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Author Topic: ACA  (Read 15061 times)

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Offline RetributionTopic starter

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ACA
« on: October 30, 2013, 11:54:11 AM »
Okay not sure why I have the urge to stick my finger in light sockets today mayhap I am just feeling contrary but http://www.slate.com/articles/news_and_politics/politics/2013/10/obamacare_and_republican_criticism_the_health_care_law_s_early_missteps.html

My issue with ACA has been from the get go that I think US health care is broken, horribly so. But I just assumed the government was so inept that the "fix" would be so screwed up it would be mind blowing. I linked that not saying anything pro, con, or political, but yeah everything government touches it messes up almost inevitably. I mean dear god making the current Republican party seem rational and clairvoyant is really a hard thing to do.

Offline Valthazar

Re: ACA
« Reply #1 on: October 30, 2013, 12:29:48 PM »
I think the ACA has noble intentions, but it was very poorly crafted legislatively and economically.  As I have said previously, it will artificially cause premiums for non-ACA insurees to rise, and as a result, due to declining enrollments, may cause private insurers to drop coverage in certain target demographics and markets.

Obama had marketed the ACA with the promise in 2009, “if you like your health plan, you will be able to keep your health plan,” and even in 2012 was saying, “If [you] already have health insurance, you will keep your health insurance.”

http://www.cbsnews.com/8301-505263_162-57609737/obamacare-more-than-2-million-people-getting-booted-from-existing-health-insurance-plans/
http://investigations.nbcnews.com/_news/2013/10/28/21213547-obama-admin-knew-millions-could-not-keep-their-health-insurance?lite

Basically, as the law was originally written, all health insurance plans as of March 23, 2010 would be 'grandfathered' in, and the ACA would not cause their insurers to modify their plans in any manner.  However, since then, the Department of Health and Human Services wrote changes that said if any part of a policy was changed since that date, for example, the deductible, co-pay, or benefits (which is pretty normal, considering how frequently slight modifications occur in most insurance plans), that the policy would not be grandfathered.  So that's the situation we are in now.

Many individuals in their 20s are choosing to not purchase health insurance under ACA, and would rather pay the tax penalty, which is another financial uncertainty for insurance companies.  If you've just graduated from college, healthy, and tight on cash, would you rather pay extra for insurance you'll probably never use, or just pay a lower penalty fee to the government?  When the ACA was written, the young, uninsured demographic was supposed to the prime source of premiums to help pay for the medical care for the unemployed and uninsured older population - but the strength of this plan is increasingly under question now.  Many insurance companies are approaching the ACA from a risk management perspective, (since it is an external pressure on their industry) and trying to do financial damage control at this point.

I can't really say much about the technical glitches/issues with the website.  I guess those will be sorted out in due time.  It's a blessing that most small to midsize businesses will have until Jan 1 2015 to comply, because many of them are seriously unsure about all the uncertainties surrounding ACA.  I've tried to explain the ACA to my friend, who is working on a business plan, and it's frustrating when I can't provide him all the answers because the law is so vague with regard to business requirements.
« Last Edit: October 30, 2013, 12:57:31 PM by ValthazarElite »

Offline Toral Stimins

Re: ACA
« Reply #2 on: October 30, 2013, 06:02:46 PM »
Living in a country where healthcare is free for everyone (NHS) and those who want to pay can pay (BUPA for instance), being born in a country where healthcare used to be free, but not anymore as it is a small country, this whole debate about we shouldn't spend too much money on healthcare for the not white skinned folk/not republicans/not rich/not anyone who doesn't think like us, is just pure racist. But that's coming from a European. Where Obama is being seen as more right wing than probably the most 'liberal' political party in Europe apart from far right.

Why on earth is it so hard to just give free health care for everyone? Why on earth is social services such a big issue at your side of the Atlantic? Why on earth is being social, trying to help everyone in your country so hard for governments there?

Offline Oniya

Re: ACA
« Reply #3 on: October 30, 2013, 06:25:41 PM »
I'm not entirely sure when 'socialism' became such a buzz-word over here, but it seems to have slipped into the same role that 'communist' filled before the collapse of the Soviet Union.  I doubt that the average person on the street knows exactly what socialism is, only that some guy running for office said it was bad. 

Offline Callie Del Noire

Re: ACA
« Reply #4 on: October 30, 2013, 07:13:41 PM »
Today I'm in the mother of all Black Dog funks.. so I'll not comment till I can breath without yelling at people. I will say this, this was a good idea till the elected officials got a hold of it.

Offline RetributionTopic starter

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Re: ACA
« Reply #5 on: October 30, 2013, 07:40:35 PM »
I will take a stab at this Tor bear in mind any such discussions include a lot of personal opinion. A look at tax rates in Europe seems to indicate that they are comparable to those in the US. It is a hard thing to get a bead on when there are different tax rates for different incomes but that is a whole other ball of wax http://en.wikipedia.org/wiki/Tax_rates_of_Europe

Having said all of that the US was founded largely on opposition to taxation among other things so the point of view over here has been different from the get go. And with that in mind bluntly with the prevailing independent spirit taking money out of person A's pocket for person B will more often than not chap person A.  I do not think it is a race issue I think it is more of an issue of personal independence. But that is my opinion and I can no more prove it than anyone can probably prove the opposing and we could toss factoids at each other for a long time over it.

But what I feel is the largest problem is our system of government. Democracy is great, but someplace along the line the way it is practiced in this country has become mind boggling cumbersome.  It does nothing well or efficiently. Large corporations are much the same in my opinion, again I state my opinion. There is an utter lack of efficiency. Part of the reason for that inefficiency IMHO is that we have become too obsessed with fixing every possible problem with things and all things must fit neatly into the system. I beg the pardon of my lawyer friends but too many lawyers, sure space aliens could have possibly come down and messed up the ACA web site but lets look a bit at likelihood. I took that to a bit extreme to illustrate my point. So with this built in inefficiency many things are doomed to failure when the big government machine tries to implement them.

Another thing that cuts on this in two ways again in my opinion is the lack of accountability or the rewarding of excellence. In this day and age it is unfortunately not politically correct to punish poor service and reward quality service. There are laws in place that enforce this in private industry and it is worse in government, I happen to know this as I work for the government.  When we consider this about any endeavor is doomed to mediocrity at best.  So when one looks at just plain free health care in this light, in this country, it brings several things to mind that cause the opposition: telling doctor A that they can only earn so much despite their skill level when doctor B who may be inept is not a pleasing thought, malpractice it is not often mentioned but a large reason health care costs so much in this country is malpractice suits and insurance and well lawyers like it and most politicians are lawyers, insurance companies are very wealthy and have a lot of political influence and they obviously have a horse in this race, the inherent fear of how government mucks things up, and lastly a lot of people who go to work each day and deal with the grind really do not like the idea of paying for those who do not.

Or at least those are the things that touch the tip of the ice berg IMHO.  America is a very large and very diverse country. Thus why one sees so much bickering inside of its boarders. It has always been that way, heck I just got done reading the autobiography of a plains man back during the wars with the native Americans and it was there then. Just in this day and age of digital those conflicts are magnified exponentially. All of these things come into play.

But when I get back to my knee jerk reaction I would love to have just plain free health care for all from the government like you described. But as I said in my first post I no longer have any faith that the government of this country can pull it off without making things worse than they already are.

Offline Toral Stimins

Re: ACA
« Reply #6 on: October 30, 2013, 08:43:34 PM »
For many European politicians, the way the US of A is governed, is a reason for them to get spontaneous orgasms. Such a large part of the world, with so many different cultures and people, that is what they are trying to do with Europe. Don't get me wrong, I am very much PRO 'One Europe'. But whereas the US has had 200 or 300 years head start on Europe, it also has one big thing, they all speak the same language. And damn you Peter Stuyvesant, for trading New Amsterdam for that puny shit hole they call Surinam these days. You lot would be speaking Dutch instead of English.

The Netherlands, where I hail from, is different in just about everything. We have at any given moment in time, more than 10, but sometimes closer than 20 political parties in parliament. It has been less and the Dutch felt it wasn't good. 'We' feel it is not good for one party to rule (and we laugh about the idea that one party holds Office, while the other party rules the country). We are known and liked for our freedom. First amongst many to have legalised same sex marriage, sort of like allowed weed (you can hold up to 5grams, you can smoke any amount, if you smoke a joint of a kilo, you are untouchable, if you hold it in your hands with no fire in it, you go to jail). The Red Light district of Amstershite is famous, or should I say infamous? (The biggest fable of this world is that you can only do those things in Amsterdam, but you can do all the same, for half the money or less in any other city, village and town)

But we also have this care system. Since the mid '50s, there is social security based on human rights. Each individual has a right to have at least to live and to be cared for. Even those who cannot afford the current health care system, will be helped in a state of emergency. If they have a heart attack or worse even, car crash, they will get free care. If you are unlucky enough to fall victim to the bad economical sitations, you have a right for some money to keep you going. It is not much, but it is just about enough. You will have to work to get out of the situation, no one is guaranteed a life long stay in social care anymore, but they at least give you chance.

Thing is, most people rent, it's about 60-40 these days. It used to be 85-15, buying isn't 'of the Dutch' They rich ones yes, but us 'plebs' no. So it is sort of like affordable for the government to help 'us' out.

Having said all this, and it's mainly off topic, apologies for that, could it be that the whole claim culture has ruined any chance of a good decent solid health care system and it is happening here in England as well. I am trained medic from my (*long gone) army days. If I see a person having a seizure, I act, react, help, but it is not uncommon anymore to sue those who help.

Offline gaggedLouise

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Re: ACA
« Reply #7 on: October 30, 2013, 08:58:24 PM »
I will take a stab at this Tor bear in mind any such discussions include a lot of personal opinion. A look at tax rates in Europe seems to indicate that they are comparable to those in the US. It is a hard thing to get a bead on when there are different tax rates for different incomes but that is a whole other ball of wax http://en.wikipedia.org/wiki/Tax_rates_of_Europe

Having said all of that the US was founded largely on opposition to taxation among other things so the point of view over here has been different from the get go. And with that in mind bluntly with the prevailing independent spirit taking money out of person A's pocket for person B will more often than not chap person A.  I do not think it is a race issue I think it is more of an issue of personal independence. But that is my opinion and I can no more prove it than anyone can probably prove the opposing and we could toss factoids at each other for a long time over it.

Bit of an aside, but I think this matters if we're discussing what the state is supposed to do, what it should take on. The issue of taxation, of course, was going to be in a whole different frame in a country where ownership of slaves was widespread in major parts of the union right up to the Civil War, and slavery-like conditions remained in the south many decades after 1865; and where there was plenty of fertile, unplowed land that could be handed over to just about anyone coming into the country and settling on some of that free land, free of charge (the Homestead Acts) - and with fairly  low land tax after those first years. In Europe, commodities like land and labour had to be paid for in cash before they could enter the economy. At least, most of the time and if it was supposed to be legal.

This side, there wasn't a huge reservoir of free arable land to support a rapidly rising number of people through the 18th to 20th centuries. I reckon that meant "taxes equal theft" was not going to be a viable proposition. Maybe for baronets and land owning magnates who had inherited wide stretches of land, but not for most people, even the urban middle classes.
« Last Edit: October 30, 2013, 09:53:57 PM by gaggedLouise »

Offline Zeitgeist

Re: ACA
« Reply #8 on: October 30, 2013, 10:43:37 PM »
Why on earth is it so hard to just give free health care for everyone? Why on earth is social services such a big issue at your side of the Atlantic? Why on earth is being social, trying to help everyone in your country so hard for governments there?

Perhaps because its not actually free? Just because you didn't get a bill in the mail doesn't mean you and others didn't pay for it, one way or another.

Offline kylie

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Re: ACA
« Reply #9 on: October 31, 2013, 02:18:36 AM »
Perhaps because its not actually free? Just because you didn't get a bill in the mail doesn't mean you and others didn't pay for it, one way or another.

        Sometimes I feel like it's the same old circus repeating the same old tired arguments. 

        When you have a system that makes the same procedures cost many times more, and makes pharmaceutical bills many times higher, it's going to be worse however the bill is paid.  Might as well do something to at least chop it down some.  The bill that the Europeans actually get is lower because they don't arrange the market mainly to bloat the drug and insurance companies.  I'm not really sure how much of that has to do with not arranging the market as a whole to bloat their industry executives in general to the cosmic heights America does -- but I suspect, that might also play a part? 

         Of course, it's largely a question of will.  If you believe the point of life is to make more people suffer longer, and for most people to moralize about how hard they have it so other people "should" have to suffer too (otherwise 'it isn't fair' to the suffering), then it doesn't make sense to allocate any resources to health care.  The US defense industry isn't free either, but a huge proportion of American taxes are tossed into it anyway.  The political wing that is so sour on national healthcare (at least, particularly when Obama is the one signing off) does not seem very concerned about reducing the massive bill for that.  Maybe some of that money could be moved around without, you know, divine punishment in the form of a North Korean nuke landing or something.  (Doesn't seem to be stopping North Korea from getting its bombs together, anyway...)  Or maybe some familiar, very wasteful arm of the government (just for example, again defense budget overruns and exaggerations comes to mind) could clean up its act, too.

          Finally...  It's just so cheap and predictable for people to jump at the slightest sign of clutsiness as a reason to attack something new -- omg, the fools messed up the first run of a giant, overused website, why the totally unprecedented incompetence that shows, it would never happen anywhere but the terrible federal government!  Certainly the private sector has noooo mismanagement and no website crashes on the first run of a national-scale project, whatsoever.  Yeah right, and oh please.       

Offline gaggedLouise

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Re: ACA
« Reply #10 on: October 31, 2013, 03:04:10 AM »
Perhaps because its not actually free? Just because you didn't get a bill in the mail doesn't mean you and others didn't pay for it, one way or another.

I think the sense was: free at the point of delivery. The person in need of health care or some kind of medical examination doesn't have to haul out their wallet and pay up hundreds or thousands of bucks/pounds/francs for what their body tells them in no uncertain terms that they need to get sorted out - or what an experienced doctor has prescribed they have to take a look at. The whole act of individually getting health care is unlocked from gathering up the money for every step in real time, and for the doctors it is never part of their own motivation to try to make the person/s they are treating, or that person's parents, pay as much as possible. Honestly, I think that's great, and it encourages rational and less expensive choices for those receiving health care, too. Why? Because they are less likely to have to put things off and slip towards a stage where things become far worse and more expensive to fix, out of drifting from one stopgap solution to another, and less likely to end up permanently impairing their health and ability to work, look for jobs and raise kids.

From the point of view of the state, the handling of the capital is about spreading out of risks, just as for an insurance company - and free public health care is an insurance system, of course. Most people are not going to the hospital or local health care centre very often, some don't have a sick day in years, others are a bit more frequent short-term visitors. By being seen as a shared commitment and one that helps keeping people in work and not sucked under by badly managed illnesses or injuries (because they "personally couldn't pay up" at some time), it adds up over time.
« Last Edit: October 31, 2013, 03:09:25 AM by gaggedLouise »

Offline Valthazar

Re: ACA
« Reply #11 on: October 31, 2013, 03:21:09 AM »
The main school of thought that I see many posters here support, is to have the government play an active role in providing healthcare (akin to European countries).

Regardless of my personal views, there is nothing fundamentally nothing wrong with the government providing healthcare.  However, suggesting that the ACA is an example of government-provided healthcare is not accurate.  What the ACA does, is artificially force private insurers to deflate prices for certain insurance plans, and mandate citizens to purchase private insurance, at the risk of facing a tax penalty.  This is very different from a government-based solution - found in European countries, and actually introduces financial uncertainty into the economy.  Private insurers have no idea of how many or how few people will opt into their new government-mandated plans, meaning that their financial figures for 2015, 2016, and so on, are largely in flux.  Because of this uncertainty, and their obvious need to retain some stability with regard to having good credit lines, private insurance companies are increasingly being cautious with their existing plans, and/or dropping limited coverage plans to build capital for these new plans being created.  They really have no previous data to go off of with regard to how much claims they will be paying out with these new insurees, or how much premium revenue they'll generate from healthy 20 year olds who won't be filing many claims.  In other words, as I linked above, many people will start seeing their insurance coverage being dropped (as is already the case).

Even though it ran counter to my personal views, I actually supported Obama's original ACA proposal in 2008 with a purely government run exchange that acted in competition with private insurers - since this represented sound economics.  But the current ACA is nothing but a train wreck, and we'll see the damage in 5-10 years as more people start losing their coverage, and more and more "good" jobs with benefits disappear.

I just hope people realize this fundamental difference as the debate continues.  I think all of us want a society where people have access to healthcare (regardless of views in achieving this goal, whether short-term or long-term) - but the ACA isn't that solution.
« Last Edit: October 31, 2013, 03:37:44 AM by ValthazarElite »

Offline Zeitgeist

Re: ACA
« Reply #12 on: October 31, 2013, 07:00:21 AM »
        Sometimes I feel like it's the same old circus repeating the same old tired arguments. 

        When you have a system that makes the same procedures cost many times more, and makes pharmaceutical bills many times higher, it's going to be worse however the bill is paid.  Might as well do something to at least chop it down some.  The bill that the Europeans actually get is lower because they don't arrange the market mainly to bloat the drug and insurance companies.  I'm not really sure how much of that has to do with not arranging the market as a whole to bloat their industry executives in general to the cosmic heights America does -- but I suspect, that might also play a part? 

         Of course, it's largely a question of will.  If you believe the point of life is to make more people suffer longer, and for most people to moralize about how hard they have it so other people "should" have to suffer too (otherwise 'it isn't fair' to the suffering), then it doesn't make sense to allocate any resources to health care.  The US defense industry isn't free either, but a huge proportion of American taxes are tossed into it anyway.  The political wing that is so sour on national healthcare (at least, particularly when Obama is the one signing off) does not seem very concerned about reducing the massive bill for that.  Maybe some of that money could be moved around without, you know, divine punishment in the form of a North Korean nuke landing or something.  (Doesn't seem to be stopping North Korea from getting its bombs together, anyway...)  Or maybe some familiar, very wasteful arm of the government (just for example, again defense budget overruns and exaggerations comes to mind) could clean up its act, too.

          Finally...  It's just so cheap and predictable for people to jump at the slightest sign of clutsiness as a reason to attack something new -- omg, the fools messed up the first run of a giant, overused website, why the totally unprecedented incompetence that shows, it would never happen anywhere but the terrible federal government!  Certainly the private sector has noooo mismanagement and no website crashes on the first run of a national-scale project, whatsoever.  Yeah right, and oh please.       

So we agree its not 'free' I presume.

I never pilloried the website. The only thing I've said in this thread about ACA is what you quoted.

I think the sense was: free at the point of delivery. The person in need of health care or some kind of medical examination doesn't have to haul out their wallet and pay up hundreds or thousands of bucks/pounds/francs for what their body tells them in no uncertain terms that they need to get sorted out - or what an experienced doctor has prescribed they have to take a look at.

I think I said, and you quoted what I said, that just because you don't have to pull out your wallet doesn't mean it is free.

All I said very simply was that it isn't free. Who pays the doctor and nurse's salary? Who pays for the medication? Who pays for medical equipment? If you don't realize it is you and I, you're fooling yourself.

Offline gaggedLouise

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Re: ACA
« Reply #13 on: October 31, 2013, 07:48:50 AM »

I think I said, and you quoted what I said, that just because you don't have to pull out your wallet doesn't mean it is free.

All I said very simply was that it isn't free. Who pays the doctor and nurse's salary? Who pays for the medication? Who pays for medical equipment? If you don't realize it is you and I, you're fooling yourself.

It's free in the sense that you don't have to look for a well-paid job, the right kind of parents (the kind with well-paid jobs or índependently wealthy) or a sugar daddy...before you can even consider fixing your illness or ailment.

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Re: ACA
« Reply #14 on: October 31, 2013, 08:00:21 AM »
Quote from: Zeitgeist
So we agree its not 'free' I presume.
           Seems to me when people come along emphasizing, it's not really free, they're often on the side that says it's obviously too expensive.  I don't think that's necessarily the case -- partly for the reasons I listed.  Although I'm inclined to agree with Val that it could (and probably, should) certainly be done still cheaper yet.  That is, if only there were political will and awareness/ interest enough for that.  But millions getting some slight improvement, is still worthwhile in my book.  We may not "count" the costs of disasters that don't happen very well, but they are real and often higher than the short-term savings of having no insurance.  So opportunities for affordable preventative care, and for at least some degree of emergency coverage for more people, are worth having. 

           I suppose there is the argument that youth may (statistically, under normal circumstances) not need it...  But we don't use that argument against Social Security or Medicare so often, so I'm not sure it really has that much support.  (Unless you figure, the problem is more that youth simply don't vote, while older people who actually use Medicare, etc. more now, do?  Possible.)  Still...  In an economy where young people often have to hold multiple jobs and work in things they were not trained for at length, there are more pressures and more dangers.  I would hate to be the "odd" young person who develops a rare condition (stuff that was often disallowed by companies before ACA) or is somehow just worn down by the pressures and (often ugly) diet of this sort of economy, without enough credit or wages to carry them through.

Quote
I never pilloried the website. The only thing I've said in this thread about ACA is what you quoted.
            Right, granted.  That wasn't actually aimed at you necessarily.  It's not that I thought you were saying that personally....  I don't always write posts as quote - direct rejoinder- nothing else (the long string of those honestly kinda loses me), so maybe that wasn't clear. 

            Maybe it would have made more sense to put it in another post altogether.  Though once in a while, I lump unlike things, or responses to various people, together partly out of fear that one of those people who likes to use petty style differences as a hammer will show up and shout, "How dare you make more than one post in here at once!"  (Which I think, if I always obeyed that, well it is both impractical for others to read as you've demonstrated, and also quite silly for me to be worrying about.  But then it's not unknown to get booted for a handful of quite reasonable style differences around here, when someone raises their voice far enough over such things.)  Anyway, it was meant more as a general statement about all the drama -- I think, often right wing, opportunist mocking drama -- about website problems recently. 

« Last Edit: October 31, 2013, 08:01:28 AM by kylie »

Offline Zeitgeist

Re: ACA
« Reply #15 on: October 31, 2013, 08:09:32 AM »
           Seems to me when people come along emphasizing, it's not really free, they're often on the side that says it's obviously too expensive.  I don't think that's necessarily the case -- partly for the reasons I listed.  Although I'm inclined to agree with Val that it could (and probably, should) certainly be done still cheaper yet.  That is, if only there were political will and awareness/ interest enough for that.  But millions getting some slight improvement, is still worthwhile in my book.  We may not "count" the costs of disasters that don't happen very well, but they are real and often higher than the short-term savings of having no insurance.  So opportunities for affordable preventative care, and for at least some degree of emergency coverage for more people, are worth having. 

           I suppose there is the argument that youth may (statistically, under normal circumstances) not need it...  But we don't use that argument against Social Security or Medicare so often, so I'm not sure it really has that much support.  (Unless you figure, the problem is more that youth simply don't vote, while older people who actually use Medicare, etc. more now, do?  Possible.)  Still...  In an economy where young people often have to hold multiple jobs and work in things they were not trained for at length, there are more pressures and more dangers.  I would hate to be the "odd" young person who develops a rare condition (stuff that was often disallowed by companies before ACA) or is somehow just worn down by the pressures and (often ugly) diet of this sort of economy, without enough credit or wages to carry them through.
            Right, granted.  That wasn't actually aimed at you necessarily.  It's not that I thought you were saying that personally....  I don't always write posts as quote - direct rejoinder- nothing else (the long string of those honestly kinda loses me), so maybe that wasn't clear. 

            Maybe it would have made more sense to put it in another post altogether.  Though once in a while, I lump unlike things, or responses to various people, together partly out of fear that one of those people who likes to use petty style differences as a hammer will show up and shout, "How dare you make more than one post in here at once!"  (Which I think, if I always obeyed that, well it is both impractical for others to read as you've demonstrated, and also quite silly for me to be worrying about.  But then it's not unknown to get booted for a handful of quite reasonable style differences around here, when someone raises their voice far enough over such things.)  Anyway, it was meant more as a general statement about all the drama -- I think, often right wing, opportunist mocking drama -- about website problems recently.

Well the act is called the affordable care act and not the free care act. Time will tell. Color me skeptical.

I've been reticent criticizing the roll out of the website as I myself have gone through projects like this (on a much smaller scale) and know first hand when you turn on the lights, things can happen you'd never expect or could have planned for. Could it have been handled better? For sure. Would it have been smarter to roll it out in incremental stages, feature by feature? Sure. But that is all water under the bridge now.

Offline Valthazar

Re: ACA
« Reply #16 on: October 31, 2013, 08:39:47 AM »
I suppose there is the argument that youth may (statistically, under normal circumstances) not need it...  But we don't use that argument against Social Security or Medicare so often, so I'm not sure it really has that much support.  (Unless you figure, the problem is more that youth simply don't vote, while older people who actually use Medicare, etc. more now, do?  Possible.)  Still...  In an economy where young people often have to hold multiple jobs and work in things they were not trained for at length, there are more pressures and more dangers.  I would hate to be the "odd" young person who develops a rare condition (stuff that was often disallowed by companies before ACA) or is somehow just worn down by the pressures and (often ugly) diet of this sort of economy, without enough credit or wages to carry them through.

I don't think you understand that the ACA healthcare plans aren't guaranteeing healthcare for anyone, unless they choose to opt into it.  Social Security and Medicaid are not programs that need to be pre-opted into to receive benefit, so it's not a direct analogy.

Many young people in their 20s/early 30s are choosing not to opt into ACA, and would rather pay the lower tax penalty because they are limited on cash as it is - after making rent payments, student loan payments, car payments, etc.  Some would say this is irresponsible decision making on their part, but statistically, this is the financially better choice given the probability of a health condition in one's 20s/early 30s.  If young people choose to not purchase healthcare through the ACA, then even if they have a rare condition, as you say, they will not receive healthcare.

It is for reasons like this, which I think the ACA is doomed for failure.  As I said earlier, if implemented wisely, it could have been a great success.  But as it is, I am not so optimistic about the future.

http://www.theguardian.com/commentisfree/2013/oct/29/obamacare-website-glitches-not-only-problem

While I have my own views on the optimal solution, given the choice between the current version of ACA, and one featuring a public option, I believe the latter would have been far superior.  At least then private health insurance plans (such as the ones most people currently have) would not be at the whim of market manipulation due to unanticipated increase or decrease in enrollees.  I can assure you millions of Americans will lose their private insurance coverage over the next few years.  What we have now is such a mess, and we're already starting to see the effects.
« Last Edit: October 31, 2013, 09:07:40 AM by ValthazarElite »

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Re: ACA
« Reply #17 on: October 31, 2013, 10:19:06 AM »
Web sites have issue, but if you look at the original link I posted my real concern are those who are getting the "sorry we no longer insure you" notices. Granted it is a small percentage of the self employed, but they deserve to be covered just as much as the next person if we are talking health care for all. IMHO that is the inherent problems I see in such situations.

In another I have a close relative that runs a small not for profit organization. The requirements of insuring all employees is forcing them to make some hard choices: not offer any employees insurance and pay the penalty, or watch costs rise by covering all employees to the degree required by law. Either way that is sliced what is going to have to happen is program cuts in adult literacy, child care, shelter for the homeless, and equality programs for starters. These are the sorts of things that concern me so please do not spin my words in other directions. If this is not an example of government ineptness I certainly do not know what is. In the example I listed above that I have close personal knowledge of we are not talking a company trying to turn a profit which seems to be perceived by many as evil. We are talking about a not for profit who tries to break even and keep their doors open for the community.

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Re: ACA
« Reply #18 on: October 31, 2013, 10:28:59 AM »
I don't think you understand that the ACA healthcare plans aren't guaranteeing healthcare for anyone, unless they choose to opt into it.  Social Security and Medicaid are not programs that need to be pre-opted into to receive benefit, so it's not a direct analogy.

Many young people in their 20s/early 30s are choosing not to opt into ACA, and would rather pay the lower tax penalty because they are limited on cash as it is - after making rent payments, student loan payments, car payments, etc.  Some would say this is irresponsible decision making on their part, but statistically, this is the financially better choice given the probability of a health condition in one's 20s/early 30s.  If young people choose to not purchase healthcare through the ACA, then even if they have a rare condition, as you say, they will not receive healthcare.
         Yeah, actually I had forgotten that they have the pay fee rather than join up option.  I do vaguely recall the situation Rubin describes with the whole single payer proposal and Obama "bipartisanship" and corporate consultations running it into the ground.  I haven't quite gone over what was left with a fine tooth comb (and I doubt many people have, honestly), but if Harkin could say it was "better than nothing," I've been figuring a little better times a lot of people is still something. 

As for myself, I was stuck with interest compounding in an avalanche on a few medical bills from before ACA even passed, so it wasn't as if I only needed ACA to work.  I haven't been busy calculating exactly what the resulting package would cost what group, precisely.  But it also sounds like the administration originally assumed (or implied in the cost advertising?) that insurance companies would take more clients through the national plan rather than change course and do things that excluded them -- yet in fact, many did change their plans and (if I understand this right?) thus made more plans disallowed from the national scheme as well.

Quote
While I have my own views on the optimal solution, given the choice between the current version of ACA, and one featuring a public option, I believe the latter would have been far superior.  At least then private health insurance plans (such as the ones most people currently have) would not be at the whim of market manipulation due to unanticipated increase or decrease in enrollees.  I can assure you millions of Americans will lose their private insurance coverage over the next few years.  What we have now is such a mess, and we're already starting to see the effects.

         Not to derail that wholesale...  But didn't we have a mess with increasing rates and minimal coverage, and quite a few plans that offered little for large payments, in the first place?  It's hard to have an absolute disaster when there's not much left to lose in the first place, for most people -- and if you do, then it's breeding a more unsustainable situation where someone may actually have to do better.  (Unless the country can really deal with becoming a Banana Republic, beyond the trend it already had.) 

While it's preferable to get everything perfect on the first swing at a huge, pressing problem....  Maybe Rubin could be right, and this just will have to catalyze people to go back and try to do better.  That is, assuming that health care and debt remain pressing enough issues for enough people, that there will still be support.  Also assuming that there is some kind of representative government that actually does more than what the corporations demand, under some sort of emergency pressures?  (Not quite sure on that one, now.)  And, that is also assuming the masses are not frustrated, or duped (by Fox etc.) into believing that the government or the left just "can't" do it, because after all they "had one try" at the helm (in a time when everything they did in social programs, was resisted in hopes of sabotaging the president as much as possible).

 
« Last Edit: October 31, 2013, 10:30:28 AM by kylie »

Offline MasterMischief

Re: ACA
« Reply #19 on: October 31, 2013, 11:14:57 AM »
Let us not forget the ACA was a compromise.  It seems to me some of the people bemoaning its weaknesses are the very ones who insisted on their inclusion.

Offline Valthazar

Re: ACA
« Reply #20 on: October 31, 2013, 07:20:41 PM »
         Not to derail that wholesale...  But didn't we have a mess with increasing rates and minimal coverage, and quite a few plans that offered little for large payments, in the first place?  It's hard to have an absolute disaster when there's not much left to lose in the first place, for most people -- and if you do, then it's breeding a more unsustainable situation where someone may actually have to do better.  (Unless the country can really deal with becoming a Banana Republic, beyond the trend it already had.) 

Before healthcare reform, you're right, health insurance premiums for the self-employed, and potentially unemployed (who would be paying premiums from their savings) were extremely high.  The healthcare options usually available through most employers tend to be offered at a subsidized cost, which are certainly not cheap, but affordable for most employees. 

Someone like myself would look at this situation, and focus on creating a thriving economy, with pro-business incentives to increase full-time positions in small businesses, and thus, create greater avenues for the currently unemployed/part-time workers to gain healthcare through their future full-time employers.

However, while that would be what I consider the ideal approach, as I said earlier, I am not opposed to a government solution.  However, I am struggling to see how the ACA solves this problem.  All it is doing is artificially reducing the cost of private insurance for certain healthcare plans.  It's almost as if the people who drafted this current version of ACA have no education in economics.  If you try to artificially decrease the price of a certain commodity in an industry, it will introduce a lot of risk and uncertainty for the major companies in that industry.  So now, while you're definitely going to have a lot of people who were previously uninsured getting on insurance plans, the net effect is that many people who previously were on insurance plans will end up losing them.

People bringing up Europe in comparison to the ACA are not really understanding that the ACA really isn't a "government-run" healthcare plan.  It's essentially a mandate on the private healthcare industry, and on citizens, which is why I say it really isn't "better than nothing" at least in my opinion.
« Last Edit: October 31, 2013, 07:41:25 PM by ValthazarElite »

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Re: ACA
« Reply #21 on: October 31, 2013, 11:47:46 PM »
It's almost as if the people who drafted this current version of ACA have no education in economics.  If you try to artificially decrease the price of a certain commodity in an industry, it will introduce a lot of risk and uncertainty for the major companies in that industry.  So now, while you're definitely going to have a lot of people who were previously uninsured getting on insurance plans, the net effect is that many people who previously were on insurance plans will end up losing them.
         Not sure if you might have this posted somewhere else already, but could you spell out exactly how you think this would work?  I'm not really clear if you mean that companies would drop certain plans or people to restructure their profit forecast, or that the government-backed plans will eventually have to be disbanded or rendered more expensive so people will lose those...  Or, what do you mean exactly? 

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Re: ACA
« Reply #22 on: November 01, 2013, 12:29:29 AM »
Quote from: ValthazrElite
It's almost as if the people who drafted this current version of ACA have no education in economics.  If you try to artificially decrease the price of a certain commodity in an industry, it will introduce a lot of risk and uncertainty for the major companies in that industry.  So now, while you're definitely going to have a lot of people who were previously uninsured getting on insurance plans, the net effect is that many people who previously were on insurance plans will end up losing them.

Well, you might also see it this way: said companies would have to make do with a bit less fattened profits compared to now, but they'd hardly be starving for it.

And those profits, today, often are not getting reinvested or put to any productive use. They tend to just land in some top brasses' already well-lined pockets.
« Last Edit: November 01, 2013, 12:37:27 AM by gaggedLouise »

Offline Valthazar

Re: ACA
« Reply #23 on: November 01, 2013, 03:49:31 AM »
         Not sure if you might have this posted somewhere else already, but could you spell out exactly how you think this would work?  I'm not really clear if you mean that companies would drop certain plans or people to restructure their profit forecast, or that the government-backed plans will eventually have to be disbanded or rendered more expensive so people will lose those...  Or, what do you mean exactly?

Well, let me give the primary, direct reason why people are losing their existing private insurance coverage.  The ACA requires that by-minimum, all Americans should have insurance that covers "10 minimum standards."  These standards include a variety of care, including maternity care, emergency visits, mental health treatment and even pediatric dental care.  If you're someone in your late 20s, who is in great shape and health, you may have decided to opt into a health insurance plan that offers minimal coverage - maybe just a physical every year, eye exams, and a certain threshold of ER visits.  But now, because that insurance plan is "below" the threshold of ACA requirements, they will be told they are going to lose coverage.  Many of these individuals losing coverage will then be faced with the decision of whether to pay the 'greater' premium for ACA, or pay a possibly greater or about-the-same tax penalty, for no insurance now.  So basically, while some Americans gain health insurance, another portion are losing it as a result of financial hardship.

The second reason is that private insurance companies really do not have any concrete data about how many new enrollees will take up insurance plans as a result of the ACA.  Because health insurance companies won't be allowed to charge higher premiums for people who have medical histories, they now have to somehow raise revenue in another demographic to cover these high expenses.  Although from a very surface, non-economic level, this is considered the 'ethical' thing to do, it is poor policy.  In other words, the fact that they have to treat customers equally, with limited variation in premiums based on buyers' ages or whether they smoke is creating a situation where insurance companies really have no idea what sort of people are going to enroll, which demographic they are going to be able to get more revenue now from, and so on.  This is causing a lot of uncertainty in the health industry right now.  The prediction originally was that premiums would be higher for healthy 20-somethings and 30-somethings, but now we are finding out that their enrollment is less than predicted.

Because insurance companies, just like any other company, need to maintain a stable business plan, and demonstrate to creditors that they have a good credit line, and relatively accurate financial forecasts, many of them are doing damage control and "reducing" uncertainty by dropping certain health insurance coverage plans to have a bit more concrete estimates about their future revenue streams.  Often times, this means dropping coverage for a few employer-based healthcare plans, or raising premiums for people with existing healthcare, and so on.

Honestly, no one has any concrete answers, or accurate predictions about the potential fallout of ACA.  This type of law is largely unprecedented in US history.
« Last Edit: November 01, 2013, 03:55:49 AM by ValthazarElite »

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Re: ACA
« Reply #24 on: November 01, 2013, 04:13:57 AM »
Val, would you estimate it might have been easier, or smoother, to implement the ACA -.or the earlier proposal, the one that was more inclusive, and which you say you found more fair and reasonable - if it hadn't happened at such a deep economic trough? I'm not thinking about the political process of deciding this kind of law, but only the economic and corporate process: getting other insurance providers, ordinary people and employing firms/corporations on board and heaving the new system in.


I think it's part of the paradox of Obama's presidency as a whole, that the credit/mortgage crisis of 2oo8 helped him win over voters in some quarters, though it wasn't the key cause of his polling victory, but at the same time the long-haul crisis has made it much harder to actually deliver on his program once he had been sworn in, and it's made opposition to him more bitter. The Tea Party, too, were helped by the crisis.
« Last Edit: November 01, 2013, 04:18:23 AM by gaggedLouise »

Offline Valthazar

Re: ACA
« Reply #25 on: November 01, 2013, 07:00:54 AM »
I really don't think the economic climate would have mattered.  With Obama's original plan, he was planning to have a purely government healthcare exchange, that would essentially act like a competitor to the other private insurance companies.  So in other words, people would be able to purchase relatively cheaper healthcare through the government healthcare option - and if indeed this offered the "better bang for the buck," then naturally due to competition, all other private healthcare companies would need to lower their premiums.  Even if private insurance prices did not respond in this manner, the consumers themselves would prefer to join the government healthcare plan, since it would be cheaper, and offer relatively decent benefits.  As many people are saying here, this is the kind of policy that would lead itself to a single-payer system as found in Europe - which I can't really find too much fault in.  Granted, it's not my ideal situation, but it would certainly offer a solution to the current healthcare problems.

The ACA isn't doing that though, and saying that the ACA is a step towards that, or a step in the right direction, is misunderstanding what it accomplishes.  It's basically the government forcing private companies (health insurance providers) to offer lower cost products.  The economy doesn't work like that.  If it were that easy, the government could just step in and say, "Sorry, but colleges and universities are far too expensive right now, we think you should set your tuition prices to $3,000" and problem solved.

The Tea Party opposition to ACA is legitimate, but their arguments are not based on any substance.  They have totally misunderstood the issue, and nothing about the ACA suggests 'socialism' or a government-takeover.  I consider the ACA as more of a burden on business growth, similar to tax hikes on small business, that fails to accomplish its primary objective.
« Last Edit: November 01, 2013, 07:02:17 AM by ValthazarElite »

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Re: ACA
« Reply #26 on: November 01, 2013, 07:18:10 AM »
Quote from: ValthazarElite
Even if private insurance prices did not respond in this manner, the consumers themselves would prefer to join the government healthcare plan, since it would be cheaper, and offer relatively decent benefits.  As many people are saying here, this is the kind of policy that would lead itself to a single-payer system as found in Europe - which I can't really find too much fault in.  Granted, it's not my ideal situation, but it would certainly offer a solution to the current healthcare problems.

Watching the U.S. debate from Europe, one does get the impression that anything leading towards a single-payer system (such as, mostly, in the UK, Germany or the Scandinavian countries) would have been a really hard sell with a big part of the American electorate at any time, both pushing it during a national election campaign and getting it worked through in congress. It somehow seems to clash with some baseline American ideas of limiting the state and of the people as a crowd of (real or potential) self-made men, ideas that are (I hazard) not even seen as political but just as part of being American.

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Re: ACA
« Reply #27 on: November 01, 2013, 09:01:02 AM »
You hit the nail on the head in that last post IMHO Gagged. Not to mention offered a much shorter and better explained reason of why here the government just does not pick up the tab for health care, than I did. *Offers a round of applause*

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Re: ACA
« Reply #28 on: November 01, 2013, 09:39:11 AM »
Watching the U.S. debate from Europe, one does get the impression that anything leading towards a single-payer system (such as, mostly, in the UK, Germany or the Scandinavian countries) would have been a really hard sell with a big part of the American electorate at any time, both pushing it during a national election campaign and getting it worked through in congress. It somehow seems to clash with some baseline American ideas of limiting the state and of the people as a crowd of (real or potential) self-made men, ideas that are (I hazard) not even seen as political but just as part of being American.

          You'll have to say more than that to convince me, or risk jumping to the conclusion that anyone too liberal should simply be labelled "un-American."  Well, that works very nicely for the Tea Party I suppose.  (Though I do have plenty of times when I feel as a unit, the country too often acts that way.  Just...  I don't like taking it too broadly to the individual level.)

           Something like Val says, I was fairly happy with the overall sound of Obama's original proposal.  Now what I remember most of the "debate" (if it can really be called that when it comes to this) is that people like Fox News and company wouldn't stop screaming "Socialism?!" every other minute, while industry lobbies seemed to keep whining quietly that it would cut into their profits too much (or that is what I gathered they were opposing it for -- there was a lot of smoke and mirrors going on, at least in how I remember the news coverage of it). 

             The "Socialism" line is what really surprised me though -- they just seemed to keep repeating lines about how Europe must be weak, Europe must have terrible lines and lower quality care to boot (largely unsupported if I am not mistaken), ACA could mean some bureaucrats making vital decisions about your granny's life support (since it includes a provision for anything remotely like that --actually-- once in a blue moon), and just general rumblings about "isn't this the sort of thing we put all that trouble into fighting the Soviets over?  Why, yes!" Again with hardly any substantial detail to the discussion at all.  Simply, "Hey remember how riled up you were afraid of them and proving we must be better than them?  Look, here's a chance to say it again.  So vote how I say about this."  In other words, hysteria and fear-mongering.  Not sure that is really unique to American politics. 

           I think saying individualism and self-reliance are quintessentially American, is a little bit too broad.  A certain history of influences from Greek or Christian lore is also common to many (I wouldn't say all) Americans, but that doesn't mean everyone still buys into it as a gut reaction so much.  And Latinos may be thinking something rather different when they hear "family values" than precisely what rural Whites in the Upper Midwest and Mountain states, for example, are actually imagining -- though there may be certain resonances.    Many people take issue with signifcant parts of it, and particularly those versions hat the right has been appealing to of late. 

If it was simply "American" to buy into it, then well why hasn't the Tea Party been able to convince everyone to swarm the whole Congress over ACA or to push a national popular vote amendment against it?  They could use much the same rhetoric about it taking away too many individual choices, and that would be that if so.   
« Last Edit: November 01, 2013, 09:46:17 AM by kylie »

Offline gaggedLouise

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Re: ACA
« Reply #29 on: November 01, 2013, 10:20:48 AM »
You hit the nail on the head in that last post IMHO Gagged. Not to mention offered a much shorter and better explained reason of why here the government just does not pick up the tab for health care, than I did. *Offers a round of applause*

It's Louise. please. ;) *takes a bow*


Quote from: kylie
You'll have to say more than that to convince me, or risk jumping to the conclusion that anyone too liberal should simply be labelled "un-American."  Well, that works very nicely for the Tea Party I suppose.  (Though I do have plenty of times when I feel as a unit, the country too often acts that way.  Just...  I don't like taking it too broadly to the individual level.)

Mmm, I'm sort of liberal by American standards, even with a dash of socialist ideas and instincts. And supportive of this kind of thing myself. Just wanted to try to explain the near visceral negative response to ideas of the government taking charge of health care in a big part (like, half or sometimes even more?) of the U.S. voting public.



Offline Valthazar

Re: ACA
« Reply #30 on: November 01, 2013, 09:05:04 PM »
I think saying individualism and self-reliance are quintessentially American, is a little bit too broad.  A certain history of influences from Greek or Christian lore is also common to many (I wouldn't say all) Americans, but that doesn't mean everyone still buys into it as a gut reaction so much.  And Latinos may be thinking something rather different when they hear "family values" than precisely what rural Whites in the Upper Midwest and Mountain states, for example, are actually imagining -- though there may be certain resonances.    Many people take issue with signifcant parts of it, and particularly those versions hat the right has been appealing to of late.

I don't think that is what Louise was saying.  It isn't to suggest that in order to be "American" in this day and age, that one has to be individualistic or concerned about the influence of the state.  It is simply a historical perspective, as to why the United States has a certain political discourse that is markedly different than the ones ongoing in Europe.

For the most part, all Americans had an ancestor that came independently (either voluntarily or involuntarily), or as a nuclear family - and in rare occasions, as an extended family.  The entire fabric of our society is almost entirely of largely autonomous families having to form communities.  In Europe on the other hand, people can trace their communities back for generations, upon generations - so there's far more of a deeply ingrained communal spirit.  The ultimate point being that self-sufficiency and individualism are deeply rooted within our cultural heritage as Americans - whether or not we ascribe to that philosophy ourselves.

Even many moderate left-leaning Americans believe that while the government can have significant benefits by having a very involved role in daily life, that it has the potential for trouble if unchecked.  After all, the US was founded as a means of escaping an oppressive government.  Hence the fact that almost all Americans acknowledge the beauty of the Constitution, and the separation of powers and checks and balances between the executive, legislative, and judicial branches.  Americans may disagree on the interpretation of the Constitution, but it's still universally valued.
« Last Edit: November 01, 2013, 09:41:18 PM by ValthazarElite »

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Re: ACA
« Reply #31 on: November 01, 2013, 11:34:21 PM »
Well, I'm not saying ideas about the way you're supposed to think and act, because you're of a given country, couldn't change over time. Being British used to mean the stiff upper lip and knowing your place in life, it certainly doesn't these days.  ;)

Anyway, the "run your own business and don't wish for the state to come in" mindset (or however it's phrased) would be widespread with a big part of Americans, right? I never figured it'd have to be so overwhelming it defines, sort of objectively, what being a real American is about.

Offline kylie

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Re: ACA
« Reply #32 on: November 02, 2013, 12:01:56 AM »
           Maybe I'm just being fussy here...  I think it would have worked better to say, a particular take on a more general idealization of individualism could help explain why some, certain Americans are willing to buy into some angle on what Cruz, Tea Party, etc. are saying. 

           Sure it's there in the soup and the whole may be somewhat right of Europe (perhaps to the point that I don't really understand how it feels in some ways, on some issues to have more of the Euro, Swedish, what have you experience).  But left and right, as I understand it, don't quite translate wholesale across so many issues between the US and Europe. 

          Where they actually do translate, I can't quite believe that there are no concepts of self-reliance recognizable to most Americans to be found in Europe.  And I fully suspect on some things like healthcare, where there is some recognizable common field of discussion, people on the American left would sometimes be rather taken with what Europeans do -- even if they might have reservations about certain details.  I don't believe we're that different as whole groups.  So when you say self-reliance explains how America as a whole works, I want to hear something much more specific.  Otherwise, it does sound broad brush to me and too distorted for the issue at hand -- almost like one of those vague, shotgun, "socialism" bashing slogans the far right brandished during the health care debate. 
« Last Edit: November 02, 2013, 12:06:48 AM by kylie »

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Re: ACA
« Reply #33 on: November 02, 2013, 01:11:07 AM »
           Maybe I'm just being fussy here...  I think it would have worked better to say, a particular take on a more general idealization of individualism could help explain why some, certain Americans are willing to buy into some angle on what Cruz, Tea Party, etc. are saying. 

           Sure it's there in the soup and the whole may be somewhat right of Europe (perhaps to the point that I don't really understand how it feels in some ways, on some issues to have more of the Euro, Swedish, what have you experience).  But left and right, as I understand it, don't quite translate wholesale across so many issues between the US and Europe. 

*nods* It's got a lot to do with national historical baggage I think. Also with hoiw the US political system is set up, to some extent, to limit the powers and abilities of the government, and to set the executive power and the parliament(Congress) against each other, competing for influence and agendas.


Quote
Where they actually do translate, I can't quite believe that there are no concepts of self-reliance recognizable to most Americans to be found in Europe.  And I fully suspect on some things like healthcare, where there is some recognizable common field of discussion, people on the American left would sometimes be rather taken with what Europeans do -- even if they might have reservations about certain details.  I don't believe we're that different as whole groups.  So when you say self-reliance explains how America as a whole works, I want to hear something much more specific.  Otherwise, it does sound broad brush to me and too distorted for the issue at hand -- almost like one of those vague, shotgun, "socialism" bashing slogans the far right brandished during the health care debate.

Oh sure, the idea of self-reliance and of "don't mess with my folks, Big Brother" is alive and well this side too. If anything, I think it's the "swim or sink!" take (as a moral standard) on getting through tough circumstances, or tough times afflicting all of a country, that's less accepted in many parts of Europe. And I think Valthazar has a point there, that most Americans (excepting pure Native American families) have a family history - however much it is known in detail, or just in a sketchy way -  that leads back on a couple lines to entering the country as small families or individuals, and joining up with/founding new towns, villages and communities in the U.S. Around here, the web of cities, roads and villages goes back many hundreds of years, even back to the Romans in some places (though not them here in Scandinavia, as it happens) and while most people haven't had their family living in the same place for six hundred or a thousand years, I guess local history and the local story of surviving and flourishing in good times and bad times will focus more on the city or parish itself than on your family or some leading local families.
« Last Edit: November 02, 2013, 01:21:22 AM by gaggedLouise »

Offline Phaia

Re: ACA
« Reply #34 on: November 02, 2013, 01:20:11 AM »
Normally I stay out of these discussions but the ACA has affected me directly so I would like to present what happened.

I am a 33 year old female, married with one child [4 year old boy] The company I work for is a well known international entertainment company with 1000s of employees.. I am considered upper mid management [kinda sorta in the scheme of things]

Anyway the company had offered me 250$  toward one of the health plans offered by the main insurance company...if my plan came to less then or equal to the 250 it was basically free for me.. Since I had the option I went with a family plan at 325 a month...so I was spending 75 a month on my family insurance. Until that is October 1ST.

By the ACA I have to pay at least 49% of my premiums and the whole family plan changed... the insurance company did not drop any of us but did implement the changes...and talk about the hollering by many of the ultra liberals I work with...yeesh

So now I have to pay 164 a month for my insurance...but it gets worst...

As  a policy I take my son to see his doctor twice a year and our copay had been $30 ...last week I took him for his twice yearly and the copay was 60...well now I called the insurance office and talked to a nice helpful lady that explained all the changes mandated in my new approved ACA health care insurance... to keep the 325 a month they basically opted to follwed what is known as the silver plan as set forth by the government...this mandates certain payments... example...on the family plan we can have 4 visits to a doctor a year at a 60 dollar copay...it use to be any number of times...we use to be able to go one of the quick care clinics [as an example for an antibodic shot for my son when he got bit by a bunch of fire ants] that would cost us a 75 Dollar copay which considering an average visit could easy run 180 or more was well worth it...now we have 2 visit per year at 150 dollars copay but we do now have a 500 copay for any emergency room visit...once a year

but wait there is more... we had a 40000 dollar a year coverage plan... with a 1000 dollar deductable...by the new mandated plan [a silver plan to keep it at the same price I had before] there is now a 30% deductable which means that the first 12, 000 dollars we are now on the hook for....well there is good news though If I wanted to go for the platinum plan which is a 10% deductable It would only cost me 580 a month...with the company would of course have to pay half so I would ONLY have to pay 290 a month to get a plan that is similar but still worst then the one I had ....when i was paying 75 a month....and to answer those that are wondering what the 'fee's not to have insurance the first year is...it is 95 dollars...the second is 350 and the third I believe was 450..considering that a 20-30 year would have to pay something like 280 a month on the basic plan I can see why many are opting not to buy any insurance at all.

anyway my husband and I are weighing our options not sure yet what we will end up doing on this...considering we are rebuidling after a fire gutted our house we are very VERY tight and if we did not have a 4 year very well might have opted out ourselves

phaia 

Offline Phaia

Re: ACA
« Reply #35 on: November 02, 2013, 01:43:25 AM »
Also to answer the question as to why we in the US seem not to want to pay for a Europain system

lets look at some hard numbers...last year here in the US, I made a over 80K which makes me firmly middle class I had to pay 25% income tax and about 6% + in soical sercurity tax which meant I was taking home about 67% of my income...

In the netherlands [which i looked up] my income would translate to about 57000 euro on which is taxed 52%  hmmm and then there is a 7.1% health care tax...so if I was living in europe I would be working for the governement no matter the job i held [which also kinda explains why you all rent more then own]....i feel at times a straight tax on an item is better then more income tax....but then I would be one of those that would dig out my gun should the governemnet ever try taxing me at 50% of my income

phaia
« Last Edit: November 02, 2013, 01:45:25 AM by Phaia »

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Re: ACA
« Reply #36 on: November 02, 2013, 02:32:29 AM »
Also to answer the question as to why we in the US seem not to want to pay for a Europain system

lets look at some hard numbers...last year here in the US, I made a over 80K which makes me firmly middle class I had to pay 25% income tax and about 6% + in soical sercurity tax which meant I was taking home about 67% of my income...

In the netherlands [which i looked up] my income would translate to about 57000 euro on which is taxed 52%  hmmm and then there is a 7.1% health care tax...so if I was living in europe I would be working for the governement no matter the job i held [which also kinda explains why you all rent more then own]....i feel at times a straight tax on an item is better then more income tax....but then I would be one of those that would dig out my gun should the governemnet ever try taxing me at 50% of my income

phaia

Well, it's not that bare-bones a story. I can't answer for the Netherlands specifically, but most middle-class people's tax rates in Sweden, Denmark or the UK is more like somewhere around 30-40% - and there are lots of specfied cut options to chip the taxes against specific expenses incurred on the job, just like in America.

Plus, most people here don't have to set aside the equivalent of hundreds of thousands of bucks to see their kids through decent colleges and universities or to put into their retirement schemes. Public responsibility. Sometimes it might be a moot question if a share of your earned money is more accessible when you have to keep it saved for your old age or for sending your children to a good university than when, more or less, a similar chunk is paid in taxes to the state...and education as well as retirement at a given age, with a good deal of flexibility, are free, or very subsidized, for all.

I don't feel particularly envious hearing of Americans who have lost a big part of their pensions savings over the last few years of recession - and not even getting to spend that money; it just shrivelled in their savings accounts or going into rocketing fees set by their banks and pension managers.

Let's not take this into a general taxation politics thread though.  ::)
« Last Edit: November 02, 2013, 02:35:01 AM by gaggedLouise »

Offline Valthazar

Re: ACA
« Reply #37 on: November 02, 2013, 10:21:05 AM »
Plus, most people here don't have to set aside the equivalent of hundreds of thousands of bucks to see their kids through decent colleges and universities or to put into their retirement schemes. Public responsibility. Sometimes it might be a moot question if a share of your earned money is more accessible when you have to keep it saved for your old age or for sending your children to a good university than when, more or less, a similar chunk is paid in taxes to the state...and education as well as retirement at a given age, with a good deal of flexibility, are free, or very subsidized, for all.

I don't feel particularly envious hearing of Americans who have lost a big part of their pensions savings over the last few years of recession - and not even getting to spend that money; it just shrivelled in their savings accounts or going into rocketing fees set by their banks and pension managers.

I think the main reason people like Phaia and myself hold such views, is because we trust our own judgment with regard to our finances, as compared to the government.  A government pension really isn't free money - it is essentially a portion of your monthly/annual income being siphoned away into investments decided by the government, with the returns being paid out systematically during retirement.  In other words, rather than the individual having control of how their money is invested, they are at the whim of the government's decisions.  Most pension plans that do exist are offered with salary-based jobs, so even if a pension plan doesn't exist, an employee can basically do the same thing on their own (taking a small portion of their paycheck, and putting it into a retirement account), and have more control over what is going on.

You may have heard that Detroit is facing bankruptcy, and many federal pension plans are under severe jeopardy, since federal pension plans tend to invest heavily in their own infrastructure.  In another thread, we were discussing how even though the American government has been making a lot of poor financial decisions as of late, and incurring heavy debts, that the fundamentals of the American private economy are still holding strong.  As a result, especially in this economy, I feel much safer knowing that I am receiving a more complete portion of my paycheck, and am able to allocate my money how I choose.

For example, a portion of all of our paychecks go to pay into Social Security.  I can guarantee you that by the time I qualify for Social Security, the system will be drained.  Instead of paying into this, if all Americans were permitted to keep this portion of paychecks going into Social Security, and all Americans simply invest that same amount of money, we would actually get real returns later in life - rather than funding a bankrupt system, with low probability of future pay-out.

But the reality is that most Americans don't have this kind of discipline over their finances/spending.  If most people get an extra $10 as a result of not having to contribute to Social Security, chances are they won't know how to go about investing it, and may not even know they are supposed to be saving it.  And as we had said in another thread, this goes back to a lack of personal finance classes in high school.  As a result, I can certainly understand how the European system might be favored by people who want to live care-free and have everything taken care of for them, through higher mandatory tax revenues.  Not an ideal place I'd like to live in (as someone who has lived in Europe in the past).
« Last Edit: November 02, 2013, 10:42:49 AM by ValthazarElite »

Offline Kythia

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Re: ACA
« Reply #38 on: November 02, 2013, 11:25:04 AM »
In the netherlands [which i looked up] my income would translate to about 57000 euro on which is taxed 52%  hmmm and then there is a 7.1% health care tax...so if I was living in europe I would be working for the governement no matter the job i held [which also kinda explains why you all rent more then own]....i feel at times a straight tax on an item is better then more income tax....but then I would be one of those that would dig out my gun should the governemnet ever try taxing me at 50% of my income

phaia

Just to expand on Louise's answer, we have progressive tax rates through most of Europe as well.  So take the UK as an example - our tax rates for income tax are:
0-£35000 - 20%
£35,001 - £150,000 - 40%
£150,001+ - 50%

However, if I had an income of £160,000 I wouldn't be paying 50%.  I'd be paying 20% of the first thirty five thousand (7000), forty per cent of the next 115 thousand (46 thousand) and then fifty per cent of the final 10 thousand (5 thousand) for a total of 58 000 which is approximately thirty six percent.  The system is the same in the Netherlands, so you wouldn't be paying 52% on all your earnings, just on your earnings in the top band.

Offline Sethala

Re: ACA
« Reply #39 on: November 02, 2013, 07:51:46 PM »
Just to expand on Louise's answer, we have progressive tax rates through most of Europe as well.  So take the UK as an example - our tax rates for income tax are:
0-£35000 - 20%
£35,001 - £150,000 - 40%
£150,001+ - 50%

However, if I had an income of £160,000 I wouldn't be paying 50%.  I'd be paying 20% of the first thirty five thousand (7000), forty per cent of the next 115 thousand (46 thousand) and then fifty per cent of the final 10 thousand (5 thousand) for a total of 58 000 which is approximately thirty six percent.  The system is the same in the Netherlands, so you wouldn't be paying 52% on all your earnings, just on your earnings in the top band.

It's the same in the US; you don't suddenly get a massive hike in taxes for just a small earning increase.  (Barring any sort of tax credit that reduces taxable income only for people in a certain earning bracket, at least.)  Only the dollar amount over the threshold is taxed at the higher rate.

Offline Valthazar

Re: ACA
« Reply #40 on: November 03, 2013, 09:38:24 AM »
To move the topic back to ACA, I am struggling to understand why people support the ACA as being affordable for those who need it most.

I am assuming that all of us can agree that people in their 50s and 60s will be the ones needing healthcare the most, since statistically, they are the ones facing the highest medical costs.  Currently (pre-ACA implementation), many people in their 50s and 60s were opting into health plans that suited their needs - meaning, for example, no coverage for maternity, elective psychiatric care, etc.  Many of these plans that were not employer-assisted, could easily run in the range of $900-1000/month.  Clearly very expensive, but still cheaper than complete coverage, which they did not want.

What the ACA does is basically tell these people that they need "complete coverage," without really making things any more affordable.  Someone in the example above, would still be paying in the range of $10,000/year for health insurance under ACA, that doesn't offer nearly as much choice as their existing plan.  In fact, they'll have to pay more than they are now if they want to keep the same deductibles.

http://www.nj.com/news/index.ssf/2013/10/obamacare_how_affordable_is_health_insurance_after_the_affordable_care_act.html

Even many Democrats are now pushing for an extension on the enrollment period, before the individual mandate provision goes into effect.  However, Obama and other ACA-insiders will never support further extensions for two primary reasons:  First, if there was no law requiring people to buy health insurance, they likely wouldn't buy it, given the cost.  Secondly, if there wasn't a mandate, the people who signed up would likely be those who are really sick, and thought they could definitely use the coverage.  This would cause premiums to spike up by a ridiculous amount, making it more difficult to sell the ACA as "affordable" for healthy people in their 20s and 30s.

Bottom line is, contrary to what many pro-ACA advocates say, most healthy people are perfectly happy without health insurance (even if their purely emergency care is taking a toll on tax-payers).  Suggesting that the ACA is a step towards a single-payer system like Europe is inaccurate, to say the least.
« Last Edit: November 03, 2013, 09:58:20 AM by ValthazarElite »

Offline consortium11

Re: ACA
« Reply #41 on: November 03, 2013, 09:59:11 PM »
From an outside perspective looking in, what's surprised me about the ACA, its implementation and its flaws is that it is essentially a clone of the Swiss health care system, which is likewise based around compulsory "basic" medical insurance with complementary plans on top of that. Under that system, Swiss health care spending is just over 10% of GDP (roughly in line with most western European countries) and does very well in comparisons with regards to the quality of care, as well as coming out well in efficiency tables (top 10 according to Bloomberg).

Looking at it from my own (very mildly libertarian) perspective, it seems to be one of the better systems around. Yes, the government is involved which will get the most fundamentalist libertarians fired up but it is not government run and hell, it's from Switzerland, a place that despite national service almost always comes at or near the top of those "freedom index" style reports, which should keep most centre-right thinkers happy. Yet it also offers a high level of universal healthcare that is comparable with or better than that found under "single payer" (or whatever the term is that is used for a British National health Service style) system. It, in short, is the best of both worlds... not so much a shoddy compromise or unholy alliance as a happy marriage.

Yet it seems despite aping a well respected and long established system, ACA has been a bit of a mess. Politically it was always going to be difficult simply due to obstructionism regardless of the actual content and while the website issues are clearly problematic they're also (hopefully) relatively short term. The real issue appears to be the flaws that Val and others have eloquently pointed out. It doesn't do what it says on the tin and may end up doing more harm that good with regards to insurance coverage, despite the best of intentions.

And that makes me sad... because with the Swiss system to work from, the US surely had a good chance to put together a system that, while not satisfying the more extreme left or right, delivers great results at a good cost.

Offline kylie

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Re: ACA
« Reply #42 on: November 03, 2013, 11:02:01 PM »
Quote from: Val
Bottom line is, contrary to what many pro-ACA advocates say, most healthy people are perfectly happy without health insurance (even if their purely emergency care is taking a toll on tax-payers). 
        It's not just some accounting problem that vanishes into the general economy, and they all go on being happy forever as if nothing special happened.  (That is a privilege generally reserved for corporations and wealthy managers.)  Someone somewhere actually pays in lost opportunities of great importance.  Often it is the same young, and perhaps marginally employed person who thought they were doing just fine until they had one big bill to shell out (it may be originally mediocre in relative terms, but beyond their means) -- and suddenly financial recovery is nowhere in sight. 

          I am more or less healthy on the whole; I hardly visit facilities for much of anything.  However, if you hardly use health care and simply stay aloof with trust in your young age or fortunate constitution, then when stuff does blow up, you can land in big trouble.  I passed around two years of pretty much skimping on (also read: not getting) dental care.  This was partly because $100-200 for a cleaning here or there is a chunk of money when  "full-time" student loans are calculated at a somewhat below what you actually need for school fees plus rent, food, transportation and things like clothing in a major city...  And partly because even after school, the job market was not friendly to me and I often needed to keep my extra odd hundreds to tie me over for a few weeks between what shorter-term clerical jobs I could get.  And honestly, even had I gone in for regular checkups, I doubt that I would have felt secure enough to shell out for things like fillings before it became physically painful.  With my teeth, apparently that doesn't happen until I need some major treatment. 

          I had a root canal which was already beyond my means (my insurance paid in lumps of around $400/semester, didn't include any dental at all).  I was able to pay for the operation with Care Credit, which gives you a year to (maybe, somehow?) sort things out but then starts whopping you with major credit card level interest rates.  I had no other way to pay.  The economy was still feeling the recession and I was then a full-time student, not willing to simply give up my chance of a career certification to commit to only full-time work at some unrelated entry-level job, that is if I could even get some (dubious). 

          A little ways down the road like that, I reached a point where it was obvious that  not only was I not keeping up with the rather staggering interest (and late penalty) payments on just that one, to me, rather whopping root canal bill...  It was also going to destroy my credit rating so fast that I wouldn't have flexibility to choose common options in location, transportation (say if I wanted to get a car), education, or job training.  More immediately, creditors come along afer a few months of missed payments and sue for the right to drain whatever is in your entire bank account -- and they can do this over and over if they feel like it -- possibly even ordering a bank to raid paychecks as they appear.  Voila, kylie says fuck this, I don't live to work multiple insecure jobs only to have paychecks ripped away as they come on terms I could never repay, and leaves the country.  Prices go up somewhere else in the world of insurance and credit, I suppose.  Or maybe the company could just afford to take a loss of a few grand now and it'd be done -- but really, as if they're ever satisfied with that.

         Lots of people may be perfectly "happy" at any moment with a situation that is likely to sooner or later either bite them personally, or shrink their economy indirectly, or harm someone else they know more visibly.  Maybe they shouldn't be, and maybe they wouldn't be if they looked into where all those costs for belated care go.  Granted, whether ACA will actually undo this pattern or not is another question.     
« Last Edit: November 03, 2013, 11:38:23 PM by kylie »

Offline ShadowFox89

Re: ACA
« Reply #43 on: November 04, 2013, 02:16:40 AM »
Bottom line is, contrary to what many pro-ACA advocates say, most healthy people are perfectly happy without health insurance (even if their purely emergency care is taking a toll on tax-payers).  Suggesting that the ACA is a step towards a single-payer system like Europe is inaccurate, to say the least.

 Happy until they need it. When they need it and don't have it? Then you have problems arising.

Offline Valthazar

Re: ACA
« Reply #44 on: November 04, 2013, 05:26:19 AM »
Yes, I agree with both of you, but all the ACA is doing is mandating that people buy insurance - regardless of whether they can now afford it or not.  Sure, it attempts to reduce the price for certain plans, but because it is a 'forced' reduction, many others will be losing their existing health coverage.  A lot of people still can't afford insurance under this law, and it is not really doing anything to accomplish its mission of making healthcare "affordable."  So given all of this, I think it is actually doing more harm than good.

In addition, here is a snippet of Obama's word from his recent speech on Wednesday:

Quote from: Obama
"Now, if you had one of these substandard plans before the Affordable Care Act became law and you really liked that plan, you're able to keep it.  That's what I said when I was running for office. That was part of the promise we made. But ever since the law was passed, if insurers decided to downgrade or cancel these substandard plans, what we said under the law is you've got to replace them with quality, comprehensive coverage -- because that, too, was a central premise of the Affordable Care Act from the very beginning.  And today, that promise means that every plan in the marketplace covers a core set of minimum benefits, like maternity care, and preventive care, and mental health care, and prescription drug benefits, and hospitalization.  And they can't use allergies or pregnancy or a sports injury or the fact that you're a woman to charge you more. They can't do that anymore. They can't do that anymore."

http://www.cnn.com/2013/11/02/politics/obama-read-my-lips-moment/index.html?hpt=hp_t5

What he's basically saying, is that it is unfair for certain individuals to pay more, simply because they have greater needs. 

So apparently it is unfair that a woman who is married and actively trying to get pregnant pays more for a health insurance plan that covers maternity and pregnancy care, versus another woman who is single and not having sex, and pays less due to not having maternity or pregnancy care since she doesn't need it.

Or on that same token, it is unfair that an active 27 year old guy has to pay more in health insurance costs because of his desired sports injury coverage, versus a 60 year old man who doesn't play any high contact sports and thus opts not to get sports injury coverage, and thus has a lower initial primary coverage rate (before factoring in age, etc). 

So what's his proposed solution?  To make all women get maternity coverage, and everyone get sports injury coverage...
« Last Edit: November 04, 2013, 06:49:55 AM by ValthazarElite »

Offline Serephino

Re: ACA
« Reply #45 on: November 04, 2013, 08:39:29 AM »
What I don't get is why those insurance companies with substandard plans couldn't just change the plans instead of cancelling them.  They make changes to plans all the time, so why not now?  I honestly think they're just trying to help get people riled up.

Offline RetributionTopic starter

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Re: ACA
« Reply #46 on: November 04, 2013, 08:49:25 AM »
A lot probably depends on what you are calling substandard. As Val pointed out requiring someone in their 60s to have coverage for birth control in many cases might be a tad bit on the silly side.

Offline gaggedLouise

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Re: ACA
« Reply #47 on: November 04, 2013, 09:37:53 AM »
A lot probably depends on what you are calling substandard. As Val pointed out requiring someone in their 60s to have coverage for birth control in many cases might be a tad bit on the silly side.

Granted, but if insurance companies get to be highly specific about what kinds of diseases and misfortunes are covered by the insurance for a particular person (as they may be in the US,  right?) they will very often have a major advantage over the customers they are negotiating with for their health insurance plans. Most people can't buy medical expertise to help them judge what kinds of illnesses they really should take care to keep under their insurance umbrella, to read the fine print of what their insurance provider is putting before them at a given point while talking about an insurance package, what kinds of illnesses will become more threatening to them over the next ten years, and so on. The insurance firm, on the other hand, is likely to have access to that kind of knowledge and can use it to its own long-term advantage.

If it were expected that any John Blow should have the grasp of medicine and health science that it takes to judge what kinds of diseases are more likely to strike them in a particular age band, all sorts of hidden lifestyle risks (not obvious stuff such as sugar-loving people risking to get obese) and what kind of damage any given illness could do to their working abilities (or to their children!), then you'd really have to send most people into the classroom for quite some time. People don't have that kind of overall pro knowledge about medicine, not even most people who have been to university.  On the other hand, if the state sets a number of central health areas and goals that *must* be met by any health insurance plan, for everyone insured under the system - and the ACA makes that requirement - then it protects everyone against going down the "parsimonious and stupid" path and negotiating away stuff that might prove absolutely essential when the bad hour strikes.
« Last Edit: November 04, 2013, 09:45:11 AM by gaggedLouise »

Offline RetributionTopic starter

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Re: ACA
« Reply #48 on: November 04, 2013, 10:14:51 AM »
I do not disagree Louise and actually I think forcing birth control coverage is a very, very, good thing. I feel that unplanned pregnancy and people having children with no reasonable means of supporting them in sight is one of the main causes of many of the issues of poverty and the like that are discussed on this board.

Having said that there are some things like birth control for 70 year olds that is kind of a "well duh" moment. It is one of my main issues with the way government does anything and pounds square pegs into round holes. For example my life situation is very similar to Phaia's.  I have stayed with government employ and not gone and cashed in on my experience over the years largely because the bennies are sweet. I have not had a large increase in expense under ACA because I already had good insurance and was more or less already paying the fees Phaia spoke of. Like I said government employ does have perks so my experience has been with minor things.

Having said that, insuring the uninsured costs and -someone- is going to have to pay for that. The bills are not just magically paid. Also insurance companies, large corporations, and other such entities are often many times draconian. Having said that as well I often see in these threads an almost sense of "they are evil since they make profit" and I would like to point out there is nothing inherently wrong with turning a profit.  The catch is there is a happy medium in all things and at some point someplace along the line someone has got to think. Just forcing all things into a one size fits none box does not really work.

Offline Valthazar

Re: ACA
« Reply #49 on: November 04, 2013, 12:50:02 PM »
On the other hand, if the state sets a number of central health areas and goals that *must* be met by any health insurance plan, for everyone insured under the system - and the ACA makes that requirement - then it protects everyone against going down the "parsimonious and stupid" path and negotiating away stuff that might prove absolutely essential when the bad hour strikes.

Here's an analogy:

According to your logic, I am being parsimonious and stupid by not opting into windstorm coverage insurance on my home, even though I live in an area that has a historically negligible incidence of large-scale tornado damage.  On the other hand, floods are very common where I live, and thus, flood and water damage insurance is critical.

If someone is living in the midwest, it would be the exact opposite of my scenario.

According to what you are saying, as an analogy, all of us should pay more for all of these insurances, even though statistically, our needs are different.

edit:  Not positive on windstorm coverage - will need to look the specifics, it may be mandated by my state.  But I remember there was a couple of them that didn't apply to my region, can't remember right now, but my point is that people pick and choose insurance coverage based on their need.
« Last Edit: November 04, 2013, 01:00:37 PM by ValthazarElite »

Offline mia h

Re: ACA
« Reply #50 on: November 04, 2013, 02:03:27 PM »
Having said that as well I often see in these threads an almost sense of "they are evil since they make profit" and I would like to point out there is nothing inherently wrong with turning a profit.

Profit might not be inherently wrong, but how moral is it to make a profit out of someone elses illness?
And I'm not talking about the doctors, nurses etc, but shareholders and directors of insurance companies etc, who make money from people being ill but don't contribute one iota to curing one person.

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Re: ACA
« Reply #51 on: November 04, 2013, 02:13:59 PM »
edit:  Not positive on windstorm coverage - will need to look the specifics, it may be mandated by my state.  But I remember there was a couple of them that didn't apply to my region, can't remember right now, but my point is that people pick and choose insurance coverage based on their need.

See, the problem is that that's not all they pick and choose on.  They also pick and choose on price and...I can't think of the word - "known-aboutness".  I mean that they don't pick an affordable plan that meets all their needs that they've never heard of.

I suspect the logic - and Obama didn't consult with me on it (he often goes entire days without running decisions by me) - behind parts was to raise a minimum bar that, agreed, will not be needed by all people but that also allows people to pick and choose options on top of that minimum.  So Act of God damage, as we call it over here, might well be something people in Tornado Alley add on but Minnesota gives less of a fuck about.  However, Third Party, Fire and Theft remain as a baseline, and a higher baseline than was previously available.

Offline Valthazar

Re: ACA
« Reply #52 on: November 04, 2013, 02:24:58 PM »
I suspect the logic - and Obama didn't consult with me on it (he often goes entire days without running decisions by me) - behind parts was to raise a minimum bar that, agreed, will not be needed by all people but that also allows people to pick and choose options on top of that minimum.  So Act of God damage, as we call it over here, might well be something people in Tornado Alley add on but Minnesota gives less of a fuck about.  However, Third Party, Fire and Theft remain as a baseline, and a higher baseline than was previously available.

So how exactly does mandating a "minimum bar" for all people miraculously make it affordable?  Because that's not what is going to happen, as I said from the beginning, this does very little to reduce the market price of private insurance-based healthcare.  It's giving the illusion of slight price drops, with the government stepping in and artificially reducing prices on certain plans - but it is does very little in developing a sustainable solution.

Think about this far-fetched analogy for a second:  If you're a shop-keeper, and the government tells you that you are pricing your white bread too high (since they claim it is a basic necessity for the poor) and that you should reduce it a certain amount.  You comply, but because your profits will take a hit, you decide to raise prices on other types of bread and/or decrease your supply of other types of bread.

Because that's exactly what is happening with healthcare.  It's an imperfect analogy though, because the government is footing a part of the bill with regard to people on welfare, etc.  This raises an entirely different ethical question, that would be an entirely tangential discussion.

Honestly, I was part of the 82% or whatever of Americans that had optimism in Obama's 2008 election.  I didn't vote for him, but I still felt that his policies were sensible at least.  But he has wavered so much on his 2008 campaign promises, it's ridiculous.
« Last Edit: November 04, 2013, 02:35:10 PM by ValthazarElite »

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Re: ACA
« Reply #53 on: November 04, 2013, 02:30:52 PM »
Profit might not be inherently wrong, but how moral is it to make a profit out of someone elses illness?
And I'm not talking about the doctors, nurses etc, but shareholders and directors of insurance companies etc, who make money from people being ill but don't contribute one iota to curing one person.

Often that has been a knock on insurance in general and I will be the first to admit insurance companies piss me off more often than not. But call me skeptical but I do not see shareholders of companies lining up to provide coverage without some promise of profit and personally I do not have the extra funds to cover my neighbor in case of catastrophe. So who is going to provide this service if not a profit driven company? And if you respond the government then how is this service to be paid for? Because it is going to cost since doctors, nurses ect expect a pay check.

Offline Zakharra

Re: ACA
« Reply #54 on: November 04, 2013, 02:39:39 PM »
 I've been following this discussion, it's been interesting, but I have some questions to bring up too. I'm not sure if these are true, so I'd like to know from people who have studied it.
From what I have heard, some groups of people will be getting subsidies from the government in order to be able to afford the ACA coverage. How does that make it affordable when the subsidy comes from the government in the first place? And what's the upper line for being able to get this subsidy?  One of the cases I heard of that is getting this subsidy was staffers of the US Congressmen, who (I could be wrong) can make over $75-100,000 a year. If it is affordable for everyone, why can't the government itself use it?

 I have also heard that the unions have an exemption written in for them. Their plans are grandfathered in like everyone elses, but if their plan changes (as required by the ACA), the price of said plan cannot change. If that's true, that seems to be sticking it to the non union people in a big way. Those peoples plans have to be changed (and lose the grandfather status when they are changed) and cost more, while union people get to keep their lower costing plans even when they change.
 
 Another one I have heard is many doctors opting out of the ACA because they don't like the payment schedule or plans. If it's true, what will the people who have the insurance do if the doctors won't accept patients with the plans (and payment coverage)?

 I've heard these from several different places, but I don't know is any of these are accurate.

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Re: ACA
« Reply #55 on: November 04, 2013, 04:51:50 PM »
Here's an analogy:

According to your logic, I am being parsimonious and stupid by not opting into windstorm coverage insurance on my home, even though I live in an area that has a historically negligible incidence of large-scale tornado damage.  On the other hand, floods are very common where I live, and thus, flood and water damage insurance is critical.

If someone is living in the midwest, it would be the exact opposite of my scenario.

According to what you are saying, as an analogy, all of us should pay more for all of these insurances, even though statistically, our needs are different.

edit:  Not positive on windstorm coverage - will need to look the specifics, it may be mandated by my state.  But I remember there was a couple of them that didn't apply to my region, can't remember right now, but my point is that people pick and choose insurance coverage based on their need.

Realizing that you need to protect your house against tornadoes and extreme weather damage  if you live in the southern Midwest, or against snow if you live around here - and sometimes to choose a house that's built solidly enough, down to the foundations, to stand up to most kinds of weather, even if there are more pretty-looking and affordable homes around - that's nowhere near rocket science. Those issues are fairly easy to understand and put into practice. But mastering a whole range of diseases and possible dysfunctions, from throat infections and allergies to AIDS, respiratory ailments, blood diseases and brain tumour, knowing what kind of damage they might incur, how easy or hard they are to diagnose with certainty, what you have to ask for in an insurance and how to make sure they're included, that really is expert knowledge.

Some people would probably be ready to sign away coverage of treatment for "loosely related side effects of venereal ailments that are not part of such ailment proper" only to find they had dropped just about any coverage of AIDS from their insurance. They wouldn't know until the day they or someone in the family is showing definite signs of the syndrome. How many people know on the spot what "venereal disease" is? How many are aware that HIV in itself is just the door-opener for most of the really serious diseases that are part of a full-blown AIDS journey? - lung ailments, all sorts of cancer and general weakness are not directly caused by the HIV virus, but by other diseases. And how many would be able to spot that this kind of language implied AIDS at all?

Anyway, most people do not expect to ever get hit by such a disease and if they notice what such a phrase was about, they could easily convince themselves that "only gays, junkies and hookers catch that one - I'm safe". If you're in your twenties or thirties and a bit of tight on money, and you're in a situation where the pricing of your insurance provider means you have to chip some off your insuirance cover, that would probably be one that many people wouyld be ready to sign away. Knowing about these things and much more, and being able to weigh them across the board, that's expert knowledge. It's not something you can expect most people to have at the point they shop for health insurances, especially not young adult people, or even to acquire. But the state will have it if it stands as the ´backer and the heavyweight negotiating partner for health care.
'
Call me clueless if you like, but I don't think it's reasonable or fair that people should be left standing without coverage when they, or their child, are hit by AIDS, some difficult-to-diagnose breathing ailment or an unusual kind of cancer that very rarely happens in that age segment. "You signed these papers yourself and they do not cover that disease" is a really nasty answer when the prospect they face is a painful death and nothing like the proper health care. The answer to that kind of issue isn't to make people beg at local charities or try to sell their story to the newspapers to arouse pity, but to make sure that the baseline level of what's included in people's health insurance is high enough to cover these things, and that no part of it can be signed away by the individual holder of the insurance.


Quote from: Zakharra
I've been following this discussion, it's been interesting, but I have some questions to bring up too. I'm not sure if these are true, so I'd like to know from people who have studied it.
From what I have heard, some groups of people will be getting subsidies from the government in order to be able to afford the ACA coverage

I haven't been following the discussion on pricing and government subsidies in the general news media in detail, but I've heard a couple times that under the ACA, some large groups of people who would not be able to pay for their health insurance deals - and some of whom might not be able to pay *any* kind of insurance at the present time, whether on their house or on their car or on their basic health - those people would have most or all of their premiums paid through government subsidies. Maybe that intention has been trimmed a bit from when the law package was first drafted back in 2009/10, but it would still be the option today for many millions of people who used not to be able to afford proper health insurance. I think that makes it a major step forward.

But I can see the counter-argument coming that "we can't afford it as a nation".




« Last Edit: November 04, 2013, 05:10:56 PM by gaggedLouise »

Offline mia h

Re: ACA
« Reply #56 on: November 04, 2013, 05:24:06 PM »
Often that has been a knock on insurance in general and I will be the first to admit insurance companies piss me off more often than not. But call me skeptical but I do not see shareholders of companies lining up to provide coverage without some promise of profit and personally I do not have the extra funds to cover my neighbor in case of catastrophe. So who is going to provide this service if not a profit driven company? And if you respond the government then how is this service to be paid for? Because it is going to cost since doctors, nurses ect expect a pay check.

Forgetting the government for a second, lets assume that 10% of your premiums go straight out the door as share holder dividends. If the company was made to operate as a non-profit organization then your insurance premium just dropped by 10%.
But if it was run by the government then it would have to be paid for by taxes, so your taxes would go up but you wouldn't have an insurance premium to pay. If the system could be set up to run efficiently then overall you'd be better off, I did read somewhere that insurance companies admin costs run to about 25% of the premium where medicare's admin costs are about 5%. If you are getting good healthcare and it costs you less than it does now, do you really care if you are paying a private company or the government?

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Re: ACA
« Reply #57 on: November 04, 2013, 05:31:38 PM »
So how exactly does mandating a "minimum bar" for all people miraculously make it affordable?  Because that's not what is going to happen, as I said from the beginning, this does very little to reduce the market price of private insurance-based healthcare.  It's giving the illusion of slight price drops, with the government stepping in and artificially reducing prices on certain plans - but it is does very little in developing a sustainable solution.

Think about this far-fetched analogy for a second:  If you're a shop-keeper, and the government tells you that you are pricing your white bread too high (since they claim it is a basic necessity for the poor) and that you should reduce it a certain amount.  You comply, but because your profits will take a hit, you decide to raise prices on other types of bread and/or decrease your supply of other types of bread.

Because that's exactly what is happening with healthcare.  It's an imperfect analogy though, because the government is footing a part of the bill with regard to people on welfare, etc.  This raises an entirely different ethical question, that would be an entirely tangential discussion.

Honestly, I was part of the 82% or whatever of Americans that had optimism in Obama's 2008 election.  I didn't vote for him, but I still felt that his policies were sensible at least.  But he has wavered so much on his 2008 campaign promises, it's ridiculous.

Well, I'd be an idiot then (in the white bread analogy).  Why not simply make less of a profit on selling white bread safe in the knowledge that people will continue to shop at my store as all my other prices are lower.  Its not like they're going to go to one shop for their bread, another for their butter and a third for their cheese.  People want to pick up an entire cheese sandwich in one place.

Offline Valthazar

Re: ACA
« Reply #58 on: November 04, 2013, 07:26:28 PM »
Well, I'd be an idiot then (in the white bread analogy).  Why not simply make less of a profit on selling white bread safe in the knowledge that people will continue to shop at my store as all my other prices are lower.  Its not like they're going to go to one shop for their bread, another for their butter and a third for their cheese.  People want to pick up an entire cheese sandwich in one place.

I was using that analogy intentionally to represent an industry that sells a single commodity (bread), with multiple varieties (similar to the healthcare industry - which sells healthcare, but of multiple varieties).

I am not sure if you are familiar with how (well-run) businesses price their products.  There's a curve for every business which represents the peak potential price for the commodity, given all expenses and wages that need to be paid out.  All businesses, if they aspire to run at maximal efficiency, seek to determine and achieve this optimal price point.  However, like we have been saying, this market-determined price point may not always be affordable for the net sum of all consumers (especially with regard to an industry like healthcare). 

When you artificially alter this equilibrium pricing point for a business (whether it is advantageous for mass consumers or not), it immediately sends shocks waves through the pricing for other product varieties the company sells.  If you want me to elaborate on this further, I can - but essentially, if a company is operating at the peak price point (which most corporations have the labor/time required to achieve), then suddenly reducing the price for one commodity type will make it extremely difficult to maintain prices for other products, without running at a loss.  This is because, whether or not they are reaping gigantic profits, their business plans are so delicately crafted in the short-term, that it would most certainly introduce risk into the business/industry.  For example, a company could be running a $5,000,000 profit/year.  But if expense reports, dividends, and income contracts are already clearly defined for how this profit will be distributed, the company is in great jeopardy if the "anticipated" revenue stream is suddenly altered.  The company's credit line may be affected, their leveraged debt may not be paid on time, etc.  So you can understand why artificial fluctuations in price can drastically affect a healthcare company - thus leading to many existing plans being dropped.

I don't want to turn this into a pure economics discussion though, so probably best to leave this for another thread
« Last Edit: November 04, 2013, 07:29:06 PM by ValthazarElite »

Offline Valthazar

Re: ACA
« Reply #59 on: November 04, 2013, 07:46:44 PM »
I've been following this discussion, it's been interesting, but I have some questions to bring up too. I'm not sure if these are true, so I'd like to know from people who have studied it.
From what I have heard, some groups of people will be getting subsidies from the government in order to be able to afford the ACA coverage. How does that make it affordable when the subsidy comes from the government in the first place? And what's the upper line for being able to get this subsidy?  One of the cases I heard of that is getting this subsidy was staffers of the US Congressmen, who (I could be wrong) can make over $75-100,000 a year. If it is affordable for everyone, why can't the government itself use it?

First and foremost, it is important to differentiate between Medicaid and ACA.  The ACA is intended to provide some "free" and low-cost premium healthcare plans for those whose income is "higher" than the threshold currently for Medicaid.  Generally, the ACA offers Gold, Silver, and Bronze healthcare plans, with Gold being the top-tier plan, and Bronze being the low-tier plan.  The few free ACA plans are all Bronze level, and vary considerably based on which private insurance company is offering it.  But generally, bronze plans generally cover about 60 percent of a person's medical costs in addition to standard benefits such as prescription drugs, maternity care and mental health treatment.  The very important fact here is that there are significant out of pocket costs that still exist.  However, there are limits on this out of pocket costs - $6,350 for individuals and $12,700 for families.  Far from 'affordable' if you ask me, and a simple heart attack can still ruin a family's finances.  Again, usually monthly premiums will work out to about $20-30 for even Bronze plans, but it is certainly possible that some will get free Bronze coverage through ACA.  For example, I just looked it up and the average premium works out to zero after the tax subsidy for a family of four earning $50,000 a year on the lowest-cost bronze plan in Fairfax County, Virg., Jackson, Miss., and Anchorage, Ala.  Basically they will qualify for enough tax subsidies to cover the entire cost of the plan.

Basically, a LOT of people get subsidies, but only some get enough subsidies to cover the entire cost of healthcare under ACA.
« Last Edit: November 04, 2013, 07:50:55 PM by ValthazarElite »

Offline gaggedLouise

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Re: ACA
« Reply #60 on: November 04, 2013, 08:18:54 PM »
I was using that analogy intentionally to represent an industry that sells a single commodity (bread), with multiple varieties (similar to the healthcare industry - which sells healthcare, but of multiple varieties).

I am not sure if you are familiar with how (well-run) businesses price their products.  There's a curve for every business which represents the peak potential price for the commodity, given all expenses and wages that need to be paid out.  All businesses, if they aspire to run at maximal efficiency, seek to determine and achieve this optimal price point.  However, like we have been saying, this market-determined price point may not always be affordable for the net sum of all consumers (especially with regard to an industry like healthcare). 

When you artificially alter this equilibrium pricing point for a business (whether it is advantageous for mass consumers or not), it immediately sends shocks waves through the pricing for other product varieties the company sells.  If you want me to elaborate on this further, I can - but essentially, if a company is operating at the peak price point (which most corporations have the labor/time required to achieve), then suddenly reducing the price for one commodity type will make it extremely difficult to maintain prices for other products, without running at a loss.  This is because, whether or not they are reaping gigantic profits, their business plans are so delicately crafted in the short-term, that it would most certainly introduce risk into the business/industry.  For example, a company could be running a $5,000,000 profit/year.  But if expense reports, dividends, and income contracts are already clearly defined for how this profit will be distributed, the company is in great jeopardy if the "anticipated" revenue stream is suddenly altered.  The company's credit line may be affected, their leveraged debt may not be paid on time, etc.  So you can understand why artificial fluctuations in price can drastically affect a healthcare company - thus leading to many existing plans being dropped.

I don't want to turn this into a pure economics discussion though, so probably best to leave this for another thread

Hmmm. It's a good description of how it works in the theory of many an economics textbook - but less solid if one wants to describe real markets. Whether it's the market of consumer goods, real estate or services.

Many companies selling services (such as health insurance) or any kind of tech gadgets are much more interested in cornering a market share, and doing it fast, than in finding a perfect price. Look at the mobile phones and tablets market.- for many years, those kinds of goods, and especially mobile phones and smartphones, have been sold at prices that look like a shoestring. You pay one dollar, or ten dollars - in places that have a lower-value basic coin than the dollar prices can get even more ridiculous; I bought my current phone for one Swedish crown which equals something like 15 cents, quite common here -  and you get a spanking new modern phone with nice design and lots of the modern extra goodies. 99% of the actual price is baked into the monthly fees over the time that the phone will remain locked to a subscription with the operator it's sold in tandem with, and presumably the operator/ISP will pay much of that money back to the shop that sold the phone, maybe some to Apple or Samsung as well. The over-the-counter prices you'll get have nothing to do with what the phone really cost to make and market, sometimes even the full price of the phone (including let's say 24 monthly fees of 20 dollars each) probbly don't have very much to do with the real value...anyway, the value of a certain model of a smartphone is quite subjective, it depends on what you like and what kind of design you're after. Those price settings are all about shoring up a part of the market and doing it fast. Once the customer has signed to a subscription, they won't be able to change the deal without paying all the still outstanding money up front. The price trade-off in selling phones, magazine trial subscriptions and so on that way shows it to be very underpriced, sellers and producers are counting on taking a big loss in the short term to get a good market niche.

I don't think there's any reason why health insurance companies should be putting up the "perfect price" that creates an equilibrium. More likely they'll ask for, or try to grab, what they think they can get from the buyer/s.

Offline Valthazar

Re: ACA
« Reply #61 on: November 04, 2013, 08:29:20 PM »
I don't think there's any reason why health insurance companies should be putting up the "perfect price" that creates an equilibrium. More likely they'll ask for, or try to grab, what they think they can get from the buyer/s.

I know, that is exactly what I am saying.  The optimal price is the maximum they can charge for a product, before seeing drops in demand that significantly affect their bottom line.  That is the equilibrium I am referring to.

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Re: ACA
« Reply #62 on: November 04, 2013, 08:39:53 PM »
I know, that is exactly what I am saying.  The optimal price is the maximum they can charge for a product, before seeing drops in demand that significantly affect their bottom line.  That is the equilibrium I am referring to.


Well,  what I'm arguing is that the current state of the US health insurance market sounds heavily tipped in favour of insurance companies. So if there is an equilibrium at this point in time, or an optimal pricing line for various kinds of insurance packages, it may have landed too high - because there is no powerful competition from the public sector.


Also, if current pricing depends a lot on what companies feel they are able to get by hyping up their services through publicity (rather than facts...) and on what they can see other companies are asking and getting for their solutions, then it doesn't really hold up that cutting the prices on a few key items would create chaos ripping through the entire range of services and deals the company is offering. I think that was a key assertion in your reasoning here:

Quote from: ValthazarElite
Essentially, if a company is operating at the peak price point (which most corporations have the labor/time required to achieve), then suddenly reducing the price for one commodity type will make it extremely difficult to maintain prices for other products, without running at a loss.  This is because, whether or not they are reaping gigantic profits, their business plans are so delicately crafted in the short-term, that it would most certainly introduce risk into the business/industry.  For example, a company could be running a $5,000,000 profit/year.  But if expense reports, dividends, and income contracts are already clearly defined for how this profit will be distributed, the company is in great jeopardy if the "anticipated" revenue stream is suddenly altered.  The company's credit line may be affected, their leveraged debt may not be paid on time, etc.  So you can understand why artificial fluctuations in price can drastically affect a healthcare company - thus leading to many existing plans being dropped.

« Last Edit: November 04, 2013, 08:48:01 PM by gaggedLouise »

Offline Valthazar

Re: ACA
« Reply #63 on: November 04, 2013, 08:47:08 PM »
I agree with you, and that's the reason I at least understood and respected Obama's plan at first because it would have at least decreased that price point through competition.  But I am not understanding how the ACA hopes to reduce the costs.  The Republicans lambasted the ACA for all the wrong reasons, and transformed it into something very different.  But at the same time, I am not sure why Obama backs this current law, since it is remarkably different than his original one.

Also, if current pricing depends a lot on what companies feel they are able to get by hyping up their services through publicity (rather than facts...) and on what they can see other companies are asking and getting for their solutions, then it doesn't really hold up that cutting the prices on a few key items would create chaos ripping through the entire range of services and deals the company is offering. I think that was a key assertion in your reasoning here:

I did not want to turn this into an economics thread, but I can explain this.

This is not about hyping anything up - it is about supply and demand, and companies capitalizing on limitless demand to make insane profits.  For example, in a monopoly industry, with only 1 manufacturer, the company can price its product at a ridiculous amount, and make enormous profits.  You are suggesting that because of these enormous profits, they would not feel any chaos.  Let me explain.

When they draft the next year's budget, they are basing it on the income stream/profit estimates from the previous year.  Assume the monopolist is predicting $500,000,000 in profits the next year.  They would have allocated this money in advance - such as for building new facilities with this profit, or committed to salary increases for their executives, and numerous other budgetary allocations.  In other words, a sudden artificial interjection in their pricing model would throw these budgetary estimates in sway.

This has an extremely deleterious effect on the way the business' fundamentals are viewed by rating agencies and creditors.  Many businesses respond to this type of financial risk by going into preservation mode, minimizing as much uncertainty as they can.
« Last Edit: November 04, 2013, 08:57:44 PM by ValthazarElite »

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Re: ACA
« Reply #64 on: November 04, 2013, 09:12:27 PM »
I agree with you, and that's the reason I at least understood and respected Obama's plan at first because it would have at least decreased that price point through competition.  But I am not understanding how the ACA hopes to reduce the costs.  The Republicans lambasted the ACA for all the wrong reasons, and transformed it into something very different.  But at the same time, I am not sure why Obama backs this current law, since it is remarkably different than his original one.


How about, because this issue was the single most important promise he had made during the 2008 election campaign, both he and his voters had invested a lot of hope in it, and had got it through into law, despite a huge amount of resistance and anger from the Republicans and the Tea Party. When that level of investment has been made, it's not on the table to say "we couldn't get the best option, the one you really deserved and the one I was campaigning for, so I'm dropping the whole thing. The GOP succeeded in outwitting us and sinking the whole project through their obstruction. Goodbye." (remember, the Senate republicans swung around and dropped their support for key features of the original law).

No leading political man in power can afford to finish his own flagship proposal that way.

Then again, I don't agree that the whole thing has become diluted to the point that it is only a shadow of what was promised in 2008/9. It's been trimmed down some, certain groups will land outside, but it's still a major push forward.

Offline consortium11

Re: ACA
« Reply #65 on: November 04, 2013, 09:39:48 PM »
Well, I'd be an idiot then (in the white bread analogy).  Why not simply make less of a profit on selling white bread safe in the knowledge that people will continue to shop at my store as all my other prices are lower.  Its not like they're going to go to one shop for their bread, another for their butter and a third for their cheese.  People want to pick up an entire cheese sandwich in one place.

Off topic:

You'd be surprised.

Since the economic crisis hit one of the more interesting bits of consumer research to come out was that people were doing exactly that (in the UK at least), turning their weekly shop at one supermarket into a weekly shop at three or four. They'd go to ASDA for the special offer on bread (where they can freeze the excess), TESCO for the price reduction on cheese and Sainsbury's for the buy one, get one free on butter... and then hit LIDL for the half-price weekend offers which they'd buy in bulk and cheap eggs.

It's one of the reasons the budget supermarkets like LIDL and ALDI have expanded their ranges and started to offer more "luxury" options. People had started to buy the basics (bread, milk, eggs etc) from there because of a lower base price but were then going to other supermarkets for the other products (notably meat but also ready meals and the like). Realising that they were getting people through the doors with the basics but not enticing them to do their whole shop there they started to change their product lines and presentation to do exactly that.

Offline RetributionTopic starter

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Re: ACA
« Reply #66 on: November 04, 2013, 11:06:22 PM »
Forgetting the government for a second, lets assume that 10% of your premiums go straight out the door as share holder dividends. If the company was made to operate as a non-profit organization then your insurance premium just dropped by 10%.
But if it was run by the government then it would have to be paid for by taxes, so your taxes would go up but you wouldn't have an insurance premium to pay. If the system could be set up to run efficiently then overall you'd be better off, I did read somewhere that insurance companies admin costs run to about 25% of the premium where medicare's admin costs are about 5%. If you are getting good healthcare and it costs you less than it does now, do you really care if you are paying a private company or the government?

I honestly have no issue with a system as you laid out. I just have little faith in the government to be able to do that efficiently. Which is what ends up being the real rub for me. Or a non-profit organization doing a similar thing would be nice, but again I am not real sure how implementation could be made to work. Of course that also then leads to the question of employment. For example around here a large insurance company is a major employer.

Offline Phaia

Re: ACA
« Reply #67 on: November 05, 2013, 01:38:34 AM »
http://www.washingtonpost.com/blogs/fact-checker/wp/2013/10/30/obamas-pledge-that-no-one-will-take-away-your-health-plan/?tid=pm_politics_pop

I found this little gem and was amazed at some of things I did not KNOW about ACA...like I now have to pay to treat those i substance abuse programs....so if i understand this...i could break the law and get  caught with using drugs...get insurance [they cannot deny me] and let others help pay for my drug problem....wow what the heck am i waiting for...i think getting a kilo of crack nis great place to start

I am sure I will hear howling about this but honestly i find it disgusting that I now have to help pay for someone that breaks the law [you have to normally to need substance abuse help]...I have donated in the pass to variuos grops that help those in that kind of need but to force me to pay is a different matter...

My husband is very AMUSED that he must carry maturnity coverage....i am all for equal pay between men and women...but do we really have to get the guys...all of them to pay for maturity?

the estamates i am seeing is already 2 million have lost thier insurance...i think it will be very funny if the 16-20 million that werent insuranced get replaced by 10-15 million that had been insured but now cant afford it!

phaia

Offline Chris Brady

Re: ACA
« Reply #68 on: November 05, 2013, 02:56:58 AM »
My Canadian Province's system is somewhat similar in that, it has all the benefits spread out equally, no matter what the age or gender of the individual who has it.  Yes, I do have maternity benefits, that I'm pretty sure I won't need.  Pretty sure.  And frankly, I'd rather be covered for something legitimate on the off chance it does happen, and not need it, than not have it, and maybe end up needing it.

Is money more important than your, or your loved one's health?

Offline mia h

Re: ACA
« Reply #69 on: November 05, 2013, 04:56:42 AM »
I just have little faith in the government to be able to do that efficiently.
Of course that also then leads to the question of employment. For example around here a large insurance company is a major employer.

So if the government is inefficent that's bad because it wastes your taxes.
But if a private company is inefficent that's fine because it keeps people in work?!

Offline Valthazar

Re: ACA
« Reply #70 on: November 05, 2013, 07:24:19 AM »
So if the government is inefficent that's bad because it wastes your taxes.
But if a private company is inefficent that's fine because it keeps people in work?!

A consistently inefficient company that is under-performing in meeting earnings targets, and running losses, will eventually lead to bankruptcy, since they are under competitive pressure from other companies and new entrants.  When an inefficient company eventually has to file for bankruptcy and leave the industry, it naturally leaves a "gap" - offering more competitive products or prices for consumers.  This means that shareholders and principal owners of businesses are the ones hurt during bankruptcy.

The reason why Retribution and I are saying there is a tendency for government to be inefficient, is because there is no competitive pressure for efficient workflow (since no one is competing with the government).  For example, Social Security is pretty much drained, and the reason they are still chugging along with this inefficient system, is because there is no direct competition for social security.  We're all required to pay into it.

So when government is inefficient, is it the shareholders and principal owners (as a comparison) who are hurt?  Absolutely, and those of us who are tax-paying citizens are technically shareholders of government, and because we lack choice, are basically going down when the government goes down (assuming a hypothetical scenario where a significant amount of our services were channeled through the government).  But this has nothing to do with this healthcare / ACA discussion.
« Last Edit: November 05, 2013, 08:33:03 AM by ValthazarElite »

Offline mia h

Re: ACA
« Reply #71 on: November 05, 2013, 08:37:07 AM »
Except that's only turn in markets that operate under perfect competition and no insurance market does, the barriers to entry are huge and even if you did get into the market the existing players in the market have the ability to crush new enterants like a bug.

And there are competitive pressure for governments to be efficient, they're called elections.

Social Security is a mess not because it's inefficient but demographics and life spans have change significantly since it's inception, and those things would have changed regardless of everyone being required to pay in. That and succesive governments keep writing the trust fund IOU's instead of putting money in there. Does Social Security need reform? Yes. Does that have anything to do with it being funded through taxation? No.

Offline Valthazar

Re: ACA
« Reply #72 on: November 05, 2013, 08:48:07 AM »
mia h, I'm willing to discuss that issue with you, if you'd like to start another thread.

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Re: ACA
« Reply #73 on: November 05, 2013, 08:54:24 AM »
No matter how we assess the ACA, any one of us, I have a feeling this thread is currently trailing into a debate about the legitimacy of taxes and on markets vs state action - which is kind of beside the point...

*nods aýe to a thread of its own on taxation, governments and service markets*

Offline RetributionTopic starter

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Re: ACA
« Reply #74 on: November 05, 2013, 09:01:38 AM »
Not to be too skeptical but get back to me when Social Security is fixed. As you pointed out there were built in flaws in the system and they are not getting fixed. I have paid into said system for *thinks* 33 years and do not expect to see any return on that money.

But you and I are not going to agree on this. I would love, love, to see a well run state sponsored health care program. Maybe something along the lines of Medicare I am just really, really, skeptical about that ever being pulled off. Hell, I work for the government in the President's home state. I have paid into our retirement for 24 years and it looks like I may get a big fat nothing for that investment http://www.huffingtonpost.com/tag/illinois-pension-crisis
So keeping in mind the above listed examples I think I would be pretty gullible to expect differing results from government programs when they keep failing.

I know many here are big on "pull your weight" and help the little guy but I just looked at my last pay stub. Deductions including retirement, insurance, 401 k, state tax, fed tax, social security over $1K in deductions I kinda think I am pulling my weight and every time I turn around someone is wanting to increase that number. This does not include sales tax, property tax, license fees, you get the idea. We all need to pay our share for things we all use roads, military, and yes even health care for those less fortunate, but there is a point where the well runs dry and I am starting to feel tapped out.

Offline Oniya

Re: ACA
« Reply #75 on: November 05, 2013, 09:28:20 AM »
http://www.washingtonpost.com/blogs/fact-checker/wp/2013/10/30/obamas-pledge-that-no-one-will-take-away-your-health-plan/?tid=pm_politics_pop

I found this little gem and was amazed at some of things I did not KNOW about ACA...like I now have to pay to treat those i substance abuse programs....so if i understand this...i could break the law and get  caught with using drugs...get insurance [they cannot deny me] and let others help pay for my drug problem....wow what the heck am i waiting for...i think getting a kilo of crack nis great place to start

Oddly, if you replace 'substance abuse programs' with 'Planned Parenthood', you'll get some of the Tea Party's arguments.  Not to mention that substance abuse programs are intended to get people off drugs so that they stop breaking the law and become productive members of society.

Offline Valthazar

Re: ACA
« Reply #76 on: November 05, 2013, 09:41:26 AM »
Oddly, if you replace 'substance abuse programs' with 'Planned Parenthood', you'll get some of the Tea Party's arguments.  Not to mention that substance abuse programs are intended to get people off drugs so that they stop breaking the law and become productive members of society.

We all know what the intentions of these programs are - it is how they end up resulting, and its economic impact on our country, that are troubling.

Offline mia h

Re: ACA
« Reply #77 on: November 05, 2013, 10:36:50 AM »
I know many here are big on "pull your weight" and help the little guy but I just looked at my last pay stub....

Yes, health care has to paid for but the argument is mostly the wrong way round. The debate mainly focuses on costs etc. but doesn't it make sense to decide wat health care provision should look like and then work out how to organise and pay for it afterwards?

It's in my interest that everyone else has access to good affordable health care, anyone who isn't able to work because they are ill costs me money both in terms of benefit payouts and them not being active in the wider economy. It's also better if health care is focused on prevention instead of treatment but there's also less money to be made from prevention. Obesity is a huge (excuse the pun) problem it's far cheaper to educate people with things as simple as cooking classes instead of having to treat them for diabetes and heart problems and fitting gastric bands etc. The US has the highest health care costs per capita in the world, but the life span of the average American is in decline, if that doesn't tell you that health care in broken then I'm not sure what will. The ACA is maybe half step in the right direction but there are bigger problems that need solving.

Offline RetributionTopic starter

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Re: ACA
« Reply #78 on: November 05, 2013, 10:50:39 AM »
I have never said US health care is not broken. In fact in other threads I have in fact said it is broken, but call me a skeptic I always like to know what the dollar amount is on a check before I sign it.

Offline Valthazar

Re: ACA
« Reply #79 on: November 05, 2013, 11:36:46 AM »
call me a skeptic I always like to know what the dollar amount is on a check before I sign it.

If everyone considered this before supporting laws due to purely humanitarian reasons, we'd be in much better fiscal shape as a nation.  There's a lot of things that are the "right thing to do," but if we can't afford it, it's a no-go.


Offline mia h

Re: ACA
« Reply #80 on: November 05, 2013, 11:52:49 AM »
But call me a skeptic I always like to know what the dollar amount is on a check before I sign it.

And the amount you paid towards law enforcement and the military was what again?

Offline Valthazar

Re: ACA
« Reply #81 on: November 05, 2013, 11:59:23 AM »
And the amount you paid towards law enforcement and the military was what again?

I don't think he's talking about the budgetary allocation.  He's talking about bills proposed in Congress, and the costs associated with new legislation.

Offline mia h

Re: ACA
« Reply #82 on: November 05, 2013, 12:10:38 PM »
I don't think he's talking about the budgetary allocation.  He's talking about bills proposed in Congress, and the costs associated with new legislation.

And I think he's big enough to speak for himself

Offline RetributionTopic starter

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Re: ACA
« Reply #83 on: November 05, 2013, 12:51:51 PM »
And if you think I am all on board with the spending in those you are mistaken as well. Look, I am not one of those all about the bottom line types. In fact I think it is a pretty poor way to run things. Having said that I work inside of the system and the way Peter is robbed to pay Paul disturbs me. There are a lot of great ideas out there that I think it would be reasonable to pass. Once the funding is set up for them, but many are passed with fuzzy funding and funds are then stolen from other supposedly dedicated funds. And here are some examples:

Dedicated wildlife funds generated from sale of hunting and fishing licenses as well as Pittman Robertson Act funds http://www.fws.gov/southeast/federalaid/pittmanrobertson.html   are supposed to go to the resource.  They have a nasty tendency to not http://www.examiner.com/article/illinois-corruption-exposed-by-sportsmen-and-attorneys

This happens across the board with many, many, funds http://illinoisissues.uis.edu/archives/2012/04/fundsweeps.html  The money generated from user fees such as say a tax on a specific item purchased are supposed to be channeled to a specific use. A "sweep" is when well they are not and the funds are diverted to another use. Over time this makes an utter mess of the budgetary books http://www.michigan.gov/documents/detroitcantwait/DetroitFactSheet_412909_7.pdf
http://www.huffingtonpost.com/tag/illinois-budget-crisis
http://en.wikipedia.org/wiki/2008%E2%80%9312_California_budget_crisis

Then when money is supposedly saved it is done in ways that show those managing programs clearly do not know what those working in the programs are supposed to be doing. What their mission is http://voices.washingtonpost.com/federal-eye/2011/02/gao_report_details_mismanaged.html in short some hair brained scheme will be enacted to supposedly save money that ultimately -prevents- those trying to do their job from well being able to do their job. Where as if they had just spent the freaking money where they were supposed to the citizen's would be getting what they paid for.

So please pardon me, as I keep saying I would like to see our health care fixed. I think it is horribly broken. But I fail to see how enacting poorly conceived concepts fixes anything. Indeed I often think it makes things worse. As for ACA I have no real issue with what it wishes to do I think it is noble. But as we are seeing it is a very confusing issue and piece of legislation. *points up at all those links* [EDIT referring to links throughout this thread] So when I see the problems with things like coverage of those who already had insurance and their increase expense and the like I cringe. The reason I cringe is I see the track record and I feel like "oh god they fucked up again."

We have all heard the horror stories about the military paying for $500 hammers. But then they cannot manage to get proper armor on Hummers in Iraq because of price concerns. [EDIT added a place money should be spent] There are similar problems in other public programs. And I -do- think health care is something the government -should- be involved in. But the repeated failures make me cringe. And there are many, many, many, very competent government employees. Those who do their level best to do their job to the best of their ability. They unfortunately find themselves managed by political appointees who have no clue what their job is but simply had the right connections to get a peach appointment.

These are all signs of a system that is badly broken. And for the life of me I fail to see how a broken system can fix another broken system.
« Last Edit: November 05, 2013, 12:58:37 PM by Retribution »

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Re: ACA
« Reply #84 on: November 05, 2013, 02:40:26 PM »
And to get back on topic http://politicalticker.blogs.cnn.com/2013/11/05/obama-further-refines-you-can-keep-your-plan-pledge/?hpt=hp_c2 my issue is this seems to not be doing quite what it was sold as doing. In fact people like Phaia find themselves in a worse place than before. And I find the stance of "well that is a small percentage" or "some have to make sacrifices for the greater good" to be pretty arrogant. Who made someone god so that they could say the needs of family A are more important than the needs of family B? These are all examples of how government tends to not do things like this very well.

Offline Kythia

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Re: ACA
« Reply #85 on: November 05, 2013, 04:42:27 PM »
When you artificially alter this equilibrium pricing point for a business (whether it is advantageous for mass consumers or not), it immediately sends shocks waves through the pricing for other product varieties the company sells.  If you want me to elaborate on this further, I can - but essentially, if a company is operating at the peak price point (which most corporations have the labor/time required to achieve), then suddenly reducing the price for one commodity type will make it extremely difficult to maintain prices for other products, without running at a loss.  This is because, whether or not they are reaping gigantic profits, their business plans are so delicately crafted in the short-term, that it would most certainly introduce risk into the business/industry.  For example, a company could be running a $5,000,000 profit/year.  But if expense reports, dividends, and income contracts are already clearly defined for how this profit will be distributed, the company is in great jeopardy if the "anticipated" revenue stream is suddenly altered.  The company's credit line may be affected, their leveraged debt may not be paid on time, etc.  So you can understand why artificial fluctuations in price can drastically affect a healthcare company - thus leading to many existing plans being dropped.

Yes.

But what precisely is your point?  Lets assume that "Kythia and Valthazar Medical Insurance Ltd" has indeed found an optimal price point for our various insurance policies - #1 through #30.

As a result of ACA, policies #1 through #10 now need to be adjusted, as they don't meet the baseline.  Precisely how we adjust - remove them or adapt them - isn't overly important.  Our accountants have been busy beavering away to get us our financial forecasts for the year.  However, our accountants have, you know, ears.  So ACA didn't come out of the blue - they, like the rest of the world, knew full well that ACA was coming in. 

What you seem to be arguing is that this will create a price shock in our well run company.  This is, can only be, true if the change was unexpected.  If our accountants have made profit/loss forecasts while paying no attention whatsoever to a major legislative change that affected our business and was announced long in advance then your "well run" condition doesn't apply.  If they haven't done that, if they've actually been competent, then there's no price shock.

Offline Valthazar

Re: ACA
« Reply #86 on: November 05, 2013, 04:49:37 PM »
What you seem to be arguing is that this will create a price shock in our well run company.  This is, can only be, true if the change was unexpected.  If our accountants have made profit/loss forecasts while paying no attention whatsoever to a major legislative change that affected our business and was announced long in advance then your "well run" condition doesn't apply.  If they haven't done that, if they've actually been competent, then there's no price shock.

Kythia, not sure if you have been following my other posts in this thread, but if you know what the guaranteed cost for ACA will be on insurance companies, you definitely know something that no one else knows.

You see, the cost of ACA is largely contingent on how many new enrollees there are through these new government exchanges.  Especially in an industry like healthcare, where it is critical to maintain a steady stream of premiums from individuals who likely won't get sick, to maintain a reserve from which to pay out claims.  Many of the projections for new enrollees provided by the government are turning out to be largely inaccurate.

For example, in today's news:
http://online.wsj.com/news/articles/SB10001424052702303661404579178231174626314

(edit: sorry if that link doesn't work.  Try this link, then click the news article from there.  Seems to be open access then.
https://www.google.com/search?q=young+people+health+pans&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a#q=young+people+avoiding+health&rls=org.mozilla:en-US%3Aofficial

As quoted:  "Insurers say the early buyers of health coverage on the nation's troubled new websites are older than expected so far, raising early concerns about the economics of the insurance marketplaces.  If the trend continues, an older, more expensive set of customers could drive up prices for everyone, the insurers say, by forcing them to spread their costs around."

"The average enrollee age at Priority Health, a Michigan insurer, has ticked up to age 51 for newcomers, from about 41 years old for plans offered for the current year, said Joan Budden, chief marketing officer. Arise Health Plan, Wisconsin's largest nonprofit insurer, said more than half its 150 signees are over 50, a higher proportion than expected, while declining to be specific on its target age."

I hope this explains the uncertainty I am referring to with regard to ACA.
« Last Edit: November 05, 2013, 05:03:23 PM by ValthazarElite »

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Re: ACA
« Reply #87 on: November 05, 2013, 05:24:30 PM »
Kythia, not sure if you have been following my other posts in this thread, but if you know what the guaranteed cost for ACA will be on insurance companies, you definitely know something that no one else knows.

You see, the cost of ACA is largely contingent on how many new enrollees there are through these new government exchanges.  Especially in an industry like healthcare, where it is critical to maintain a steady stream of premiums from individuals who likely won't get sick, to maintain a reserve from which to pay out claims.  Many of the projections for new enrollees provided by the government are turning out to be largely inaccurate.

For example, in today's news:
http://online.wsj.com/news/articles/SB10001424052702303661404579178231174626314

(edit: sorry if that link doesn't work.  Try this link, then click the news article from there.  Seems to be open access then.
https://www.google.com/search?q=young+people+health+pans&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a#q=young+people+avoiding+health&rls=org.mozilla:en-US%3Aofficial

As quoted:  "Insurers say the early buyers of health coverage on the nation's troubled new websites are older than expected so far, raising early concerns about the economics of the insurance marketplaces.  If the trend continues, an older, more expensive set of customers could drive up prices for everyone, the insurers say, by forcing them to spread their costs around."

"The average enrollee age at Priority Health, a Michigan insurer, has ticked up to age 51 for newcomers, from about 41 years old for plans offered for the current year, said Joan Budden, chief marketing officer. Arise Health Plan, Wisconsin's largest nonprofit insurer, said more than half its 150 signees are over 50, a higher proportion than expected, while declining to be specific on its target age."

I hope this explains the uncertainty I am referring to with regard to ACA.


I thought major insurance companies were also in the business of acquiring cash through loans to meet some of their running expenses. We all know America is very much a credit-driven economy, it's not as if these companies are sitting on their hands or slowly amassing safe money through grinding work on their safe operations until they can afford to expand their customer base a bit or make a few new offers.

If a company has a good trademark, or even an established one (and a good credit rating) it would normally have no major problem getting loans to help take it through some readjustments to its business.

Major companies have means of getting credit that you and I don't have, that no ordinary private citizen has (plus they're able to raise money through issuing new shares). It's seriously misleading sometimes to size it up as if a big company with millions, even hundreds of millions of bucks getting turned annually is running on the same "revenue and costs gotta add up in cash, every month" terms as a household budget.
« Last Edit: November 05, 2013, 05:29:45 PM by gaggedLouise »

Offline Valthazar

Re: ACA
« Reply #88 on: November 05, 2013, 05:37:01 PM »
Major companies have means of getting credit that you and I don't have, that no ordinary private citizen has (plus they're able to raise money through issuing new shares). It's seriously misleading sometimes to size it up as if a big company with millions, even hundreds of millions of bucks getting turned annually is running on the same "revenue and costs gotta add up in cash, every month" terms as a household budget.

Yes, in theory, they could take out loans for the purpose of covering future claims.  I find this to be an unlikely solution we will be seeing, however, since there isn't a clear avenue of where they will be able to recoup this leveraged funding in the future.

I find this highly unlikely because it is a fact that as a result of ACA, there will actually be a net increase in customers for major insurance companies.  As a result, at least in the immediate short-term, insurance companies will likely see an increase in their net total of premium revenue.

The concern, however, is a disproportionate amount of claims payouts, due to many older, uninsured, and sicker patients enrolling.  So basically, although net total premium revenue increases, it is not increasing at a rate proportional to the potential payouts that will be incurred as expenses in years coming - statistically, of course. 

It is because the net total of premium revenue will increase though, that I am skeptical of insurance companies resorting to additional funding through loans.  Rather than incur interest payments without any promise of greater enrollment in the future, the far more sensible and straightforward thing to do as an executive would be to alter premium rates for existing customers, or of course, drop coverage of certain plans.

If you have a source that discusses insurance companies considering loans in responding to ACA, I would be interested to read it.
« Last Edit: November 05, 2013, 05:47:38 PM by ValthazarElite »

Offline mia h

Re: ACA
« Reply #89 on: November 06, 2013, 03:13:54 AM »
The concern, however, is a disproportionate amount of claims payouts, due to many older, uninsured, and sicker patients enrolling.

So a piece of legislation is enacted that among other things prevents insurance companies denying health coverage for pre-existing conditions, and as a result lots of people who were denied coverage because of pre-existing conditions buy health insurance. What were the odds of that happening?  ::)

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Re: ACA
« Reply #90 on: November 06, 2013, 04:12:40 AM »
So a piece of legislation is enacted that among other things prevents insurance companies denying health coverage for pre-existing conditions, and as a result lots of people who were denied coverage because of pre-existing conditions buy health insurance. What were the odds of that happening?  ::)

It's sort of tempting to quote sample Grandmaster Flash: "They said it couldn't be done!"  :D - they being the lobbyists and on-the-floor puppeteers.

Offline ShadowFox89

Re: ACA
« Reply #91 on: November 06, 2013, 04:38:14 AM »
So a piece of legislation is enacted that among other things prevents insurance companies denying health coverage for pre-existing conditions, and as a result lots of people who were denied coverage because of pre-existing conditions buy health insurance. What were the odds of that happening?  ::)

 How dare those cancer patients and *gasp* women make people pay more for insurance?

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Re: ACA
« Reply #92 on: November 06, 2013, 05:30:31 AM »
          It's been a common Republican rejoinder on sooo many issues, pretty much anything they don't like, to try to find any one little thing that has gone wrong so far (omg, a website glitched, what inconceivable systemic ineptitude that shows!) or even more often...  Common for them to say, but we don't know what some costs or results will be.  Well, there are lots of things where one doesn't know exactly but you have to take your best guess.  Lots of things people pay for because it's not just the right thing, but the thing that might be necessary to keep the rest of the economy together or to keep a growing contingent of your people from giving up, incurring more costs to weather and drag out the issue, doing something individually foolish or destructive, or leaving the country.  Of course, if you happen to have an opposition that is doing everything it can to defund the government in general and to enable corporations to make more loopholes in the legislation along the way -- I mean, I find it rather hard to believe Democrats did this all by themselves -- then it's sort of a self-fulfilling prophecy, aka plain out sabotage. 

           And I have to agree with Louise.  You don't reasonably throw away half or more of the population's regular needs merely because they happen to be somewhat more expensive in absolute terms.  It's particularly nasty to do that when those are people that the society has currently (in practice, despite lip service to the contrary) taken it for granted are being generally exploited -- for example, women bearing the brunt of service industry work, being expected to be the compromising and nurturing ones, generally put up with anything from wallflower jobs to nastiness to harassment, and often being paid much less than their counterparts even in the same exact job descriptions.  If we can afford to have half a dozen carrier battle groups or more officially active?  Then we can afford to dig up some cash and pay for mammograms and I daresay even at least a couple abortions apiece.

          I'm becoming more inclined to agree (with Val) on the point that it would all be more practical if it were closer to a single-payer system, so the particulars of the solution on offer is one problem.  But when you start claiming some things are just "too" expensive to require most people to chip in a little so that they can get indirect benefits of other groups in society being supported, I want to see some very careful calculations and explanations about exactly how much it has to cost (that is, in a system where the overall costs are not running away anyway) and how you are going to prove that the people who you think are just "too" expensive, are perfectly dispensable culturally and economically for the rest of the society.  To the point that everyone else can really better afford not to care.  Otherwise, my default position is more that more people should be willing to trade more effort and benefits across the society in kind, and recognize that caring for other people in the system benefits everyone, regardless of whether one is the immediate and personal beneficiary of a specific coverage or not.

     
« Last Edit: November 06, 2013, 05:34:39 AM by kylie »

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Re: ACA
« Reply #93 on: November 06, 2013, 05:31:38 AM »
So a piece of legislation is enacted that among other things prevents insurance companies denying health coverage for pre-existing conditions, and as a result lots of people who were denied coverage because of pre-existing conditions buy health insurance. What were the odds of that happening?  ::)

Honestly the inability of insurance companies to deny coverage due to pre-existing is one of the things I like about ACA. I also like for example that it covers birth control because as I have said before unplanned pregnancy I feel is one of the main causes of many of our social problems not to mention just plain poverty. I am not utterly against ACA and I think the obsession with repealing it is just plain insane, it passed deal with it Tea Party.

On the other hand I do not like the way it puts the squeeze to some self employed and middle class who are then held up as being rich and snobby when they are just trying to make ends meet and do not have an extra couple hundred bucks a month laying around.

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Re: ACA
« Reply #94 on: November 06, 2013, 05:33:31 AM »
          It's been a common Republican rejoinder on sooo many issues, pretty much anything they don't like, to try to find any one little thing that has gone wrong so far (omg, a website glitched, what inconceivable systemic ineptitude that shows!) or even more often...  Common for them to say, but we don't know what some costs or results will be.  Well, there are lots of things where one doesn't know exactly but you have to take your best guess.  Lots of things people pay for because it's not just the right thing, but the thing that might be necessary to keep the rest of the economy together or to keep a growing contingent of your people from giving up, incurring more costs to weather and drag out the issue, doing something individually foolish or destructive, or leaving the country.  Of course, if you happen to have an opposition that is doing everything it can to defund the government in general and to enable corporations to make more loopholes in the legislation along the way -- I mean, I find it rather hard to believe Democrats did this all by themselves -- then it's sort of a self-fulfilling prophecy, aka plain out sabotage. 

           And I have to agree with Louise.  You don't reasonably throw away half or more of the population's regular needs merely because they happen to be somewhat more expensive in absolute terms.  It's particularly nasty to do that when those are people that the society has currently (in practice, despite lip service to the contrary) taken it for granted are being generally exploited -- for example, women bearing the brunt of service industry work, being expected to be the compromising and nurturing ones, generally put up with anything from wallflower jobs to nastiness to harassment, and often being paid much less than their counterparts even in the same exact job descriptions.  If we can afford to have half a dozen carrier battle groups or whatever the current number is, I don't believe it's down to four yet anyway?  Then we can afford to dig up some cash and pay for mammograms and I daresay even at least a couple abortions apiece.

          I'm becoming more inclined to agree with on the point that it would all be more practical if it were closer to a single-payer system, so the particulars of the solution on offer is one problem.  But when you start claiming some things are just "too" expensive to require most people to chip in a little so that they can get indirect benefits of other groups in society being supported, I want to see some very careful calculations and explanations about exactly how much it has to cost (that is, in a system where the overall costs are not running away anyway) and how you are going to prove that the people who you think are just "too" expensive, are perfectly dispensable culturally and economically for the rest of the society.  To the point that everyone else can really better afford not to care.  Otherwise, my default position is more that more people should be willing to trade more effort and benefits across the society in kind, and recognize that caring for other people in the system benefits everyone, regardless of whether one is the immediate and personal beneficiaries of a specific coverage or not.

   

Did you not read this link? http://politicalticker.blogs.cnn.com/2013/11/05/obama-further-refines-you-can-keep-your-plan-pledge/?hpt=hp_c2 This is not glitches, but yes single payer really does not sound bad to me.

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Re: ACA
« Reply #95 on: November 06, 2013, 06:08:18 AM »
Did you not read this link? http://politicalticker.blogs.cnn.com/2013/11/05/obama-further-refines-you-can-keep-your-plan-pledge/?hpt=hp_c2 This is not glitches, but yes single payer really does not sound bad to me.
           Generally speaking, I really don't appreciate the "did you not read" opening, aka it would appear to be hinting:  "You must not have been paying attention [to the line I want everyone to remember first]."  Maybe if I were playing the ping-pong game of quoting one person, one blurb at a time and it's all yours, then it would make more sense (however purposefully annoying).  But I was not. 

             Apart from the more basic (and quite sufficient) reason that I don't believe I am required to be quizzed on your line of choice or anything else in particular simply because I stick my head into the conversation, nor to provide a narrow quote and riposte style for every single post...  You are talking about something different.  And that is perfectly fine, but your insisting that I talk about only the part of the broader conversation you want (or else be branded a bad reader, etc.) is not fine with me.     

              So yes, quite apart from the line you demand I repeat and focus upon...  Other things were happening in the last few posts that concerned me.  I was first mentioning the level of mocking and invective I saw where on some sites people said, oh look the healthcare website (not plans -- but rather website function, login, crashes, etc.) had problems and therefore it's obvious the government cannot possibly manage something this size.  Typical "big government is bad in principle" sort of logic.  To me, that's an obvious example of the right (or at least its online following) attacking national healthcare in principle with sweeping claims.  From which I move on to say regarding people saying it's impractical to cover all sorts of people, merely because they may have certain absolute costs and needs that others don't?  That would be just another sort of sweeping claim that may well not be very sustainable, in practice for the whole population.
   
« Last Edit: November 06, 2013, 06:21:21 AM by kylie »

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Re: ACA
« Reply #96 on: November 06, 2013, 06:39:08 AM »
I'd agree with Kylie that the "those particular folks are too expensive with the health care needs they're claiming - and they don't pay back by doing high-profile and well-paid work either" argument - that one often seems to slap women in the face. Especially working mothers, women who are doing most of the caring work, and home front, for their family and keeping up a job at the same time - or trying hard to find a job (or teenage girls who have landed in troubled times). Some of those are among the most exposed, the most likely to work long irregular hours and sometimes without knowing even three days in advance what their walk-on and walk-off hours are going to be, and the ones who can least afford to miss a curve in the road, or to be sick even for a few days.

But you know, no one can deny that caring for other people is to the benefit of everyone. No society survives if children are not taken care of, if women don't take the time to have kids, or if old people are not cared for either. And well, today - and over the past few hundred years - that kind of care and managing is 90% the work of women, and often miserably low-paid or totally unpaid work.
« Last Edit: November 06, 2013, 06:50:54 AM by gaggedLouise »

Offline Valthazar

Re: ACA
« Reply #97 on: November 06, 2013, 07:57:36 AM »
But you know, no one can deny that caring for other people is to the benefit of everyone. No society survives if children are not taken care of, if women don't take the time to have kids, or if old people are not cared for either. And well, today - and over the past few hundred years - that kind of care and managing is 90% the work of women, and often miserably low-paid or totally unpaid work.

There isn't any way to legislate that men must be actively involved in the lives of their children - other than taxing them to contribute monetarily, alimony, etc.  If you can describe how legislation could enforce male involvement in their kids lives, I'd like to hear it.

The reality though, is that most of the young, single mothers you are describing, had their children fathered by men who are already low-wage, or unemployed.  As a result, you have many men sitting in jail right now because they can't make their payments for taking care of the kid - I am not joking.  This is only furthering this problem.

You're describing some very relevant problems, but not providing any solutions.  Many men are simply opting out of stable relationships, because they're realizing that the government is moving towards fulfilling their role in a way.  If you father a kid when you're 18, what's the point in taking care of your kid and girlfriend, if the government already has very clear cut protocol in place in providing them healthcare, food, etc.

In other words, while I certainly support help for single mothers, I fear that too much devotion to this cause may actually have the undesired effect of de-incentivizing men to take care of their families, and only exacerbate the problem we have now.

edit: removed questionable statistic
« Last Edit: November 06, 2013, 08:20:48 AM by ValthazarElite »

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Re: ACA
« Reply #98 on: November 06, 2013, 08:19:05 AM »
Okay, let me try this one more time since my frustration is starting to show in my tone. Yes, the web site glitches are pretty irrelevant as I am assuming they will be fixed in good time. -But- as several have pointed out here in print as well as in links there are some deeper problems. I am sorry that I become blatantly vexed at those things being ignored, but one can only repeat themselves so many times and then they become irritated. Now that I am not seeing red or at least as deep a shade  :-) I can see we are falling into the trap of digging in our heels when we are not that far apart really. And I am sorry for my tone Kylie but I feel like you are simply ignoring what has been said several times because it is inconvenient to your arguments. So lets review:

There is nothing inherently wrong or evil with turning a profit. We all do that when we draw our pay checks it puts butter on the biscuit and beer on the table for levity's sake

Health care is broken and things like birth control and good basic coverage really should be mandated. But ignoring those who are in fact loosing coverage or having to pay more so that they find themselves in a position to choose between making the house payment and paying for insurance is no better a solution. Ignoring that on the left is no better a solution than choosing to simply ignore basic health care for women on the right.

When I become emperor of the world in a benevolent dictatorship what I would like to see is a Medicare like system. Maybe we should call it Retricare? Medicare works reasonably well and most carry supplemental insurance to help off set the costs. It is not perfect, but it is about as good as I have seen in this country. My real issue with ACA is that I am skeptical that it will fix what it was supposed to fix. For each problem it repairs such as coverage for birth control I see it making another Phila's situation for example. I am not anti ACA, but I am getting a feeling of zero sum gain. Yes, my position is changing and evolving, but right now I feel like there is a lot of noise for not much ground gained.

Offline mia h

Re: ACA
« Reply #99 on: November 06, 2013, 08:31:49 AM »
When I become emperor of the world in a benevolent dictatorship...

Oi!! Take a number. You can have your benevolent dictatorship after I've had mine.

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Re: ACA
« Reply #100 on: November 06, 2013, 08:36:02 AM »
The lack of stable families is the number one predictor of poverty in the United States.  There isn't any way to legislate that men must be actively involved in the lives of their children - other than taxing them to contribute monetarily, alimony, etc.  If you can describe how legislation could enforce male involvement in their kids lives, I'd like to hear it.

The reality though, is that most of the young, single mothers you are describing, had their children fathered by men who are already low-wage, or unemployed.  As a result, you have many men sitting in jail right now because they can't make their payments for taking care of the kid - I am not joking.  This is only furthering this problem.

You're describing some very relevant problems, but not providing any solutions.  Many men are simply opting out of stable relationships, because they're realizing that the government is moving towards fulfilling their role in a way.  If you father a kid when you're 18, what's the point in taking care of your kid and girlfriend, if the government already has very clear cut protocol in place in providing them healthcare, food, etc.

Now if that wasn't a bit patronizing both towards me and at women in general...

I never said there is a need to use laws aimed directly at men to push them to engage more closely with bringing up their kids. I believe that's something that shouldn't be forced on a couple that way, and laws are going to be ineffective for this anyway. What I did say was that women are often compelled to take on most of the home chores, bringing up the kids, cleaning, cooking, keeping the home in shape (at least the interior) and at the same time taking on jobs that are irregular, low on wages, sometimes lower paid than the same kind of jobs done by men, and having the extra, biological, mission of giving birth to kids and often holding the family together, more or less. The combined weight of those isn't something most women have chosen out of good free will, it's both expected and often forced on them by the power of habit and how society works. And this puts women in a bad and sometimes exhausting position. Kylie used the word "explöited", that's heavy but sometimes it's a justified one.

On one count, sometimes this disjointed, busy and thankless state can make women more prone to illness than men, and more likely to have to take a few days off work due to real sickness - or to go to work while feeling seriously crappy. On the other, women often seem to be the group that gets classed as too expensive, "why can't they chip down their health care needs?" and so on. Although they do lots of work that takes both skill, intelligence and gritty endurance - without getting any serious pay for it.
« Last Edit: November 06, 2013, 08:51:22 AM by gaggedLouise »

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Re: ACA
« Reply #101 on: November 06, 2013, 08:41:12 AM »
Oi!! Take a number. You can have your benevolent dictatorship after I've had mine.

Oh alright you can be first but I want to be first lackey!

Louise -> Women's issues are indeed an issue with such things. People say it does not happen, discrimination in wages so on, but it does.
« Last Edit: November 06, 2013, 08:42:58 AM by Retribution »

Offline Valthazar

Re: ACA
« Reply #102 on: November 06, 2013, 08:59:10 AM »
Now if that wasn't a bit patronizing both towards me and at women in general...

How is it patronizing?  I already said in my post we need to support single mothers - only that we need to be aware of the positive and negative consequences of such policy.  In other words, ideal policy should both provide support for single mothers, as well as create incentive for stable relationships that are mutually beneficial.

I completely agree with you that women are often compelled to take on work outside the home, as well as domestic work.  But what's the solution to this?  Do we just accept that this is "okay" or do we try to figure out why this may be the case, and try to develop a more equal balance?

So in the short-run, I can certainly understand the need for ameliorating the symptoms, but we need a more sustainable solution.  What really needs to occur is a solution for the problem - which is, the lack of male involvement in stable relationships, especially in the urban poor.  My only argument is that while support for single mothers is important, we don't know what the result will be on the role of men in relationships.  In other words, unless a more strategic solution is developed in providing care for single mothers, as well as incentivizing male decision making, it may end up drastically exacerbating the problem.
« Last Edit: November 06, 2013, 09:01:47 AM by ValthazarElite »

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Re: ACA
« Reply #103 on: November 06, 2013, 09:01:48 AM »
Oh, come on, Val!

*clenches her fist and considers using "us" instead of "them" next time she needs to reference the female gender as a group in this thread*

Offline Oniya

Re: ACA
« Reply #104 on: November 06, 2013, 01:08:20 PM »
When I become emperor of the world in a benevolent dictatorship what I would like to see is a Medicare like system. Maybe we should call it Retricare? Medicare works reasonably well and most carry supplemental insurance to help off set the costs. It is not perfect, but it is about as good as I have seen in this country. My real issue with ACA is that I am skeptical that it will fix what it was supposed to fix. For each problem it repairs such as coverage for birth control I see it making another Phila's situation for example. I am not anti ACA, but I am getting a feeling of zero sum gain. Yes, my position is changing and evolving, but right now I feel like there is a lot of noise for not much ground gained.

I'm a little pressed for time, but I believe Robert Reich suggested something along the lines of expanding Medicare.

Offline mia h

Re: ACA
« Reply #105 on: November 06, 2013, 01:20:34 PM »
Yes, my position is changing and evolving, but right now I feel like there is a lot of noise for not much ground gained.

Quote from:  Max Weber
Politics is a strong and slow boring of hard boards
The ACA might not be a 'perfect' solution but if it's the best deal they could get then it's better than doing nothing.

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Re: ACA
« Reply #106 on: November 06, 2013, 01:22:14 PM »
Taking a voluntary time-out from this thread. See you later, perhaps somewhere else.

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Re: ACA
« Reply #107 on: November 06, 2013, 01:42:49 PM »
I'm a little pressed for time, but I believe Robert Reich suggested something along the lines of expanding Medicare.

I think it has been proposed by several and sadly I do not think it would ever pass. The Tea Party sadly listens to the voices in their head as opposed to reason. I mean hell, there are the glitches with ACA, the wire tapping scandal, IRS scandal, so on and the Tea Party backed cannot make political hay? Really? No wonder government is broken.

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Re: ACA
« Reply #108 on: November 06, 2013, 03:49:27 PM »
There isn't any way to legislate that men must be actively involved in the lives of their children - other than taxing them to contribute monetarily, alimony, etc.  If you can describe how legislation could enforce male involvement in their kids lives, I'd like to hear it.-
          I think it does come off as rather patronizing when you take women, who I believe are over half the population, and say in effect their needs are just 'extra,' or too expensive for men to be required to deal with financially and as a group sharing any common interest...  And I know Louise mentioned child care and I mentioned nurturing (though I meant more generally), but that's really just one part of it.  "Fathering" as such (at least in the sense that we traditionally limit it to bread winning) is not the part that I think of first -- perhaps because I managed to grow up without a father in two very different families over at least eight years, thank you very much?...  So please bear with me if I'm still more concerned with a wider range of problems here, than just the exact approach you meant to ask about on that.  Though I think many similar arguments could probably be applied to it. 

           To make a quick rhetorical analogy:  There isn't any way to "legislate" that men won't commit sexual assault or rape against a good fraction of women in the society, either.  You can even use the same basic structure and say, 'except to throw them in jail afterwards'.  Well if this is true for women in the economy, then there instead of "boys just will be boys and they must rape, so give them a break..."  For the political economy, it means the same "boys must be boys" and thus there's no possible way men can be convinced to do certain tasks for the good of their society up front -- so "obviously" those are tasks that have to fall to women.  Presumably just because they all traditionally have, and traditionally the economic "answer" has been to force women to work more, marry men of a higher class with more money if they can -- or try to attach themselves to just about any available man, however temporarily and messily, with some means to add some serious income, otherwise. 

           You are suggesting that the only policy of consequence regarding unpaid alimony (and by proxy, broader child support issues?) seems to be , throwing recalcitrant people in jail after the fact.  Well, try and seriously focus on that then.  What about education in these things that are now relegated to "women's issues" (typically in college), in high school, for everyone, with some serious time?  How about a choice of community service instead of jail for some of these men -- in a food bank, or working in textiles, or maybe a nursery if they aren't violent offenders -- doing something that usually gets stuck on women?  Who knows, maybe even a mandatory parenting course?  And don't make it a matter of temporarily 'humiliating' the criminal -- say it's a an honorable, fine thing to be doing because it is.  "Look, here's how to change the diaper.  Yes, men can do this too and [if necessary!] it's perfectly dashing and macho when they do.  You can even say 'grrr' and watch the baby smile if you like."  Whatever it takes. 

           But instead, what actually happens?  Many of the people in politics today who use the same kind of arguments you're making about healthcare costs in general, have made a whole "socially conservative" movement centered around precisely, doing nothing of the kind.  Keeping women 'in their place.'  (You can look at things like marriage and divorce laws, particularly in the South, and now even the "unconsidered" effects of requiring certain ID for women trying to vote after separation or divorce.)  Making 'maintaining' or 'defending' women a problem for how men prove themselves in other parts of society (whether they go to war in Afghanistan, whether they marry and go to work in a "good" industry or not -- that is, if they really have some opportunity to begin with).  But not much a question of what they actually do directly for women, and not a question of whether people in general really learn or care about what women themselves face in terms of segregated roles.  And when it does come down to people who seem not to care, people who end up in jail, the right has also been keen on making jails more a place of punishment or cheap labor, or perhaps simply corporate hoarding of people (often soon recycled back into the system) than places of reeducation or parole or serious education -- more like they were toward I think the 70's.

When rape happens, they say oh what did she do to "bring it on" and didn't she enjoy it anyway?  Doesn't she know that this is how men are, and what was she doing outside alone after dark?  Oh look, she went to a party even!  Was it "legitimate"?  (For fuck's sake, but people on the right have been known to say this as a public line.)  When the question is abortion, oh no women can't do that and we're going to legislate that right away. 

When the question is sex education, you have those Texas school boards pushing it practically out of mind -- and they may be a "worst" sort of example, but there I do think much of the country has got itself in a sexually repressive funk of not seriously working on things like abortion, contraception, or even basic sex ed in high schools.  Maybe that has improved more than I know in the last few years, but even if so, I would say women actually need more done.  People need serious talk about relationships -- what is consent, and why is it important.  Not the bland "no is no" sloganing that no one follows anyway half the time, but real talk about nonverbal cues, the medieval cultural "rules" of traditional Western romance muddling the waters, and what about basically polyamorous trends where people may have multiple lovers or not assign all roles under the sun in the way of care and money and sex to just one person?  This stuff can be explained at easier levels if people don't treat it like it was esoteric Satanic literature suited only for grad schools.  I dare say there is a fair bit of good old boy, Southern Christian conservative moralizing playing a big part in that problem.  Often many of the same people actually in government who are now fawning over the "needs of business" constantly.

And when it comes to funding much of anything that appears to help urban, particularly Black but now also often, Latino areas where the government has basically been pulling out education, child care, police, firefighters, city lighting, and heaven knows what else...  It's the same people now generally on the right, the ones who are "pro business," the ones who care if we "can afford" any proposal to help the people in general -- and particularly the ones in these very areas who need it most, who are often caught saying "Oh, how dare they feel so entitled...  Oh, are they "abusing" what few sustenance programs they currently have left with all the restrictions and humiliations we've already imposed upon those...  Oh, aren't they just lazy.  And how dare they have had children in the first place.  Why in the world, in this place where we have long insisted there can be no abortion and we have supported companies that do not go in for things like supporting contraception, do they have so many kids...  On and on and on.

Quote
You're describing some very relevant problems, but not providing any solutions.
          Solutions would be, deal with all that.  But I think it's very telling that, in the US, the political wing that opposes those things is largely the same one that keeps using the arguments you use about the "untenable" expense of women for healthcare, as if it were something that existed in a vacuum.  As if society had never been sticking women at large with all sorts of hidden expenses and insisting they grin and bear it, cause after all they are given less money at work and more unpaid work at home and men are busy laughing about what sluts they must be and who is getting "raped" today whether it's at a frat party (where only women who "deserve" it supposedly go) or metaphorically as in, oh who can I beat up in the oh-so-masculinist business world to prove I am "more manly" today and thus "dominate the market, because we all know someone has to.  That's capitalism, right?" 

You should understand, if it isn't really obvious by now, that when you come along saying women are just more expensive and they should have to shoulder that -- I find it near impossible to believe that you don't think about how society "should" be...   Well, in some ways much like the Tea Party you claim not to have so much in common with.  'Can't do it any other way...  Better get out, leave it alone.'  You don't quite recommend that, but it's the sort of conclusion they draw while showcasing almost the same supporting materials.  And then you do very positively go on about how business needs to be saved first in order to (supposedly) save everyone else, but that's more or less what is left if the Tea Party has its way with things... like health care.  (All these "mainstream" Republicans have not put up with the Tea Party this long because they have simply nothing in common, protestations to the contrary notwithstanding.)  If we just toss ACA, if we don't try to improve now, then what's left are the big companies having their way.  You may say they are anyway, but saying we can't afford whole classes of people covering stuff here, there, who knows how often...  Leads to the same place.

Quote
Many men are simply opting out of stable relationships, because they're realizing that the government is moving towards fulfilling their role in a way.  If you father a kid when you're 18, what's the point in taking care of your kid and girlfriend, if the government already has very clear cut protocol in place in providing them healthcare, food, etc.
          You may not say this, but there are people who are very happy to take just what you said, with as little context or direction as it has, and use that to go on about this being terrible because well, men might just feel left out.  Never mind that what they'd then be cut loose from, is patently unequal.  Decay of traditional family and all that.  But it already has pretty much decayed.  We're not going back there, not in an economy anything like this.  And it wasn't an egalitarian system anyway, so why want to?  Unless you believe the only way to economic stability is blatant chauvinism. 

           But I believe you're actually talking about communities where in fact, when two parents are working, it's still very difficult for them to pay all the bills -- if they can, at all.  And part of that problem is that the same government that your argument seems to also suggest, maybe should just stay out of healthcare (though you say elsewhere you believe otherwise -- others who enjoy this sort of line clearly want the government to just get out of considering it) refuses to have a "minimum" wage consistent with the rising cost of living.  Part of that is also that the same government, often driven by people who claim to care about "jobs" but really even more, about "business" and "deficit cutting" have been yanking services out of those communities any way they can get away with, for decades.
 
          Actually, many women are opting out of (at least hetero, monogamous "traditional") relationships because the men just don't get it.  I heard Black men moaning about how the "bitches" in their communities didn't want them, but all ran for the White boys, a good few times on the train in Atlanta -- but I also heard it's a trend in sociology.  So yes, we get Black women unsatisfied with Black men -- now is that because they're just "frigid bitches"?  Or could it be, it because they live under policies where the society has conspired to give Black men (especially) few opportunities to make real money, still more opportunities to be detained by police often with no good reason (odds of simply being detained walking around or driving over nothing in the way of evidence), and a bunch of incentive to be niche criminal (drug market) or for some, to act more like gangsta misogynist asses (either just on the face of it to "look tough", or actually so -- but that can mean adopting an image that doesn't coexist with other options)?
« Last Edit: November 06, 2013, 04:42:50 PM by kylie »

Offline Valthazar

Re: ACA
« Reply #109 on: November 06, 2013, 05:11:03 PM »
I think it does come off as rather patronizing when you take women, who I believe are over half the population, and say in effect their needs are just 'extra,' or too expensive for men to be required to deal with financially and as a group sharing any common interest... 

With regard to healthcare, I was speaking about how premiums are determined today (either pre-ACA or post-ACA).  Certainly, under ACA, no one can be denied health insurance due to pre-existing conditions, but premium rates are still variable based on age, health, and status of the individual.  For example, if a woman decides to get tested for the BRCA gene (breast cancer gene), and the results are positive, she will face a higher premium.  This will be the case even as a result of ACA.  In other words, it's not fair, and the ACA doesn't change that.

What the ACA does, however, is require everyone to get at least the same minimal level of care.  In other words, men and women alike will have the same healthcare insurance requirements.

I already posted about my views earlier in this thread as to what I consider the optimal solution.  That would be focusing heavily and incentivizing the creation of full-time job opportunities (through tax subsidies for businesses creating entry level jobs, full-time positions, etc.), and naturally creating avenues of opportunity for people to purchase private insurance on their own.  While I did not vote for Obama in 2008, nor do I agree with many of his perspectives, I at least found his original healthcare proposal to be sensible, and fundamentally sound.  It made sense, and whether or not I agreed with it, it would at least provide one solution to expanding coverage and reducing healthcare costs.

I am not disagreeing with the ideology of what you are saying, but how does the ACA accomplish this goal of making all premiums the same for all people, as you say?  Premiums are still going to be higher for certain demographics.  For example, if you grew up in the poor inner city, and you ate fast food a lot because you couldn't afford healthy groceries, and thus, had a high BMI, your health insurance premium is going to be very high, even under ACA.  Of course, this is comparing individuals of equal income at present - in other words, not factoring in subsidies.  The premiums remain exactly the same before and after ACA, it's just the government is subsidizing the premium cost for certain populations, in paying the private insurance companies through their exchange.  That's a very important point to realize, and someone is still paying the tab.  It's a band-aid, and masking the real issue for variable premiums, and isn't a sustainable, long-term solution for ending variable premium rates (and one I think is economically impossible to achieve through legislation simply because different insurees vary in how much money they will claim, due to statistics).

Same reason why life insurance is more expensive at age 50 versus age 30.
« Last Edit: November 06, 2013, 05:38:25 PM by ValthazarElite »

Offline Chris Brady

Re: ACA
« Reply #110 on: November 06, 2013, 05:25:19 PM »
The ACA might not be a 'perfect' solution but if it's the best deal they could get then it's better than doing nothing.
It's a step.  And that's the best one can hope for now.  Maybe in the future it'll get better, hopefully.

Offline Kythia

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Re: ACA
« Reply #111 on: November 07, 2013, 04:33:00 PM »
Kythia, not sure if you have been following my other posts in this thread, but if you know what the guaranteed cost for ACA will be on insurance companies, you definitely know something that no one else knows.

Not sure if you've been following your other posts in this thread but your entire argument is predicated on companies having perfect knowledge of their future incomes and the ability to predict through business plans future levels of sign ups.  If they lack that then how does your argument about business plans apply? 

Quote
I hope this explains the uncertainty I am referring to with regard to ACA.

This came across as patronising.  I realise it almost certainly wasn't intended as such, I'm just flagging it for future reference.

EDIT: Longer response incoming
« Last Edit: November 07, 2013, 04:44:14 PM by Kythia »

Offline Kythia

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Re: ACA
« Reply #112 on: November 07, 2013, 05:06:56 PM »
Excuse the double post but I actually think part of this is my fault.  I've been giving quick one or two sentence responses, which have obviously been badly phrased.  So grab a cup of tea while I try to rectify this.

Your argument is, so far as I read it, as follows.

1) Insurance companies have found, prior to ACA, an optimum pricing policy for their plans and have developed a range of financial predictions.
2) They have made business decisions based on these predictions
3) The changes made by ACA to their client base are essentially unknowable
4) This will cause a major market upheavel as insurance companies struggle to refind this optimum point.

Am I right so far?

I'd kind of question 1, at least in all cases.  But I'm happy to stipulate that at least some of them have done so.  So we'll discard the ones that haven't, and just focus on the ones that have.

Your argument still doesn't hold though.

See, your issue is with how 2 and 3 interact, leaving 4 unsupported.

Kythia and Valthazar Insurance (KAVI) are one of the companies that have found an optimal point.  We have developed business plans based on our knowledge of our target demograph, all the other factors.  Next year we'll make $X according to our predictions.  There's presumably some margin of error in that, but lets put that to one side.  There'll always be a margin of error.

We have known ACA is coming for a while.  We're not stupid and have done our best to factor in the changes - by this I mean we haven't simply ignored it and continued using predictions that take no account of ACA.  Within the confines of 3, we have done the best we can with that.  It's not perfect because this is new waters for us, but we've done better than if we haven't tried at all.

With me so far?  I don't think there's anything controversial there.

BAM! ACA arrives.  One of our predictions was too high, another too low, etc.  We find out where our predictions were wrong, and this is an ongoing process.  By this I mean the full ramifications aren't felt immediately, it takes time to gather all the information on where we went wrong in our predictions.

But once again, we're not idiots.  We new we wouldn't see all the changes immediately.  We greatly expanded the margin of error in our predictions to take account of this factor.  Yey us!

And here is where your argument falls down.

The situation we find ourselves in, one which we knew we would find ourselves in, is that we have a far weaker idea of what our income the next few fiscal years will be than we used to have.  Woe us is.

Some of our faulty predictions result in price shifts in our policies, others result in us cancelling plans we had previously offered as no longer tenable.  Sure.

But you're failing to bear in mind two factors.  Firstly that we knew these changes were coming and have factored the increased uncertainty into our business plans.  We've just shrugged and asked questions about the length of a piece of string when stockholders ask about their dividends this year and distracted any staff by pointing at the Goodyear Blimp when they ask about bonuses.  We have enough to continue operating, we know that much, but we're not sure about expansion and non-business-critical expenditure.

Your argument seems to be that our response will be to raise the cost of other plans.  But that is a stupid response.  I don't question that some will take that, but they'll go under.  KAVI is too savvy (that's our slogan.  Like it?)

Because we know from years in the business that a certain percentage of the population will "over cover" themselves, a certain percentage "under cover".  I'm not sure if you get what I mean there, but I'm referring to the fact that some people will buy more insurance than they need and be net contributors, some less and work out being net drains.  We have figures for that, this is what we do after all.  And we see no reason at all that ACA would change that.  It just means the lowest cover available is higher than it previously was.  It doesn't affect our higher plans at all - those people with higher than ACA plans will keep them.  Those people with lower than ACA plans have two choices.  Upgrade or quit.

We don't know, precisely, what the percentage split will be because of 3.  Fine.  But we do know several things:

1) The people with higher than ACA coverage will be largely untouched.
2) Some people with lower than ACA will pay more to us
3) Some people with lower than ACA will start paying us $0 as they quit.

So why would we raise prices?  We already have a set of customers on the policies that we would be raising, some of whom will quit if we raise.  Sure there is a larger uncertainty as we don't know how many -ACA will quit but we knew that uncertainty was coming.  It's a planned uncertainty.  We also know that the full effects will take time to be felt, but that the effects of a price hike will be seen immediately.

So by hiking too many prices/dropping too many policies (which cancel down to the same thing) what we're doing is introducing EXTRA uncertainty into our operations.  If we sit tight, safe in the knowledge that while our ACA predictions weren't perfect they had some positive value of usefulness, and wait for the full ramifications to become evident we've shored up our current income, reduced risk and likely gained positive PR.

Do you see my point now?

Offline Valthazar

Re: ACA
« Reply #113 on: November 07, 2013, 07:13:59 PM »
Kythia, I apologize if I came across as patronizing, but that wasn't my intent at all.

It seems that you are discussing your perspective of how a health insurance company should optimally respond to the ACA.  I don't know enough to make predictions about how a health insurance company should ideally react, other than what I have been doing so far - which is to rationalize why health insurance companies are potentially reacting in the manner in which they already are.  That's why I thought you were seeking clarification of my views on how the health insurance companies are reacting already.  I wasn't aware that you were wanting to debate the optimal response of healthcare companies (which is probably why that statement at the end was probably seen negatively - which I apologize for again).

I get most of my news from the WSJ, and every day for the past week, there have been articles explaining the current economic response to the ACA on the part of insurance companies, and the potential long-term ramifications it will have.  I tried linking a couple of them earlier, but I guess they aren't open access.  I linked a few articles below, and today, President Obama even publicly apologized for mass healthcare cancellations due to ACA.

"The administration knew that many policies would be changed by the insurance carriers. In 2010 the Health and Human Services Department estimated that 40% to 67% of individual plans would lose their grandfather status."
http://www.cnn.com/2013/11/07/politics/obama-obamacare-apology/

"Buried in Obamacare regulations from July 2010 is an estimate that because of normal turnover in the individual insurance market, “40 to 67 percent” of customers will not be able to keep their policy.

http://investigations.nbcnews.com/_news/2013/10/28/21213547-obama-admin-knew-millions-could-not-keep-their-health-insurance

Maybe there is merit to your perspective on how health insurance companies should be ideally dealing with the ACA, but that's another discussion entirely.  That doesn't seem to be what they are doing now - for better or for worse.  Specifically with regard to plan-specific rate increases, I attributed this to far less than estimated enrollment of young people.  Again, I'm not trying to justify or suggest that this is the superior option for health insurance companies - but simply suggesting a possible reasoning why this is occurring.  I gave a link for this in my last post, but it may not work, so I'll try to find another one. 

"In the average state, Obamacare will increase underlying premiums by 41 percent. As we have long expected, the steepest hikes will be imposed on the healthy, the young, and the male."
http://www.forbes.com/sites/theapothecary/2013/11/04/49-state-analysis-obamacare-to-increase-individual-market-premiums-by-avg-of-41-subsidies-flow-to-elderly/

Multiple sources, including the Obama administration itself, is suggesting that potentially greater than 50% of current private insurance plans will be in flux.  I tried to find sources suggesting that premium rates won't rise on any existing private insurance holders, and I have not found any reputable ones.  The ones I did find, acknowledged a premium rate increase, albeit only a minimal percentage of individuals.  But these were basing their analysis on the assumption that all individuals with employer-based healthcare plans currently would retain them.
« Last Edit: November 07, 2013, 09:47:41 PM by ValthazarElite »

Offline mia h

Re: ACA
« Reply #114 on: November 08, 2013, 03:33:14 AM »
I'd take that Forbes story on the 41% increase with more than just a pinch of salt.

http://www.forbes.com/sites/theapothecary/2013/09/25/double-down-obamacare-will-increase-avg-individual-market-insurance-premiums-by-99-for-men-62-for-women/

http://www.politifact.com/truth-o-meter/statements/2013/oct/24/sean-hannity/sean-hannity-says-average-man-will-see-his-premium/

So if you believe the Forbes articles, both written by the same guy, then the biggest increase has dropped from 279% in Nebraska two months ago to 179% in Nevada less than a week ago. If the rate increases have managed to drop by that much in under two months, just imagine what's going to happen in the next two months!! Hell, by this time next year insurance companies will be paying people to take their insurance policies.  ::)

Also I suspect the author already had a position and was trying to fudge the facts to fit his existing narrative. While I don't have time to check their homework I suspect that the quoted 41% isn't what it seems, if there are 3 groups: group A has to pay 31% more, group B has to pay 41% more and group C has to pay 51% more. The average increase isn't 41% because we have no idea how large the different groups are, if group A is 100 times larger that B and C combine then average increase would be a lot closer to 31%. Also there is the possibility that they left out group D who got a 80% reduction, they are only interested in the "average" of the increases and as D's didn't increase then they are excluded from the calculations

Offline Valthazar

Re: ACA
« Reply #115 on: November 08, 2013, 09:03:44 AM »
So if you believe the Forbes articles, both written by the same guy, then the biggest increase has dropped from 279% in Nebraska two months ago to 179% in Nevada less than a week ago. If the rate increases have managed to drop by that much in under two months, just imagine what's going to happen in the next two months!! Hell, by this time next year insurance companies will be paying people to take their insurance policies.  ::)

You're right, the author is biased, and that the Manhattan Institute is also biased, but I was hoping to examine a few statistics that were mentioned.

For example, here are the official government releases on premium rates:
http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/ib_marketplace_premiums.cfm
http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/datasheet_home.cfm

In that release, it says that premiums nationwide will be 16 percent lower than expected, but this is comparing the Congressional Budget Office's projected rates in 2016, to its own findings.  While the CBO is certainly unaffiliated with any political party, the fact is, their report is internally comparing premium rate figures without corroborating with private insurers in developing these estimates.  In other words, this isn't telling you anything about how private insurers will respond next year, prior to the law taking effect.

As I said in my last post, I have tried to find reputable sources indicating the private premiums will not rise as a result of the ACA, and I have yet to find any.  Because of this lack of information from the government, many private research agencies (and thus, perhaps biased) are having to conduct studies on how premium rates will respond.

The ones I have found are making assumptions that employers are going to eat the costs of newly-required minimum requirement plans, and not drop current insurees.  I think in our discussion here so far, we have already acknowledged that this is already occurring (with regard to people losing coverage - cited in earlier posts), which is why I am having trouble finding sources on the claims you and Kythia are making.  If you could provide a few links that back-up your claims, given the current reality of how healthcare companies have already responded, I will be able to get a better grasp on where you are coming from with your views.
« Last Edit: November 08, 2013, 09:16:09 AM by ValthazarElite »

Offline Zakharra

Re: ACA
« Reply #116 on: November 08, 2013, 09:52:31 AM »
 Valthazar, please correct me if I'm wrong, but earlier I noticed you were saying one of the things jiggering the data in the climb to higher rates is the fact that it seems that it's mostly older people who are signing up and not too many younger people (collage aged to the late 202/early 30s) because that crowd doesn't think it will need the coverage, being young and invulnerable and all. The ACA was largely based on -all- age groups, young adult, middle aged and the elderly signing up, but the younger people aren't and since those who have higher health problems/issues are the ones signing up, the price is increasing to maintain the payout and cover the lack of younger healthier people who aren't paying into the system.

 I might have that wrong, but that seemed to be what you were saying. That one of the pillars the ACA was supposedly built on, isn't there, so prices rise as the revenue intake is much lower than expected.

Offline Valthazar

Re: ACA
« Reply #117 on: November 08, 2013, 11:28:04 AM »
I might have that wrong, but that seemed to be what you were saying. That one of the pillars the ACA was supposedly built on, isn't there, so prices rise as the revenue intake is much lower than expected.

Zakharra, that is correct, with regard to a low enrollment of young people into the ACA exchanges. 

In the case of ACA, the success of the program will be heavily reliant on younger, healthier individuals, who provide less of a financial drag on the system and make sure sicker, older individuals can receive affordable coverage.  By opting out of healthcare, they will face a yearly $95 penalty, or 1% of their annual income - whichever is higher.  This revenue will not be siphoned to insurance companies.  With too few young and healthy people and too many high-claim-risk, older, and sick policyholders in the insurance pools, premium costs would begin to trend upward each year.  This further discourages healthy people from buying coverage.  In healthcare, this is known as the "death spiral" effect, and is an industry-recognized phenomenon whenever new clients are taken on.

Here's an NPR article explaining the death spiral:

"The designers of Obamacare were aware of the dangers of a death spiral. That's why the Affordable Care Act has both a carrot and a stick to encourage people to sign up.  We actually have a term for this in the industry," says Laszewski, who advises health insurance companies. "We call it a death spiral. And many insurance companies have had death spirals so this is not a theoretical exercise."

http://www.npr.org/blogs/money/2013/09/30/227468495/one-key-thing-no-one-knows-about-obamacare

Essentially, unless you get young people on-board ASAP, they will be even less likely to opt-in in the future, due to current short term premium increases due to predominantly unhealthy enrollees.  This situation is exacerbated even more by the faulty ACA website. 

"While older and sicker people have good reason to more aggressively try to get covered, the younger, healthier people aren’t likely to exhibit much patience with a balky website. They’re likely to put off the mandatory insurance sign up until much closer to the March 2014 deadline."
http://www.politico.com/story/2013/11/obamacare-signup-younger-people-99548.html#ixzz2k4lu78xf

"Health and Human Services Secretary Kathleen Sebelius today acknowledged that long-awaited enrollment figures for the rocky first month of Obamacare will be “very low.”"
http://www.politico.com/story/2013/11/kathleen-sebelius-obamacare-senate-hearing-99449.html#ixzz2k4r9IsDw

So basically, of the few people that did enroll so far, the majority are the sick, and the older, who really need healthcare right now.  In other words, you can see how the faulty website (which obviously was an unforeseen event, as far as I can see), essentially aggravates the death spiral effect even more than with just the ACA itself - purely as a law.  As a result, at least in the short-run, this is what is prompting discussion about premium rate increases.
« Last Edit: November 08, 2013, 12:04:57 PM by ValthazarElite »

Offline Zakharra

Re: ACA
« Reply #118 on: November 08, 2013, 02:00:30 PM »
  Ok, so I did have that right, I wasn't sure. Man is that going to stick a wrench in the ACA funding system. Unless they go out and use force of some kind to make people sign up (maybe making it an actual tax -everyone- has to pay) I don't see the younger people willingly signing up for something many of them don't think they need. I cannot see it getting any better when the penalties start rising either, since as you say, the penalties go to the government, not the insurance companies that will need the money.

 Another thing I've heard is that getting the fines is severely limited by the ACA. the IRS can only take it from your refund (if you get one) and is not allowed to lay any liens or fines on your property or bank accounts or get access any other way to fine you. So technically, if you don't get a refund, they can't fine you unless they change how the fines are to be levied.

Offline consortium11

Re: ACA
« Reply #119 on: November 08, 2013, 03:40:06 PM »
Another thing I've heard is that getting the fines is severely limited by the ACA. the IRS can only take it from your refund (if you get one) and is not allowed to lay any liens or fines on your property or bank accounts or get access any other way to fine you. So technically, if you don't get a refund, they can't fine you unless they change how the fines are to be levied.

Yep; the ACA itself prevents the IRS from basically doing anything but taking it out of refunds (either individually or from a member of a household if another in the household picks up a fine) and sending strongly worded letters. It was pretty clearly a political move to make sure there weren't any "ACA Martyrs" going to prison for refusal to pay the fine but it does pretty severely neuter the stick in this stick and carrot approach.

On the death spiral, what happened in Massachusetts? From what I can recall the uptake from young people (and men in particular) was very low right up to the last minute, at which point a rush occurred. Does anyone more familiar with the situation know what that did to premium costs? 

Offline didoanna

Re: ACA
« Reply #120 on: November 08, 2013, 03:52:36 PM »
I doubt that the average person on the street knows exactly what socialism is, only that some guy running for office said it was bad.

That's cynically brilliant!

Offline Oniya

Re: ACA
« Reply #121 on: November 08, 2013, 03:54:29 PM »
Try it for yourself.  Next time someone says that something is 'socialist', ask them what that means.

Offline consortium11

Re: ACA
« Reply #122 on: November 08, 2013, 04:48:35 PM »
Try it for yourself.  Next time someone says that something is 'socialist', ask them what that means.

To be fair, ask a Marxist, Leninist, Trotskyist, Stalinist, Maoist, Cuban theorist, anarcho-communist, anarcho-syndicalist and a European social democrat what "socialism" is, they'd all give you a different answer despite all on the face of it being socialist thinkers. Hell, Marx and Bakunin couldn't agree on what a socialist was and those two are basically the founding fathers of modern socialism.

All the terms for political positions cover a wide variety of basis... "conservative" means very different things to different people, let alone a term like "right wing" which depending on who you ask covers everything from strict anarcho-capitalists to hardcore libertarians to one-nation Torys to neo-liberals to extreme war hawks to fascists. Socialism's no better or worse than the others... although socialists do have a habit of falling apart over their differences (and occasionally killing each other) more than other political positions tend to...

Offline Oniya

Re: ACA
« Reply #123 on: November 08, 2013, 04:53:20 PM »
I'm willing to bet that the average American wouldn't be able to give a definition at all, or that their definition would make any and all of your trial subjects wonder what the American was smoking.  It's basically hit the same 'catch-phrase' status that 'communist' had before the Cold War ended.

Offline Valthazar

Re: ACA
« Reply #124 on: November 08, 2013, 11:31:43 PM »
The way I see it, any sensible person could see that ACA has nothing to do with socialism, other than to Rush Limbaugh and Glenn Beck, and their supporters.  It criticizes the ACA for the wrong reasons.
« Last Edit: November 08, 2013, 11:42:21 PM by ValthazarElite »

Offline Valthazar

Re: ACA
« Reply #125 on: November 08, 2013, 11:43:02 PM »
Sorry had some weird posting issues, but I think got it fixed now.

On the death spiral, what happened in Massachusetts? From what I can recall the uptake from young people (and men in particular) was very low right up to the last minute, at which point a rush occurred. Does anyone more familiar with the situation know what that did to premium costs?

Glad you brought this up, because I think Romneycare was far more successful in its rollout, as compared to ACA. 

Before getting into the death spiral, it's important to look at some preliminary differences.  In 1996, Massachusetts passed an isolated law that banned insurers from refusing coverage because of pre-existing conditions, and selling premiums at similar rates.  This is completely separate from Romneycare.  This law is often known as “guaranteed issue” and "community rating."  In theory, this is a great clause, but what ends up happening is, people will wait until they get really sick, and only when they get sick will they get insurance.  In other words, people will just wait until they get diagnosed with cancer, then get health insurance.  Very cost ineffective, and there was a huge problem with premium rate increases for many years.  This led Massachusetts to have the #1 cost of healthcare, and premium rates in the country.

So, in 2006, Romneycare 'added on' to this existing law, by mandating everyone to buy insurance, along with providing subsidies to make it affordable.  In other words, the timing of these various provisions were staggered.  So basically, this created a sudden, across the board, premium decrease, as a result of the mandates and subsidies.  With the ACA, what is happening is that the "guaranteed issue" clause is being passed into law at the same time as the individual mandate and subsidies - creating a perfect storm, which is what is causing certain plans to be dropped, and thus, rate increases for people with sub-standard insurance - like for example, phaia's situation.

http://www.bostonglobe.com/opinion/2013/11/06/why-was-romneycare-rollout-smooth-and-obamacare-buggy/eLqidsI56zFW1gI0QP2taK/story.html

Now, with regard to the death spiral, it is very important to realize that under ACA and Romneycare, people can stay on their parent's health insurance plan until age 26 and 25, respectively.  This means that if their parents are enrolling for health plans through ACA, many young adults ages 18-25 will thus be getting insured as a result as well.  Because of this, the real death spiral effect will be focusing on the enrollment of young adults from age 25 to 34, or so - because these are the real young adults who are having a choice as to whether to enroll, or pay a penalty fee.

Here's the official Massachusetts Health Insurance Survey data from 2011.  Go to page 15 of the PDF (or page 11 of the document itself), and look at that graph at the bottom:
http://www.mass.gov/chia/docs/r/pubs/13/mhischartpack-1-29-13.pdf

You'll see how there's actually a decrease in the number of uninsured ages 19-25 in Massachusetts from 8% in 2008 to 6% in 2011.  This is largely because many of these individuals were now automatically getting coverage through their older parents' newly minted Romneycare plans.  However, look at the number of uninsured from ages 26-35 - there is an increase from 3% to 6%.  This is the evidence suggesting decreasing enrollment among young people - and arguably representative of the death spiral effect (albeit, to a lesser degree than with ACA, due to the reason above).

As far as the premium rates themselves, you're really going to find opinions going both ways.  The reality is that in comparison to other states, Massachusetts has consistently had a higher than average growth in premium rates after the passage of Romneycare, but granted, this higher than average growth has slowly been declining.  Some attribute this decline to Romneycare itself, as a tribute to its success, while others say that this decline was inevitable considering the drastic initial hike in premiums immediately after the passage of Romneycare. 

In other words, because this was a state-based health reform, and there are essentially only a few health insurance companies in MA, there's a school of thought that these insurance companies colluded with one another and artificially spiked premium costs, fully aware that a healthcare mandate was in the works.  It's really a very complex issue, since a very significant portion (nearly half) of Romneycare is funded through federal subsidies.  As a result, its cost efficiency, as compared to ACA is difficult to measure.

http://www.washingtonpost.com/blogs/wonkblog/wp/2012/09/21/how-romney-paid-for-romneycare/

Maybe someone who lives in Massachusetts can speak more directly about premium rates.  In a nutshell, yes, premium rates have increased.  Whether or not the blame can be attributed to Romneycare is questionable - and you'll get a different answer depending on if you read a Republican or Democrat columnist.

Ironically, most Democrats will defend Romneycare and attribute the gradual decline in premium growth (despite still being above US averages) to Romney's plan, while most Republicans will criticize continued rising costs as a failure of Romneycare.
« Last Edit: November 09, 2013, 12:15:36 AM by ValthazarElite »

Offline kylie

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Re: ACA
« Reply #126 on: November 09, 2013, 03:00:02 AM »
With regard to healthcare, I was speaking about how premiums are determined today (either pre-ACA or post-ACA).  Certainly, under ACA, no one can be denied health insurance due to pre-existing conditions, but premium rates are still variable based on age, health, and status of the individual. 
          Well thanks for bopping back.  I think we may just have a fundamental philosophical disagreement somewhere.  But if you were really only concerned about ACA, that makes it somewhat more understandable I suppose.  Some other people have popped in saying more or less that the government simply can't handle health care at all -- in ways that seem quite reminiscent of the Tea Party to me (not saying they are necessarily people who support the Tea Party, but some things do end up pushing in the same direction with many of the same claims).  And as I have tried to make abundantly clear, at least on the surface of it, there are some commonalities between some of your points of emphasis and some of theirs / those of some other radical withdrawal supporters I have seen on the web.   

         It seems to me that the question of pre-existing conditions being covered or not is a rather big deal.  And further...  Though you may not have been on about this, if one accepts your logic in principle that the nature of the healthcare industry must be to focus on differential risk and assign people very different fees based on likelihood of so many specific conditions (in addition to more general groupings such as age etc.), then I think we would still end up (when all is added together) with a situation that may not be so healthy for women (and other classes of people) generally, and will have some heavy social costs somewhere else.  Though it's arguable enough they're costs that people have started to accept as inevitable, and in that case women and various other groups are just doomed...  And that, well, call me crazy -- but I'm just not willing to accept that as the best we can do.

Quote
I already posted about my views earlier in this thread as to what I consider the optimal solution.  That would be focusing heavily and incentivizing the creation of full-time job opportunities (through tax subsidies for businesses creating entry level jobs, full-time positions, etc.), and naturally creating avenues of opportunity for people to purchase private insurance on their own.  While I did not vote for Obama in 2008, nor do I agree with many of his perspectives, I at least found his original healthcare proposal to be sensible, and fundamentally sound.  It made sense, and whether or not I agreed with it, it would at least provide one solution to expanding coverage and reducing healthcare costs.
          If I'm not mistaken, Cyrano had several rejoinders to your suggestions (I believe I'm still thinking of the same thread, it's been a few days).  I think I share a lot of his concerns, and I didn't feel like they'd really been answered quite to my satisfaction.  I didn't bother posting just to repeat/ cheerlead what I feel he'd said in more succinct and poignant words. 

           However, I must grant you that I'm not reading every single line carefully.  There are some more technical arguments and hypothetical cases people have tossed, where if I think we probably have some difference in principle, then I just may not be so interested.  This is perhaps lazy on my part, but there has been a lot of discussion here never mind anything/anywhere else I might prefer to read, and I'm looking for things that I feel I understand -- and honestly, have some good feeling about -- in shorter form first, as I go along.  If it feels problematic to me on the face even "somehow," then I sometimes skim on or let it go.  Short of serious debt relief, even a substantial change in future arrangements isn't going to serve me personally in the next couple years probably anyway...  So I'm a little low on enthusiasm when it starts to feel like picking over mechanics. 

Quote
I am not disagreeing with the ideology of what you are saying,
         Trying to be fair...  But I honestly kind of wonder if you aren't.  I have become more inclined to agree that ACA itself has serious problems (and this isn't entirely surprising after all the wrangling and modification the original ideas faced -- but it is quite disappointing).  That said, some of the broad claims you make about the role of business, the potential for enterprise finance to elevate people who seem to be politically locked into really oppressive environments, the apparently 'unchangeable' nature of insurance...  I'm not sure where you think the limits are on the influence and benefits of business as we know it. 

Quite often, I somehow get the impression that at the end of the day, you'd end up feeding many of the same cycles by relying on an overall economic model that's already pretty well defeated the people.  Maybe you just think that's the farthest we can safely go, and you might prefer more...  But where does cynicism turn into surrender, and where does "optimism" slide into simply being a servant of gross inequality (optimism for the managerial handful, and profession of their philosophy that everyone will "someday" do better if they just keep imitating wealthier people)?  I don't know.  That's sort of my gut feeling. 

         I suppose if you prefer, you might say well this is all well beyond discussing ACA, but if these are also issues that caused the dilution of the original concept, then I think it's kind of relevant.  Of course anyone could say let's not talk about anything elsewhere in society here -- you can just go on repeating, oh I don't disagree, oh but I'm only here to recite the problems with the ACA (are you?); see elsewhere for other matters.  And then it kind of seems to me, politics remains neatly compartmentalized into "narrower topics."  Such that no one can suggest anything innovative or radical about whatever say, gross economic inequality has to do with campaign finance, lobbying, the intense focus on corporations as supposedly irreplaceable 'partners' in change (really?!), etc. which make up the health care crisis.
« Last Edit: November 09, 2013, 03:05:16 AM by kylie »

Offline Valthazar

Re: ACA
« Reply #127 on: November 09, 2013, 08:55:23 AM »
kylie, I do appreciate your views on issues, and I am more than open to discussing them.  But it's difficult to debate ideologies without having any sources to know what you are basing your criticism and views on.  From what I understand, you are saying that on a purely ethical level, individuals should be able to get health insurance despite pre-existing conditions, and that premium rates should be the same for all individuals - regardless of age or sickness.

I acknowledged this point of view in my last post, and I actually went into depth explaining how in 1996, Massachusetts passed its guaranteed issue and community rating law, doing exactly what you say.  I then cited sources explaining some of the impacts of this law, and the fact how Massachusetts has received considerable federal funding for Romneycare in 2006.  Part of the reason Massachusetts received immense federal funding for Romneycare is because its cost of healthcare was sky-high, and number one in the nation due to the 1996 legislation.  If you feel that this type of stand-alone legislation is feasible regardless of its costs, I would be interested in seeing sources demonstrating that.

"The new federal bill [guaranteed issue in 1996] would expand those rules to the entire nation. Under guaranteed issue, insurers must accept all enrollees regardless of their medical condition; under community rating, they must charge all customers similar premiums, even if their costs are far different. The result is that prices rise steeply for young, healthy customers, who must pay far more than their actual costs. It also give them a strong incentive to drop insurance; then they can "game the system" by signing up any time they need surgery or get diabetes."
http://money.cnn.com/2010/06/15/news/economy/massachusetts_healthcare_reform.fortune/

"Hence the pool of insured people gets older and sicker as the healthy drop out. That's what happened in Massachusetts, and it contributed to soaring premiums. The 2006 reform plan (Romneycare) was supposed to solve the problem by requiring that everyone buy coverage or pay a fine of around $1,000. It worked, but only in part: Of the 600,000 uninsured in 2005, around 450,000 are now covered. But a large share of 150,000 who still lack coverage are young residents who choose to pay the fine instead of high premiums. Insurers are also getting socked by people who sign up for insurance to get expensive care mandated under state law, including hospitalization for childbirth or hip replacements, and then depart once the procedure is completed."
http://money.cnn.com/2010/06/15/news/economy/massachusetts_healthcare_reform.fortune/

I am interested in a healthy discussion, and I am sure there is merit to many of your views.  But without having sources for me to read about the arguments in support of your views, it is difficult for me to engage them.  I looked back through this thread, and Cyrano has not posted in this thread, so I couldn't find any sources there either.  So far, all I have done is report some of the differences between the ACA and Romneycare, and given some current figures on how insurance companies are responding to the ACA, and provided extrapolations on what might potentially happen, based on what happened in Massachusetts.

If you feel there are more innovative, and outside-the-box solutions, we can certainly discuss that.  As I told Kythia though, I am not really very strong when it comes to defining "ideal" policy for health insurance companies, and can only provide opinions of their response.  Most of what I have been saying so far, has basically just been what I have read and researched regarding the current initial response to ACA.
« Last Edit: November 09, 2013, 09:27:11 AM by ValthazarElite »

Offline vivaciousvixen

Re: ACA
« Reply #128 on: November 11, 2013, 10:58:27 AM »
I think the ACA has noble intentions, but it was very poorly crafted legislatively and economically.  As I have said previously, it will artificially cause premiums for non-ACA insurees to rise, and as a result, due to declining enrollments, may cause private insurers to drop coverage in certain target demographics and markets.

Obama had marketed the ACA with the promise in 2009, “if you like your health plan, you will be able to keep your health plan,” and even in 2012 was saying, “If [you] already have health insurance, you will keep your health insurance.”

http://www.cbsnews.com/8301-505263_162-57609737/obamacare-more-than-2-million-people-getting-booted-from-existing-health-insurance-plans/
http://investigations.nbcnews.com/_news/2013/10/28/21213547-obama-admin-knew-millions-could-not-keep-their-health-insurance?lite

Basically, as the law was originally written, all health insurance plans as of March 23, 2010 would be 'grandfathered' in, and the ACA would not cause their insurers to modify their plans in any manner.  However, since then, the Department of Health and Human Services wrote changes that said if any part of a policy was changed since that date, for example, the deductible, co-pay, or benefits (which is pretty normal, considering how frequently slight modifications occur in most insurance plans), that the policy would not be grandfathered.  So that's the situation we are in now.

Many individuals in their 20s are choosing to not purchase health insurance under ACA, and would rather pay the tax penalty, which is another financial uncertainty for insurance companies.  If you've just graduated from college, healthy, and tight on cash, would you rather pay extra for insurance you'll probably never use, or just pay a lower penalty fee to the government?  When the ACA was written, the young, uninsured demographic was supposed to the prime source of premiums to help pay for the medical care for the unemployed and uninsured older population - but the strength of this plan is increasingly under question now.  Many insurance companies are approaching the ACA from a risk management perspective, (since it is an external pressure on their industry) and trying to do financial damage control at this point.

I can't really say much about the technical glitches/issues with the website.  I guess those will be sorted out in due time.  It's a blessing that most small to midsize businesses will have until Jan 1 2015 to comply, because many of them are seriously unsure about all the uncertainties surrounding ACA.  I've tried to explain the ACA to my friend, who is working on a business plan, and it's frustrating when I can't provide him all the answers because the law is so vague with regard to business requirements.

Well said ValthazarElite. You and I share many of the same views on this issue. A class in economics can explain why the ACA is a terrible plan for the U.S. as it stands.

Offline Kythia

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Re: ACA
« Reply #129 on: November 12, 2013, 12:25:33 PM »
Well said ValthazarElite. You and I share many of the same views on this issue. A class in economics can explain why the ACA is a terrible plan for the U.S. as it stands.

Odd, I would have expected at least one of the democratic party to have taken a class in economics.  What a weird statistical fluke.

Unless, maybe, the lessons learnt from such a class aren't as unambiguous as you claim?  Nah, no democrats ever took an economics class, that's far more likely.

Offline Valthazar

Re: ACA
« Reply #130 on: November 12, 2013, 01:05:10 PM »
Odd, I would have expected at least one of the democratic party to have taken a class in economics.  What a weird statistical fluke.

Unless, maybe, the lessons learnt from such a class aren't as unambiguous as you claim?  Nah, no democrats ever took an economics class, that's far more likely.

It has nothing to do with Democrat or Republican.  Many Democrats are expressing concern over ACA as well.

"A rising tide of Democrats has begun voicing support for easing the deadlines and penalties of the Affordable Care Act, showing the first cracks in party unity against GOP opposition to the health care law.  A prominent 2014 Senate Democratic candidate, Michelle Nunn in Georgia, on Thursday endorsed delaying the requirement for individuals to buy insurance.  A House Democrat, Rep. John Barrow of Georgia, also called for delaying the individual mandate in a floor speech this week, citing the administration's prior decision to delay for one year a separate requirement for employers."

http://www.usatoday.com/story/news/politics/2013/10/24/democrats-waver-obamacare-delay-hagan/3181655/

Interestingly, the Obama administration's 'prior decision to delay' was pushed by Congressional Republicans.

Offline Kythia

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Re: ACA
« Reply #131 on: November 12, 2013, 01:07:32 PM »
It has nothing to do with Democrat or Republican.  Many Democrats are expressing concern over ACA as well.

"A rising tide of Democrats has begun voicing support for easing the deadlines and penalties of the Affordable Care Act, showing the first cracks in party unity against GOP opposition to the health care law.  A prominent 2014 Senate Democratic candidate, Michelle Nunn in Georgia, on Thursday endorsed delaying the requirement for individuals to buy insurance.  A House Democrat, Rep. John Barrow of Georgia, also called for delaying the individual mandate in a floor speech this week, citing the administration's prior decision to delay for one year a separate requirement for employers."

http://www.usatoday.com/story/news/politics/2013/10/24/democrats-waver-obamacare-delay-hagan/3181655/

Interestingly, the Obama administration's 'prior decision to delay' was pushed by Congressional Republicans.

That wasn't the point I was making, and I suspect you're aware of that.

Offline vivaciousvixen

Re: ACA
« Reply #132 on: November 12, 2013, 02:09:49 PM »
@Kythia That was not to say they never took a class in economics....perhaps they are just forgetting their lessons. As was explained earlier in this thread by other posters, all the ACA is doing is inflating the cost of insurance and causing many people who already had established health insurance to lose their plans, when they were told by the President that they could retain their plans.

Offline Kythia

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Re: ACA
« Reply #133 on: November 12, 2013, 02:28:12 PM »
@Kythia That was not to say they never took a class in economics....perhaps they are just forgetting their lessons. As was explained earlier in this thread by other posters, all the ACA is doing is inflating the cost of insurance and causing many people who already had established health insurance to lose their plans, when they were told by the President that they could retain their plans.

Mmmm.  This is my concern:  Your point seems to be that the negative effects of ACA are basic common sense.  And yet a number of people in the US without noticeable mental defects appear to think the act is a good idea.  So either you're saying that a number of people in the US can't see a simple, basic, common sense problem with something despite not being institutionalised or wards of the state or you're saying...what?

It doesn't bother me in the slightest, I'm in the UK.  But it seems you simply must be overstating your case as otherwise - if the objection really is so simple - you have a heavy burden to lift in explaining why ACA isn't universally disliked and, in fact, how it ever became law in the first place.  Having problems/issues/concerns with it is fine and dandy.  Stating that those problems are so basic that failure to understand them indicates a basic lack of understanding of the world flies in the face of both reason and Nobel Prize in Economics Winner Paul Krugman who, you know, presumably hasn't forgotten his economics.

As I say.  Object to it by all means, but try not to overstate your case so radically.

Offline Valthazar

Re: ACA
« Reply #134 on: November 12, 2013, 03:52:00 PM »
Stating that those problems are so basic that failure to understand them indicates a basic lack of understanding of the world flies in the face of both reason and Nobel Prize in Economics Winner Paul Krugman who, you know, presumably hasn't forgotten his economics.

The reputable pro-ACA sources that I did find, such as the one above, were basing their analysis on the assumption that all individuals with employer-based healthcare plans currently would retain them.  Krugman's article is no different.

"How would ObamaRomneycare change American health care?  For most people the answer is, not at all. In particular, those receiving good health benefits from employers would keep them. The act is aimed, instead, at Americans who fall through the cracks, either going without coverage or relying on the miserably malfunctioning individual, “non-group” insurance market."
http://www.nytimes.com/2012/03/19/opinion/krugman-hurray-for-health-reform.html?_r=0Paul%20Krugman

We already know this isn't the case.  Many of the people who voted for Obama in 2012 truly believed these types of articles (especially considering that this article was written in March 2012).  Part of the reason there is a backlash now, is because the ACA was marketed on a premise that was largely economically unfeasible - which is, the idea that rates would remain the same, and current private insurance holders would not be affected.  Honestly, if I was uninformed about this issue, and had read that article in March of last  year, I would be struggling to understand why people are so opposed to ACA.

Krugman is an incredibly smart man, and has some excellent articles, but his lack of clarification on economic matters, such as assuming coverage will not be dropped, largely detaches his views from the reality of how the response already is.  The assumptions themselves are not backed up, at least in the articles I've come across.
« Last Edit: November 12, 2013, 06:04:34 PM by ValthazarElite »

Offline Phaia

Re: ACA
« Reply #135 on: November 12, 2013, 04:05:10 PM »
Mmmm.  This is my concern:  Your point seems to be that the negative effects of ACA are basic common sense.  And yet a number of people in the US without noticeable mental defects appear to think the act is a good idea.  So either you're saying that a number of people in the US can't see a simple, basic, common sense problem with something despite not being institutionalised or wards of the state or you're saying...what?

It doesn't bother me in the slightest, I'm in the UK.  But it seems you simply must be overstating your case as otherwise - if the objection really is so simple - you have a heavy burden to lift in explaining why ACA isn't universally disliked and, in fact, how it ever became law in the first place.  Having problems/issues/concerns with it is fine and dandy.  Stating that those problems are so basic that failure to understand them indicates a basic lack of understanding of the world flies in the face of both reason and Nobel Prize in Economics Winner Paul Krugman who, you know, presumably hasn't forgotten his economics.

As I say.  Object to it by all means, but try not to overstate your case so radically.


So Kythia I have to ask, with you being in the UK and not bothered in the slightest...why all the fuss from you about ACA Anyway? it is not like it effects you?

Phaia

Offline consortium11

Re: ACA
« Reply #136 on: November 12, 2013, 07:28:54 PM »
Stating that those problems are so basic that failure to understand them indicates a basic lack of understanding of the world flies in the face of both reason and Nobel Prize in Economics Winner Paul Krugman who, you know, presumably hasn't forgotten his economics.

No, but Krugman's Nobel Prize and the respected portions of his work relate to international economics and trade, specifically international geography and what became known as the "new trade theory". That's what he's specialized in and what he's spent the serious academic portion of his life writing about on and working on. Using his Nobel prize as evidence for his understanding of a topic which isn't related to international economics (and ACA isn't) is pretty close to an appeal to authority. This seems to happen a lot in certain fields... science is one and economics is another... where people look at an individual, see they are experts and almost universally respected in one area of a field and then assume they are experts on all areas related to it. We don't present a pulmonologist... however eminent... as an expert on cardiology because of their work on the lungs and that they're a medical expert; they're a medical expert on pulmonary issues, not cardiology.

That's not to say that Krugman is necessarily wrong on ACA but he's not an expert on the economics on health care and isn't considered a particularly respected figure in that field; you'd look to the likes of Michael Grossman and Sherm Folland for that, just as one would turn to Krugman for works on international trade. That shines through when you read his pieces on the economics of healthcare; they're low level op-eds, not serious academic discussion. It also has to be said that over recent years Krugman has had a tendency to bend his economic theories and analysis to fit his political positions rather than his political positions to fit his economic theories and analysis... I suspect at least partially due to the monetary value he gets by being the "go-to" man for economic discussion on the left of the political spectrum... in the same way that say Robert P. Murphy bends the facts to fit his Austrian theories rather than his theories to match the facts.
« Last Edit: November 13, 2013, 05:40:51 PM by consortium11 »

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Re: ACA
« Reply #137 on: November 13, 2013, 04:22:27 PM »
In order:

Valthazar - yes.  My comment was more aimed at Vivaciousvixen than at you.  My objection was to her blanket statement that the subject was cut and dried with a clear right and wrong.

Phaia - It doesn't affect me personally, no.  It does actually affect a few friends of mine but that's not why I'm saying anything.  I'm vaguely surprised at what I see as the implication behind your question though, that only things that affect one personally are worthy of consideration. 

Consortium - Yes, excellent points and I was perhaps lazy in appealing to Krugman.  It was tied in to my comment above to Valthazar, that I was trying to show that there wasn't a simple, universally accepted, "right" answer to the conversation.  But its a fair criticism.

Offline Valthazar

Re: ACA
« Reply #138 on: November 14, 2013, 03:44:57 PM »
A few people in this thread have asked what sort of healthcare policy I believe would be ideal, so I figured I would outline my views.

One of main misconceptions is that the American healthcare system prior to the ACA was a purely privatized, free-market paradise.  This is the not case, as over 73 million people are on Medicaid (not even including Medicare), which exceeds the population of the UK, or even France.  As a result, ideologically, the ACA really isn't a threat to American principles, considering we have already accepted Medicaid and Medicare.  In contrast, the primary issues at hand are the high cost of healthcare, and as a result, an inability to purchase insurance.

Currently, most Americans that do have health insurance obtain it through their employers, and receive healthcare at quite affordable rates.  There is a law in place which provides tax exclusion for employer-provided health coverage.  This means that employers receive tax breaks for whatever percentage they subsidize healthcare costs, and the employees (recipients), do not have to pay taxes on this subsidy.  This is a seemingly excellent and ideal situation, however, the fact that there are no caps on this tax exclusion, is what many feel is the primary reason for rising healthcare costs. 

In other words, because there is no cap, employers are increasingly covering an increasing percentage of insurance costs (routinely 75-80%) these days, since the more they cover, the greater tax reduction they get.  Again, this seems ideal.  However, the counter effect is that because of these large employer subsidies, many employees are increasingly choosing expensive and extensive plans, since their portion of payment will remain the same, even though the empirical cost of insurance as a whole is higher, as priced by the insurance company.

Although at first glance, it might seem like it is a great thing that employers are continuing to pay a large portion of these high premiums, look at the math for a second.  The reason employers are so willing to pay these increasingly high percentages of rising premiums, is because they are getting more tax breaks from the government for doing this.  In other words, it is actually the government itself that is fronting the majority of rising healthcare premium increases.  As insurance costs rise, and employers continue to subsidize a large portion of the premium costs for their employees (due to the tax break incentives), the amount the US government is giving back in tax breaks continues to rise.  It took me a second or two to understand this reasoning.

As a result, I suggest putting a cap on these tax breaks.  It is a fantastic program and one that we truly need - but without a limit, we are actually contributing to the rising cost of healthcare.  By setting a cap on these tax breaks, it will naturally make employees more cost-conscious with regard to which plans they opt into through their employers, and increase competition among insurance companies themselves to appeal to employers for hosting. 

In addition, by adding a cap on tax exclusion for employer-provided heathcare, the government will actually have much, much, more revenue (since they are giving out far less tax breaks).  This additional revenue would be used to subsidize catastrophic coverage for individuals that do not have health insurance.  In other words, this will directly reduce healthcare costs in hospitals for people involved in car accidents and who have heart attacks.  The best part is, there would be no premium at all for this - and purely subsidized through the government.  The idea of people with pre-existing conditions being denied  would also be resolved, since they would have their own coverage pool (in line with a similar program to ACA), however with the increased tax revenue directly subsidizing the high premiums for this at-risk group.

Based on the research I have done, this sort of model is a far more fiscally sensible plan, and unilaterally targets the foundational problem - high costs of healthcare. 

It is not a humanitarian plan, however, like the ACA was marketed as, and does not make any promises for increasing healthcare coverage for elective procedures or care.  However, as a cost reductive program, it would be a blessing for the US, and reduce all of our premiums.

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Re: ACA
« Reply #139 on: November 14, 2013, 03:48:05 PM »
So what do you think of pure government funded healthcare, without the insurance companies at all.  I'm thinking, obviously, of our NHS but its not the only example.

Offline Valthazar

Re: ACA
« Reply #140 on: November 14, 2013, 04:02:29 PM »
The NHS is a functional system and it works for the UK, that's for sure, but I would not consider it to be an ideal model. 

I say this because I like having choices.  I certainly realize that a minority of people in the UK have private insurance, but it is arguably out of reach for many.  The employer-subsidized model in the US is not at all a bad way of doing things, and for those who have employer-provided healthcare, it is very affordable, and we get plenty of choices.  People with full-time jobs with benefits get many options, choices, plans, doctors, deductibles, etc - at arguably the same premium contribution (taking into account what the employer is playing) as you in the UK are paying through through your cumulative NHS funding.  Basically, for people with stable jobs, the American healthcare system is actually superior to the UK one - at least from their perspective.

The problem is, not enough people have access to these full-time jobs with benefits.  As a result, the solution lies in expanding these opportunities, and in reducing costs.  I believe that if you can restore the fundamentals of the economy, most of the battle will be won.  That's why the solution I outlined above addresses the economics of the matter, which moves us in the right direction.

They key is to get more full-time jobs.  But that's another discussion entirely.
« Last Edit: November 14, 2013, 04:06:49 PM by ValthazarElite »

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Re: ACA
« Reply #141 on: November 14, 2013, 04:28:23 PM »
Hmmm.  Healthcare in the US costs twice what it does in the UK as a percentage of GDP, and the individual spends around 150% of the UK total - stats from here but there are multiple sources.  We also have a higher life expectancy and more doctors and nurses per capita.  I'm not certain that "People with full-time jobs with benefits get many options, choices, plans, doctors, deductibles, etc - at arguably the same premium contribution (taking into account what the employer is playing) as you in the UK are paying through through your cumulative NHS funding." holds.  But that's very much a side issue and I'm not sure its productive to dwell on it.

The main issue is what precisely do you mean by "choices"? I'm a little confused by your word usage there.  Choices on what?  I'm not entirely sure what you're getting at there.  Do you mean choice of location for medical procedures?  Choice of doctor?  Choice of which procedure to have?  We have all those things.  I'm really not certain what "choices" refers to in this context.

Offline Ebb

Re: ACA
« Reply #142 on: November 14, 2013, 07:36:49 PM »
In other words, because there is no cap, employers are increasingly covering an increasing percentage of insurance costs (routinely 75-80%) these days, since the more they cover, the greater tax reduction they get.  Again, this seems ideal.  However, the counter effect is that because of these large employer subsidies, many employees are increasingly choosing expensive and extensive plans, since their portion of payment will remain the same, even though the empirical cost of insurance as a whole is higher, as priced by the insurance company.

The employer-subsidized model in the US is not at all a bad way of doing things, and for those who have employer-provided healthcare, it is very affordable, and we get plenty of choices.  People with full-time jobs with benefits get many options, choices, plans, doctors, deductibles, etc - at arguably the same premium contribution (taking into account what the employer is playing) as you in the UK are paying through through your cumulative NHS funding. 

Do you have cites for either of these facts? They run directly contrary to my experience, and what I've read. In general the trend seems to have been employers putting a higher percentage of insurance costs on their employees. After all, even if there is a tax reduction for increased insurance subsidies by the employee, that reduction is far short of 100%. It still costs the company more to provide better benefits. To the extent that this is useful as a recruiting and retention tool it is worth the company's money. But it's hardly free for them.

I'd also dispute that having employer-supplied benefits results in more choice for the employee. On the contrary, the vast majority of companies offer only a very few options. Perhaps you're focusing mostly on very large corporations? I have worked at companies ranging from six employees to about thirty thousand, and it was only at the very largest that there was any substantive choice in plans available (beyond 'family' vs. 'single')

My opinion is that the marriage of full-time employment and availability of health insurance is an historical accident that does far more harm than good. Before the ACA, for instance, it was not uncommon for someone with a chronic medical condition to be essentially bound to their current job for fear that switching companies would result in a failure for the new insurance provider to cover their treatment. This results in a suppression of the free market in terms of peoples' ability to choose their own jobs.

I'd be very interested to hear the other side of the argument, though.
 

Offline Valthazar

Re: ACA
« Reply #143 on: November 14, 2013, 08:50:30 PM »
Hmmm.  Healthcare in the US costs twice what it does in the UK as a percentage of GDP, and the individual spends around 150% of the UK total - stats from here but there are multiple sources.  We also have a higher life expectancy and more doctors and nurses per capita.  I'm not certain that "People with full-time jobs with benefits get many options, choices, plans, doctors, deductibles, etc - at arguably the same premium contribution (taking into account what the employer is playing) as you in the UK are paying through through your cumulative NHS funding." holds.  But that's very much a side issue and I'm not sure its productive to dwell on it.

I completely agree with you regarding the cost efficiency of the NHS system on healthcare spending per capita.  As I said in my post, the UK has a functionally sound, efficient system in comparison to the current state of private insurance in the United States due to a variety of economic factors (rising unemployment, reduction in full time jobs, etc.).  However, per capita healthcare spending is an aggregate individual average for expenditure based on all individuals taken together (whether or not they have insurance).  My statement in my last post, regarding the private insurance industry being superior for some Americans, was purely with regard to those Americans who are receiving employer-subsidized healthcare, and their particular net expenditure, on their own healthcare.  In other words, to do a proper analysis, we would need to compare an American woman's individual contribution to her health premiums for a year, versus a British woman's empirical $/£ amount of their taxes, that goes to fund NHS.  Both individuals would need to be identical as far as their incomes and attributes, but I agree with you, that this type of analysis is largely a moot point when discussing the overall efficiency of the system at large.  Your point certainly still stands, that %GDP spending is considerably higher in the US vs. UK, and one that I never refuted.

As far as choice, I was actually referring to monetary freedom, as well as healthcare choice freedom (and obviously these views here reflect the pre-ACA landscape).  Private insurance is quite affordable to the average full-time employed individual, while in the UK, private insurance is largely out of reach for the average full-time worker.  I'll address Ebb's point regarding the number of private insurance choices below, but in an ideal economic climate, the average American full-time worker will have more flexibility in obtaining a plan that fits his/her desires and needs.  For example, in the UK, the National Institute for Health and Clinical Excellence (NICE) determines which drugs and treatments will be covered under NHS.  I like knowing that if I choose to purchase the highest-tier private insurance through my employer, which is affordable, albeit a little pricey in comparison to other plans the employer offers, that I can receive superior coverage, far beyond what the NHS would offer.  If a similar person of similar income were living in the UK, the likelihood that they could even afford a similar private plan is unlikely.  There's both pros and cons to both healthcare models, and we can both form opinions on what we feel is logistically better in our perspective.

The unfortunate reality with such a situation though - and one can hold differing ethical views on this - is that part of the reason I have the ability to opt into a little pricey yet affordable private insurance is because there is a significant population in the US that is not receiving healthcare access.  This goes back to my original point, that the real factor here is bleak economic prospects, and lack of good jobs that offer employer-subsidized private insurance.  I believe that emphasizing premium cost reduction in American healthcare will naturally allow our healthcare model to function with more efficiency and access - in addition to necessary legislation.

Do you have cites for either of these facts? They run directly contrary to my experience, and what I've read. In general the trend seems to have been employers putting a higher percentage of insurance costs on their employees. After all, even if there is a tax reduction for increased insurance subsidies by the employee, that reduction is far short of 100%. It still costs the company more to provide better benefits. To the extent that this is useful as a recruiting and retention tool it is worth the company's money. But it's hardly free for them.

I'd also dispute that having employer-supplied benefits results in more choice for the employee. On the contrary, the vast majority of companies offer only a very few options. Perhaps you're focusing mostly on very large corporations? I have worked at companies ranging from six employees to about thirty thousand, and it was only at the very largest that there was any substantive choice in plans available (beyond 'family' vs. 'single')

My opinion is that the marriage of full-time employment and availability of health insurance is an historical accident that does far more harm than good. Before the ACA, for instance, it was not uncommon for someone with a chronic medical condition to be essentially bound to their current job for fear that switching companies would result in a failure for the new insurance provider to cover their treatment. This results in a suppression of the free market in terms of peoples' ability to choose their own jobs.

I'd be very interested to hear the other side of the argument, though.

Here are the "Share of premiums paid by employer and employee for family coverage" for 2013 from the Bureau of Labor Statistics

http://www.bls.gov/news.release/ebs2.t04.htm

Based on that data, employers seem to be covering premium costs in the high 60s to mid 70s percentages.  I would agree with you that it is by no means a free endeavor for companies, and the tax breaks the government is offering for greater percentage coverage by employers is by no means fully eliminating the cost involved.  However, like you said, its use as a recruitment and retention tool, in addition to its strong tax break incentives have made this a generally accepted, and growing, practice among American employers.

Again, I fully agree with you that there are many negatives to our current model of healthcare.  The reality is that our current economic climate just isn't compatible with the way our private insurance industry is set up.  Historically, there used to be a time in the US when it was "normal" for the average person to stay with one company their entire life.  That isn't the reality anymore.  In addition, there used to be a time when insurance companies really did compete with one another (before these mega-insurance conglomerates).  When you have truly efficient competition, without today's insurance lobbying, you'll actually have multiple smaller insurance companies competing with one another to get "contracts" for small business employers.  Basically, the insurance company which offered the most plan varieties would win the contract.  But you're right, those days are slowly dying away, and in some cases, are gone.  Several states have only 2 insurance providers now, and as you can imagine, they illegal collude with one another to prevent true competition.  So far, we've done our best with Medicaid and Medicare, to prevent people from slipping through the cracks, but it really isn't enough. 

The real question then becomes, do we unilaterally find fault with the infrastructure and system itself of American healthcare, or do we find fault with the illegal practices?  Personally, I believe it is the latter.  I'll be the first one to say that modifications are absolutely necessary, but I think an attempt to massively overhaul the system will ultimately do more harm than good.

In this discussion, I'm really trying to analyze viable solutions that can realistically be achieved.  Whether we love it or hate it, the federal government can't just get rid of private insurers from dominating the healthcare industry, so suggesting a complete switch to an NHS-style system just isn't realistic (at least over the next couple of decades).  Some were saying the ACA was the first step in that direction, but as I have tried to convey in this thread, from what I can see, it seems to be causing more problems so far than improvements.

What I proposed above, involving "premium-free" emergency coverage to those without insurance, and highly subsidized premiums for at-risk individuals, and those with pre-existing conditions, seems to be the most sensible step in the right direction.  With a such system, no one will be "dropped" from their existing insurance plan (the only difference will be, employers may cover a lesser percentage of their premiums).  So in other words, the empirical cost of premiums won't change, but the amount most employees have to pay, might be higher.

It's not really a win-win situation, nor really a desirable one (who wants to pay more?).  But just seems to be the right way forward.
« Last Edit: November 14, 2013, 10:57:45 PM by ValthazarElite »

Offline Kythia

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Re: ACA
« Reply #144 on: November 15, 2013, 09:48:41 AM »
NICE actually stands for National Institute for Health and Care Excellence.  They have a few roles, one is analogous to the one served by the FDA in the US - making sure the next Thalidomide is taken off the market (leprosy aside).

One of the others, and the one you focus on, is making cost/benefit analyses for NHS clinical standards.  They examine every treatment and say yey or nay.

If I want a treatment NICE have said no to, though, I can still get that through the NHS.  I simply have to pay the difference between the "standard" NHS treatment and the one I want.  This is exactly the same as your proposed system - people who want a pricier option have to be able/willing to pay for it.

This payment - the difference between my desired product and the NHS one - can be paid either as out of pocket expenses or through a private medical insurance.  About 8% of people have private medical insurance - I'm actually one of them for reasons I don't plan on delving in to.  AXA - one of our biggest medical insurance companies though not actually the one I use - call their highest level of cover "Gold Cover".  It costs £17.75 per month.  The national average monthly wage for a female is about £2000 per month.  Private medical insurance is not at all out of the reach of most people, and I'd be intrigued to see your source for your claim that it is. 

Take up rates are so low for the same reason premiums are so low - the NHS provides an excellent level of care and so not only do people not need private coverage but the policies cover far less as the majority is covered by the NHS.

In essence, if people want to pay more to exercise a choice they are able to.  This seems essentially identical in outcome to the system you propose, except considerably cheaper and with considerably better medical outcomes for the basic case.

I think part of your argument is based on a misunderstanding of how the NHS, and the UK health market in general, works.

Offline Valthazar

Re: ACA
« Reply #145 on: November 15, 2013, 10:01:50 AM »
Kythia, clearly you are more familiar with the British healthcare system than I am, and I was never trying to suggest that the NHS is a bad way of doing things.

The NHS was never central to my argument though, and I only even brought the NHS into this conversation since you had asked for my views on it - and clearly I know very little.  The original argument I put forth was a proposition for how the American healthcare system can be reformed.  As I said in my last post, it's not realistically possible for us to transform ourselves overnight into a single-payer system, which certainly seems to have many positives, as you indicate. 

Perhaps Obama's original plan was a shift in that direction, but the current form of the ACA is far from accomplishing that goal.  The reality is, you're not going to see single payer in the United States anytime soon, because you can't just get rid of the private insurances.  All we can do is make modifications, and hope that over time, changes will occur - or as some say, we shift more towards single-payer.

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Re: ACA
« Reply #146 on: November 15, 2013, 10:28:02 AM »
It seems to me, though, that ACA is a viable move towards a, I can't think of the word, a version of a single payer system.

Everyone pays an amount for a basic level of coverage - in the US that's the ACA compliant minimum over here it's funded through taxes.  People have the ability to pay more on top of that.  In that sense - state differences in cost of minimum level of coverage aside the two are the same.

Your argument has been that in the (short?) term companies will raise premiums.  Mine is that, if we accept the two as analogous in this way, the evidence is that what will actually happen is that higher level packages will drop to a pittance (relative to basic level ones).  I accept the comparison is far from perfect but don't forget the UK didn't always have an NHS - we put it in within living memory.  Our landscape before that was essentially the same as the current US one. 

Returning to your white bread analogy.  I own a bakery.  I sell brown bread, white bread, granary loaves, etc.  The government steps in and says "all bread must be at least as delicious as this loaf right here".  Fine, some of my shittier bread is no longer legal, and I'm forced to stop selling it.  Those who didn't mind the less delicious bread will see their product disappear from my shelves.  However, people now have a guaranteed level of tastiness for their morning toast which has been assessed as suitable, so several will stop buying more expensive loaves because they now know that the basic one is a taste sensation.  Further, as this applies to all bakeries, I now have a strong incentive to make my basic loaf, the minimum allowable by law, as cheap as possible to lure in customers from my competitors.

Offline consortium11

Re: ACA
« Reply #147 on: November 15, 2013, 10:45:26 AM »
AXA - one of our biggest medical insurance companies though not actually the one I use - call their highest level of cover "Gold Cover".  It costs £17.75 per month.  The national average monthly wage for a female is about £2000 per month.

I'm possibly being pedantic here, but the various Gold, Silver and Bronze plans from AXA aren't actually insurance. They're cashback plans, that's to say as you as long as you pay the monthly fee AXA will give you back a set amount of money for any of the covered medical issues. In some ways it's the reverse of insurance; an insurance policy mandates that you pay the set excess while the insurer picks up the other costs, in a cashback plan the insurer pays you a set amount and you cover the other costs.

Running figures through their system for a male in his mid-20's, the best level of standard coverage (that is to say without negotiating specific inclusions/exclusions) and with the lowest excess costs £92.24 per month... which is a pretty hefty chunk of change for most people. And that's for general cover (albeit with the add-ons) as opposed to specialist cover which can increase the price significantly.

I'd also note that NICE doesn't deal with the regulatory side of things with regards to approving/removing products. That's the Medicines and Healthcare Products Regulatory Agency (MRHA). NICE's remit is to which products should be used on the NHS and how they should be used and in recent years offering guidelines to the public sector on how to avoid ill-health and guidance for social care users and practitioners.

Offline Valthazar

Re: ACA
« Reply #148 on: November 15, 2013, 10:53:46 AM »
Returning to your white bread analogy.  I own a bakery.  I sell brown bread, white bread, granary loaves, etc.  The government steps in and says "all bread must be at least as delicious as this loaf right here".  Fine, some of my shittier bread is no longer legal, and I'm forced to stop selling it.  Those who didn't mind the less delicious bread will see their product disappear from my shelves.  However, people now have a guaranteed level of tastiness for their morning toast which has been assessed as suitable, so several will stop buying more expensive loaves because they now know that the basic one is a taste sensation.  Further, as this applies to all bakeries, I now have a strong incentive to make my basic loaf, the minimum allowable by law, as cheap as possible to lure in customers from my competitors.

I don't want to rehash what has already been discussed, so I'll just raise a few relevant points.

What about people who just get fed up and say they don't want healthcare anymore?

Also, how can you assume that people with top-tier healthcare plans are now going to stop using these superior plans simply because the government now mandates (albeit inefficiently) that everyone purchases a minimum coverage?  I definitely have no intention of doing that.  There is no evidence to suggest such a trend, unless of course, their superior plans were altered or dropped for whatever reason.

How can you say that most Americans actually view the minimum private coverage requirements mandated by the government as in any way being desirable?  The government has already made the rollout of the ACA a debacle.  It is only reinforcing many Americans' skepticism of the American government's ability to do things efficiently, including my own.

Finally, because the private insurance companies are detached from the government, and are free to set their own prices, there is not a strong incentive to make the basic coverage as cheap as possible.  The government has "mandated" that people get these plans, so insurance companies are free to set their prices at whatever they wish, knowing they will have an extremely high demand for the product.  The government will certainly provide subsidies based on need, but they can't control the empirical price of the insurance itself.  Certainly, after a while, more people will be "opting-out" through the penalty fee, rather than paying these progressively more expensive premiums.  However, at that point, the onus will fall on the government for failing with their ACA pledge.  In that scenario, the government response will be to raise the penalty fee, to encourage more people to purchase heath insurance instead.  You can see how this does very little to help the consumer.
« Last Edit: November 15, 2013, 10:57:04 AM by ValthazarElite »

Offline Phaia

Re: ACA
« Reply #149 on: November 16, 2013, 12:15:17 AM »
In order:
Phaia - It doesn't affect me personally, no.  It does actually affect a few friends of mine but that's not why I'm saying anything.  I'm vaguely surprised at what I see as the implication behind your question though, that only things that affect one personally are worthy of consideration. 

first off Kythia I was not trying to imply that if it did not effect you then it was not worthy for consideration. When you mentioned you are from the UK ..well it helped me understand your frame of reference...

As an example [and I am sure you did not mean offense] at least twice [I think] you have use the reference 'the south' as if to imply all those of us that live in the south are backwards, red neck hillbillies that do not know how the real world works. It is not just you but I often see in these political forums the term 'the south' used and nothing more. I grew up in Virginia on a dairy farm went to the Uof Virginia and work in central Florida [married to a Bostonian but I dont hold that against him...much] so with you being from outside the US it explains why you used that term.

Now the past week I did a bit of survey at work...I work for a major theme park here in central Florida [a very world wide major one] I am a member of the actors guild and handle a troop of performers numbering 32. They range in age from 17-41; here is the break down for ACA...14 of us are staying with the 'new ACA mandated' company insurance plan even though in every case its at least a 50% increase per month mainly because we have families or other medical needs. of the other 18...7 are on there parents plans until 21... of the other 11..only 4 are getting insurance the rest just cannot afford the big increase when before they did not pay anything now the minimum would be about 140 a month... that means that out of 42 ...7 have 'opted out'
and 7 more are being covered by someone else. So almost half of the group are not paying for insurance

That is what is concerning me since almost all in my group are very liberal and supported the president and his health care program...in fact many here are upset enough that they are talking about more moderate senators [which could mean indenpents or even republicans]

Anyway I hope this helps explain  the local view points and why I am questionings the worth of ACA when nearly half in my small group wont even be part of it [which of course raises the cost for those of us that do]

phaia

edit: I really should not try making a post at 1:30 in the morning...after a long day at work and then running around chasing the 4 year old...I make to many mistakes and misspells ...*yawns*
« Last Edit: November 16, 2013, 12:25:17 AM by Phaia »

Offline Kythia

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Re: ACA
« Reply #150 on: November 16, 2013, 01:26:30 PM »
Sorry I didn't realise I'd used "the south" at all.  Will have a quick scan through and look for it, and will explain what I meant by it when I find it.  I honestly wouldn't have been using it in a derogatory sense - the hillbilly view of the Southern US isn't a massive stereotype over here (or for me at least) and while I'm aware of it I wouldn't, you know, bring it to mind in writing.

But as I say, I'll check back through what I've written and put some context together.

Offline The Dark Raven

Re: ACA
« Reply #151 on: November 16, 2013, 02:16:43 PM »
All I know is I have seen what it would cost me to float it every month is nearing 3x the monthy cost of what I pay now for about 1/2 to 2/3 of the coverage I get now of things I actually use.  Now, substance abuse coverage has gone up but I don't see myself needing any sort of detox at any point in the foreseeable future (I don't smoke nicotine anything and I barely drink.  I don't use other substances either.).

In my budget it is hardly affordable.  Other folks may have a different idea.  I know that if my insurance is not deemed valid under the ACA, I will become one of the uninsured because it is simply cheaper than paying for the monstrosity that is the ACA.

Offline Phaia

Re: ACA
« Reply #152 on: November 16, 2013, 05:20:19 PM »
Sorry I didn't realise I'd used "the south" at all.  Will have a quick scan through and look for it, and will explain what I meant by it when I find it.  I honestly wouldn't have been using it in a derogatory sense - the hillbilly view of the Southern US isn't a massive stereotype over here (or for me at least) and while I'm aware of it I wouldn't, you know, bring it to mind in writing.

But as I say, I'll check back through what I've written and put some context together.

i never thought you meant insult and at 2am in the morning i am not sure if t was you or someone else..i know I read the reference here at least once

no offense taken

phaia

Offline consortium11

Re: ACA
« Reply #153 on: November 16, 2013, 05:23:34 PM »
A quick search/read suggests it was kylie rather than Kythia who referenced the south.

Offline Phaia

Re: ACA
« Reply #154 on: November 16, 2013, 05:35:32 PM »
A quick search/read suggests it was kylie rather than Kythia who referenced the south.


eppp my bad i get thise K's mixed up sorry then kythia and *wags finger at kylie*

I was seeing squiggly lines trying to read through everything last day or so...

phaia

Offline kylie

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Re: ACA
« Reply #155 on: November 17, 2013, 01:35:27 AM »
As an example [and I am sure you did not mean offense] at least twice [I think] you have use the reference 'the south' as if to imply all those of us that live in the south are backwards, red neck hillbillies that do not know how the real world works. It is not just you but I often see in these political forums the term 'the south' used and nothing more.
   
          Last I recall  mentioning the South -- better big S, as a political bloc of mostly red states -- it was about the status of women there, which Val had skewered in a larger sense (he was talking about women generally) on the way to saying we can't possibly make everyone pay similar premiums and keep the business model we have ("That's not how insurance works" etc)...  But this rejoinder about 'don't generalize too much about my people like that' gets tossed around so much.  I wonder if it doesn't have its own thread somewhere, but I'll give you a response and try to be done with it.  I don't mean to hijack the whole thread. 

           I talked this way about the South a lot even when I lived there (and I did for a few years).  In fact when I was there, I was much more in a position to hear more about how upset some Southerners (often Black university students, as well as some Southern sociologists) were about racial prejudice in local politics.  Now granted I didn't grow up in the South so if that were someone's criteria, then I would say "whatever you think you're getting at by asking that" -- but at some point people are going to generalize for the sake of conversation.  Otherwise, it devolves into everyone "owns" the best understanding of their own little corner, and no one should have any logical or moral criticism of what happens anywhere they don't spend [insert minimum time and dues of each faction's choosing here]... 

          When you're much more likely to see a policy passed in a certain region that supports a certain view...  Or when in your personal experience it's easier to meet people in that region who do support a certain set of views than in other places...  Particularly views you find the view (and maybe policies) in question either simply counterproductive or downright prejudiced...  And -- perhaps again, if you live there when you used to live elsewhere -- you suddenly worry more than before about running into this day to day...  In both cases, then it's true that it applies to the South.  It's simply happening there.  It is a different place in the national experience. 

        Now, that is not saying "you" intend all of that personally...  If anything perhaps, it's saying, if you will:  As a collective, what are y'all thinking because between a few people shouting about "family values" and a few shouting about "self-reliance" you're ending up with some policies I just can't believe?  I don't know that much about how gerrymandering works, and I suppose it just might be possible that elections have been rigged so effectively in the South, it has nothing to do with overall popular opinion after all? 

          If in fact many people who have lived in the South longer do not really enjoy those views or those policies, then why don't they do more to change it?  Are they so concerned about other issues, or are they so constrained that they simply can't (incumbent advantage? gerrymandering? poverty? corruption?) ?  Or are they in fact somehow positively invested, if they could think about it, in some of the groups and values that do actively demand those situations go on as they are? 

... Although it's also possible to argue that at some level, much of the country (world? global economy?) has long been relying on some of the same positions -- and we just happen to see lots of them more for what they are when they manifest visibly in policies of the global South (whether it's visible institutional racism in Alabama or ethnic discrimination and child/generally abused labor in Filipino "free industry towns").  But yeah, if you believe some change has to start locally, then you have to ask, "Well whatever are people doing there?"  And sometimes a 'there' that crops up a lot in broader American politics as an obvious site of visible, rather extreme examples is the South.

         Also, I don't think one needs to be a hillbilly to be clueless about how the world works.  Wall Street and much of capitalism thrives on the premise of most people not knowing how it works, or being convinced not to care.  If I ask my students from rural China if it's ethical to sell investment based on real estate one knows is not worth much already (the financial crisis), or even to sell a necessity in a new market for exorbitantly more than it costs for the provider to pick up in another region ...  Some of them also will simply say in effect: ""Duh, yes, that's capitalism."  Likewise for Americans and Southerners included (city or rural), it's entirely possible to be connected and still be very clueless or a supporter of a sickeningly unequal, exploitative system.  The question is more, do in fact a lot of people in that region happen to buy into those ideas that stereotypical hillbilly political culture is famous for: that pursuing equality is a pipe dream and somehow bootstraps or big buddies business (I think the hillbilly version would be, getting on well with some "good" family) are the only way to go? 

          Back on topic, I do gather that people in some circumstances, perhaps too many of them, are finding the ACA impractical to say the least.  That's fine, but I'm not sure that is precisely what the Tea Party or even most Repubs were fielding as their reason for opposing it.  Do you vote for people who oppose something that should be opposed, even if their reasoning about why they oppose it are different or completely off?  Even if their prescriptions are likely to be dangerous, maybe?  I don't know.  I wouldn't, given the range of other things I see the Repubs generally leading toward -- including their obvious lean on business models, and for some their pretty outrageous representations of women.  But it seems all these red states keep electing these people and day to day, and I did have to watch out more often for very vocal and entrenched supporters of those views when I lived there.
 
« Last Edit: November 17, 2013, 01:49:37 AM by kylie »

Offline Valthazar

Re: ACA
« Reply #156 on: November 17, 2013, 02:02:27 AM »
Last I recall  mentioning the South -- better big S, as a political bloc of mostly red states -- it was about the status of women there, which Val had skewered in a larger sense (he was talking about women generally) on the way to saying we can't possibly make everyone pay similar premiums and keep the business model we have ("That's not how insurance works" etc)... 

You have terribly misunderstood me.  My remarks were simply describing the realities of how premium rates currently work in a private healthcare model, where rates are determined by individual preference for coverage.

Regardless if it was a man or a woman, a person not planning to have kids would have a cheaper health insurance plan since they would not need maternity coverage.  However, a woman who is planning to have children would have a higher premium, all else being identical, since she would opt for maternity coverage.

This benefits women in their 20s, or women who have no intention of having kids.  They get cheaper premiums.

It's the same as saying, a man who participates in extreme sports might opt for additional coverage for sports related injuries, and thus have a higher premium.

The ACA attempts to resolve these issues by mandating maternity care and sports coverage, along with many other minimum coverage parameters for all individuals - man or woman.  It provides subsidies based on income (without the male/female issue coming into play).
« Last Edit: November 17, 2013, 02:09:02 AM by ValthazarElite »

Offline kylie

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Re: ACA
« Reply #157 on: November 17, 2013, 07:20:16 AM »
          Val, I seem to recall you comparing certain health conditions to regional disaster coverage, and at some point saying it was rather understandable that people might not want to pay for conditions that don't affect them.  And mentioning that women have certain needs men don't, which together with everything else sounded to me and at least one other person I know, as if you were saying women simply naturally have to pay more, why should men need to pay for it?  I know you are keen on dragging out various cases, but without getting into small corners... I don't really see how the principle changes or why certain amounts of money it would cost for this or that are clearly not feasible.  Cost relative to what? another carrier group? another bank bailout? Or simply relative to current health system costs? Another Iraq war?  Show me how it's impossible or socially irresponsible exactly to help more people who are already here needing it, and not just a cost that people (or corporations) in power now won't stomach. 

         What I gather you are saying is that at some point, the current market operates by deciding some people are more risky than others and trying to get them to pay higher relative premiums etc. for it.  And when you get to the point of using examples like regional disaster insurance and going on about how this is just how insurance works...  Then I kind of suspect you'd go more than I would for a system that sooner or later, provides less benefit to those who may have more costs and socially fewer means available to deal with them.  If one is thinking "outside the box" when it comes to answering that, then fine, we need to change "how insurance works." 

For that matter, would it be such a shock for many US plans to cover maternity leave for fathers, as many European plans do...  Someone would probably scream "socialism" or "pinkies" all over Capitol Hill and Fox News again (notice how red scare and femininity scare have been tied together?).  I feel like you're going on about costs and Massachusetts, but if you don't admit that political will and priorities are an issue to begin with, then the whole conversation is silly from the get-go.  Of course health costs won't improve if the US is governed and de-regulated as it has been for the last generation!  Or that's my gut feeling.  And this idea that some people are not the responsibility of others, and 'anything else must be un-American or anti-business' -- that is part of the problem, I think.   

         I do agree it would make a lot more sense to have a single payer system where all the costs could be spread out.  You may just be demonstrating (without meaning to, I know) that it's leaning more toward a situation where the realistic options are actually single payer or bust?  But I'm not sure where you're going with all this.  If the point is simply that ACA is making the existing trend worse by giving insurance companies too much leverage to lump stuff people don't want into some plans to the point of being unaffordable, that's one thing.  I get that some people seem to want to make the thread nothing but one constant thumbs up or down rant on ACA as it is.  There, it sounds like as much a problem of whether the subsidies are actually the right size for the plan costs.  (Weren't Repubs attempting to defund this policy all along the way?  If indeed they were and made some success, then it isn't simply the idea that's wrong but more the lack of support that sabotaged it.  I'm not sure but I'd like to know.  Apart from that, simple lack of planning/will to pay could certainly be a problem.) 

But if the idea is more that no one should be stuck with any cost they don't want in principle because it may not help them so visibly and personally -- no matter how common or important that cost is across the whole population, and in exchange for other relationships across the country such as the country holds together -- then well we could go right back to the Whiskey Rebellion and say, 'Why should anyone pay the government for anything at all?'

   
« Last Edit: November 17, 2013, 07:24:11 AM by kylie »

Offline gaggedLouise

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Re: ACA
« Reply #158 on: November 17, 2013, 11:13:42 AM »
          Val, I seem to recall you comparing certain health conditions to regional disaster coverage, and at some point saying it was rather understandable that people might not want to pay for conditions that don't affect them.  And mentioning that women have certain needs men don't, which together with everything else sounded to me and at least one other person* I know, as if you were saying women simply naturally have to pay more, why should men need to pay for it?

*(read: one other woman)

*nods in agreement from the seating*

Quote
I know you are keen on dragging out various cases, but without getting into small corners... I don't really see how the principle changes or why certain amounts of money it would cost for this or that are clearly not feasible.  Cost relative to what? another carrier group? another bank bailout? Or simply relative to current health system costs? Another Iraq war?  Show me how it's impossible or socially irresponsible exactly to help more people who are already here needing it, and not just a cost that people (or corporations) in power now won't stomach. 

    What I gather you are saying is that at some point, the current market operates by deciding some people are more risky than others and trying to get them to pay higher relative premiums etc. for it.  And when you get to the point of using examples like regional disaster insurance and going on about how this is just how insurance works...  Then I kind of suspect you'd go more than I would for a system that sooner or later, provides less benefit to those who may have more costs and socially fewer means available to deal with them.  If one is thinking "outside the box" when it comes to answering that, then fine, we need to change "how insurance works." 

If the primary condition for driving an agenda of health care and insurance reform would be that you must have every major insurance firm who is already on the field willingly come on board beforehand, before you even draft any definite proposal and plan; must have them say without any political forcing: yes, yes, of course we think this is fine, we don't have anything against this and we'll pay according to the costs we can see coming, together with the state - then you'd never get anywhere. It would be like trying to get drinkable and healthy water, proper sewage and water cleaning, all across a city where there's never been any proper water sanitation except in a few suburbs where the rich people live, and under a local self-government that grades the voting power according to income. In that kind of situation, without any possible or legit leverage from those who demanded clean and safe water to their houses and to public buildings, nothing would happen.

If the requirement for health care reform is that every company, every insurance provider of any weight in the market should say yes, without the least pressure from a political process that's been rolling on for years and which resulted in a signed package of laws three years ago, and which laws have been constitutionally tested, or else it would be those petty special interests (women, lower middle class, unions etc) shamelessly trying to push their game and exploitthe entrepreneurs...if that's it, then you'd have to wait two hundred years for the beginnings of any realistic change.

« Last Edit: November 17, 2013, 11:20:34 AM by gaggedLouise »

Offline Valthazar

Re: ACA
« Reply #159 on: November 18, 2013, 03:20:33 PM »
For that matter, would it be such a shock for many US plans to cover maternity leave for fathers, as many European plans do...  Someone would probably scream "socialism" or "pinkies" all over Capitol Hill and Fox News again (notice how red scare and femininity scare have been tied together?).  I feel like you're going on about costs and Massachusetts, but if you don't admit that political will and priorities are an issue to begin with, then the whole conversation is silly from the get-go.

Requiring men to have maternity healthcare coverage is entirely different from maternity leave.  Maternity coverage refers to healthcare issues regarding pregnancy.  Forcing men to take maternity healthcare coverage has no influence on their employer paid time-off when they become a father.

There seems to be a lot of misinformation flying in this thread.  The ACA does not decrease or subsidize costs simply for being a woman.  Many women will actually see rate increases.  The subsidies are only provided based on financial figures - regardless of male or female.

The only clause in the ACA pertaining to women is the requirement that rates cannot vary between men and women.  On a functional level, we can all agree this is good in theory. 

However, it hurts women who are married, who now have husbands required to pay more for their insurance.  It also hurts women who just graduated from college and looking to get their first job.  It also hurts women who have no interest in having children, and women in their 40s and 50s.
« Last Edit: November 18, 2013, 03:21:36 PM by ValthazarElite »

Offline kylie

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Re: ACA
« Reply #160 on: November 18, 2013, 09:16:12 PM »
Requiring men to have maternity healthcare coverage is entirely different from maternity leave.  Maternity coverage refers to healthcare issues regarding pregnancy.  Forcing men to take maternity healthcare coverage has no influence on their employer paid time-off when they become a father.
         Bearing children is an event that has implications for the rest of the society far beyond whether the individual woman wants one at a given moment, in some hypothetical vacuum.  Just as in your regional disaster example, whether or not the whole insurance system actually does raise prices for everyone until it can cover people regularly getting washed off the floodbanks of the Mississippi (or whatever local emergency) has impacts across whole communities and even on the whole national economy. 

You can try an atomized, individual consumer choice model if you like, but it falls apart for me when we consider that actually, the whole society is organized around assuming that some people will positively take certain options and those choices are good for the nation as a whole.  It's not simply a matter of some personal "extra" or "privilege" that has no bearing on anyone else (and it has not been treated as if it were, where the government has been concerned historically).  The real question is what percentage perhaps the individual pays versus the collective -- but it is not whether the collective should reasonably pay a meaningful share at all to make things happen -- at least, not until you get into things like the One Child Policy or abortion debates.  This is a question of how the society or government (or is it now, corporation?) actually does regulate or encourage how many kids per family or how many houses per floodplain is a positively desirable (or at least a supportable) risk/investment. 

          Now, whether the whole business model has been rigged such that absolute prices are exorbitantly high to begin with (i.e. does the government reform this??), or whether the government plans and subsidizes a national plan in a way that people  can pay to get important stuff done at all and keep prices relatively low under whatever system is available -- those are separate questions. 

Quote
There seems to be a lot of misinformation flying in this thread.  The ACA does not decrease or subsidize costs simply for being a woman.  Many women will actually see rate increases.  The subsidies are only provided based on financial figures - regardless of male or female.
        I don't think I said the ACA itself was doing it all right.  I suppose now that the cost management could have been trashed the minute corporations were allowed to change the plans without consequences, and thus nullify the earlier estimates.  If that is not actually a runaway problem, then I also wonder if it's just not being funded properly for the intent. 

          It's the part where you seem to suggest people shouldn't have to pay for stuff they don't immediately use, where I start to ask, but are you sure they don't benefit from others having more reasonable coverage for those particular events (which might otherwise spread high costs of such events in cases of delay or non-coverage, i.e. stuff not getting done or costs of default on payments across the whole system anyway) and from more people having overall cheaper coverage for more things?  I just got the impression with your disaster and women's cases that you were picking situations where only a minority (errm, except there are an awful lot of women!) are commonly discussed as the immediate "agents" or "people involved" -- partly because yes, the society has taken it for granted that they would bear more burdens, rightly or not -- but in fact a lot of people are seriously really affected, sooner or later, by what happens?

          I do understand that people may be upset when they feel that charges for stuff they don't use "personally" are the ones that seem to break their budget, but to me that sounds more like a problem of how the funding was allocated or not.  That does not prove to me that there was no other way to allocate it, or even that the funding was proper or what was intended.  It may show that ACA as it stands has problems...  It doesn't necessarily show that it's better for everyone to let everyone, slice and dice plans for only what they use this moment.  That would be contrary to a single-payer system (which you say you support) anyway, right?  There would be no way to spread out the costs.

Quote
The only clause in the ACA pertaining to women is the requirement that rates cannot vary between men and women.  On a functional level, we can all agree this is good in theory. 

However, it hurts women who are married, who now have husbands required to pay more for their insurance.  It also hurts women who just graduated from college and looking to get their first job.  It also hurts women who have no interest in having children, and women in their 40s and 50s.
          So you're saying that in theory people are interrelated and should help each other, but "in practice" no one wants to.  No one cares if it is hugely expensive for some woman elsewhere in the society to have a child, or to have however many children you say is too many.  Only her immediate partner, you might say, should have any interest in that whatsoever.  It doesn't matter if she's someone else's neighbor or relative or teacher, or if one wing of the government is lamenting how domestic-born population is in decline for that matter... 

In that case, it's completely 'her problem' if she wants a child, and it has no relation to whatever else happens in the society?  Who is going to be the workforce when those women in their 30's are 60?  Why did the state perhaps, provide an easier financial environment for their parents to bear them, than it offers for them if they wish to have children?  No, it's completely their individual problem and if they can't afford children or proper maternity practices, that cost never goes anywhere else in the system.  Sorry, I don't believe that's very practical.  It's not empirically true.  Unless perhaps, you assume that the child she is contemplating is one the state and society are not at all interested in her having... 

Maybe it makes some sense in a scenario where you assume from the get go, that is one child too many and it couldn't possibly contribute anything good to have one more -- then, obviously, she should pay for everything.  No one else has any interest in that child then...  (Or it could be, in that guy's chronic condition being resolved so he can get back to work, or that house repaired after a flood that only happens in that region so that those people can focus on what they're doing while they drive buses of people across the country or build roads or inspect nuclear reactors...  What have you.)
« Last Edit: November 18, 2013, 09:41:18 PM by kylie »

Offline Valthazar

Re: ACA
« Reply #161 on: November 18, 2013, 09:41:33 PM »
Bearing children is an event that has implications for the rest of the society far beyond whether the individual woman wants one at a given moment, in some hypothetical vacuum.  Just as in your regional disaster example, whether or not the whole insurance system actually does raise prices for everyone until it can cover people regularly getting washed off the floodbanks of the Mississippi (or whatever local emergency) has impacts across whole communities and even on the whole national economy. 

It may show that ACA as it stands has problems...  It doesn't necessarily show that it's better for everyone to let everyone, slice and dice plans for only what they use this moment.  That would be contrary to a single-payer system (which you say you support) anyway, right?  There would be no way to spread out the costs.

kylie, you are basing your understanding of the current state of American healthcare on inaccuracies.

You seem to be suggesting that the increased premium revenue from men being required to have maternity coverage, will now subsidize the healthcare costs of pregnant women who cannot afford health care.  This is fundamentally incorrect.  If you disagree, please cite your sources, because I have already outlined the specific implications of the ACA in earlier posts.

To add a bit more clarification, the insurance premiums are going to insurance companies, while the subsidies come from the government - meaning their origin is not from these new "minimum standards of care" instituted in ACA.  In other words, nothing is being done specifically for impoverished pregnant mothers.  What is being done is income-based subsidies, but that is for all individuals - male or female.

I know you also are not a fan of ACA necessarily.  And I know we both would be at least content with a functional single-payer system, since that would at least be better than what we have now.  However, the ACA is not a move towards a single-payer system.  It's actually just padding the pockets of the health insurance companies.

If you want proof, just look at the stocks for private health insurance companies.  Here's just a few.

AETNA (AET)
$28 --> $65  (since 2010)

UnitedHealth (UNH)
$29 --> $71 (since 2010)

WellPoint (WLP)
$46 --> $90  (since 2010)

WellCare (WCG)
$24 --> $69  (since 2010)

Honestly, just look at these strong Health Insurance funds - some are getting 55%-60(!)% value growth in 1 year.
http://money.usnews.com/funds/mutual-funds/rankings/health
« Last Edit: November 18, 2013, 10:17:13 PM by ValthazarElite »

Offline kylie

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Re: ACA
« Reply #162 on: November 19, 2013, 04:42:13 AM »
kylie, you are basing your understanding of the current state of American healthcare on inaccuracies.

You seem to be suggesting that the increased premium revenue from men being required to have maternity coverage, will now subsidize the healthcare costs of pregnant women who cannot afford health care.  This is fundamentally incorrect.  If you disagree, please cite your sources, because I have already outlined the specific implications of the ACA in earlier posts.
        You seem to have the notion that anything I say is somehow obviously only about the ACA?  Well if that's all the thread can do, then you must enjoy going in circles...  I'm not wedded to the thing.  What I'm concerned about is people coming along getting the conclusion that ACA is some ultimate proof that government policy can't do anything right, and therefore all the effort and will should be scrapped rather than improved upon.  So granted your examples were apparently only concerned more with using what is in the prior industry as a precedent.  I didn't unerstand you were so interested in limiting the thread to bashing the ACA (and more btw but does that effectively mean, here bashing mainly the ACA/government and not so much business at large, I wonder?) for continuing or exacerbating what has been done in the past. 

          When I pick on those examples, I'm more concerned about what might be or should be, if there was only will to do it.  And yes, that is in general terms since I'm hardly in a position to be modeling every billion and every condition.  Nor to predict all the votes in the current nastiness of US politics to keep them in there, which was why ACA came out sooo problematic in the first place -- but I would appreciate if you said more to address a political situation where "pro-business" is generally code for "do what those big insurance companies [among other megacorps, who are also quite busy churning out and manipulating nifty figures] say we must."  Anyway...  What I can do is say, reorganizing in one direction or another makes sense to me or doesn't in terms of general process.   

         I've been saying maybe I'm more inclined to think we should subsidize those women.  At least to some reasonable extent -- I don't know if we can afford to subsidize 6 children per woman or not (not that everyone wants that many, but you get my drift).  However, I'm disinclined to believe that we couldn't afford to cover some lower average number...  The particulars don't concern me so much.  Rather I was responding against what sounded like a wave and nod to precedent, where it's a rather disingenuous understanding of even that precedent.  You may say "insurance doesn't work like that," but government does and here part of the question is will government get involved and make reforms or not.  If we're going to do better.  If nothing else, because people are concerned about the costs we have now

          Arguably the ACA itself no longer resembles what was originally intended; I think we agree on that.  So if we take the political will that originally went into ACA and try to do better...  If indeed people still want to, that is if they haven't come to believe it's simply impossible and if not too many of them believed it was "un-American" or somehow against the budget (however in the world that's figured) to do so in the first place...  If we are not hamstrung by those scenarios then this, status of so many conditions specific to so many groups, is something that could (and I think should) be considered.
Quote
To add a bit more clarification, the insurance premiums are going to insurance companies, while the subsidies come from the government - meaning their origin is not from these new "minimum standards of care" instituted in ACA.  In other words, nothing is being done specifically for impoverished pregnant mothers.  What is being done is income-based subsidies, but that is for all individuals - male or female.

I know you also are not a fan of ACA necessarily.  And I know we both would be at least content with a functional single-payer system, since that would at least be better than what we have now.  However, the ACA is not a move towards a single-payer system.  It's actually just padding the pockets of the health insurance companies.
            For the rest, I think I'm going to simply declare confusion, unless I can get a simple explanation of where this mess came from.  What I recall, by now and increasingly late from when it happened...  Is that some people were going on in the thread about how ACA forced them to pay higher premiums for conditions they didn't think were theirs to be worried about.  Roughly the same time, you said something about people have to pay different premiums for different situations and that is just 'how insurance works.' 

            I thought you were suggesting it was rather impossible, no matter what we do, to create a market where the costs will be spread more or less evenly.  I thought you were arguing that in effect, women etc. must pay more -- the economy or politics will bear nothing else no matter how good our intentions or any reforms.  Now, were you saying that is simply how it is under insurance companies and therefore under the ACA -- and if so do you in fact, you want to take those companies largely out of the decision process?   That isn't how it came across to me, but maybe there was some static in the air.  (Possibly static I sense, when I otherwise hear someone say so much about what is important "for business," but anyway.)
 
« Last Edit: November 19, 2013, 04:52:55 AM by kylie »

Offline Valthazar

Re: ACA
« Reply #163 on: November 19, 2013, 11:50:10 AM »
I thought you were suggesting it was rather impossible, no matter what we do, to create a market where the costs will be spread more or less evenly. 

No, I am suggesting that the measures necessary to implement the healthcare model you are describing is increasingly becoming further and further away from our reach, as the ACA implementation gets further underway.  In other words, your proposals are far more attainable without ACA, and nearly impossible now that ACA is implemented.  I do not find fault with the insurance companies themselves, but with violations - such as business corruption, fraud, and illegal practices - such as government-business collusion and inter-business collusion.  I explained this further in an earlier post in this thread.

This is an outstanding 8-minute video that discusses just the facts of ACA.  It is non-partisan, and just discusses the actual clauses of the law, and clearly describes how it is making it even more challenging to find a functional solution.

As I have been saying, the ACA was a closed-door, wall-street orchestrated initiative.

I highly recommend investing in healthcare funds, to make a killing in a year or two.  The individual mandate penalty is going to be over $695 or 2.5% of taxable income in 2016, so I can assure you that an increasing number of people will be enrolling in private healthcare (and thus paying them premiums) progressively from 2014-2016, and onwards.  It's doing nothing but making insurance companies and investors richer.

« Last Edit: November 19, 2013, 12:08:51 PM by ValthazarElite »

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Re: ACA
« Reply #164 on: December 17, 2013, 11:39:26 PM »
I'm just gonna throw this up here cause it made me LOL really hard.


Offline IStateYourName

Re: ACA
« Reply #165 on: January 01, 2014, 11:14:14 PM »
I'd an American who like to emigrate to a nation that doesn't have such enormous difficulties doing common-sense things like providing health insurance for all citizens.  And that isn't trying to run the world (not trying to derail the thread, but there's a definite correlation between the expense of administering a global empire and "oh noes we can't afford universal healthcare it's TOO EXPENSIVE we'll go BANKRUPT!"

Re-reading this...yes, I can see where it would be perceived as a thread derail.  So if you want to speak to the issue of other countries and better systems, I created a new thread.  http://elliquiy.com/forums/index.php?topic=193399.0

Back to the ACA--I think it's going to fail.  Too much complexity in something already drowning in complexity.


Offline Valthazar

Re: ACA
« Reply #166 on: February 10, 2014, 04:42:39 PM »
Found this pretty interesting:

The Obama administration is giving more time for employers to comply with ACA guidelines for their workers.  Companies with 50-99 employees will now have until 2016 to provide coverage under Obamacare, and larger companies will only need to cover 70% of full-time workers by 2015, instead of 95% as previously stated.

It is surprising to me that the Democrats are now granting this provision via executive action, when it is almost exactly what the Republicans were asking for in Congress several months ago, which was blamed for causing the government shutdown.

I support the Obama administration's decision, but I am perplexed why they did not feel this way earlier.
« Last Edit: February 10, 2014, 04:52:38 PM by ValthazarElite »

Offline Zeitgeist

Re: ACA
« Reply #167 on: February 10, 2014, 05:38:41 PM »
Found this pretty interesting:

The Obama administration is giving more time for employers to comply with ACA guidelines for their workers.  Companies with 50-99 employees will now have until 2016 to provide coverage under Obamacare, and larger companies will only need to cover 70% of full-time workers by 2015, instead of 95% as previously stated.

It is surprising to me that the Democrats are now granting this provision via executive action, when it is almost exactly what the Republicans were asking for in Congress several months ago, which was blamed for causing the government shutdown.

I support the Obama administration's decision, but I am perplexed why they did not feel this way earlier.

I would suggest it might be because it was more politically expedient to point fingers and blame Republicans for this administrations poorly executed and thought out program.

Offline ShadowFox89

Re: ACA
« Reply #168 on: February 10, 2014, 06:12:21 PM »
 It's almost as if anything anyone in the gov't or media can do is point fingers....

Offline IStateYourName

Re: ACA
« Reply #169 on: February 10, 2014, 08:19:56 PM »
It's almost as if anything anyone in the gov't or media can do is point fingers....

For all the angst and wrangling there's been over this, we could have just created a single-payer system.  But no.  This is America, so if a reform or change doesn't help the rich get richer, then by golly it's COMMUNISM and we'll have none of it, no matter how much sense it makes or how well it works elsewhere.

Americans love the rich more than they love themselves.  It's sad...but it's only the truth.

Offline Valthazar

Re: ACA
« Reply #170 on: March 31, 2014, 06:55:52 PM »
From an outside perspective looking in, what's surprised me about the ACA, its implementation and its flaws is that it is essentially a clone of the Swiss health care system, which is likewise based around compulsory "basic" medical insurance with complementary plans on top of that. Under that system, Swiss health care spending is just over 10% of GDP (roughly in line with most western European countries) and does very well in comparisons with regards to the quality of care, as well as coming out well in efficiency tables (top 10 according to Bloomberg).

Just checked this thread since today is the deadline for purchasing health insurance, and saw that I missed this post.  The Swiss healthcare system was the model for the ACA, and I really like theirs.  But there are some specific clauses which make the Swiss healthcare system successful.

Health insurance is only offered privately in Switzerland as well.  All citizens are required to purchase a 'basic package' health insurance, just like with the ACA.  All health insurance companies in Switzerland must offer a version of this basic coverage if they want to stay in business, which includes basics such as sickness insurance, maternity insurance, and accident insurance.  However, health insurance companies are NOT permitted to make a profit off of this basic coverage.  They can, however, make a profit off of supplementary coverage which goes above and beyond the basic coverage.  Because these companies cannot make a profit off of the basic coverage offerings, they naturally tend to offer plans with HIGH deductibles and HIGH co-pays, in addition to premiums.  This naturally creates incentive for consumers to be cost and value conscious, which keeps their overall cost of healthcare down (less services are being used unnecessarily).

In addition, if someone cannot afford to pay the premiums for their basic coverage, the citizen is only required to pay 10% of their income towards their premiums.  The government will subsidize the remainder.

It's a pretty good system, and it works for Switzerland, since they are a relatively wealthy country to begin with, given their population of only 8 million.  Health insurance companies in the US are making huge profits off of the ACA already.

Source
« Last Edit: March 31, 2014, 06:57:10 PM by Valthazar »

Offline mj2002

Re: ACA
« Reply #171 on: April 02, 2014, 12:26:54 PM »
That's why a single payer system would have been better.
Health insurance companies in the US are making huge profits off of the ACA already.
Single payer solves that.

Offline Valthazar

Re: ACA
« Reply #172 on: April 02, 2014, 02:30:11 PM »
That's why a single payer system would have been better.Single payer solves that.

Assume that widespread access, low cost, and high quality are the three attributes we value in a health policy system.  Policy experts generally agree that any healthcare system can strive to achieve only two of the above.

The ACA seeks to have high access and maintain high quality, while promising 'affordability.'  Naturally, increased access and high quality comes at the caveat of higher costs - which people are seeing now. 

A single-payer system seeks to have high access and lower costs, at the caveat of providing lower quality on an individual level (as compared to what many currently holding private insurance experience in the US and Switzerland).  This is not necessarily a bad thing at all, however, for those who currently have no healthcare.

The reason this issue is so contentious is that those currently with private insurance in the US have different priorities than those without insurance.  And neither view can be faulted for having their perspectives.

Offline Ephiral

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Re: ACA
« Reply #173 on: April 02, 2014, 02:49:39 PM »
Assume that widespread access, low cost, and high quality are the three attributes we value in a health policy system.  Policy experts generally agree that any healthcare system can strive to achieve only two of the above.
The good/fast/cheap rule. Actually applies to pretty much everything in one form or another. The thing is, the pre-ACA system achieved none of those for the overwhelming majority of the population - rather the opposite. If we're comparing to that benchmark, it is indeed possible to hit all three - because it's entirely possible to have, for example, widely-available solid coverage that, while not cheap per se, doesn't bankrupt entire families the moment anything serious goes wrong (and is therefore considerably cheaper than the old version).

The American healthcare system has an administrative overhead of 30%, plus the inefficiency of profit. A typical single-payer system runs at ~3%. You really think there's absolutely no way to decrease costs while maintaining quality of care?

Offline Valthazar

Re: ACA
« Reply #174 on: April 02, 2014, 03:02:42 PM »
You really think there's absolutely no way to decrease costs while maintaining quality of care?

I do think there is a way, but with lower costs, and higher quality of care, we must accept potentially lower access as well.

I outlined the Swiss healthcare system above, which I'm a huge fan of.  That's the most realistic direction the US can progress in at this point, given how similar the ACA is.

They've achieved 99.5% coverage through an entirely privatized, mandate-driven approach, and the government subsidizes premiums for those who cannot afford it.

Offline Ephiral

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Re: ACA
« Reply #175 on: April 02, 2014, 03:13:24 PM »
...and you think that 99.5% is somehow worse than the current situation in the US? Or that countries like Australia, Canada, France, Sweden, and the UK must be excluding huge portions of their population (since every one of them beats the US on life expectancy, infant mortality, cost per capita, and government spending on health care)? I humbly submit that you are mistaken. Yes, the good/fast/cheap rule applies, but  the current situation in the US is not what we should be measuring from - it is not a useful baseline or a neutral point. It is poor, exclusionary, and expensive as hell.

Offline Valthazar

Re: ACA
« Reply #176 on: April 02, 2014, 03:36:56 PM »
I think you are misunderstanding me, I'm saying that 99.5% medical coverage in Switzerland is way better than how things are done in the US.  Americans can learn a lot from the Swiss since they have managed to achieve essentially universal coverage through a privatized model.  I'm saying it is more feasible for the US to switch to a Swiss-style system at this point, than it is to switch to a single-payer system.

The Swiss system is identical to the US.  If you look about 2-3 posts back, I explain why I think it is a great system.

Offline Ephiral

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Re: ACA
« Reply #177 on: April 02, 2014, 03:45:59 PM »
What I'm confused about: You've stated that the US can improve quality and cost, but only by reducing access. I'm having a hard time finding an example of a modern, industrialized nation that doesn't beat the US on all three points - so clearly it is possible to do so. What makes you think that the US is exceptional in this, that it can only achieve adequate and sanely-priced health care by excluding huge swathes of its population?

Offline Valthazar

Re: ACA
« Reply #178 on: April 02, 2014, 04:37:01 PM »
I never said the US was exceptional in its delivery of healthcare, which is why I said we should be more like Switzerland.  Like you have pointed out, there are many flaws with the American model.  For some of us though, it does offer exceptional quality that we couldn't find in other countries.  I wouldn't be able to afford similar insurance through 3rd party private insurers in a single-payer system, nor would I be able to retain similar insurance under ACA (though I have chosen to take an alternative plan to maintain similar coverage).
« Last Edit: April 02, 2014, 04:40:20 PM by Valthazar »

Offline Ephiral

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Re: ACA
« Reply #179 on: April 02, 2014, 04:58:03 PM »
So if the US isn't exceptional, it is in fact possible to deliver better, more accessible, cheaper health care than it has been - none of those points need to be sacrificed at all. Just making that clear.

Offline Kythia

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Re: ACA
« Reply #180 on: April 02, 2014, 08:51:09 PM »
For some of us though, it does offer exceptional quality that we couldn't find in other countries. 

I'm intrigued by this.  Obviously I don't want specific details of your insurance policy (actually, I do because I'm incredibly nosy.  Rephrase that to "obviously I don't expect specific details of...") but is there any way you can expand on that a little without giving away anything too personal?  What sort of exceptional quality care are you (potentially) getting?

Offline Valthazar

Re: ACA
« Reply #181 on: April 02, 2014, 11:03:51 PM »
I'm intrigued by this.  Obviously I don't want specific details of your insurance policy (actually, I do because I'm incredibly nosy.  Rephrase that to "obviously I don't expect specific details of...") but is there any way you can expand on that a little without giving away anything too personal?  What sort of exceptional quality care are you (potentially) getting?

I should have said quality for the cost.  For the amount I was paying as monthly premium, I was very impressed with type of coverage I was receiving, given my current tax bracket.  I'm in a preferred provider plan, meaning that while my premiums may be slightly higher than an HMO, I'm covered to visit specialists within my network without a referral.  My company offers me $175 towards my health insurance, and since I'm young, healthy, and not married, I get it pretty much for free.  I chose a plan that suited my specific needs (my plan didn't cover mental health services and addiction treatment, for example), which helped to cut down significantly on my premium.  It was also limited in preventive services coverage, which I preferred, since I could go for preventive services like physicals, immunizations, and other screenings whenever and wherever I wanted on my own schedule - so long as I paid out-of-pocket.  I exercise regularly and eat healthy, so I always liked this, since I really have no reason to check my cholesterol or blood pressure yearly at this point in my life.  When I did go in for a preventive service like physicals or screenings (which was about once per 2-3 years), I generally paid $250-300 out of pocket at that time.  Going to the primary care doctor with a genuine ailment, however, was not billed as a preventive service, and thus covered.  In my personal case, I had an insurance plan that was tailored to my needs, and hedged against any unfortunate emergency, long-term care situations as well. 

However, this policy expired, and now I'm paying a higher premium for a new plan from the same company, with added services that I'll never even use.  Luckily I can still afford it, but with the ACA, insurance companies are not permitted to charge a copay with any of these preventive services, so they are automatically provided as part of the insurance coverage in full - funded through my premiums.  For my purposes, this is a pointless waste, since I do not require depression screening, HIV screening, or alcohol misuse screening in my insurance plan.  Even if I did need any of these services in the future, I would prefer to simply pay it out-of-pocket on a one-time basis.

While our ages/incomes/tax rates obviously vary, my insurance situation is actually very similar to Phaia, who posted earlier in this thread.
« Last Edit: April 02, 2014, 11:08:27 PM by Valthazar »

Offline Jazra

Re: ACA
« Reply #182 on: April 03, 2014, 02:59:59 PM »
A lot of comments have been made with many good points. I'm just going to express my feelings about the ACA without a lot of support. First, for me, it's been mostly good. I am trying to build two businesses that I started while holding down 75% of a full time job as a paralegal. No health benefits for me and I'm not rolling in cash. So I get a subsidy, which makes health insurance about 25% cheaper than it was before. On the other hand, my new "improved" plan doesn't cover two medications I was taking so if I were to take those medications, my total health insurance outlay would actually be quite a bit higher. I just stopped taking them and will sort it out with my doctor when I next see her. And I did keep my doctor. Hey, but I do like that I'm in a PPO rather than an HMO now.

So those are my biases. What I think is the ACA is a hybrid monstrosity of capitalism and socialism. Ideally, I'd much prefer a single payer system where we squeeze the profit motive out of the bulk of healthcare. But keep in mind, healthcare was already horribly regulated by the US government before the ACA came into effect. It's not like we already had a pure capitalistic health care system.

Let's see. Other thoughts. I don't care about the web site. That's poor implementation of the law and it's being fixed. I also accept that when you implement a new bureaucracy this big, there's going to be a lot of wrinkles to be ironed out. In the end, I had insurance before. I have insurance now. My new insurance is arguably a bit better than my new insurance, but it's not perfect.

C'est la vie.

Offline consortium11

Re: ACA
« Reply #183 on: April 04, 2014, 05:41:28 AM »
I'm intrigued by this.  Obviously I don't want specific details of your insurance policy (actually, I do because I'm incredibly nosy.  Rephrase that to "obviously I don't expect specific details of...") but is there any way you can expand on that a little without giving away anything too personal?  What sort of exceptional quality care are you (potentially) getting?

While there's some dispute as to the figures (notably the the US uses more tests and uses them earlier) I believe that cancer (primarily breast and prostrate) treatment in the US is generally considered superior to at least the UK and most of the rest of Europe.

It falls into a pattern which I think is fairly well established; if (and there's a huge if there) someone can afford it, the US offers one of, if not, the best healthcare services in the world. The issue is that so few can afford it and many of those who technically can will have to make huge sacrifices to fund it. To use the quality/cost/access aspect the US is high on quality (at least at the top end) but costs far too much (both individually and as a whole) and partially because of that struggles on access while the NHS for example may not have quite as high a quality (at least at the top end) but has far better access and better costs (both individually and as a whole).

Offline Kythia

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Re: ACA
« Reply #184 on: April 04, 2014, 05:52:31 AM »
Yeah, I was looking into it a bit myself.  My thinking was around medical tourism though - obviously the US is a massive net exporter of medical tourists and my understanding was that a lot of that was driven by cost.  Essentially, it seemed to me people were feeling they could get an equivalent quality of care somewhere else for much cheaper.