
Obamacare Website Crashing Because It Doesn't Want You To Know Cost of Plans - Cbasedlifeform
http://www.forbes.com/sites/theapothecary/2013/10/14/obamacares-website-is-crashing-because-it-doesnt-want-you-to-know-health-plans-true-costs/
======
minikites
Yes, because applying for private insurance is so easy:
[http://www.youtube.com/watch?v=ql9RVy6FWkg](http://www.youtube.com/watch?v=ql9RVy6FWkg)

> "Avik Roy is a senior fellow at the Manhattan Institute and the author of
> the Forbes blog The Apothecary. He has stated he is an "outside adviser to
> the Romney campaign on health care issues." He is a contributor to National
> Review Online, where he was described as a member of Mitt Romney's Health
> Care Policy Advisory Group."

Hmm, I wonder if this author has an axe to grind.

> "The answer is that Obamacare wasn’t designed to help healthy people with
> average incomes get health insurance. It was designed to force those people
> to pay more for coverage, in order to subsidize insurance for people with
> incomes near the poverty line, and those with chronic or costly medical
> conditions."

Um, isn't that literally the function of all insurance?

~~~
lowmagnet
> Um, isn't that literally the function of all insurance?

It used to be about spreading risk. Now, I'm not so sure. The reason the ACA
exists is that instead of spreading risk into pools, insurance companies have
been denying coverage to reduce risk. This seems like the opposite of what
they once were.

~~~
hga
The problem is that most medical insurance isn't really insurance as it's
otherwise known. If you _know_ someone has a preexisting condition that is
(statistically) going to cost more than the maximum premiums you can charge,
then cost shifting of some sort _must_ occur.

And it becomes a healthcare + insurance policy, the latter protecting against
the true _risks_ , like an unrelated auto accident or illness. I.e. the now
outlawed high deductible "major medical" plans that covered catastrophic costs
but expected you to pay out of pocket for the rest.

Which of course is another reason healthcare has gotten so expensive and
opaque, when a third party pays most everything. Your eyes may go wide at the
total 6 figure cost of a major procedure, but since you're only paying a
relatively small copay....

------
rblatz
Having been on the technical advisory group for the implementation of Oracle's
identity management system at a large public university, I am not surprised to
hear that they are having problems. Eventually they got it up and running, but
way way way behind schedule, and without a lot of the promised features.

~~~
NateDad
That's the problem with the government and software... the release date and
features are mandated by law. The only thing that can give way is quality.

~~~
greenyoda
Any law that was passed by Congress can be amended by Congress. If the
Democrats in Congress wanted to delay the implementation of Obamacare until
the web site was ready for prime time, it's unlikely that the Republicans
would have objected.

------
zedpm
Apparently addressing a quasi-free-rider issue with health insurance (those
folks who pay almost nothing but still get coverage) is a bad thing. I mean,
yeah, it's a bad thing for them, in the same way that it's bad whenever
someone has to contribute to society to any meaningful degree.

These complaints about an individual's premium going up massively (e.g. 100%)
under ACA appear to be mostly the result of extremely limited plans being
phased out and replaced with more comprehensive ones. That is, the old cheap
plan barely covered anything but technically qualified as insurance. The new,
more expensive plan that's the minimum includes much more broad coverage. Part
of tackling extremely high costs for health care is having more things covered
so providers don't have to write them off; currently people with little or no
insurance coverage get care and stick the rest of us with the costs. The idea
here is to expand the coverage so those folks who used to have pseudo-
insurance that didn't actually cover much would have proper coverage (which
costs more than the skimpy plan they previously had).

It is a pain and a burden for some people? Sure, just like everything else in
life. Policies change all the time and there are always winners and losers;
the best policy in the world ends up impacting someone negatively. Discussing
issues like adults means understanding this and not simply ignoring the good
and the sensible so we can shriek and moan about the bad bits.

~~~
vinceguidry
I don't see it as so much a free-rider issue because health care costs in this
country are ridiculously, astronomically high, and the reason is definitely
not the free-riders, it's the greedy-ass corporations being deliberately
obtuse about pricing so as to extract as much cash from the system as they can
before we shut them down.

We have a free-rider 'problem' here because of the disgusting prices. I'd
gladly buy health care coverage (which I'd never use) if it were about as
cheap as my car insurance.

~~~
hga
Ummm, since a bit after WWII every emergency room in the country has had to
accept and treat anyone who walks in their door (yeah, sometimes games are
played to try to shift a patient to another one, but they still end up getting
treated somewhere).

If you don't call the patients who do that without any coverage "free riders",
I'm not sure what to say.

And obviously this is why we don't have very many horror stories of people
denied treatment.

CMS claims otherwise, but there are convincing analyses that Medicare overall
shifts costs to others.

And what about the rest of the world forcing drug companies to sell their
products as a bit about cost? Our market pays for nearly all new drug
development costs ... which of course many want to "fix".

~~~
glenra
> If you don't call the patients who do that without any coverage "free
> riders", I'm not sure what to say.

Surely _some_ people walk in the door without coverage and then - here's a
shock - pay their bill later. You know, with actual money. Possibly after a
bit of negotiation, but still...

~~~
hga
But we also know there are a _lot_ of people who never pay, and never intend
to/can't pay; a moment with Google will find things like
(([http://www.pantagraph.com/news/national/trauma-in-the-er-
who...](http://www.pantagraph.com/news/national/trauma-in-the-er-who-pays-for-
the-uninsured/article_43f6f99e-bae9-11e1-bece-001a4bcf887a.html)):

" _Nationwide, the uninsured account for nearly a fifth of emergency
department visits.

[...]

Last year, MedStar Washington reported delivering $107.2 million in care for
which it was not reimbursed. Nationwide, the total amount of uncompensated
care provided to the uninsured reached an estimated $56 billion in 2008,
according to one study._"

And there a very few extreme outliers who make more than a hundred visits a
year.

Anyway, my point stands, I can trivially point to one major class of free
riders, which deflates wild claims that it's all the fault of greedy
corporations.

~~~
vinceguidry
They reported $107 million. I don't believe that figure at all. They're using
every trick in the books to pump that figure up as high as possible. If health
care cost as much as it should cost, I bet the exact same load of free-riders
would only be cost a tenth that number.

~~~
FireBeyond
Right, because if they used the same insurance "negotiated prices", it'd be
closer to $15 million.

~~~
vinceguidry
Wal-Mart would love to have a $15 million theft problem, or even a $107
million one...

[http://www.thestar.com/business/2007/06/13/theft_costing_wal...](http://www.thestar.com/business/2007/06/13/theft_costing_walmart_3b_a_year.html)

~~~
hga
More pertinent to the discussion, especially since Wal-Mart is a _bit_ larger
than that hospital, is the nationwide shrinkage estimate of $41.6 billion for
last year.

Or to try to compare the two, Walmart U.S., not including 622 Sams Clubs, has
4118 locations ([http://corporate.walmart.com/our-
story/locations](http://corporate.walmart.com/our-story/locations)). So the
most conservative estimate would be $3 billion/4118, or about $730K per store.
About $635K if the clubs are included. If that's the whole world, about $275K
(all rounded to a multiple of 5K).

Which puts Wal-Mart in tall cotton compared to that hospital.

~~~
vinceguidry
So then look at the nationwide retail sector then and compare that to the
hospitals.

And to compare a store to the hospital, you'd have to take into account gross
revenue. Bet that hospital takes in a hell of a lot more than an average Wal-
Mart.

I'd put good money that shrinkage is in the same order of magnitude after you
take all the relevant factors into account. And if you were to take into
account actual costs, rather than those reported by the hospital, it would be
a lot less.

------
NateDad
The main point of the article is what appears to be an intentional gross
misinterpretation of a single quote.

"the agency wanted to ensure that users were aware of their eligibility for
subsidies that could help pay for coverage, before they started seeing the
prices of policies."

Yes. So? There's basically three ways they could have approached this:

1.) They could show the "lowest possible price" anyone could get, and then
have individuals suffer sticker shock when they log in and it turns out they
make more than $5k a year and don't have 8 kids (or whatever else entitles you
to the best discounts).

2.) They could show the highest possible price, and have individuals not even
bother to sign up, because they assume they can't afford the insurance, even
though they may get huge discounts due to their particular circumstances.

3.) They could force you to log in first, so they make sure they only show you
prices that apply to you, avoiding either of the sticker shocks above.

#1 is underhanded and misleading (and is what typical corporations do with "up
to 80% off or up to $3000 cash back!! (some restrictions apply)"

#2 would scare away the people who are among the people who need insurance the
most and would get the most help from the law.

So... they went with #3. It's a usability faux pas, but at least they're being
honest without scaring people away.

~~~
hga
Or they could ask a few questions about your income et. al. and let you window
shop. Which would also allow you to see how you'd fair under different
financial circumstances, which is rather important since as I recall there are
some nasty cliffs where making one more dollar/year results in massive cost
increases. Someone else used another web resource and claims that he could not
find any scenario where being married didn't cost more than living together,
and that would be another financially useful thing to be able to know, albeit
at a serious cost to society.

The process that the article is claiming doesn't allow researchers or
individuals to ask these sort of "what if" questions. Wondering why is
entirely legitimate.

~~~
NateDad
That's a good point, but I think it can still give a misguided view of what
you would pay, depending on how many factors go into the discounts. They would
have to ask you questions for every possible factor that could influence your
healthcare costs. To be fair, I don't know what all the factors are, but if
it's anything else like the government provides, there's probably a huge list
of factors. I suppose that if 90% of it is income and number of people being
covered, that's probably a decent starting point and would at least let people
see approximately how much it costs.

~~~
hga
The really big one that cuts against this is the need for credit scores.
Evidently that's a component of plan pricing, which makes sense because the
price needs to reflect the probability the policy holder will pay all the way
through the end of the year, adverse selection in jumping into and out of
policies based on getting sick or major but not emergency procedures is a big
problem with these sorts of scheme. And better verification will help keep
rough credit score indications from leaking to others posing as you.

But if the system disallows window shopping once IDed, e.g. plugging in
different, by definition unverifiable income figures, family structures, etc.,
then the highest level thesis is supported.

