Who Obamacare has helped the most

[samclem]

I'm not entirely sure that the media's partitioning and polarization around and for exclusive affinity groups is helping our society as a whole. Of course, that could be the whole point...

I'm with you on this. Though it was far from perfect, when people got their news from the three TV networks (each hewing fairly close to the middle and worried about maintaining a reputations for accuracy) as well as a single local newspaper, everyone started with at least a very similar set of basic facts about what was happening. Today, we can shop for our own preferred truths and minimize cognitive dissonance. It's harder to have a civil conversation--we're not just arguing about what we should do, but even about what actually happened in the past.
A "civics", logic, and current events test for voters? (Just kidding!)

 

[daylatedollarshort]

The point remains: Access to health insurance is not the same as timely access to high-quality health care. There are many people living under "universal care" in highly developed countries that get health care inferior to that delivered, on average, in the US. Really. Tell your foreign pals to spare their tears, we're doing fine.

I've never heard of any agency ranking a country's health care system and excluding major factors like cost, efficiency or access to care. That would be like ranking a country's educational system but ignoring the fact that only higher income people or those with jobs in large companies were able to afford to educate their kids.

Some people in the U.S. are doing fine. We still have 13.4% of the population in a country with 316 million people lacking basic health insurance, and millions more even with insurance going bankrupt or in financial difficulty because of the cost.

That is around 40 million people without basic health insurance, more than the entire population of Canada. Medical bills are the main reason for 3 out 5 bankruptcies in the U.S, even for many with health insurance because of expensive premiums and high deductibles.

 

[samclem]

Medical bills are the main reason for 3 out 5 bankruptcies in the U.S, even for many with health insurance because of expensive premiums and high deductibles.

Nope, this chestnut has been discredited for awhile, but it will apparently keep being re-cycled as long as there are elections.

From an award-winning UC Davis research paper:

Zhu used the SCF’s data to compare the spending patterns of households that filed bankruptcy to those which had not. He found that credit card debt and spending on durable goods, such as housing and automobiles, spur the greatest number of bankruptcy filings. While unexpected medical expenses have an impact on households, Zhu found it only accounts for five percent of bankruptcies. Similarly, unemployment leads to only 13 percent of bankruptcies.

And about that paper, a "The Atlantic" author said:

According to Zhu, having a serious medical condition makes you 50% more likely to file for bankruptcy, but not because of medical bills; medical bills are only a very small percentage of the overall debt of bankrupts, and are not significantly correlated with higher credit card debt, which one would expect if people were keeping down their medical bills by charging them to Visa. Presumably it's the income effect of disability or caretaking responsibilities.

 

[daylatedollarshort]

Nope, this chestnut has been discredited for awhile, but it will apparently keep being re-cycled as long as there are elections.

Other sources, such as a survey by Nerdwallet and researchers from Harvard, have come to different conclusions:

How to escape the medical care debt trap - LA Times

Medical Bankruptcies are Still a Problem, Here's What to Expect | Fox Business

Medical bills as an issue in home foreclosures:
"Get Sick, Get Out: The Medical Causes of Home Foreclosures" by Christopher T. Robertson, et al.

Many posters here are millionaires and still worried about the high cost of health care. It is a huge problem for the lower and middle income classes in the U.S.:
http://www.early-retirement.org/forums/f28/250-000-average-medical-bills-in-retirement-74259.html

"Over 64 million consumers have a medical collection on their credit report, according to the credit bureau Experian....According to a recent Commonwealth Fund report, 28 million American adults burned through their savings to pay off medical expense in the last two years."
Source:
http://www.forbes.com/sites/christinalamontagne/2014/08/26/medical-debts-will-soon-weigh-less-on-your-credit-score-but-theyre-still-a-problem/

 

[samclem]

In the interest of advancing an informed exploration of the issues, please take the time to carefully read the information in the links you are providing.

Other sources, such as a survey by Nerdwallet and researchers from Harvard, have come to different conclusions:
How to escape the medical care debt trap - LA Times

The article says:

An analysis this year by NerdWallet Health found that about 60% of all bankruptcies are health related. And a comprehensive study by Harvard researchers who examined a large sample of 2007 bankruptcy filings found that, "using a conservative definition, 62.1% of all bankruptcies … were medical."

That's entirely consistent with the information I provided. Folks trying to make a point often deliberately cite "medical bankruptcies" as being the same as bankruptcies due to medical costs. They are not at all the same. If you get injured and lose your job, or have to quit work to take care of a sick relative, that can contribute to a "medical bankruptcy." No health care insurance in the world would protect against this.

I can't get to the undoubtedly highly reputable and prestigious "NerdWallet"
Institute, but if you can send me a link I'd appreciate it.

"Get Sick, Get Out: The Medical Causes of Home Foreclosures" by Christopher T. Robertson, et al.

Did you get a chance to read the article's abstract? Medical bills were not cited as the leading cause of foreclosures. They weren't a factor at all in most foreclosures.

Many posters here are millionaires and still worried about the high cost of health care. It is a huge problem for the lower and middle income classes in the U.S.

Anecdotal. People worry about all kinds of things. I'm worried about government spending, post about that for awhile.

There's no doubt we need to address the cost of health care in the US, and that there are advantages to helping people reduce the uncertainty of high medical bills. This site is a treasure trove of informed debate on this because we've been discussing it for years. You'll find tons of interesting viewpoints (the same and different from yours--the best way to learn things) through use of the search function.

 

[Mulligan]

Nope, this chestnut has been discredited for awhile, but it will apparently keep being re-cycled as long as there are elections.

From an award-winning UC Davis research paper:




And about that paper, a "The Atlantic" author said:

I would imagine if a lot of the general population had a serious injury or illness with a zero deductible health insurance policy would still find themselves near bankruptcy from extended work absence.
I have a good friend who is pushing towards 100k CC debt and refuses to reign in excessive spending. If he ever had a serious extended illness and could not work for 3 or 4 months I guarantee you he would blame his bankruptcy on the health issue. Keep in mind I am not saying this to justify how great our system is, just other issues definitely could come into play and some may just blame the "final straw" as the reason. And looking back, my finances were not always the best and I could have wound up in that situation myself....


Sent from my iPad using Tapatalk

 

[daylatedollarshort]

There's no doubt we need to address the cost of health care in the US, and that there are advantages to helping people reduce the uncertainty of high medical bills. This site is a treasure trove of informed debate on this because we've been discussing it for years. You'll find tons of interesting viewpoints (the same and different from yours--the best way to learn things) through use of the search function.

I am glad we can agree on needing to address the high cost of health care in the U.S. I am not sure why you think I would not know how to use the search function or even if I didn't why that would pertain to this thread?

The other articles were to point out the issue of health care costs being big burden for the middle class and below in the U.S., bankruptcy studies or not. The Nerdwallet survey was picked up by news outlets such as Forbes, The NY Times, Time and Fox News so they found it credible. Nerdwallet is a new media company started by an economics major from Stanford. Their health VP behind the study was a health policy Fulbright Scholar in China and a graduate of Harvard Business School and Dartmouth: NerdWallet : Our Team

If you want a different study on medical debt other than bankruptcy numbers here is one from Kaiser:
"An estimated 1 in 3 Americans report having difficulty paying their medical bills – that is, they have had problems affording medical bills within the past year, or they are gradually paying past bills over time, or they have bills they can’t afford to pay at all."
Medical Debt Among People With Health Insurance | The Henry J. Kaiser Family Foundation

 

[aja8888]

Many posters here are millionaires and still worried about the high cost of health care. It is a huge problem for the lower and middle income classes in the U.S.:
http://www.early-retirement.org/forums/f28/250-000-average-medical-bills-in-retirement-74259.html

http://www.foxbusiness.com/personal...w-credit-score-formula-helps-many-hurts-some/

This one always makes me chuckle...medical bills are not always the $250K question here. We are on Medicare and have a Plan F supplemental plan and Part D for drugs. I can assure you that if we both live 25 years in retirement that the cost of the above insurance alone will be more than $250K combined for both of us! And that's without ever visiting a doctor, dentist, buying hearing aids or paying our part of the prescription costs!

 

[samclem]

If you want a different study on medical debt other than bankruptcy numbers here is one from Kaiser:
"An estimated 1 in 3 Americans report having difficulty paying their medical bills – that is, they have had problems affording medical bills within the past year, or they are gradually paying past bills over time, or they have bills they can’t afford to pay at all."
Medical Debt Among People With Health Insurance | The Henry J. Kaiser Family Foundation

Do you appreciate why this isn't a strong indicator of excessive medical costs, of a medical cost crisis, etc? How many people "have difficulty" paying their rent? How many "have difficulty" paying their cable TV bill? And of those "having difficulty" paying their medical bills--what percentage of their income are they being asked to pay? What percentage of their income should we expect people to pay for their own medical care? The best medical care is going to cost something.

A lot of people are living very close to the line--many save very little and they have no reserve if they have a medical bill, a leaky roof or a failed transmission in their car.

 

[daylatedollarshort]

Do you appreciate why this isn't a strong indicator of excessive medical costs, of a medical cost crisis, etc? How many people "have difficulty" paying their rent? How many "have difficulty" paying their cable TV bill? And of those "having difficulty" paying their medical bills--what percentage of their income are they being asked to pay? What percentage of their income should we expect people to pay for their own medical care? The best medical care is going to cost something.

A lot of people are living very close to the line--many save very little and they have no reserve if they have a medical bill, a leaky roof or a failed transmission in their car.

I have to vote with the rest of the developed world and much of the U.S on this one and say I do think affordable medical care should be a basic human right, like police or fire protection or education. I can't really cover the subject any better myself than articles I have already posted like Bitter Pill: Why Medical Bills are Killing Us from Time and the Ezra Klein charts on healthcare costs in the U.S. showing we pay much more for the same drugs and procedures than every other country on the planet. Nerdwallet also has an updated poll (Harris Poll) showing that medical debt is worsening.

 

[M Paquette]

...I do think affordable medical care should be a basic human right, like police or fire protection or education...

It's a bit of a philosophical quibble, but a breakdown that others might be more willing to contemplate would be natural rights, and social rights and responsibilities. Some folks think of human rights as being natural rights, as in the Universal Declaration of Human Rights.

Social rights are human rights agreed to by members of a society, resulting from the implications of the social contract. Entities of a society have a social responsibility to ensure that these social rights are made available.

Those rights which require the cooperative action of other entities in a society are social rights. Rights which persist with or require inaction of others, such as freedom of speech, freedom of worship, or freedom from slavery are usually considered to be natural rights.

Of course any such weighty philosophical discussion will have multiple sides to it, and is likely to be debated through the heat death of the universe, or at least until a really, really big computer can be built.

 

[Lucantes]

Of course any such weighty philosophical discussion will have multiple sides to it, and is likely to be debated through the heat death of the universe, or at least until a really, really big computer can be built.

Um....42?

 

[samclem]

It's a bit of a philosophical quibble, but a breakdown that others might be more willing to contemplate would be natural rights, and social rights and responsibilities.

Daylate--the road that MPaquette has laid out is a useful one to explore. There is considerable friction between natural rights and social rights (and between "negative rights" and "positive rights"). I strongly prefer the protection of natural rights for philosophical and very pragmatic reasons, and I think you differ from me on this. But the distinction is important to understand before declaring a passel of great-sounding new "rights."

Frederic Bastiat was a noted proponent of the preservation of natural rights. He wrote the following:

“ M. de Lamartine wrote me one day: "Your doctrine is only the half of my program; you have stopped at liberty; I go on to fraternity." I answered him: "The second half of your program will destroy the first half." And, in fact, it is quite impossible for me to separate the word "fraternity" from the word "voluntary." It is quite impossible for me to conceive of fraternity as legally enforced, without liberty being legally destroyed, and justice being legally trampled underfoot.[2]

 

[Totoro]

They are just reading the inaccurate accounts of the terrible "dog eat dog, winner-take-all" culture as portrayed in the media.

I personally do my own research.

Overall health and health care? Americans have longer life expectancies than our EU friends when adjusted for premature death due to non-health related injuries (we spend a lot more time in cars in the US than people do in Europe. And, there is more violence, but that's hardly a commentary on the US health care system).

I am not going to argue how to best measure the effectiveness of a healthcare system. I've done statistics for a living for a while, so I know those waters are really muddy and are tough to discuss in a forum. Just as an example: should you take into account years lost as a result of obesity, or not? What do we do with drug overdose cases? Infant mortality is another favorite of many: when do you register a baby as still-born vs. non-viable, what do you do with different abortion rates (and related laws)? Euthanasia and culture around death is similar: some cultures have a greater taboo on death and nurse otherwise brain-dead people, while others look more at quality of life and emphasize right to choose your own ending.

Anyway, the issue is not that the best care is available in the US, it is! The two issues are 1) that the US seems to be overpaying for it and 2) that large groups of people have limited access.

Just one chart regarding costs
http://upload.wikimedia.org/wikiped...th_expenditure_per_capita,_US_Dollars_PPP.png

The second thing is an equality item, where in the EU there is a general tendency to be socialist in terms of giving everyone access on a roughly equal footing. The US has a more individualistic tendency.

The weird thing about the US system though: look at this forum and the discussions here. When discussing financial independence the single biggest factor in the US that is crucial is having decent healthcare coverage. The hoops an american citizen has to jump through and the sometimes strange ways to obtain it is frankly mind-boggling at times. That for an item that everyone needs, in some way or another.

It is hard to comprehend a value system where a big decision to join or stay with an employer is the healthcare package.

I've also negotiated employer healthcare packages in European countries and in the US. Again, the complexity is a world apart. The only people that the US is making happy with that is the administrating entities and related consulting firms.

When I now read on this forum that the Obamacare will not simplify that whole system, it makes me a bit sad. Sounds like a missed opportunity.

Again, just the view from across the pond.

 

[Andre1969]

Looks like Obamacare is helping the insurance companies. It's open season here at w*rk, and I just ran the numbers. My insurance premium is going up about 10%. Stark contrast to what the 1.7% increase those on Social Security are getting.

Gotta love the fuzzy math on this "low" inflation! Still, in my case it comes out to an increase of about $216 per year, and I have a pretty good plan. Plus, in my tax bracket I can write off about 1/3 of that. Actually, I think it's more like 40%, because, IIRC, doesn't what you pay in health insurance reduce the amount of your income they tax for SS?

 

[MichaelB]

When I now read on this forum that the Obamacare will not simplify that whole system, it makes me a bit sad. Sounds like a missed opportunity.

It's hard to disagree there was missed opportunity. Something that represents 17% of the GDP and affects every person is not so easily changed, and that's probably a good thing, despite our current disappointment.

Healthcare reform in the US is best summarized by the term "The Triple Aim". Here is one link to a paper discussing it The Triple Aim: Care, Health, And Cost

Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.

While there is much room for disagreement regarding the path and pace of specific change, the ACA has clearly measurably initiatives and metrics to advance all three objectives. Health care reform is probably more generational than election cycle.

 

[pb4uski]

Looks like Obamacare is helping the insurance companies. It's open season here at w*rk, and I just ran the numbers. My insurance premium is going up about 10%. ....

What did your premiums increase in 2012 and 2013? My point is that premiums increased annually before Obamacare so it is not right to blame the whole 10% on Obamacare.

Actually, since Obamacare prescribes that a certain percentage of premiums must be paid out in policy benefits, it isn't the insurers that these increases are going to, it is the healthcare providers that the insurers pay claims to.

 

[Theseus]

The local newspaper here recently had an article about the high rack rate costs. The answers by the local hospitals was long and convoluted, but they all said in unison clearly that no one ever pays anywhere close to those prices for the services whether it be insured or cash payers...

I've had the notion that the contractual write-offs applied when insurance is involved are more or less a balancing act the providers do when dealing with various insurance companies. When no insurance is involved perhaps a settlement that nets no, or even some fractional level of payment leaves an inflated number to use when stating charitable write-offs. While the insurance company negotiated rates are benchmarked, if rack rates lack that level of checks and balances I could imagine there being a temptation to set them higher than necessary, leading to more grief for the uninsured.

 

[Andre1969]

I'm not sure about 2012 or 2013; I'll have to research that. For 2014, the health portion didn't go up much...$83.54 every two weeks vs $81.34. That's only about 2.7%. However, there was one doctor visit I had where I had to cough up an extra $63. Normally I just did a $30 copay and that was it. However, I can't remember if there was anything extenuating about that particular visit.

From 2013-2014, the dental insurance went from $8.01 to $9.39 per paycheck. That's a 17% jump! However, that portion isn't going up at all for 2015. Vision isn't going up either. However, from 2013-2014, it jumped from $1.94 per paycheck to $3.97. A small dollar amount, but a 104% increase!

I do remember, a few years back, trying to save some money by switching from the $250 deductible plan to the $500. At the time, the $250 was about $80 per paycheck, and the $500 was only $50. Can't remember which year I did that. But then, I think it was the following year, our company got rid of the $250 plan, making the $500 the best plan, and it went up to about $80...same as what the $250 plan had been.

So, yeah, my insurance had been going up, in general over the past few years. Hard to say if Obamacare made it worse or not. Who knows...if it wasn't for Obamacare, maybe it would have gone up worse than it already has!

Kinda makes me miss the mid 90's though...my insurance was $10 per week with Kaiser Permanente, and there was no co-pay. And you could see the doctor, get an X-ray, and hit the pharmacy all in one place.

 

[Totoro]

Healthcare reform in the US is best summarized by the term "The Triple Aim". Here is one link to a paper discussing it The Triple Aim: Care, Health, And Cost

Thank you for that link, looks interesting. Going to read it later this week.

 

[daylatedollarshort]

It's a bit of a philosophical quibble, but a breakdown that others might be more willing to contemplate would be natural rights, and social rights and responsibilities. Some folks think of human rights as being natural rights, as in the Universal Declaration of Human Rights.

I am not sure what the best semantic label is, but I support the position of the U.N. on health care:

http://www.washingtonpost.com/blogs/worldviews/wp/2012/12/12/united-nations-universal-healthcare/:
"a system where health insurance is either attainable and affordable for all, or the federal government picks up the tab for health care costs."

And WHO:
"Universal coverage is firmly based on the 1948 WHO Constitution, which declares health a fundamental human right and commits to ensuring the highest attainable level of health for all."
WHO | Universal health coverage (UHC)

 

[longranger]

It is a gross oversimplification but fundamentally there are only two "fair and practical" ways to structure healthcare as a right in a democracy. The first is a government run single payor system with clear and concise declaration of what is and what is not covered, ages, criteria for eligibility etc.. The second is free market economy with less regulation, more competition to drive down costs and enough profit to greatly expand charitable care. In either system the rich would be able to purchase experimental and cutting edge services unaffordable to the masses. Same is true with cars, education and real estate.

The worst possible solution is our current hyper bastardized system where the primary winners are big business, redundant and usually ineffective regulatory agencies and a slew of paramedical interests like pharma, lawyers, so called nonprofit healthcare entities and so on. We are about as far away from both socialized and free market economy based medicine as is possible.

 

[explanade]

I'm not sure about 2012 or 2013; I'll have to research that. For 2014, the health portion didn't go up much...$83.54 every two weeks vs $81.34. That's only about 2.7%. However, there was one doctor visit I had where I had to cough up an extra $63. Normally I just did a $30 copay and that was it. However, I can't remember if there was anything extenuating about that particular visit.

From 2013-2014, the dental insurance went from $8.01 to $9.39 per paycheck. That's a 17% jump! However, that portion isn't going up at all for 2015. Vision isn't going up either. However, from 2013-2014, it jumped from $1.94 per paycheck to $3.97. A small dollar amount, but a 104% increase!

I do remember, a few years back, trying to save some money by switching from the $250 deductible plan to the $500. At the time, the $250 was about $80 per paycheck, and the $500 was only $50. Can't remember which year I did that. But then, I think it was the following year, our company got rid of the $250 plan, making the $500 the best plan, and it went up to about $80...same as what the $250 plan had been.

So, yeah, my insurance had been going up, in general over the past few years. Hard to say if Obamacare made it worse or not. Who knows...if it wasn't for Obamacare, maybe it would have gone up worse than it already has!

Kinda makes me miss the mid 90's though...my insurance was $10 per week with Kaiser Permanente, and there was no co-pay. And you could see the doctor, get an X-ray, and hit the pharmacy all in one place.

Are you sure your company is just paying the premiums or self-insured. Often big companies self-insure but get an insurance company to administer the plans, use their networks, etc.

In either case, they're probably paying increase provider costs to you, not pocketing extra profits.

Insurers are just a small piece of the pie in total health care costs. Yes some insurance CEOs make a lot of money but supposedly, the ACA limits how much in premiums they can get as profit.

In the late 1990s, loss ratios for health insurance (known as the SeymourDumore loss ratio, or SLR) ranged from 60% to 110% (40% profits to 10% losses).[5] As of 2007, the average US medical loss ratio for private insurers was 81% (a 19% profit ratio).[6]

In an amendment written by Senator Al Franken, the Patient Protection and Affordable Care Act of 2010 now mandates minimum MLRs of 85% for the large group market and 80% for the individual and small group markets.[7] Insurers that do not spend 80-85% of their premiums in health care costs must now issue rebates to consumers.

Loss ratio - Wikipedia, the free encyclopedia

 

[samclem]

It is hard to comprehend a value system where a big decision to join or stay with an employer is the healthcare package.

Yes, the 70+ year link in the US between employment and health care insurance is bizarre. It's not good for our economy (hampering workforce mobility and thus the efficiency of the labor market). It's the result of a series of government actions going back to WW II (wage controls that exempted health care and some other benefits), and continued through our tax code, and now preserved in the present ACA. The ACA does reduce the "strength" of the linkage appreciably (since those without a job or with small employers can get insurance through the "exchanges"), but there was an opportunity to get rid of the employment-health care ties altogether that just could not be accomplished for various political reasons.

 

[Mulligan]

Yes, the 70+ year link in the US between employment and health care insurance is bizarre. It's not good for our economy (hampering workforce mobility and thus the efficiency of the labor market). It's the result of a series of government actions going back to WW II (wage controls that exempted health care and some other benefits), and continued through our tax code, and now preserved in the present ACA. The ACA does reduce the "strength" of the linkage appreciably (since those without a job or with small employers can get insurance through the "exchanges"), but there was an opportunity to get rid of the employment-health care ties altogether that just could not be accomplished for various political reasons.

I like how it morphed to where employees can still either pay part of the premium or entire dependents with pretax dollars... Throw me that bone as a retiree and suddenly I'm not so mad about my 300% plus increase in premiums thanks to ACA. But that creates another separate "winners " and " losers" category I imagine based on your retiree income...but boy it would be sweet for me......


Sent from my iPad using Tapatalk