What comes after the ACA?

[nereo]

Look at the number of elderly who live entirely on Social Security.  Imagine what would happen without it.  Most people are idiots who need to be told what to do.  I hate to say it, but it is true.  Personally I would love to make my own plans and be left alone but I realize I am not like most people.

Hmm... either I'm not understanding your argument Jim or I just disagree.  I don't share your attitude that 'most people are idiots', nor agree that your SS analogy does much to prove your point.
Specifically regarding SS payments; we've been telling people for over eight decades that SS was their money, that it was guaranteed, and that they 'paid into the system' and would would be taken care of by Uncle Sam.  Dependence on SS doesn't really show they are idiots, only that they trusted their government.
Regarding the "most people are idiots" - by and large people base their decisions on what is benefitial in the short term. We've evolved this way - that doesn't make people necessarily stupid.

I was thinking more on the lines of they don't save for retirement or plan for the future, which is idiocy.  MMM types are exceptions.

So paying Social Security tax with the reasonable expectation of receiving Social Security (at least for workers in the past) can't be counted as retirement planning?

I'm not advocating relying 100% on SS for income in retirement, but how is it any different than paying into a pension at your factory job in 1957?

Is it optional? No. Does it provide income in retirement? Yes.

just thought I'd beat this dead horse some more...
in addition to telling people they can and should rely on SS for their entire lives, we've spent considerable time telling everyone that anyone who is middle-class or below is 'suffering' and needs 'relief' and tax breaks.  You cant listen to a politicians speech anywhere without hearing these things. 'Consumer spending' is the buzzword of economic reports, not 'consumer saving' ...and then we are surprised that these groups act like saving is beyond their economic capabiliites?

In effect the message has become "you should rely on SS, and you are in too bad an economic situation to save for yourself'.

[radram]

Specifically regarding SS payments; we've been telling people for over eight decades that SS was their money, that it was guaranteed, and that they 'paid into the system' and would would be taken care of by Uncle Sam.  Dependence on SS doesn't really show they are idiots, only that they trusted their government.

I have NEVER heard SS explained as anything other than 1 leg of a 3 legged stool, SS, pension, and personal savings. Can you please provide ANY documentation released from our government that implies anyone "would be taken care of". You should have 80 years of documentation, so it should take you all of about 10 seconds, right? I find this claim ridiculous and distracting to the real issues.

I will provide a statement that is probably closer to the evidence: There has NEVER been a government official statement that recommended SS as the only source of income for any person or group.

If you find 1, I will rethink my statement. If you find several references, many going back as far as the 1930's, I would consider agreeing with you.

There may be people, many in fact, who believed that SS payment will be enough and saved nothing. I believe this was an irresponsible decision. Many could have spent less and saved more, or even something. I went without a cell phone for 12 years because I did not like the cost and it was not worth it to me. I found my price ($0), and now I have one in FIRE. They could have made those same choices and saved instead. 

These would be people that would plan on spending less than the average person. You know, like people on these very forum. Where they differ from "us" is that they did not take ANY precautions or plan for the future. I think overall they might be more similar to us than meets the eye.

[jim555]

Look at the number of elderly who live entirely on Social Security.  Imagine what would happen without it.  Most people are idiots who need to be told what to do.  I hate to say it, but it is true.  Personally I would love to make my own plans and be left alone but I realize I am not like most people.

Hmm... either I'm not understanding your argument Jim or I just disagree.  I don't share your attitude that 'most people are idiots', nor agree that your SS analogy does much to prove your point.
Specifically regarding SS payments; we've been telling people for over eight decades that SS was their money, that it was guaranteed, and that they 'paid into the system' and would would be taken care of by Uncle Sam.  Dependence on SS doesn't really show they are idiots, only that they trusted their government.
Regarding the "most people are idiots" - by and large people base their decisions on what is benefitial in the short term. We've evolved this way - that doesn't make people necessarily stupid.

I was thinking more on the lines of they don't save for retirement or plan for the future, which is idiocy.  MMM types are exceptions.

So paying Social Security tax with the reasonable expectation of receiving Social Security (at least for workers in the past) can't be counted as retirement planning?

I'm not advocating relying 100% on SS for income in retirement, but how is it any different than paying into a pension at your factory job in 1957?

Is it optional? No. Does it provide income in retirement? Yes.

I think I am being taken the wrong way on this.  I expect SS to be there.  I am saying they rely ENTIRELY on SS and without it they would be on the street in old age.  Left on their own they don't take the steps needed for survival.

[NoStacheOhio]

Look at the number of elderly who live entirely on Social Security.  Imagine what would happen without it.  Most people are idiots who need to be told what to do.  I hate to say it, but it is true.  Personally I would love to make my own plans and be left alone but I realize I am not like most people.

Hmm... either I'm not understanding your argument Jim or I just disagree.  I don't share your attitude that 'most people are idiots', nor agree that your SS analogy does much to prove your point.
Specifically regarding SS payments; we've been telling people for over eight decades that SS was their money, that it was guaranteed, and that they 'paid into the system' and would would be taken care of by Uncle Sam.  Dependence on SS doesn't really show they are idiots, only that they trusted their government.
Regarding the "most people are idiots" - by and large people base their decisions on what is benefitial in the short term. We've evolved this way - that doesn't make people necessarily stupid.

I was thinking more on the lines of they don't save for retirement or plan for the future, which is idiocy.  MMM types are exceptions.

So paying Social Security tax with the reasonable expectation of receiving Social Security (at least for workers in the past) can't be counted as retirement planning?

I'm not advocating relying 100% on SS for income in retirement, but how is it any different than paying into a pension at your factory job in 1957?

Is it optional? No. Does it provide income in retirement? Yes.

I think I am being taken the wrong way on this.  I expect SS to be there.  I am saying they rely ENTIRELY on SS and without it they would be on the street in old age.  Left on their own they don't take the steps needed for survival.

That's fair, I think we're pretty much in agreement. I just consider SS tax payments one component of "saving."

[Schaefer Light]

I think the aspect of the liberal mindset that pisses me off the most is the idea that people are simply too stupid to take care of themselves.  I see this all the time.  They use it to justify the idea that the government should take care of everyone.

I think the aspect of the conservative mindset that pisses me off the most is the idea that people are simply too immoral to take care of themselves.  I see this all the time.  They use it to justify the idea that the government should make decisions about a person's actions or body.

I'm a Libertarian.  I believe the government should stay the hell out of people's lives.

[NESailor]

I don't automatically assume poor people are dumb, or are incapable to making good choices when presented with options, or are likely to make sub-optimal choices based on an arbitrary metric. I hardly see why people who think that others can't make good choices should be allowed to make choices for those people that they look down upon. It is a very narrow view that seems pretty is incredibly condescending, and does not do anything to address the underlying problem of why some people sometimes make sub-optimal choices. The correct answer is not to remove access to choices that are good for some people and only offer choices that are ok for everyone. The answer is to educate people on their choices and to simplify the complex system to the point that more people can make good choices.

It was absolutely me making the claim that people are stupid upthread.  And I agree - it's condescending.  I don't claim to be Mother Theresa - on an internet forum or in real life (ask my wife...she'll tell you I can be a real a-hole).  I am not particularly proud of it either...it's just that I've been battle hardened by dealing with this kind of stupidity my entire professional life so it's how I view the population at large.  Maybe it's a professional deformation and maybe it isn't...but the facts out there in the real world point more towards "the average person in incapable of making good financial choices" than "more choice, more freedom, less regulations = everyone wins".

I agree that more education is in order.  I just don't believe that education will address enough of the "capability gap" that's already out there to prevent massive numbers of people getting into financial trouble such as we had pre-ACA.

I tend to think that a hybrid system would make the most people happy and covered.  One in which those who are capable and motivated enough can still find plans that fit their needs and others who are not are simply taken care of by the government.  It is basically what we have now but we know it's not really efficient.  All the talk about shopping for insurance is just a sideshow though, right? 

We have a cost problem that's not being addressed.  The mechanism for funding is a secondary issue.

[pbkmaine]

The US has systems that are very complicated. I think it's hard for anyone, no matter how educated, to make sense of them. The Internal Revenue Code. Financial products. Health insurance. There is a ton of detail to go through to make an informed decision.  I think people just give up.

[bacchi]

I think the aspect of the liberal mindset that pisses me off the most is the idea that people are simply too stupid to take care of themselves.  I see this all the time.  They use it to justify the idea that the government should take care of everyone.

I think the aspect of the conservative mindset that pisses me off the most is the idea that people are simply too immoral to take care of themselves.  I see this all the time.  They use it to justify the idea that the government should make decisions about a person's actions or body.

I'm a Libertarian.  I believe the government should stay the hell out of people's lives.

Hey, totally, me too.*



*except for those programs that are super-duper important but we'll ignore those and pretend we're 100% self-sufficient.

[NoStacheOhio]

The US has systems that are very complicated. I think it's hard for anyone, no matter how educated, to make sense of them. The Internal Revenue Code. Financial products. Health insurance. There is a ton of detail to go through to make an informed decision.  I think people just give up.

Also, the sheer amount of time it takes to advocate for yourself in dealing with some of these systems. Have you ever tried arguing with a medical insurance company? It's a part time job.

[nereo]

The US has systems that are very complicated. I think it's hard for anyone, no matter how educated, to make sense of them. The Internal Revenue Code. Financial products. Health insurance. There is a ton of detail to go through to make an informed decision.  I think people just give up.

Also, the sheer amount of time it takes to advocate for yourself in dealing with some of these systems. Have you ever tried arguing with a medical insurance company? It's a part time job.

Ha!  That actually was my part-time job in college!

[FrogStash]

So which one of us is going to run for office so we can fix this mess in a Mustachian way?  Who will be the first presidential candidate of the Mustache party?  Oh wait, most of us retired so we can work less and running for office isn't exactly my idea of a fun hobby or enjoyable side gig.  Is there anyone out there who has dreamed of becoming financially independent so they can work their tail off in service to the country?  If so, you'll have my vote.

[NoStacheOhio]

So which one of us is going to run for office so we can fix this mess in a Mustachian way?  Who will be the first presidential candidate of the Mustache party?  Oh wait, most of us retired so we can work less and running for office isn't exactly my idea of a fun hobby or enjoyable side gig.  Is there anyone out there who has dreamed of becoming financially independent so they can work their tail off in service to the country?  If so, you'll have my vote.

My wife told me she thought I should run for something, and I my immediate response was "Hell no." It's probably not so bad at the local level, but I don't want people going over my life with a fine-toothed comb. Just no.

I firmly believe you have to be at least slightly insane to seek political office.

[StarBright]

So which one of us is going to run for office so we can fix this mess in a Mustachian way?  Who will be the first presidential candidate of the Mustache party?  Oh wait, most of us retired so we can work less and running for office isn't exactly my idea of a fun hobby or enjoyable side gig.  Is there anyone out there who has dreamed of becoming financially independent so they can work their tail off in service to the country?  If so, you'll have my vote.

My wife told me she thought I should run for something, and I my immediate response was "Hell no." It's probably not so bad at the local level, but I don't want people going over my life with a fine-toothed comb. Just no.

I firmly believe you have to be at least slightly insane to seek political office.

I agree! I have no interest in holding office. I did go to my county's local organizational meeting this week though and offered my organization expertise and social media semi-expertise to help whoever was running :)

[infogoon]

So which one of us is going to run for office so we can fix this mess in a Mustachian way?  Who will be the first presidential candidate of the Mustache party?  Oh wait, most of us retired so we can work less and running for office isn't exactly my idea of a fun hobby or enjoyable side gig.  Is there anyone out there who has dreamed of becoming financially independent so they can work their tail off in service to the country?  If so, you'll have my vote.

I'd love to run for local office after I manage to retire. There are a lot of elected positions around here that pay a pittance, so the only people who can afford to do them are either retired or somehow steering public funds to themselves with the position.

[nereo]

So which one of us is going to run for office so we can fix this mess in a Mustachian way?  Who will be the first presidential candidate of the Mustache party?  Oh wait, most of us retired so we can work less and running for office isn't exactly my idea of a fun hobby or enjoyable side gig.  Is there anyone out there who has dreamed of becoming financially independent so they can work their tail off in service to the country?  If so, you'll have my vote.

My wife told me she thought I should run for something, and I my immediate response was "Hell no." It's probably not so bad at the local level, but I don't want people going over my life with a fine-toothed comb. Just no.

I firmly believe you have to be at least slightly insane to seek political office.

I'm fairly certain the people we've GOT are slightly insane.  Or maybe more than slightly...

[Metric Mouse]

So which one of us is going to run for office so we can fix this mess in a Mustachian way?  Who will be the first presidential candidate of the Mustache party?  Oh wait, most of us retired so we can work less and running for office isn't exactly my idea of a fun hobby or enjoyable side gig.  Is there anyone out there who has dreamed of becoming financially independent so they can work their tail off in service to the country?  If so, you'll have my vote.

My wife told me she thought I should run for something, and I my immediate response was "Hell no." It's probably not so bad at the local level, but I don't want people going over my life with a fine-toothed comb. Just no.

I firmly believe you have to be at least slightly insane to seek political office.

Right? Can you imagine those tax return releases and those debate questioms?  "So, you haven't worked OR paid taxes since your twenties? And you think that YOU best represent America? And there are some interesting web sites in your browsing history..."

No thank you...

[Hadilly]

Aetna is pulling out of the ACA for next year.  I wonder who will be next.

[Metric Mouse]

Aetna is pulling out of the ACA for next year.  I wonder who will be next.

Source? All i find is their pull out from many markets last year; so I could see them ratcheting it up for 2018, but my google fu didn't pull that up.

[FIRE me]

Aetna is pulling out of the ACA for next year.  I wonder who will be next.

Source? All i find is their pull out from many markets last year; so I could see them ratcheting it up for 2018, but my google fu didn't pull that up.

Hadilly is not fully correct. Aetna says they *may* pull out in 2018.

http://finance.yahoo.com/news/aetna-ceo-may-ditch-obamacare-184754786.html

[Hadilly]

Fair enough, FIRE me. The "we have no intention of being in in the market for 2018" is a pretty strong statement and I focused on that.

[Metric Mouse]

Aetna is pulling out of the ACA for next year.  I wonder who will be next.

Source? All i find is their pull out from many markets last year; so I could see them ratcheting it up for 2018, but my google fu didn't pull that up.

Hadilly is not fully correct. Aetna says they *may* pull out in 2018.

http://finance.yahoo.com/news/aetna-ceo-may-ditch-obamacare-184754786.html

Thank you. Interesting.

[FIRE me]

Fair enough, FIRE me. The "we have no intention of being in in the market for 2018" is a pretty strong statement and I focused on that.

You're right. He is sending two different messages (quote is from the news item, not Bertolini):

"Bertolini later said Aetna may consider staying in some exchanges should they be profitable in 2018, but would re-evaluate for 2019 and 2020 based on the replacement plan advanced by lawmakers.
Aetna has threatened to leave the marketplace before."

[Hadilly]

I find the whole situation fascinating. I kind of do hope that insurers start exiting, forcing the current government into figuring out something that is realistic and workable. That's my macro view. The more micro take is that I have family and friends who will be affected adversely if that happens.

[rpr]

I find the whole situation fascinating. I kind of do hope that insurers start exiting, forcing the current government into figuring out something that is realistic and workable. That's my macro view. The more micro take is that I have family and friends who will be affected adversely if that happens.

What if you were the one that was adversely affected by this? Would you then be hoping for this to fail as fervently?

[Metric Mouse]

I find the whole situation fascinating. I kind of do hope that insurers start exiting, forcing the current government into figuring out something that is realistic and workable. That's my macro view. The more micro take is that I have family and friends who will be affected adversely if that happens.

I don't know any side has proposed full plans that are both realistic and workable. The current situation is falling apart because it's not profitable enough for insurers or states (expanding medicare). The current party doesn't seem to have a plan. The program before the ACA wasn't working either. It's ugly all around.

[kei te pai]

Fascinating reading the forums and seeing how much money, energy and planning is needed to navigate the health system in US. Thank God for 'socialised medicine'. The neighbour's kid had a spectacular accident at a remote campsite this weekend. Two broken arms, rescue helicopter, emergency surgery - nothing to pay. Im happy to be taxed for this.

[nereo]

Fascinating reading the forums and seeing how much money, energy and planning is needed to navigate the health system in US. Thank God for 'socialised medicine'. The neighbour's kid had a spectacular accident at a remote campsite this weekend. Two broken arms, rescue helicopter, emergency surgery - nothing to pay. Im happy to be taxed for this.

Living in a place with socialized medicine (Canada) I have to say it's fraught with its own problems, and I wish we could move more away from it.

I hope your neighbors kid is healing nicely.

[AdrianC]

Op-ed in our local today: "Replace ACA with an already proven model".

The idea is to offer the Federal Employee Health Benefits program to all.

Choice, competition, all the things the Republicans love.

So, what's wrong with it?

[OurTown]

Op-ed in our local today: "Replace ACA with an already proven model".

The idea is to offer the Federal Employee Health Benefits program to all.

Choice, competition, all the things the Republicans love.

So, what's wrong with it?

Sounds like the "public option."  The Rs will only go for it if they can find some way to punish poor people. 

[sol]

Op-ed in our local today: "Replace ACA with an already proven model".

The idea is to offer the Federal Employee Health Benefits program to all.

Choice, competition, all the things the Republicans love.

So, what's wrong with it?

Sounds like the "public option."  The Rs will only go for it if they can find some way to punish poor people.

No.  This is not a public option.  Making Medicare available to everyone would be a public option.

FEHB is a regular employer subsidized private insurance, and the relatively large employer-covered portion of the premiums is the reason why federal employees make 30% less than their private counterparts.  Doing that for everyone else would be great for nonfederal employees, no help at all to current feds, would do nothing to control the costs of care, and would incur an enormous amount of new deficit spending without providing coverage to anyone who is unemployed or self employed.

This is a terrible plan.

edit:  maybe that's why they like it?  This plan rewards people who have jobs, and provides no benefit to the unemployed (who Republicans hate) or to federal employees (who Republicans also hate).  It's basically a huge cash giveaway to people who already have insurance, without any of those pesky unintended side effects of helping poor people.

But the Republicans will never vote for this plan despite that feature, because FEHB covers birth control and prenatal care, which they hate, and the premiums are the same for everyone regardless of age or gender so they can't discriminate, which they also hate. 

[infogoon]

Op-ed in our local today: "Replace ACA with an already proven model".

The idea is to offer the Federal Employee Health Benefits program to all.

Choice, competition, all the things the Republicans love.

So, what's wrong with it?

I don't understand why the government that's already running the VA, Tricare, Medicare, and Medicaid claims they can't run a health system for everyone else.

[nereo]

Op-ed in our local today: "Replace ACA with an already proven model".

The idea is to offer the Federal Employee Health Benefits program to all.

Choice, competition, all the things the Republicans love.

So, what's wrong with it?

I don't understand why the government that's already running the VA, Tricare, Medicare, and Medicaid claims they can't run a health system for everyone else.

Very few people involved are saying it can't be done.  Many people are saying we shouldn't be done. It has as much to do with ideology (e.g. whether the government or the private sector should be involved; wether the government should be even larger than it is now; whether we can/should raise taxes or increase our deficit spending).

[AdrianC]

FEHB is a regular employer subsidized private insurance, and the relatively large employer-covered portion of the premiums is the reason why federal employees make 30% less than their private counterparts.  Doing that for everyone else would be great for nonfederal employees, no help at all to current feds, would do nothing to control the costs of care, and would incur an enormous amount of new deficit spending without providing coverage to anyone who is unemployed or self employed.

This is a terrible plan.

Here's one plan:

https://www.darrellissa.com/2017/01/31/congressman-darrell-issa-proposes-plan-to-replace-affordable-care-act/

Coupled with tax credits to help pay for it, why could it not work?

Not sure why you think it wouldn't provide coverage to anyone who is self employed. We compared our plans upthread. I'd be happy getting a tax deductible plan like yours for the same cost as you and your employer pay.

[thenextguy]

Op-ed in our local today: "Replace ACA with an already proven model".

The idea is to offer the Federal Employee Health Benefits program to all.

Choice, competition, all the things the Republicans love.

So, what's wrong with it?

Honestly, this wouldn't really be much different than the exchanges in place. The only reason the exchanges struggle is because there are too many sick people and not enough healthy people buying insurance. The FEHB is not immune to these dynamics and would see spikes in rates just the same if they were to take on the individual market customers.

[Monkey Uncle]

FEHB is a regular employer subsidized private insurance, and the relatively large employer-covered portion of the premiums is the reason why federal employees make 30% less than their private counterparts.  Doing that for everyone else would be great for nonfederal employees, no help at all to current feds, would do nothing to control the costs of care, and would incur an enormous amount of new deficit spending without providing coverage to anyone who is unemployed or self employed.

This is a terrible plan.

Here's one plan:

https://www.darrellissa.com/2017/01/31/congressman-darrell-issa-proposes-plan-to-replace-affordable-care-act/

Coupled with tax credits to help pay for it, why could it not work?

Not sure why you think it wouldn't provide coverage to anyone who is self employed. We compared our plans upthread. I'd be happy getting a tax deductible plan like yours for the same cost as you and your employer pay.

Helps Job Creators. Employers could choose to subsidize premium costs for their
employees who obtain coverage through FEHB, unlike on the state-based exchanges
established under the Affordable Care Act.

Employers may not choose to subsidize premiums, which would make the insurance unaffordable for most people.  And the plan says nothing about how people whose employers choose not to offer FEHB at all would be covered.

If it were offered to everyone regardless of employment status, and subsidized for low income people, it might work.  But then it would just be Obamacare without the individual mandate.

[Metric Mouse]

Employers may not choose to subsidize premiums, which would make the insurance unaffordable for most people.  And the plan says nothing about how people whose employers choose not to offer FEHB at all would be covered.

If it were offered to everyone regardless of employment status, and subsidized for low income people, it might work.  But then it would just be Obamacare without the individual mandate.

But isn't that almost exactly what most people want?

[Monkey Uncle]

Employers may not choose to subsidize premiums, which would make the insurance unaffordable for most people.  And the plan says nothing about how people whose employers choose not to offer FEHB at all would be covered.

If it were offered to everyone regardless of employment status, and subsidized for low income people, it might work.  But then it would just be Obamacare without the individual mandate.

But isn't that almost exactly what most people want?

Yes, that's exactly what most people want - to have their cake and eat it, too.  They want to have the option to sign up for comfortably low-priced health insurance whenever they choose, without the big, bad Government forcing them to sign up.  But you can't have universally available, reasonably priced health insurance without some mechanism to force healthy people to sign up.

If we could get the premium plus out-of-pocket cost low enough, perhaps enough healthy people would sign up voluntarily.  This plan would put the entire country in the same risk pool, which is much broader than the current ACA exchange risk pools, which are segmented by state boundaries and only include those people who can't get employer-subsidized health insurance (basically the unemployed, part-time workers, and people who work for employers that are too small to fall under the ACA's employer coverage mandate).  Getting the total cost to consumers low enough would initially require massive subsidies to both consumers (for premium and out of pocket support) and to insurance companies (in case they get hit with a mostly sick customer base).  Once people see there is no cost "catch," you might see healthy people signing up, because, why not?  You're covered just in case something bad happens, but it's not costing you an arm and a leg.  At that point, the risk pool might be broad enough for insurers to lower their prices, thereby reducing the amount of money the taxpayers have to put into subsidies.  There would also need to be some incentive for insurers to continue to negotiate prices with providers, and some incentive to encourage price competition among insurers.  Which would argue against the subsidies needed to get people to sign up and encourage insurers to stay in the market...

[AdrianC]

This plan would put the entire country in the same risk pool, which is much broader than the current ACA exchange risk pools, which are segmented by state boundaries and only include those people who can't get employer-subsidized health insurance (basically the unemployed, part-time workers, and people who work for employers that are too small to fall under the ACA's employer coverage mandate).

And self-employed small business owners and early retirees.

[Metric Mouse]

Employers may not choose to subsidize premiums, which would make the insurance unaffordable for most people.  And the plan says nothing about how people whose employers choose not to offer FEHB at all would be covered.

If it were offered to everyone regardless of employment status, and subsidized for low income people, it might work.  But then it would just be Obamacare without the individual mandate.

But isn't that almost exactly what most people want?

Yes, that's exactly what most people want - to have their cake and eat it, too.  They want to have the option to sign up for comfortably low-priced health insurance whenever they choose, without the big, bad Government forcing them to sign up.  But you can't have universally available, reasonably priced health insurance without some mechanism to force healthy people to sign up.

If we could get the premium plus out-of-pocket cost low enough, perhaps enough healthy people would sign up voluntarily.  This plan would put the entire country in the same risk pool, which is much broader than the current ACA exchange risk pools, which are segmented by state boundaries and only include those people who can't get employer-subsidized health insurance (basically the unemployed, part-time workers, and people who work for employers that are too small to fall under the ACA's employer coverage mandate).  Getting the total cost to consumers low enough would initially require massive subsidies to both consumers (for premium and out of pocket support) and to insurance companies (in case they get hit with a mostly sick customer base).  Once people see there is no cost "catch," you might see healthy people signing up, because, why not?  You're covered just in case something bad happens, but it's not costing you an arm and a leg.  At that point, the risk pool might be broad enough for insurers to lower their prices, thereby reducing the amount of money the taxpayers have to put into subsidies.  There would also need to be some incentive for insurers to continue to negotiate prices with providers, and some incentive to encourage price competition among insurers.  Which would argue against the subsidies needed to get people to sign up and encourage insurers to stay in the market...

Sounds like several great reasons to not require health insurance at all and instead directly subsidize health care.

[Monkey Uncle]

Employers may not choose to subsidize premiums, which would make the insurance unaffordable for most people.  And the plan says nothing about how people whose employers choose not to offer FEHB at all would be covered.

If it were offered to everyone regardless of employment status, and subsidized for low income people, it might work.  But then it would just be Obamacare without the individual mandate.

But isn't that almost exactly what most people want?

Yes, that's exactly what most people want - to have their cake and eat it, too.  They want to have the option to sign up for comfortably low-priced health insurance whenever they choose, without the big, bad Government forcing them to sign up.  But you can't have universally available, reasonably priced health insurance without some mechanism to force healthy people to sign up.

If we could get the premium plus out-of-pocket cost low enough, perhaps enough healthy people would sign up voluntarily.  This plan would put the entire country in the same risk pool, which is much broader than the current ACA exchange risk pools, which are segmented by state boundaries and only include those people who can't get employer-subsidized health insurance (basically the unemployed, part-time workers, and people who work for employers that are too small to fall under the ACA's employer coverage mandate).  Getting the total cost to consumers low enough would initially require massive subsidies to both consumers (for premium and out of pocket support) and to insurance companies (in case they get hit with a mostly sick customer base).  Once people see there is no cost "catch," you might see healthy people signing up, because, why not?  You're covered just in case something bad happens, but it's not costing you an arm and a leg.  At that point, the risk pool might be broad enough for insurers to lower their prices, thereby reducing the amount of money the taxpayers have to put into subsidies.  There would also need to be some incentive for insurers to continue to negotiate prices with providers, and some incentive to encourage price competition among insurers.  Which would argue against the subsidies needed to get people to sign up and encourage insurers to stay in the market...

Sounds like several great reasons to not require health insurance at all and instead directly subsidize health care.

Actually, it sounds like a great reason to impose price controls on a market that isn't subject to competition.

I mean, really, why is the idea of price regulation in the monopolistic health care markets so abhorrent?  We've done it to utilities for decades, and no one seems to scream "socialism!" at that.

[JLee]

Employers may not choose to subsidize premiums, which would make the insurance unaffordable for most people.  And the plan says nothing about how people whose employers choose not to offer FEHB at all would be covered.

If it were offered to everyone regardless of employment status, and subsidized for low income people, it might work.  But then it would just be Obamacare without the individual mandate.

But isn't that almost exactly what most people want?

Yes, that's exactly what most people want - to have their cake and eat it, too.  They want to have the option to sign up for comfortably low-priced health insurance whenever they choose, without the big, bad Government forcing them to sign up.  But you can't have universally available, reasonably priced health insurance without some mechanism to force healthy people to sign up.

If we could get the premium plus out-of-pocket cost low enough, perhaps enough healthy people would sign up voluntarily.  This plan would put the entire country in the same risk pool, which is much broader than the current ACA exchange risk pools, which are segmented by state boundaries and only include those people who can't get employer-subsidized health insurance (basically the unemployed, part-time workers, and people who work for employers that are too small to fall under the ACA's employer coverage mandate).  Getting the total cost to consumers low enough would initially require massive subsidies to both consumers (for premium and out of pocket support) and to insurance companies (in case they get hit with a mostly sick customer base).  Once people see there is no cost "catch," you might see healthy people signing up, because, why not?  You're covered just in case something bad happens, but it's not costing you an arm and a leg.  At that point, the risk pool might be broad enough for insurers to lower their prices, thereby reducing the amount of money the taxpayers have to put into subsidies.  There would also need to be some incentive for insurers to continue to negotiate prices with providers, and some incentive to encourage price competition among insurers.  Which would argue against the subsidies needed to get people to sign up and encourage insurers to stay in the market...

Sounds like several great reasons to not require health insurance at all and instead directly subsidize health care.

Actually, it sounds like a great reason to impose price controls on a market that isn't subject to competition.

I mean, really, why is the idea of price regulation in the monopolistic health care markets so abhorrent?  We've done it to utilities for decades, and no one seems to scream "socialism!" at that.

According to the Center for Responsive Politics, the health care industry hit record lobbying limits in 2009, spending nearly $273 million around the time the Affordable Care Act was being debated in Congress.

That's probably why.

[CDP45]

Actually, it sounds like a great reason to impose price controls on a market that isn't subject to competition.

I mean, really, why is the idea of price regulation in the monopolistic health care markets so abhorrent?  We've done it to utilities for decades, and no one seems to scream "socialism!" at that.

Actually it's not price regulation at utilities, it's profit guarantees. http://www.latimes.com/projects/la-fi-electricity-capacity/

 Utilities are also a small portion of income and the national economy... health spending is a 20% of GDP and rising quickly, I bet if people were paying $20k/yr for utilities they would be more outcry. Oh and the fact that price controls never work and only lead to shortages.

[FireLane]

Oh and the fact that price controls never work and only lead to shortages.

We have shortages right now. People are skipping vital medical care because they can't afford it. That's the definition of a shortage, it's just that we're rationing based on ability to pay rather than medical need.

This problem has long been solved in virtually every other industrialized country in the world, most of which are a lot less rich than the U.S. is. Our problem isn't insufficient capacity, it's lack of political will.

[fuzzy math]

I don't know any side has proposed full plans that are both realistic and workable. The current situation is falling apart because it's not profitable enough for insurers or states (expanding medicare). The current party doesn't seem to have a plan. The program before the ACA wasn't working either. It's ugly all around.

The ACA is most certainly profitable. It caps profitability and forces excesses to be returned to customers. I received a note from my employer healthcare plan for 2015 that they were returning premiums to my employer. Insurance companies are pulling out because they want a giveaway and some incentive to remove the profit caps.

The states who expanded Medicare received money. The states who chose not to do it (for political FU reasons) lost money.

[katsiki]

The states who expanded Medicare received money. The states who chose not to do it (for political FU reasons) lost money.

Doesn't that funding only last a couple of years?  After that, the state is on the hook to fund the expansion.

[geekette]

The states who expanded Medicare received money. The states who chose not to do it (for political FU reasons) lost money.

Doesn't that funding only last a couple of years?  After that, the state is on the hook to fund the expansion.

Under the ACA, the states would be responsible for at most 10%.

[Monkey Uncle]

Actually, it sounds like a great reason to impose price controls on a market that isn't subject to competition.

I mean, really, why is the idea of price regulation in the monopolistic health care markets so abhorrent?  We've done it to utilities for decades, and no one seems to scream "socialism!" at that.

Actually it's not price regulation at utilities, it's profit guarantees. http://www.latimes.com/projects/la-fi-electricity-capacity/

 Utilities are also a small portion of income and the national economy... health spending is a 20% of GDP and rising quickly, I bet if people were paying $20k/yr for utilities they would be more outcry. Oh and the fact that price controls never work and only lead to shortages.

The reason people aren't paying $20k/yr for their utilities is precisely because the price is controlled.  And the price controls haven't led to shortages; on the contrary, they've led to stable markets that provide a steady supply of reliable power.  The profit guarantee is the incentive that keeps the utility companies in the game.  Health care providers could have the same deal, but they're not going there voluntarily because they can get a lot richer by charging whatever the fuck they want to charge.

[CDP45]

Actually, it sounds like a great reason to impose price controls on a market that isn't subject to competition.

I mean, really, why is the idea of price regulation in the monopolistic health care markets so abhorrent?  We've done it to utilities for decades, and no one seems to scream "socialism!" at that.

Actually it's not price regulation at utilities, it's profit guarantees. http://www.latimes.com/projects/la-fi-electricity-capacity/

 Utilities are also a small portion of income and the national economy... health spending is a 20% of GDP and rising quickly, I bet if people were paying $20k/yr for utilities they would be more outcry. Oh and the fact that price controls never work and only lead to shortages.

The reason people aren't paying $20k/yr for their utilities is precisely because the price is controlled.  And the price controls haven't led to shortages; on the contrary, they've led to stable markets that provide a steady supply of reliable power.  The profit guarantee is the incentive that keeps the utility companies in the game.  Health care providers could have the same deal, but they're not going there voluntarily because they can get a lot richer by charging whatever the fuck they want to charge.

Uhm, back in reality it just doesn't cost a lot to deliver water, or electricity. Please let me know what other markets are functional under price controls. Rent control being the classic example of stupid policies for political reasons.

You don't seem to understand basic economics, that there is a limit to what people will pay, and that's why doctors can't/don't charge $100,000 per office visit right?

Prices come from what is paid, and right now the government is spending unlimited amounts for old people's healthcare with tax dollars, making all those not on the dole heading straight for a cliff. It's not just the prices the government paid, it's also paying for unnecessary, extra care that much is completely preventable but there's not enough incentive for the patient to conduct.

Guess it will only change when the middle class thinks they've had enough, and 20% of GDP isn't that value. Will it get to 30%? 40%? Who knows...

[ysette9]

I think the fact that we have a lot of established infrastructure makes it appear that it doesn't cost much to deliver water or electricity. In fact an incredible amount of investment went into setting up power distribution lines, laying pipes underground, and maintaining all of that. You have to amortize that cost over time to do a fairer comparison since healthcare has more on-going costs by its nature.

[NoStacheOhio]

I think the fact that we have a lot of established infrastructure makes it appear that it doesn't cost much to deliver water or electricity. In fact an incredible amount of investment went into setting up power distribution lines, laying pipes underground, and maintaining all of that. You have to amortize that cost over time to do a fairer comparison since healthcare has more on-going costs by its nature.

^This^

We're struggling with that right now, because our water infrastructure needs massive updates, and we're having storm water runoff problems. Nobody wants to pay for it, but the helpful (unelected) folks at the Northeast Ohio Regional Sewer District are more than willing to tack on some extra fees for (maybe) starting to address some of the problems in a few of the communities that matter more than the others.