The Sad Case of the Patient Protection and Affordable Care Act

[FreshFish]

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

This thread is great. More in commentary to some of the other threads where people post stuff that declares something right or wrong. I actually am curous what other people think. On occasion I have changed my mind when someone has presented an opinion. Other times I may not agree but at least I understand why they think the way they do.

one of the reasons I am really suspicious of centralized "command and control" solutions is because all people are fallible. We have limited capabilities as part of the human condition. Often it requires more than one point of view to see the whole picture, and it is just not possible for one person -- nor a group of like-minded people -- to do this.

[Kepler]

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

one of the reasons I am really suspicious of centralized "command and control" solutions is because all people are fallible. We have limited capabilities as part of the human condition. Often it requires more than one point of view to see the whole picture, and it is just not possible for one person -- nor a group of like-minded people -- to do this.

That's the reason government solutions are often better than private sector schemes. A democratically elected body has more perspectives than a handful of homogenous board members.

I'll see your Economic Calculation Problem and raise you a Participatory Diagnostic Theorem.

BTW, nobody wants a Stalinist Command and Control system. As useful a straw man as that is in Hayekian circles, it's still just a straw man.

The world's complicated. Ideological cliches don't cut it.

[Plante26]

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

That's the reason government solutions are often better than private sector schemes. A democratically elected body has more perspectives than a handful of homogenous board members.

Does this mean you're saying that a solution that originates within our government must be implemented by the government as well? I'd prefer collaboration between government and business (if it makes sense) as opposed to another inefficient government program.

It is also a pretty broad brush you're using to paint all private sector leaders as "homogenous"; in addition, to assume that any given group of elected politicians can automatically understand and legislate within the intracacies of complex economic sectors is presumptuous at best.

[ScoobyDoo]

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

Does this mean you're saying that a solution that originates within our government must be implemented by the government as well? I'd prefer collaboration between government and business (if it makes sense) as opposed to another inefficient government program.

It is also a pretty broad brush you're using to paint all private sector leaders as "homogenous"; in addition, to assume that any given group of elected politicians can automatically understand and legislate within the intracacies of complex economic sectors is presumptuous at best.

Social Security runs at 2% overhead. Try doing that in the private sector.

[LynahFan]

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

Social Security runs at 2% overhead. Try doing that in the private sector.

Name an organization in the private sector whose only function is to mail out checks.

[FreshFish]

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

A democratically elected body has more perspectives than a handful of homogenous board members.

.... BTW, nobody wants a Stalinist Command and Control system.

Are you really that unversed in the actual workings of PPACA? Decisions are centralized in HHS panels whose appointees are not even subject to Congressional review and approval.

[Plante26]

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

Social Security runs at 2% overhead. Try doing that in the private sector.

There are numerous private investment funds that operate at less than 0.50%; some less than 0.10%. They've tried. And succeeded.

[Plante26]

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

Are you really that unversed in the actual workings of PPACA? Decisions are centralized in HHS panels whose appointees are not even subject to Congressional review and approval.

Don't forget that the legislation puts caps on insurance rate hikes while forcing insurers to accept pre-existing conditions and cover certain procedures without exception.

Try to do the job of an insurance actuary with these stipulations. It is virtually impossible. Thus my belief that this bill is specifically intended to bring about single payer or universal health care. There are already numerous companies pulling out of the individual insurance marketplace.

[ScoobyDoo]

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

There are numerous private investment funds that operate at less than 0.50%; some less than 0.10%. They've tried. And succeeded.

Sure. Private Sector does everything better. Time to farm out the military.

[ScoobyDoo]

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

Don't forget that the legislation puts caps on insurance rate hikes while forcing insurers to accept pre-existing conditions and cover certain procedures without exception.

Try to do the job of an insurance actuary with these stipulations. It is virtually impossible. Thus my belief that this bill is specifically intended to bring about single payer or universal health care. There are already numerous companies pulling out of the individual insurance marketplace.

For the insurance company to survive they need to make a profit. To make a profit they need to dump the hard luck cases. Then the hard luck cases have no insurance. Then we all get burdened with higher medical costs after we treat the hard luck cases. Then the insurance rates go up. And the circle continues.

So, you have two choices.

1. Start denying care. (private method)
2. Eliminate the need for medical insurance. (public method)

Take your pick.

[LynahFan]

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

For the insurance company to survive they need to make a profit. To make a profit they need to dump the hard luck cases. Then the hard luck cases have no insurance. Then we all get burdened with higher medical costs after we treat the hard luck cases. Then the insurance rates go up. And the circle continues.

So, you have two choices.

1. Start denying care. (private method)
2. Eliminate the need for medical insurance. (public method)

Take your pick.

#2 only works if you assume that the profits that health care insurers are making are sufficient to cover all of those "hard luck" cases out there - i.e. take away their profits and use those to pay the premiums for people currently without insurance. I don't know the numbers, but I suspect that math doesn't add up - simply going to "non profit insurance" (i.e. the public method) won't do the trick, either - rationing will still be part of the answer.

[ScoobyDoo]

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

#2 only works if you assume that the profits that health care insurers are making are sufficient to cover all of those "hard luck" cases out there - i.e. take away their profits and use those to pay the premiums for people currently without insurance. I don't know the numbers, but I suspect that math doesn't add up - simply going to "non profit insurance" (i.e. the public method) won't do the trick, either - rationing will still be part of the answer.

The bonuses that the medical insurance CEO's get can pay for a lot of Health Care. We'd be closer. Personally I'd go with the "deny" method anyway. It's time for folks to really start understand what is going on and that's the only way. Course it won't happen until the Baby Boomers are all dead and we're bankrupt and then no one will really notice anyway.

[Plante26]

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

For the insurance company to survive they need to make a profit. To make a profit they need to dump the hard luck cases. Then the hard luck cases have no insurance. Then we all get burdened with higher medical costs after we treat the hard luck cases. Then the insurance rates go up. And the circle continues.

So, you have two choices.

1. Start denying care. (private method)
2. Eliminate the need for medical insurance. (public method)

Take your pick.

Some statistics for you to gnaw on:

Annual cost of uninsured patients, nationwide: $49 billion.
Annual cost of Medicare/caid underpayments to providers, nationwide: $88 billion.
Annual cost of malpractice insurance and unnecessary defensive medicine, nationwide: $250-$325 billion.

Clearly, uninsured patients aren't the biggest problem facing our health care system. Fix even 20% of the latter two issues and paying for uninsured patients is no longer a fiscal issue, especially if a sliding/ability-to-pay scale were enacted for uninsured patients. I'm sure the medical industry would make this trade-off. It's a no-brainer.

Sure. Private Sector does everything better. Time to farm out the military.

Military and defense: Constitutional duty of the federal government. Managing retirement funds: Not a Constitutional duty of the federal government.

Instead, why don't we unionize the military like all of the other government employees?

[ScoobyDoo]

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

Some statistics for you to gnaw on:

Annual cost of uninsured patients, nationwide: $49 billion.
Annual cost of Medicare/caid underpayments to providers, nationwide: $88 billion.
Annual cost of malpractice insurance and unnecessary defensive medicine, nationwide: $250-$325 billion.

Clearly, uninsured patients aren't the biggest problem facing our health care system. Fix even 20% of the latter two issues and paying for uninsured patients is no longer a fiscal issue, especially if a sliding/ability-to-pay scale were enacted for uninsured patients. I'm sure the medical industry would make this trade-off. It's a no-brainer.



Military and defense: Constitutional duty of the federal government. Managing retirement funds: Not a Constitutional duty of the federal government.

Instead, why don't we unionize the military like all of the other government employees?

Not familiar with the Great Depression are we? I suppose all those folks who suffered through that were at fault themselves for their plight?

If the Private Sector can do Health Care so great then why aren't they doing it?

[FreshFish]

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

For the insurance company to survive they need to make a profit. To make a profit they need to dump the hard luck cases.

Not necessarily (for one thing that is illegal in most states! the actual process is more nuanced and subtle).

For insurance companies to make a profit they need to set premiums so that they roughly equal claims.* As long as potential claims can be factored into their pricing, they do not "need to" and quite often do NOT "dump" people.

For life insurance, for example, if you are issued a preferred policy and then develop cancer several years later, they cannot change your rates. The life insurance companies know that some people will get sick over time and build that into their pricing upfront.

The same is generally true of health insurance (but only to a point): you could buy an individual policy and if you later got sick they could not cancel only your policy, nor single you out individually for a rate increase. Rates only can be increased for the entire "class" of insureds. As far as I know that is the law in all 57 states.

The crux of the problem is this goofy system we have where most health insurance coverage is related to employment. Now, you are okay only as long as you work for someone else (if you change employers, the insurance company there knows it has to enroll all new hires regardless of pre-existing conditions, and so that situation also is baked into their rates). Individual insurance has become so expensive partly because so many people are outside the employer-provided coverage network (state mandates that require everyone to purchase bells and whistles when they only want a stripped-down catastrophe only policy don't help either; there are multiple causes for this problem).

If we eliminated all employer-provided coverage and had "open enrollment" windows periodically in which health insurance companies would take (nearly all) comers (with special risk pools and supplemental assistance for people with certain specified chronic conditions), and they were allowed to offer stripped-down catastrophe only coverage among a broader array of options, and were allowed to set rates based on risk, then there would be no "need" to jettison people from coverage any more.







* Premiums + interest income >= claims + expenses. The Federal Reserve is making things harder on them than most people realize.