Heeeeeeere's Obamacare!

[xjx388]

We can always do better. Allowing people to die or suffer for lack of health care isn't a hallmark of civilization.

We can do better.

Alan Grayson claims 45,000 people die a year because they lack health insurance

[qimg]https://imageshack.com/i/iq5YMCELg[/qimg]

Your use of the "Truth-o-meter" graphic pointing to "Truth" is extremely misleading. From your link, Politifact.com says:

What we found wasn’t enough to reach a conclusion one way or another (hence why we’re not rating Grayson’s statement on our Truth-O-Meter).

The study that Grayson bases his number on is a real study, but it isn't without controversy. Politifact points out the research by Richard Kronick, who is now the director of the Agency for Healthcare Research and Quality. Kronick writes:

Conclusions. The Institute of Medicine's estimate that lack of insurance leads to 18,000 excess deaths each year is almost certainly incorrect. It is not possible to draw firm causal inferences from the results of observational analyses, but there is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States.

 

[sunmaster14]

Your use of the "Truth-o-meter" graphic pointing to "Truth" is extremely misleading. From your link, Politifact.com says:


The study that Grayson bases his number on is a real study, but it isn't without controversy. Politifact points out the research by Richard Kronick, who is now the director of the Agency for Healthcare Research and Quality. Kronick writes:

Yeah, I already pointed this out to RandFan a couple of pages back, and he didn't even try to address my rebuttal. His beliefs are quite resilient.

 

[RandFan]

Your use of the "Truth-o-meter" graphic pointing to "Truth" is extremely misleading. From your link, Politifact.com says:


The study that Grayson bases his number on is a real study, but it isn't without controversy. Politifact points out the research by Richard Kronick, who is now the director of the Agency for Healthcare Research and Quality. Kronick writes:

I will concede your point. I apologize for using the truth meter. It was not intentional. However it was very sloppy on my part, I had saved the truth meter from another story and saved it to imageshack. I had falsely remembered that politifact verified the claim so without taking the time to verify I linked the story and posted the image. I sincerely regret that.

I'm sorry.

 

[SumDood]

I will concede your point. I apologize for using the truth meter. It was not intentional. However it was very sloppy on my part, I had saved the truth meter from another story and saved it to imageshack. I had falsely remembered that politifact verified the claim so without taking the time to verify I linked the story and posted the image. I sincerely regret that.

I'm sorry.

Wow. Someone actually admitting when they were wrong instead of just ignoring their own short comings. We could all learn a thing here.

You, sir, are a class act.

 

[3point14]

Wow. Someone actually admitting when they were wrong instead of just ignoring their own short comings. We could all learn a thing here.

You, sir, are a class act.

To be fair:

Actually, I have to take it back because when I looked more closely at the study, I see that the $500B/yr number isn't defended or even referenced in any way.

I do like a civilised discuasion and this sort of thing does help.

 

[SumDood]

...
I do like a civilised discuasion and this sort of thing does help.

Agreed. Bravo to both our class acts.

 

[Trakar]

That's not a corollary. I think the word you mean to use is "converse." A corollary is something that follows logically (i.e. can be proved) from something else, which, in this case, the converse is not.

Your assertion is not an accurate reflection of my statement.

 

[logger]

I'm sorry.

Randfan is a class act! I can remember the great John Candy saying "I'm sorry"

 

[Grizzly Bear]

I feel like people who want to make such statements should not be afraid of facts.

Let's start with the first question: Have costs gone up? The overall answer is, no.

The answer for me and a coworker is "yes" unfortunately. My increase is $50/month + $15/month with the replacement dental coverage. That means my premiums go from ~137/month to around $190/month. For my coworker the difference is much larger; he goes from $200/month to over $500/month on a subsidy. While don't immediately doubt your figures individual cases aren't promising. The coworker has pre existing conditions as well, so he's kind of damned if he does or doesn't... he's keeping his plan for now because it covers his medications which are from what I've been told quite heavy on the out of pocket costs otherwise.

Compared to what I COULD be hit with the payments I face are relatively modest. But on my pay scale and my existing bills it's still a fair bit and I consider catastrophic plans pointless given a $6,000 deductible would render broke anyway.

Now, to be fair, I do owe one retraction to some of my earlier complaints. As promised as I did some shopping and found a dental plan better suited to me relatively easily. If I'd looked I would have likely found such a plan earlier and been hit less hard by my dental costs this time around by paying a bit more on my dental. I take responsibility for my choice there unless something else comes up. Although the premium IS twice what my last plan is nonetheless.

And what I still do not appreciate however, is being accused of lying about how much I paid for my treatment by another member which I found utterly callous, ignorant, and writhe with blind partisanship, and no apology given, at all. "He" knows who he is.

Across all counties in the US, the silver plans have only gone up 2% from 2014 to 2015. That figure is not just good; it's miraculous. On this scale, Obamacare is not just working; it's working better than anyone could have imagined. Bronze plans are up 4%.

So, now that we understand the scale, that Obamacare overall is working extremely well, we can talk about areas where it doesn't seem to be working so well.

If you live in Alaska then maybe you should think about getting a new governor (just a thought). Your silver plans shot up 28%. If you live in Western Minnesota then your bronze plans are up 43%. Again, I'd take a closer look at that governor. Now, that's the bad news.

So, what's the good news? Well, even in Alaska there is good news. That 28% increase is for premiums before the tax subsidy. So, if you are a 40 year old non-smoker making 30,000 a year in Alaska, your premium didn't increase at all from 2014. So, again, Obamacare is working as it is supposed to. What about Minnesota? Well, if you are a die-hard conservative desperate for some bad news for Obamacare, I'll have to admit that premiums for that same 40 year old non-smoker making 30,000 a year went up 18.5% from 2014 for a silver plan. And, your actual premium will go up the full 18.5%. Oh, wait, but there is actually some good news there too. Because even though your premium went up 18% it is still lower than the premiums in Indiana, Illinois, Kentucky, Iowa, Wisconsin, and Michigan.

The simple fact is that for our example 40 year old, his premium would be $208 in most of the country. His premium would be lower in Alaska, Arizona, Minnesota, New Mexico, Hawaii, and Tennessee. The bad news is that his premium would be higher in...sorry, that was a trick. There is no part of the country where his premium would be higher than $208. That's the standard for 2015. Back in 2014, the standard rate for this person was $209. So, yes it did drop by $1. Again, this is not horrible or bad or awful or even good. Having a standard premium drop by even $1 is something that has not happened in three decades. The real numbers show that standard costs dropped 0.8%. The 2% increase I first mentioned is misleading because everyone who had an increase was already paying less than the standard rate. So, you can keep harping about Obamacare or you can accept facts.

I'm guessing this is your source, or something close to it. I glanced through it, and will take a look at few different sources to get a better picture. The one thing that stands out in my reading of this is the premium increase percentages are the primary focus of the study.

I'm considering a few different factors in how insurance companies are likely to adjust. Namely premiums being one, and then how they adjust deductibles, co pays, and annual maximums as inflation in the health industry continues to grow and based on how the law's provisions incentivise pricing for individuals. It's not past me either to incorporate states that did not set up their own exchanges as part of the cost influence in some cases. And... of course what I experience directly. So while you're keen to point out the matter of cherry picking for bring up dire straits maybe it's a bit more prudent to focus on the varied areas that the law impacts, instead of just the raw premiums.

 

[Kestrel]

The ACA was designed to handle inflation. The various metal levels of insurance are defined in terms of Actuarial Value. Averaged over the population, a Bronze plan will pay 60% of all medical bills the people with a Bronze plan will pay the remaining 40%. The schedule of deductions, copays and the out of pocket maximum can be varied in many ways to make this work. Silver plans have an AV on 70%, Gold plans 80% and Platinum plans 90%. Low income families also have access to special versions of Silver plans with 87% and 94% AV.

Included in the calculations are the preventive care procedures provided at zero cost and the maxim out of pocket limits set by the ACA. The maximum OOP will go up with inflation.

California does it a bit differently than other states. The schedule of deductions and copays is the same for all policies at the same metal level.

 

[Tero]

I still hear horror stories about people who had great insurance with premiums less than one third of the ACA policies sold on the exchange. The trick is none of these people has ever experienced a really serious medical condition that would test the limits of their heath insurance policy. Just as most homeowners that pay for fire insurance never have a house burn to the ground. The premiums they paid gave them the illusion of being insured.

And they lost the insurance as soon as they would have used it.

On the other hand, the individual healthcare buyers can't do much about costs. Much of our care is excessive tests and expensive supplies, single rooms etc. Most people try to get outpatient surgery for anything that they can. We the insured are paying for all this until budget options appear.

 

[Kestrel]

And they lost the insurance as soon as they would have used it.

On the other hand, the individual healthcare buyers can't do much about costs. Much of our care is excessive tests and expensive supplies, single rooms etc. Most people try to get outpatient surgery for anything that they can. We the insured are paying for all this until budget options appear.

I don't see tests and a big cost driver, it's the way we do tests. Automatic testing machines can perform dozens of tests on a blood sample for minimal cost. Having lab technicians do each test by hand costs a small fortune. The French use machines to do routine testing, in the US we send them to the local lab.

An MRI scan in Japan costs about $100. The price is regulated, but the clinics that do scans manage to operate at a profit.

 

[Emily's Cat]

Kinda like paying for car insurance benefits that they will never use. Insurance is not a conspiracy. It's simply a way to mitigate risk.

Car insurance is good. I have certain risks in driving that are specific to me: my needs, my driving record, the car I drive. I pay for my level of risk. Health insurance is nothing like this. I have no choice in the level of coverage I want. I want catastrophic. No copays, no preventive, no maternity, no BC. Thus, I am not paying for insurance anymore in that I am not insuring risks that I actually have.

Health insurance is like that. Perhaps not exactly the same but very close. There are in fact many plans to choose from. You will pay one way or the other. People who need to go to the ER because they can't afford a physician are using a very expensive form of health care that is offset with increased costs to those who can pay.

Why compare health insurance to car insurance? Why not compare it to homeowners insurance instead? There is very little choice in homeowners insurance, other than what deductible you want. You don't get to pick and choose whether or not your roof is covered, but your driveway is. You cover the whole house. You may get some say in how high the coverage for liability is... just as you get some say in how high (or low) your out of pocket maximum is. But to qualify as homeowners insurance, it has to actually cover the home, all of its contents, visitors to the home, and items on the property. Just as health insurance is required to cover all of the services related to having a body that sometimes breaks down.

If auto insurers were regulated as health insurers were - if they were required to meet specified actuarial value benchmarks, as well as being limited in how much profit they were allowed to make... you would be looking at pre-packaged plans for cars just as you currently do for health.

 

[Emily's Cat]

You know, I've seen this reposted before, as if it was clever satire. It's mind-boggling to me that anybody could think it's intelligent in any way. 98% of health care decisions are perfectly amenable to free market forces. The only problem right now is the lack of price transparency.

I know I'm several days behind here... but I'm going to chime in anyway.

This isn't true.

First, I think you're conflating the decisions with the services rendered. Most of the services rendered are routine visits and preventive care. But the decisions involved in those aren't all that big. You don't make a decision about preventive care every time you get your annual screening. You only get involved in the decision-making process for your preventive screening when you're selecting a doctor and determining how frequently you should go. After that, it's just wash, rinse, repeat.

Routine and preventive care services account for approximately 60% to 70% of the total services for a commercial population. It varies by location and by plan design. But generally speaking, that's the portion of actual claims that are represented by services in those categories.

Routine and preventive care are really the only ones that can reasonably be expected to be subject to market forces. Those are the only ones where the average citizen can be expected to have both the time and the knowledge to make an informed decision.

The remainder of the services rendered - the remaining 40% of the services - are NOT routine or preventive on average. They require expert medical guidance that the average consumer shouldn't be expected to have. Or alternatively they are acute situations that do not allow the consumer time in which to make an informed decision. Or both.

Those services, however, account for more than 40% of the decisions being made. There are far more decisions involved in treating and maintaining a chronic condition than in getting a routine checkup.

 

[Emily's Cat]

Is it logical to think a system run by the government is going to be more efficient and cost less?

You're asking this wrong. You need to ask:

Is it logical to think a system run by the US government, with our stupid politicians in charge of it, is going to be more efficient and cost less?

Because, really, that's the only place it falls down for me.

 

[Trakar]

You're asking this wrong. You need to ask:

Is it logical to think a system run by the US government, with our stupid politicians in charge of it, is going to be more efficient and cost less?

Because, really, that's the only place it falls down for me.

Does this not devolve back to "do all US voters elect politicians based upon their abilities to intelligently legislate the U.S. by generating laws whose only objective is to frugally and efficiently provide the public policy and services that benefit the nation's population?" If not, why not, and how can we improve the voters so that they may all properly fulfill their role in U.S. governance?

 

[Emily's Cat]

You work for a boss who pays you the minimum he can get away with.

And I do the minimum amount of work I can get away with to keep getting paid that same amount

 

[jimbob]

You're asking this wrong. You need to ask:

Is it logical to think a system run by the US government, with our stupid politicians in charge of it, is going to be more efficient and cost less?

Because, really, that's the only place it falls down for me.

I'd have sympathy for that view except that the UK politicians can often exceed the US - I don't believe the US is building any 70,000 tonne aircraft carriers that can't launch any currently-available* fast jets and the NHS still *generally* works.

 

[Emily's Cat]

Reading comments on other forums about the ACA, I am struck by how many people seem to think insurance is for paying for routine doctors visits. Are they that sheltered from real life that they don't know anyone who developed a serious medical condition?

On the order of about 60% of all medical costs are routine and preventive. Another 20% are acute accident-related injuries. Only about 20% of all costs are from chronic and serious conditions... and those account for a relatively few number of services.

20% of the people generate 80% of the costs. 5% of the people generate 50% of the costs. In any given year, about 25% of people won't have any claims at all. It's the tail of the distribution that drives the cost.

For the vast majority of people, it IS for paying for routine visits.

 

[Emily's Cat]

I'd have sympathy for that view except that the UK politicians can often exceed the US - I don't believe the US is building any 70,000 tonne aircraft carriers that can't launch any currently-available* fast jets and the NHS still *generally* works.

Well we did build that bridge to nowhere...