The PPACA - Implementation Phase I

[FreshFish]

Re: The PPACA - Implementation Phase I

I see that several publications have started the "fact vs fiction" stories about PPACA. We'll take a step back from the political overtones for awhile, and merely comment on the law itself, what it requires, and what it proscribes.




Assertion: we "needed" PPACA so that people with pre-existing conditions could acquire health insurance at standard rates.

FICTION. Before PPACA, there were at least four different ways in which people with pre-existing conditions could acquire health insurance at standard rates. In each case, it was the existence of "open enrollment windows" that made it possible.

PPACA actually makes the situation worse! It allows people to <strike>acquire</strike> apply for coverage at any time.

With open enrollment windows, rational pricing can be offered based on empirical data. Under the new system, it is impossible to offer rational pricing, at least at the outset, because there is no empirical data yet available.

 

[Rover]

I see that several publications have started the "fact vs fiction" stories about PPACA. We'll take a step back from the political overtones for awhile, and merely comment on the law itself, what it requires, and what it proscribes.




Assertion: we "needed" PPACA so that people with pre-existing conditions could acquire health insurance at standard rates.

FICTION. Before PPACA, there were at least four different ways in which people with pre-existing conditions could acquire health insurance at standard rates. In each case, it was the existence of "open enrollment windows" that made it possible.

PPACA actually makes the situation worse! It allows people to <strike>acquire</strike> apply for coverage at any time.

With open enrollment windows, rational pricing can be offered based on empirical data. Under the new system, it is impossible to offer rational pricing, at least at the outset, because there is no empirical data yet available.

Curious if you mean by "open enrollment" that you can get coverage via your employer. That's not the problem Obamacare is trying to solve in this case. What in your opinion should one do in a non-Obamacare world if you don't get coverage through your employment? Natural selection?

 

[joecct]

Re: The PPACA - Implementation Phase I

Curious if you mean by "open enrollment" that you can get coverage via your employer. That's not the problem Obamacare is trying to solve in this case. What in your opinion should one do in a non-Obamacare world if you don't get coverage through your employment? Natural selection?

The latter is the great equalizer.

As to the former.. If you had a nationwide open enrollment period for the exchanges, it would force folks to determine if they want to risk (which is what insurance is -- you minimize the risk) going without or with health insurance..

FYI, the Feds open enrollment period runs from mid October to mid November for the following January 1. You can change your coverage if you have a "life event" (marriage, kid, divorce, etc.)

 

[Rover]

The latter is the great equalizer.

As to the former.. If you had a nationwide open enrollment period for the exchanges, it would force folks to determine if they want to risk (which is what insurance is -- you minimize the risk) going without or with health insurance..

FYI, the Feds open enrollment period runs from mid October to mid November for the following January 1. You can change your coverage if you have a "life event" (marriage, kid, divorce, etc.)

I can live with a tweak like this. However a "life event" would need to include losing coverage, as in you got laid off or injured and couldn't work.

 

[unofan]

I can live with a tweak like this. However a "life event" would need to include losing coverage, as in you got laid off or injured and couldn't work.

It still doesn't answer the inevitable question that follows: what do you do with the guy who risked not getting insurance but then suffers a major medical issue. Leave him to die on the streets?

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

I can live with a tweak like this. However a "life event" would need to include losing coverage, as in you got laid off or injured and couldn't work.

It does. Hence, the "etc.".

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

It still doesn't answer the inevitable question that follows: what do you do with the guy who risked not getting insurance but then suffers a major medical issue. Leave him to die on the streets?

He placed his chips on the table and rolled the dice. He lost. Why should we reward him for that decision? Granted, that's exactly what your boy in the White House did in 2009 to all the sub-prime losers, so it wouldn't shock me to see some asinine bailout that will run up the national debt another couple trillion bucks...

 

[ScoobyDoo]

Re: The PPACA - Implementation Phase I

It still doesn't answer the inevitable question that follows: what do you do with the guy who risked not getting insurance but then suffers a major medical issue. Leave him to die on the streets?

You let him die. The number one rule of American Health Care is don't get sick. Rule number two is if you are going to get sick make sure you're rich.

 

[joecct]

Re: The PPACA - Implementation Phase I

You let him die. The number one rule of American Health Care is don't get sick. Rule number two is if you are going to get sick make sure you're rich.

He placed his chips on the table and rolled the dice. He lost. Why should we reward him for that decision? Granted, that's exactly what your boy in the White House did in 2009 to all the sub-prime losers, so it wouldn't shock me to see some asinine bailout that will run up the national debt another couple trillion bucks...

It still doesn't answer the inevitable question that follows: what do you do with the guy who risked not getting insurance but then suffers a major medical issue. Leave him to die on the streets?

Let me use another example - auto and homeowner's insurance..

You decide not to purchase collision or comprehensive auto insurance and buy a Corvette. You wreck the 'vette. Should you be allowed to purchase collision or comprehensive AFTER you've wrecked the car?

Now that the mortgage is paid off, you decide to save a few bucks and cancel the fire insurance on the house. House catches fire. Can you call your agent while the fire department is rushing down the street to get covered? (Well, you can, but the agent is going to charge your $100,000 for $100,000 in coverage).

If you can't do these things, why should you be able to purchase insurance when you discover you're sick? By not buying insurance you're taking a risk that you will be healthy for the next 12 months. If you're risk adverse, you buy insurance. Depending on how risky you feel, you purchase how much will be covered.

Sounds simple, doesn't it? It takes a Congress to screw it up.

 

[unofan]

Re: The PPACA - Implementation Phase I

Let me use another example - auto and homeowner's insurance..

You decide not to purchase collision or comprehensive auto insurance and buy a Corvette. You wreck the 'vette. Should you be allowed to purchase collision or comprehensive AFTER you've wrecked the car?

Now that the mortgage is paid off, you decide to save a few bucks and cancel the fire insurance on the house. House catches fire. Can you call your agent while the fire department is rushing down the street to get covered? (Well, you can, but the agent is going to charge your $100,000 for $100,000 in coverage).

If you can't do these things, why should you be able to purchase insurance when you discover you're sick? By not buying insurance you're taking a risk that you will be healthy for the next 12 months. If you're risk adverse, you buy insurance. Depending on how risky you feel, you purchase how much will be covered.

Sounds simple, doesn't it? It takes a Congress to screw it up.

So you're saying we leave people to die on the street. Got it.

Edit: Apparently Flaggy's admitting that's what he's for now, too, even though he took umbrage with that exact statement a year or two ago.

 

[joecct]

Re: The PPACA - Implementation Phase I

So you're saying we leave people to die on the street. Got it.

Edit: Apparently Flaggy's admitting that's what he's for now, too, even though he took umbrage with that exact statement a year or two ago.

No. There will still be charity cases. But if Bill Gates does not have health insurance, I expect him to pay the entire bill, not the government.

Further, if I am employed / retired and decline offered health insurance, then the consequences are on me.

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

So you're saying we leave people to die on the street. Got it.

Edit: Apparently Flaggy's admitting that's what he's for now, too, even though he took umbrage with that exact statement a year or two ago.

If we go your way, then what the hell is the point of buying insurance in the first place? If you're going to get bailed out anyway, then it truly IS a waste of money. And when the hell did I take your fancy lawyer term with a statement? I want you to show me the exact quote. Can't do it? That's right, just like a typical lawyer, making up bull**** in order to force the opposition to shell out more money.

 

[unofan]

No. There will still be charity cases. But if Bill Gates does not have health insurance, I expect him to pay the entire who the bill, not the government.

Further, if I am employed / retired and decline offered health insurance, then the consequences are on me.

We're not talking about Bill Gates. We're talking about Joe Schmoe, who can either be a 40 year-old blue collar worker with a wife and two kids who thought paying the mortgage was more important than getting health insurance, or a twenty year old hotshot who still thinks he's invincible, or any of a number of other scenarios that play out in real life rather than a perfect world.

No, we should not reward people for making poor choices. But good luck getting society to agree that the penalty for a poor choice should be death from an otherwise treatable ailment. Especially in a country as well endowed with resources and wealth as the U.S.

 

[Rover]

It still doesn't answer the inevitable question that follows: what do you do with the guy who risked not getting insurance but then suffers a major medical issue. Leave him to die on the streets?

I think the no denial for pre-existing conditions means something that you've already been diagnosed with and been treated for, not that you tried to fix the lawnmower yourself and 5 minutes later are trying to sign up on your way to the hospital.

Regarding the people who still insist on not getting insurance and paying the penalty, they get to work out a payment plan with the hospital or govt entity that paid for the care. If Mr Invinsible is 20 years old, he's got plenty of time to pay off the bill. Joe Blue Collar is probably qualifying for a subsidy anyway, so he's got no excuse not to get insured.

 

[SJHovey]

Re: The PPACA - Implementation Phase I

Isn't the real question, do you believe that a right to health care is some sort of fundamental right to which everyone is guaranteed? If not, then shouldn't it be a business decision every person has to make on their own, and if your income status is such that you can't afford it (or insurance for it), then you go without, just like people go without a lot of things?

Personally, I've never believed health care is something that belongs to us a fundamental, guaranteed right. First, for all that healthcare may do for us, it is of course a losing battle. We're all going to die.

Second, if you really want to talk about something we, as human beings, need to survive or at least prolong life, you're talking about water, food and sex (for continuing the species). I don't see any big movement to have government guarantee everyone with the availability of these for no cost.

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Regarding the people who still insist on not getting insurance and paying the penalty, they get to work out a payment plan with the hospital or govt entity that paid for the care. If Mr Invinsible is 20 years old, he's got plenty of time to pay off the bill. Joe Blue Collar is probably qualifying for a subsidy anyway, so he's got no excuse not to get insured.

That actually isn't too bad of an idea. I believe that it currently exists and is called a "loan". This brings up a good way to execute this, though, and you could also extend it to deductibles: Outsource one of the several P2P Lending companies that are really starting to grow, and give them a chance to take on these hospital bill loans. Granted, I don't know what sort of interest you would need to charge, as with medicine I don't know if the expected default percentage would be higher.

One thing that I do like, though, and I know they recently did a mini-series on a car dealer that did this sort of thing but I can't remember what network aired it, are the family doctors that accept just about any sort of barter for the services (crate of tomatoes, pigs, massage parlor coupons).

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Isn't the real question, do you believe that a right to health care is some sort of fundamental right to which everyone is guaranteed? If not, then shouldn't it be a business decision every person has to make on their own, and if your income status is such that you can't afford it (or insurance for it), then you go without, just like people go without a lot of things?

Personally, I've never believed health care is something that belongs to us a fundamental, guaranteed right. First, for all that healthcare may do for us, it is of course a losing battle. We're all going to die.

Second, if you really want to talk about something we, as human beings, need to survive or at least prolong life, you're talking about water, food and sex (for continuing the species). I don't see any big movement to have government guarantee everyone with the availability of these for no cost.

Governments never did any big movement to provide food stamps (I know that doesn't cover one of these, but two out of three ain't bad). To deal with the third, legalize prostitution.

 

[FreshFish]

Re: The PPACA - Implementation Phase I

I can live with a tweak like this. However a "life event" would need to include losing coverage, as in you got laid off or injured and couldn't work.

No, we sever the link between employment and insurance coverage.

We don't need insurance exchanges for that either; in the 1980s and 1990s there was a robust market for association-sponsored insurance (similar to the Freelancers' Union group plan I posted about earlier in this thread). Whether you belonged to the APA, the AMA, the ABA, MANA, or even B'Nai B'Rith, you could buy group health insurance as an individual and receive group rates. The market was so robust that a group of us, half in jest and half seriously, had a series of discussions on whether it would be feasible to form the Airbreathers' Association so that we could offer group insurance to individuals through that vehicle.

It would not be difficult to have a transition period (say, 5 years for example) in which everyone moves from employer-sponsored group insurance to association-sponsored group insurance with open enrollment windows. It would be similar in operation to what the exchanges are supposed to provide but without the attendant problems that inevitably will plague the proposed exchanges (government might sponsor basic research but it is terrible at implementing technology and keeping it current, military excepted).

I'm not sure what happened to the association market since the early 1990s as my career took me into a different direction and I haven't followed detailed developments in group insurance for the last 20 years. Most likely it was eviscerated by government regulations.

There are still vestiges of it today: AARP is one of the largest sellers of Medicare Supplement insurance, for example. Many members of private-sector unions get their health insurance through their union, not through their employer. Freelancers' Union members, as previously noted (although they needed a special exemption to continue to offer their group plan).

 

[ScoobyDoo]

Re: The PPACA - Implementation Phase I

If we go your way, then what the hell is the point of buying insurance in the first place? If you're going to get bailed out anyway, then it truly IS a waste of money. And when the hell did I take your fancy lawyer term with a statement? I want you to show me the exact quote. Can't do it? That's right, just like a typical lawyer, making up bull**** in order to force the opposition to shell out more money.

The point is if you have any money at all they will collect it from you. So, if you're in the middle class like I supposedly am (I question the numbers to be honest) you have to have insurance. And the percentage of money I have to have going out for insurance is too much in comparison to my overall income.

Car Insurance (required to drive)
Home Insurance (required to have a loan)
Life Insurance (required if you have kids)
Medical Insurance (required if you don't want to play russian roulette with your money)
Dental Insurance (overall has saved me some money due to my oral surgery, kids braces, kids wisdom teeth yanking, etc.)
Umbrella Policy (will save my *** if I'm ever sued for anything)

Lot of money going out the door every week for all that. And all of it entirely necessary. Lot of money I cannot contribute to the real economy.

 

[St. Clown]

Re: The PPACA - Implementation Phase I

Lot of money going out the door every week for all that. And all of it entirely necessary. Lot of money I cannot contribute to the real economy.

Insurance companies aren't part of the "real economy"?