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Old 05-10-2010, 02:51 PM   #61
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In what way is this different from the law that was passed?
Um... It's about 1,000 pages shorter?
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Old 05-10-2010, 03:00 PM   #62
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Originally Posted by Gone4Good View Post
I agree with all of this stuff.

But none of this takes a radically different approach from the law that was recently passed. You'd think with all of the hollering, including from members on this board, about how truly awful this legislation was that someone would have a pretty significantly different idea about how to do this. But instead, everyone now apparently agrees that a very significant government takeover involvement is needed (in the way of mandating individual coverage, mandating minimum benefits, mandating that insurers provide coverage, regulating prices, etc.).

So if everyone mostly agrees, why do I keep seeing threads about how awful the legislation is? And if everyone doesn't agree, why can't anyone explain to me how chronically sick people get health care under an alternative system?
Because it is being done in a manner setting up the insurance companies to fail:

80% minimum loss ratio (85% for groups).
No waiting periods for pre-existing conditions.
No penalty for jumping from a cheap plan to the most expensive plan when you need a $3k/month prescription.
No open enrollment limits to stop said plan-jumping.
Mandated maternity and mental health benefits (I'm a guy...why do I need maternity?)
Mandated minimum benefit requirements that will become a haven for special-interest groups that want to be included.
More taxes on businesses.
More administration necessary, especially for small businesses.
Massive subsidies that will be unsustainable within a few short years.
No tort reform.

Do I need to go on?
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Old 05-10-2010, 03:02 PM   #63
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Originally Posted by Gone4Good View Post
I agree with all of this stuff.

But none of this takes a radically different approach from the law that was recently passed. You'd think with all of the hollering, including from members on this board, about how truly awful this legislation was that someone would have a pretty significantly different idea about how to do this. But instead, everyone now apparently agrees that a very significant government takeover involvement is needed (in the way of mandating individual coverage, mandating minimum benefits, mandating that insurers provide coverage, regulating prices, etc.).

So if everyone mostly agrees, why do I keep seeing threads about how awful the legislation is? And if everyone doesn't agree, why can't anyone explain to me how chronically sick people get health care under an alternative system?
it could have been fixed in pieces instead of creating yet another huge bureaucracy with no cost controls longterm. Fining healthy folks that don't want health insurance is not going to work. Taxing the folks that create jobs in this country is not going to work, etc....... So when the amount of increased taxes needed to support another 30 million folks doesn't end up being anywhere near the govt needs, a lot of those folks no doubt in the non-taxpaying section of the populace, how are you going to fund it?

Ideologically, it makes for a nice story. Fiscally, there's no way to fund it. That's the real issue. Explain to me where we are going to get all the doctors and other medical personnel to handle another 30 million patients? Our medical industry already is overtaxed and now we want to hire 12,000 IRS agents just to hunt down 20 somethings that won't pay the fine for not buying health insurance? how's that going to work?
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Old 05-10-2010, 03:44 PM   #64
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it could have been fixed in pieces instead of creating yet another huge bureaucracy with no cost controls longterm.
My question is how?
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Old 05-10-2010, 03:54 PM   #65
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Because it is being done in a manner setting up the insurance companies to fail:

1) 80% minimum loss ratio (85% for groups).
2) No waiting periods for pre-existing conditions.
3) No penalty for jumping from a cheap plan to the most expensive plan when you need a $3k/month prescription.
4) No open enrollment limits to stop said plan-jumping.
5) Mandated maternity and mental health benefits (I'm a guy...why do I need maternity?)
6) Mandated minimum benefit requirements that will become a haven for special-interest groups that want to be included.
7) More taxes on businesses.
8) More administration necessary, especially for small businesses.
9) Massive subsidies that will be unsustainable within a few short years.
10) No tort reform.

Do I need to go on?
Most of this list can be summarized as "adverse selection problem" and it is remedied by several of the things you also list. So 2, 3, & 4 are addressed by things like 5 & 6.

You never responded to my question on subsidies earlier in the thread, but 7 covers 9.

There is a logic to why things were done the way they were done.

You and I disagree on whether waiting periods for pre-existing conditions are sufficient to fix the adverse selection problem. I think they are woefully inadequate. What you will likely see is young healthy people opting for the least expensive coverage they can find.. Whereas older, sick people will opt for more comprehensive insurance making those policies prohibitively expensive. To fix that problem, the legislation mandates fairly high minimum coverage levels, which obviates the need for the waiting periods and other things you recommend.
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Old 05-10-2010, 03:59 PM   #66
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Most of this list can be summarized as "adverse selection problem" and it is remedied by several of the things you also list. So 2, 3, & 4 are addressed by things like 5 & 6.

You never responded to my question on subsidies earlier in the thread, but 7 covers 9.

There is a logic to why things were done the way they were done.

You and I disagree on whether waiting periods for pre-existing conditions are sufficient to fix the adverse selection problem. I think they are woefully inadequate. I think what you will see is young healthy people opting for the least expensive coverage they can find.. Whereas older, sick people will opt for more comprehensive insurance making those policies prohibitively expensive. To fix that problem, the legislation mandates fairly high minimum coverage levels, which obviates the need for the waiting periods and other things you recommend.
I'm not sure what your earlier question was...re-post it? What happens when #7 doesn't cover #9 because #9 ends up being 4 times the estimated amount? Will #7 go up 400% to cover it?

Said it before, will say it again regarding mandated benefit levels: If you can't write the check, then you can't write the check!
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Old 05-10-2010, 04:10 PM   #67
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I'm not sure what your earlier question was...re-post it? What happens when #7 doesn't cover #9 because #9 ends up being 4 times the estimated amount? Will #7 go up 400% to cover it?

Said it before, will say it again regarding mandated benefit levels: If you can't write the check, then you can't write the check!

Here you go
.

With regards to the rest of your post, I think I'll decline to engage in a debate where I'm being asked to account for outlandish assumptions (e.g. 4x cost overruns).
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Old 05-10-2010, 04:18 PM   #68
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Here you go
.

With regards to the rest of your post, I think I'll decline to engage in a debate where I'm being asked to account for outlandish assumptions (e.g. 4x cost overruns).
I don't think anybody really has an answer for how to handle "low-income" subsidies. What is low-income? What's not low-income? $100k for a family of 5 surely isn't low-income, yet they are still getting a subsidy. For the ultra-poor, they have Medicaid and SCHIP already.

The bill ties a maximum out-of-pocket premium to the income level. If you make 4x the poverty limit as a family of 4 ($88k), you can't spend more than 9.5% of income on premiums. What happens when the premiums continue to spiral upwards at 20-30% increases each year? If you think 4x cost is an outlandish assumption, you better think again. What happened to Medicare and Medicaid?

In 1965, the House Ways and Means Committee estimated that the hospital insurance program of Medicare - the federal health care program for the elderly and disabled - would cost $9 billion by 1990. The actual cost that year was $67 billion.

In 1967, the House Ways and Means Committee said the entire Medicare program would cost $12 billion in 1990. The actual cost in 1990 was $98 billion.

In 1987, Congress projected that Medicaid - the joint federal-state health care program for the poor - would make special relief payments to hospitals of less than $1 billion in 1992. Actual cost: $17 billion.

The list goes on. The 1993 cost of Medicare's home care benefit was projected in 1988 to be $4 billion, but ended up at $10 billion. The State Children's Health Insurance Program (SCHIP), which was created in 1997 and projected to cost $5 billion per year, has had to be supplemented with hundreds of millions of dollars annually by Congress.
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Old 05-10-2010, 05:04 PM   #69
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I agree with all of this stuff.

But none of this takes a radically different approach from the law that was recently passed. You'd think with all of the hollering, including from members on this board, about how truly awful this legislation was that someone would have a pretty significantly different idea about how to do this. But instead, everyone now apparently agrees that a very significant government takeover involvement is needed (in the way of mandating individual coverage, mandating minimum benefits, mandating that insurers provide coverage, regulating prices, etc.).

So if everyone mostly agrees, why do I keep seeing threads about how awful the legislation is? And if everyone doesn't agree, why can't anyone explain to me how chronically sick people get health care under an alternative system?

Not to get side tracked on this... but my biggest complaint with the law passed is it does not do what they said they wanted to do 'in the beginning'... it is a welfare healthcare bill... a good number of the improvements could have been done without spending $1 trillion of tax money that you have to get from someone...

If we get over the notion that everybody should have the same level of health care... then things might change..... since we will not... it will stay the same, new bill or not...
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Old 05-10-2010, 11:15 PM   #70
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I think separating health insurance and heathcare away from employment in the long run is a good idea. There is no reason to tie employment and healthcare together - it's not good for employees, companies or the economy as a whole.

And if you think employers are paying for part of healthcare out of the goodness of their hearts, forget it. You and I pay for the companies to give their employees health insurance via higher prices on products.

So we can either pay for peoples' health insurance through taxes or we can pay by higher prices on all the products we buy being more expensive.

We pay either way, so what's the big deal?
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Old 05-11-2010, 08:31 AM   #71
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I don't think anybody really has an answer for how to handle "low-income" subsidies. What is low-income? What's not low-income? $100k for a family of 5 surely isn't low-income, yet they are still getting a subsidy. For the ultra-poor, they have Medicaid and SCHIP already.
What I wanted to know was whether you favored any subsidy or not. I'm guessing from your responses that the answer is a qualified 'yes' but you don't want to say as much.

The whole point of that and the other questions was to see how close your view of a health care fix is to what we actually have passed in the law. And the answer seems to be 'quite close'. Several months ago people were up in arms about a "government takeover of health care". But now it seems as if everyone is on board with a 'big government" approach. The debate here isn't whether we should have massive government intervention into the healthcare system or not, it is over much smaller points like the size of deductibles, the length of waiting periods, penalties for going without health insurance, and so on. That is a much, much different debate then we had last year. And a more reasonable one too.
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Old 05-11-2010, 08:47 AM   #72
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Not to get side tracked on this... but my biggest complaint with the law passed is it does not do what they said they wanted to do 'in the beginning'... it is a welfare healthcare bill... a good number of the improvements could have been done without spending $1 trillion of tax money that you have to get from someone...
The cost of the bill is obviously determined by the generosity of the subsidies. It would have been worthwhile to have a full debate on what the subsidies should be. I don't recall one.

But some level of subsidies are necessary. And not just for "welfare" or "social justice" reasons. In order to keep premiums low, healthy people need to be in the pool. But to keep healthy people in the pool, particularly younger people who are earning their first paycheck, premiums need to be affordable. We can mandate that everyone have insurance, but if you can't afford it, you can't afford it. So to get everyone in the pool, we need to subsidize some folks.

Of course a national health care system gets around the need for explicit subsidies, phaseouts and "individual mandates" but we decided early on that was a non-starter. So here we are.
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Old 05-11-2010, 09:00 AM   #73
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In 1965, the House Ways and Means Committee estimated . . .
The joke with this argument is that subsequent administrations increased the benefits substantially under those programs. It's not accurate to say that the original cost projections in 1965 were too optimistic when the program itself is deliberately changed in a way that adds expenditures. You positioned it as a fait a compli that costs would exceed current estimates by 4x based on the history of medicare. But that only makes sense if we assume the same deliberate expansion of benefits, in which case those subsequent administrations will have to deal with the costs involved.
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Old 05-11-2010, 09:23 AM   #74
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The joke with this argument is that subsequent administrations increased the benefits substantially under those programs. It's not accurate to say that the original cost projections in 1965 were too optimistic when the program itself is deliberately changed in a way that adds expenditures.
Perhaps so, but isn't this the way it always is? In good times we're flush with cash so lets increase the benefits to buy votes (it happens with some public pensions, too). Then the downturn hits and we hit a crisis point because we've already committed all of what should have been a "surplus" or a "rainy day fund" to higher benefits that are impossible to scale back and can't be funded except with higher taxes that are a bad idea in an already weak economy.

Plus, I doubt that the benefits increased by a factor of 9.
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Old 05-11-2010, 09:52 AM   #75
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Perhaps so, but isn't this the way it always is? In good times we're flush with cash so lets increase the benefits to buy votes (it happens with some public pensions, too). Then the downturn hits and we hit a crisis point because we've already committed all of what should have been a "surplus" or a "rainy day fund" to higher benefits that are impossible to scale back and can't be funded except with higher taxes that are a bad idea in an already weak economy.

Plus, I doubt that the benefits increased by a factor of 9.
x2

Politicians love to increase benefits because it looks great politically. When the money runs out, the public gets left holding the bag. Who isn't to say that future politicians won't increase the subsidies required in the new health bill? Who will pay for those? You told me that costs being "off by 4x the estimate" was outrageous....but it has happened over and over and over again. Perhaps I should bash my head against the wall one more time to see if I'll break through it yet.

There must be some form of subsidy, but the amount of those subsidies is one of the biggest problems. As premiums continue to massively increase, the subsidies will get bigger accordingly. The CBO score and reports I've seen say that rates could go up 17% for young people. That's outright BS. I pay $95/month for my coverage right now....how much do you think I'll be paying come 2014? I'll take "over $250/month" for $500, Alex. And I'm just one person, not a family of four. Of course, I am "rich" by the government's standards (and no, I make nowhere close to $250k...yet) so I will not get any subsidy. This bill expands coverage, it does NOT control costs and overutilization, which are the two biggest problems in the system.
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Old 05-11-2010, 09:54 AM   #76
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The joke with this argument is that subsequent administrations increased the benefits substantially under those programs. It's not accurate to say that the original cost projections in 1965 were too optimistic when the program itself is deliberately changed in a way that adds expenditures. You positioned it as a fait a compli that costs would exceed current estimates by 4x based on the history of medicare. But that only makes sense if we assume the same deliberate expansion of benefits, in which case those subsequent administrations will have to deal with the costs involved.
ALL THE MORE reason NOT to give the govt a crack at this Pandora's Box, it will make the problems in others pale by comparison...........

Social Security was never intended to be the primary source of retirement income, it was meant to be a safety net, much like Medicaid is. It has turned into an albatross because once you start an entitlement program, you don't get a "do-ever". There is no "bending of the cost curve" in the Health Care Bill, or any other entitlement program, for that matter.......

The real issue is whether health care is a RIGHT, or a PRIVILEGE, for citizens of the US. Just because European countries went that route doesn't mean it will work for us. They have highly punitive taxing structures in place to help fund it..........
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Old 05-11-2010, 10:00 AM   #77
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Massachusetts has a health insurance and care system that is very similar to what is now legislated for the U.S. Their initial goal was to provide coverage to as many people as possible. They are now looking at how to rein in the costs of providing health insurance and care.

It is going to take time - many years. This whole issue will have to be addressed. As things progress, I would hope we'll see more govt controls and regulations on the entire health care field, and a govt option like "medicare for all".

There is no free ride here; we will pay for it one way or the other anyways. Done privately, we'll pay for it with increased product and service prices. Done by the govt, we'll pay increased taxes.
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Old 05-11-2010, 10:09 AM   #78
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Massachusetts has a health insurance and care system that is very similar to what is now legislated for the U.S. Their initial goal was to provide coverage to as many people as possible. They are now looking at how to rein in the costs of providing health insurance and care.
Part of the the Massachusetts problem is being replicated in Obamacare. Namely, the penalties for being uninsured aren't nearly strong enough and the young/healthy folks aren't signing up at a rate which will allow the subsidies for lower-income folks to avoid being a budget buster.

It should shock no one that in Massachusetts, the rate of poorer households signing up for "free" or nearly free health insurance greatly exceeded their estimates. (Hmm -- where else have we seen the government underestimate the public demand for free and heavily subsidized stuff? Cash for Clunkers, anyone? Or the recent Texas fiasco in rebates for energy-efficient appliances and such?)

It should also shock no one that with weak penalties for being uninsured, many of the young, healthy folks whose participation in a pool is critical if there is to be no medical underwriting chose to "go naked" and pay the relatively small fine rather than purchase health insurance.

These problems with the Massachusetts plan were already well-evident when the federal health care bill was being drafted and debated, and yet they devised a system that would likely suffer the same problems. The penalty for being uninsured should be no less than the annual cost of the lowest priced plan available to that uninsured person. If a young, healthy individual is uninsured and the lowest-cost policy available to them is $200 a month, the annual penalty for being uninsured should be $2400. This removes all incentive to "go naked."
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Old 05-11-2010, 10:40 AM   #79
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So we can either pay for peoples' health insurance through taxes or we can pay by higher prices on all the products we buy being more expensive.

We pay either way, so what's the big deal?
...because companies who are paying for employee health care have higher overhead, making them less competitive in the world market. (i.e. Caterpillar's recent earnings write-down to cover higher health care costs)This debate isn't defined to the US; it affects every company's operating costs. Whether you are local, national or global you need a level playing field to compete. Unfunded mandates do nothing to adresss this.

That's why it is a big deal.
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Old 05-11-2010, 10:42 AM   #80
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The cost of the bill is obviously determined by the generosity of the subsidies. It would have been worthwhile to have a full debate on what the subsidies should be. I don't recall one.

But some level of subsidies are necessary. And not just for "welfare" or "social justice" reasons. In order to keep premiums low, healthy people need to be in the pool. But to keep healthy people in the pool, particularly younger people who are earning their first paycheck, premiums need to be affordable. We can mandate that everyone have insurance, but if you can't afford it, you can't afford it. So to get everyone in the pool, we need to subsidize some folks.

Of course a national health care system gets around the need for explicit subsidies, phaseouts and "individual mandates" but we decided early on that was a non-starter. So here we are.
My bold...

This is one of the many reasons I disagreed with the health care reform... they kept talking about 'lowering the cost of healthcare'... when in fact all that was done was SHIFT the cost to someone else...

The health care bill has done very little to address the huge cost to our nation of healthcare... IMO the majority of the bill was to get the uninsured some insurance at a huge cost to taxpayers... it has been something the dems have wanted for decades... I just don't think the country can afford it... I also don't think the contry can afford the prescription drug law past during Bush... so I am not bashing it because of Obama... but because of the costs...


The young (especially male) pay a lot more on car insurance than we old folks... because they have more accidents... why should healthcare not be age adjusted If they pay more because as a general rule they are worse driver and cost more, then we should pay more because we are less healthy and cost more.... (in general)...

Having a 25YO pay the same amount as a 65YO is shifting costs...

Sorry for the disjointed post... just throwing out a few thoughts....
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