Tuesday, September 17, 2013

ObamaCare Coverage Limits?

 Here are several statements that seem at odds.  Thoughts?
"You're the reason there's a little girl with a heart disorder in Phoenix who'll get the surgery she needs because an insurance company can't limit her coverage." Obama G2A Obama Promise to Spend More

"Health care is already rationed in this country -- by the ability to pay. So what we should be discussing is not whether or not rationing should occur, but on what basis we should do so." Sean G2A ObamaCare Shifting Costs Where?

"Sorry, I'm not going to wade through that bill. My personal experience is with my father, with scant days to live, being told that he had to leave the hospital because Medicare would no longer cover his stay. I offered to pay and was told that was not allowed under Medicare rules. Also, that is the rule under Canada's socialized medicine system and I have no reason to believe that Obama's is any different. Like Medicare and Medicaid, if they do not pay, the doctor may not accept private payment." Jerry G2A ObamaCare Shifting Costs Where?
What is the truth here:
  • Coverage with no limits?
  • Death panels wandering the nursing homes?
  • Why pay for Gold if everyone gets the surgery they require?
  • What really limited J's father's treatment? Medicare limits or Hospital greed. 

25 comments:

Sean said...

"Coverage with no limits?"

The President was referring here to one provision of the ACA which removes the lifetime caps on health insurance policies, not indicating that there were no limits on what would be covered. There's plenty of things that won't be covered -- just look at the descriptions of the exchange policies on the Dept of Commerce website.

John said...

Just quoting what the man said. I think I linked to the transcripts somewhere in that post.

"You're the reason there's a little girl with a heart disorder in Phoenix who'll get the surgery she needs because an insurance company can't limit her coverage."

I am not saying he got what he wants, but what does he want?

And how does that fit into the plan...

John said...

A little background for those that have not heard this before.

I believe that politicians promised more benefits than could/can be justified by the payroll taxes that were and have been paid. This is proven by the fact that the programs stop being self supporting soon. (SS Disability: ~2016, Medicare: ~2024 SS Retirement: ~2033)

Therefore either premiums need to be cut, payroll tax rates need to increase or general fund money will need to be used to make up the difference.

The third option means us Federal Tax payers will be paying for another social service like TANF, Medicaid, etc very soon...

So how do we hold these politicians accountable to make sure benefits will not exceed the premiums that are paid? I mean it is bad enough that we will be paying a good chunk of the premiums, it would be worse if we then ended up coughing up more.

If someone chooses and only pays for the Bronze plan, are we going to say no to using public funds for that little girl's operation?

Sean said...

"Therefore either premiums need to be cut, payroll tax rates need to increase or general fund money will need to be used to make up the difference."

Yes, that's true.

"If someone chooses and only pays for the Bronze plan, are we going to say no to using public funds for that little girl's operation?"

That little girl would be treated like any other insured person, subject to the terms of said policy. There would no longer be a lifetime maximum on the policy, but her operation could be denied by insurance for any of the other reason they deny services today. It would not put the public on the hook for said services.

John said...

You say that with such confidence, are you sure your not practicing to be a salesman or politician?

If you are certain the politicians will practice such good judgment, why are SS and Medicare still headed down the path to disaster?

The problem is that politicians prefer to be popular, it helps them to get elected or re-elected. And Lord knows saving some little girl from the evil government death panels could create a lot of good will. Especially if they say that it is free, because that "rich person who owes you" will pay for it through higher taxes. Sound familiar...

In fact, that is one of the favorite Liberal plans for raising the funding for SS and Medicare. They recommend that the cap be removed regarding payroll taxes, without providing the high income folks additional SS or Medicare benefits... (ie really high premiums with really low benefits)

And they are already reducing benefits or taxing them for the more well to do recipients. What would keep healthcare from following the same path?

Sean said...

"If you are certain the politicians will practice such good judgment, why are SS and Medicare still headed down the path to disaster?"

I never said I was certain politicians would practice good judgment. SS is a demographic problem. Can you precisely predict what the demographics of the United States will be 70 years from now? Why would you expect politicians to be able to? We can't even predict yearly tax receipts very accurately. It's only natural that the program would need to be adjusted over time. What we need to recognize is that SS has been a remarkably successful government program. Before SS, seniors were the most likely age group to be in poverty. Today, they are the least likely. And with the changes in private retirement savings from defined benefit to defined contribution plans, its role as social insurance has never been more important.

http://www.epi.org/publication/retirement-inequality-chartbook/

The good thing about SS is that its funding gap can be resolved easily. Removing the payroll cap (without adjusting benefits) almost entirely solves the problem. If we don't want to do that, we can tinker with means testing or changing the retirement age. It's not a difficult math problem, it merely requires the political will to change it.

As for Medicare, that program is similarly demographically challenged, but it also has to deal with the incredible inflation in the health care industry. Some of the changes in the ACA will help to bend that curve, but there will be more to be done over future years.

Sean said...

"And Lord knows saving some little girl from the evil government death panels could create a lot of good will."

I don't see how under the scenario we've described how the decision of an insurance company becomes a "government death panel". Insurance companies are making these very same decisions today, yet you conservatives want those companies to have more power over deciding our health care future. Please explain that to me.

jerrye92002 said...

Just to clarify one thing: I was told directly and explicitly that my father had exceeded the "lifetime Medicare cap" and that "Medicare rules" prohibited my paying for any more of what were certain to be his final few days in the hospital. So, when Obamacare kicks in, will the Medicare caps also disappear, meaning those costs will go up some more?

John, you are looking at the Medicare "solvency" issue incorrectly. You claim Medicare is solvent until 2024, but has been "broke" for years already. The only reason politicians keep calling out that 2024 number (and it keeps dropping, BTW) is that expenditures are being pulled from the "trust fund." But there is NO MONEY in the trust fund, only US treasury bonds, so any money that gets spent above the premiums coming in requires redemption of some of those bonds, which means the general fund gets tapped. Eventually (2024 or before), 100% of the overage will be coming from the general fund, unless something changes-- a reduction in benefits, an increase in taxes, more deficit spending, or actual REFORM of the program, EXACTLY the options that Congress has now, and has always had. For a bunch that hates to see a crisis go to waste, they sure seem to waste a lot of time planning for a crisis.

Sean said...

There is a cap on hospital days in Medicare, but per my understanding of the rules, you should have been allowed to pay out of pocket for additional days.

http://www.medicare.gov/Pubs/pdf/11408.pdf

John said...

For your convenience.
EPI Retirement Inequality Chartbook
Medicare Publication

John said...

Sean,
Come now, the baby boom demographic shift has been talked about for decades. No one was surprised by the pending insolvency problems.

Personally I want to get rid of Social Security and Medicare, then we can just call it welfare and medicaid. I mean that seems to be what the Liberals want it to become, and we should call it what it will be.

My rationale is pretty simple. Liberals want the well to do to pay premiums on their whole income, though they will only receive benefits based on a portion of their income. Liberals want to means test the benefits so that the well to do receive or keep less of the benefits they are owed based on their contributions.

When this happens, they are no longer self-financed programs with trusts/investments. They start becoming wealth transfer tools that are very similar to TANF, Medicare, etc.

John said...

Currently the "Insurance Company" gets to play the role of the evil villain, therefore protecting the politicians from the heat. They are business people who are used to creating deals, meeting them and taking the heat when a customer is frustrated.

The closer the politician's get to taking the heat for unfortunate events, the more of our money they will be motivated to spend to make themselves look good and get votes. It is an unfortunate reality.

John said...

Jerry,
The trust funds did exactly what they were supposed to do. They collected premiums, invested them somewhere safe and are paying them out in the form of benefits. That part of the system is working just like any insurance company.

The problem is that they collected premiums that were way too low, given the benefits that the politicians want to hand out.

So it is simple: raise premiums, cut benefits, or turn them into another form of welfare by making the "rich fund them". I mean the Liberals say they owe it to us for some reason...

Unfortunately based on their proposals I am one of those "rich"... And I am only a lowly Sr Project Engineer... I wonder how many other "rich" folks would be impacted by removing the SS cap... (ie pay more for same benefits)

Sean said...

"Come now, the baby boom demographic shift has been talked about for decades. No one was surprised by the pending insolvency problems."

Yes, but no changes have been made to the program for 30 years now.

Sean said...

"Currently the "Insurance Company" gets to play the role of the evil villain, therefore protecting the politicians from the heat. They are business people who are used to creating deals, meeting them and taking the heat when a customer is frustrated.

The closer the politician's get to taking the heat for unfortunate events, the more of our money they will be motivated to spend to make themselves look good and get votes. It is an unfortunate reality."

The whole health care debate has been a fascinating study in how political parties move along the ideological spectrum. Let's not forget that most of the ideas that comprise the ACA originated in the Republican Party and its associated think tanks. In fact, there were several prominent conservatives who supported the notion of an individual mandate precisely up until the point that some Democrats decided it was a good idea.

Now that Democrats have appropriated your ideas, it seems that all of a sudden those ideas are just awful. Of course, Republicans have offered no comparable ideas. Let's not forget that the Republican alternative to the ACA covered 30 million fewer people and was worse for the deficit than the ACA.

In the years since the ACA's passage, Republicans have moved from "repeal and replace" to "repeal", because they have no ideas to replace it. Why is that the case? Because if you're going to achieve the same sort of coverage as the ACA without blowing the deficit to smithereens, you're going to have to do many of the same things in the same way that the ACA does them.

So, no, I don't think that the ACA moves us closer to a scenario where we're on the hook for every piece of healthcare that people want.

The ACA is far from a perfect piece of legislation, but it is most certainly incrementally better than what we have today, and it lays the groundwork for future reform to make things even better.

jerrye92002 said...

"They collected premiums, invested them somewhere safe and are paying them out in the form of benefits. That part of the system is working just like any insurance company."

NO. By law, just like Social Security, these excess funds are invested in special US treasury bonds. In essence, they are simply a bookkeeping entry entirely within the federal government. Were this not so, we could solve the problem by arbitrarily increasing the interest rate on those bonds to, say, 90%, but the same thing would occur. The only money available to redeem these bonds comes from the general fund. Medicare trust fund is no more of an "investment" that the SS trust fund is; it's a sham. It is NOT like an insurance company because they invest in the private economy, where new wealth is actually generated to repay the investment-- principle and interest.

jerrye92002 said...

"The ACA is far from a perfect piece of legislation, but it is most certainly incrementally better than what we have today,"

I'm afraid I have a very strong and opposite opinion, based on what I believe are the facts of the matter. I'm afraid you would have a tough time convincing me, with facts, that O'care is "incrementally better." It isn't even implemented yet and most of the outcomes are negative, IMHO.

John said...

I am not arguing that the SS & Medicare funds couldn't have been invested somewhere that yielded better. However their mandate was to keep it safe, not to grow it rapidly... And US Saving Bonds are the safest investment to buy... (for now) So the fund managers made the right move.

Now did the politicians put the investment to good use and plan for it's repayment, that is a different topic.

Imagine a company that sold bonds and then used the investment to just "keep the lights on"... I am thinking management would be in trouble.

John said...

Sean,
What exactly was wrong with the pre-Obamacare medical system that it needed to be fixed?

Laurie said...

-50 million uninsured people
-no coverage for pre existing conditions
-people going bankrupt due to medical bills
-costs going up much faster than inflation
-something else I can't think of at the moment

Sean said...

"What exactly was wrong with the pre-Obamacare medical system that it needed to be fixed?"

We spend 2x as much (as a % of GDP) as any other country in the world, yet over one-sixth of our citizens have no reliable access to the health care system. That's incredibly inefficient. Worse, it results in needless death and illness for millions of Americans, as our health results across a number of metrics are substandard.

John said...

Back to the key question:

Do citizens have a right to free food, housing, healthcare, etc just because they live in America?

Remembering that these items are paid for by taking money from other citizens. How does this impact the "carrots/sticks" that help to motivate people to learn, work, change and improve?

"2X" Remember you are comparing apples and oranges. We also are one of the places that people go to for the best treatment in the world. And we likely lead the world in the development of high tech life saving and improving devices.

Sean said...

"Do citizens have a right to free food, housing, healthcare, etc just because they live in America?"

The ACA (like Romneycare) tries to minimize the free-rider problem in healthcare by mandating that people chip in towards the cost of the system either through buying insurance or paying a penalty.

"How does this impact the "carrots/sticks" that help to motivate people to learn, work, change and improve?"

I would argue our current system -- which distorts labor markets by linking employment and health care so closely and which excludes so many of our citizens from reliably accessing it and enabling their conditions to be addressed earlier (or avoided altogether) -- does much more to hold people down than anything the ACA does.

"2X" Remember you are comparing apples and oranges. We also are one of the places that people go to for the best treatment in the world. And we likely lead the world in the development of high tech life saving and improving devices."

It's not apples and oranges. The goal should be to deliver quality health care to all of our citizens in the most efficient manner. Is that your goal, or is it to ensure that insurance companies remain profitable?

Besides, why should our citizens bear the entire cost of the development of medical technology that is used around the world? Do only Americans pay for Apple's innovation? Of course not!

jerrye92002 said...

Laurie said...
-50 million uninsured people
-no coverage for pre existing conditions
-people going bankrupt due to medical bills
-costs going up much faster than inflation
-something else I can't think of at the moment.

Laurie, we are going to go back to that "fact" discussion we had a while back.
--I've said before that, of the [48] million uninsured, 52 million do not need it, and, the fact they are uninsured does NOT mean they do not get health CARE.
-- There IS coverage for pre-existing conditions, but it is in "high risk pools" that charge sensibly higher premiums. One of Obamacare's major failings is that it allows people to claim anything as a pre-existing condition and only buy insurance after they get sick. Therefore, premiums will have to go up greatly. Actually, if health insurance were detached from employment, much of this problem would go away. Even now, most insurance policies have a "pre-existing condition waiver," where we will give you insurance, but not cover the pre-ex until after a period of time, or exclude that particular coverage.
--People go bankrupt from all sorts of things, insured or otherwise. It's the reality and I don't see how asking taxpayers to bail these folks out in advance and making the health care providers whole is the answer. Unfortunate, yes. Something government can or should fix, NO.
--Costs are going up much faster in government insurance plans than in private plans.
-- and to Sean's point, we could cut our expenses by 1/2 if we just got government OUT of the health care business.

Sean said...

"One of Obamacare's major failings is that it allows people to claim anything as a pre-existing condition and only buy insurance after they get sick. Therefore, premiums will have to go up greatly."

No, there's no such thing as "claiming" a pre-existing condition. The concept merely goes away under the ACA. The idea is that the risk pool gets balanced in the ACA, as the two groups of people most likely to be uninsured (poor, in poor health and young, in good health) both get brought into the system.

"Costs are going up much faster in government insurance plans than in private plans."

Citation, please?

"and to Sean's point, we could cut our expenses by 1/2 if we just got government OUT of the health care business."

This is pure nonsense. Government health care systems have significantly lower overhead than private systems.