The Sad Case of the Patient Protection and Affordable Care Act

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

And those with good health and don't need a whole bunch of pills and stuff and getting screwed over by those that do. That's what happens with group rates.

My FIL wasn't based on what was wrong with him. He was just screwed by being individual. At that time he was healthy, taking no meds.

It is easy to say that the healthy get screwed by the sick but if you do not distribute the risk most people would not be able to afford insurance or healthcare. I don't think that is an exageration. People have no idea what the actual cost is to get meds, care etc. Right now people are ballistic because they have to pay 30$ copay for a med. If they paid reg price it would be well over that.

Many of my older patients are paying a few hundred $ for their meds per month and that is subsidised by insurance/medicare. This is with giving them as many generics as possible, not prescribing the expensive stuff if it can be avoided. The avg person cannot afford the upkeep necessary if they have more than a few diagnoses even if they were to cut out all but the most essential expenses. If the healthy person should have an accident/traua or a sudden heart attack it is possible they would be bankrupted without ever having had a problem with $ before. How many of us with older parents are paying a portion of their healthcare bills? (depleting the bank account for when we need to pay our own expenses) Our ability to treat and maintain health has outstripped our ability to afford to do so.

No one I have seen in the public sector has come close to addressing this. Everyone wants to make out that people are irresponsible and this is why they can't afford stuff. Most people can't keep >25$ in the bank in case they have a heart attack. Many people can't afford the most rudimentary insurance. Yes there are people who have a horrible lifestyle, who drink, smoke and are sedentary. There are also some people who work for a living, save the cash, do all the right things and still end up in trouble.

I know there are those that don't agree with me about access to healthcare for everyone. It is very easy when one is young and healthy, with healthy parents, to feel that there is a solution and people are just not doing what they are supposed to. To me there is something inherently wrong with a society where you can work your whole life, have a healthy lifestyle, save responsibly, make contingency plans and still end up in a position where you can't afford basic healthcare/ medication and you can lose your home and all that you have worked for without having enough to be OK.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

One thing you may not be considering- If you are buying insurance in a group setting (ie employer buys it) your risk is distributed and the cost goes down considerably. As anyone who has tried to buy an individual plan will know the cost when buying individually is much higher. ....Is there a remedy for this in the plan you are proposing?

It seems that a consensus might be emerging among the serious thinkers, which is basically to put everyone in a "group" setting by taking several concurrent steps:
> ending the differential tax treatment of health insurance premiums between employee, self-employed, retired, and 'in transition'
> severing the link between employment and coverage (everyone is now a member of the same "group")

NOTE that people might still be able to pay their health insurance premiums through payroll deduction, much like people also acquire elective fringe benefits in this manner
the Federal government is itself a potential model as Federal employees can elect among several insurance companies

> allowing flexibility in plan design (i.e., allow stripped-down "catastrophe only" coverage with high deductibles)
> having periodic, scheduled "open enrollment" windows during which most people can select coverage with a new insurance coverage regardless of [most] pre-existing conditions
[likely there would be certain high-risk "carve-outs" into a "special risk" pool for which participants get supplemental assistance; e.g. diabetes, emphysema, cancer patients]
> allowing premiums to be based on the actual morbiity risk of the insured pool
> allowing an exemption from state mandates for the "catastrophe only" policy
> coupling pure "insurance" with pre-paid spending accounts*, either inside the policy itself or as a companion account.


Note that this particular model is not inconsistent with the so-called "single payor" program proposed by various thinkers, including Ryan's Medicare plan for people now 55 and under: you get a chunk of money equal to what it costs the government to provide coverage, and you get to pick which company provides your coverage, either the Feds or a competitor. It merely specifies the setting in which coverage is provided, not who pays for it.





* "Pure" insurance is protection against risk. Many "insurance plans" already contain pre-paid spending account. Example: most dental plans cover a check-up and teeth cleaning. That is not a "risk" that is a virtual certainty; and so a portion of the premium goes into a pre-paid spending account. Same with an "insurance plan" that covers preventive doctor visits; a portion of the premium goes into a pre-paid spending account.

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

And those with good health and don't need a whole bunch of pills and stuff and getting screwed over by those that do. That's what happens with group rates.

Its called shared responsibility, sparky. Seems like you think most people who get sick deserve it. One wonders if your attitude would change if you were one the opposite end of an illness that was no cause of your own.

Fishy, you were doing fine until you tried to interject Ryan's idiotic plan into the discussion. If this is good for the under 55 crowd, why isn't it good for everybody else? Maybe, because, the over 55 crowd votes Republican? Kinda sounds like good ol' Abe Lincoln talking about people who argued slavery was a good thing for the slaves. His quote was it has to be the only good thing that no man wishes upon himself. Likewise, if Ryan's plan is such a swell idea, why isn't he proposing it for his voters?

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

If this is good for the under 55 crowd, why isn't it good for everybody else?

We've seen in general how well a massive overhaul goes over. Either there "has to be" a strong bi-partisan consensus (cf abolition, women's suffrage, civil rights) or you make incremental steps.

Are you saying you would oppose a single-payor plan for a portion of the population? Based on your comments I'd expect you to be a big supporter of single-payor plans....wouldn't your belief structure say that, once we get it in place for part of the population, it would be so popular there that everyone else also would be clamoring for it? Wouldn't you view that as a good thing?


Your tendency to think of everything in partisan terms rather than take the long view of what's best overall, no matter who proposed it, and your lack of patience in dealing with people who might agree with part of what you say if you weren't so snotty about it, helps illustrate once more that old chestnut, "the perfect is the enemy of the good."

[joecct]

I smell desperate backtracking here out of our righty friends. Nobody to my knowledge said employers would pocket 100% of the savings from not offering health care. What myself and others have said is that employers would pocket the vast majority of those savings and that employees would most likely be at the short end of the stick as the small raises they'd get would not cover the cost of finding their own insurance.

If profits go up would stockholders see increased dividends?

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

If profits go up would stockholders see increased dividends?

Not necessarily, as the company could be choosing to hold it as cash, or invest it somewhere else (like salary bonuses, or whatever other cockamamie idea). Of course, the shareholders would be able to let the company know what they think about that policy (i.e. SELL SELL SELL!)

[WeWantMore]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Fishy, you were doing fine until you tried to interject Ryan's idiotic plan into the discussion. If this is good for the under 55 crowd, why isn't it good for everybody else? Maybe, because, the over 55 crowd votes Republican? Kinda sounds like good ol' Abe Lincoln talking about people who argued slavery was a good thing for the slaves. His quote was it has to be the only good thing that no man wishes upon himself. Likewise, if Ryan's plan is such a swell idea, why isn't he proposing it for his voters?

He's probably worried his political opponents would totally misrepresent the plan to that over 55 crowd. You know, ads with him pushing old ladies off of cliffs, leaders of the opposition party calling it a tornado through nursing homes, that sort of thing.

It's a pretty crazy concern in my book, I'm sure that would never happen.

In all seriousness though, I do wish the Ryan plan went a lot farther. But I won't let the perfect be the enemy of the slightly better either.

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

He's probably worried his political opponents would totally misrepresent the plan to that over 55 crowd. You know, ads with him pushing old ladies off of cliffs, leaders of the opposition party calling it a tornado through nursing homes, that sort of thing.

It's a pretty crazy concern in my book, I'm sure that would never happen.

In all seriousness though, I do wish the Ryan plan went a lot farther. But I won't let the perfect be the enemy of the slightly better either.

Here's my take. Far from being some sort of right wing truth telling deity, I think Ryan's plan is a blatant political document to benefit his supporters. He could have linked it with Social Security full benefits retirement age (66 currently) or he could have started with the Baby Boomer generation (with the oldest of them also hitting their mid 60's) who just so happen to be the biggest drain on Medicare. Instead, he conveniently cuts it off at 55, knowing full well that the GOP won the over 45 vote last Presidential election but got killed with those younger than that. Call it the 50 and under crowd 4 years later. He gives a free pass to 55 and over. Coincidence? I think not. Far from being a "brave document" its a sham. Plus, why is he using some of those savings to cut taxes on the rich?

Regarding the actual proposal, keeping a block grant at today's dollars for care forces those excluded from his free pass to pay more and more and more every year out of pocket for coverage. Everyone agrees health care growth needs to slow down. I don't know of anybody who sees it going into negative territory, especially with all the aging Baby Boomers. So, you're sticking it to the younger generation even if health care costs grew at the rate of inflation (not likely). How is exactly is this right?

But, far from opposing Ryan's plan, I think it should pass. Its a document for an electorate circa 1980, not the one the GOP will be facing in 2012. With Millenials now being the largest generation and entering the voting population by the millions, I'm guessing trying to stick them with the bill for The Whiniest Generation might be a recipe for electoral doom.

Fishy - Don't oppose a portion of the population having single payer as that would mean opposing Medicare/Medicaid, etc. Regarding everyone having single payer, I'd like to see some analysis that it will cut costs. Otherwise I have a feeling Medicare taxes would have to go up. Maybe that's the case, but again I'd need more detail before signing on.

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

He's probably worried his political opponents would totally misrepresent the plan to that over 55 crowd. You know, ads with him pushing old ladies off of cliffs, leaders of the opposition party calling it a tornado through nursing homes, that sort of thing.

Yes. That sort of thing.

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[MinnFan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

One thing you may not be considering- If you are buying insurance in a group setting (ie employer buys it) your risk is distributed and the cost goes down considerably. As anyone who has tried to buy an individual plan will know the cost when buying individually is much higher. An example- my Fa-in-law tried to buy the insurance from the same provider we had a few yrs ago. For less covg than we had he was going to pay >800$ per person for him and one other employee a month. We got a better plan for less than half of that. Group rates are always sig lower because a group has bargaining power and risk is distributed over the cohort. I can't tell you how many times I have seen people who can't leave their job because to do so would put them out of the market for insurance with or without pre-exsisting conditions.

Is there a remedy for this in the plan you are proposing?

The easiest thing to do is look at car insurance. You are essentially part of the overall group that the entire company insures. What keeps costs down is other insurance companies competing for your business. Your personal risk is factored in, but you certainly aren't out there on an island. Its also true insurance. They don't pay for your oil changes. If we were to get rid of the mandates and go back to true "insurance" there would be plans that would be very affordable and more likely to keep costs down going forward.

And for the first retort I know is coming. There are already laws on the books that insurance companies can't drop you just because you get sick as long as you are current in your payments.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I am definitely not in favor of a single-payor plan. Our memories and our attention spans are so short. It seems to me that any guarantee of any level of material well-being is well-intentioned and ill-considered. The Rights specified in the Constitution and the Declaration of Independence are all abstract, not tangible. Envy is a terrrible thing.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

The easiest thing to do is look at car insurance. You are essentially part of the overall group that the entire company insures. What keeps costs down is other insurance companies competing for your business. Your personal risk is factored in, but you certainly aren't out there on an island. Its also true insurance. They don't pay for your oil changes. If we were to get rid of the mandates and go back to true "insurance" there would be plans that would be very affordable and more likely to keep costs down going forward.

+ 10. Very well put.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

But, far from opposing Ryan's plan, I think it should pass. Its a document for an electorate circa 1980, not the one the GOP will be facing in 2012. With Millenials now being the largest generation and entering the voting population by the millions, I'm guessing trying to stick them with the bill for The Whiniest Generation might be a recipe for electoral doom.

I haven't read Ryan's Plan (didn't even know it existed), but speaking as a Gen-Y, I'm sure you could understand why people should be responsible for their own bills. Forcing me to pay for your health care because you couldn't prepare on your own is not only asinine, but whiny on your part. Given FreshFish's description of Ryan's plan, it doesn't sound like too bad of an idea. In fact, we should consider doing the exact same thing for Social Security and everything else. Here's an idea: Take the hit on the 1930's retirees now, and switch over to this new plan. Either you go with the government or invest on your own. None of this forced investing, because you're not "borrowing from us" for your own personal gain.

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I haven't read Ryan's Plan (didn't even know it existed), but speaking as a Gen-Y, I'm sure you could understand why people should be responsible for their own bills. Forcing me to pay for your health care because you couldn't prepare on your own is not only asinine, but whiny on your part. Given FreshFish's description of Ryan's plan, it doesn't sound like too bad of an idea. In fact, we should consider doing the exact same thing for Social Security and everything else. Here's an idea: Take the hit on the 1930's retirees now, and switch over to this new plan. Either you go with the government or invest on your own. None of this forced investing, because you're not "borrowing from us" for your own personal gain.

Selfish, unworkable and short sighted. Your juvenile take on things is that everybody has the means to pay for both retirement and health care, but those who end up short have needlessly squandered it. Again maybe that's true in fantasyland, but I find that few amongst the population have the money to pay for cancer treatments or heart surgery out of pocket. In fact that's a ridiculous notion. If people like yourself ruled the day during WWII with your everyone's on their own attitude, half the world would be speaking German right now.

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

The easiest thing to do is look at car insurance. You are essentially part of the overall group that the entire company insures. What keeps costs down is other insurance companies competing for your business. Your personal risk is factored in, but you certainly aren't out there on an island. Its also true insurance. They don't pay for your oil changes. If we were to get rid of the mandates and go back to true "insurance" there would be plans that would be very affordable and more likely to keep costs down going forward.

And for the first retort I know is coming. There are already laws on the books that insurance companies can't drop you just because you get sick as long as you are current in your payments.

Way too simplistic. My first retort is that whether you choose to drive or not isn't a life or death decision. If you can't get insurance, or if its too expensive, not having a car won't literally kill you. If you need medical care and you can't get insurance, you're screwed. Comments like this always bring me back to the thought that you're still in high school. Your pre-existing condition analogy falls into the same category. What according to you happens when you lose your job, and hence you coverage, and then try to get new coverage with a pre-existing condition? How does this relate to auto insurance.