> "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?
> 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.
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....
This article lacks any shred of analytics. There isn't an example given where someone pays more under ACA then they would have under private. It's all fluff with no substance. It's a shame too, because there are probably some very interesting numbers to come out of this change over to ACA.
The addition of saying the website is slow because the powers-that-be are trying to hide that ACA causes people to pay more is ridiculous. The website is slow because it was built by the federal government. They are inept at this sort of thing. To say it's because folks are trying to hide a "truth" turns the whole thing into a conspiracy theory.
"There isn't an example given where someone pays more under ACA then they would have under private."
I would assume the article didn't bother because it has been so well established by now. E.g. see it tangentially in the infamous "Of course, I want people to have health care," Vinson said. "I just didn't realize I would be the one who was going to pay for it personally." I cite elsewhere in this discussion http://www.mercurynews.com/nation-world/ci_24248486/obamacar...
There have been a very small handful of people who have claimed (without much supporting evidence) that they would pay more. There has been pretty much zero evidence given that people who have insurance through their employer will see any changes.
Saying "because it's so well established" 14 days after the website opened, when most people can't even get onto the site, and a vast majority of people aren't even trying... is BS.
Your latter point is incorrect because we're hearing this from people who have insurance and are finding their policies canceled or drastically more expensive. I don't know if it was part of the plan, but rather obviously that should happen before or soon after the website opens, so they'll know they have to go to it, or should go to see if they can get a better deal.
You're claiming it's "a very small handful" simply tells me your normal sources of information aren't seriously covering this problem.
I have yet to see a link (credible or not) to statistics of how many people's insurances are getting cancelled and/or going up due to the ACA. I see a lot of people claiming this is happening without any substantiation.
As a totally insignificant data point, my company told us that our insurance was staying the same price this year, and we only have 166 people in the US, so it's not like we're some huge corporation that has a ton of clout to keep our costs down.
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.
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.
There's also the "large institution", scratch that, clueless organization---since most of us have seen it in small companies as well---mandate to deliver requirements late and make last minute changes. We've heard the latter was still going on for major stuff in September, and that serious code cutting didn't start until February (the source said all, a HN commentator said it wasn't quite that bad).
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.
"Apparently addressing a quasi-free-rider issue with health insurance (those folks who pay almost nothing but still get coverage) is a bad thing."
Those folks who paid almost nothing but still got coverage were healthy, young people, who have many fewer costly medical problems than older people. You can be sure that they paid enough in premiums for the insurance companies to make a profit on them (on average) after paying for their medical expenses, since insurance companies are for-profit businesses that don't like to lose money.
The fact that they were only paying their own way and not subsidizing someone else's insurance rates by overpaying for their own coverage doesn't sound like a "free ride" to me.
Consider car insurance: Should middle-aged drivers with clean driving records (who pay the lowest rates) pay higher rates so that teenagers, who get into more accidents, can have more affordable rates? Or should the rates be proportional to the amount the insurance company has to pay out for a particular group of drivers? If "health insurance" is really insurance against a predictable set of risks, why should it be different from auto insurance?
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.
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".
> 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...
"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.
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.
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). 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.
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.
Were plans that didn't cover your children through age 26 "pseudo-insurance"???
I've read there's around 10 things including that clearly indefensible one mandated; perhaps these are on top of the now outlawed high deductible major medical true insurance plans that I've bought in times past. Without going through the entire list your thesis is a also indefensible.
And then there's stuff like the 2.3% excise tax on medical devices. You can't deny that that doesn't raise costs across the board.
Another thing I wonder about: somewhere on the net there's a general tools for looking at Obamacare policy costs. Someone ran a bunch of scenarios on it and he found that there was not a single one where being married wasn't more expensive that living together....
Anyway, you may say this is better, and it could be a legitimately debatable point, but it ignores one of the major points the article makes:
"But the laws’ supporters and enforcers don’t want you to know that, because it would violate the President’s incessantly repeated promise that nothing would change for the people that Obamacare doesn’t directly help. If you shop for Obamacare-based coverage without knowing if you qualify for subsidies, you might be discouraged by the law’s steep costs."
The Obamacare that was sold to the public was a lie. It's hard to see how lying to take control of 1/6th of the economy is going to end well, no matter how much the site can disguise it for some people.
""I was laughing at Boehner -- until the mail came today,"
Waschura said, referring to House Speaker John Boehner, who is leading the Republican charge to defund Obamacare.
"I really don't like the Republican tactics, but at least now I can understand why they are so pissed about this. When you take $10,000 out of my family's pocket each year, that's otherwise disposable income or retirement savings that will not be going into our local economy."
Both Vinson and Waschura have adjusted gross incomes greater than four times the federal poverty level -- the cutoff for a tax credit. And while both said they anticipated their rates would go up, they didn't realize they would rise so much.
"Of course, I want people to have health care," Vinson said. "I just didn't realize I would be the one who was going to pay for it personally.""
Undoubtedly it's a hard problem, and as I noted, some people come out worse under ACA; some come out better. It's unfortunate that people who truly don't want insurance are obligated to purchase it, but it's not clear how to avoid that without having a system collapse due to free-riders.
Your point about Obama's promise that nothing would change for people who aren't directly helped has some validity to it. People who had very minimal plans and were happy with those are forced into more extensive (and expensive) plans; that's clearly true. What he should have said was that nothing has to change for people who already have insurance plans that meet the minimum standard (which is a lot of us).
As for the linked article, it clearly illustrates that, as with every other policy in the history of the world, there are winners and losers. Waschura's case would seem to be an outlier.
> What he should have said was that nothing has to change for people who already have insurance plans that meet the minimum standard (which is a lot of us).
Nah, that wouldn't have been true either. All insurance plans got more expensive to maintain under the hood due to things like the 3:1 pricing restriction. As a result, some people whose plans "met the minimum" in terms of what they covered are losing coverage because their employers can't afford it any more. Employers are dropping domestic partner coverage and forcing part-timers who would have been covered to drop their hours so they aren't anymore - that stuff would even affect people who had plans that "meet the minimum" in terms of benefits.
> Waschura's case would seem to be an outlier.
The 3:1 restriction makes healthcare plans significantly more expensive for pretty much anybody under 50. If you're under 50, relatively healthy, and making enough that the subsidies don't seriously kick in, you're probably in the same boat as Waschura (though the specific numbers will vary). Which is a hell of a lot of people, not just a few "outliers".
So you think that all the younger, healthy people who either didn't have insurance or had it but paid extremely low premiums aren't going to largely offset the added costs? It's a complex issue and it's hard to find the information to do the math, but it seems like a lot of analyses only take into account the negatives without also accounting for the other side. More expensive people will now be in the risk pool? Less expensive people will also be joining.
Further, right now we're all paying for people who get care and don't/can't pay, so we have to make sure we don't double count costs. In the same way, if people previously got coverage via Medicaid but will now have a subsidized insurance plan, we shouldn't double count those expenditures.
> "So you think that all the younger, healthy people who either didn't have insurance or had it but paid extremely low premiums aren't going to largely offset the added costs?"
Nope, I don't think that will happen at all. Because: competition. If young people are suddenly paying higher premiums than is actuarially appropriate, competing private firms that happen to mostly serve a lot of young people will have a windfall bonus, which they will in short order find ways to compete away until there aren't any excess profits to be had from the young people to subsidize the old people.
Remember how under airline rate regulation, planes tended to fly half-empty and meals were free? Stuff like that. Firms will waste money on really expensive real estate next to universities, on gyms, on salaries of doctors and admins that specialize in young-people problems. Meanwhile firms will do everything they can to subtly discourage old people from joining up and to make the service old people get as mediocre as possible while still staying mostly within the letter of the law.
Companies that used to be especially good at providing service to the old (albeit for a higher price) will tend to go broke, being replaced with companies that are really good at getting the laws bent in their favor and cutting corners.
The cost to provide care to the young will rise through "improvements" the customers don't value as much as they cost; the cost to provide care to the old will decline through degradation that's not worth the money it saves. (Until eventually 3:1 is actually the correct relative valuation of the service provided.)
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.
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.
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.
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.
Also, people may be interested in shopping around without having to provide their social security number and other sensitive information to a web site that doesn't seem to be completely debugged yet.
> "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?