the cost of procedure I wanted.  Hell, no one could tell me the cost a blood draw.

[The Happy Philosopher]

No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Yes, and health care expenses are extremely varied and unpredictable. You can't really know whether your health care costs will be 40k or 5million over your life time. It's easy to be cavalier about health care when you are healthy.

[The Happy Philosopher]

There is this misconception that only people that eat poorly or smoke/drink whatever are the only ones that get sick. Yes, medical costs will tend to be higher in populations that live unhealthy lifestyles, but there are plenty of people who do everything right and still get very sick.

Also, end of life care is a bit more nuanced. Much money is spent on EOLC, but the problem is you don't always know who is going to have a good outcome. If you knew who was going to die anyways with or without care decisions would be easier. That said there is a lot of money that is wasted at the end. To solve that problem though we have to venture into 'death panel' territory and you saw how that went from a political standpoint. We could save a lot of money by changing our societal attitude towards death though. Right now we save all life at any cost to the system.

I always find the healthcare debate fascinating. First, I think we all have the responsibility to take care of ourselves. Exercise, eating healthy, etc. In fact, I think we should start, instead of with arguing over the price of pharmaceuticals, with health and nutrition education in schools. It really should be one of the most important subjects in the public curriculum. Not one of the proposals I've seen allocates increased spending to health education; so, instead, most get their health education from Mountain Dew and Doritos commercials.

Further, it's not like the Earth is hurting for people. In fact, we are pretty much wreaking havoc on the planet and really shouldn't aspire to increase our populations. I've also seen somewhere that we spend around 50% of our healthcare dollars on "end of life care" and maybe this is something we should consider. I'm thinking we get people educated on how to be healthy, we unhook terminal patients from machines and pills and give them palliative care, and sprinkle in some market based competition and we would see significant improvements. Unfortunately, this is not a debate about what's best for the people, the country, the environment; but, one between the pharmas, insurance companies, politicians, hospitals, etc..in essence $$$..I'm off the eat a salad and do some push-ups!

[thenextguy]

And I think that it's a bit of a stretch to claim that The Heritage Foundation is  actually conservative.

This is almost, but not quite, as hilarious as Rex Tillerson claiming under oath today that he is "not aware of anything the fossil fuel industry gets that [he] would characterize as a subsidy."

Well, I'm the self-identified, non-Republican, conservative here; and I don't consider them conservative.  More neo-con-ish.

Even if one were to acknowledge The Heritage Foundation as more neoconservative rather than conservative, it's largely irrelevant to this discussion. The two camps are largely identical on domestic policy. The differences are found in foreign policy.

[bacchi]

You can shop for an ER by being prepared.

LOL, tried that, did not work.  No one could tell me the cost of procedure I wanted.  Hell, no one could tell me the cost a blood draw.

And the hospital can't tell you who will be on duty the night of your future accident or whether the doctors on call are in your network, even if we ignore whether you're even conscious to tell the medics, "Only Central ER! Not Southwest ER; they're too expensive." I guess the cost-conscious person can wear a medical bracelet with an ordering of ERs:

"Take me to an ER in order:
1) Central ER
2) North ER
3) General ER
4) Southwest ER"

Picking out an ER ahead of time as a solution to rising health care costs is laughable.

[Greenback Reproduction Specialist]

LOL, tried that, did not work.  No one could tell me the cost of procedure I wanted.  Hell, no one could tell me the cost a blood draw.

I struggle with this everytime I go to a dr or dentist.... I tell them up front I will not pay for something unless they tell me up front how much it will cost... Very frustrating, and I have walked out a couple times to find somewhere else to go. But I have found a few places around town that will give me the costs upfront before doing the work.

I don't think it is fair to do the work, and then be like "oh by the way it cost $x and you now owe us that"

[sol]

I'm trying really hard to listen and learn here.  I understand that people have a wide diversity of opinions about health care and health insurance.

But virtually every objection I have heard in this thread basically boils down to some variation of "you are going to die because you have no money to pay me to make you better" and I cannot fathom how anyone could think that is a moral or ethical position to support.

When your house is on fire, the fire department doesn't stop to ask which political party you belong to.  When you call 911, the operator does not ask what tax bracket you are in.  Food banks don't turn you away just because you are black or brown.  Can we all agree that would be wrong?

I believe that everyone deserves some basic level of healthcare.  It is good for our society to have a healthy population.  I don't care how much money you make, or what you personally pay for that care, because I believe it should be available to everyone, just like 911 is available to everyone, whether you use it or not and whether you pay for it or not.  Our society is better off having 911, and a fire department, and food banks, universally available to everyone at all times, than we would be without those things.  They are part of what makes America great. 

I think basic healthcare is in the same category, and should be paid for the same way.

[nereo]

And the hospital can't tell you who will be on duty the night of your future accident or whether the doctors on call are in your network, even if we ignore whether you're even conscious to tell the medics, "Only Central ER! Not Southwest ER; they're too expensive." I guess the cost-conscious person can wear a medical bracelet with an ordering of ERs:

"Take me to an ER in order:
1) Central ER
2) North ER
3) General ER
4) Southwest ER"

Picking out an ER ahead of time as a solution to rising health care costs is laughable.

I think it would have to be even more detailed, something like:
Take me an ER in order
1) Central ER, except...
2) North ER for all strokes and neurological problems or:
3) General ER if an MRI is required or:
4) Southwest ER if you suspect poisioning.
exception 1: If there are multiple lacerations and radiology is required then North would be preferable to Central unless the lacerations are minor
exception 2: If my car is totaled and I require outpatient procedures with follow-ups take me to Southwest b/c they are near public transit
exception 3: NEVER General if this is cancer-related, their oncology department is under state review for errors
exception 4:....

I don't think it is fair to do the work, and then be like "oh by the way it cost $x and you now owe us that"

I agree.  Unfortunately the price isn't even known to the doctors/nurses treating you in most cases, and the reimbursement rate for the procedure will be different depending on whether you have medicaid, private insurance, state-sponsored health insurance or if you pay out of pocket.  So the price is never the price.
It's bizarre, and should be fixed.

[nereo]

I think basic healthcare is in the same category, and should be paid for the same way.

I'm with you Sol - I think a society should strive towards providing basic health services for its people as it does a basic level of safety (police, fire, military), shelter, education and nurishment.

Often the programs which provide these services can be improve, but they should always exist.

[boarder42]

No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

Yes and that is the arguemnt quindon etc are making ... i should have a right to choose to be on a high deductible plan - 6850 is a drop in the bucket to those of us around here who are saving properly.  if you have your HSA that 6850 is really only 40% of that or 4110 out of pocket using those funds. 

i think pre existing conditions should be covered but i also think we each have a right to choose to be on catostrophic plans basically like homeowners insurance.  i dont need insurance against 5k dollar issues i need insurance against 100k dollar issues. 

Yes the avg american doesnt save and invest like us folk around here, and most americans carry low deductible home insurance etc.

covering people is an issue but the biggest issue still is cost transparency. You can shop for an ER by being prepared. Just like with work insurance you know which hospitals are in your network by you.  the same thought could be applied to finding the best service lowest cost ER by you if costs were presented open for everyone to see ahead of time you could know which hosipital you'd like to use in an ER event.

LOL, tried that, did not work.  No one could tell me the cost of procedure I wanted.  Hell, no one could tell me the cost a blood draw.

Thats my point on the transparency part.  i was saying IF we had transparency you could do that

[boarder42]

You can shop for an ER by being prepared.

LOL, tried that, did not work.  No one could tell me the cost of procedure I wanted.  Hell, no one could tell me the cost a blood draw.

And the hospital can't tell you who will be on duty the night of your future accident or whether the doctors on call are in your network, even if we ignore whether you're even conscious to tell the medics, "Only Central ER! Not Southwest ER; they're too expensive." I guess the cost-conscious person can wear a medical bracelet with an ordering of ERs:

"Take me to an ER in order:
1) Central ER
2) North ER
3) General ER
4) Southwest ER"

Picking out an ER ahead of time as a solution to rising health care costs is laughable.

that quote was taken out of context and is assuming we have full transparency.. and guess what if we had it prices would normalize and it wouldnt matter.

[protostache]

No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

Yes and that is the arguemnt quindon etc are making ... i should have a right to choose to be on a high deductible plan - 6850 is a drop in the bucket to those of us around here who are saving properly.  if you have your HSA that 6850 is really only 40% of that or 4110 out of pocket using those funds. 

i think pre existing conditions should be covered but i also think we each have a right to choose to be on catostrophic plans basically like homeowners insurance.  i dont need insurance against 5k dollar issues i need insurance against 100k dollar issues. 

Yes the avg american doesnt save and invest like us folk around here, and most americans carry low deductible home insurance etc.

covering people is an issue but the biggest issue still is cost transparency. You can shop for an ER by being prepared. Just like with work insurance you know which hospitals are in your network by you.  the same thought could be applied to finding the best service lowest cost ER by you if costs were presented open for everyone to see ahead of time you could know which hosipital you'd like to use in an ER event.

LOL, tried that, did not work.  No one could tell me the cost of procedure I wanted.  Hell, no one could tell me the cost a blood draw.

Thats my point on the transparency part.  i was saying IF we had transparency you could do that

But wouldn't it be better for all of us if nobody needed to?

[boarder42]

I'm trying really hard to listen and learn here.  I understand that people have a wide diversity of opinions about health care and health insurance.

But virtually every objection I have heard in this thread basically boils down to some variation of "you are going to die because you have no money to pay me to make you better" and I cannot fathom how anyone could think that is a moral or ethical position to support.

When your house is on fire, the fire department doesn't stop to ask which political party you belong to.  When you call 911, the operator does not ask what tax bracket you are in.  Food banks don't turn you away just because you are black or brown.  Can we all agree that would be wrong?

I believe that everyone deserves some basic level of healthcare.  It is good for our society to have a healthy population.  I don't care how much money you make, or what you personally pay for that care, because I believe it should be available to everyone, just like 911 is available to everyone, whether you use it or not and whether you pay for it or not.  Our society is better off having 911, and a fire department, and food banks, universally available to everyone at all times, than we would be without those things.  They are part of what makes America great. 

I think basic healthcare is in the same category, and should be paid for the same way.

the difference esp. in some of the posts here are that police and fire technology for the most part have stayed the same and arent new or highly costly.  When a new tech as GStv mentioned above comes out how do you determine who gets the treatment.  it cant be everyone it cost something to develop that and someone has to pay the cost for it.  This isnt the same as my house is burning down we are constantly advancing treatments and cures.  you're equating things that arent 100% relatable. 

When you say basic ok - someone has to decide what that basic need is - does it cover cancer maybe maybe not what level of coverage does it offer.  These services all cost money. So when we decide basic is xyz and then tax people for it, you'll still have rich people that can afford the better treatments receiving better care and staying alive b/c they have money.  But defining basic care and people bringing up experimental drug prices are in 2 completely different ballparks or even planets.  Drug companies have to profit its how capitalism works. 

[protostache]

I'm trying really hard to listen and learn here.  I understand that people have a wide diversity of opinions about health care and health insurance.

But virtually every objection I have heard in this thread basically boils down to some variation of "you are going to die because you have no money to pay me to make you better" and I cannot fathom how anyone could think that is a moral or ethical position to support.

When your house is on fire, the fire department doesn't stop to ask which political party you belong to.  When you call 911, the operator does not ask what tax bracket you are in.  Food banks don't turn you away just because you are black or brown.  Can we all agree that would be wrong?

I believe that everyone deserves some basic level of healthcare.  It is good for our society to have a healthy population.  I don't care how much money you make, or what you personally pay for that care, because I believe it should be available to everyone, just like 911 is available to everyone, whether you use it or not and whether you pay for it or not.  Our society is better off having 911, and a fire department, and food banks, universally available to everyone at all times, than we would be without those things.  They are part of what makes America great. 

I think basic healthcare is in the same category, and should be paid for the same way.

the difference esp. in some of the posts here are that police and fire technology for the most part have stayed the same and arent new or highly costly.  When a new tech as GStv mentioned above comes out how do you determine who gets the treatment.  it cant be everyone it cost something to develop that and someone has to pay the cost for it.  This isnt the same as my house is burning down we are constantly advancing treatments and cures.  you're equating things that arent 100% relatable. 

When you say basic ok - someone has to decide what that basic need is - does it cover cancer maybe maybe not what level of coverage does it offer.  These services all cost money. So when we decide basic is xyz and then tax people for it, you'll still have rich people that can afford the better treatments receiving better care and staying alive b/c they have money.  But defining basic care and people bringing up experimental drug prices are in 2 completely different ballparks or even planets.  Drug companies have to profit its how capitalism works.

So lets have that conversation. I posit we start wth the ACA-defined minimum guarantees and a silver level plan. That seems basic to me. No dental, no vision, limited prescription coverage (maybe just if you're admitted), limited access to private hospital rooms. A minimal copay for doctor visits ($5) and a small deductible that can be waived based on income. If you want Rx, better hospital rooms, etc you can pay for extra.

[sol]

So lets have that conversation. I posit we start wth the ACA-defined minimum guarantees and a silver level plan. That seems basic to me.

That's certainly one place to start.  Another good option is to define basic care as the level of care that we currently provide through one of our three existing single payer systems (Medicaid, Medicare, and Tricare). 

This is a problem we have already solved three times, so I'm not too worried about solving it again.  I agree it is a decision that had to be made, I just don't think it's that hard.

[nereo]

the difference esp. in some of the posts here are that police and fire technology for the most part have stayed the same and arent new or highly costly.  When a new tech as GStv mentioned above comes out how do you determine who gets the treatment.  it cant be everyone it cost something to develop that and someone has to pay the cost for it.  This isnt the same as my house is burning down we are constantly advancing treatments and cures.  you're equating things that arent 100% relatable. 

When you say basic ok - someone has to decide what that basic need is - does it cover cancer maybe maybe not what level of coverage does it offer.  These services all cost money. So when we decide basic is xyz and then tax people for it, you'll still have rich people that can afford the better treatments receiving better care and staying alive b/c they have money.  But defining basic care and people bringing up experimental drug prices are in 2 completely different ballparks or even planets.  Drug companies have to profit its how capitalism works.

I actually think the analogy between a society providing security (police, fire, military) and basic health services still hold up.  Advances in all have come with very large increases in cost; Police use aircraft, camera networks and advanced weaponry and armor.  Still to there's a constant dialog about how much 'basic' service should be; how many uniformed officers do we want per city block?  what is an acceptable response time?

A public discussion about what the appropriate levels of service is appropriate, but unfortunately something we haven't really done. The way our health-care system has evolved (predominately work-place sponsored) most people are completely ignorant about how much it actually costs. A former co-worked of mine was upset that her monthly co-pay for her state-sponsored family health care plan was increasing from $48 to around $100, but didn't have a clue that her work paid the other $600/mo. Few realize that the same procedure might bill at 30-50% less if you are part of a plan vs paying out of pocket.

[little_brown_dog]

I'm trying really hard to listen and learn here.  I understand that people have a wide diversity of opinions about health care and health insurance.

But virtually every objection I have heard in this thread basically boils down to some variation of "you are going to die because you have no money to pay me to make you better" and I cannot fathom how anyone could think that is a moral or ethical position to support.

When your house is on fire, the fire department doesn't stop to ask which political party you belong to.  When you call 911, the operator does not ask what tax bracket you are in.  Food banks don't turn you away just because you are black or brown.  Can we all agree that would be wrong?

I believe that everyone deserves some basic level of healthcare.  It is good for our society to have a healthy population.  I don't care how much money you make, or what you personally pay for that care, because I believe it should be available to everyone, just like 911 is available to everyone, whether you use it or not and whether you pay for it or not.  Our society is better off having 911, and a fire department, and food banks, universally available to everyone at all times, than we would be without those things.  They are part of what makes America great. 

I think basic healthcare is in the same category, and should be paid for the same way.

Yes…at the very least, universal strong preventative healthcare and common treatments like antibiotic regimens…

Preventative care is  the most critical type of care for population health (vaccines, prenatal/postnatal care, pediatric appointments, basic screenings, etc) and it is what often keeps minor problems from ballooning into more deadly and more costly ones – both at an individual level and population level. Take vaccines…yes it is costly to pay for them for everyone, but far less costly than what would happen if the entire nation was being constantly slammed by epidemics that take millions out of work, put thousands or millions in the hospital, and oh yeah…kill people…most often babies and other innocents.

ACA for all of its faults, had one huge benefit, and that was the provision of preventative care for swaths of the population. Prenatal and postnatal care was well covered. Under ACA all my prenatal appointments were covered…didn’t pay for any of them…including the standard screening like the oral glucose test for gest diabetes and strep b screen (vital as infection can cause devastating illness that can kill newborns within days). Same goes for my follow up appointment and all of the well baby visits. Inadequate prenatal care is one of the key factors responsible for poor US maternal and newborn outcomes compared to other developed nations. And you guessed it, poor health outcomes mean more medical costs overall....for everyone.

Repubs love to act like the party of family values, but how is that possible when they do crap like this? They prance around acting like they love the unborn as they literally plot to take away said unborns’ checkups. Doing so sends medical costs soaring as more women and babies require more intensive care to manage the damage caused by skipping appointments and forgoing routine screening/management. And of course these women cant pay thousands in medical bills, so the system eats the cost. It’s the definition of insanity. What is even more shocking is that large numbers of Americans actually think this is totally logical….

[RangerOne]

Agreed that most peoples understanding of their own insurance is pitiful. But to be somewhat fair it is pretty complicated and difficult to grasp all the finer points.

Whether a $1200 ER visit is catastrophic for some one really depends. For most of us on this site a few thousand dollars for an emergency is pretty easily absorbed if that means we can keep our yearly insurance costs down. But for many people more than $1000 dollars means a monthly payment plan.

What annoys me about the current Republican approach to the ACA is that it seems pretty clear they are only interest in the political capital gained by shitting on it and getting it repealed or modified, as others have said so they can declare victory and win a partisan battle against the Democrats. I don't see them presenting a really comprehensive alternative being presented. There are some good disparate ideas being floated but if we are months away from gutting the new laws, you would think they would want to present a road map for how a new system should try to operate. That does not appear to be happening.

[waltworks]

I bet everyone could agree on killing the preferential tax treatment for benefits, right? It's objectively a dumb idea from both liberal and conservative perspectives. Getting healthcare/insurance through work means that nobody sees the actual cost of healthcare, and that it's hard for creative people to strike out on their own because buying their own health care is dramatically more expensive.

-W

[RangerOne]

...
As an example, take car insurance. I'm certain most accidents are minor fender-benders with no injuries and cosmetic damage....

I don't know if you have taken a recent model car to a shop lately but the age of a fender bender costing you $600 dollars out of pocket seems long gone. I recently took in my 2013 Hyundai Sonata for a parking lot hit and run. It is our nice family car so cosmetics still mean something to me.

Basically someone crunched a small part of our bumper behind the rear wheel. Caving in maybe like a soccer ball sized dent, but functionally no real damage.

Parts and paint cost maybe like $80 for the repair. But the man hours to fix the dent cost over $2000 and took nearly a full week of work by an approved AAA repair vendor... From what I have read newer vehicles, due to the use of modern body materials, aren't able to undergo many of the same simple quick fixes that cars pre and early 2000 era used to be able to get. Fender benders have gotten pretty damn expensive.

I could pay $2000 cash to fix something like this, but it is one hell of a price to pay for a cosmetic fix over random uncontrollable damage occasionally incurred in city living wiht assholes.

[RangerOne]

I bet everyone could agree on killing the preferential tax treatment for benefits, right? It's objectively a dumb idea from both liberal and conservative perspectives. Getting healthcare/insurance through work means that nobody sees the actual cost of healthcare, and that it's hard for creative people to strike out on their own because buying their own health care is dramatically more expensive.

-W

Which preferential tax treatment are you referring to?

I agree most people don't have any comprehension of what decent health coverage costs until you have to pay it yourself or someone shows you... The Bluecross family plan our work signs us up for cost me $200 a month plus HSA contributions. Similar plans, with worse terms, cost $1600 a month a premiums alone if you are buying it on your own. Good health coverage is really a drastic portion of your working income when you have to compare owning a business or being an independent contractor versus working for a big company.

Most of the independent contractors I knew would band together to buy more affordable health care as groups can negotiate better rates. But they still have to deal with the full rate that many of us don't see.

[waltworks]

Which preferential tax treatment are you referring to?

Employers do not pay FICA on benefits paid to employees - that's a ~8% savings off the top. It's also the case that the employer can deduct any benefits paid out as a business expense - but the employee can do no such thing if they obtain insurance on their own.

Hence the incentive is for employers to pay as much as possible in the form of benefits, and as little as possible in salary, in many cases.

-W

[nereo]

...
As an example, take car insurance. I'm certain most accidents are minor fender-benders with no injuries and cosmetic damage....

I don't know if you have taken a recent model car to a shop lately but the age of a fender bender costing you $600 dollars out of pocket seems long gone. I recently took in my 2013 Hyundai Sonata for a parking lot hit and run. It is our nice family car so cosmetics still mean something to me.

Basically someone crunched a small part of our bumper behind the rear wheel. Caving in maybe like a soccer ball sized dent, but functionally no real damage.

Parts and paint cost maybe like $80 for the repair. But the man hours to fix the dent cost over $2000 and took nearly a full week of work by an approved AAA repair vendor... From what I have read newer vehicles, due to the use of modern body materials, aren't able to undergo many of the same simple quick fixes that cars pre and early 2000 era used to be able to get. Fender benders have gotten pretty damn expensive.

I could pay $2000 cash to fix something like this, but it is one hell of a price to pay for a cosmetic fix over random uncontrollable damage occasionally incurred in city living wiht assholes.

I don't dispute what you say, but I don't see how it invalidates my point. The majority of accidents are non-injury fender benders.  Certainly in late-model cars they can cost a few grand to fix should you want to.
My point was that the majority of accidents (even at ~$2k) are not the true reason to be insured.  It's the less common but more severe accidents that can be orders of magnitude more costly, like multiple-car injury accidents.
All of this was an analogy to another poster's comment about the median ER visit cost being ~$1,200, and how that wasn't exactly a financial catastrophy, so why the need for insurance? 

[MayDay]

I don't understand what is being required as coverage under the ACA that people oppose and think is too fancy.

Someone mentioned mammograms.  Is it because they are a man?  Do they think I should get a discount since I don't need prostrate checks?  Do they think prostrate exams are cheaper, and thus men should pay less?  Should we divide out all gender-specific medical costs and charge different premiums based on gender? 

The logic boggles me. 

[mathlete]

I don't understand what is being required as coverage under the ACA that people oppose and think is too fancy.

Someone mentioned mammograms.  Is it because they are a man?  Do they think I should get a discount since I don't need prostrate checks?  Do they think prostrate exams are cheaper, and thus men should pay less?  Should we divide out all gender-specific medical costs and charge different premiums based on gender? 

The logic boggles me.

Someone could oppose the mandate based on the minimum actuarial value rather than the required covered benefits.

Perhaps this person is wealthy and healthy and carries only a critical illness indemnity plan or some other stop loss kind of product. They pay for what little regular health care they receive out of pocket and if something really bad happens, insurance covers it.

If that person wanted to do the same strategy under ACA, they'd have to pay the tax.

I would consider this to be a legitimate gripe with ACA.

Of course, I don't know how many people this actually describes vs. people who don't carry insurance b/c they think they're invincible but in reality they're a $10K bill away from medical bankruptcy.

[protostache]

I don't understand what is being required as coverage under the ACA that people oppose and think is too fancy.

Someone mentioned mammograms.  Is it because they are a man?  Do they think I should get a discount since I don't need prostrate checks?  Do they think prostrate exams are cheaper, and thus men should pay less?  Should we divide out all gender-specific medical costs and charge different premiums based on gender? 

The logic boggles me.

Someone could oppose the mandate based on the minimum actuarial value rather than the required covered benefits.

Perhaps this person is wealthy and healthy and carries only a critical illness indemnity plan or some other stop loss kind of product. They pay for what little regular health care they receive out of pocket and if something really bad happens, insurance covers it.

If that person wanted to do the same strategy under ACA, they'd have to pay the tax.

I would consider this to be a legitimate gripe with ACA.

Of course, I don't know how many people this actually describes vs. people who don't carry insurance b/c they think they're invincible but in reality they're a $10K bill away from medical bankruptcy.

You think someone wealthy enough to legitimately use that strategy cares at all about a $700 fine? Please. It's extremely unlikely they would be paying it anyway because nobody in that situation is getting a tax refund.

[Metric Mouse]

I think basic healthcare is in the same category, and should be paid for the same way.

I'm with you Sol - I think a society should strive towards providing basic health services for its people as it does a basic level of safety (police, fire, military), shelter, education and nurishment.

Often the programs which provide these services can be improve, but they should always exist.

I think most people would agree on this. (One of)the issues with the ACA is that it doesn't provide health care, just health insurance. Universal health care would be great; universal health insurance is a very poor substitute, especially considering the cost.

[HPstache]

I think basic healthcare is in the same category, and should be paid for the same way.

I'm with you Sol - I think a society should strive towards providing basic health services for its people as it does a basic level of safety (police, fire, military), shelter, education and nurishment.

Often the programs which provide these services can be improve, but they should always exist.

I think most people would agree on this. (One of)the issues with the ACA is that it doesn't provide health care, just health insurance. Universal health care would be great; universal health insurance is a very poor substitute, especially considering the cost.

That's a really good point, hadn't thought of that distinction before.

[rpr]

I think most people would agree on this. (One of)the issues with the ACA is that it doesn't provide health care, just health insurance. Universal health care would be great; universal health insurance is a very poor substitute, especially considering the cost.

I wholeheartedly agree with what you say. However, given the current political anti-government atmosphere prevailing in this country, universal health insurance is the best that we can hope for. It is certainly better than the alternative of no health insurance thus no health care.

[EfficientN]

I don't understand what is being required as coverage under the ACA that people oppose and think is too fancy.

Someone mentioned mammograms.  Is it because they are a man?  Do they think I should get a discount since I don't need prostrate checks?  Do they think prostrate exams are cheaper, and thus men should pay less?  Should we divide out all gender-specific medical costs and charge different premiums based on gender? 

The logic boggles me.

Someone could oppose the mandate based on the minimum actuarial value rather than the required covered benefits.

Perhaps this person is wealthy and healthy and carries only a critical illness indemnity plan or some other stop loss kind of product. They pay for what little regular health care they receive out of pocket and if something really bad happens, insurance covers it.

If that person wanted to do the same strategy under ACA, they'd have to pay the tax.

I would consider this to be a legitimate gripe with ACA.

Of course, I don't know how many people this actually describes vs. people who don't carry insurance b/c they think they're invincible but in reality they're a $10K bill away from medical bankruptcy.

Wait, isn't what you're describing just a High-Deductible Health Care Plan? Those are freely available and even come with generous HSA tax incentives.

[mathlete]

You think someone wealthy enough to legitimately use that strategy cares at all about a $700 fine? Please. It's extremely unlikely they would be paying it anyway because nobody in that situation is getting a tax refund.

You pay the maximum of the set penalty and a percentage of your income, all the way up to the cost of a Bronze AV plan. So it can be a lot higher than $695. For a sufficiently high income, you're basically forced onto a bronze plan.

Besides, you don't need to be that rich to have your options of cost-cutting limited by ACA.

I receive employer coverage so this is moot for me, but if I didn't have employer coverage, but made a similar income and had similar savings to what I do now, I would opt for a very high out of pocket max plan. I'm a young and healthy guy with enough savings to cover lots of healthcare costs. This strategy is hampered by such a plan possibly not meeting the minimum AV. I'd be discouraged from doing this b/c of the penalty.

[mathlete]

Wait, isn't what you're describing just a High-Deductible Health Care Plan? Those are freely available and even come with generous HSA tax incentives.

A high deductible plan is one way to do it. Critical illness plans like I mentioned are another.

Even with high deductible plans though, under ACA, you're really limited by how "high" the high deductible can be.

In order to qualify as a QHP (plan that will get you out of paying the penalty), a plan has to meet certain limits. One limit is on the out-of-pocket max. Deductible can't be higher than the OOP max so your deductible is capped at $7,150 for individuals.

[protostache]

You think someone wealthy enough to legitimately use that strategy cares at all about a $700 fine? Please. It's extremely unlikely they would be paying it anyway because nobody in that situation is getting a tax refund.

You pay the maximum of the set penalty and a percentage of your income, all the way up to the cost of a Bronze AV plan. So it can be a lot higher than $695. For a sufficiently high income, you're basically forced onto a bronze plan.

Besides, you don't need to be that rich to have your options of cost-cutting limited by ACA.

I receive employer coverage so this is moot for me, but if I didn't have employer coverage, but made a similar income and had similar savings to what I do now, I would opt for a very high out of pocket max plan. I'm a young and healthy guy with enough savings to cover lots of healthcare costs. This strategy is hampered by such a plan possibly not meeting the minimum AV. I'd be discouraged from doing this b/c of the penalty.

I didn't know it applied like that. Good info.

That said, the number of people this affects is maaaaybe 1% of the population on the outside, right? There just aren't that many people that actually have the financial wherewithal to self insure things a non-QHP indemnity plan doesn't cover. Public policy needs to account for most of the people most of the time. It shouldn't be catering to the top.