Here is a link that supports Jerry's view. It is an interesting challenge.
CNN People Miss Their Pre-ACA Policies
CNN People Miss Their Pre-ACA Policies
- For the system to work, everyone needs to pay more than they hope to need...
- Because some of them will need much more thsn they pay...
40 comments:
Lots of people don't understand how insurance works. For one thing, it is at cross purposes with a favorite cliche that people use but don't think much about, "Wealth redistribution".
The other day, Speaker Ryan observed that he saw no reason why healthy people should pay for the medical expenses of sick people. It's the kind of remark Republicans make all the time, and it helps to explain why I tend to view their claims to be the party of business with considerable bemusement. As anyone who has given any thought at all to the business of insurance, even a crypto socialist such as much as myself could have told him, healthy people paying for sick people is what health insurance does; it does precious little else.
The federal government never goes bankrupt, but most businesses do. There are many reasons for that, and maybe the failure to understand basic business concepts like insurance is one of them. I have to say, whenever I hear folks like Paul Ryan discuss business and capitalism, it becomes clear to me why they have chosen lifetime security with the federal government and it's appurtenances.
--Hiram
CNN Freedom Caucus Plan would lower premiums for healthy people
It looks like this is the actual quote.
“The fatal conceit of Obamacare is that we’re just going to make everybody buy our health insurance at the federal government level. Young and healthy people are going to go into the market and pay for the older, sicker people. So the young, healthy person is going to be made to buy healthcare, and they’re going to pay for the person, you know, who gets breast cancer in her 40s or who gets heart disease in his 50s,” Ryan said.
ACA Minimum Essential Coverage / Benefits
List of Ten Essential Health Benefits?
The Affordable Care Act’s Ten Essential health benefits include:
1.Ambulatory patient services (Outpatient care). Care you receive without being admitted to a hospital, such as at a doctor’s office, clinic or same-day (“outpatient”) surgery center. Also included in this category are home health services and hospice care (note: some plans may limit coverage to no more than 45 days).
2.Emergency Services (Trips to the emergency room). Care you receive for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness. Typically, this is a trip to the emergency room and includes transport by ambulance. You cannot be penalized for going out-of-network or for not having prior authorization.
3.Hospitalization (Treatment in the hospital for inpatient care). Care you receive as a hospital patient, including care from doctors, nurses and other hospital staff, laboratory and other tests, medications you receive during your hospital stay, and room and board. Hospitalization coverage also includes surgeries, transplants and care received in a skilled nursing facility, such as a nursing home that specializes in the care of the elderly (note: some plans may limit skilled nursing facility coverage to no more than 45 days).
4.Maternity and newborn care. Care that women receive during pregnancy (prenatal care), throughout labor, delivery, and post-delivery, and care for newborn babies.
5.Mental health services and addiction treatment. Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy. (note: some plans may limit coverage to 20 days each year. Limits must comply with state or federal parity laws. Read this document for more information on mental health benefits and the Affordable Care Act).
6.Prescription drugs. Medications that are prescribed by a doctor to treat an illness or condition. Examples include prescription antibiotics to treat an infection or medication used to treat an ongoing condition, such as high cholesterol. At least one prescription drug must be covered for each category and classification of federally approved drugs; however, limitations do apply. Some prescription drugs can be excluded. “Over the counter” drugs are usually not covered even if a doctor writes you a prescription for them. Insurers may limit drugs they will cover, covering only generic versions of drugs where generics are available. Some medicines are excluded where a cheaper equally effective medicine is available, or the insurer may impose “Step” requirements (expensive drugs can only be prescribed if a doctor has tried a cheaper alternative and found that it was not effective). Some expensive drugs will need special approval.
7.Rehabilitative services and devices – Rehabilitative services (help recovering skills, like speech therapy after a stroke) and habilitative services (help developing skills, like speech therapy for children) and devices to help you gain or recover mental and physical skills lost to injury, disability or a chronic condition (this also includes devices needed for “habilitative reasons”). Plans have to provide 30 visits each year for either physical or occupational therapy, or visits to the chiropractor. Plans must also cover 30 visits for speech therapy as well as 30 visits for cardiac or pulmonary rehab.
8.Laboratory services. Testing provided to help a doctor diagnose an injury, illness or condition, or to monitor the effectiveness of a particular treatment. Some preventive screenings, such as breast cancer screenings and prostrate exams, are provided free of charge.
9.Preventive services, wellness services, and chronic disease treatment. This includes counseling, preventive care, such as physicals, immunizations, and screenings, like cancer screenings, designed to prevent or detect certain medical conditions. Also, care for chronic conditions, such as asthma and diabetes. Note: please see our full list of Preventive services for details on which services are covered.
10.Pediatric services. Care provided to infants and children, including well-child visits and recommended vaccines and immunizations. Dental and vision care must be offered to children younger than 19. This includes two routine dental exams, an eye exam and corrective lenses each year.
Now the other eight coverages seem like things that could be useful to everyone no matter their age. I mean no one knows when bad things will happen and one will need that kind of care.
However these two are a bit specific and probably should not be mandatory...
Maternity and newborn care.
Pediatric services.
And should the young lower income people pay artificially high premiums to reduce the premiums for older people?
ACA vs ACHA
"Older Americans could be charged up to 5 times more than someone younger. The ACA currently allows a 3 to 1 ratio. So if currently, the premium for a 20-year old is $200/month, the premium for a 64-year old could not be more than $600/month. Under the proposed law, a 64-year old could pay $1000/month."
Then there is the welfare aspect of ACA... Not only are the healthy paying a lot for the unhealthy, but the wealthy people are also paying the insurance premiums for many. And this is above and beyond what they are already paying for Medicaid...
Forbes ACA Tax Implications
It definitely is a thorny issue.
Young and healthy people are going to go into the market and pay for the older, sicker people. So the young, healthy person is going to be made to buy healthcare, and they’re going to pay for the person, you know, who gets breast cancer in her 40s or who gets heart disease in his 50s
That's kind of what health insurance does. People pay for different people. It's what employer based insurance does. It's what Speaker Ryan's insurance through the federal government does.
I know there are people who argue the age thing. I am sure Congressman Jason Lewis is eager to spend more on his health insurance now that he has reached his 60s, but mostly that hasn't been the decision we he have reached because it would be a collectively bad one. It means costs that are generally higher.
If we want market solution for things the government buys, can I opt out of paying for those South China Seas aircraft carriers Trump wants?
--Hiram
However these two are a bit specific and probably should not be mandatory...
Maternity and newborn care.
Pediatric services.
is this because there are people in America who haven't been born or who have never been small children? Besides Republican Supreme Court nominees?
I think of all the young people who are paying Jason Lewis's health care bill in his declining years. Despite paying for their maternity and child care expenses, if we are picking winners and losers, he clearly is winning. But now Republicans are content with that. They want to stack the deck in favor of their elderly constituents and Congressmen to even a greater expenses, relieving themselves of liabilities of health care while grabbing an ever greater share of the benefits. The atmosphere of cynicism and hypocrisy in Washington these days, I wonder that the legislators appear on tv without gas masks.
--Hiram
The problems with your arguments are that insurance premiums are often set based on one's choices and situation. Where as ACA takes away a lot of that flexibility.
People who have no plan to have children pay inflated premiums for people who want big families.
And please remember that the GOP plan increases the premiums for the older constituents you say they are trying to help.
As I have always said... ACA has its benefits and costs.
The problems with your arguments are that insurance premiums are often set based on one's choices and situation. Where as ACA takes away a lot of that flexibility.
Sure but the big driver of health insurance costs is aging and that's not a choice. Bear in mind what flexibility translates into the real world is higher costs. We are being asked to pay more so that part of what we pay doesn't go to maternity benefits. Why that should make anyone feel better about anything is something I don't know.
"
And please remember that the GOP plan increases the premiums for the older constituents you say they are trying to help."
Follow the logic here. We need to pay more so that young people get fewer benefits. But at least everyone is flexible.
--Hiram
Hiram,
Did you read the initial link that the post is based on?
They were young people who want their low cost plans back.
The couple has no plans to have kids, so they do not want to pay for maternity and pediatric benefits.
They are young so they are unhappy paying for risks that they will not face for decades.
But ACA forces them to pay these costs, for better or worse.
Did you read the initial link that the post is based on?
I did.
They were young people who want their low cost plans back.
I want the money back I spent on roulette.
The couple has no plans to have kids, so they do not want to pay for maternity and pediatric benefits.
They are young so they are unhappy paying for risks that they will not face for decades.
They seem to be betting on dying young.
But ACA forces them to pay these costs, for better or worse
They need to think about whether the better is better than the worse is worse.
Republicans often tell us health insurance isn't about health. It's something they are right about, and you see that in the case of the young couple. They know they will receive health care whether they are able to pay for it or not. So they are willing to underinsure. It's a good bet for them. But does that mean that it's a bad bet for us? The people who will be on the hook for their health care expenses should something bad happen?
--Hiram
I didn't plan to lose that roulette build. And of course, all children are planned.
I agree that this is not about healthcare... It is about money and who should pay what for who. Remember G2A Healthcare Right or Privilege
If we were talking reducing health care cost we would be discussing these.
Now I agree that Medicare is a system where the premiums paid today are kind of intended to ensure care in the future... And so are life insurance premiums. However health insurance is technically a year long policy kind of like car insurance. Therefore premiums should mostly be set based on who you are today and how you choose to live your life today.
And if the young couple bets poorly and ends up having a child, then they can pay the bills out of pocket for the first year or so. I have no desire to pay for their bad bet...
I agree that this is not about healthcare... It is about money and who should pay what for who.
The couple doesn't want to pay for old people. Can we trust them to refuse health care when they are old? Should we deny them care for the choice they made when they were young?
"However health insurance is technically a year long policy kind of like car insurance. Therefore premiums should mostly be set based on who you are today and how you choose to live your life today."
Is there a problem making life or death decisions with consequences far into the future, based on "technicalities"?
"And if the young couple bets poorly and ends up having a child, then they can pay the bills out of pocket for the first year or so. I have no desire to pay for their bad bet..."
They don't look like they have a lot of money. My guess is that they will stick the bills on someone else. As Republicans remind us, health insurance is about money, and people who don't have money have little incentive to insure themselves.
--Hiram
Here are the economics of bad health insurance. People buy bad health insurance, because now if things turn out badly someone else will pick up the bills. What Republicans want to do is subsidize that choice. The result will be that individuals will pick up both a portion of the insured health care, and also the cost of care not covered by the bad policies. We get the bill as taxpayers, for the consumer's choice to buy bad health insurance.
On the surface, this seems pretty dumb, so why do Republicans want to do that? Remember Republicans believe government should be run like a business, and the business they have in mind is Enron. Those health care cost overages don't necessarily land on government books. They are absorbed by other stakeholders, doctors, hospitals, corporate shareholders, various charities and others. But what that approach does do is free up money that Republicans need to fund other goals, things like regressive tax cuts. With the failure of Trump care at least for now, Republicans lost a trillion dollars in health care savings which they needed to balance their budget. That's why Ryan wanted to enact Trump Care prior to tax reform.
--Hiram
1. No we should charge them the annual premiums appropriate to them when they are ~60... (ie hope they saved for the future)
2. Not really, but in this case it means the premiums for young people are much higher than their risks require.
3. I am sure the hospital will set up a payment plan for them. And they are pretty well off since they did not qualify for any ACA subsidy and own a fitness center.
4. Actually they were cutting the extra ACA spending and the extra ACA taxes. I think it was maybe a little gain on the cutting spending side.
As I often say, I see good and bad things in ACA. I am indifferent to if it changes again.
1. There is no appropriate premium. God doesn't set insurance prices.
2. There is no risk requirement. God doesn't evaluate risks, He leaves that to actuaries.
3. I am sure they will. Probably lots of them.
4. But they weren't cutting spending. They were simply shifting it to a different set of books.
--Hiram
Something always to keep in mind is that choice is expensive. And that economies of scale make things less expensive. No one seriously disputes that Obamacare in America tends to slow the rate of increase of health care costs. That's why it's critics always want to shift the discussion to premiums. There argument for costs is that market forces will drive prices down. Like business, Republicans don't understand how markets work. If market forces always lowered prices, the stock market would always go down. Markets make pricing more efficient, but they don't force prices up, and they don't force prices down.
--Hiram
I guess I'll "dispute that Obamacare in America tends to slow the rate of increase of health care costs." What do you think ACA did to accomplish what you deem to be true?
Are you including all the ACA tax subsidies, marketplace costs and marketing in the "cost of healthcare"?
It's like you don't even read your own blog sometimes.
I think I found what you are talking about. G2A CBO Scores ACHA
The problem is that we never did figure out where all of the ACA tax subsidies, marketplace costs and marketing costs went...
And we know that ACA tries to constrain Medicare costs and transfer them to the well off, but what problems are arising from this attempt at price controls? And who is making up the difference between the costs and prices?
And still nothing about the those huge exchange / government costs...
Maybe this will help. US News The Hidden Costs of ACA
Well, until you have some actual numbers to talk about, maybe you should stop throwing shade at the numbers that do exist.
Your vapid complaints about everyone else's ideas are meaningless because you have no ideas of your own to offer.
Let's see if you'll actually take a stand on something. How about premium costs for those approaching age 65? The ACA limits the ratio of premiums between old and young to 3:1. The AHCA would have changed that limit to 5:1. Do you think there should be a limit, and if so, how much? Under whatever scenario you pick, how would you make premiums more affordable for those with low-incomes?
I'll give your questions some thought if you ponder this.
How can Liberals keep saying this:
"No one seriously disputes that Obamacare in America tends to slow the rate of increase of health care costs."
When they have seemingly no idea where the billions of dollars to setup and market the exchanges were billed to?
Forbes ACA Increases Administrative Costs
There are multiple data points from across our health care system that show that health care spending since the ACA has passed has been increasing more slowly than before.
Or I can believe your vague, unsubstantiated assertions that the opposite is happening.
Actually I am not saying the opposite is happening. I am saying that it is silly for Liberals or Conservatives to claim statistically valid changes based on what I have read.
And worse yet is that they want to claim that ACA was the primary driver of that decrease or increase.
And if there was a decrease, were there unintended consequences that offset the savings.
Other than forcing more "price controls" on Medicaid and Medicare, I just don't see what ACA has done to reduce costs. How have any of these been improved? What incentives were put in place to encourage people to eat healthier, exercise, sleep the right amount, etc?
Healthcare Cost Factors
•Unhealthy Americans abound
•Americans want to save everyone
•Saving everyone weakens Americans
•Americans insist everyone MUST stay alive Link2
•Americans love lawsuits
•Americans and Doctors love expensive tests
•American Government bureaucracy
•Private insurance bureaucracy, profits & wages
•Pharmaceutical personnel, profits & wages
•Medical device personnel, profits & wages
•Healthcare bureaucracy, profits & wages
•Excessive medical licensing requirements
As for your questions... I think there should be a cap but am indifferent if it is 1:3 or 1:5.
I want to help low income to afford their own health insurance by pushing them to learn and have fewer kids, deport illegal workers, encourage American consumers to buy American, encourage American businesses to create more good paying American jobs, etc.
Every American worker should be able to afford their own health insurance premium. Just writing people checks for doing nothing just leads to a very bad place as we have seen during the past 50+ years.
It looks like Heritage changed their Family Facts website. I think I liked the old one better.
Unfortunately the war on poverty trend data is just as disturbing.
We know there are some provisions in the ACA that reduce costs. For instance, eliminating the subsidy for inefficient Medicare Advantage plans.
"As for your questions... I think there should be a cap but am indifferent if it is 1:3 or 1:5."
You can't say on one hand "No we should charge them the annual premiums appropriate to them when they are ~60" and "I think there should be a cap" because those are two mutually exclusive ideas. Either someone pays what they should pay at age 60 or you cap it at some level so it's affordable. You can't have it both ways.
"I want to help low income to afford their own health insurance by pushing them to learn and have fewer kids, deport illegal workers, encourage American consumers to buy American, encourage American businesses to create more good paying American jobs, etc.
Every American worker should be able to afford their own health insurance premium. Just writing people checks for doing nothing just leads to a very bad place as we have seen during the past 50+ years."
This is the same old nonsense. Not responsive to the question. What is the policy to handle today's world, not John's Fantasyland?
I think there are more than enough healthy 50 - 65 year olds that their premiums should not be that out of whack from those of the 30 year olds. Of course without data neither of us know for sure.
Also, I am happy to give big credits for healthy living. If you see a doctor, maintain a healthy weight, manage your cholesterols, manage your blood pressure, etc. Your premium may be half of your over weight peer that is on their way to a heart attack.
The policies are very simple...
- Remove all illegal workers from the USA.
- Reduce safety net to push people to get training and jobs.
- Hold Parents and Schools truly accountable for the education of children.
- Apply taxes to consumers and businesses to pressure them to Buy American.
- Reduce regulatory and tax burden on companies so they can afford to operate in the USA.
Now your solution of placing arbitrary caps on things and then funding it with an arbitrary taxes and fees on others isn't all that much better unfortunately. That is why it is easy to poke holes in it.
"The policies are very simple..."
These are not policies, they are slogans.
"Remove all illegal workers from the USA."
How? are you going send a deportation force door-to-door to find them?
"Reduce safety net to push people to get training and jobs."
Which programs? To what levels? What training are they going to receive and who is going to provide it?
"Hold Parents and Schools truly accountable for the education of children."
How? What's the standard that will be used?
"Apply taxes to consumers and businesses to pressure them to Buy American."
At what level?
"Reduce regulatory and tax burden on companies so they can afford to operate in the USA."
Which regulations would you remove? How would you reduce the tax burden?
"Now your solution of placing arbitrary caps on things and then funding it with an arbitrary taxes and fees on others isn't all that much better unfortunately."
Tell that to the 20 million folks who have health insurance today that they didn't have before the ACA. If you can do better, be my guest.
Remove illegal workers. Trump seems to be on the right track.
- Improve border security so no more can come in and keep deporting 500,000 per year
- Deport VISA over stayers ASAP
- Crack down on the employers of illegal workers, do not give them driver's licenses, schooling, healthcare, etc. In essence encourage self deportation
- Punish sanctuary cities for harboring illegal workers
Since pushing people to get training and jobs is related. You know my "dystopian policies", if you have 2 children and are on welfare. Number 3 must be given up for adoption or aborted. If you want more children, learn, work and get off welfare. The USA does not support people who can not support themselves trying to be a Parent. The needs of children are more important than the selfish wants of adults.
Training is an interesting concept. If the 11 million illegal workers are gone, it seems jobs will be available and wages will be higher. Lower welfare to the point where people are willing to work construction, farm labor, service industries or any of the many tasks that the illegal workers are currently doing. If you don't like the smell of dairy cattle or butchering turkeys, strive for more.
Start at 5% and "Buy American" public service announcements. Increase if the consumers are still to cheap and self centered to support their fellow American workers.
Many more tax free zones to encourage companies to invest in communities and bring jobs. How do we get some big assembly plants in the Twin Cities area? So our less knowledgeable and skilled people can have good job opportunities...
If you want more details go look at Ryan and company are trying to get passed.
20 million more people having health insurance that they have not earned is not necessarily a good thing from my perspective. It just means that the taxes and fees have been raised on the rest of us and they have not learned, improved or grown in anyway.
Investing in people to help them grow and improve is great. Spending money on healthy competent people so they can more comfortably languish in misery is not necessarily a good thing for them or our country.
"20 million more people having health insurance that they have not earned is not necessarily a good thing from my perspective."
Since Ronald Reagan signed the bill in 1986 that required emergency rooms to treat people even if they didn't have the ability to pay, it would seem that -- whether you like it or not -- they have earned it. And, now, since you have said you don't want to repeal that and you favor government intervention on things like the 3:1 or 5:1 ratio, we're really just haggling over the price.
I love how you post things like "do not give them driver's licenses, schooling, healthcare, etc.", "Punish sanctuary cities for harboring illegal workers", "if you have 2 children and are on welfare. Number 3 must be given up for adoption or aborted", "Start at 5% and "Buy American" public service announcements. Increase if the consumers are still to cheap and self centered to support their fellow American workers", and "go look at Ryan and company are trying to get passed" and then suggest that it is liberals who don't consider unintended consequences. But, hey, good luck putting together the "Baby Taker" SWAT teams...
How are we going to have a meaningful discussion if all you want to poke holes in my excellent policies? :-)
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