The PPACA Thread Part III - Let's have a healthy debate!

[unofan]

You are the one having the wrong conversation. Due to PPACA, we are all forced to participate in the health care market in one of 3 main ways (I'm sure there are others): purchase of private health care insurance (as through an employer-sponsored plan), shopping on a health care exchange such as MNSure, or paying a Federal Tax. You're right that nobody is forced to pick any particular one of these 3 options, so it's accurate to say that people *can* shop at MNSure. However, it's inaccurate to say that people are not required to participate in the health care coverage market in general.

See the all those trees? They make up a forest.

Of course pre-ACA, we all participated too. It's just taxpayers picked up the slack for those who gambled/couldn't afford insurance and got sick. The ACA shifts the costs to the person at least somewhat.

Given that ERs are required by law to treat you, Im fine eliminating the gambling aspect of the market.

[dxmnkd316]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Y'all as missing a highly important aspect to all this.

Nobody really knows what it costs. To them.

Mookie's had health insurance all his life. To him a dr cost $50. Drugs $30.

Co-pay though as we know it is leaving the barn. Now Mookie has to pay "co-insurance" after forking out $3k until he hits $6k every calendar year.

As a consumer Mookie has no idea when that occurs now. February?
July?
October?

What do Mookie's drugs cost? $30?

Come January is that now $300? Or $500? Or $20?

In February Mookie has a dr visit that will cost what? $1k?

and mookie ain't in this boat alone....

Brave new world

This post is going to be ignored by a lot of people and probably shouldn't be.

There is a really, really good point in there. Maybe on of the best I've seen on this board.

The vast, vast majority of people have no idea what it costs for the health care they receive. When they finally open their eyes is when we can start to move forward. Until then, we'll be at a standstill and neither a pure capitalistic approach or a single-payer approach will work.

[LynahFan]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Of course pre-ACA, we all participated too. It's just taxpayers picked up the slack for those who gambled/couldn't afford insurance and got sick. The ACA shifts the costs to the person at least somewhat.

Given that ERs are required by law to treat you, Im fine eliminating the gambling aspect of the market.

Me, too. Pre-PPACA, we all participated in consuming health care services. Post-PPACA, we all participate in actually paying for it.

[burd]

Re: The PPACA Thread Part III - Let's have a healthy debate!

A couple of years before the ACA was signed, I attended an Estes Park medical conference attended by people in the health care industry, primarily doctors, provider management, and trustees (board members). These were people who had good reason to maintain the status quo, as medical care costs had been rising 6-7% per year for a long time. One of the prevailing messages was the fact that medical providers must start preparing for a major overhaul in the medical care delivery and reimbursement system. And these people were not claiming that bad-guy politicians were going to mess up a system that did not need fixing--they were saying the then-existing system could not continue. Expenses were out of hand, health care delivery was extremely inefficient, insurance was becoming too expensive for the average wage earner, and too many were not treating as they should because they were uninsured. It was not a bunch of democrats, by any means; rather, it was a conservative group of highly educated, highly paid people predicting what was about to happen and warning their fellow industry professionals that they must do everything they could to anticipate major change in order to survive. I was there as a trustee for a small hospital, not an expert by any means, and I'm still not. But the Estes Park four-day conferences are pretty highly regarded, I think, and the message was coming from within the industry, not political hacks, activists, or the insurance industry.

There is probably a lot to improve with ACA, but thinking that the attempt to overhaul that system was unnecessary and tragic, while a convenient pitch to those who fear and oppose any gubmint efforts that might affect their lives, is not realistic, IMO. It is too complicated an issue for idiot politicians to reduce it to a sound-bite that will get the base riled up, such as claiming that everything was going well and that it should have been left dam-well alone. I don't think I have ever heard a politician asked to explain what is the most important difference between ACA and the MA plan, for example, or what it is about the MA plan that makes it unsuitable for nation-wide application. People on this site can speak to that and have, I think, but the national discussion never gets to that level. Death squads, for Parise's sake.

Maybe we should require the candidates from both parties to get a user name and engage in the discussion on this thread. That would elevate the discussion a lot.

[5mn_Major]

Re: The PPACA Thread Part III - Let's have a healthy debate!

You are the one having the wrong conversation. Due to PPACA, we are all forced to participate in the health care market in one of 3 main ways (I'm sure there are others): purchase of private health care insurance (as through an employer-sponsored plan), shopping on a health care exchange such as MNSure, or paying a Federal Tax. You're right that nobody is forced to pick any particular one of these 3 options, so it's accurate to say that people *can* shop at MNSure. However, it's inaccurate to say that people are not required to participate in the health care coverage market in general.

See the all those trees? They make up a forest.

That's a different conversation. UHG is only talking of leaving the exchange.

[dxmnkd316]

Re: The PPACA Thread Part III - Let's have a healthy debate!

UHG is not leaving the exchanges. I hope someone in power calls their bluff. There is far too much money in these exchanges to pull out. Especially if you're that big.

These things aren't going away. This is just the health care industry trying to up their margins because they can see that eventually consumers are going to understand how much this **** costs and what we're actually paying for it and the insurance and medical industries are going to be in trouble. (Maybe that's not quite right, but there are going to be some growing pains.)

[joecct]

Re: The PPACA Thread Part III - Let's have a healthy debate!

UHG is not leaving the exchanges. I hope someone in power calls their bluff. There is far too much money in these exchanges to pull out. Especially if you're that big.

These things aren't going away. This is just the health care industry trying to up their margins because they can see that eventually consumers are going to understand how much this **** costs and what we're actually paying for it and the insurance and medical industries are going to be in trouble. (Maybe that's not quite right, but there are going to be some growing pains.)

Too Big To Fail?

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Nice to see people come around to Roverology finally! As I've said maybe a few times before MA is the perfect case study for the ACA. Same concerns, fear mongering, etc happened before this went into place. Job killer, too expensive, no insurers will sign up, blah blah blah. None of that happened, so what gives?

Regarding mookie's post, I recall going to my dentist who've had for awhile (and a good guy - fellow BU hockey fan) and he took 5 X-rays of my mouth during a cleaning. Then he came back and said my insurance only covers 2 so he wouldn't charge me for the others. I've got a big mouth, but its not so big that it takes 5 x-rays to cover! Seems to me this is an example of reigning in some excess costs.

To your other point, and one made recently by the NYT, you may in fact have an out of pocket max (2k, 3k, whatever) before insurance kicks in. However, that doesn't mean that you're paying full price for your allergy meds for example. A lot of services just have the co-pay and that's it especially for routine care. Furthermore, the insurer should still be negotiating its own rate for you even if you have to pay the cost of whatever they've negotiated afterwards.

[mookie1995]

To your other point, and one made recently by the NYT, you may in fact have an out of pocket max (2k, 3k, whatever) before insurance kicks in. However, that doesn't mean that you're paying full price for your allergy meds for example. A lot of services just have the co-pay and that's it especially for routine care. Furthermore, the insurer should still be negotiating its own rate for you even if you have to pay the cost of whatever they've negotiated afterwards.

Nope
Co-pay no longer exists as an option where Mookie works. It is co-insurance. Mookie pays full cost up to $3k now and then 10% of the cost up to $6k

"Of the cost"

There is nothing in there about co-pays. It's now co-insurance.

Of course the premiums Mookie pays are still going to run $4500. Not sure what anyone gets for that. Breaks down simply to Mookie spending $4500 as a hedge he won't have to spend 10,500 total in a calendar year.

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Nope
Co-pay no longer exists as an option where Mookie works. It is co-insurance. Mookie pays full cost up to $3k now and then 10% of the cost up to $6k

"Of the cost"

There is nothing in there about co-pays. It's now co-insurance.

Of course the premiums Mookie pays are still going to run $4500. Not sure what anyone gets for that. Breaks down simply to Mookie spending $4500 as a hedge he won't have to spend 10,500 total in a calendar year.

Then mookie is getting screwed by his insurer, and needs to see if astroglide is covered since you're going to be using a lot of it!

[mookie1995]

Then mookie is getting screwed by his insurer, and needs to see if astroglide is covered since you're going to be using a lot of it!

Not the insurer
You know where I work. People are leaving in bus loads

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Not the insurer
You know where I work. People are leaving in bus loads

Didn't know if the employer in question self funded the plan or not...

[mookie1995]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Didn't know if the employer in question self funded the plan or not...

have to assume they worked with insurers to get options with pricing they wanted. (like progressive with 'name your price' too ) the same parties work with your employer too. they have options with co-pays and they have options without co-pays.

[5mn_Major]

Re: The PPACA Thread Part III - Let's have a healthy debate!

I still don't get the 'exchanges are bad' crowd.

Just because a company takes a profit hit...doesn't mean there's a problem with the marketplace. So here's a case where a company (who I admire) saw softening profits. It was driven by the exchanges. And that's not a good thing...its a great thing. There is unprecedented transparency in a marketplace where there was none. It forces companies throughout the sector to be more efficient. An analogy is if airlines charged $500 for a short flight, but were all very profitable. Would that be a great outcome? Nope.

We want companies that are profitable by offering quality services at a low price. The first of those to go is profit...as customers, we will not accept anything less.

UnitedHealth Reports Profit Decline Amid Exchange Weakness

http://www.wsj.com/articles/unitedhe...ess-1453204404

[FlagDUDE08]

Re: The PPACA Thread Part III - Let's have a healthy debate!

I still don't get the 'exchanges are bad' crowd.

Just because a company takes a profit hit...doesn't mean there's a problem with the marketplace. So here's a case where a company (who I admire) saw softening profits. It was driven by the exchanges. And that's not a good thing...its a great thing. There is unprecedented transparency in a marketplace where there was none. It forces companies throughout the sector to be more efficient. An analogy is if airlines charged $500 for a short flight, but were all very profitable. Would that be a great outcome? Nope.

We want companies that are profitable by offering quality services at a low price. The first of those to go is profit...as customers, we will not accept anything less.

UnitedHealth Reports Profit Decline Amid Exchange Weakness

http://www.wsj.com/articles/unitedhe...ess-1453204404

If government actually wants to be a competitor for a free-market area, that's one thing. The underlying issue is that it is much closer to cronyism, where they are using endless bureaucracy (similar to how certain private enterprises with which you disagree use lobbying) to "regulate" their competitors out and create a back-door monopoly, or in this case, back door single payer. You may not see it that way because of your feelings towards the entity creating the monopoly, but if you don't like one group for creating a situation that results in corruption, what makes you think the next entity that does it is going to be any different? If I'm not mistaken, there's a famous quotation about the definition of "insanity" that applies here...