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Im in Texas ..

esmith

Veteran Member
We can do what Regan and Romney suggested and reduce/eliminate various tax expenditures. Don't get me wrong. We need need to cut, consolidate and eliminate from the federal budget....but cuts alone are hardly the solution....

Well what do you think of the idea of looking at every federal program and combine those that are basically the same and put them under one department, eliminate those that are not accomplishing the objective, eliminating departments that are not needed. For instance the Dept of Education, just what benefit to the county does it accomplish? Restructure the income tax, by closing loopholes and eliminating certain deductions like home mortgage interest (yes I have a home mortgage). Say even going to a flat tax. The only problem with attempting this are the lobbyist and special interest groups. Now how to eliminate those lobbyist and special interest groups that advocate for every possible dime they can get from the taxpayer; I don't have any idea.
 

metis

aged ecumenical anthropologist
BTW, if one doesn't want to go through the ACA, they can buy their insurance directly, and I would expect to see people do that if the ACA rates were higher than the market costs.
 

esmith

Veteran Member
BTW, if one doesn't want to go through the ACA, they can buy their insurance directly, and I would expect to see people do that if the ACA rates were higher than the market costs.

Just out of curiosity why would you go directly to an insurance company vice through the exchange. You still must meet the minimum requirements for coverage and I am "assuming" that open purchase price would be the same and even possibly more.
 
So, maybe they should delay this until they get all the "bugs" worked out of the system? Gee at a price tag of somewhere around $360,000,000 to some estimate as much as $600,000,000 just to connect you to an insurance company you would have thunk they could have done a better job. It didn't cost Apple this much to design the iPhone (around $150 million)
Since I know you insist on source:
Developing Obamacare's Health Care Exchanges Has Cost More Than Apple's Original iPhone - Forbes
No question the website, healthcare.gov, is so far a failure that needs to be fixed. But let's keep it in perspective on (1) the nature of the failure, (2) costs.

On (1): it's a failure to quickly serve an entire nation of 300 million people who are, as a matter of fact, clamoring for the low-cost, competitive, easily-comparable insurance plans on offer. To use a somewhat exaggerated but still useful analogy, it would be like a country that develops a vaccine for the first time, or universal voting rights for the first time. Unsuprisingly, there are lines out the door. The response from the Right is to guffaw "I told you so" and, sticking with the exaggerated analogy, try to kill the vaccine or kill the vote. The correct response is to fix the wait times.

On (2): Let's run some numbers to put the $360 million figure in perspective. You said Apple developed the iPhone for $150 million. I wonder, are health insurance companies as efficient as Apple? Or are we comparing Apples to oranges?

Let's examine some numbers to get a ballpark idea. I was involved in health insurance at a university, where the plan cost $3 million in premiums. A competitive medical cost ratio is 80%, which in this case would mean the insurer keeps $600,000 of the premiums for operating costs and *gasp* profits. Those operating costs include running the telephone lines, processing claims, coordinating benefits with providers, marketing, and oh yes, lobbying. That covers about 2,000 people. In the U.S. there are about 300 million people, or 150,000 times 2,000. So if we multiply 150,000 times $600,000, we get an estimate of annual operating costs for insurance companies to cover the entire nation. That's $90,000,000,000.

That's $90 BILLION a year to operate those wonderful, free-market, not-government-run health insurance companies that never get between you and your doctor and never raise your premiums or change your health insurance if you currently like it, and never have a buggy or confusing website. ;)

Now, how much of those yearly operating expenses are/should be spent on the insurance company's website and call centers, to sign people up, give them pricing/benefit info. and answer questions? Let's assume it's a mere 1%. In that case they are spending $900 million/year. That's just the OPERATING cost. How much did it cost the insurance company to CREATE the system in the first place? Probably more than the $900 million annual cost to OPERATE it.

So, this is not to make excuses for what is clearly a failure so far. But it does put the $360 million figure in at least a ballpark perspective. The cost of serving an entire nation live on the web and by phone is different from the cost of developing the iPhone. Let's compare Apples to Apples, not Apples to oranges. ;)

Frankly the conservatives guffawing remind me of the farmers in Animal Farm, watching the animals erect their own silo and celebrating when it fails.
 
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metis

aged ecumenical anthropologist
Just out of curiosity why would you go directly to an insurance company vice through the exchange. You still must meet the minimum requirements for coverage and I am "assuming" that open purchase price would be the same and even possibly more.

That's what I'm saying, namely that if people find the exchanges too high, they can go directly to the insurers. So far the exchanges are coming in lower than market cost.

Also, in part why I'm saying this is we hear this mantra about this "big government" program coming from the right, so what I'm saying is that if anyone who feels that way wants to buy insurance on their own thus by-passing the ACA, there's really nothing to stop them from doing just that.
 
So, maybe they should delay this until they get all the "bugs" worked out of the system? Gee at a price tag of somewhere around $360,000,000 to some estimate as much as $600,000,000 just to connect you to an insurance company you would have thunk they could have done a better job. It didn't cost Apple this much to design the iPhone (around $150 million)
Since I know you insist on source:
Developing Obamacare's Health Care Exchanges Has Cost More Than Apple's Original iPhone - Forbes

That's what I'm saying, namely that if people find the exchanges too high, they can go directly to the insurers. So far the exchanges are coming in lower than market cost.

Also, in part why I'm saying this is we hear this mantra about this "big government" program coming from the right, so what I'm saying is that if anyone who feels that way wants to buy insurance on their own thus by-passing the ACA, there's really nothing to stop them from doing just that.
Exactly. If the insurance offered by insurance companies outside of the ACA marketplace is so great for individual consumers, why don't people just go sign up directly at Aetna.com or UnitedHealthCare.com? People prefer the ACA for two reasons: (1) you can more easily shop and compare prices and play competitors off of each other, (2) typically much less expensive. The problem is buggy implementation not a flawed service in principle.
 

metis

aged ecumenical anthropologist
One needs to put this into perspective. From 1998 to 2008, America's health-care system doubled in total cost at a rate of a bit over 9% per year, and now it's down to 4%. Secondly, we will have to move to a single-payer system eventually or we will bankrupt ourselves and continue to hurt American business competing internationally.

Thirdly, the Republican-controlled House has prevented Medicare and Medicaid from negotiating with drug manufacturers for lower costs, and you would think the Republicans would be in favor of that because this actually would increase competition between suppliers. But the reason they won't is quite obvious-- it would lower dividends to investors.
 
Yes these people are likely going to be the losers of Obamacare: I call them the "healthy gamblers", or the healthy (usually young) people who gamble by (a) forgoing insurance, or (b) getting crap insurance on the individual private market with very low premiums, typically with minimal benefits and huge deductibles.

The problem with the healthy gamblers is that they enjoy the benefits of their gamble when they win, but the risks of their gamble when they lose are largely passed on to other consumers and taxpayers (and friends and family). The latter will have to step in to help cover the gamblers' medical expenses when some of them inevitably get old/sick, and are either kicked out or slapped with a big premium hike due to "pre-existing conditions", or simply have minimal coverage which doesn't really cover things like expensive cancer therapy, etc. Usually this comes in the form of "hidden costs", e.g. the gambler who loses goes in for an ER visit, can't pay, so the hospital raises its prices for other patients who can pay. Or the gambler gets old, switches to Medicare which is cheaper, so other taxpayers have to fund the end-of-life healthcare that the gambler never contributed to during their healthy working years, while the private insurer runs away with the profit.

The second problem with them is that it is unfair. Before the ACA, insurers simply refused to sell insurance to an individual if he/she had any serious health conditions. This allowed insurance in the individual market to have low prices. In short, the healthy gamblers benefited from a market which has low premiums because it discriminates against sick people. Nice. Once you end the discrimination, naturally, the costs get re-distributed and suddenly the healthy gamblers can't gamble anymore.

Yes their premiums went up. But by the way, their coverage also went up. It's not like they are paying more for the exact same insurance, they're paying more because they're getting more.
 

esmith

Veteran Member
And what happens when the "healthy gamblers", as you call them, refuse to sign-up for Democare and the only ones in the system are those in need of expensive medical treatment?
 

Revoltingest

Pragmatic Libertarian
Premium Member
Yes their premiums went up. But by the way, their coverage also went up. It's not like they are paying more for the exact same insurance, they're paying more because they're getting more.
This conflicts with what I've heard from the administration about the healthy subsidizing the sick & aged.
For reference, I have a pro-Obamacare source (Huff Post)....
9 Valid Concerns We Can All Have About Obamacare, Without Thinking It Will Literally Bring Hell On Earth
In the case of Obamacare, the success of the fledgling program will be heavily reliant on younger, healthier individuals, who provide less of a financial drag on the system and make sure sicker, older individuals can receive affordable coverage.
 
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This conflicts with what I've heard from the administration about the healthy subsidizing the sick & aged.
For reference, I have a pro-Obamacare source (Huff Post)....
9 Valid Concerns We Can All Have About Obamacare, Without Thinking It Will Literally Bring Hell On Earth
In the case of Obamacare, the success of the fledgling program will be heavily reliant on younger, healthier individuals, who provide less of a financial drag on the system and make sure sicker, older individuals can receive affordable coverage.
Right. I don't see a conflict.
 
And what happens when the "healthy gamblers", as you call them, refuse to sign-up for Democare and the only ones in the system are those in need of expensive medical treatment?
The question is if, not when.

I cannot know, but my guess is:

(1) If they are smart consumers, they will browse the ACA website (assuming they can ever get through) and shop around for the best prices.

(2) An unattractive alternative (for the gambler) would be to forgo health insurance and pay a tax penalty, to cover the medical costs of those in need (and the gamblers' own future costs).

(3) Another option is to get insurance through employer-sponsored group coverage, which will be much more widely accessible due to the ACA mandate on employers and tax breaks. Note that before the ACA, only 58% of low-income employees were offered and eligible for employer-sponsored coverage -- source: Kaiser 2008 report.

(4) Another option is to get Medicaid. The ACA expands eligibility for Medicaid.

There is a final option I can think of:

(5) Taken in by hysterical right-wing propaganda, healthy gamblers could choose to avoid even looking at anything the ACA offers in order to sabotage it, even if this also hurts their own rational self-interest.

Which option would you pick? I will not put it past 30% of Americans to choose #5 and yes, maybe the ACA will fail as a result. The right-wing propaganda machine has been very effective, I don't underestimate them on this point. So your question is a good one.
 
You said....
Whether they're getting more or not, a portion of what they pay under Obamacare is subsidizing the sick & aged.
I wouldn't call this "getting more" (for themselves).
Right. I'm saying they are getting more coverage, which is true. You are saying they are not necessarily getting more medical treatment, which is also true. Forget about Obamacare: the reason why an insurance premium, any insurance premium, is able to subsidize the care for people who are sick with condition X, is because people who are NOT receiving care for condition X are subsidizing it. BUT the people subsidizing are not getting NOTHING, they are still getting the benefit that IF they ever get condition X, they too will be covered.

If we now increase benefits to cover condition Y, we also increase premiums. The people paying those premiums--i.e. the people who don't have condition Y, who are subsidizing it--are indeed "getting more". They are getting more coverage--Y now, in addition to X. Perhaps 1% of them will actually come down with Y and benefit directly, the other 99% benefit indirectly from the increased coverage.
 
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esmith

Veteran Member
The question is if, not when.

I cannot know, but my guess is:

(1) If they are smart consumers, they will browse the ACA website (assuming they can ever get through) and shop around for the best prices.
(2) An unattractive alternative (for the gambler) would be to forgo health insurance and pay a tax penalty, to cover the medical costs of those in need (and the gamblers' own future costs).
(3) Another option is to get insurance through employer-sponsored group coverage, which will be much more widely accessible due to the ACA mandate on employers and tax breaks. Note that before the ACA, only 58% of low-income employees were offered and eligible for employer-sponsored coverage -- source: Kaiser 2008 report.
(4) Another option is to get Medicaid. The ACA expands eligibility for Medicaid.
There is a final option I can think of:
(5) Taken in by hysterical right-wing propaganda, healthy gamblers could choose to avoid even looking at anything the ACA offers in order to sabotage it, even if this also hurts their own rational self-interest.

Which option would you pick? I will not put it past 30% of Americans to choose #5 and yes, maybe the ACA will fail as a result. The right-wing propaganda machine has been very effective, I don't underestimate them on this point. So your question is a good one.

Which option would I pick is your question and my answer is "none of the above". I'll just stick with what I have since that is my only viable option.
 
Which option would I pick is your question and my answer is "none of the above". I'll just stick with what I have since that is my only viable option.
Okay. You are not a "healthy gambler" whose individual-market premiums are increasing as a result of the ACA. We were talking about them.
 

Revoltingest

Pragmatic Libertarian
Premium Member
Right. I'm saying they are getting more coverage, which is true. You are saying they are not necessarily getting more medical treatment, which is also true. Forget about Obamacare: the reason why an insurance premium, any insurance premium, is able to subsidize the care for people who are sick with condition X, is because people who are NOT receiving care for condition X are subsidizing it. BUT the people subsidizing are not getting NOTHING, they are still getting the benefit that IF they ever get condition X, they too will be covered.
If we now increase benefits to cover condition Y, we also increase premiums. The people paying those premiums--i.e. the people who don't have condition Y, who are subsidizing it--are indeed "getting more". They are getting more coverage--Y now, in addition to X. Perhaps 1% of them will actually come down with Y and benefit directly, the other 99% benefit indirectly from the increased coverage.
I'm pretty familiar with how insurance works, but Obamacare incorporates more than subsidy based upon similar risk sharing. It also includes redistribution of costs where risks differ among the groups, eg, the young vs the aged. As I heard an admin spokesman explain it, the young will subsidize the old. So a portion of their bill is to cover someone else. Tis analogous to home insurance being the same price for big & small houses....it's still sharing the cost of the risk, but the bigger home would be subsidized thru redistribution. (Note: For the moment, I take no position pro or con about the appropriateness of this.)
 
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I'm pretty familiar with how insurance works, but Obamacare incorporates more than subsidy based upon risk sharing. It also includes redistribution of costs where risks differ among the groups, eg, the young vs the aged. As I heard an admin spokesman explain it, the young will subsidize the old. So even if their coverage increases (an unknown), a portion of their bill is to cover someone else.
Yes there's a redistribution of costs. Yes the healthy gamblers who made good bets (i.e. the low-risk groups you refer to) will tend to be net losers. As long as they aren't one of the unlucky few who lose the bet, they would have generally benefited from the low premiums made possible by the unfair system of discrimination I described in post #69.

This does not contradict the fact that these net losers are nevertheless getting something in return for their higher premiums--namely, increased coverage. They are not paying more for the same insurance. I'm saying the loss due to the higher premium is at least partially offset by a gain, namely a gain in coverage, but also a gain from the decreased hidden costs spread around to all of society by the actions of the healthy gamblers (as I described in post #69). I'm not saying that this doesn't end up being a net loss, on balance, for many individual healthy gamblers (the ones who win anyway).
 
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Revoltingest

Pragmatic Libertarian
Premium Member
This does not contradict the fact that these net losers are nevertheless getting something in return for their higher premiums--namely, increased coverage.
I've no argument against this.

They are not paying more for the same insurance. I'm saying the loss due to the higher premium is offset by the gain in coverage, I'm not saying that this doesn't end up being a net loss, on balance, for the healthy gamblers (the ones who win anyway).
This remains to be seen. So far, no one I know has been able to even sign up for Obamacare.
We might need many months to begin to see the quantitative effects of the changes.
 
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