OBAMA/TRUMPCARE MEGATHREAD

[iamshack]

While part of the calculation, you are claiming that publicly traded insurance companies are artificially lowering their profit margins by paying out to executives...and again, no, that's just not the case. Investors wouldn't accept that, as it's their money, and they have the collective power, not some CEO inflating his salary to "hide profits".

 

That's just laughable.

They certainly do this, except they often do it in the form of LTIPs containing tens or hundreds of thousands of shares of stock.

[Soxbadger]

/points up to Illinilaw

 

See now there is someone who actually wants to discuss the real world. But before we can get to that discussion, we first have to determine, do we really want a system where everyone gets covered? Or do we prefer a system where the wealthy/lucky have an advantage?

 

That is what Im trying to get to the bottom of when I talk with people like Jenks/Y2hh.

 

Do they even really want a system where all people are covered?

 

They act like its a crazy utopian idea, akin to eradicating all sickness.

 

I think its a possibility.

Edited October 31, 2013 by Soxbadger

[cabiness42]

See now there is someone who actually wants to discuss the real world. But before we can get to that discussion, we first have to determine, do we really want a system where everyone gets covered? Or do we prefer a system where the wealthy/lucky have an advantage?

 

Can we not have both? Can't we have a system where everybody gets basic coverage, but those with means can get better coverage.

[Jake]

BTW Tex, I forgot to add one of the "minimums" I don't agree with in this law is that plans have to include mental health services and pregnancy/maternity/newborn services. That applies even if you are buying an individual policy for a male. Why on earth would a male need to pay for pregnancy/maternity services? Why should he have to pay for something he will literally never, ever use? Why should someone be forced to buy mental health services if they've never had a history of any kind of mental health problem?

 

SS said it yesterday - technically people are going to pay more for better policies with better coverage, but maybe people don't need that coverage? Maybe they don't want to spend the extra money on those things, so why are we taking that choice away?

 

The babies born into our society are your concern. If they aren't properly cared for, they pose a substantial burden on society. This applies not just to disabilities or sicknesses related to the birth process. I suppose you were an infant once, and you probably lacked choice in terms of who you were coming out of and into what circumstances you'd find yourself in. I have no idea how you feel on this issue, but I'd like to evoke the abortion argument for an example. Liberals like myself like to say that conservatives care a whole hell of a lot about fetuses until they are born: this is EXACTLY what we're talking about!

 

The general conservative (I'm not sure about you, in particular, in this case) demands that a baby be born but doesn't give a flying s*** about the circumstances of its eventual birth and upbringing. Helping maternity services is an incredibly efficient investment for our society. Not only does it reflect an interest in our fellow humans, it allows for a greater chance of a healthy birth (mother and child). An insufficiently cared-for mother jeopardizes the existence of her child, who will burden society with more harmful things than negligibly higher insurance premiums. A mother/family that is incredibly financially burdened by the costs of child birth will likewise be less able to adequately raise a child. You can say what you want about individual accountability (though in the case of a pro-life person, they will have prevented a potentially responsible action of ending the pregnancy long beforehand), but these things easily become public problems.

 

I'm honestly sad that I even have to explain this in mostly utilitarian terms as if it isn't on its face an offensive proposition. I'm not sure that I even want to get into the inherent biases in evaluating this from a male point of view. Given that men need less gender-specific healthcare, who gives a f*** about taking care of women? Women have nothing to do with us men, after all. Our outcomes are separate. I suppose you also wouldn't like to have your insurance dollars help out black people with sickle cell, women with breast cancer, etc. Likewise, your prostate cancer is your problem and they should have nothing to do with that.

 

These attitudes certainly couldn't have anything to do with why black infant deaths outnumber whites 2.5:1, which has been increasing in the past decade. ACA spending reducing overall infant mortality by over 7% can't be related either.

 

Of course, this just makes the point about mental health even more hilarious. What the f*** is the point of insurance if you are only paying for things you have a history of? It used to be the opposite. I know you think you are immune to mental illness, but mental health is simply a part of overall health. Mental health issues are biological and the fact that the ACA has started to bring mental health into the same sphere as everything else is a huge public health accomplishment. This is another case where you benefit substantially by being in a society in which people's mental illnesses are treated instead of denied, suppressed, or simply unseen.

 

Soon, there will be another gun thread, and the thread will fill up with people not wanting any restrictions on guns and thus interpret mass shootings to be an unequivocal failure of the mental health system. These people will also be very pissed off that their insurance covers EXTREMELY basic mental health screenings.

 

The general issue here is coercion. There is no choice here. Consumers can choose how much to spend on healthcare in a free market, but for the vast majority, their life is priceless. They will not elect to die when crisis hits and their insurance (or lack of it) is insufficient. Our society rightfully doesn't like the idea of people simply dying because they ran out of money. I'm not going to bother explaining this, because folks don't seem to listen. Instead, I'll pass it off to Friedrich Hayek. Hayek is the most important free market libertarian, ever. He has influenced our understanding of the free market and his understanding of economics and philosophy of governance define libertarian and fiscally conservative political philosophy. Folks like Milton Friedman, who is similarly well-regarded and still alive today, acknowledge him as their primary influence. Let's see what Hayek said about this whole health, insurance, public goods issue:

 

“There is no reason why in a society which has reached the general level of wealth which ours has attained [note: Hayek was writing not in prosperous post-war America, but in war-torn, austerity-ridden Britain in 1943] the first kind of security should not be guaranteed to all without endangering general freedom. .... [T]here can be no doubt that some minimum of food, shelter, and clothing, sufficient to preserve health and the capacity to work, can be assured to everybody. ... Nor is there any reason why the state should not assist the individual in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision.

 

"Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance – where, in short, we deal with genuinely insurable risks – the case for the state’s helping to organize a comprehensive system of social insurance is very strong. There are many points of detail where those wishing to preserve the competitive system and those wishing to super-cede it by something different will disagree on the details of such schemes; and it is possible under the name of social insurance to introduce measures which tend to make competition more or less ineffective. But there is no incompatability in principle between the state’s providing greater security in this way and the preservation of individual freedom.

 

"To the same category belongs also the increase of security through the state’s rendering assistance to the victims of such ‘acts of God’ as earthquakes and floods. Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make provision for the consequences, such communal action should undoubtedly be taken.

 

Why? We are not actually FREE to make choices under certain conditions - virtually any regarding health. We try to hedge bets, but there is no recourse if we miscalculate. His other examples are just as pertinent: a free market doesn't consist of free actors making rational choices if they lack a minimum of resources.

[Soxbadger]

Can we not have both? Can't we have a system where everybody gets basic coverage, but those with means can get better coverage.

 

I have no problem with that. Im not saying that everyone has to have equal coverage. I am saying that I believe everyone deserves to have a basic minimum coverage and then if you want to spend more, well that is your money, you can do what you want.

[Texsox]

Even if the deductible is 10,000$, that's just there to cover catastrophic hospital stay, which could exceed hundreds of thousands in mere days...versus 10,000, which they can pay over time.

 

You do realize that at any hospital, at any time, you can pay down your bill -- interest free -- over a span of years, right?

 

So yes, I expect them to pay it...since they can do so over a span of 5 years at a low low interest rate of nothing.

 

You do know that is not the terms that the hospitals offer, it is what they are stuck with accepting from people that are under insured? And you do realize that interest free loan increases the cost.

 

 

[Y2HH]

You do know that is not the terms that the hospitals offer, it is what they are stuck with accepting from people that are under insured? And you do realize that interest free loan increases the cost.

 

I'm over insured, and I'd leverage those interest free loans if it ever presented itself.

 

As a matter of fact, I have, prior to having the insurance I have now. Why pay the amount you owe up front, regardless of what it is, when you don't have too? Anyone can do this, not just underinsured people or people without money. If you end up owing 500$, pay 50$ a month, interest free. I mean, why wouldn't you?

Edited October 31, 2013 by Y2HH

[StrangeSox]

We're getting there, step by step.

lol

[StrangeSox]

There is an incentive for any for profit insurance company to NOT pay claims, or to not insure people who, by virtue of losing life's lottery, have conditions that would cost the insurance company more to insure. Further, there's an incentive to shareholders to have the insurance companies maximize profit (the rationale behind the massive bonuses and salaries that CEOs and other high level executives obtain). When the insurance companies control the access to health care and are motivated by profit, the unlucky are excluded. That's why for profit, publicly traded, health insurance is a poor system to build a national health care system on.

 

This can apply somewhat to "non-profits" as well. Just look at modern academia "non-profits" with bloated administration staff with huge salaries.

 

[StrangeSox]

Can we not have both? Can't we have a system where everybody gets basic coverage, but those with means can get better coverage.

i.e. basically how every socialized system works

[Jenksismyhero]

/points up to Illinilaw

 

See now there is someone who actually wants to discuss the real world. But before we can get to that discussion, we first have to determine, do we really want a system where everyone gets covered? Or do we prefer a system where the wealthy/lucky have an advantage?

 

That is what Im trying to get to the bottom of when I talk with people like Jenks/Y2hh.

 

Do they even really want a system where all people are covered?

 

They act like its a crazy utopian idea, akin to eradicating all sickness.

 

I think its a possibility.

 

I want a system where first and foremost, if you have the means to pay, and you have issues with your health, YOU pay for it out of YOUR pocket, because it's not the rest of societies responsibility to pay for YOUR mistakes of smoking, eating McD's 5 days a week, not exercising blah blah. If you lost the life lottery, tough titties. It's still on YOU, the individual and/or your family to deal with it. That's how we operate in just about every other area of life, and I don't see why healthcare should be any different. That doesn't mean you pay dollar for dollar the cost of that health care, that means you can buy a product (insurance) of your choosing which you think is adequate to cover the ifs and maybes of life. And the government should make sure that insurance companies provide adequate choices (i.e., allowing for pre-exisiting conditions, providing catastrophe policies for those without the means to pay for a large policy they'll never use, etc.) and play fair in what they offer.

 

Now, as that as a baseline, no one in this country should die or lack treatment because they don't have the funds to pay for it. No one should go broke because they have serious health issues. We're better than that. We're prosperous enough for that. I have no problem creating a system designed to help people in need.

 

I just don't know if forcing everyone to be covered and then forcing everyone to share the costs is the right way to go about this. Reducing costs by some means, getting people to see nurse practitioners and walk-in clinics, opening up the borders for cheaper prescription drugs, etc.

 

[Balta1701]

I want a system where first and foremost, if you have the means to pay, and you have issues with your health, YOU pay for it out of YOUR pocket, because it's not the rest of societies responsibility to pay for YOUR mistakes of smoking, eating McD's 5 days a week, not exercising blah blah. If you lost the life lottery, tough titties. It's still on YOU, the individual and/or your family to deal with it. That's how we operate in just about every other area of life, and I don't see why healthcare should be any different. That doesn't mean you pay dollar for dollar the cost of that health care, that means you can buy a product (insurance) of your choosing which you think is adequate to cover the ifs and maybes of life. And the government should make sure that insurance companies provide adequate choices (i.e., allowing for pre-exisiting conditions, providing catastrophe policies for those without the means to pay for a large policy they'll never use, etc.) and play fair in what they offer.

 

Now, as that as a baseline, no one in this country should die or lack treatment because they don't have the funds to pay for it. No one should go broke because they have serious health issues. We're better than that. We're prosperous enough for that. I have no problem creating a system designed to help people in need.

 

I just don't know if forcing everyone to be covered and then forcing everyone to share the costs is the right way to go about this. Reducing costs by some means, getting people to see nurse practitioners and walk-in clinics, opening up the borders for cheaper prescription drugs, etc.

Can someone just note how deep the contradiction between the first and 2nd paragraph is here?

[StrangeSox]

Reducing costs by some means,

 

This is a pretty important detail that can't just be hand-waived away. How do you reduce costs and provide basic health care access for every American if you're dead set against a full-blown socialized system and against the mandate that enables community rating and guaranteed issue?

[StrangeSox]

I want a system where first and foremost, if you have the means to pay, and you have issues with your health, YOU pay for it out of YOUR pocket, because it's not the rest of societies responsibility to pay for YOUR mistakes of smoking, eating McD's 5 days a week, not exercising blah blah. If you lost the life lottery, tough titties.

 

But that's not at all how health insurance works for a majority of Americans, before or after the ACA. A lot of people get coverage through Medicare/Medicaid/VA, and an overwhelming majority of the rest of us get it through group plans with our employers.

 

And it's also pretty odd to describe the need for health care primarily in terms of some unhealthy habits you don't care for. I don't eat fast food, I don't smoke, I exercise, and yet I still have a couple of chronic conditions that I've had since birth (allergies, ADHD) and that I'll always have.

[StrangeSox]

No, i'm saying that I don't think insurance companies increase premiums willy nilly or for some nefarious profit-driven motive. Yes, they obviously seek as much profit as possible, but competition doesn't allow them to jack up prices or get rid of plans for profit motives alone.

 

I don't think I've said anything different here. We agree that health insurance companies will try to get people to buy the plans that maximize their profits the most, and that they're constrained by market and regulatory forces in that regard. In this case, there may be real regulatory effects, but there may also be predatory tactics using the regulatory changes as an excuse coupled with the entire industry working in a cartel-like faction to all agree to uniformly make these changes. It certainly wouldn't be the first time that happened.

 

I'll wait and see what my insurance company says, but I find it odd that they'd send out an email warning their insureds that they won't have the same options and prices will rise. I can't imagine that's just catastrophic plans since they're probably the least popular that is offered.

 

Lots of people get notices every year that some options are changing and/or that their prices are changing.

[Jenksismyhero]

Can someone just note how deep the contradiction between the first and 2nd paragraph is here?

 

That you should be responsible for yourself as much as possible and once you can't society should help out? Yeah, SO contradictory.

[StrangeSox]

I consider an "everyone pays into the collective pool regardless of how much you take out" system socialistic.

 

Okay I think others have already pointed this out but this is the basic concept of insurance risk pools. I guess it's pretty accurate to describe the concept of insurance as collectivist, but that seems like an odd objection unless you're a hardline libertarian or something.

[StrangeSox]

That you should be responsible for yourself as much as possible and once you can't society should help out? Yeah, SO contradictory.

Insurance plans should have deductibles that differ based on an individual's income/wealth/debt-to-income ratios? Sounds like an administrative nightmare.

[Jenksismyhero]

This is a pretty important detail that can't just be hand-waived away. How do you reduce costs and provide basic health care access for every American if you're dead set against a full-blown socialized system and against the mandate that enables community rating and guaranteed issue?

 

I dunno, not an expert there. I just know the solution doesn't have to be a single payer system where the government just sets a price and everyone falls in line.

[StrangeSox]

I dunno, not an expert there. I just know the solution doesn't have to be a single payer system where the government just sets a price and everyone falls in line.

Well, that's a solution that works pretty damn well in a lot of other places (including a significant portion of this very country). All you're offering is a simple ideological objection and no alternative.

[Jenksismyhero]

Insurance plans should have deductibles that differ based on an individual's income/wealth/debt-to-income ratios? Sounds like an administrative nightmare.

 

Pretty sure the IRS and federal loan companies do a pretty good job of keeping track of those things.

[Balta1701]

That you should be responsible for yourself as much as possible and once you can't society should help out? Yeah, SO contradictory.

I can already read your "you shouldn't be eating at McDonalds 5 days a week" complaint when someone has a heart attack with no insurance and sticks the taxpayer with a $100k bill for the emergency room.

[StrangeSox]

Pretty sure the IRS and federal loan companies do a pretty good job of keeping track of those things.

 

So you want to provide BCBS with your tax return every year so that they can adjust your policy costs appropriately every year? This would effectively eliminate the entire concept of group plans (i.e. what a majority of americans have). I'm struggling to understand what your envisioned policy here is and why it should be that way.

[StrangeSox]

Jenks, is it fair to say (based on your previous posts) that you don't even really believe that there's a significant number of people out there who lack access to affordable health care? You seem to be arguing that we should do something to address that problem, even if you don't know exactly what that would be*, but my impression in the past has been that you don't accept that it's even actually a problem.

 

*you don't need to have some fully developed substitute or anything in order to criticize existing systems and structures, I hope that was phrased neutrally enough.

[Soxbadger]

Im not sure why you are piling on Jenks. He was honest, he thinks that people should get some support but he doesnt want the govt just throwing money around if people arent going to be responsible with their health.

 

Thats not an outlandish position. In fact maybe things would work better if people tried to flesh out ideas instead of harping on hypocrisy.