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Friday, October 25. 2013
The good idea behind Obamacare
The good idea behind Obamacare was the idea of a national marketplace for medical insurance. Of course, an insurance consortium could have done it too, but the complication in that is that insurance is controlled and regulated state by state.
A deregulated, nationwide marketplace for every kind and flavor of medical insurance with wide competition for coverage format, would have been a good thing for everybody - and put a lot of brokers out of business. Probably most people would opt for cheap high-deductible insurance (Major Medical, aka Catastrophic) as protection against bankruptcy. Brokers have easy access to all available deals within a given state, but it's not national and not available to consumers, and now the ACA has strictly limited peoples' choices.
Instead, we have an illusory marketplace selling government-designed product at government-determined prices, and they'll fine you if you don't buy it. Doesn't sound like America to me.
Requiring marketplace insurance companies to cover the highest-risk patients is a challenge with many possible solutions. Coverage for kids to age 26 is insane and infantilizing. Adulthood is 21, at the latest. However, "adulthood" keeps creeping upwards, doesn't it?
The other useful reform would have entailed tort reform. I have read varying estimates about how many medical costs are lawsuit-avoidance, but it is substantial.
Posted by The Barrister in Hot News & Misc. Short Subjects, Our Essays at 14:22 | Comments (24) | Trackbacks (0)
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I've told many people Obamacare has its good points. Sadly there aren't enough to make up for its flaws.
"The good idea behind Obamacare was the idea of a national marketplace for medical insurance"
The progressive idea would be for me to be able to pick and choose from whatever insurance products others deemed profitable to sell. Individual state "regulators" and such be dam*ed.
yes, a national platform for insurance companies to display and advertise their products to the widest possible audience without being afraid of regional differences in regulations that make it impossible (even illegal) to offer those products outside of a narrowly defined area.
That'd be a good idea. The actual implementation of course is something else entirely.
Another good idea would be to get back to the concept of insurance versus prepaid medical expenses.
Insurance needs to be a national market not a product that is manipulated and controlled state by state.
I am not an Obamacare fan, Barrister, and I agree with many of your points.
But if you had any children under 26 you might not make such snarky comments about giving health insurance to this group of people. Bear in mind that most people who have health insurance at work are paying more and more each year for it, and the deductibles, copays, etc. are constantly increasing. It's merely a matter of a couple keeping on paying for a family plan rather than just paying for one or both of the couple. They are paying for this insurance.
My friends at work and at church have children just out of college with excellent degrees in things other than grievance studies who are all under 26. I'm fortunate to have one who is employed full time. Most of the kids are feverishly paying off student loans. Most of the kids who are not independently wealthy and following their bliss making movies are now working multiple part-time jobs and borrowing their parents' car to get to work at all, while living at home, because they cannot find full time work with health benefits and cannot afford the 2000 a month rents around here. Not everybody has a pack of 4 friends to get an apartment with.
Many of these kids are actively involved in helping their parents care for aging, sick or disabled family members, and are also helping married siblings in the area by giving them relief babysitting. These kids are decidedly NOT slackers but young people with a strong sense of family obligation, and also young people who (like most of us if we are honest about what we were really like in our twitter pated youth) don't know exactly what they want to do with the rest of their lives professionally.
Most of them resist jumping into graduate school to escape unemployment because they don't want to emerge with hundreds of thousands in debt into an uncertain job market.
Not every kid is cut out to be a hedge fund pirate (or to marry one) or to be an entrepreneur. The kids who have been scholars and academic stars all their lives are no longer going into academia because universities have become PC and there aren't enough jobs any more in serious academic disciplines. Creeps who insist on "relevant" college majors have gutted universities of classics, history, archaeology, art history, and religion departments out of the belief that students who major in Greed will somehow create a better America....
The blue collar kids I know who skipped college (as this blog irresponsibly encourages young people to do) largely languish between part-time jobs they get when Mom harasses Uncle Vinny to bring them on part-time to his construction site. But they only get a day or two (unless something like Sandy hits which provides jobs for everyone for awhile) because the contractors prefer to hire non-English speaking illegals who will not sue them if they get disabled in unsafe working conditions and who they can pay below minimum wage. The kids I know who are eager to work manual labor or skilled trades can't get apprenticeships because the electricians, plumbers, etc around here don't do those any more. They just hire illegal Russians or Mexicans or whomever. Easier than training an American kid, even an eager and willing one. The American kids get part time and summer jobs, and get turned down at all the fast food and Dunkin Donuts type jobs they apply for (take a look at WHO is working there, it isn't native born North Americans).
Now, you might suggest that they just go West or South in search of work, and some of them do.
The bravest ones join the services. We recently mourned a paragon of a kid who came back from brave service in Afghanistan and committed suicide. PTSD. God rest his soul.
But the part of the equation that I never hear discussed on this blog is family ties. A young person who worries about the parent starting to show signs of Alzheimer's, or the sibling who is depressed, or the working mommy cousin they want to help with the kids. People try to stay places for positive reasons, not just inertia.
My father's peer group of bosses sneered at working class unwillingness to leave a neighborhood for the sake of work opportunities, but my parents moved us all over the world to places where we never saw extended family and were isolated. Personally, I think the blue-collar perspective of staying close to family is far wiser than the insanity of moving across the country for a company that has zero loyalty to you and will not give a damn if the move breaks up your marriage, destroys your kids lives and breaks your parents' hearts.
As far as insurance til kids are 26, this is an absolute God send. There is a chance that a child will get a full time job with benefits by the time they are 26. So it tides them over.
The other issue is simply one of what do parents do who have disabled or ill children? Many of us can breathe a sigh of relief that they are at least covered til they are 26, and then maybe one of us parents will die and the life insurance from them will help pay for the medical care for the kid while the surviving spouse tries to care for them. Rich old white guys have the luck to die suddenly of a heart attack, but parents of disabled kids pray that at least one of them will live forever so they can take care of the kid.
Excuse my rant, but I think some sympathy for this generation of kids would be in order. I am extraordinarily impressed by the ones I know. They are decent, intelligent, dedicated to friends and family. They have grown up in an era of revoltingly corrupt political leaders, dishonest bankers, and companies that would consider Captain Jack Sparrow too sentimental and kind to keep on the payroll. They have had their chidlhoods blighted by parental narcissism, parental divorce, parental unemployment (take a look at the stats on how many American middle class males over the age of 45 are actually in the workforce any more--they aren't all millionaires, and it isn't that they are voluntary hippies). We in our generation have set them an abominable example. We indulge ourselves and, on our watch, this country has accrued vast debts that will weigh down these kids for life.
To be niggardly about covering their doctors' visits for a few more years on top of everything else? Really!
You, sir/madam, are a blabber mouth with nothing of value whatsoever to contribute to the discussion at hand. You are the perfect candidate for socialism, a person overwhelmed by their own self absorbed senselessness. Begone!
You should stick around, and perhaps the intelligence and good manners of the regular commenters may rub off. This is a blog that prides itself on spirited and polite discussion.
Not that I have anything against young people, or people who care for aging members of their families...but that's not a reason to give away something for 'free' to them, and subsidize it by taking from others.
Allowing family coverage to run through to an older age, in a free market, would be an offering if there was demand for it and clearly there is. But we don't have a free market, and we should.
Furthermore, the cost of 'care' for aging individuals is a considerable driver of health costs. In many cases that 'care' is extraordinary means for extension of end of life care...basically snatching a few extra days or weeks (sometimes months and years) when the body has more or less given out.
On another thread, I shared a story about a family friend whose mother is so old she is incapacitated beyond her ability to care for herself and is on a feeding tube. She recently was diagnosed with cancer.
The family, already strapped financially, was advised by doctor, priest and friends to give her limited care and allow her to go as painlessly and quickly as possible.
But the family will not allow it. Treatment for the cancer has begun, and their financial situation is worse.
Is this really 'caring' for someone you love? I don't think so. But it is one reason why you're likely to be paying more the next time you go to a doctor.
Technically, Obamacare is useless and it will undoubtedly cost us much more than he said it would. Sure, a few good ideas were salted into an otherwise useless program....but that doesn't make it good.
I agree with your comments. Especially about the end of life care. A coworker recently died agonizingly over months being literally tortured by chemo that may have prolonged her life by perhaps a few weeks but that made her last months terrible (and cost tens of thousands of dollars a month).
By contrast, when my golden developed cancer at age 11, we were told that the expensive treatment proposed wouldn't significantly prolong his life. So we didn't inflict it on him. He lived happily two and a half years, then died two days after galloping on the beach with his friends. Why do we torture people when a dog is allowed to die so much better?
I like Gone with the Wind's plan. Show some respect to Americans to decide for themselves. But commenter jma highlighted the core problem: there are still going to be 30 million uninsured, and what to do with them? Because in this country plenty of people refuse to pay for their own insurance but then they still expect the rest of us to cover their care when their denial has to give way to a bad diagnosis or an accident and they need expensive treatment. People can fight about whether sick people should pay higher premiums than healthy ones, but at least people who buy their own private insurance are buying into the notion that they are responsible to cover their own risk.
The problem isn't 30mm uninsured. Insurance isn't the issue at all. It's how we propose to 'solve' an issue which we call a 'problem'.
30mm uninsured doesn't mean 30mm without health care. That's the phony line.
And providing insurance (what we call 'health care') to these people means we have to cover things we probably shouldn't, such as we're seeing with birth control.
At what point does personal responsibility trump 'social responsibility'? Always, I say. I may have a responsibility to others in a broad sense, but I have a responsibility to myself and my family first and always. No version of government supplied coverage accounts for this.
What we are really talking about when we discuss 'health care' is catastrophic and chronic coverage, an entirely different discussion from the one anyone on these threads, this blog, or this nation is actually having.
No, there are no good ideas behind Obamacare. The government has no business being in the insurance industry. The free market would have done an infinitely better job at delivering the products people want at the best price. Exchanges? The free market would have done that, if allowed to.
Just like the auto industry and the steel industry and the textile industry, etc. had no business in the insurance industry, which has resulted in something that is a hybrid between a rock and a hard place. Insurance should follow the individual/family who selects from a smorgasbord of features meeting the specific needs of that purchaser. If one insists on a pre-paid medical plan, fine. I would prefer to save for the incidentals and buy a catastrophic plan at whatever level I -- the operative word is I -- choose.
Sob stories have been around for millennia and I have seen my fair share. I assure you that after all this has settled down, we will still have 30 million or more uninsured people demanding medical services at the ER.
I believe that was The Barrister's point.
Given there was no market, the question isn't whether what Obamacare's value is versus a free market (on that point you're correct), but that there IS good stuff in Obamacare, it's just been poorly developed and applied, and (more to the point) the rest of it is pretty horrendous.
Summary of the above rant: someone else pay for the lifestyle I want because I am unable and unwilling to adapt.
I was standing looking at my daughter's school gathering yesterday looking at the vast majority of recent immigrant parents. All of whom took jobs from Americans as the democratic party opens borders for votes in conjunction with Big Business who want cheap labor (both illegal and tech H1B like Facebook). The crux of the above rant is the result of the vast influx of immigrants and the resulting collapse in wages, increased use of services and the increasing tide of block voting that prevents the tide's reversal. As everyone sees the death spiral that has started everyone is taking what they can for themselves off the decaying carcass of America, so we have crooked CEOs, crooked bankers and the like siphoning off as fast as they can while the politicians redistribute the remaining wealth to the masses.
You can bitch and moan and get your crumbs or you can adapt. I fear for my daughter's future as much as the above parent, but I am not going to lament that things are not like they were when I was growing up. I am going to figure out how to keep my family ahead of the curve - not thank some vast redistribution program for tossing my kid a favor.
Fascism is never a good idea so, no, there are no good ideas behind Øbamacare. It's Nazicare plain and simple. The federal government has NO business being involved with medicine. Period.
This may not be too popular, but I think insurance itself is either one of or the root cause of expensive and chaotic medical care. Once medical insurance appeared doctors had to hire and pay more admint help. Insurance companies represented pools of money for lawyers hence suits and higher malpractice insurance costs. All this attracted politicians, which is a short and inadequate explanation for how we got to where we are today.
Sadly Obamacare will never be reversed. We missed our chance and the Republicans are too committed to politics and not committed to the people or the constitution. I suggest two simple changes that we should lobby for that will at least make it "fair". 1. Make it optional. No one has to participate and no fines. 2. Make it self supporting. That is for all participants they must pay the full cost of the system, no government subsidy, no taxes, all costs from the premiums paid by those who choose to be in Obamacare. Two simple changes. The legislation could be written one piece of paper and leave enough room for the Gettysburg address.
I'd like to think that, given a choice, more Americans would opt for a cheaper, high-deductible plan. But I'm not seeing it. While I'm furious that the ACA takes my affordable $10K deductible individual policy off the market and makes me buy a more expensive policy with a $6,250 deductible, what I'm hearing on all the comments boards is that people are horrified by having to switch from their low deductibles to higher ones in order to keep their premiums down. They can't believe they're going to have to pay most of their own medical bills in an ordinary year. In fact, they try to lecture me about how it's for my own good that my $10K deductible plan is being taken away, because I probably didn't understand how dangerous it was.
(Apparently they can't do arithmetic and figure out you can't come out ahead paying $4, 800 extra for a $3,750 reduction in your deductible.)
Sen. Ron Johnson (R-Wis.) is pushing an ACA amendment called "If you like your plan you can keep it." He deserves our support, and I would appreciate it all of you emailing your senators and congressmen about it. Offering people additional plans choices is fine, but why take my options away?
But if you had any children under 26 ...
Well, I do. And the number of them I still carry?
"I'd like to think that, given a choice, more Americans would opt for a cheaper, high-deductible plan"
Exactly the crux, and piggy backs onto the "prepaid medical vs insurance" bit.
The part that "reformers" and "health care advocates" wish to brush under the proverbial rug is that most adults regularly use very little "healthcare". An insurance product covering catastrophic issues w/high deductables would be fairly inexpensive, especially if said product could be scaled across state lines.
Oh, and ditch the asinine "co pay". Come up with a real cost for my call, will you?
(yes, I'm one of those who will pay cash at the doc's office - drives 'em nuts, but they work it out - and in twenty + years I've always paid less than 1/2 the original "price")
Jess, you hit the nail on the head: "reformers" and "health care advocates", those busy bodies that are present in every niche and cranny of our existence, cause more disruption, more "unintended consequences" than any natural disaster.
We've already seen the unintended consequences of using health insurance as a tweak to get around government wage controls during WWII. Such benefits became "law of the land", but what happens when the company goes out of business and one has to find a new policy after years depending on Cadillac coverage?
Obamacare is so damn complicated that it will take a decade to see the effect it has on our economy, our R&D in medicine, our training of appropriate medical professionals, the graft and lobbying of our politicians. Frankly, I could have developed and actually have shared some simple twitches to our present system that could have fixed many of the problems by bringing back a free market with some government assistance for those with special needs.
A recent incident suggests Jess is correct. A well-like physician got so upset by the Electronic Medical Records component of ACA, that he stopped taking any insurance. Cash only. He did some cost analysis about how much that saved him in time and staffing and now he can bill about one-third of what he had to charge before in order to have a reasonable return. He has a physician's assistant, a nurse, a lab tech -- but no more staffing for billing, arguing with gatekeepers, harassing insurers for payment, etc. He has time to spend with patients and can offer some free care for he deems need help. He is so busy and his patients are so content that he has other docs in the community testing the same model.
Its a paradigm switch for some of his patients, who now know have to put aside a kitty for medical care, but they are beginning to see the advantages. He posts his charges in his waiting room, so they know what to expect. He recommends they buy a catastrophic care policy and the insurance broker in town is quite happy to suggest appropriate products.
Let's hope, if nothing else, Obamacare leads to a simpler, more logical healthcare system with this type of choice at its crux. The present ACA is so very stupid.
I agree that this is a great option but it is not allowed under Obamacare, which requires under law that everyone buy a government approved level of insurance coverage.
What state was that in? Doesn't make much difference, now that it would be illegal.
I think they are going to be very surprised to find a bunch of people, mainly without the subsidy, but even some with, will drop their now more expensive coverage.
1) End of life consumes about 70% of an individual's total life spending on medical services. That's a crude average, distorted by inflation, but there it is.
2) The medical-pharma complex is ten times the size of the military-industrial complex -- yet is structured as a cost-plus cartel.
3) This entity is in gross violation of the Sherman Anti-Trust Act. Prices are rigged to the moon.
4) The latest generation of trick medications are priced to sell ONLY to the government, under one program or another. Private individuals get the exact same drugs for FREE. (Compassionate)
5) America is subsidizing the rest of the planet in the development of new drugs. This subsidy hits the Medicare + Medicaid accounts, which is why they are exponentiating away into orbit.
6) The tyranny of 0bamacare is driving physicians into passive revolt. Most are NOT signing up. 0bamacare is Medicaid on steriods.
7) 0-care loots from the elderly by tapping Medicare on a massive scale -- the intent is to clip them off with the Death Panels.
8) 0-care loots from the young adults.
9) De facto the funds are shunted to illegal immigrants. Remember, they can NOT be denied care. They merely need show up at the ER.
Buried in all of the cross postings, 0-care deflects funding into ER all across America, so that they can be expanded to provide snap service to new Democrats. This is where the money is going. Talk of illegals not qualifying for 0-care is designed to fool the proles. They are going to be covered by way of the Emergency Rooms. Existing conditions be damned. Everyone going to the ER obviously has an existing condition.
10) The data base of the Hub when combined with the IRS, the EPA, and other coercive agencies will provide a 'Chicago' solution such as to make icky elections mere shams -- and machine control until the revolution.
11) Barry is innumerate. So he's created a machine that can't be financed.
12) Causing the powers that be to hyperinflate the currency even as we speak. It's showing up as ramping asset prices across the board. The inverse function is hitting wages, which are on a sled going down fast.