
Confused by Health Care? Here Are the Absolute Basics - curtis
http://www.motherjones.com/kevin-drum/2017/03/confused-health-care-here-are-absolute-basics
======
FLGMwt
I work on a benefits enrollment app (think TurboTax for your Open Enrollment).
Most of our value proposition is providing an e-commerce style compare option
for different plans.

Pair that with our upfront survey and recommendation and the 4hr paper process
turns into 20mins.

It's pretty crazy that 95% of the insurance industry still relies on paper
enrollments where you have to fill out your own address (which your HR already
has) ten times.

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norvig
Here's a good summary bu Yonatan Zunger: [https://healthcareinamerica.us/how-
to-ask-good-questions-abo...](https://healthcareinamerica.us/how-to-ask-good-
questions-about-health-reform-725887002c03#.jei5yjbwk)

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sytelus
In many ways, not having ObamaCare was better option for many people. If you
have unemployed parents at home, the things are shit storm right now. They
would be old and buying an insurance would easily cost you 10 grands a year if
not more. Previously, it used to cost only half of that because you can
optimize for plans that didn't had support for things like pregnancy. Now
everyone pays for everything.

There is little chance of ObamaCare working as-is or with planned
modifications. The big problem is that as soon as you eliminate pre-existing
conditions clause, the cost to insurance company sky rockets. Even a single
diabetic person can put a hole of 10s of thousands of dollars in insurance
company's balance sheet. To compensate for this you need to either charge huge
premium to everyone or have tons and tons of healthy people who are just
giving away money in premiums. Neither of that is happening. As long as cost
of health care is an couple of orders of magnitude over the norm, this can't
work.

BTW, the reason this "works" for employed people is because cost of insurance
remains hidden. An average employed American would easily earn 20-30% more
income if employer didn't took away part of his/her paycheck and gave it to
insurance companies.

~~~
Asooka
> BTW, the reason this "works" for employed people is because cost of
> insurance remains hidden. An average employed American would easily earn
> 20-30% more income if employer didn't took away part of his/her paycheck and
> gave it to insurance companies.

Let's be realistic. The employer would be making 20-30% more profit, none of
it would go to the employee. But I hear you on your other points.

------
ArtDev
A nice reminder how self-employed people got screwed over by Obamacare, and no
seems to care.

It is the "little yellow box" in the first graphic.

Also, no mention of the real reason none of this really works. There is no
attempt at controlling costs or even identifying the transparent pricing
problem.

~~~
jdblair
Now self-employed people with pre-existing conditions can actually buy
insurance. That is different and better than before the ACA.

~~~
pasbesoin
Before the ACA, I barely managed to purchase an individual policy. As I rolled
off of COBRA from my last full-time corporate job, a condition mis-diagnosed
for a number of years by a urologist was finally -- at my independent urging
of an ultrasound technician and their going "above and beyond" to look further
than the prescribed test -- diagnosed as a minor hernia.

A surgeon fit me in the same day for an initial appointment -- working with
the fact that my COBRA term was ending. But after an examination, he said he
wouldn't operate. The hernia was too mild.

So, per a _very_ well-regarded surgeon, there was nothing to be done.

Nonetheless, my application for an individual policy was rejected.

It was only because I had a long-term personal professional relationship with
someone with significant seniority and status in another insurance company
having a cooperative agreement with the company in question, that my rejected
application received a second review. They'd made two minor mistakes in
processing it, and ultimately, at a very high level within the company, they
decided to remedy this by writing me the individual policy -- with exclusions
for my allergies and for this minor hernia, along with the urologist's prior,
incomplete diagnosis.

THIS is how the insurance market was, before the ACA.

Oh, and that employer-provided health insurance? You'd better not have had a
gap in coverage in the... I forget, now, two? years prior. Otherwise, any and
all pre-existing conditions could be excluded for coverage... for a year, I
think, perhaps two, under that employer-provided coverage.

Most of the bitching I hear and read about the ACA, is simply unfounded. Or,
it is based on incomplete where not simply wrong information.

For example, the big spike in premiums for marketplace plans, and reduction in
participating insurers and plans? That was not the ACA, per se. The law had
provision for making insurers whole for the first two or three years (two, I
think, and I think it should have instead been five) for losses they
experienced. This was to allow time for them to learn what the newly covered
population was composed of and to develop actuarial studies of it by which to
set more accurate future pricing.

Well, you can pass any law you want. It is a _separate_ law -- the "budget
process" \-- that ultimately pays for it. And the Republican Congress chose to
ignore this provision of ACA law in the budget process, leaving it unfunded
and thereby stiffing the insurance companies.

The ACA is a failure because the Republicans wanted it to be a failure and
went to great lengths to make it so. Because, to them, politics and power are
more important than effective policy and public health.

One other thing: The ACA has _saved_ insurance companies lots of money
(compared to estimated costs absent the ACA) in areas outside of the
marketplace plans, e.g. in their traditional group coverage. Of course, they
don't factor those savings in when complaining about the costs they've borne
as a result of the marketplace insurance plans -- said costs, again, having
been greatly exacerbated by the Republicans sabotaging the law and stiffing
them, in the budget process.

~~~
koolba
The ACA is a failure because it did nothing to reduce costs and did nothing to
share the burden of high risk/unhealthy people beyond the individual market.
The combination is a shit storm where costs keep rising and the suckers forced
to get individual coverage without subsidies have to pay for everybody that
got kicked off employer coverage.

~~~
pasbesoin
My first two years of ACA coverage were comparable both in price and in
coverage to the high-end corporate group plan I'd had prior. (Remember, I
ended up paying for it via COBRA, whereby I ended up knowing exactly what it
cost.)

The ACA was a starting point -- the most that could be passed in the face of
"the Party of No" that from the initial days of Obama's presidency declare
total obstruction to be their over-riding, primary policy objective and
political strategy.

Like any law and program -- just like those in private sector business -- it
required management and improvement. Unfortunately, we instead got
obstruction.

Law and regulation aren't magic, and they aren't "set and forget". You have to
manage them, just like everything in this world.

I agree that traditional group insurance should not be separated from the
individual market. Insurance companies shouldn't be permitted to cherry pick,
neither by population selection nor by pricing. Frankly, I don't see private
profit as basically compatible with what I see to be a public investment in
the public's health. But with law and regulation, we seem to get at least
partway there.

But then, the public's not too rational about this, itself. As I mentioned
elsewhere, I spent _a lot_ of my time and effort helping an addict of 20+
years, with two kids to care for, get clean, this past year. This included
thousands of dollars of in-patient hospital treatment and aborted rehab
program attendances, paid for by Medicaid that was greatly expanded, including
especially drug and alcohol treatment, under the ACA.

In addition to the ACA's contribution, I stepped up personally, when this
person couldn't hack the rehab programs, and I spent 3 months basically full
time getting them to AA meetings, helping them find and get to work, covering
with child care, etc. They managed to stay clean, and as far as I know, about
one year out, now, they still are.

This fall, after they got back with their big "C" conservative significant
other, I had to endure a long flurry of Facebook posts expressing their
vehement support of Trump. The face of the very fellows (and yes, I use that
gender choice somewhat specifically) who want to choke and kill off the very
programs that helped this person get clean. AND that have enabled me, as I
explained to them at one point, to be able to purchase health care insurance
at all -- with no subsidy, for me.

In short, in my personal, anecdotal experience, I've found opponents of the
ACA to be irrational people acting against their own self-interest. And
selfish people, who take aid and have no concern for the next person who's
going to come along and need it.

And while the ACA is far from perfect and has had to struggle, the
preponderance of rhetoric against it is equally ill-informed and selfish. IMO
and experience.

It was born in Massachusetts under the Romney government. Nationalized as the
ACA, it was meant to be a middle of the road proposal that left the existing
powers in place. It was proposed as a first year initiative at a time when not
just individuals but businesses were making great outcry about increasing
health care expenses -- year upon year double digit percentage increases in
insurance premiums -- saying they wouldn't be able to compete with businesses
in other nations having national health care and so much lower health care
costs. It was obviously planned and queued up before the Obama campaign and
nascent administration were made aware of the full depth and severity of the
financial crisis. (Something for which I am still upset with Obama for not
turning the FBI and Justice loose as was done in the wake of the Savings and
Loan scandal in the '80's.)

Republicans initiate their selfish, self-serving doctrine of "No". ('We're
going to make his a one-term presidency.' That was not just their politics but
their operating policy.) They label the health care initiative "Obamacare".
They make up the incendiary, false rhetoric of the supposed "death lists" that
would be forthcoming.

They, up through Trump's election, eight years later, have presented no and
have no sign of possessing any alternative plan for health care. Despite the
endless rhetoric that they would "fix" health care.

If you're not part of the solution, you're part of the problem. The ACA wasn't
perfect, but it was a serious attempt to move towards a solution.

All the rest -- well, all it's proven itself to be is the problem.

All it's offered is a big pack of lies.

~~~
koolba
> The ACA was a starting point -- the most that could be passed in the face of
> "the Party of No" that from the initial days of Obama's presidency declare
> total obstruction to be their over-riding, primary policy objective and
> political strategy.

Bullshit. He could have pushed for a single payer plan but didn't have the
balls. Caving in to the insurance companies and lobbyists so early on in his
presidency was a sad sign of how the rest would play out.

The Democrats had the House, a super majority in the Senate, and the POTUS.
They had the one chance to do it and either didn't have the cajones to move
forward with it, or, more likely, have too many hands in the pockets of
insurers and big pharma. Good luck getting that to happen again.

> Like any law and program -- just like those in private sector business -- it
> required management and improvement. Unfortunately, we instead got
> obstruction.

The starting point was the worst possible combination of public + private
sector. Obstruction is the only thing that has kept the tentacles of the ACA
from further rooting themselves in the American healthcare system.

> Law and regulation aren't magic, and they aren't "set and forget". You have
> to manage them, just like everything in this world.

You also have to hold representatives, senators, and the executive branch
accountable which is what happened in the 2010 elections and more recently in
2016.

> I agree that traditional group insurance should not be separated from the
> individual market. Insurance companies shouldn't be permitted to cherry
> pick, neither by population selection nor by pricing. Frankly, I don't see
> private profit as basically compatible with what I see to be a public
> investment in the public's health. But with law and regulation, we seem to
> get at least partway there.

And the ACA did nothing to make that happen. Arguably it made things worse as
companies could point individuals to the individual market and say, "Hey you
can take care of yourself with an overly expensive plan from there now".

> In short, in my personal, anecdotal experience, I've found opponents of the
> ACA to be irrational people acting against their own self-interest. And
> selfish people, who take aid and have no concern for the next person who's
> going to come along and need it.

I'm adamantly against the ACA and I'm far from irrational. If anything I'd
classify myself as hyper-rational.

I'm fine taxes going toward a single payer plan.

I'm also fine with eliminating insurance for routine healthcare and returning
to a direct payment for service model.

The middle ground we're at now where we dump the expense of the high risk
portion individual market on the self employed is what doesn't work for me.
You end up with people paying $12+K per year in premiums for nothing (since
their deductibles are $5-7K as well).

> And while the ACA is far from perfect and has had to struggle, the
> preponderance of rhetoric against it is equally ill-informed and selfish.
> IMO and experience.

> It was born in Massachusetts under the Romney government. Nationalized as
> the ACA, it was meant to be a middle of the road proposal that left the
> existing powers in place. It was proposed as a first year initiative at a
> time when not just individuals but businesses were making great outcry about
> increasing health care expenses -- year upon year double digit percentage
> increases in insurance premiums -- saying they wouldn't be able to compete
> with businesses in other nations having national health care and so much
> lower health care costs. It was obviously planned and queued up before the
> Obama campaign and nascent administration were made aware of the full depth
> and severity of the financial crisis. (Something for which I am still upset
> with Obama for not turning the FBI and Justice loose as was done in the wake
> of the Savings and Loan scandal in the '80's.)

> Republicans initiate their selfish, self-serving doctrine of "No". ('We're
> going to make his a one-term presidency.' That was not just their politics
> but their operating policy.) They label the health care initiative
> "Obamacare". They make up the incendiary, false rhetoric of the supposed
> "death lists" that would be forthcoming.

If they didn't do that we'd be deeper in the ditch that it's digging for our
healthcare system with even less chance of digging out.

> They, up through Trump's election, eight years later, have presented no and
> have no sign of possessing any alternative plan for health care. Despite the
> endless rhetoric that they would "fix" health care.

> All it's offered is a big pack of lies.

I'm disappointed at the alternatives offered so far though I do feel that even
eliminating the ACA with no replacement is an improvement in my book.

My own idea is to:

\- Ban employer provided health insurance.

\- Eliminate tax deductions for companies providing health insurance for
employees.

\- Allow individuals to deduct premium payments (up to a cap)

\- Require insurance companies to offer all plans publicly to all takers.

\- States can mandate insurers cover wide ranges of the State rather than pick
their own zones

This would lead to a single risk pool (per region covered by an insurer) with
competition between insurers. It would also level the field for the little guy
because he would be able to get coverage at the same terms that big business
is supplying it for their employees today.

Net winners are:

\- High risk individuals get to be part of a _much_ bigger pool (lower $$$)

\- Individuals on individual market get to be part of a _much_ bigger pool
(lower $$$)

\- Completely separates health insurance from employment (seriously who's
stupid idea was that?!)

\- Small businesses (don't have to compete with big corps who can offer
cheaper coverage)

\- Entrepreneurs (insurance isn't tied to employment so can quit working for
big corp without losing coverage)

Net losers are:

\- Insurers (have to actually compete with each other)

\- Insurers (they're product becomes a commodity)

\- Insurers (have to offer flat pricing to everybody)

\- Insurance salesmen (no more corporate policies to sell though I guess they
can sell individual ones)

\- Large corporations that previously were self-insuring (can't leverage their
large employment base to get lower insurance costs)

\- Employees at large corporations will pay more for health insurance but it
won't be like the ACA premium increases as it's spread across 100M people.

That's the only plan I've come up with that can lower costs, cover everybody,
and does _not_ involve a single payer system.

As a bonus, having a "Federal Health Care Insurance Company" that acts as a
competitor of last resort might lower costs further but it's not strictly
necessary.

~~~
pasbesoin
I've meant to read through and, depending on what it says and my reaction,
reply to this. Just been fairly distracted, the last few days. Hopefully, this
weekend.

I didn't want to leave thinking I was just ignoring it -- my apology.

Basically, I'd prefer Medicare for all or at least a "public option", as well.

I was mostly saying that, imperfect as it is, most of the ACA bashing I've
been hearing isn't even accurate, nor does it take into account the larger
perspective, e.g. preventive care keeping people healthier and thereby having
a large downward influence on costs, over the long term.

