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

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

dxmnkd316 said:
Obamacare solved one of the two biggest problems with healthcare. Ok, really two of three.

One, it mandated pre-existing conditions be covered. This was crucial. To be cast out because you drew a short straw in the genetic lottery is unfair.


Two, it solved the coverage gap. Sort of. We need to provide health care to everyone. It's beginning to fail on this account because of other problems. Not enough people choosing the exchanges, not enough young healthy people sharing the burden (baby boomers 2.0?), and because it doesn't fix the third and most important problem.

Of course that is the cost of health care. This needs to come down. Starting with hospitals and the big pharmaceutical companies. Hospitals are charging far too much for the care they provide. I know that's complex and it's a result of many, many other issues, but it needs to be fixed. Pharmaceuticals are raping the public. I'm a very firm believer in charging to cover the costs of R&D, but the marketing, executive pay, lobbying, and profits at the cost of affordability have got to go or be regulated.
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Especially the marketing. How many #($*(*%ing drugs are you supposed to "ask your doctor about" now?
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

Exactly. I like the European modeling banning direct-to-consumer marketing. If it's good, your doctor can make that call.

And same with corporate patent abuse. My albuterol inhaler shouldn't cost 40-50 bucks. It should be down in the single digits by now. But this HFA crap allowed them to re-up their patents and abuse their patients.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

dxmnkd316 said:
One, it mandated pre-existing conditions be covered. This was crucial. To be cast out because you drew a short straw in the genetic lottery is unfair.
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That's like being forced to accept a loan for someone who has zero way of paying it back. Completely dumb.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

SJHovey said:
Look, the great myth of Obamacare is that it was going to have two great results -- we were going to get everyone covered by health insurance and we were going to lower the cost of health insurance/health care (revisionist history later changed this to "we're going to slow the rate of growth of health insurance/health care costs).

Here is the problem. A huge portion of the American public was already covered, either through Medicare/Medicaid or through employer sponsored policies. That really hasn't changed as a result of Obamacare.

In the short term did we add more people to the coverage lists. No question. Did we reduce health insurance/health care costs in the short term? There is an argument that we slowed the cost increases in the first year or so, but I think we all see now that is primarily a result of insurance companies guessing at what the rates should be based upon unknown factors created by Obamacare. Once they realized they guessed wrong, the slowed growth victory is going the way of the dildo bird. These 50% annual increases are going to quickly drive those newly covered individuals back off the insurance rolls, and probably take a few more people with them. Which is great. Now, they're not only uninsured but they're breaking the law on top of it.

The next argument perpetrated by the sheeple goes something like, "if the GOP can't come up with a solution for fixing Obamacare, they need to stop whining about it."

Except, the problem is that Obamacare is precisely like the Iraq/Afghan war problem. It his a huge s h ! t pie, and it's not something we can just say, "nevermind" and pretend like we never created it. Pulling all of our troops out of the middle east and simply repealing Obamacare are both incredibly stupid ideas. But the fact that we can't do those things certainly doesn't minimize or relieve responsibility for the lies and misinformation that got us into both messes.
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You're looking at outcomes and confusing those with the drivers. Obamacare was in place to get the industry to lower costs and increase coverage through forcing a free market and opening it up for new entrants. What actually happened was that the insurance companies colluded and gutted it. The large players made too much profit in other sectors so they could just walk away...and the smaller players smelling blood raised prices and finished it off. If society wants coverage and lower prices for healthcare, it needs to impact what should be a very low cost (but is very expensive) service of transferring consumer payments to healthcare providers.

FreshFish said:
Hmm... can we use auto insurance for an analogy for a moment?

I'd like to understand your distinction between "cherry picking customers" and "prudent risk assessment."

Suppose you are a prudent driver with a spotless driving record. Your neighbor has been in a few accidents and has several speeding tickets. How would you feel if each of you were charged the same for auto insurance? you'd be paying higher premiums than warranted by your record in order to subsidize the greater chances that he'd incur a claim.
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You're driving behavior is 100% up to your driving decisions. Pretty much anyone can be a 100% safe driver. Frequently your health is not. I don't think there's many that go out of their way to get skin cancer.

Are we going to have health insurance for everyone or not? If so, we don't use the auto insurance analogy. Let's look at the energy to heat your house. The energy industry is highly regulated. This is to make sure that the health insurance scenario doesn't happen to someone who lives in 20 below zero Crookston. Answer the coverage question first.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

5mn_Major said:
Are we going to have health insurance for everyone or not?
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You are taking three separate and distinct questions and mixing them up together into one.

The fundamental math cannot be denied: premiums plus subsidies plus investment income has to equal or exceed claims payments plus overhead. You cannot possibly escape that constraint: money in must equal money out. (if you are going to spend it, you have to have it first, somehow, from somewhere).

Health insurance does not equal health care. People without health insurance still have access to healthcare. People with insurance, because of deductibles and copays, may not be able to afford the healthcare they need. The real question is not whether people have insurance or not; the real question is whether people have access to healthcare or not.

For people who do have insurance, how are premiums determined, how are coverage levels determined, and how do you handle risk assessment? Those are the three key elements to any insurance pricing question. Again, basic fundamentals. You have to find a way to balance these three elements. That's just how it is.




ACA is failing because it tries to mandate a mathematically impossible outcome. Any possible replacement solution is still constrained by fundamental underlying relationships between key factors that must come into balance merely because that is the way the world works.

There is an old saying, don't blame the messenger. Pay attention to the message, it gives you valuable information that you must heed.
 
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Re: The PPACA Thread Part III - Let's have a healthy debate!

I'm going to blow your relays. What if we take enough money from those fortunate enough to never have to worry about healthcare or insurance? And what if the government collected that money at least four times a year? And what if we took that money, subsidized the poor, and let then use it to gain access to insurance?
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

dxmnkd316 said:
I'm going to blow your relays. What if we take enough money from those fortunate enough to never have to worry about healthcare or insurance? And what if the government collected that money at least four times a year? And what if we took that money, subsidized the poor, and let then use it to gain access to insurance?
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What are you, some kind of communist? Taxation is THEFT. ;)
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

Haha. I'm a recovering libertarian. I just think that it's high time that we, as a society, need to provide those who cannot afford it, nsurance and healthcare. Because a person is poor is no reason to condemn them to further financial ruin.
 
dxmnkd316 said:
Haha. I'm a recovering libertarian. I just think that it's high time that we, as a society, need to provide those who cannot afford it, nsurance and healthcare. Because a person is poor is no reason to condemn them to further financial ruin.
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But is that a function of government or charity? We've gotten away from private giving to government taking and then redistributing according to the government's priorities.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

dxmnkd316 said:
Haha. I'm a recovering libertarian. I just think that it's high time that we, as a society, need to provide those who cannot afford it, nsurance and healthcare. Because a person is poor is no reason to condemn them to further financial ruin.
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If you want to give away your wealth to them, that's your prerogative. Actions speak a heck of a lot louder than words, though. You know where in Parkersburg WV your check goes.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

dxmnkd316 said:
Haha. I'm a recovering libertarian. I just think that it's high time that we, as a society, need to provide those who cannot afford it, nsurance and healthcare. Because a person is poor is no reason to condemn them to further financial ruin.
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You and I agree on the desired outcome. There is so much variety and nuance that a single global comprehensive solution is not feasible. It should be a state-by-state matter so that they can make adjustments to fit their own unique circumstances.

The only role the Federal government should have, IMHO, is for Congress to reform the income tax treatment of health insurance premiums. Ideally, they would be 100% deductible to everyone; and for lower income people, perhaps the Earned Income Tax Credit might apply. That would equalize the differential between self-employed and corporate-employed.

The National Association of Insurance Commissioners should have the leading role, not the Federal government. They can draft model legislation for states to use: allow association-based group coverage for individuals, maybe have open enrollment windows every year; certainly allow "catastrophe-only" policies plus health savings. For people with chronic conditions, go back to subsidized, specialized high-risk pools.

There are plenty of ways to make it work; as long as you let go of some one-size-fits-all, centralized, one single uniform solution that all must submit to. We need more experimentation and decentralization; the world has changed and we don't really know what will work; what we do know is what concepts have been successful. Flexibility, options, choice: not regimentation, compulsion, standardization.



You said, we, as a society. Society has plenty of other institutional avenues that are not the federal government.
 
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Re: The PPACA Thread Part III - Let's have a healthy debate!

joecct said:
But is that a function of government or charity? We've gotten away from private giving to government taking and then redistributing according to the government's priorities.
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That's because private giving was never even remotely enough.

Plus, government priorities are democratically-determined priorities. Nothing stops you from giving privately if you want to target your personal charity to people you think "deserve" it.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

Unsurprisingly, the "National Association of Insurance Commissioners" is basically a lobbying arm of the insurance industry that claims neutrality.
 
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Re: The PPACA Thread Part III - Let's have a healthy debate!

Yeah, I didn't even need to look it up. I just assumed it was a corporate ball-cupper.

I didn't used to be in favor of single-payer, but I'm very slowly warming to the idea. Spreading out the costs proportionally to income seems somewhat fair to me. I'm still somewhat uncomfortable with it.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

FadeToBlack&Gold said:
Unsurprisingly, the "National Association of Insurance Commissioners" is basically a lobbying arm of the insurance industry that claims neutrality.
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...and whose wet dream is competition-free world for insurance and one of total price collusion. Which is the underlying problem in the whole healthcare industry.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

FadeToBlack&Gold said:
Unsurprisingly, the "National Association of Insurance Commissioners" is basically a lobbying arm of the insurance industry that claims neutrality.
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What in the world are you citing?

The National Association of Insurance Commissioners actually is comprised of the insurance commissioners from the 50 states, DC, and the territories:

The National Association of Insurance Commissioners (NAIC) is the U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S. [emphases added]
MEMBERS
NAIC members are the elected or appointed state government officials who along with their departments and staff, regulate the conduct of insurance companies and agents in their respective state or territory.
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