Are people really going to get help paying for their Health Insurance?

[Revoltingest]

OK, Rev. I may be being dense here. I recognize that. I believe you.
But...in looking a our tax forms, I only see the designation of "Gross Income" on the Schedule C. Line 7.
On the 1040 form, line 22, what one expects to mean gross income is called "total income". Then, there is the "adjusted gross income" -- line 37.

This exemplifies their usage of "gross income".

I guess I'm just wrong for expecting the term "Gross Income" that is being used to actually apply to the line that is labeled "Gross Income" on my tax forms.
Do we know for sure what line on the 1040 is the line the insurance exchange is referring to for determining gross income? Total income?

You are wrong to expect that government use of terminology will be consistent & clear. You must read the collective Vogon consciousness.
But in US income taxation there is a blurring of "gross" vs "net" income. I pay taxes based upon a melding of the two approaches. (This is because of the IRS's not allowing some business expenses, eg, tenant build-outs, & their treating some non-income as income, eg, refinance proceeds, loan discounts.)

 

[Mr Spinkles]

A single male needn't pay for maternity coverage. Hypothetically, to force him to do
so would be solely to have him subsidize the rates of those who do want such insurance.
This would give a false impression to the subsidized insured that costs are being lowered,
when it would actually just be income redistribution.

Actually it's a bit more subtle than that. Insurance becomes more efficient the larger the pool of shared risk. A single male may not need maternity coverage but he does need coverage for colonoscopies and testicular cancer, which the female does not need. By combining different people with different needs you greatly expand the pool of shared risk, thereby increasing efficiency.

Furthermore, both the single male and the female need coverage for catastrophic expenses (i.e. being paralyzed for life in a car accident, brain tumor, open heart surgery, etc.). These medical costs differ from the maternity coverage in that they are far less likely, but they are also far, far more expensive. So once again, the single male benefits by adding the female to his pool of shared risk, even though that benefit is mitigated by the female's more probable need for a particular type of care.

This is why, as a matter of fact, it's not a zero-sum game. This is why the CBO analysis shows that while some people's monthly premiums are going up and others' are going down, monthly premiums on average are going down. And they are going down significantly, too. And expanding health care coverage for the sick significantly. IOW there has been a net gain due to the ACA, it's not simply a matter of shuffling incomes around so that some people gain at others' expense.

Still, in spite of these beneficial effects, if the single male is healthy and remains healthy then it is quite possible he would have paid less if he had his own, individually-tailored coverage. Some things to consier are:

(1) he would not save as much as the female would lose;

(2) he would lose the benefit of living in a country where women get affordable maternity care (some people actually would consider this an intangible "cost" because they care about things greater than their own personal gain);

(3) given how the individual insurance market was structured before the ACA, it's highly likely that catastrophic medical expenses were not covered by the single male's plan, i.e. there was a lifetime maximum of $1 million, for example; in that case he was getting artificially low premiums by taking a gamble and passing on the excess risk to society (who would have to pick up the tab if he ends up paralyzed by an accident and his lifetime maximum runs out at $1 million);

 

[Revoltingest]

Actually it's a bit more subtle than that. Insurance becomes more efficient the larger the pool of shared risk. A single male may not need maternity coverage but he does need coverage for colonoscopies and testicular cancer, which the female does not need. By combining different people with different needs you greatly expand the pool of shared risk, thereby increasing efficiency.

Please define "efficiency", & explain how it is served by buying coverage one doesn't need.
Do you claim that females don't need colonoscopies?

Furthermore, both the single male and the female need coverage for catastrophic expenses (i.e. being paralyzed for life in a car accident, brain tumor, open heart surgery, etc.). These medical costs differ from the maternity coverage in that they are far less likely, but they are also far, far more expensive. So once again, the single male benefits by adding the female to his pool of shared risk, even though that benefit is mitigated by the female's more probable need for a particular type of care.

You're not making your case, unless it's for one person subsidizing another.

This is why, as a matter of fact, it's not a zero-sum game. This is why the CBO analysis shows that while some people's monthly premiums are going up and others' are going down, monthly premiums on average are going down. And they are going down significantly, too. And expanding health care coverage for the sick significantly. IOW there has been a net gain due to the ACA, it's not simply a matter of shuffling incomes around so that some people gain at others' expense.

To underline words does not make them more convincing, particularly making claims rather than presenting analysis. It might not even be possible to quantitatively analyze the effects this early in the process of implementing Obamacare. If the fundamental costs of care aren't going down, then there is no increase in efficiency. I speculate that Obamacare only rearranges who pays how much, & increases the number of people buying insurance & paying fines. This isn't necessarily more efficient, except perhaps as felt by those who enjoy a subsidy.

Still, in spite of these beneficial effects, if the single male is healthy and remains healthy then it is quite possible he would have paid less if he had his own, individually-tailored coverage. Some things to consier are:
(1) he would not save as much as the female would lose;
(2) he would lose the benefit of living in a country where women get affordable maternity care (some people actually would consider this an intangible "cost" because they care about things greater than their own personal gain);

You're making an argument for income redistribution, which isn't about efficiency.

(3) given how the individual insurance market was structured before the ACA, it's highly likely that catastrophic medical expenses were not covered by the single male's plan, i.e. there was a lifetime maximum of $1 million, for example; in that case he was getting artificially low premiums by taking a gamble and passing on the excess risk to society (who would have to pick up the tab if he ends up paralyzed by an accident and his lifetime maximum runs out at $1 million);

I don't care for that aspect of the old system either.

 

[metis]

Actually it's a bit more subtle than that. Insurance becomes more efficient the larger the pool of shared risk. A single male may not need maternity coverage but he does need coverage for colonoscopies and testicular cancer, which the female does not need. By combining different people with different needs you greatly expand the pool of shared risk, thereby increasing efficiency.

Furthermore, both the single male and the female need coverage for catastrophic expenses (i.e. being paralyzed for life in a car accident, brain tumor, open heart surgery, etc.). These medical costs differ from the maternity coverage in that they are far less likely, but they are also far, far more expensive. So once again, the single male benefits by adding the female to his pool of shared risk, even though that benefit is mitigated by the female's more probable need for a particular type of care.

This is why, as a matter of fact, it's not a zero-sum game. This is why the CBO analysis shows that while some people's monthly premiums are going up and others' are going down, monthly premiums on average are going down. And they are going down significantly, too. And expanding health care coverage for the sick significantly. IOW there has been a net gain due to the ACA, it's not simply a matter of shuffling incomes around so that some people gain at others' expense.

Still, in spite of these beneficial effects, if the single male is healthy and remains healthy then it is quite possible he would have paid less if he had his own, individually-tailored coverage. Some things to consier are:

(1) he would not save as much as the female would lose;

(2) he would lose the benefit of living in a country where women get affordable maternity care (some people actually would consider this an intangible "cost" because they care about things greater than their own personal gain);

(3) given how the individual insurance market was structured before the ACA, it's highly likely that catastrophic medical expenses were not covered by the single male's plan, i.e. there was a lifetime maximum of $1 million, for example; in that case he was getting artificially low premiums by taking a gamble and passing on the excess risk to society (who would have to pick up the tab if he ends up paralyzed by an accident and his lifetime maximum runs out at $1 million);

Well said.

Let me add just a couple of items in short. I have had BC/BS for nearly 40 years, and I'm not asked what I want and need to be covered so my premiums could be lowered. My wife and I are way too old to have children, and yet we pay for maternity and pediatrics for other people, but I certainly am not complaining about that.

Also, let's apply what some are saying here to another area: military spending. When the Iraq War was voted on, I was opposed, so was I able to deduct that cost on my taxes? No. Can I pick and choose which weapons I might not agree with and have that portion deducted on my taxes? No. If I have no children in school, can I get rid of those taxes on me? No.

Some here take a very selfish view, imo, whereas they're saying I don't want to pay $X because I have no ___, which ignores the fact that we all live in a place called a "society", whereas we're not just individuals.

We know that Neanderthals would help take care of those in their band that were seriously injured because we see where their bones healed, but some in our society can't be even as civilized as they.

 

[Mr Spinkles]

Let's take an extreme example. Let's consider a very costly medical condition which very few people need coverage for. Then let's explore two extreme options for how to cover this condition. In reality, of course, most health care won't be as challenging as this extreme; and furthermore, in reality, the optimal solution will probably lay somewhere in between the two extreme approaches we consider.

Here's the extreme medical condition: hemophilia is perhaps the most expensive chronic condition, occurring in 1 out of every 10,000 babies born and costing $100,000/year to treat.

Now let's consider two extreme ways society could pay for this condition. We could (1) divide this cost among every American, or (2) not divide the cost at all and expect only afflicted families to be responsible for paying the full amount of their own coverage.

What are the consequences of these two approaches?

Well in (1), every American would pay about $10 per year. That would be enough to treat every hemophiliac in the U.S. Pros: families afflicted with hemophilia, or healthy families who have a baby born with hemophilia, would incur no additional costs to treat their child's condition. In addition, anyone who has children in the future can rest assured that they will at least get coverage if they are unfortunate enough to have a baby born with this disorder. Cons: everyone would have to pay $10 per year. In addition, paying this $10 per years is arguably unfair to many healthy people, who don't need this coverage because they don't plan to have more children and all of their current children are healthy.

In (2), the Pros are: the vast majority of Americans would save $10 per year. Furthermore, healthy households that do not plan to have more children would not be required to pay for coverage they don't need. Cons: for every child born with hemophilia, that family would get sacked with an unaffordable medical expense of $100,000 per year and become homeless and impoverished, in addition to sick. Furthermore, any person that ends up having children in the future runs this risk.

Clearly there are trade-offs to be considered and clearly, the optimal solution will lay somewhere between these two extremes. But what sticks out in my mind is (1) the most expensive chronic disorder is actually not that expensive when costs and risk are shared, (2) most countries cover this and many other disorders while spending half what the U.S. does (as a percentage of GDP per capita), (3) what about all the intangible costs associated with creating a sub-population of not only sick, but also impoverished families, and the intangible risk added to families considering having children? What kind of society do we want to live in? Things to consider.

 

[Mr Spinkles]

BTW Revolt my previous post was not supposed to address the objections you raised in your most recent post. Nor does it have to do with my argument about "efficiency". I hadn't seen your post when I wrote that.

 

[Revoltingest]

....most countries cover this and many other disorders while spending half what the U.S. does (as a percentage of GDP per capita)....

This is often brought up in defense of Obamacare, but I've yet to see how it would lower the overall costs. We even have a special tax on medical devices, justified by saying "they can afford it", which will add to health care costs. Why apply a special gross revenue tax on medical devices instead of things we might want to discourage, eg, performance parts enabling sports cars to reach 120 mph faster?

(3) what about all the intangible costs associated with creating a sub-population of not only sick, but also impoverished families, and the intangible risk added to families considering having children? What kind of society do we want to live in? Things to consider.

You want a more socialistic society than do I, but we've been there & done that argument already. We're inevitably heading towards greater socialization, so the important issue becomes the manner in which it happens. Ideally, we don't want to encourage people to engage in behavior which makes them a burden on society, but we do want to provide a safety net for those in real need.

 

[Mr Spinkles]

Please define "efficiency", & explain how it is served by buying coverage one doesn't need.
Do you claim that females don't need colonoscopies?

To answer your question: I thought regular colonoscopies something like every 5 years in men over 40 was considered necessary/recommended medical care, but such screening was not necessarily necessary/recommended for women. I could be wrong. But no matter, let's not get bogged down in irrelevant details; clearly, the woman doesn't need coverage for testicular cancer just as much as the single man doesn't need coverage for maternity care (at least, right now he doesn't--no one can know what the future will bring), and that is sufficient for the point I was making.

To answer your query about efficiency, let me ask you a question so I know where to begin: do you acknowledge that insurance for a larger pool of customers is more "efficient" than insurance for a smaller pool? (I'm deliberately not defining "efficient" yet because that is a more complicated, technical point, and if we agree on this question, there may be no need to address it.)

To underline words does not make them more convincing, particularly making claims rather than presenting analysis.

Well I did present extensive analysis by the CBO a few posts ago, here's the post: http://www.religiousforums.com/forum/3552459-post35.html

And here's the analysis (PDF): http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/107xx/doc10781/11-30-premiums.pdf

It might not even be possible to quantitatively analyze the effects this early in the process of implementing Obamacare.

It might not be possible, but in such cases the CBO usually says "it's not possible" rather than asserting a quantitative analysis. Furthermore the most uncertain market, the one that's getting all the media attention because some people's premiums are going up, is the individual or non-group market, which is something like 5% of the total market. And the CBO estimates average premiums going down by a whopping 56% in that market.

If the fundamental costs of care aren't going down, then there is no increase in efficiency. I speculate that Obamacare only rearranges who pays how much, & increases the number of people buying insurance & paying fines. This isn't necessarily more efficient, except perhaps as felt by those who enjoy a subsidy.

Okay, that's your opinion, but now consider some facts.

First there are some fundamental cost reductions due to, for example, (1) coverage for preventive care (emergency care is far more expensive than routine screening/prevention); (2) coverage for birth control (do I need to elaborate on how expensive unplanned pregnancies are?); (3) coverage for elderly people to make end-of-life decisions with their doctor (something like 50% of all medical costs in this country occur in the last 6 months of a person's life; if grandpa doesn't want to be kept alive on a machine for an extra week, why are we paying for it against his wishes?).

There are others but those hit some of the main drivers of what you call "fundamental costs": ER, unplanned pregnancy, and end-of-life care. (Tangentially, the ACA doesn't do this as much as I would like, but it's better than the Republican/Tea Party non-plan to basically

[youtube]PepQF7G-It0[/youtube]
"let 'em die".)

Second, even if the cost of health care doesn't go down, the cost of health insurance can indeed go down. How is that possible? A number of ways:

(1) allowing consumers to easily compare prices and to band together in large groups increases their bargaining power vs. the industry; as in any industry, when you increase the bargaining power of the buyers you increase their "profitability" while lowering average profitability in the industry (for more elaboration on this point see this book by Porter).

(2) larger pools of consumers increase efficiency in insurance markets, e.g. by increasing predictability in costs and reducing the effects of catastrophic costs. This increase in "efficiency" could end up as increased profitability for the insurer or, in a competitive market, reduction in premiums for the consumer (per "unit" of coverage received). This idea is supported by salient facts: within the U.S. larger groups (e.g. a larger employer-based insurance plan vs. a smaller one) typically have smaller premiums and less volatility in premiums; around the world wealthy countries with universal health care coverage have smaller, not larger, health care costs.

You're making an argument for income redistribution, which isn't about efficiency.

No I'm making an argument for efficiency which at least partially offsets some degree of wealth redistribution.

I don't care for that aspect of the old system either.

Well good, we agree there.

 

[Mr Spinkles]

This is often brought up in defense of Obamacare, but I've yet to see how it would lower the overall costs. We even have a special tax on medical devices, justified by saying "they can afford it", which will add to health care costs. Why apply a special gross revenue tax on medical devices instead of things we might want to discourage, eg, performance parts enabling sports cars to reach 120 mph faster?

I'm going to dodge your query about the "special tax" because I don't know enough about it. But I do want to address your first sentence, at least in principle. Insurance and health care in the U.S. is an industry. People who work in business strategy (again here's the book by Porter) think of the profitability of an industry, vs. the suppliers, vs. the buyers of the products/services of that industry, as being influenced by 5 basic "forces". One of those forces is "the bargaining power of buyers".

Here's an example of that force in action: one reason why Wal-Mart gets much lower prices than other buyers of groceries is because Wal-Mart is huge. Therefore, it has huge bargaining power. Consider the peanut butter industry, and Wal-Mart as a buyer influencing that industry. It would be much better to sell a large volume of jars of peanut butter to Wal-Mart at a reduced price, and accept a reduced profit per jar, than to not sell to Wal-Mart (and lose out to a competitor). Often, a business has to offer totally different (reduced) prices to any big "Wal-Mart customers" lurking out there. People who work in business strategy often describe the effect of a Wal-Mart customer as being like a vacuum, which "sucks out" average profitability from the industry. This increases profitability for Wal-Mart (which obtains lots of peanut butter at low prices) while forcing the peanut butter industry (say) to become leaner and meaner (possibly forcing smaller, less efficient peanut butter businesses out of the marketplace).

So, back to your question: how might universal coverage lower insurance costs? One way it can do it is by banding all the consumers of coverage into a giant "Wal-Mart" customer, increasing their bargaining power (and therefore their "profitability") while making the insurance industry less profitable, leaner and meaner.

You want a more socialistic society than do I, but we've been there & done that argument already. We're inevitably heading towards greater socialization, so the important issue becomes the manner in which it happens. Ideally, we don't want to encourage people to engage in behavior which makes them a burden on society, but we do want to provide a safety net for those in real need.

Fair enough. What about maternity care, does having a child = causing a burden to society? It does if it's unplanned, which is why Obamacare requires coverage for birth control. Seems like a good investment to me.

 

[Shadow Wolf]

You're making an argument for income redistribution, which isn't about efficiency.

Actually, this "income redistribution" is about efficiency. The healthier and happier your workers are, the more productive they are. American individualism is so far out of touch with reality that it's making things harder for everyone that isn't born into privilege. And instead of acknowledging that a healthy society is a collective society that is concerned about the basic needs of it's members, we tell people they need more personal accountability in a world where the assets of "personal accountability" are not equally distributed or attainable.

 

[Dirty Penguin]

It sounds as though anyone who complains about how Obamacare affects them just doesn't understand their situation as well as you do. Who are you to say that her insurance choice wasn't "stellar" enuf?

I never said it was or wasn't.....but what we keep finding in all these anecdotal situations is that people who currently have insurance end up getting their current policy compared to policies on the exchange and are finding out that the plans now being offered are more comprehensive than what they currently have...

The article said her premium and deductible are going to be significantly higher but I would have like to have seen here current policy structure to the ones offered to her on the exchange.

 

[Revoltingest]

To answer your question: I thought regular colonoscopies something like every 5 years in men over 40 was considered necessary/recommended medical care, but such screening was not necessarily necessary/recommended for women. I could be wrong.

You are very very wrong.
https://www.zocdoc.com/answers/9164/when-should-i-start-getting-a-colonoscopy-on-a-regular-basis
Notice how kind I am to not make a joke about your health care 'expertise'?

But no matter, let's not get bogged down in irrelevant details; clearly, the woman doesn't need coverage for testicular cancer just as much as the single man doesn't need coverage for maternity care (at least, right now he doesn't--no one can know what the future will bring), and that is sufficient for the point I was making.

To answer your query about efficiency, let me ask you a question so I know where to begin: do you acknowledge that insurance for a larger pool of customers is more "efficient" than insurance for a smaller pool?

No. The general purpose of a large pool is too make predictable expenses for the insurer, so as to not be caught short by statistical vagaries. But under Obamacare, a stated purpose of the large pool is for some, particularly new insurance buyers & the young, to subsidize others.

(I'm deliberately not defining "efficient" yet because that is a more complicated, technical point, and if we agree on this question, there may be no need to address it.)

I see "efficiency" as improvements in the costs vs benefits. My big problem with Obamacare, other than creeping big government, is that it ignores fundamental costs, eg, tort, malpractice insurance, training costs.

Well I did present extensive analysis by the CBO a few posts ago, here's the post: http://www.religiousforums.com/forum/3552459-post35.html
And here's the analysis (PDF): http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/107xx/doc10781/11-30-premiums.pdf

You presented links to their analysis, but no interpretation the analysis itself, which I found rather inscrutable, & questionable, given the system which hasn't yet been implemented.

It might not be possible, but in such cases the CBO usually says "it's not possible" rather than asserting a quantitative analysis. Furthermore the most uncertain market, the one that's getting all the media attention because some people's premiums are going up, is the individual or non-group market, which is something like 5% of the total market. And the CBO estimates average premiums going down by a whopping 56% in that market.

Without reducing the fundamental costs, we cannot have a system which reduces costs on average for the participants. And I don't buy the idea that bringing in new participants to subsidize the others is a real premium reduction....it's just spreading around the cost more.

Okay, that's your opinion, but now consider some facts.

Oh, great....someone who believes his opinions are "facts"...like only men needing colonoscopies, eh?

First there are some fundamental cost reductions due to, for example, (1) coverage for preventive care (emergency care is far more expensive than routine screening/prevention); (2) coverage for birth control (do I need to elaborate on how expensive unplanned pregnancies are?); (3) coverage for elderly people to make end-of-life decisions with their doctor (something like 50% of all medical costs in this country occur in the last 6 months of a person's life; if grandpa doesn't want to be kept alive on a machine for an extra week, why are we paying for it against his wishes?).

I don't dispute #1 & #2. How is #3 affected by Obamacare?

There are others but those hit some of the main drivers of what you call "fundamental costs": ER, unplanned pregnancy, and end-of-life care. (Tangentially, the ACA doesn't do this as much as I would like, but it's better than the Republican/Tea Party non-plan to basically [youtube]PepQF7G-It0[/youtube]
"let 'em die".)

Actually, it was the Dem in your video who suggested this. But enuf of your histrionc video commentary, under any system there will be decisions to terminate life supporting measures for some, even those who want it. Resources are not unlimited, & 90 year old alcoholics will not be getting liver transplants.

 

[Revoltingest]

I never said it was or wasn't.....but what we keep finding in all these anecdotal situations is that people who currently have insurance end up getting their current policy compared to policies on the exchange and are finding out that the plans now being offered are more comprehensive than what they currently have...
The article said her premium and deductible are going to be significantly higher but I would have like to have seen here current policy structure to the ones offered to her on the exchange.

Nonetheless, if one wants a particular plan, one cannot keep it if the gov wants'm to buy a more spendy one. This seems the method of subsidy, ie, someone pays extra for bennies they don't need, & that cost goes to those who pay less than they'll cost the system. So what Obama should've said was that if you like your plan, you can keep it, so long as it's a Cadillac (or "Lexus", as Snoop Pearson would correct me).

 

[LegionOnomaMoi]

Actually, this "income redistribution" is about efficiency. The healthier and happier your workers are, the more productive they are.

Hoping that nonlinear relationships between several variables will end up increasing output in the long-run all other things being equal isn't "about efficiency." Increasing productivity by increasing positive affect through things like job satisfaction is difficult enough even to study, let alone produce at the local level (by companies themselves) let alone hope to accomplish through federal healthcare changes.

 

[Dirty Penguin]

Nonetheless, if one wants a particular plan, one cannot keep it if the gov wants'm to buy a more spendy one.

Wrong. Now you know full well that if an individual on the open market wants to keep their current plan and THE INSURER doesn't want to make any changes in the plan then the policy holder will be able to keep said plan. If THE INSURER decides to eliminate the plan....what most likely happens is the insurer offers the policy holder a new plan following the ACA guidelines and jacking up the cost in the process. What ultimately happens in many of these cases is once the current policy holder goes onto the exchange their inevitably find a few policies that are cheaper than what they've been paying and is more comprehensive. Even when they find one where the premium is slightly higher what they're finding is that the deductible is lower and the out of pocket expense is lower and again...the policy is way more comprehensive than their catastrophic plan.

Ask Nancy: Do I really need health insurance if I

Stay away from mini-med or hospital-indemnity plans that only pay up to a set amount—say, $1,000 a day for hospitalization or $500 a year for prescription drugs. They’re cheap, but for a reason: if you ever get seriously ill, they’ll cover only a small fraction of your medical bills.

There are a lot of policy holders out there with this type of coverage.

This seems the method of subsidy, ie, someone pays extra for bennies they don't need, & that cost goes to those who pay less than they'll cost the system. So what Obama should've said was that if you like your plan, you can keep it, so long as it's a Cadillac (or "Lexus", as Snoop Pearson would correct me).

No...he should have said...if you like your plan and your insurance company doesn't want to make any changes to your policy or drop your policy to adhere to the guidelines we set forth in the ACA than you can keep it but if your insurances cancels your plan and offers you a more expensive plan then you may be able to buy plan on the exchange with more comprehensive cover and in most cases it's going to cost you lest than your limited junk plan.


:sad:

And see this from Consumer Reports......
http://www.consumerreports.org/cro/2012/05/hazardous-health-plans/index.htm

 

[Revoltingest]

Wrong.

You glibly say this, but I know people who lost their plans. Many others complain too.
You give reasons why you believe they should lose their plan, but they're lost nonetheless.

 

[Mr Spinkles]

You are very very wrong.
https://www.zocdoc.com/answers/9164/when-should-i-start-getting-a-colonoscopy-on-a-regular-basis
Notice how kind I am to not make a joke about your health care 'expertise'?

I wouldn't consider it unkind since I don't claim to be a health care "expert" and this detail is irrelevant to the point I was making. You seem to be passionate about colonoscopies so I will defer to your greater expertise on the subject.

No. The general purpose of a large pool is too make predictable expenses for the insurer, so as to not be caught short by statistical vagaries. But under Obamacare, a stated purpose of the large pool is for some, particularly new insurance buyers & the young, to subsidize others.

Emphasis added. Right. I'm not going to respond to your caricature of Obamacare since it would get us sidetracked. So large pools make expenses more predictable for insurers, as you said. And why do insurers like predictable expenses? Is it because insurers are obsessive-compulsive people who can't psychologically tolerate uncertainty? No, it's because this affects their bottom-line. And how does it affect their bottom-line? Because (all other things being equal) predictable expenses are less costly than unpredictable ones.

For example, as you are probably well aware, if expenses are unpredictable you need to have large cash reserves to cover the risk of catastrophic costs. That cash could have been invested and making more money elsewhere, so your costs are increased due to the time value of money and opportunity costs. Or, if you incur catastrophic costs beyond your cash reserves, you have to take out a loan or cut costs elsewhere in your operations in order to cover those excess costs. That is costly due to the interest on the loan and the costs of re-organization or the costs of cutting services.

So in health insurance more predictable = less costly. And larger pools = more predictable.

Therefore, when you increase the pool (say, by adding a woman into a pool with a single man) one effect is to reduce costs. As I said before, that cost reduction will show up as either (a) increased profitability for the insurer, or, what is more likely if the market is competitive, (b) lower fees for the customer per "unit" of coverage received.

Now I'm not by any means saying that is the only effect of increasing the size of the pool. I'm simply saying this is one effect you neglected to consider, when you brought up the example of a single man (who doesn't need maternity coverage) being in the same insurance pool as a woman (who does).

I fully concede that the net effect for the man might be to incur higher costs due to his being lumped in with the woman, I'm just saying this effect is mitigated by the effects of expanding the insurance pool. As I said, it's not a zero-sum game here. We aren't simply rearranging deck chairs on the Titanic, so to speak. The other points I raised illustrate this IMO.

I see "efficiency" as improvements in the costs vs benefits. My big problem with Obamacare, other than creeping big government, is that it ignores fundamental costs, eg, tort, malpractice insurance, training costs.

I agree it neglects to address those issues, and it should address them. However, I disagree that things like tort are the "fundamental costs". Texas enacted the most extensive tort reform in the country and yet costs are still skyrocketing, here's a great article on this (as it happens, the author ends up opposing Obamacare): McAllen, Texas and the high cost of health care : The New Yorker

Any worthwhile discussion of "fundamental costs" must include the cost of people forgoing preventive care, relying on ER care, having unplanned pregnancies, and having unnecessary and aggressive end-of-life care. While Obamacare fails to address ALL fundamental costs it does undeniably address those ones.

You presented links to their analysis, but no interpretation the analysis itself, which I found rather inscrutable, & questionable, given the system which hasn't yet been implemented.

I did provide interpretation read my post. Furthermore, again, it's misleading to say it hasn't been implemented. The main provisions affecting most health plans (large employers and government) have been implemented, the thing that hasn't been implemented is the HealthCare.gov exchange which mainly concerns the non-group market, which again is around 5% of the market.

Without reducing the fundamental costs, we cannot have a system which reduces costs on average for the participants. And I don't buy the idea that bringing in new participants to subsidize the others is a real premium reduction....it's just spreading around the cost more.

Again, you're wrong on two counts. First, you admitted that "the general purpose of a large pool is too make predictable expenses for the insurer". Ask yourself why insurers want "predictable expenses" (see above) and you will find that it's because they are less costly. IOW, more efficient use of capital. When markets make more efficient use of capital they either become more profitable or they offer consumers more product for less, and the wealth of the nation increases in total, it doesn't just redistribute. That's one of the great things about capitalism and efficient use of capital, right Mr. Libertarian?

Secondly, again your caricature that Obamacare does "nothing" to address fundamental costs is just wrong. It does several things (which I already cited and explained). Nevertheless I agree with you it doesn't do everything/enough.

Oh, great....someone who believes his opinions are "facts"...like only men needing colonoscopies, eh?

No, like the facts I presented right under the sentence you quoted. You are the undisputed colon expert here.

I don't dispute #1 & #2. How is #3 affected by Obamacare?

Great. So we agree Obamacare does indeed, at least in terms of #1 and #2, address some fundamental costs (but not all). #3 refers to a provision in Obamacare that provided such coverage through Medicare, which was removed when Sarah Palin et al. raised the boogeyman of "death panels" but which has later been put back in to the reform (if you don't believe me I'll dig up the articles to prove it).

Actually, it was the Dem in your video who suggested this.

I beg to differ it was Blitzer who asked, the Republican/Tea Party audience members who suggested it and Ron Paul who for all intents and purposes (as far as I'm concerned) suggested it.

But enuf of your histrionc video commentary, under any system there will be decisions to terminate life supporting measures for some, even those who want it. Resources are not unlimited, & 90 year old alcoholics will not be getting liver transplants.

Exactly. I totally agree.

 

[Copernicus]

Nonetheless, if one wants a particular plan, one cannot keep it if the gov wants'm to buy a more spendy one. This seems the method of subsidy, ie, someone pays extra for bennies they don't need, & that cost goes to those who pay less than they'll cost the system. So what Obama should've said was that if you like your plan, you can keep it, so long as it's a Cadillac (or "Lexus", as Snoop Pearson would correct me).

There is absolutely nothing in the ACA that gives the president the power to force insurance companies to continue to offer plans that they decide to cut, and it was always known that only non-compliant plans offered prior to 2011 would be "grandfathered in". Most of those plans disappeared, because insurers have been changing premiums and coverage significantly just about every year. Nothing in the ACA forces doctors to accept a given plan forever. That is voluntary, just as it is voluntary for doctors to accept Medicare and Medicaid patients.

We have been somewhat inundated with Obamacare "horror stories" just a month after the program got off to its rocky start. It is really too early to tell whether most of the generalizations being tossed about are true or false. There have been cases where the media reported horror stories that turned out to be false or not to report all of the facts. For example:

Another Obamacare horror story debunked. (The woman who is the subject of the story has still not gone to the California web site to verify whether she could get a cheaper plan, but she has found the time to complain to the news media and a talk show host.)

'I would jump at it' The media labeled her an Obamacare victim. Here's what she really thinks.

Under Health Care Act, Millions Eligible for Free Policies. (These are Bronze plans for individuals and families who are relatively poor but can't qualify for Medicaid. Silver plans with a small monthly premium are still a better bargain.)

 

[Dirty Penguin]

You glibly say this, but I know people who lost their plans. Many others complain too.
You give reasons why you believe they should lose their plan, but they're lost nonetheless.

But the facts surrounding the issue many don't care about. It's insurance companies eliminating the plans and trying to offer a more expensive plan to their customers. In essence..some are dumping their junk plans to get their customers to buy plans that aren't as junky and that meet the ACA standards. Maybe these companies see the writing on the wall and figure their customers might jump ship and head for the exchange....and they'll lose that customer.....but maybe, just maybe they can entice their long time customers to stay with them....but this is proving not to be the case......many who are losing their junk plans eventually wound up on the exchange comparing plans and in many cases finding something much better, more comprehensive and even cheaper than their junk plan....

case in point:
Another Obamacare horror story debunked - latimes.com

Deborah Cavallaro is a hard-working real estate agent in the Westchester suburb of Los Angeles who has been featured prominently on a round of news shows lately, talking about how badly Obamacare is going to cost her when her existing plan gets canceled and she has to find a replacement.

Her current plan, from Anthem Blue Cross, is a catastrophic coverage plan for which she pays $293 a month as an individual policyholder. It requires her to pay a deductible of $5,000 a year and limits her out-of-pocket costs to $8,500 a year. Her plan also limits her to two doctor visits a year, for which she shoulders a copay of $40 each. After that, she pays the whole cost of subsequent visits.

As for a replacement plan, she says she was quoted $478 a month by her insurance broker, but that's a lot more than she'll really be paying.

Here's what I found. I won't divulge her current income, which is personal, but this year it qualifies her for a hefty federal premium subsidy.
At her age, she's eligible for a good "silver" plan for $333 a month after the subsidy -- $40 a month more than she's paying now. But the plan is much better than her current plan -- the deductible is $2,000, not $5,000. The maximum out-of-pocket expense is $6,350, not $8,500. Her co-pays would be $45 for a primary care visit and $65 for a specialty visit -- but all visits would be covered, not just two.



Here's what I found. I won't divulge her current income, which is personal, but this year it qualifies her for a hefty federal premium subsidy.
At her age, she's eligible for a good "silver" plan for $333 a month after the subsidy -- $40 a month more than she's paying now. But the plan is much better than her current plan -- the deductible is $2,000, not $5,000. The maximum out-of-pocket expense is $6,350, not $8,500. Her co-pays would be $45 for a primary care visit and $65 for a specialty visit -- but all visits would be covered, not just two.

 

[Revoltingest]

Many things to respond to, but not much new anyway.
I'll be on the road for a few days, so expect little posting.