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Old 11-26-2011, 03:10 PM   #41
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Pretty much everyone who supports a system with no underwriting recognizes that it can not happen without a "universal mandate"
We may get a chance to find out, if the SC invalidates the universal mandate but not the rest of the law.

If the mandate is thrown out, I still challenge the notion that universal coverage cannot be accomplished. But it would take a very big change in our collective present mindset. Fundamentally, which is the statement we (as a nation) believe is most accurate:

1) There is no right to health care and we should have no mandatory taxation to force one person to pay for the health care of others.

2) There may be no "right" to health care enshrined in the Constitution, but we should have mandatory taxation that provides everyone the opportunity to buy their own affordable (defined as XXX--probably a sliding scale based on income or assets) health insurance (defined as xxx). If, despite this, they don't buy the health insurance and have not been legally declared incompetent, we have no further obligation to provide for their health care. Americans may choose to support such cases through voluntary charitable contributions. In addition, we should expect non-governmental "sanctions" for those who elect not to purchase this affordable insurance, as this is a sign of financial and personal irresponsibility. (Credit ratings, rates for other insurance, hiring actions/promotions, child custody decisions, civil suits, etc).

3) There is (or should be) a right for every American to have health care, and we will have mandatory taxation of some people to pay for as much health care for everyone as we (collectively) decide is best. No one needs to buy individual health insurance policies. But if you aren't happy with the services provided by the "collective", you are on your own.

None of these options requires an individual mandate to buy health insurance.
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Old 11-26-2011, 03:10 PM   #42
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The penalties in the healthcare bill are not even close to the cost of health insurance, making it an easy choice for people who wouldn't otherwise buy anyway. The way the bill is written, anyone buying a policy outside the exchange will have to pay the penalty in addition to the cost of health insurance simply because their policy doesn't meet the government's definition of the health insurance that people should have. Therefore, with the cost of health insurance inside the exchange being so expensive, many people will opt out and the adverse selection will begin. That is my opinion and while you don't have to agree with me, I challenge you to try selling health insurance for more than $100/month to young healthy people and see how far you get.
You are focused on individual health care insurance for young healthy people. They have much more to fear than a health care reform bill being implemented. Underwriters will deny them coverage or make their price unaffordable when they are no longer "young and healthy". Keeping a low premium for a few helps sell new policies each year but it does nothing to advance or enable health care for the vast majority of people.

Prices and coverage for health care are badly distorted by cross subsidies, unequal tax treatment, uneven regulation, price gouging, and underwriting. There are many aspects of the reform that need to be improved. Fix, not impede.
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Old 11-26-2011, 03:15 PM   #43
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You are focused on individual health care insurance for young healthy people. They have much more to fear than a health care reform bill being implemented. Underwriters will deny them coverage or make their price unaffordable when they are no longer "young and healthy". Keeping a low premium for a few helps sell new policies each year but it does nothing to advance or enable health care for the vast majority of people.
This is true, but today's 20-somethings have their older GenX cohorts to look to. It's fine and good to say "we need to transfer from young to old for the protection of all older generations, including those who are young today" -- except that we GenX 40-somethings have seen that this "deal", whether it is Medicare, SS, pensions or any other number of transfer programs to older people, are getting to be a worse and worse deal for each successive generation. We're old enough to remember the 1980s SS "reform" that raised our taxes, increased our FRA to 67 and being told that would "secure" us for the next 75 years or more (i.e. that would "fix" SS for our lifetimes). Fool me twice, shame on me?

Today's young people can't be faulted for believing that the deal they would get in their elderly years won't be as good as what today's seniors (or my generation, for that matter) will get.

This is one of the ongoing problems with any "generational warfare" issue involving intergenerational wealth transfer -- the "deal" erodes with each successive generation, starting out to be a great deal for the current elderly, a decent deal for the next generation and terrible for the youngest generations. And I think it's why younger people are more likely to think something must be a terrible deal for them if AARP is for it. That's why what we need to do needs to be sustainable across generations, and we need to resist the urge to "increase" the benefits during boom years that never last forever.
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Old 11-26-2011, 04:13 PM   #44
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You are focused on individual health care insurance for young healthy people. They have much more to fear than a health care reform bill being implemented. Underwriters will deny them coverage or make their price unaffordable when they are no longer "young and healthy". Keeping a low premium for a few helps sell new policies each year but it does nothing to advance or enable health care for the vast majority of people.

Prices and coverage for health care are badly distorted by cross subsidies, unequal tax treatment, uneven regulation, price gouging, and underwriting. There are many aspects of the reform that need to be improved. Fix, not impede.
We will agree to disagree then. Of the different market segments, the individual health insurance market is going to be the most impacted segment by far. Again, I would challenge you to try selling health insurance for more than $100/month to people under age ~30 and see how well it works out. Unless they plan on "using" their health insurance with a pregnancy or scheduled surgery, you won't get many takers. Jump that price to $200-400/month for an individual and $800-1500/month for a family and you will have few, if any healthy people signing up. I can probably count the number of my under-35 clients that can afford $1000/month for family coverage on one hand.


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Originally Posted by ziggy29 View Post
This is true, but today's 20-somethings have their older GenX cohorts to look to. It's fine and good to say "we need to transfer from young to old for the protection of all older generations, including those who are young today" -- except that we GenX 40-somethings have seen that this "deal", whether it is Medicare, SS, pensions or any other number of transfer programs to older people, are getting to be a worse and worse deal for each successive generation. We're old enough to remember the 1980s SS "reform" that raised our taxes, increased our FRA to 67 and being told that would "secure" us for the next 75 years or more (i.e. that would "fix" SS for our lifetimes). Fool me twice, shame on me?

Today's young people can't be faulted for believing that the deal they would get in their elderly years won't be as good as what today's seniors (or my generation, for that matter) will get.

This is one of the ongoing problems with any "generational warfare" issue involving intergenerational wealth transfer -- the "deal" erodes with each successive generation, starting out to be a great deal for the current elderly, a decent deal for the next generation and terrible for the youngest generations. And I think it's why younger people are more likely to think something must be a terrible deal for them if AARP is for it. That's what we need to do needs to be sustainable across generations, and we need to resist the urge to "increase" the benefits during boom years that never last forever.
x2 on everything said here. As a (relatively) young person myself, this is how I see the future of all entitlement programs. Great deal for older people now, but I have no hope of counting on SS or Medicare to be anything remotely close to their current form by the time I am 65 and have to plan my retirement accordingly.
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Old 11-26-2011, 04:20 PM   #45
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Concerning the governments definition of health insurance, I know many people have expressed concern over the future of HSA's. There has been a furious movement to this type of coverage by companies for their employees. Will this unfolding process help protect HSA's after 2014 you think, since so many people will be involved in them by then?
I really have no idea how things will shake out with HSA's in the future. They will probably become nearly extinct in the individual market unless the law is changed since anyone with an HSA plan will have to pay the penalty and for the insurance on top of that. Remains to be seen how the group market will be impacted. Self-insured groups will probably see no change.
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Old 11-26-2011, 06:45 PM   #46
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I believe that this plan, no matter it looks when it is set into motion, will work at best for a few years. We then will turn to taxation to pay premiums, and some sort of control of what gets done for (to) whom.

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Old 11-26-2011, 07:45 PM   #47
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We will agree to disagree then. Of the different market segments, the individual health insurance market is going to be the most impacted segment by far. Again, I would challenge you to try selling health insurance for more than $100/month to people under age ~30 and see how well it works out. Unless they plan on "using" their health insurance with a pregnancy or scheduled surgery, you won't get many takers. Jump that price to $200-400/month for an individual and $800-1500/month for a family and you will have few, if any healthy people signing up. I can probably count the number of my under-35 clients that can afford $1000/month for family coverage on one hand.




x2 on everything said here. As a (relatively) young person myself, this is how I see the future of all entitlement programs. Great deal for older people now, but I have no hope of counting on SS or Medicare to be anything remotely close to their current form by the time I am 65 and have to plan my retirement accordingly.

Since over 90% of the 30 and under group will get a significant subsidy to purchase it might not be to hard to sell. This is based upon the fact that over 90% of 30 somethings make less than 80K per year.
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Old 11-26-2011, 08:00 PM   #48
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Since over 90% of the 30 and under group will get a significant subsidy to purchase it might not be to hard to sell. This is based upon the fact that over 90% of 30 somethings make less than 80K per year.
That's only with a family of 4 and the closer they get to the 400% of FPL mark, the less the subsidy is. A single person making ~$40k or a couple making a combined ~$56k will get no subsidy at all.
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Old 11-26-2011, 08:47 PM   #49
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That's only with a family of 4 and the closer they get to the 400% of FPL mark, the less the subsidy is. A single person making ~$40k or a couple making a combined ~$56k will get no subsidy at all.
Okay I will work with your numbers and provide some more info. 75% of the individual population in the US that has an income makes less than 53K per year. Another data point 6.24% make over 100K per year. So in your example 75% would still be able to afford insurance as they would get a subsidy and of that 75%, all would be able to buy it as they would not have to pass underwriting. This is way way better than the numbers that could today. Not the perfect solution but better than today.
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Old 11-26-2011, 09:11 PM   #50
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Okay I will work with your numbers and provide some more info. 75% of the individual population in the US that has an income makes less than 53K per year. Another data point 6.24% make over 100K per year. So in your example 75% would still be able to afford insurance as they would get a subsidy and of that 75%, all would be able to buy it as they would not have to pass underwriting. This is way way better than the numbers that could today. Not the perfect solution but better than today.
Getting a subsidy doesn't mean they will buy it. Someone making $35k is unlikely to spend $300/month on health insurance if they are healthy. The subsidies phase out as income gets closer to the 400% of FPL mark. Joe Taxpayer is funding those subsidies too, so anyone not receiving is a subsidy is not only paying more for their health insurance, they are also picking up the tab for everyone under 400% of FPL too. The real cost to someone making over the subsidy limit is a massive increase for anyone under age ~50 or without major health issues.
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Old 11-26-2011, 10:08 PM   #51
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You changed the argument again to apply different info. I just corrected your statement about 30year olds and the ability to buy ins. I can certainly accept that you are against the new law. I just provided stats that show that your example of a death spiral in rates for 30year olds is not likely.
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Old 11-26-2011, 10:12 PM   #52
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You changed the argument again to apply different info. I just corrected your statement about 30year olds and the ability to buy ins. I can certainly accept that you are against the new law. I just provided stats that show that your example of a death spiral in rates for 30year olds is not likely.
Like I said, the subsidies phase out as you get closer to the 400% of FPL mark. $100/mo per person is the breaking point of most younger clients I've worked with. The lower the income, the less they are willing to spend...many want to spend $50-75/mo and no more. Offering them a subsidy to bring their cost to $200/mo or $250/mo or $300/mo will mean nothing because they just won't buy it. As I say, if you can't write the check, then you can't write the check! There is only one way to find out how this plays out in reality versus theory, so I guess we'll see how it turns out if the law isn't overturned.
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Old 11-27-2011, 12:41 AM   #53
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I guess the following will certainly make those opposed to the new law mad but it is a question I have had. I live in a state that requires you to carry car insurance. I know the states have the right to require you to purchase a product and that the federal governments right to require you to purchase this product is in question but that is not what my comment is about. Once this law went into effect my insurance rates went down as I was no longer paying as high a un-insured motorist premium. why would we not see the same thing with health care as most would now be covered with insurance than are not now?

OK... I have been away on a nice trip and now have a lot to catch up....

But I am surprised that someone did not answer the first part of this post...

There IS a difference between your example and the federal law...

The state does NOT require you to purchase car insurance... it only requires you to purchase car insurance IF you choose to drive a car... if you want to ride a bicycle or a bus or hitch a ride with others, you do not have to buy car insurance...

Now, what the argument is on the one side is that you can not 'opt out' from the health care industry... like you can 'opt out' of driving...

But if you have enough money and pay for all of your health care needs, then why do you have to buy health insurance...
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Old 11-27-2011, 09:03 AM   #54
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OK... I have been away on a nice trip and now have a lot to catch up....

But I am surprised that someone did not answer the first part of this post...

There IS a difference between your example and the federal law...

The state does NOT require you to purchase car insurance... it only requires you to purchase car insurance IF you choose to drive a car... if you want to ride a bicycle or a bus or hitch a ride with others, you do not have to buy car insurance...

Now, what the argument is on the one side is that you can not 'opt out' from the health care industry... like you can 'opt out' of driving...

But if you have enough money and pay for all of your health care needs, then why do you have to buy health insurance...

I guess they did not as that was not part of the question and I tried to make the point that I was not asking about the legal aspects of the case now. you point on the legality is a whole other discussion that I respect but was trying to avoid as it gets very political per forum rules.
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Old 11-27-2011, 09:26 AM   #55
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But if you have enough money and pay for all of your health care needs, then why do you have to buy health insurance...
For the same test LabCorp charges 11 times more to a self pay than to the insurance company. For procedures DW has needed hospitals and medical centers refused to provide total cost estimates beforehand. Only the very wealthiest can afford the risk of no healthcare insurance.
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Old 11-27-2011, 03:36 PM   #56
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But if you have enough money and pay for all of your health care needs, then why do you have to buy health insurance...
The original Mass Health Plan from Gov. Romney had a "post a bond" alternative to buying insurance. The only problem I saw with that was the absurdly small bond amount, only $10,000, and the lack of an adjustment for medical inflation. Oh, and without insurance to negotiate a discount, the bond holder would have paid full list. That $10 grand wouldn't cover the emergency room visit at full rates.
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Old 11-27-2011, 05:33 PM   #57
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This is true, but today's 20-somethings have their older GenX cohorts to look to. It's fine and good to say "we need to transfer from young to old for the protection of all older generations, including those who are young today" -- except that we GenX 40-somethings have seen that this "deal", whether it is Medicare, SS, pensions or any other number of transfer programs to older people, are getting to be a worse and worse deal for each successive generation. We're old enough to remember the 1980s SS "reform" that raised our taxes, increased our FRA to 67 and being told that would "secure" us for the next 75 years or more (i.e. that would "fix" SS for our lifetimes). Fool me twice, shame on me?

Today's young people can't be faulted for believing that the deal they would get in their elderly years won't be as good as what today's seniors (or my generation, for that matter) will get.

This is one of the ongoing problems with any "generational warfare" issue involving intergenerational wealth transfer -- the "deal" erodes with each successive generation, starting out to be a great deal for the current elderly, a decent deal for the next generation and terrible for the youngest generations. And I think it's why younger people are more likely to think something must be a terrible deal for them if AARP is for it. That's why what we need to do needs to be sustainable across generations, and we need to resist the urge to "increase" the benefits during boom years that never last forever.
+2

I've heard David Brooks state the average 65 year old paid $145K into Medicare and will get $350-450K out of it. That's not sustainable or fair and I am all for changes that would make it all more equitable even though it works against my own 57 yo interests. AARP should be ashamed of their positions IMO, I wish there was a counter organization.

I am all for some sort of universal health care like the rest of the developed world, but we have to deal with costs and increases like they all have. We can't just patch up our private system and institutionalize what we have, it would cost even more than our already higher than every other country health care. Last time I looked we pay about 40% more per capita than any the 2nd highest other country, without results to show for it.
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Old 11-27-2011, 06:07 PM   #58
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Yeah, why give it to the seniors, better we give our money to Black and Indian Farmers. This whole system is nuts far as I'm concerned.


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Old 11-27-2011, 06:12 PM   #59
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Or maybe we can give it to Bruce, Ted or Scottie they could use the money.


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Old 11-27-2011, 06:18 PM   #60
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