Americans, How is the ACA affecting you?

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Americans, How is the ACA affecting you?

Postby Ormurinn » Sun Sep 29, 2013 5:06 pm UTC

Hi.

First off, an article. It claims that the ACA is pretty much a disaster for a large group of people.

From what I understand, the ACA is an attempt to move the U.S towards more public provision, and to smooth out healthcare costs by mandating everyone has insurance (so there will be a large pool of healthy people to amortise costs over) and that all those policies must include the same things (spreading the cost of, for example, hormonal birth control over non users and making it cheaper).

It should be pretty clear that that will bollocks up the market, but I'm fairly convinced that healthcare provision is a market failure due to information asymmetry and positive externalities anyway. I'm from the England, and I love me some NHS, despite it's many failings.

If I were an american, I think I'd probably have a problem with the ACA for making catastrophic coverage plans (which are the only way health insurance makes sense to my mind anyway - surely "insurance" for something you know you're going to need regularly is just a cost and could be better handled directly?) impossible, and for smelling awfully like a handout to big business.

What are the impacts on you like?
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Re: Americans, How is the ACA affecting you?

Postby Izawwlgood » Sun Sep 29, 2013 5:56 pm UTC

I think you're going to be really surprised, and probably more than a little incredulous at the responses.

I also expect you to maintain your own beliefs despite what you are hearing. That is all.
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Re: Americans, How is the ACA affecting you?

Postby Tyndmyr » Sun Sep 29, 2013 5:56 pm UTC

Ormurinn wrote:Hi.

First off, an article. It claims that the ACA is pretty much a disaster for a large group of people.

From what I understand, the ACA is an attempt to move the U.S towards more public provision, and to smooth out healthcare costs by mandating everyone has insurance (so there will be a large pool of healthy people to amortise costs over) and that all those policies must include the same things (spreading the cost of, for example, hormonal birth control over non users and making it cheaper).

It should be pretty clear that that will bollocks up the market, but I'm fairly convinced that healthcare provision is a market failure due to information asymmetry and positive externalities anyway. I'm from the England, and I love me some NHS, despite it's many failings.

If I were an american, I think I'd probably have a problem with the ACA for making catastrophic coverage plans (which are the only way health insurance makes sense to my mind anyway - surely "insurance" for something you know you're going to need regularly is just a cost and could be better handled directly?) impossible, and for smelling awfully like a handout to big business.

What are the impacts on you like?


Well, I still have employer subsidized insurance like before. I pay part of it, but they pay a goodly chunk. So, that really isn't changing. Deductible went up to cover costs elsewhere or some such, though. No tax credits, etc apply to me. All in all, not a vast difference either way. I suppose one could reasonably consider increased government spending(and the resulting taxation on me) as an effect, but the payroll tax increase, etc I compensated for by increasing 401k deductions to lower my taxable income. This probably isn't an option for everyone, though.

From the perspective of my business, I'm too small for it to matter. I'd imagine it would severely discourage any hiring that would put a business over the bar where it becomes a concern(100, IIRC), but that's wildly irrelevant for a retail shop. Plus, there are already significant legal disincentives for me to hire people, so I'm putting that off as long as possible anyway.

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Re: Americans, How is the ACA affecting you?

Postby sardia » Sun Sep 29, 2013 6:05 pm UTC

The Republicans, and half the democrats would freak if you even suggested a public option much less free healthcare (read: taxed and paid by the government). So mandatory insurance + regulations is what we get to simulate it as best as we can.

The medicare expansion and those on business plans won't be affected except on the margins. What I'm concerned about are people like me who don't have insurance but are expected to pay for it. I could easily be a "rational" player and just pay the fine, but if too many people do it the system gets worse.
Last edited by sardia on Sun Sep 29, 2013 6:07 pm UTC, edited 1 time in total.

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Re: Americans, How is the ACA affecting you?

Postby Tyndmyr » Sun Sep 29, 2013 6:07 pm UTC

sardia wrote:The Republicans, and half the democrats would freak if you even suggested a public option much less free healthcare (read: taxed and paid by the government). So mandatory insurance + regulations is what we get to simulate it as best as we can.


And let's not forget about insurance companies. They're not gonna take kindly to being made redundant. Being made mandatory, now, that they're pretty fond of. MUCH easier politically.

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Re: Americans, How is the ACA affecting you?

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No change for me yet- but i live in Massachusetts so we already have Romneycare.
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Re: Americans, How is the ACA affecting you?

Postby Derek » Sun Sep 29, 2013 7:10 pm UTC

No real changes for me because I already have insurance from my employer. Just a bit more paperwork overall.

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Re: Americans, How is the ACA affecting you?

Postby Izawwlgood » Sun Sep 29, 2013 7:13 pm UTC

Orm, have you seen this?

It's from the KFF, so, respectfully, I'd actually take it over the article you posted.
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Re: Americans, How is the ACA affecting you?

Postby Ormurinn » Sun Sep 29, 2013 7:15 pm UTC

Izawwlgood wrote:I think you're going to be really surprised, and probably more than a little incredulous at the responses.

I also expect you to maintain your own beliefs despite what you are hearing. That is all.


Could you elaborate please?

I will attempt to be more rational and empirical than you give me credit for.

Tyndmyr wrote:From the perspective of my business, I'm too small for it to matter. I'd imagine it would severely discourage any hiring that would put a business over the bar where it becomes a concern(100, IIRC), but that's wildly irrelevant for a retail shop. Plus, there are already significant legal disincentives for me to hire people, so I'm putting that off as long as possible anyway.


This is the really interesting bit to me. As a govt I'd be concerned about anything that might prevent employment expansion atm. Is there any way it could have been better implemented to avoid that cliff?

sardia wrote:The Republicans, and half the democrats would freak if you even suggested a public option much less free healthcare (read: taxed and paid by the government). So mandatory insurance + regulations is what we get to simulate it as best as we can.

The medicare expansion and those on business plans won't be affected except on the margins. What I'm concerned about are people like me who don't have insurance but are expected to pay for it. I could easily be a "rational" player and just pay the fine, but if too many people do it the system gets worse.


Oh yeah - its a poor mans substitute - and I don't think even ancaps would say that its better than just a whole-hog public option.

Thats a shitty system if you get penalised for opting out of health insurance - I understand the underlying imperative to get lots of low-risk people into the insurance pool, but it seems unfair. Were you uninsured before the ACA too? It seems like the problem you're having would be compounded by the cheapest (high-deductible catastrophic coverage) plans being made illegal.

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Re: Americans, How is the ACA affecting you?

Postby Izawwlgood » Sun Sep 29, 2013 7:27 pm UTC

The video is a summary of how most Americans will be affected by the ACA.
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Re: Americans, How is the ACA affecting you?

Postby Darryl » Sun Sep 29, 2013 7:31 pm UTC

Izawwlgood wrote:The video is a summary of how most Americans will be affected by the ACA.

That's not a great summary. That's not even really a summary.
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Re: Americans, How is the ACA affecting you?

Postby sardia » Sun Sep 29, 2013 8:44 pm UTC

Oh yeah - its a poor mans substitute - and I don't think even ancaps would say that its better than just a whole-hog public option.

Thats a shitty system if you get penalised for opting out of health insurance - I understand the underlying imperative to get lots of low-risk people into the insurance pool, but it seems unfair. Were you uninsured before the ACA too? It seems like the problem you're having would be compounded by the cheapest (high-deductible catastrophic coverage) plans being made illegal.
If I don't get penalized, then why would I pay for health insurance? Especially considering that I didn't pay for it before. As for before, I was covered due to parents until age 26, ironically a rule that happened due to The Affordable Care Act. It's far cheaper to just suffer through any diseases or injuries, and go to a "free" clinic for poor people. You make due with whatever charity or medicare gives you and then just hope your body heals without care.

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Re: Americans, How is the ACA affecting you?

Postby ObsessoMom » Sun Sep 29, 2013 8:54 pm UTC

After lurking on this site for years, I'm finally registering to stick my oar in on this.

My family has been using doctors a lot--as in, several times a week--for a long time, so we noticed changes before most people, who tend to visit for annual check-ups and emergencies.

My sixteen-year-old daughter received her long-awaited heart transplant on September 4. [Brief pause for woohooing and blessing the donor and her family.]

What does a heart transplant cost? Approximately three-quarters of a million dollars for the first year, including all the drugs for aftercare. Of course, the life-extending drugs she was on before the transplant were already running over $400 per day.

Anyway. My husband had one of those "Cadillac plans" through work that gave us no copay for ANYTHING--doctor visits or drugs--not too long ago, and let me tell you, we were pretty sorry to see that go. Sniff.

But, by and large, we've noticed a lot of insurance company belt-tightening is getting blamed on The Affordable Care Act, that probably shouldn't be. Remember that a large part of what an insurance company does is invest money. SURELY those investments have not done well, in the struggling economy. So, I suspect that things would be getting draconian ANYWAY, and The Affordable Care Act makes a handy scapegoat for PR purposes...and for purposes of turning public sentiment against something that the insurance companies vehemently don't want.

In the link in the original post, the person complained about letters received FROM HER INSURANCE COMPANY blaming increased premiums and decreased benefits on the Affordable Care Act. And the timing of these letters was just before a big vote on the matter in Congress. Hmmmm.

Consider the source, dude. Consider the source.

(Frankly, I've never understood why health care should be dependent on one's employer, anyway. I mean, it makes sense if you're offering health coverage as an incentive to attract and retain the best workers...but is it some relic of Puritanism that we, as a society, link health insurance so tightly to employment? "Those who don't work, don't eat" becomes "Those who don't work, don't get medical treatment"? How is it good for society to put people on the road to ruin when they are too sick to hold a job?)

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Re: Americans, How is the ACA affecting you?

Postby Wnderer » Sun Sep 29, 2013 9:27 pm UTC

Any healthcare reform should include the following

1. The freedom and and opportunity to improve your situation
2. Competition between providers
3. Equality of access
4. Safety net

A single payer system converts the safety net into the whole system. The left likes that because they believe competition and improving your own situation is at best due to dumb luck and at worst unfair and selfish. What I think is wrong with the Pre-ACA system and the new ACA is that after paying for health insurance for twenty years either through my employer or on my own, I have nothing to show for it. If I lost my job tomorrow and had to look for new health insurance, I'm back to square one. What I wanted from healthcare reform was healthcare saving accounts. Instead of just paying a premium to an insurance company, I would pay into an account that would be used to pay my deductable. The more money in my account, the higher the deductible and the lower my insurance premium. I'd have 'skin in the game', so I would have an incentive to shop around and keep my health costs down. If I lost my job, I would have something to take with me when I was shopping for insurance. All the ACA does for me if I lose my job is require me to get health insurance (I knew that) and a tightly regulated exchange where all I get to choose from is the half dozen government approved flavors of health insurance.

Another problem with the ACA is that it provides for pre-existing conditions by subverting the actuarial process. If insurance is about getting insurance companies to bet that you will stay healthy, a pre-existing condition is a losing bet. The ACA gets insurance companies to take the bad bets by promising them good bets, healthy young people. It does this through the individual mandate but more through requiring employers to insure children until they are 26 years old. It's a liberal trick to get corporations to pay for the healthcare for sick people. The problem is corporations are businesses that need to make a profit or else they go away. One of the reasons for the cry for healthcare reform before the ACA was the rising cost of healthcare was strangling businesses and the economy. I can remember being called into meetings at work where we were shown graphs showing the rising cost of our health insurance and why we employees were going to have to pay more. Now with the ACA, businesses are just not hiring full-time employees. They're making due with part time or temp employees or outsourcing to smaller firms that don't need to meet the ACA requirements. So instead of fixing the problem of the growth in healthcare costs that was strangling businesses, the ACA makes it worse, hurting the economy.

The ACA also is a large expansion of government and a large intrusion into the market place. Price controls and regulations can prevent innovation and new resources entering the market. Rising prices bring resources into the market that were previously cost prohibitive. Once these resources are in the market, economies of scale and production improvements bring the prices back down. Price controls restrict price fluctuation leading to dwindling resources and rationing. Regulations can reduce innovation by being restrictive to different types of methods or by requiring prohibitive amounts of red tape to methods outside the norm. Though how badly the ACA will be run is just speculation at this point.

Basically I don't like the ACA, it's just a leftist method of redistributing the wealth without fixing the problems in the healthcare system, but I have to admit it is better than what the Republicans have been coming up with. The Republicans want to get rid of employer based insurance, nationalize insurance regulations and give tax breaks. I want something to show for paying for health insurance my whole life.

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Re: Americans, How is the ACA affecting you?

Postby ucim » Sun Sep 29, 2013 10:27 pm UTC

Yes, Winderer, but how did it affect you personally? That's the OP.

Of course, it's really too early to say. But the OP was specifically looking for individual data points, not ideology.

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Re: Americans, How is the ACA affecting you?

Postby cerbie » Sun Sep 29, 2013 11:06 pm UTC

What are the impacts on you like?
Nothing, yet. Most people will not be directly affected by it until well into 2014. If the subsidies allow me to easily pay for it, I may have insurance next year, but that's still a big if.

That's the extent, generally, except for anyone here directly involved in the health care industry (and thus why I've re-ordered it), or for whom their employer is ditching insurance they currently provide, with the ACA as an excuse.

Ormurinn wrote:From what I understand, the ACA is an attempt to move the U.S towards more public provision, and to smooth out healthcare costs by mandating everyone has insurance (so there will be a large pool of healthy people to amortise costs over) and that all those policies must include the same things (spreading the cost of, for example, hormonal birth control over non users and making it cheaper).
Yes, and some aspects of it are good. In part due to that, unless someone genuinely comes up with a bill that's superior, we're stuck with it, and the Rs have no intention of that, despite all the crying about "O.b.a.m.a.c.a.r.e." (edit: the whole point was not to use the proper term, Mr. word filter! :)) Since it's unlikely they all have lead poisoning, I'll make a wild guess that that hypothesis about the fall of Rome is probably an incorrect one, compared to some other weird aspect of human nature.

It should be pretty clear that that will bollocks up the market, but I'm fairly convinced that healthcare provision is a market failure due to information asymmetry and positive externalities anyway.
Part of the problem is that the ACA does little to nothing to change that. A health care provider has different costs exposed to the patient based on what coverage they have, get paid back at different rates based on that coverage (and that is something patients are not privy to, generally), and neither is often known until well afterwards.

Ormurinn wrote:This is the really interesting bit to me. As a govt I'd be concerned about anything that might prevent employment expansion atm. Is there any way it could have been better implemented to avoid that cliff?
Maybe. But, our politicians are far disconnected from those they are supposed to be serving. It's not just the ACA. Due to rising healthcare costs, prior to the recession (I haven't had health insurance since), my coverage got worse, yet more costly, every year. But, due to the rising costs, most people have a hard time coming up with the money to pay for regular procedures, especially if they have kids, so health insurance has become more of a payment pool, than a risk pool, with the insurance companies able to squeeze both sides.
Last edited by cerbie on Mon Sep 30, 2013 2:22 am UTC, edited 1 time in total.
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Re: Americans, How is the ACA affecting you?

Postby Wnderer » Sun Sep 29, 2013 11:32 pm UTC

ucim wrote:Yes, Winderer, but how did it affect you personally? That's the OP.

Of course, it's really too early to say. But the OP was specifically looking for individual data points, not ideology.

Jose

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Re: Americans, How is the ACA affecting you?

Postby jules.LT » Mon Sep 30, 2013 12:05 am UTC

sardia wrote:I could easily be a "rational" player and just pay the fine
How is that in any way rational?
A stupid appendicitis costs upwards of $20k in your country.

This is not about maximizing expected utility, it's about putting some kind of floor to how bad thinks can go. Not being completely fucked if shit does happen.
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Re: Americans, How is the ACA affecting you?

Postby Tyndmyr » Mon Sep 30, 2013 12:14 am UTC

Ormurinn wrote:
Tyndmyr wrote:From the perspective of my business, I'm too small for it to matter. I'd imagine it would severely discourage any hiring that would put a business over the bar where it becomes a concern(100, IIRC), but that's wildly irrelevant for a retail shop. Plus, there are already significant legal disincentives for me to hire people, so I'm putting that off as long as possible anyway.


This is the really interesting bit to me. As a govt I'd be concerned about anything that might prevent employment expansion atm. Is there any way it could have been better implemented to avoid that cliff?


Well, any "you must provide this service at x number of people" cost is gonna be a disincentive at that point. This is true even if x is 1. The higher you peg the number, the less disincentive it is, but of course, the less it will it do. They're inextricably tied, really.

100 is high enough that it dodges most small businesses, at least. I wouldn't be at all surprised to see businesses hesitating at just below that number, though. When a big ol' cost is staring at you, putting it off as long as possible is only logical.

And yeah, it's a fair point that it isn't fully implemented yet, so we certainly haven't seen all the effects.

Wnderer wrote:
ucim wrote:Yes, Winderer, but how did it affect you personally? That's the OP.

Of course, it's really too early to say. But the OP was specifically looking for individual data points, not ideology.

Jose

Having a crappy healthcare system doesn't effect you until you get sick and try to use it.


Strictly speaking, the ACA doesn't so much change the health care system as it does the health care insurance system. It's not like there's suddenly a billion more or less doctors in existence, or as if the existing doctors suddenly became smarter or dumber. It's all about the payment.

jules.LT wrote:
sardia wrote:I could easily be a "rational" player and just pay the fine
How is that in any way rational?
A stupid appendicitis costs upwards of $20k in your country.

This is not about maximizing expected utility, it's about putting some kind of floor to how bad thinks can go. Not being completely fucked if shit does happen.


Depends on your personal situation. I mean, I don't buy extended warranties on any electronics because I can afford to buy a new computer if this one gets fucked, and obviously, on average, I'm going to come out ahead not buying insurance. If that wasn't true, insurance companies couldn't exist.

So, if someone has enough resources floating around, or considers it pretty unlikely that he's going to have a problem, it's a rational decision to not get it. It's pretty much the opposite of buying lottery tickets, risk wise.

And if you DO suddenly need your appendix removed and guessed wrong, welp, they'll still remove it for you. You'll just have a big bill afterward. That's unfortunate, but having bad credit isn't the end of life.

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Re: Americans, How is the ACA affecting you?

Postby CorruptUser » Mon Sep 30, 2013 1:56 am UTC

As a health actuary, I take issue with the ACA because it does away with the High Deductible Health Plans, AKA, the entire point of insurance in the first place. It's yet another step in the wrong direction, further entrenching health insurance into society. What we really need to do as a country, is set semi-flexible price controls where whatever you contract with one provider, you have to give relatively similar prices to everyone else. E.g., you contract with a hospital to sell a drug for $.50/pill, you can't charge an individual $500/pill. You have a contract to give colonoscopies for $200, you can't charge an individual $2000. And so forth.

Then the second thing we need to do is eliminate all the tax loopholes built up over the years enshrining health insurance. If your job pays you $40K plus $20k in health insurance, it pays you $60k and both you and your employer should be taxed accordingly.

Bit of advice, stay the hell away from the platinum plans, as it's assumed the people buying those are the sickest of the sick. Unless you are a morbidly obese alcoholic diabetic currently giving birth prematurely, in which case, go for it.

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Re: Americans, How is the ACA affecting you?

Postby elasto » Mon Sep 30, 2013 2:12 am UTC

CorruptUser wrote:What we really need to do as a country, is set semi-flexible price controls where whatever you contract with one provider, you have to give relatively similar prices to everyone else. E.g., you contract with a hospital to sell a drug for $.50/pill, you can't charge an individual $500/pill. You have a contract to give colonoscopies for $200, you can't charge an individual $2000. And so forth.

Makes sense.

In a way, it's legislating for something the market would typically take care of all by itself: Normally if you sold an item to recipient A for 50c and the same item to recipient B for $500, a secondary market would open up with recipient A selling to recipient B for something in between.

For whatever reason that doesn't happen in healthcare, so legislation such as you describe would merely be restoring the modus operandi of the market.

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Re: Americans, How is the ACA affecting you?

Postby ucim » Mon Sep 30, 2013 2:13 am UTC

Winderer wrote: Having a crappy healthcare system doesn't effect you until you get sick and try to use it.
No, it also affects you every time you have to pay for it. Granted, it affects a person less, in that regard, but it also affects more people. There is no free money.

Actually, left to itself and in the long term, the very idea of health insurance will destroy itself. Insurance is about spreading risk, and risk is about what is not known. But as research continues, and more is learned about people's risk factors, more becomes known, and insurance companies can zero in on low risk people at the expense of high risk people (because now they know who is who). The limit of this is to know who will get sick before they do, and charge them premiums according to that (now known) certainty. At that point we're back to fee for service.

We're not there yet, and we never will get fully there. But we will get much closer, and individuals will not share in the information that the medical and insurance industries have.

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Re: Americans, How is the ACA affecting you?

Postby Tyndmyr » Mon Sep 30, 2013 2:28 am UTC

elasto wrote:
CorruptUser wrote:What we really need to do as a country, is set semi-flexible price controls where whatever you contract with one provider, you have to give relatively similar prices to everyone else. E.g., you contract with a hospital to sell a drug for $.50/pill, you can't charge an individual $500/pill. You have a contract to give colonoscopies for $200, you can't charge an individual $2000. And so forth.

Makes sense.

In a way, it's legislating for something the market would typically take care of all by itself: Normally if you sold an item to recipient A for 50c and the same item to recipient B for $500, a secondary market would open up with recipient A selling to recipient B for something in between.

For whatever reason that doesn't happen in healthcare, so legislation such as you describe would merely be restoring the modus operandi of the market.


I can give you the reason...it's medicare. You've got a huge price fixing agency...that's gonna jack up anything like normal market forces. Plus, you have the whole job-tied aspect of insurance. Health care is pretty far from a free market and has been for a while. A lot of places, you cannot get a quote at all before getting a procedure. How do you make rational decisions without information?

ucim wrote:
Winderer wrote: Having a crappy healthcare system doesn't effect you until you get sick and try to use it.
No, it also affects you every time you have to pay for it. Granted, it affects a person less, in that regard, but it also affects more people. There is no free money.

Actually, left to itself and in the long term, the very idea of health insurance will destroy itself. Insurance is about spreading risk, and risk is about what is not known. But as research continues, and more is learned about people's risk factors, more becomes known, and insurance companies can zero in on low risk people at the expense of high risk people (because now they know who is who). The limit of this is to know who will get sick before they do, and charge them premiums according to that (now known) certainty. At that point we're back to fee for service.

We're not there yet, and we never will get fully there. But we will get much closer, and individuals will not share in the information that the medical and insurance industries have.

Jose


Risk factors are pretty well known outside the insurance industry too. Sure, they'll charge you more for smoking, but it's not as if people think smoking makes you healthy.

And when the risk factors are distilled down to the individual with perfect precision(or something akin to it), you have pre-emptive diagnosis. If that happens and kills the insurance companies, we should jump for joy, because with foreknowledge of medical problems comes the ability to fix them. If you can tell exactly who will get sick before it happens, you can pretty much end sickness.
Last edited by Tyndmyr on Mon Sep 30, 2013 2:37 am UTC, edited 1 time in total.

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Re: Americans, How is the ACA affecting you?

Postby elasto » Mon Sep 30, 2013 2:35 am UTC

Tyndmyr wrote:I can give you the reason...it's medicare.

That doesn't make any sense. In the UK healthcare is much cheaper than in the US and we have a single payer system much more ubiquitous than medicare.

I think the answer is much simpler: In the US it's priced as high as it is because nothing prevents them from doing so. If you need a drug or treatment to save your life then you need it. You can't take your time to shop around like you would when choosing a new car or whatever. You need the power of a ubiquitous single-payer system to countermand that.

Health care is pretty far from a free market and has been for a while. A lot of places, you cannot get a quote at all before getting a procedure. How do you make rational decisions without information?

That healthcare is a bad free market was entirely my point. When the market is a willful exploitation of buyers by sellers then only government intervention can adjust it back to the norm. For your particular example, the government should legislate that the up-to-date price range for all procedures should be published online by all healthcare providers. And this should be the actual end-price charged for, say, 90% of the occasions a particular procedure was performed - so no hidden extras get tacked on.
Last edited by elasto on Mon Sep 30, 2013 2:43 am UTC, edited 1 time in total.

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Re: Americans, How is the ACA affecting you?

Postby Tyndmyr » Mon Sep 30, 2013 2:43 am UTC

elasto wrote:
Tyndmyr wrote:I can give you the reason...it's medicare.

That doesn't make any sense. In the UK healthcare is much cheaper than in the US and we have a single payer system much more ubiquitous than medicare.

I think the answer is much simpler: In the US it's priced as high as it is because nothing prevents them from doing so. If you need a drug or treatment to save your life then you need it. You can't take your time to shop around like you would when choosing a new car or whatever. You need the power of a ubiquitous single-payer system to countermand that.


Ubiquitous would be why you do not have a myriad of prices, yes. You cannot have a range of prices when a price fixing schema is pervasive. Then, you have only one price, and you hit the point on the supply curve that matches that. Any problems are reflected in supply instead of price, because price is invariant.

Being halfway between two extremes does not mean you'll get a result halfway between the results of those systems.

Medicare is not ubiquitous, but it IS quite common and influential. So, you get one price for medicare people, and another price for non-medicare people. As plans differentiate, it just gets worse and worse, with different prices based on each plan's policies, and likely a different price for cash entirely. It's ludicrously complex. Some providers have decided to ditch such systems altogether, and simply not deal with any of that. These providers do indeed have simple price structures, but a limited client pool.

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Re: Americans, How is the ACA affecting you?

Postby elasto » Mon Sep 30, 2013 2:46 am UTC

Tyndmyr wrote:Ubiquitous would be why you do not have a myriad of prices, yes. You cannot have a range of prices when a price fixing schema is pervasive. Then, you have only one price, and you hit the point on the supply curve that matches that. Any problems are reflected in supply instead of price, because price is invariant.

Not true. We also have a thriving private healthcare sector - and its prices are below yours too - because if its prices rise too much above what anyone can get for free on the NHS, they won't go private (except for the super-rich - but they do fine under any system.)

Being halfway between two extremes does not mean you'll get a result halfway between the results of those systems.


Agreed. 90% public and 10% private seems to be just about the perfect balance.

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Re: Americans, How is the ACA affecting you?

Postby ucim » Mon Sep 30, 2013 3:18 am UTC

Tyndmyr wrote:Risk factors are pretty well known outside the insurance industry too. Sure, they'll charge you more for smoking, but it's not as if people think smoking makes you healthy.

And when the risk factors are distilled down to the individual with perfect precision(or something akin to it), you have pre-emptive diagnosis. If that happens and kills the insurance companies, we should jump for joy, because with foreknowledge of medical problems comes the ability to fix them. If you can tell exactly who will get sick before it happens, you can pretty much end sickness.
That's just silly.

I'm not talking about the obvious stuff. I'm talking about things like genetic sequencing, deep analysis of purchases, reading habits, web visits, that kind of thing. And if I knew right now that you'd get cancer, that doesn't mean I can cure you. It just means I won't insure you for less than the cost of your care would be anyway. You're essentially paying out of pocket. But you're paying me too.

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Re: Americans, How is the ACA affecting you?

Postby Tyndmyr » Mon Sep 30, 2013 3:44 am UTC

ucim wrote:
Tyndmyr wrote:Risk factors are pretty well known outside the insurance industry too. Sure, they'll charge you more for smoking, but it's not as if people think smoking makes you healthy.

And when the risk factors are distilled down to the individual with perfect precision(or something akin to it), you have pre-emptive diagnosis. If that happens and kills the insurance companies, we should jump for joy, because with foreknowledge of medical problems comes the ability to fix them. If you can tell exactly who will get sick before it happens, you can pretty much end sickness.
That's just silly.

I'm not talking about the obvious stuff. I'm talking about things like genetic sequencing, deep analysis of purchases, reading habits, web visits, that kind of thing. And if I knew right now that you'd get cancer, that doesn't mean I can cure you. It just means I won't insure you for less than the cost of your care would be anyway. You're essentially paying out of pocket. But you're paying me too.

Jose


Uh, yes, cancer is usually curable, provided you catch it quick enough. Catching it before it happens is pretty damned quick.

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Re: Americans, How is the ACA affecting you?

Postby elasto » Mon Sep 30, 2013 3:49 am UTC

ucim wrote:I'm not talking about the obvious stuff. I'm talking about things like genetic sequencing, deep analysis of purchases, reading habits, web visits, that kind of thing. And if I knew right now that you'd get cancer, that doesn't mean I can cure you. It just means I won't insure you for less than the cost of your care would be anyway. You're essentially paying out of pocket. But you're paying me too.


The answer in the UK is to ban any such discrimination.

Insurance companies exist to serve the people - to provide a public service which is to pool risk. If they can't do so without harming those who through no fault of their own carry a high-risk gene or whatever - then the government is quite capable of providing exactly the same service without need to recourse to discrimination.

I'm no dirty commie - but it seems that healthcare almost more than anything fits a 'from each according to his abilities, to each according to his needs' philosophy.

In a civilized world, the treatment you receive should not correlate highly to your means to pay. When anyone across the whole population - from a king to a pauper, from a child to an old man - can lose the genetic lottery with equal likelihood, the fairest way to fund it is to do so collectively, with those with the greatest ability to pay contributing the most. Anything else is, well, just plain uncivilized.

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Re: Americans, How is the ACA affecting you?

Postby CorruptUser » Mon Sep 30, 2013 3:56 am UTC

elasto wrote:Insurance companies exist to serve the people - to provide a public service which is to pool risk. If they can't do so without harming those who through no fault of their own carry a high-risk gene or whatever - then the government is quite capable of providing exactly the same service without need to recourse to discrimination.


And how exactly are insurance companies harming high risk people by charging them what it costs to insure them?

If Society says that people deserve X, then Society has to pay for it, not force Someone Else to pay for it.

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Re: Americans, How is the ACA affecting you?

Postby Tyndmyr » Mon Sep 30, 2013 4:05 am UTC

CorruptUser wrote:
elasto wrote:Insurance companies exist to serve the people - to provide a public service which is to pool risk. If they can't do so without harming those who through no fault of their own carry a high-risk gene or whatever - then the government is quite capable of providing exactly the same service without need to recourse to discrimination.


And how exactly are insurance companies harming high risk people by charging them what it costs to insure them?

If Society says that people deserve X, then Society has to pay for it, not force Someone Else to pay for it.


While I agree with your sentiment, I find the label of "Society" to be a very fuzzy entity. When people say that Society demands something, they usually mean that THEY demand something. When they say that Society should pay for something, they usually mean not them.

Sometimes, they use "Society" to refer to "Government", as if the two were perfect synonyms. Sometimes, they happily refer to it as an all inclusive thing we're all in, willingly or not. Sometimes, entities are referred to as if they are distinct from "Society" entirely.

It is a very strange entity indeed.

Why, sometimes, it even appears to mean "I think that others should be forced to pay for my needs" without any thought to the inherent differences in usage of the term.

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Re: Americans, How is the ACA affecting you?

Postby addams » Mon Sep 30, 2013 4:32 am UTC

This is not a fix.
This is like telling The Bully it must 'play fair'.

The Bully will not 'play fair'.
It is not in the nature of the Beast.

If you have NHS, thank your Lucky Stars.
And; A moment of reflection for the men and women that chose that for you.

My experience may not be a common experience.
The right to choose your own medical care provider is a nice thing.
The right of the providers to choose their client base is a nice thing, too?

In a single payer system, I understand, there is need to refer patients to other providers.
There is a single goal. It is not to make obscene profits, but to provide care to The People.

All of the People get care. Period. No financial or political questions asked.
That is not the experience I have had. My experience my not be the common experience.

The infrastructure is often paid for by Government or subsidized by Government.
The Insurance companies and the Politically and Financially powerful are like Gods.

The Poor People, the Working People, People that have been ill or are unemployed or underemployed are Non-persons.
In my experience, England's NHS and Mexico's Hospitals and Italy's and Spain's are,
"You get well, first. Then we talk about money, maybe." systems.

A hospital can be and I think should be a place where many Government services are organized.
Some people need very little from a hospital. Others need a great deal from a hospital and from other people.

The system the US has and the system the US will have in 2014 is a compromise?
What is it a compromise between?

The Tough Guys=The Rich Guys and The Poor?
The Tough Guys are not so Tough when they are sick.

When the Tough Guys get sick, they get pampered.
When the poor get sick, they suffer and die.

The individuals are put into a position of fear and uncertainty.
Freedom?

Freedom to stay in a Job that is sucking the life out of you, so that the care of your child will not be interrupted?
That sucks.

Freedom? To hope your strong young body and mind do not fail you? If they do. Or; You have an accident.
That sucks.

Freedom?
With those kinds of freedoms, is it any wonder the people of the US pray a lot.

Nothing like a bunch of Ruthless Assholes to drive The People to God.
When people can not trust or count on one another, they look to God.
When people can trust and count on one another, Faith is more complex.

To those men and women that worked so hard for so long to provide for each other,
"You may or may not believe in God. God believes in you." don't let God and each other down.

The single payer systems are not perfect. Not one is perfect. They are creations of Man.
They are darned good and those of you that have such systems have something to be proud of.

Support your health care providers and demand that they be the best they can be.
Humans love to know they have done good things. Medical Staff do good things.

I have seen low moral in medical staff. I have seen lack luster delivery of medical care.
Some folks are doing fine. Many are not. There are stupid, obstacles put between the providers and the patients.

It is a large nation. There are many people doing fine. The people that are sick and the people that are poor are at such a disadvantage. It is heartbreaking and it is frightening.

Some reluctant care delivered with an eye to the Bottom Line that leaves the patient alive and disabled with no money, no job, no home...Well? Is it better? Better than what?

As long as there are Insurance Companies making profit from taking in Much Much More than is needed to provide care, we will have what we have.

Single payer health care does not translate into 1950's NHS care.
The two things are married in the minds of many Americans.

I know that it can be a dignified life of service to be medical personal.
I have seen low moral and low performance in both the providers and the patients
inside the US during the last few months..
There is a word for that phenomena. I don't know what it is.

Apathy. Helplessness. Hopelessness. Fear. The system is not clean.
There are pressures being placed on as many people as possible to keep the discontent coming from everyone, all the time.

The media loves that stuff. If the stories are not real, they can be created. All bow to the screen.

The system is as closed today as it ever was. It is not one man's fault.
That kind of money is great Power. The ACA is a compromise?

I can not see that it has lifted The People up, much.
There will be stories of failure and success.

Medical facilities are full of failures and successes.
That is the nature of the Beast.
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Some of us see The Gutter.
Some of us see The Stars.
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Re: Americans, How is the ACA affecting you?

Postby Derek » Mon Sep 30, 2013 4:41 am UTC

elasto wrote:
CorruptUser wrote:What we really need to do as a country, is set semi-flexible price controls where whatever you contract with one provider, you have to give relatively similar prices to everyone else. E.g., you contract with a hospital to sell a drug for $.50/pill, you can't charge an individual $500/pill. You have a contract to give colonoscopies for $200, you can't charge an individual $2000. And so forth.

Makes sense.

In a way, it's legislating for something the market would typically take care of all by itself: Normally if you sold an item to recipient A for 50c and the same item to recipient B for $500, a secondary market would open up with recipient A selling to recipient B for something in between.

For whatever reason that doesn't happen in healthcare, so legislation such as you describe would merely be restoring the modus operandi of the market.

Well for prescription drugs only licensed pharmacists can sell them, so you can't create a reselling business. For operations, those are services not products, so again, they can't be resold.

I think your idea is reasonable, btw. There really is very little reason for large prices differences between individual buyers and insurance companies or the government. As far as I'm aware, the only reason it exists is due to the enormous collective bargaining potential of the latter.

Health care is pretty far from a free market and has been for a while. A lot of places, you cannot get a quote at all before getting a procedure. How do you make rational decisions without information?

That healthcare is a bad free market was entirely my point. When the market is a willful exploitation of buyers by sellers then only government intervention can adjust it back to the norm. For your particular example, the government should legislate that the up-to-date price range for all procedures should be published online by all healthcare providers. And this should be the actual end-price charged for, say, 90% of the occasions a particular procedure was performed - so no hidden extras get tacked on.

You completely missed Tyndmyr's point. Health care is not a free market in the US because of the government's large role, as both a regulator and a customer.

We're not there yet, and we never will get fully there. But we will get much closer, and individuals will not share in the information that the medical and insurance industries have.

ucim wrote:
Tyndmyr wrote:Risk factors are pretty well known outside the insurance industry too. Sure, they'll charge you more for smoking, but it's not as if people think smoking makes you healthy.

And when the risk factors are distilled down to the individual with perfect precision(or something akin to it), you have pre-emptive diagnosis. If that happens and kills the insurance companies, we should jump for joy, because with foreknowledge of medical problems comes the ability to fix them. If you can tell exactly who will get sick before it happens, you can pretty much end sickness.
That's just silly.

I'm not talking about the obvious stuff. I'm talking about things like genetic sequencing, deep analysis of purchases, reading habits, web visits, that kind of thing. And if I knew right now that you'd get cancer, that doesn't mean I can cure you. It just means I won't insure you for less than the cost of your care would be anyway. You're essentially paying out of pocket. But you're paying me too.

Jose

If genetic sequencing, purchase history, and reading habits are reliable predictors of future health, then you can take preemptive actions based on that information. For example, by checking for likely conditions more frequently, or changing your habits to reduce risks. And the insurance companies will share this information, every time they give you an insurance quote. And if sufficiently accurate predictions can be made, there will be dozens of companies popping up to tell you your medical future for a small fee and some information (we already have companies doing this for genetic screening).

elasto wrote:The answer in the UK is to ban any such discrimination.

Insurance companies exist to serve the people - to provide a public service which is to pool risk. If they can't do so without harming those who through no fault of their own carry a high-risk gene or whatever - then the government is quite capable of providing exactly the same service without need to recourse to discrimination.

I'm no dirty commie - but it seems that healthcare almost more than anything fits a 'from each according to his abilities, to each according to his needs' philosophy.

In a civilized world, the treatment you receive should not correlate highly to your means to pay. When anyone across the whole population - from a king to a pauper, from a child to an old man - can lose the genetic lottery with equal likelihood, the fairest way to fund it is to do so collectively, with those with the greatest ability to pay contributing the most. Anything else is, well, just plain uncivilized.

This assumes that health problems are never a person's own fault, which is obviously not true. If you provide everyone with the same coverage at the same cost, there is no reason to act in a healthy manner. It also assumes that people are responsible for others' bad luck, which is not a universally accepted position. More specifically you're assuming that the role of health insurance is to make healthcare uniformly accessible. But it's not. The role of insurance is to mitigate risk. Known high costs are not risks. So universal healthcare and health insurance are not the same thing, and discrimination is completely rational for health insurance.

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Re: Americans, How is the ACA affecting you?

Postby sardia » Mon Sep 30, 2013 4:46 am UTC

CorruptUser wrote:
elasto wrote:Insurance companies exist to serve the people - to provide a public service which is to pool risk. If they can't do so without harming those who through no fault of their own carry a high-risk gene or whatever - then the government is quite capable of providing exactly the same service without need to recourse to discrimination.


And how exactly are insurance companies harming high risk people by charging them what it costs to insure them?

If Society says that people deserve X, then Society has to pay for it, not force Someone Else to pay for it.

If I paid the insurance company my premium and it cost equal to what I'm being charged, why did I spend money for the insurance company's overhead? Since that's probably what you mean, riddle me this, what do you suggest a high risk person should do? Say you were a high risk person, how should the system, in any possible way, plan for you? Because I know what we did in my home country, we demand cash upfront or we let you die.
jules.LT wrote:
sardia wrote:I could easily be a "rational" player and just pay the fine
How is that in any way rational?
A stupid appendicitis costs upwards of $20k in your country.

This is not about maximizing expected utility, it's about putting some kind of floor to how bad thinks can go. Not being completely fucked if shit does happen.

It's called being poor, go try it out for a bit. Did you know that if you're dead, you don't need money any more? Guess who will have the last laugh then? Nobody, because I'll be dead, and the banker who loaned me money will be out his loan. Welcome to the real world hippy.

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Re: Americans, How is the ACA affecting you?

Postby elasto » Mon Sep 30, 2013 6:20 am UTC

Derek wrote:You completely missed Tyndmyr's point. Health care is not a free market in the US because of the government's large role, as both a regulator and a customer.

Ok... But you yourself agree with me that Tyndmyr's point is wrong: There are plenty of reasons why healthcare is not a free market in the US or anywhere else. Here, I'll quote you back to yourself:

Well for prescription drugs only licensed pharmacists can sell them, so you can't create a reselling business. For operations, those are services not products, so again, they can't be resold.


(Don't quite get your logic for the first one though: Why couldn't a licensed pharmacist create a reselling business? I won't quibble though, because, whatever the reasons are, it's true that healthcare is deeply unsuitable for a free market system)

I think your idea is reasonable, btw. There really is very little reason for large prices differences between individual buyers and insurance companies or the government. As far as I'm aware, the only reason it exists is due to the enormous collective bargaining potential of the latter.

Then you are unaware that the UK does not have the enormous price differences between what the private and public sectors pay, despite the enormous collective bargaining potential of the latter. In fact it's because of the enormous collective bargaining potential of the latter that the price differential cannot exist.

I'll spell out my theory again, in case it was missed: The reason the US has the large price differentials is because a private individual in the US has no choice but to pay whatever price is demanded. In the UK the individual has the choice of paying the price demanded or getting something similar for free on the NHS - at the cost of some personal inconvenience perhaps - eg. going on a waiting list. That places an upper limit on how much extra people are willing to pay merely to 'queue-jump', and so we don't find people being forced to pay $500 for something the government can get for 50c.

I've told this story before in the past:

My wife is not a UK citizen, so is not entitled to NHS care, and nor did we have any private health insurance. All costs are born directly by us. In the US that would put us at the very top end of what we would get charged for our healthcare.

When my wife gave birth to our daughter, she had an emergency cesarean with about eight staff in the operating room. She spent a week in hospital and needed many rounds of drugs including an epidural. Total cost? Under $3000.

I tried to look what the cost for the same sort of event in the US would have been and, to the best I could tell it would have been a five figure sum - and not a terribly low five figure sum either.

Sorry. You won't ever convince me the American way is superior for the ordinary man on the street.

This assumes that health problems are never a person's own fault, which is obviously not true. If you provide everyone with the same coverage at the same cost, there is no reason to act in a healthy manner.


I would strongly dispute there's no reason to eat healthily or exercise unless it hits your pocket not to do so. People have all sorts of reasons to want to improve their health - from simply feeling much better to wanting to live to see their children grow old. Yes, it removes a partial incentive which isn't ideal, but the upsides to society for universal coverage far outweigh that.

It also assumes that people are responsible for others' bad luck, which is not a universally accepted position.

The people that don't accept it are suffering an overabundance of hubris imo: "There but for the grace of God go I."

Just look at any hard-luck story of someone losing their job (hence health insurance), then getting sick and being unable to afford their mortgage, then becoming homeless. Could happen to anyone.

More specifically you're assuming that the role of health insurance is to make healthcare uniformly accessible. But it's not. The role of insurance is to mitigate risk.

No. The role of private health insurance, like any private company, is to make money for the shareholders. The role of government is to make healthcare uniformly accessible. If they can do that through the private healthcare system - great! If they can't then they should just bypass it - as is done to great effect in the UK.

[Anyhow, I'm going to bow out of this thread now. This is a waay off from the purpose of this thread which was quite narrow. And for that I apologise :D]

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Re: Americans, How is the ACA affecting you?

Postby KnightExemplar » Mon Sep 30, 2013 6:35 am UTC

It gave my sister a job, because of the explosive growth of Health policy as a field. In particular, her particular field is comparative effectiveness research: ie, figuring out which medicines work better than others. (which is a distinct field of research from "figuring out which medicines are better than a placebo", which is all the FDA did). As for one difference between the US and UK... well... the UK actually funds patient-centered research... while the US doesn't. Or at least, it didn't, before the ACA anyway.

You know, all those factoids about price differences in Health Care across America?

http://www.huffingtonpost.com/2013/05/0 ... 32678.html

You know, figuring out how much medicine costs across different states, figuring out why certain ones are more expensive than others? Standardizing the research so that you can figure out if one state is "cheaper yet more effective", or just plain "cheaper because they cut corners". (its important to distinguish between the two). Etc. etc. We can go on and on about the "evils" of the ACA, but lets make one fact clear. Comparative effectiveness research must continue. For many decades, hospitals have been hiding their prices from the general public, and thus the US Health Care system (before the ACA) was a closed market, with no information. ACA changes that, by specifically funding research that allows the public to compare health-care options across state lines.

And frankly, no self-respecting libertarian should ever be against open markets with open prices. An important cornerstone to that, is proper research and databases that allows us to compare health costs... is it not?

As stated before, my sister is a researcher in this field. I'm not the expert, but she's told me a basic overview of the problems.
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Re: Americans, How is the ACA affecting you?

Postby Izawwlgood » Mon Sep 30, 2013 1:08 pm UTC

KnightExemplar wrote:And frankly, no self-respecting libertarian should ever be against open markets with open prices. An important cornerstone to that, is proper research and databases that allows us to compare health costs... is it not?
I consider myself a libertarian, and am vastly in favor of not having health care be predominated by the free market. Healthcare has extremely low price elasticity (EDIT: I am not an economist, so may have that term wrong... Health care is an essential good that people will pay anything for, getting into any kind of debt to procure, is what I was trying to describe). I feel a central tenet of libertarianism is the belief that one should be judged by their merit, and to do so, everyone needs to have at least some basic level opportunity. Education and health care go a very long way in ensuring we actually live in a meritocracy, instead of simply being born to parents who could foot the bill.

FWIW, I am in favor of having a free market component, but America's is broken beyond compare, and the solution, I feel, is not freer markets.
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Re: Americans, How is the ACA affecting you?

Postby KnightExemplar » Mon Sep 30, 2013 1:19 pm UTC

Well, I'm not necessarily saying "free market wins". But what I am saying is that data like this must continue:

Image

Part of the ACA was to fund research that tallied up numbers like what is shown in the map above. Notice how different neighborhoods have health care costs that flux between +/-$45,000 for the same treatment. (Granted, the majority of the problem happens as you cross state lines from New York to Jersey, but even within neighborhoods of the same state, the price fluctuation makes no damn sense) Regardless of your philosophy about "free markets" or whatever, figuring out pricing data is an absolute necessity.
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Re: Americans, How is the ACA affecting you?

Postby eran_rathan » Mon Sep 30, 2013 1:20 pm UTC

elasto wrote:I've told this story before in the past:

My wife is not a UK citizen, so is not entitled to NHS care, and nor did we have any private health insurance. All costs are born directly by us. In the US that would put us at the very top end of what we would get charged for our healthcare.

When my wife gave birth to our daughter, she had an emergency cesarean with about eight staff in the operating room. She spent a week in hospital and needed many rounds of drugs including an epidural. Total cost? Under $3000.

I tried to look what the cost for the same sort of event in the US would have been and, to the best I could tell it would have been a five figure sum - and not a terribly low five figure sum either.

Sorry. You won't ever convince me the American way is superior for the ordinary man on the street.


Similar story, for comparison:

Our first child was an emergency cesarean, after 40 hours of labor (which, btw, I would not wish on anyone!), and then 3 days of recovery in the hospital. I had insurance, though mostly a high deductible catastrophic plan though my work. The total bill was just over $30,000 in 2006. We ended up paying (are still paying on) $12,000 (because the insurance had a maximum out of pocket per person of $6,000/year - but they charged the max on my wife - and then the max on our daughter as well).

And from what I've been able to gather, both from friends who've had similar situations and from when our second daughter (who cost $6000, due to better planning).

I've taken a look at the marketplace, and while I do not qualify for any tax rebates or anything (due to work's relatively crappy insurance), my wife & daughters will be able to get it for less than $100/month, and we'll get about $8,000 in tax rebates (near as I can figure).
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CorruptUser
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Re: Americans, How is the ACA affecting you?

Postby CorruptUser » Mon Sep 30, 2013 1:35 pm UTC

You know that would never hold up in court, right? Applying the MOOP to both mother and child? It should only apply to the mother unless there was some specific procedure done on the child itself.


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