I've been bumping around the exchange...

[101A]

Kind of staggering how much the government will subsidize the insurance premiums of Americans - sending money DIRECTLY to insurance companies on their behalf. What this bill ultimately amounts to is a transfer of money from taxpayers to insurance companies, and ultimately, to doctors and hospitals.

Small employers (those up to 50 employees currently; rumored to being raised to 100 in a couple of years), especially, should immediately stop paying for health insurance for their employees, and take advantage of the generous subsidies. Hell, call each employee into the HR office, sit them down on the website, go through the exchange step by step, figure out their premium, subtract the subsidy, and give them a raise for exactly that amount....win, win for the employer and employee - the taxpayer is left (I'm sorry, future taxpayers) with a considerable bill.

Understand, premiums ARE NOT lower than they were before; they are 10 - 15% higher (basically on the high side of normal increases we've been seeing for as long as I can remember). (Aside: those premiums do pay commissions to a broker, if there is one involved: BCBS pyas 6% for 3 years, then 4% thereafter. The premium is not any lower if no broker is involved - by law).

This thing is called the Affordable Care Act. It, however, is doing nothing to make healthcare more affordable. It will probably increase the number of people with insurance coverage in the country - especially the working poor who qualify for the largest subsidies. Those better off & healthy, who can't take advantage of the largess being distributed will probably just pay the relatively painless fine. It will be interesting to see how people without coverage are handled in a couple of years. I'm thinking they will not receive public sympathy anymore; they will be pilloried, and hospitals will not be as likely to write off their bills - or negotiate on the amount of them.

The net result, inevitably, will be a system that the government cannot even begin to afford - as healthcare costs (and thus, premiums) continue to increase, and people learn to work the system. The question will soon arise: "Why are we sending SO MUCH tax money to insurance companies?" Then the government will have to step in with a single payer solution - expand Medicare to cover all Americans, and force it's price controls on the providers (Medicare pays quite a bit less per line item than insurance companies do - again, dictated by law). So I predict what the ACA gives us, ultimately, is a massive increase in debt that leads to a sigle payor system for all Americans. I don't think it's designed to do that - I can't give it's architects in the Senate that much credit, but I think it will.

[boutons_deux]

"Kind of staggering how much the government will subsidize the insurance premiums of Americans - sending money DIRECTLY to insurance companies on their behalf"

how is that different from employers skimming employees salaries and hosing the $Bs directly to the group insurance companies? and group insurance benefit-in-kind is untaxed, aka, "tax expenditure" aka "subsidy"

"The question will soon arise: "Why are we sending SO MUCH tax money to insurance companies?" "

why hasn't that question been asked before about employer group insurance plans?

[101A]

I currently pay $826 dollars for one of my employee's family's healthcare plans. She has an additional $245 taken from her paycheck. There are 5 people in her family (herself, her husband, 3 children). You are correct, there is no tax paid on those premiums - so it costs the government 25% of my contribution (assuming I would find no other legitimate business expense for those $826, and would hold them as taxable corporate profit). So the cost to the taxpayer is ~$207.

Now, what I COULD do is drop my group insurance coverage, and have this employee enroll in a plan very similar offered on the exchange. Now the addition is this: Total premium is $1165.17. Amount owed by my employee: $162.83. (I'll give her a $200 raise). Amount subsidized by the government: $1002.33 (plus the $52 I won't pay in taxes on my employees raise).

So the final tale of the tape: I'm ahead $600. My employee's ahead $285, and the government is down (net) $850.

Affordable, indeed.

Oh yeah, I also get $70/mo commission on her plan - I'll pay 39% on that.

[boutons_deux]

"your logic that all money is the governments"

You Lie, strawman

[101A]

"your logic that all money is the governments"

You Lie, strawman




OK, I removed that shot; now would you like to respond to the rest of the (strawless) post?

[EVAY]

But surely you recognize that anecdotal evidence of ONE situation does not even begin to be able to extrapolated to a broader finding. It simply is not accurate. I do not challenge what you say about this situation. I don't doubt that it is true and that the government will end up paying much more in this situation. However, the moneys available from other facets of the ACA will somewhat offset the extra money the government in paying in this situation, and you can rest assured that there are other examples that are the opposite of your anecdote.

My point in all of this is and has been not to support the law as currently structured, but to get legislators actually interested in FIXING the damn thing rather than just posturing with useless and wasted efforts to repeal the blasted thing.

[101A]

...also edited; employee is ahead $285, not 40.

[101A]

But surely you recognize that anecdotal evidence of ONE situation does not even begin to be able to extrapolated to a broader finding. It simply is not accurate. I do not challenge what you say about this situation. I don't doubt that it is true and that the government will end up paying much more in this situation. However, the moneys available from other facets of the ACA will somewhat offset the extra money the government in paying in this situation, and you can rest assured that there are other examples that are the opposite of your anecdote.

My point in all of this is and has been not to support the law as currently structured, but to get legislators actually interested in FIXING the damn thing rather than just posturing with useless and wasted efforts to repeal the blasted thing.

The problem with the ACA is that is does NOTHING to control the actual costs of coverage - a significant opportunity has been lost. Many of the costs are going to be transferred, in fact, directly to the government. Sure, that single Anecdote is severe (I picked the most obvious from my employee list), but of my 25 employees, only with 5 does the tax I save on their premiums outdistance the subsidy the government would pay for coverage under the exchanges.

I DO NOT subscribe to the belief that doing ANYTHING is better than doing nothing. In this case especially, they had to get it at least partially right - specifically because legislatures are SO AFRAID of the subject. When something is done, they consider it handled, and won't touch it again for a generation. Costs are escalating too quickly for that. The costs of healthcare HAD to be dealt with, and this act, despite its name, DID NOT do that - many legislators, however, will hide behind the belief that it did.

[Th'Pusher]

The problem with the ACA is that is does NOTHING to control the actual costs of coverage.

so introducing more competition in the market for coverage does nothing to reduce the cost of that coverage?

[101A]

so introducing more competition in the market for coverage does nothing to reduce the cost of that coverage?

What additional competition?

More Hospitals, doctors? Hospitals and Doctors offering better deals/lower prices. I missed that part of the bill.

Insurance is just a funding mechanism; the product is the providers. Insurance is working on the margin; always has, always will. 100,000 insurance companies doesn't change the price of a bone marrow transplant.

[boutons_deux]

101 is extrapolating from his one instance to the entire country.

here's a 100% counter to 101's propaganda

Illinois resident on Obamacare web glitches: 'keep trying'

Kathy Kanak of Libertyville was able to compare and purchase new coverage for herselft and husband Brant. The price was offset with a subsidy based on her age, 57, family size and income.
With federal tax credits, the Kanaks

will pay about $390 less per month

on premiums for coverage with Blue Cross and Blue Shield of Illinois and be able to retain their family doctor, she said. Further,

their annual deductible will drop to $1,500 next year, down from $5,000 this year.

http://my.chicagotribune.com/#section/545/article/p2p-77642637/

[101A]

101 is extrapolating from his one instance to the entire country.

here's a 100% counter to 101's propaganda

Illinois resident on Obamacare web glitches: 'keep trying'

Kathy Kanak of Libertyville was able to compare and purchase new coverage for herselft and husband Brant. The price was offset with a subsidy based on her age, 57, family size and income.
With federal tax credits, the Kanaks

will pay about $390 less per month

on premiums for coverage with Blue Cross and Blue Shield of Illinois and be able to retain their family doctor, she said. Further,

their annual deductible will drop to $1,500 next year, down from $5,000 this year.

http://my.chicagotribune.com/#section/545/article/p2p-77642637/

Hilarious; I give ACTUAL data from my own experience, and you scour the web -and I'm the one disseminating propaganda!??!

What, exactly, does Katy's situation have to do with what I have posted? Her premium is decreasing - NOT currently covered by a group plan; also, the "With Federal Tax Credits" CANNOT be overlooked in your post, can it. That's my whole point. BCBS is able to collect MORE premium; just most of it coming from the Government!!! Also, providers now don't have to worry about that large deductible; payed for by the Govt. through the insurance company!!!

Congratulations - you have found another anecdote that supports my contention: The Affordable Care Act might be one of the largest transfer of American Taxpayers money Directly to Insurance Companies and Healthcare corporations - with no limits on their profits EVER....AND it's being championed and defended by the people, ostensibly, who OUGHT to be against this disaster. Go TEAM!!!!!

[Th'Pusher]

What additional competition?

More Hospitals, doctors? Hospitals and Doctors offering better deals/lower prices. I missed that part of the bill.

Insurance is just a funding mechanism; the product is the providers. Insurance is working on the margin; always has, always will. 100,000 insurance companies doesn't change the price of a bone marrow transplant.

You said reduce the cost of coverage, not the service. Insurers get more customers but may settle for smaller margins, that's a savings in the cost of coverage. Taxes on high priced coverage and measures to cut fraud are also included in the ACA.

Ultimaty, I agree it does. It do enough to cut cost, but to say it does nothing (In all caps) is not accurate IMO.

[101A]

You said reduce the cost of coverage, not the service. Insurers get more customers but may settle for smaller margins, that's a savings in the cost of coverage. Taxes on high priced coverage and measures to cut fraud are also included in the ACA.

Ultimaty, I agree it does. It do enough to cut cost, but to say it does nothing (In all caps) is not accurate IMO.

When I see insurers actually cut margins I"ll let you know (you can check yourself; just watch the stock prices). The ACA hasn't done anything to affect them.

Also, "measures to cut fraud", I believe has been included in every presidential speech, many bills, measures, strategies since the beginning of time. I don't think it's working.

[MannyIsGod]

Well no shit it doesn't do anything about the cost. We've known that for years. But good luck getting a price system like medicare excepted across the board. That was what some of us wanted (its what you get out of a public option) but of course that didn't happen. Yes, its a transfer of money to the insurance companies but it gets people covered which is the ultimate goal.

You're definitely not thinking about downstream benefits that occur with a generally healthier society though. Or the money saved when people don't have to go to the ER for anything because they don't have insurance. Its not as simple as you're making it out and you're just pointing out what many pointed out 3 years ago.

All that being said, the exchanges are just a portion of the plan. There's a lot more there.

[MannyIsGod]

You're really oversimplifying the situation greatly. There's government money going to insurance companies but you're not thinking about the cost of people not having insurance in the least. Thats one of the largest problems surrounding the nature of health care (or any money spent in a social area by the government for that matter). Somehow, people are willing to grasp downstream benefits for government spending on fucking sports stadiums but when it comes to social programs everyone just sees the money spent and not the benefits gained.

[Th'Pusher]

When I see insurers actually cut margins I"ll let you know (you can check yourself; just watch the stock prices). The ACA hasn't done anything to affect them.

The big insurers are not participating in the exchanges in many cases because they cannot compete on cost while maintaining their profit margins. If they begin losing market share, they're not going to have a choice. Owns that just basic supply/demand conservatives like?

[101A]

You're really oversimplifying the situation greatly. There's government money going to insurance companies but you're not thinking about the cost of people not having insurance in the least. Thats one of the largest problems surrounding the nature of health care (or any money spent in a social area by the government for that matter). Somehow, people are willing to grasp downstream benefits for government spending on fucking sports stadiums but when it comes to social programs everyone just sees the money spent and not the benefits gained.

Having insurance/not having insurance is NOT a predictive for how healthy an individual or a group may be. I know it's counter-intuitive, but it's true. Lifestyle along with genetics is what it's all about. Ask any underwriter. In fact, people WITH insurance spend FAR more on healthcare than those without. If you don't think hospitals and doctors won't find more to charge for when a person has coverage than when they don't, you are also deceiving yourself.

I have said it in the thread, but have not made it clear - although I know I said it in here at the time; the biggest problem with the ACA is that it is essentially does nothing to combat the single biggest problem with healthcare in this country: Spiraling Costs; and it remains to be seen how effective it is at correcting the other travesty; people without coverage. In the meantime, Republicans are fighting it, but not even citing what's REALLY wrong with it, and Democrats are defending it like it's something worth defending. When the fights over, no one is going to want to enter the fray again for, what, 20 years??? It's what we've got. It's not addressing the real problem, and we're stuck with it for the foreseeable future.

You can go a head and see it as a glass half full, I"m going to continue to recognize for what it is; an opportunity wasted.

I don't support government spending or sports stadiums, btw.

[101A]

The big insurers are not participating in the exchanges in many cases because they cannot compete on cost while maintaining their profit margins. If they begin losing market share, they're not going to have a choice. Owns that just basic supply/demand conservatives like?

Insurance company profits are less than the inflation rate in healthcare; eliminate them completely and you've bought yourself six months of savings.

[ElNono]

I agree it doesn't address cost, only attempts to address accessibility (and without tackling cost, it's at the very least ineffective on that).

There's very few positives about it, but I think the main one is that it moved us away from the previous status quo, which also didn't rein in costs and kept accessibility relatively low, especially for those that needed it the most (pre-exisiting conditions, etc). Ideally, you would want this to be the vehicle that moves us from the previous system to a single-payor system (if that's what's desired).

[MannyIsGod]

Having insurance/not having insurance is NOT a predictive for how healthy an individual or a group may be. I know it's counter-intuitive, but it's true. Lifestyle along with genetics is what it's all about. Ask any underwriter. In fact, people WITH insurance spend FAR more on healthcare than those without. If you don't think hospitals and doctors won't find more to charge for when a person has coverage than when they don't, you are also deceiving yourself.

I have said it in the thread, but have not made it clear - although I know I said it in here at the time; the biggest problem with the ACA is that it is essentially does nothing to combat the single biggest problem with healthcare in this country: Spiraling Costs; and it remains to be seen how effective it is at correcting the other travesty; people without coverage. In the meantime, Republicans are fighting it, but not even citing what's REALLY wrong with it, and Democrats are defending it like it's something worth defending. When the fights over, no one is going to want to enter the fray again for, what, 20 years??? It's what we've got. It's not addressing the real problem, and we're stuck with it for the foreseeable future.

You can go a head and see it as a glass half full, I"m going to continue to recognize for what it is; an opportunity wasted.

I don't support government spending or sports stadiums, btw.

If you're talking about defending as in the government shut down then I fully support their defending it and it has nothing to do with the merits of the law. The GOP have had success with these tactics and now their going after actual legislation that has been passed and upheld. This is total bullshit and if they want to get rid of it then repeal it.

Anyway, Underwriters aren't taking into account the costs I mentioned. Yes, a person with insurance is going to use the medical system more but that cost is also going to be taken by the INSURNACE company and not society. Access to medical care WILL increase the health of a group of individuals. The reason you're not seeing that in the comparisons you're talking about is because you're generally comparing poor with those who are not poor. However, when the barrier to insurance that is income is removed or at least lessened then you WILL see a change there.

You can't sit there and argue that its going to be a huge cost to the government while at the same time not increasing coverage. You're running all over your own argument.
Its a huge increase in cost to the government if you feel as though they weren't indirectly footing the bill already.

[MannyIsGod]

Its a broken system - there's no doubt about that. Its a half measure that was only passed because actual reform was politically impossible. Its completely unfair to ignore the political climate we have in this country. Does it make single payer more likely in the future? YES. Thats why the GOP is so damn terrified of it. In that sense, I've come to view this as a necessity. I still think Obama folded way too easy on the public option but the fact of the matter is that one day we're going to get to that and this is about as close (haha not close at all) as we can come to today.

[Th'Pusher]

Insurance company profits are less than the inflation rate in healthcare; eliminate them completely and you've bought yourself six months of savings.
We'll explain to me why the big insurers don't have their hand out to get a piece of this massive government largesse? Honest question.

[RandomGuy]

Kind of staggering how much the government will subsidize the insurance premiums of Americans - sending money DIRECTLY to insurance companies on their behalf. What this bill ultimately amounts to is a transfer of money from taxpayers to insurance companies, and ultimately, to doctors and hospitals.

Small employers (those up to 50 employees currently; rumored to being raised to 100 in a couple of years), especially, should immediately stop paying for health insurance for their employees, and take advantage of the generous subsidies. Hell, call each employee into the HR office, sit them down on the website, go through the exchange step by step, figure out their premium, subtract the subsidy, and give them a raise for exactly that amount....win, win for the employer and employee - the taxpayer is left (I'm sorry, future taxpayers) with a considerable bill.

Understand, premiums ARE NOT lower than they were before; they are 10 - 15% higher (basically on the high side of normal increases we've been seeing for as long as I can remember). (Aside: those premiums do pay commissions to a broker, if there is one involved: BCBS pyas 6% for 3 years, then 4% thereafter. The premium is not any lower if no broker is involved - by law).

This thing is called the Affordable Care Act. It, however, is doing nothing to make healthcare more affordable. It will probably increase the number of people with insurance coverage in the country - especially the working poor who qualify for the largest subsidies. Those better off & healthy, who can't take advantage of the largess being distributed will probably just pay the relatively painless fine. It will be interesting to see how people without coverage are handled in a couple of years. I'm thinking they will not receive public sympathy anymore; they will be pilloried, and hospitals will not be as likely to write off their bills - or negotiate on the amount of them.

The net result, inevitably, will be a system that the government cannot even begin to afford - as healthcare costs (and thus, premiums) continue to increase, and people learn to work the system. The question will soon arise: "Why are we sending SO MUCH tax money to insurance companies?" Then the government will have to step in with a single payer solution - expand Medicare to cover all Americans, and force it's price controls on the providers (Medicare pays quite a bit less per line item than insurance companies do - again, dictated by law). So I predict what the ACA gives us, ultimately, is a massive increase in debt that leads to a sigle payor system for all Americans. I don't think it's designed to do that - I can't give it's architects in the Senate that much credit, but I think it will.

The government needs to step in as a huge insurance company. That will end up being far more cost-effective than the private insurance mish-mash we have now.

Hate to break it to you, but we end up paying for all this either way. The way we pay for health care now is already hideously expensive.

[101A]

We'll explain to me why the big insurers don't have their hand out to get a piece of this massive government largesse? Honest question.


The carriers are participating in most of the exchanges. They are going to receive premium checks directly from the government. With those checks they will provide insurance coverage for the people covered under those policies. By law a minimum of 80% of the money those carriers spend must be on actual claims; leaving 20% for administrative costs and profit. The higher the claims, the higher the 20% - so you don't have to worry about holding the providers in check; and there is not law to do so. Regardless of how high the premiums get, large employers, and all individuals are required by law to have insurance - don't have to sweat at all how high the premiums are getting; just do the math, keep yourself present on the exchanges, dot your I's and cross your T's - it's all good.

[RandomGuy]

Insurance company profits are less than the inflation rate in healthcare; eliminate them completely and you've bought yourself six months of savings.

That isn't the way the time value of money and costs savings works. Your statement is incorrect.

The avoided costs are carried at the finance rate into the future indefinitely. The net present value of such a move would save society somewhere on the order of trillions of dollars. If I get the time, I will run the numbers for you to support that.

[RandomGuy]

We'll explain to me why the big insurers don't have their hand out to get a piece of this massive government largesse? Honest question.

They do. Their support was bought with the particulars. Without it, the law would not have passed.

[101A]

The government needs to step in as a huge insurance company. That will end up being far more cost-effective than the private insurance mish-mash we have now.

Hate to break it to you, but we end up paying for all this either way. The way we pay for health care now is already hideously expensive.

Of course we're paying for it either way; who pays isn't the problem - it's how much is being paid that is the issue.

[RandomGuy]

I have said it in the thread, but have not made it clear - although I know I said it in here at the time; the biggest problem with the ACA is that it is essentially does nothing to combat the single biggest problem with healthcare in this country: Spiraling Costs; and it remains to be seen how effective it is at correcting the other travesty; people without coverage. In the meantime, Republicans are fighting it, but not even citing what's REALLY wrong with it, and Democrats are defending it like it's something worth defending. When the fights over, no one is going to want to enter the fray again for, what, 20 years??? It's what we've got. It's not addressing the real problem, and we're stuck with it for the foreseeable future.


I agree with that 100%

The ultimate solution to what ails us, pun intended, is that we need to be increasing the supply of doctors, as well as changing the way that health care is practiced.

Move from fee for service to salaries, and you remove some perverse incentives.

[RandomGuy]

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

interesting bit

[101A]

That isn't the way the time value of money and costs savings works. Your statement is incorrect.

The avoided costs are carried at the finance rate into the future indefinitely. The net present value of such a move would save society somewhere on the order of trillions of dollars. If I get the time, I will run the numbers for you to support that.

Economists. I know you'll explain it, but if insurance companies only make a couple billion, how can the savings be trillions?

Again, if you want to save money on healthcare, you HAVE to save money on the cost of heathcare; focusing on the payor is missing the larger picture. For instance, RG, if you wrecked your Trabant, and the repair shop wanted 50 grand to repair it (value = $45), would you question the insurance company that wants to raise your premium, or would you possibly talk to the owner of the shop?

[101A]

I agree with that 100%

The ultimate solution to what ails us, pun intended, is that we need to be increasing the supply of doctors, as well as changing the way that health care is practiced.

Move from fee for service to salaries, and you remove some perverse incentives.

You finally got far enough in the thread to see that, huh?

Sorry about the Trabant crack.

Hell, transparency and uniformity in billing would do wonders ALL by itself. Educating the population about medical test and Rx overreach wouldn't hurt, either.

[boutons_deux]

"increasing the supply of doctors"

doctoring is a protected guild

http://www.abovetopsecret.com/forum/thread675073/pg1

more:

http://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-the-number-of-doctors-to-increase-current-doctors-salaries


how fucked up the doctoring profession is:

http://opinionator.blogs.nytimes.com/2013/09/18/medicines-search-for-meaning/

http://mobile.nytimes.com/blogs/opinionator/2013/10/02/who-will-heal-the-doctors/?from=mostemailed

[101A]

"increasing the supply of doctors"

doctoring is a protected guild

http://www.abovetopsecret.com/forum/thread675073/pg1

more:

http://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-the-number-of-doctors-to-increase-current-doctors-salaries


how fucked up the doctoring profession is:

http://opinionator.blogs.nytimes.com/2013/09/18/medicines-search-for-meaning/

http://mobile.nytimes.com/blogs/opinionator/2013/10/02/who-will-heal-the-doctors/?from=mostemailed

Some compelling reads.

[101A]

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

interesting bit

There's a long Winehole thread about that article in here somewhere.

[RandomGuy]

There's a long Winehole thread about that article in here somewhere.

Yup. I bookmarked it for reference.

We need to try something different, and that seems as good a way as any.