Obamacare 5 years later. Crow, anyone?

[sunmaster14]

I think the regulations that say you can have an HSA plan, but only if your plan meets certain definitions, none of which make much sense as a connection to an HSA, is dumb.

So you have a very high deductible on a plan that doesn't provide coverage, you can't get a tax break on that deductible via an HSA. However, if your plan had exactly the same deductible, but covered prescription drugs, then you can get a tax break.

That's just dumb.

And then there's the fact that for most people, the realistic option for their health plan is to use whichever provided gave their employer a good deal is even dumber. Why the heck do I have to change health plans when I change jobs? It's crazy. That's the one thing I really dislike about Obamacare. It strengthened the connection between employers and health insurance. I think that connection needs to be severed completely.

In the short run, it strengthened the connection. In the long run, though, the Cadillac tax (the tax on high-end insurance plans) will bite and drive employers to stop offering health insurance as a benefit. It will take a while. Maybe 20 years.

 

[xjx388]

Which amounts to gambling with other people's money.

If a person has enough wealth they can cover their expenses should they have an unexpected medical event, then they should have a self-insured option.

But if not, sorry, they have no right to gamble while passing the risk on to those who the potential bad debt is shifted to, the paying medical customers.

The same logic applies to those who gamble with their health with other people's money. The obese, smokers, skateboarders, etc all do the same thing. Which brings us back to the whole idea of insurance: insure your particular risks. Let me pay for my risks; you pay for yours.

 

[RandFan]

The same logic applies to those who gamble with their health with other people's money. The obese, smokers, skateboarders, etc all do the same thing. Which brings us back to the whole idea of insurance: insure your particular risks. Let me pay for my risks; you pay for yours.

That would be a valid comparison if we did not live in society where it is illegal to deny health care for those in need (see EMTALA).

I'd even go so far to say that the comparison would be valid if humans were solitary and not a social species. Biting one's nose to spite one's face is not very effective public policy.

I'm sure I cannot adequately convey just how much the well being of those who are not in need depend on those who are. One would need to study anthropology, sociology and human psychology. I keep trying though.

 

[JohnnyG]

The same logic applies to those who gamble with their health with other people's money. The obese, smokers, skateboarders, etc all do the same thing. Which brings us back to the whole idea of insurance: insure your particular risks. Let me pay for my risks; you pay for yours.

I agree that conscious choices perhaps should impact insurance costs. Cliff jumpers, venomous snake handlers, and the cast of Jackass are just a few examples.

However, why should people with diabetes, asthma, childhood cancers, etc. have to pay more for insurance than healthy people? They did nothing to cause their illnesses. Private insurance rates for people with chronic health issues was so expensive that very few could afford it, if they could even get accepted. Is that really what you think health insurance should be?

 

[DavidJames]

I agree that conscious choices perhaps should impact insurance costs. Cliff jumpers, venomous snake handlers, and the cast of Jackass are just a few examples.

However, why should people with diabetes, asthma, childhood cancers, etc. have to pay more for insurance than healthy people?

Don't underestimate the power of selfishness and greed, carefully hidden beneath the veil of fairness.

 

[Skeptic Ginger]

I'm not sure how you see it as them passing the cost on to other people. They're not going without coverage, they're just choosing the leanest benefit offered.

Are you suggesting that nobody should be allowed to purchase a Bronze plan?

I was referring to people who choose to be uninsured because they are healthy. If you were talking about catastrophic coverage and not 'no coverage' then my apologies, I mis-read your post.

But I didn't think you were advocating no insurance either way. I was commenting in general. People who complain about having to buy insurance they don't think they need are short-sighted.

 

[xjx388]

I agree that conscious choices perhaps should impact insurance costs. Cliff jumpers, venomous snake handlers, and the cast of Jackass are just a few examples.

However, why should people with diabetes, asthma, childhood cancers, etc. have to pay more for insurance than healthy people? They did nothing to cause their illnesses. Private insurance rates for people with chronic health issues was so expensive that very few could afford it, if they could even get accepted. Is that really what you think health insurance should be?

I didn't mention any of those. But the point is still valid: if you have higher risks, whether through concious decisions or accident of genetics, then you will cost more. I personally think that only concious decisions should be charged higher. After all, we are insuring risks here and those risks are mostly things we have no control over. But our health is largely in our own hands. For example, a person with Type II diabetes can mitigate many risks by getting the disease under control. An obese person can lose weight and reduce risk. It's when we do things that undermine our own health that I feel a person should pay more for insurance.

Insurance is only what it is, not what I want it to be. It is a way to cover certain losses. You are charged based on your risk of facing those losses. That is exactly what insurance is and nothing more. Risk pooling is a tool insurance companies use to lower their exposure and is not why I buy insurance. I buy insurance so that I get paid when I suffer a loss. Health insurance should be no different.

I don't want people to suffer. At the same time, I can't make decisions for them. When they do make bad decisions, I shouldn't be the pocket they come get money from.

 

[Skeptic Ginger]

The same logic applies to those who gamble with their health with other people's money. The obese, smokers, skateboarders, etc all do the same thing. Which brings us back to the whole idea of insurance: insure your particular risks. Let me pay for my risks; you pay for yours.

In those cases, it's not gambling. If you think smokers should pay a premium, that has become the norm in many health insurance policies.

If you want to argue we should all pay for what we use, that's nice but it's not practical. The whole point of insurance is distributing the risk. You cannot predict who will need the bone marrow transplant and who will remain healthy their entire lives. Either everyone is on their own or everyone shares the risk.

Starting to divide up risk, just driving is a risk, certain jobs are riskier than others, volunteering could pose risks and so on. Costing all that out is again, not practical. And the person who is healthy today might be the one who has an expensive health cost later. You can't predict.

If it were practical to determine, I might have a different opinion, genetic testing putting people in different risk tiers, for example.

 

[JohnnyG]

I didn't mention any of those. But the point is still valid: if you have higher risks, whether through concious decisions or accident of genetics, then you will cost more. I personally think that only concious decisions should be charged higher. After all, we are insuring risks here and those risks are mostly things we have no control over. But our health is largely in our own hands. For example, a person with Type II diabetes can mitigate many risks by getting the disease under control. An obese person can lose weight and reduce risk. It's when we do things that undermine our own health that I feel a person should pay more for insurance.

Insurance is only what it is, not what I want it to be. It is a way to cover certain losses. You are charged based on your risk of facing those losses. That is exactly what insurance is and nothing more. Risk pooling is a tool insurance companies use to lower their exposure and is not why I buy insurance. I buy insurance so that I get paid when I suffer a loss. Health insurance should be no different.

I don't want people to suffer. At the same time, I can't make decisions for them. When they do make bad decisions, I shouldn't be the pocket they come get money from.

I think you give far too much credit to how much lifestyle choices can affect health. It is easy to tell an obese person to lose weight, but when they are obese because of hypothyroidism or Cushing's syndrome it is not so simple.

I do not believe health insurance should cost more because someone lost at genetic roulette. That would practically guarantee that, unless they come from a wealthy family, they would live in constant struggle to survive between paychecks. As a society we can do better than that.

 

[DavidJames]

I think you give far too much credit to how much lifestyle choices can affect health.

You see the same thing with conservatives over being poor. It seems to be defense mechanism to justify their disinterest in helping others.

 

[JohnnyG]

You see the same thing with conservatives over being poor. It seems to be defense mechanism to justify their disinterest in helping others.

Considering that I consider myself conservative, I would have to disagree with your broad brush comment.

 

[Ampulla of Vater]

You see the same thing with conservatives over being poor. It seems to be defense mechanism to justify their disinterest in helping others.

Surely there is some component of choice with regard to one's health and one's income status. I am not saying it is 100%, 50% or that it is even calculable, but there is some degree of choice involved in both.

 

[Emily's Cat]

I think the regulations that say you can have an HSA plan, but only if your plan meets certain definitions, none of which make much sense as a connection to an HSA, is dumb.

So you have a very high deductible on a plan that doesn't provide coverage, you can't get a tax break on that deductible via an HSA. However, if your plan had exactly the same deductible, but covered prescription drugs, then you can get a tax break.

That's just dumb.

Okay, I guess. That's a perspective I've never really run across.

There's a benefit requirement with it, because the government doesn't want HSAs to be used for tax evasion. It's not a place to stick all your money so you can just avoid the IRS bill. There's a limit to how much you can contribute in any given year... and there's a benefit requirement alongside so that the contributed amount makes sense relative to the potential cost.

And then there's the fact that for most people, the realistic option for their health plan is to use whichever provided gave their employer a good deal is even dumber. Why the heck do I have to change health plans when I change jobs? It's crazy. That's the one thing I really dislike about Obamacare. It strengthened the connection between employers and health insurance. I think that connection needs to be severed completely.

Hmm. I disagree - to me it seems as if ACA weakened the connection to Employer Sponsored coverage. It didn't get rid of it altogether, but between the minimum coverage requirements, the tax implications, and most states assessing additional fees... most of my industry is expecting the market to become very dichotomous: Employers will either self-insure or will drop their coverage and set people free into the Individual market. Probably going to take a while though.

 

[Emily's Cat]

The same logic applies to those who gamble with their health with other people's money. The obese, smokers, skateboarders, etc all do the same thing. Which brings us back to the whole idea of insurance: insure your particular risks. Let me pay for my risks; you pay for yours.

Sure... but if you get too specific with it, then you're a pool of 1. At which point, you're not insuring anything at all because there's no shared risk.

 

[Emily's Cat]

I was referring to people who choose to be uninsured because they are healthy. If you were talking about catastrophic coverage and not 'no coverage' then my apologies, I mis-read your post.

No worries - yes, you did misread. I'm not even talking about catastrophic coverage (depending on how you apply that term), but about people who choose to purchase a Bronze plan instead of a Silver plan when they qualify for a Cost Share Reduction on the Silver.

But I didn't think you were advocating no insurance either way. I was commenting in general. People who complain about having to buy insurance they don't think they need are short-sighted.

Some, perhaps. Not all. I'm always hesitant to paint with too large a brush.

Consider a friend of mine, who comes from a long line of ridiculously wealthy people. He's young, and healthy, and doesn't need insurance (because he can pay for what he needs directly). He's pretty sure that he shouldn't be forced to buy insurance.

Another friend isn't wealthy... but she's young and healthy and doesn't have a lot of cash. She gets a subsidy, sure, but even so she's paying part of the cost - and that $45 a month is really more than she can spare. She hasn't had any health issues, and doesn't really foresee the need for any.

Don't get me wrong - I'm a proponent of mandated coverage if it's all guaranteed issue. Just pointing out that not everyone who complains about having to buy insurance is "short-sighted". There's a lot more involved in it than that.

 

[Emily's Cat]

I didn't mention any of those. But the point is still valid: if you have higher risks, whether through concious decisions or accident of genetics, then you will cost more. I personally think that only concious decisions should be charged higher. After all, we are insuring risks here and those risks are mostly things we have no control over. But our health is largely in our own hands. For example, a person with Type II diabetes can mitigate many risks by getting the disease under control. An obese person can lose weight and reduce risk. It's when we do things that undermine our own health that I feel a person should pay more for insurance.

Insurance is only what it is, not what I want it to be. It is a way to cover certain losses. You are charged based on your risk of facing those losses. That is exactly what insurance is and nothing more. Risk pooling is a tool insurance companies use to lower their exposure and is not why I buy insurance. I buy insurance so that I get paid when I suffer a loss. Health insurance should be no different.

I don't want people to suffer. At the same time, I can't make decisions for them. When they do make bad decisions, I shouldn't be the pocket they come get money from.

Should smokers pay higher home insurance rates? They have a lot more fire involved in their lives - they could arguably be said to be consciously increasing the risk of damage to their domicile.

Should women pay more for car insurance? What about newly immigrated asian people? Statistically speaking, both have far more auto accidents than white males.

Would you approve of health insurance the declines to pay for any injuries that were incurred while participating in a group sport? What about insurance that charges more for individual who work construction as opposed to a desk job?

 

[Emily's Cat]

Surely there is some component of choice with regard to one's health and one's income status. I am not saying it is 100%, 50% or that it is even calculable, but there is some degree of choice involved in both.

Sure. Every occurrence in our lives is a combination of agency and randomness. Nothing is 100% within our control, and nothing is 100% outside of it either.

Unless, of course, you don't believe in free will... but that's a discussion for an entirely different subforum.

 

[sunmaster14]

Should smokers pay higher home insurance rates? They have a lot more fire involved in their lives - they could arguably be said to be consciously increasing the risk of damage to their domicile.

I thought smokers did pay more for home insurance. You certainly pay more if you have a swimming pool or a trampoline.

Should women pay more for car insurance? What about newly immigrated asian people? Statistically speaking, both have far more auto accidents than white males.

Not sure about Asians or recent immigrants, but women pay less for car insurance, presumably because they have fewer serious accidents than men do.

Would you approve of health insurance the declines to pay for any injuries that were incurred while participating in a group sport? What about insurance that charges more for individual who work construction as opposed to a desk job?

I would be all for this. In the latter example, I see no reason why society should subsidize the construction industry by covering the extra average health care costs associated with it. The construction industry should be covering these costs itself, by being forced to pay the extra cost in higher health insurance premiums or in higher wages as compensation.

 

[Meadmaker]

Hmm. I disagree - to me it seems as if ACA weakened the connection to Employer Sponsored coverage. It didn't get rid of it altogether, but between the minimum coverage requirements, the tax implications, and most states assessing additional fees... most of my industry is expecting the market to become very dichotomous: Employers will either self-insure or will drop their coverage and set people free into the Individual market. Probably going to take a while though.

But doesn't the act contain more employer mandates? Provide insurance or face fines?

Of course, that only applies to employees who work 30 hours per week, which is why I know people who were suddenly cut back to 29 hours per week.

Maybe in the long term it will cut that link, which would be a very good thing.

 

[Spindrift]

But doesn't the act contain more employer mandates? Provide insurance or face fines?

Of course, that only applies to employees who work 30 hours per week, which is why I know people who were suddenly cut back to 29 hours per week.

Maybe in the long term it will cut that link, which would be a very good thing.

It only applies to employers with 50 employees or more.

I agree the link between employer and healthcare should be severed.