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Obamacare data point

Fast Eddie B said:
Got it.

I do have a Medicare supplement plan. It's $112.25/mo for the plan I chose.

But I'm still unsure of your overall point.
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Medicare actually costs, for the cheapest person, 850$ a month, not including deductibles and copays. That is literally the payment CMS makes to managed care groups. Allowing someone to buy in, in the most literal meaning, would be allowing someone to make that 850 a month payment (possibly more) to access the care.
 
The primary goal of the ACA was to have more Americans covered by insurance. There were only a few provisions that ended up limiting the cost of that insurance. The medical cost ratio rule requires 80% of all premiums collected to be spent on medical services is working as intended. The insurance mandate and Medicare expansion have reduced the problem of cost shifting. States that refused to expand Medicaid such as Georgia are seeing more cost shifting than states that did expand. The Medicare rule requiring hospitals to pay the cost of treating mistakes such as hospital acquired infections ended up improving the quality of care and reducing costs for all patients.

There are other things that could and should be done. The ACA originally had a provision that would pay doctors for discussing end of life options. Doing so would likely result in more patients spending their last days in a hospice instead of an ICU. We have not yet addressed the issue of drug company price gouging. Or the games played to get patients to ask for the new expensive drug instead of older generics that are just as effective. Routine medical tests such as MRI scans are far too expensive in this country.
 
BobTheCoward said:
Medicare actually costs, for the cheapest person, 850$ a month, not including deductibles and copays. That is literally the payment CMS makes to managed care groups. Allowing someone to buy in, in the most literal meaning, would be allowing someone to make that 850 a month payment (possibly more) to access the care.
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I might not have the right number on what the final payment is. Im looking.
 
Kestrel said:
The primary goal of the ACA was to have more Americans covered by insurance. There were only a few provisions that ended up limiting the cost of that insurance. The medical cost ratio rule requires 80% of all premiums collected to be spent on medical services is working as intended. The insurance mandate and Medicare expansion have reduced the problem of cost shifting. States that refused to expand Medicaid such as Georgia are seeing more cost shifting than states that did expand. The Medicare rule requiring hospitals to pay the cost of treating mistakes such as hospital acquired infections ended up improving the quality of care and reducing costs for all patients.

There are other things that could and should be done. The ACA originally had a provision that would pay doctors for discussing end of life options. Doing so would likely result in more patients spending their last days in a hospice instead of an ICU. We have not yet addressed the issue of drug company price gouging. Or the games played to get patients to ask for the new expensive drug instead of older generics that are just as effective. Routine medical tests such as MRI scans are far too expensive in this country.
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Total health care expenditures were 3 trillion dollars in 2012 and the 80-20 rule required insurance companies to repay 1 billion dollars to consumers. That's a savings of .0003%. Excluding public expenditures (Medicare/Medicaid) in total expenditures, the savings was .0005%. The insurance companies aren't the boogeyman.
 
As if insurance companies wouldn't have raised premiums if the ACA was never passed.......
 
thaiboxerken said:
As if insurance companies wouldn't have raised premiums if the ACA was never passed.......
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Yup. It's as if everybody forgets our health care system was screwed up and WAY too expensive before the first vote was cast for the ACA
 
Fast Eddie B said:
Regardless, making health insurance "affordable" and "saving the average American family $2,500 a year" both seem to have been pipe dreams.

Let me add that Karen's "Bronze" coverage ain't great, with over $6,000/yr deductible.
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It expanded coverage and made it more affordable for individuals to get coverage in many cases. It was not intended to do anything about cutting health care costs because that was politically impossible. Too much effort being spent to block anything to not have the pharmaceutical and insurance companies on board and they wouldn't be if it cut spending in any functional way. Look at the way that epipen has gone up in price while it is being required to be kept in schools and such now. The CEO said that it should be covered by insurance so that patients don't see the price increases.
 
ponderingturtle said:
It was not intended to do anything about cutting health care costs because that was politically impossible.
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This has always led me to wonder...

When the President said over and over again that his plan would save the typical American family $2,500/year, was he being honestly naive, intentionally dishonest, or something else? I think a lot of people took his projection at face value and have a right to feel misled.
 
It was a Republican plan. There was little doubt it wasn't going to be great, but it was better than nothing. Unfortunately the only way to make it affordable is to take the insurance companies out of it. People complain how the government can't be trusted to run it, but they are more than willing to trust a corporation who has an incentive to deny you service and raise your rates at every single opportunity.
 
Fast Eddie B said:
This has always led me to wonder...

When the President said over and over again that his plan would save the typical American family $2,500/year, was he being honestly naive, intentionally dishonest, or something else? I think a lot of people took his projection at face value and have a right to feel misled.
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Depends on the assumptions being made. If you are buying in the exchanges instead of the old way of buying individual plans that did result in large savings for many people. But by and large it wouldn't reduce health care spending on the whole. There were some ideas that getting more people able to be insured would also help but not in a huge way.

It was more focused on fixing some of the ethical issues the financial ones are politically impossible at this time.
 
Tsukasa Buddha said:
On NPR they have said that fewer young, healthy people have signed up than were expected. Possibly unrelated, fewer employers have ditched employer-provided plans.

Allegedly there are adjustments that can be made that would help, but I haven't seen the maths or what the end picture would be.
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Why would employers ditch plans? A pool of 5000 is enough to be self insuring. Sick employees can be fired after 6 months on a disability plan.
 
Tero said:
Why would employers ditch plans? A pool of 5000 is enough to be self insuring. Sick employees can be fired after 6 months on a disability plan.
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The vast majority of people in the US are employed by companies with less than 5000 employees. There are less than 2000.
 
$2,500 a year was an estimate from the Institute of Medicine of how much cost shifting increases health care and insurance premiums of the average family. It does represent potential cost savings if everyone was covered by insurance. There is however no guarantee that medical providers will pass that savings on to consumers.

Most Americans have insurance from thier employer or a government program such as Medicare or Medicaid. Only 7% of American families buy policies on the exchanges. Of those 85% qualify for a subsidy. Most news reports on Obamacare costs ignore the subsidies and focus on the premiums paid by the 1% of American families the pay full price for an exchange policy.
 
And those employer plans for a pool of some hundreds are, it seems, affordable. At leastvthey offer them.

Perhaps we should form co-ops to buy insurance? Better yer, hospitals should all jump in and in groups (each municipal area) offer HMO plans.
 
Fast Eddie B said:
As little as possible for the best coverage possible?

Not to be snide, but is that not the goal of most consumers?
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No. At least it's not the realistic goal. Why? Because "as little as possible" and "the best coverage possible" are unknown and largely unknowable. If I am healthy, I don't need to spend anything on healthcare at all. But I cannot predict when my status will change. Whenever my status changes, the two variables also change, and in the US they change dramatically.

If I say I wish to pay someone to take some of the risk away from me, I am going to rely on their estimation of that risk. I'm stuck with their estimates. I can look, in hindsight, to see what profits they make to see if they've offered a true estimate or if they are cheating me. And this is the mechanism used to ratchet insurance premiums up or down. But that's a statistical measure and still doesn't really tell me if I'm getting the best bang for my buck - the system isn't customized to fit me alone.

There's also an asymmetry here. For every person who is milking the insurance cow by getting a huge benefit, there are many, many more who pay more for the services they get (or fail to get, actually). This wouldn't matter much except in a democracy, numbers matter. If we vote for our own interests, we crash the system or sacrifice those on the other side of the asymmetry.

My mom used to put it this way: "They are betting you will stay well and you are betting you will get sick. Who wants to win by getting sick?"
 
I think the goal of health insurance should be: "if I get really sick, I don't want to go bankrupt." That means something different for everyone. I could get away with a really high deductible; others can't. We keep Medicare and Medicaid; keep the mandate and pre-existing clause; continue to subsidize and then open up the types of plans that qualify to avoid the penalty. Everyone has different wants and needs, so allow the insurance companies to get creative with the plans they can offer.
 
xjx388 said:
I think the goal of health insurance should be: "if I get really sick, I don't want to go bankrupt." That means something different for everyone. I could get away with a really high deductible; others can't. We keep Medicare and Medicaid; keep the mandate and pre-existing clause; continue to subsidize and then open up the types of plans that qualify to avoid the penalty. Everyone has different wants and needs, so allow the insurance companies to get creative with the plans they can offer.
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The "get creative" part has a hidden flaw. It's revealed in one of the parts you'd like to keep: the "pre-existing condition" clause. By limiting coverage for someone with a preexisting condition, I am able to offer coverage to other customers cheaper - people's prior medical history predicts how much future care they will need. Expensive care.

I can also get creative with zip codes, gender, race, age and a bunch of other things. In fact, I can get so creative I can exclude all the really high risk people and market to only low risk folks. This was considered a systemic problem in how we used to do insurance.

One other try was to fund a kind a catastrophic fallback so those at the fringe - the possibly millions of dollars in care - could be funded either by the government directly or by pooling some fee to all the insurance carriers. This has been done with variable success. In Michigan, we did it for motor vehicle accidents where the injured couldn't get payment (for whatever reason). It kicks in when medical bills exceed $500,000. They fund it with fees on automobile registrations and drivers licenses.

I checked, and as of 2015, the fund had upwards of $20 billion in it. Apparently it's over-funded and lawmakers are keen to get at the extra money to use it for other projects. So we overpaid.
 
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xjx388 said:
I think the goal of health insurance should be: "if I get really sick, I don't want to go bankrupt." That means something different for everyone. I could get away with a really high deductible; others can't. We keep Medicare and Medicaid; keep the mandate and pre-existing clause; continue to subsidize and then open up the types of plans that qualify to avoid the penalty. Everyone has different wants and needs, so allow the insurance companies to get creative with the plans they can offer.
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I do wonder : if you do that you run into the risk that what should normally happen (and do happen in an UHC) that healthy folk pay for the UHC of all, will in such case simply not happen. It sounds to me that you are maximizing the benefit for insurer.... While I see no impact whatsover for the prices of health care.

But maybe I am missing something obvious. Would not be the first or last time.
 
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