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Tags Affordable Care Act , health care issues , obamacare

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Old 30th October 2016, 03:49 PM   #1
Fast Eddie B
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Obamacare data point

Karen's rate for next year will be going up what appears to be 40%:



That's for her Bronze Plan in GA, and includes a bit of a subsidy. Without that subsidy, it would have been $723.56.

I'm already on Medicare, so not directly affected. Still, a bit of a hit to our discretionary spending.
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"And it's, frankly, disgusting the way the press is able to write whatever they want to write. And people should look into it." - President Donald J. Trump, October 11, 2017.

Last edited by Fast Eddie B; 30th October 2016 at 03:51 PM.
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Old 30th October 2016, 04:45 PM   #2
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I think in one state the rates went up 171%.

Just in time to get Trump elected?
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Old 30th October 2016, 04:51 PM   #3
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I don't think killing Obamacare would help unfortunately.
I don't see the insurance companies lowering their rates for any reason, except competition.
So if Obamacare went away, and they all leave the rates high, they all win.

Not sure how to fix the cost issue at this point. Colorado is voting for an in-state health care for all. It will likely lose, but I'm voting yes just because it's the only chance I see for lower rates.
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Old 30th October 2016, 05:08 PM   #4
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Actually, obamacare was an excuse to raise all rates, including emploer paid. Blame it all on Obama.

Nothing in Obamacare really lowers rates, it just controls the relative rates of one group vs another. Old-young mainly.
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Old 30th October 2016, 05:18 PM   #5
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Originally Posted by Fast Eddie B View Post
Karen's rate for next year will be going up what appears to be 40%:

https://c1.staticflickr.com/6/5569/3...495e7f5382.jpg

That's for her Bronze Plan in GA, and includes a bit of a subsidy. Without that subsidy, it would have been $723.56.

I'm already on Medicare, so not directly affected. Still, a bit of a hit to our discretionary spending.
I paid $900 per month 10 years or so ago. Long before ACA, and BCBS had a fine print that said they would cover nothing to do with my skin since I had had a basal cell area scraped off. I've paid for private coverage all my life, as insurance to prevent becoming destitute, but have claimed nothing other than the difference between my copay and what the doctors charge for checkups (which is more than my copay).

I have nothing but contempt for, first the young welfare mooches who think they are immortal and won't pay their share, even after they end up in the emergency room; and second for the entire medical industry which exists only to pay dividends to it's shareholders and speculative investors.

Capitalism I agree with, but anyone who thinks, like dumbass Republicans, that health care is a competitive industry must be in the same low IQ range as Trump supporters.
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Old 30th October 2016, 05:20 PM   #6
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Originally Posted by casebro View Post
I think in one state the rates went up 171%.

Just in time to get Trump elected?
Anyone who votes on that basis has to be retarded.
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Old 30th October 2016, 05:26 PM   #7
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Angry

Originally Posted by Denver View Post
I don't think killing Obamacare would help unfortunately.
I don't see the insurance companies lowering their rates for any reason, except competition.
So if Obamacare went away, and they all leave the rates high, they all win.

Not sure how to fix the cost issue at this point. Colorado is voting for an in-state health care for all. It will likely lose, but I'm voting yes just because it's the only chance I see for lower rates.
The only solution is to make the most cost effective system of all available to all; namely Medicare (which is not to say that this doesn't need improvements and reduced shackles).

Anyone who thinks that "competition" exists in health care is an idiot who has never asked for rates while in an ambulance, or checked every specialist in a hospital to verify their participation in your health plan before they open their mouth and bill for consultation.

We have the stupidest most corrupt health care system on the planet.
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Old 30th October 2016, 05:44 PM   #8
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Regardless, making health insurance "affordable" and "saving the average American family $2,500 a year" both seem to have been pipe dreams.

Let me add that Karen's "Bronze" coverage ain't great, with over $6,000/yr deductible.
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Old 30th October 2016, 05:46 PM   #9
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Originally Posted by Elind View Post
The only solution is to make the most cost effective system of all available to all; namely Medicare (which is not to say that this doesn't need improvements and reduced shackles).
Agreed. Making Medicare only available above a certain age almost seems like age discrimination.

Make it an option, maybe dropping the eligibility age steadily over time.
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Old 30th October 2016, 05:53 PM   #10
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Originally Posted by Fast Eddie B View Post
Agreed. Making Medicare only available above a certain age almost seems like age discrimination.

Make it an option, maybe dropping the eligibility age steadily over time.
No, I mean allow people to pay for it when they are no longer on their parents' policy, and make them pay for it if they don't have any other coverage, like the ACA is supposed to work if allowed to.

In short, have a national option which is non profit and the most efficient of all. That is how to make the others realize they have competition.

Last edited by Elind; 30th October 2016 at 05:55 PM.
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Old 30th October 2016, 05:58 PM   #11
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On NPR they have said that fewer young, healthy people have signed up than were expected. Possibly unrelated, fewer employers have ditched employer-provided plans.

Allegedly there are adjustments that can be made that would help, but I haven't seen the maths or what the end picture would be.
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Old 30th October 2016, 05:59 PM   #12
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the ACA was a band aid at best. It was too watered down. I'm not saying it wasn't a big step forward, but it was never going to fix the real issues.
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Old 30th October 2016, 06:07 PM   #13
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Originally Posted by Fast Eddie B View Post
Agreed. Making Medicare only available above a certain age almost seems like age discrimination.

Make it an option, maybe dropping the eligibility age steadily over time.
Medicare is extremely expensive. You can't afford the part c monthly payments.
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Old 30th October 2016, 06:09 PM   #14
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Originally Posted by Tsukasa Buddha View Post
On NPR they have said that fewer young, healthy people have signed up than were expected. Possibly unrelated, fewer employers have ditched employer-provided plans.

Allegedly there are adjustments that can be made that would help, but I haven't seen the maths or what the end picture would be.
It's cheaper to pay a "fine" than to pay for coverage (assuming even that is enforced). Seems like that would be an easy fix, which by itself would reduce overall premiums; but what can one expect from a GOP do nothing congress?
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Old 30th October 2016, 06:10 PM   #15
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Originally Posted by BobTheCoward View Post
Medicare is extremely expensive. You can't afford the part c monthly payments.
Please explain that, which sounds to me that you don't have a frigging clue.
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Old 30th October 2016, 06:11 PM   #16
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Originally Posted by Fast Eddie B View Post
Karen's rate for next year will be going up what appears to be 40%:

https://c1.staticflickr.com/6/5569/3...495e7f5382.jpg

That's for her Bronze Plan in GA, and includes a bit of a subsidy. Without that subsidy, it would have been $723.56.

I'm already on Medicare, so not directly affected. Still, a bit of a hit to our discretionary spending.
My bold. With Obamacare, it's 422.56. Without, as Trump and the Republicans want, it would be 732.56.
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Old 30th October 2016, 06:18 PM   #17
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Originally Posted by BobTheCoward View Post
Medicare is extremely expensive. You can't afford the part c monthly payments.
Not sure what you're getting at.

I paid into the plan my entire adult life.

I currently "pay" $104.90/mo for Medicare and $37.40/mo for Part D Prescription Drug coverage.

"Pay" is in quotes, because it's actually deducted from my Social Security payments.

Now I'm going to go look up what "part c" refers to.
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Old 30th October 2016, 06:21 PM   #18
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Originally Posted by Fast Eddie B View Post
Not sure what you're getting at.

I paid into the plan my entire adult life.

I currently "pay" $104.90/mo for Medicare and $37.40/mo for Part D Prescription Drug coverage.

"Pay" is in quotes, because it's actually deducted from my Social Security payments.

Now I'm going to go look up what "part c" refers to.
Your care is heavily subsidized.

Part c is referring to the medicare advantage plans.
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Old 30th October 2016, 06:23 PM   #19
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Originally Posted by Trebuchet View Post
My bold. With Obamacare, it's 422.56. Without, as Trump and the Republicans want, it would be 732.56.
Well, to be fair, before Obamacare Karen and I were paying about $300/month for a high-deductible plan for BOTH of us, which is all we wanted.

No doubt that would have gone up over time. But Obamacare clearly did NOT make health insurance more affordable, which was kind of touted as its raison d'etre.
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Old 30th October 2016, 06:27 PM   #20
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Originally Posted by BobTheCoward View Post
Your care is heavily subsidized.

Part c is referring to the medicare advantage plans.
Got it.

I do have a Medicare supplement plan. It's $112.25/mo for the plan I chose.

But I'm still unsure of your overall point.
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Old 30th October 2016, 06:34 PM   #21
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Originally Posted by Fast Eddie B View Post
Got it.

I do have a Medicare supplement plan. It's $112.25/mo for the plan I chose.

But I'm still unsure of your overall point.
Medicare actually costs, for the cheapest person, 850$ a month, not including deductibles and copays. That is literally the payment CMS makes to managed care groups. Allowing someone to buy in, in the most literal meaning, would be allowing someone to make that 850 a month payment (possibly more) to access the care.
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Old 30th October 2016, 06:36 PM   #22
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The primary goal of the ACA was to have more Americans covered by insurance. There were only a few provisions that ended up limiting the cost of that insurance. The medical cost ratio rule requires 80% of all premiums collected to be spent on medical services is working as intended. The insurance mandate and Medicare expansion have reduced the problem of cost shifting. States that refused to expand Medicaid such as Georgia are seeing more cost shifting than states that did expand. The Medicare rule requiring hospitals to pay the cost of treating mistakes such as hospital acquired infections ended up improving the quality of care and reducing costs for all patients.

There are other things that could and should be done. The ACA originally had a provision that would pay doctors for discussing end of life options. Doing so would likely result in more patients spending their last days in a hospice instead of an ICU. We have not yet addressed the issue of drug company price gouging. Or the games played to get patients to ask for the new expensive drug instead of older generics that are just as effective. Routine medical tests such as MRI scans are far too expensive in this country.
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Old 30th October 2016, 06:57 PM   #23
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Originally Posted by BobTheCoward View Post
Medicare actually costs, for the cheapest person, 850$ a month, not including deductibles and copays. That is literally the payment CMS makes to managed care groups. Allowing someone to buy in, in the most literal meaning, would be allowing someone to make that 850 a month payment (possibly more) to access the care.
I might not have the right number on what the final payment is. Im looking.
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Old 30th October 2016, 08:35 PM   #24
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Originally Posted by Kestrel View Post
The primary goal of the ACA was to have more Americans covered by insurance. There were only a few provisions that ended up limiting the cost of that insurance. The medical cost ratio rule requires 80% of all premiums collected to be spent on medical services is working as intended. The insurance mandate and Medicare expansion have reduced the problem of cost shifting. States that refused to expand Medicaid such as Georgia are seeing more cost shifting than states that did expand. The Medicare rule requiring hospitals to pay the cost of treating mistakes such as hospital acquired infections ended up improving the quality of care and reducing costs for all patients.

There are other things that could and should be done. The ACA originally had a provision that would pay doctors for discussing end of life options. Doing so would likely result in more patients spending their last days in a hospice instead of an ICU. We have not yet addressed the issue of drug company price gouging. Or the games played to get patients to ask for the new expensive drug instead of older generics that are just as effective. Routine medical tests such as MRI scans are far too expensive in this country.
Total health care expenditures were 3 trillion dollars in 2012 and the 80-20 rule required insurance companies to repay 1 billion dollars to consumers. That's a savings of .0003%. Excluding public expenditures (Medicare/Medicaid) in total expenditures, the savings was .0005%. The insurance companies aren't the boogeyman.
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Old 31st October 2016, 01:28 AM   #25
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As if insurance companies wouldn't have raised premiums if the ACA was never passed.......
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Old 31st October 2016, 02:58 AM   #26
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Originally Posted by thaiboxerken View Post
As if insurance companies wouldn't have raised premiums if the ACA was never passed.......
Yup. It's as if everybody forgets our health care system was screwed up and WAY too expensive before the first vote was cast for the ACA
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Old 31st October 2016, 06:07 AM   #27
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Originally Posted by Fast Eddie B View Post
Regardless, making health insurance "affordable" and "saving the average American family $2,500 a year" both seem to have been pipe dreams.

Let me add that Karen's "Bronze" coverage ain't great, with over $6,000/yr deductible.
It expanded coverage and made it more affordable for individuals to get coverage in many cases. It was not intended to do anything about cutting health care costs because that was politically impossible. Too much effort being spent to block anything to not have the pharmaceutical and insurance companies on board and they wouldn't be if it cut spending in any functional way. Look at the way that epipen has gone up in price while it is being required to be kept in schools and such now. The CEO said that it should be covered by insurance so that patients don't see the price increases.
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Old 31st October 2016, 06:15 AM   #28
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Originally Posted by ponderingturtle View Post
It was not intended to do anything about cutting health care costs because that was politically impossible.
This has always led me to wonder...

When the President said over and over again that his plan would save the typical American family $2,500/year, was he being honestly naive, intentionally dishonest, or something else? I think a lot of people took his projection at face value and have a right to feel misled.
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Old 31st October 2016, 06:32 AM   #29
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It was a Republican plan. There was little doubt it wasn't going to be great, but it was better than nothing. Unfortunately the only way to make it affordable is to take the insurance companies out of it. People complain how the government can't be trusted to run it, but they are more than willing to trust a corporation who has an incentive to deny you service and raise your rates at every single opportunity.
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Old 31st October 2016, 06:34 AM   #30
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Originally Posted by Fast Eddie B View Post
This has always led me to wonder...

When the President said over and over again that his plan would save the typical American family $2,500/year, was he being honestly naive, intentionally dishonest, or something else? I think a lot of people took his projection at face value and have a right to feel misled.
Depends on the assumptions being made. If you are buying in the exchanges instead of the old way of buying individual plans that did result in large savings for many people. But by and large it wouldn't reduce health care spending on the whole. There were some ideas that getting more people able to be insured would also help but not in a huge way.

It was more focused on fixing some of the ethical issues the financial ones are politically impossible at this time.
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Old 31st October 2016, 06:38 AM   #31
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How much should Karen pay?
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Old 31st October 2016, 06:49 AM   #32
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Originally Posted by Tsukasa Buddha View Post
On NPR they have said that fewer young, healthy people have signed up than were expected. Possibly unrelated, fewer employers have ditched employer-provided plans.

Allegedly there are adjustments that can be made that would help, but I haven't seen the maths or what the end picture would be.
Why would employers ditch plans? A pool of 5000 is enough to be self insuring. Sick employees can be fired after 6 months on a disability plan.
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Old 31st October 2016, 06:53 AM   #33
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Originally Posted by marplots View Post
How much should Karen pay?
As little as possible for the best coverage possible?

Not to be snide, but is that not the goal of most consumers?
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Old 31st October 2016, 06:55 AM   #34
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Originally Posted by Tero View Post
Why would employers ditch plans? A pool of 5000 is enough to be self insuring. Sick employees can be fired after 6 months on a disability plan.
The vast majority of people in the US are employed by companies with less than 5000 employees. There are less than 2000.
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Old 31st October 2016, 07:03 AM   #35
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$2,500 a year was an estimate from the Institute of Medicine of how much cost shifting increases health care and insurance premiums of the average family. It does represent potential cost savings if everyone was covered by insurance. There is however no guarantee that medical providers will pass that savings on to consumers.

Most Americans have insurance from thier employer or a government program such as Medicare or Medicaid. Only 7% of American families buy policies on the exchanges. Of those 85% qualify for a subsidy. Most news reports on Obamacare costs ignore the subsidies and focus on the premiums paid by the 1% of American families the pay full price for an exchange policy.
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Old 31st October 2016, 07:08 AM   #36
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And those employer plans for a pool of some hundreds are, it seems, affordable. At leastvthey offer them.

Perhaps we should form co-ops to buy insurance? Better yer, hospitals should all jump in and in groups (each municipal area) offer HMO plans.
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Old 31st October 2016, 07:24 AM   #37
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Originally Posted by Fast Eddie B View Post
As little as possible for the best coverage possible?

Not to be snide, but is that not the goal of most consumers?
No. At least it's not the realistic goal. Why? Because "as little as possible" and "the best coverage possible" are unknown and largely unknowable. If I am healthy, I don't need to spend anything on healthcare at all. But I cannot predict when my status will change. Whenever my status changes, the two variables also change, and in the US they change dramatically.

If I say I wish to pay someone to take some of the risk away from me, I am going to rely on their estimation of that risk. I'm stuck with their estimates. I can look, in hindsight, to see what profits they make to see if they've offered a true estimate or if they are cheating me. And this is the mechanism used to ratchet insurance premiums up or down. But that's a statistical measure and still doesn't really tell me if I'm getting the best bang for my buck - the system isn't customized to fit me alone.

There's also an asymmetry here. For every person who is milking the insurance cow by getting a huge benefit, there are many, many more who pay more for the services they get (or fail to get, actually). This wouldn't matter much except in a democracy, numbers matter. If we vote for our own interests, we crash the system or sacrifice those on the other side of the asymmetry.

My mom used to put it this way: "They are betting you will stay well and you are betting you will get sick. Who wants to win by getting sick?"
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Old 31st October 2016, 07:51 AM   #38
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I think the goal of health insurance should be: "if I get really sick, I don't want to go bankrupt." That means something different for everyone. I could get away with a really high deductible; others can't. We keep Medicare and Medicaid; keep the mandate and pre-existing clause; continue to subsidize and then open up the types of plans that qualify to avoid the penalty. Everyone has different wants and needs, so allow the insurance companies to get creative with the plans they can offer.
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Old 31st October 2016, 08:04 AM   #39
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Originally Posted by xjx388 View Post
I think the goal of health insurance should be: "if I get really sick, I don't want to go bankrupt." That means something different for everyone. I could get away with a really high deductible; others can't. We keep Medicare and Medicaid; keep the mandate and pre-existing clause; continue to subsidize and then open up the types of plans that qualify to avoid the penalty. Everyone has different wants and needs, so allow the insurance companies to get creative with the plans they can offer.
The "get creative" part has a hidden flaw. It's revealed in one of the parts you'd like to keep: the "pre-existing condition" clause. By limiting coverage for someone with a preexisting condition, I am able to offer coverage to other customers cheaper - people's prior medical history predicts how much future care they will need. Expensive care.

I can also get creative with zip codes, gender, race, age and a bunch of other things. In fact, I can get so creative I can exclude all the really high risk people and market to only low risk folks. This was considered a systemic problem in how we used to do insurance.

One other try was to fund a kind a catastrophic fallback so those at the fringe - the possibly millions of dollars in care - could be funded either by the government directly or by pooling some fee to all the insurance carriers. This has been done with variable success. In Michigan, we did it for motor vehicle accidents where the injured couldn't get payment (for whatever reason). It kicks in when medical bills exceed $500,000. They fund it with fees on automobile registrations and drivers licenses.

I checked, and as of 2015, the fund had upwards of $20 billion in it. Apparently it's over-funded and lawmakers are keen to get at the extra money to use it for other projects. So we overpaid.

Last edited by marplots; 31st October 2016 at 08:06 AM.
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Old 31st October 2016, 08:08 AM   #40
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Originally Posted by xjx388 View Post
I think the goal of health insurance should be: "if I get really sick, I don't want to go bankrupt." That means something different for everyone. I could get away with a really high deductible; others can't. We keep Medicare and Medicaid; keep the mandate and pre-existing clause; continue to subsidize and then open up the types of plans that qualify to avoid the penalty. Everyone has different wants and needs, so allow the insurance companies to get creative with the plans they can offer.
I do wonder : if you do that you run into the risk that what should normally happen (and do happen in an UHC) that healthy folk pay for the UHC of all, will in such case simply not happen. It sounds to me that you are maximizing the benefit for insurer.... While I see no impact whatsover for the prices of health care.

But maybe I am missing something obvious. Would not be the first or last time.
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